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  1. Malignant otitis externa hospitalizations: Analysis of patient characteristics.

    PubMed

    Sylvester, Michael J; Sanghvi, Saurin; Patel, Viral M; Eloy, Jean Anderson; Ying, Yu-Lan Mary

    2017-10-01

    Malignant otitis externa (MOE) is a rare disorder that is not well studied in the inpatient setting. The Nationwide Inpatient Sample (NIS) database was utilized to analyze characteristics and predischarge outcomes of hospitalized MOE patients. MOE hospitalizations were identified in the 2002 to 2013 NIS. Patient demographics, length of hospital stay, hospital charges, concomitant diagnoses, treatment-related procedures, complications, and in-hospital mortality rates were examined, with comparisons made among age cohorts and between diabetes mellitus (DM) and non-DM groups. A total of 8,300 cases of inpatient MOE were identified, with elderly DM patients compromising 22.7% of cases. Compared to adults, elderly patients had more inpatient procedures, longer hospitalizations (6.0 vs. 4.3 days), higher hospital charges ($26,712 vs. $19,047) (all P < 0.001), greater odds of in-hospital complications, and in-hospital mortality (odds ratio 14.435, 95% confidence interval 5.313-39.220). Adult/elderly patients with DM had more comorbidities, longer hospital stays (5.5 vs. 4.0 days), and higher hospital charges ($25,118 vs. $17,039) (all P < 0.001) than non-DM patients. However, DM was not associated with greater in-hospital mortality rates (0.6% vs. 0.5%; P = 0.640). Compared to the adult/elderly cohort, pediatric patients had higher rates of nonelective admissions (19.8% vs. 14.5%), shorter hospital stays (2.9 vs. 4.9 days), and lower hospital charges ($8,876 vs. $21,672) (all P < 0.05). Elderly diabetic patients made up a smaller fraction of hospitalized MOE cases than anticipated. Elderly patients had greater in-hospital complications and mortality. Diabetes mellitus in adult/elderly patients was not associated with increased mortality. Pediatric patients fared well with low complications rates and no instances of in-hospital mortality. 2C. Laryngoscope, 127:2328-2336, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  2. A study of acute otitis externa at Wellington Hospital, 2007-2011.

    PubMed

    Jayakar, Rahul; Sanders, James; Jones, Emily

    2014-01-01

    Acute otitis externa (AOE) is a common inflammatory condition affecting the external ear that occasionally presents with persistent, severe pain, which may be unresponsive to first-line therapy and require assessment and treatment in the hospital setting. To identify the microorganisms responsible for cases of otitis externa presenting to Wellington Hospital, New Zealand, over a five-year period between 2007 and 2011. We also aim to evaluate current management of this condition and to recommend future treatment options. A five-year retrospective study, with data obtained from case notes and electronic records for all patients presenting with otitis externa to Wellington Hospital between 2007 and 2011. Of three hundred and forty-seven cases identified, 144 were included in the study. Pseudomonas aeruginosa (P. aeruginosa) was the most common organism (46.5 per cent), while Staphylococcus aureus (S. aureus) was the second most common (31.9 per cent). Most patients received appropriate topical treatment. However, a significant number were treated with systemic antibiotics alone without adverse outcomes. Pseudomonas aeruginosa is the most common microbe causing acute otitis externa in patients that require hospital level management in Wellington, New Zealand. In most cases, patients received appropriate topical therapy; however, it appears a large number received systemic antibiotic therapy without topical treatment. We recommend broad-spectrum topical antimicrobial therapy in all patients with uncomplicated AOE and culture-sensitive topical treatment with consideration of systemic antimicrobials for severe AOE requiring hospital admission.

  3. [Neuropaediatric care in the Hospital General Universitario de Guadalajara].

    PubMed

    Peña-Segura, J L; López-Pisón, J; Marco-Olloqui, M; Mateos-Hernández, J; Adrados-Razola, I; Jiménez-Bustos, J M

    Influenced by medical, scientific and social advances, the changes that have taken place in the needs of the population have given rise to a growing demand for health care in neuropaediatric pathology. The aim of this study was to determine the neuropaediatric health care requirements at the Hospital General Universitario de Guadalajara, a secondary care hospital that is a reference centre for the province of Guadalajara. We studied the children up to the age of 10 years with a neurological pathology attended at the Hospital General Universitario de Guadalajara over an 8-year period, since the Neuropaediatric unit was opened on 1 July 1992. In all 1,236 children were evaluated, which represents 8.45% of all the children below the age of 10 in the province of Guadalajara, with an average of 154.5 new patients per year. There was a predominance of males, 56.4%, and a high percentage of very young children: 26.05% under the age of 1 year and 50.56% under the age of 3. There has been a progressive increase in the number of Neuropaediatric outpatients, which in the year 2000 accounted for 20% of first visits and 16% of the total number (first and successive) of Paediatric outpatients. 12.94% of the patients in our series had also been examined in different tertiary care hospitals. There is a very high demand for neuropaediatric care in Guadalajara and it is growing in a significant and progressive manner. We suggest it would be advisable to have a tertiary reference hospital available to help cope with this situation.

  4. Otitis externa in children

    PubMed Central

    Price, John

    1976-01-01

    The commonest cause of ear-ache in children is otitis externa and five new cases of otitis externa will be seen for every case of otitis media. Acute otitis externa and otitis media are quite different and distinct clinical entities in children: the former is a tender, dirty, pruritic ear, often recurring in children with simple febrile illnesses; the latter is more isolated than is realised, non-recurrent and usually accompanying upper respiratory catarrhal illness. The fleeting nature of otitis externa as seen in childhood is typical of clinical material in general practice that presents quite differently from that in hospital practice. The long aetiological lists quoted in all series of cases of otitis externa in adults do not apply to otitis externa as seen in children. PMID:966211

  5. [Organization and management of nutritional care process in hospitalized patients: the model implemented in the "Hospital Universitario de La Ribera"].

    PubMed

    Llopis-Salvia, P; Luna-Calatayud, P; Avellana-Zaragoza, J A; Bou-Monterde, R

    2012-01-01

    Hospital malnutrition shows a high prevalence and is an indicator of poor quality care. The intervention of different professionals involved in the nutritional care process performing uncoordinated and with different criteria is one of the reasons that contribute to perpetuate this situation. To describe the model implemented in the "Hospital Universitario de la Ribera" for providing nutritional care to patients. The model implemented in the "Hospital Universitario de la Ribera" is characterized by the coordinated intervention of the health professionals performing with the common goal of providing patients' nutritional care. The nutrition plan is carried out comprehensively from malnutrition identification to the establishment of the nutrition plan and monitoring as well as its adaptation to the patient's progress and discharge recommendations. The key elements to achieve this goal are described: the Nutrition Department and the Pharmacy Department, the information system available that allows to share and exchange information effectively and a dynamic and interdisciplinary Commission of Nutrition and Dietetics. At the "Hospital Universitario de la Ribera" an organization that ensures continuity of care throughout the nutritional process and its connection with primary health care has been established.

  6. Design, Planning and Management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón.

    PubMed

    Fuente-Martín, C de la; Fuente Martín, B de la; Grifol-Clar, E

    2017-12-01

    The design and management of a Hospital Custody Unit at Hospital Universitario Fundación Alcorcón, to focus the aim of this study on specialized medical care for extra-penitentiary patients who have suffered from a disease. We are building a new space to facilitate their daily lives at hospital and we want to offer a double function to the patients that consists of a custody space and a health rehabilitation space. We carried out a scientific literature search on the international and national databases, about Hospital Custody Units or Restricted Access Units. The language of the reviews that we checked was English and Spanish. We wrote the Action Guide of the Hospital Custody Unit for the design, planning and management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón. (We included complementary bibliographic material and the Quick Guide in the Unit). The Hospital Custody Unit will be compatible with medical activity, occupational safety and the custody of patients that are in prison. We thus require consensus with police departments about custody protocols along with assistance from the clinicians' teams at penitentiary centers and referral hospitals. Furthermore, it is important to step up special care for mental health and to promote telemedicine and new technologies to streamline medical care along with coordination with healthcare professionals.

  7. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends.

    PubMed

    Chawdhary, G; Liow, N; Democratis, J; Whiteside, O

    2015-06-01

    Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed. A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated. There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421). Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

  8. [Mycoses at Hospital Universitario "Ruiz y Páez", Ciudad Bolívar, Venezuela, 2002].

    PubMed

    Cermeño, Julman R; Hernández, Isabel; Godoy, Gerardo; Cabello, Ismery; Cermeño, Julmery J; Orellán, Yida; Blanco, Ytalia

    2005-03-01

    To estimate the prevalence of mycoses in the Universitary Hospital "Ruiz y Páez" (Bolivar State, Venezuela) during 2002, a retrospective study was carried out. Four hundred and fifty six mycoses were diagnosed in 250,956 patients. The most frequent mycoses, the cutaneous form (94.5%), were produced by dermatophytes, Malassezia furfur and Candida spp. in 90%. Deep mycoses were detected in 4.7% and consisted of histoplasmosis (2.6%), paracoccidioidomycosis (1.7%) and cryptococcosis (0.4%). Several patients with deep mycoses presented HIV infection, tuberculosis and hematological disorders (neoplasias among them). The frequency of mycoses in the general population that attend the Hospital Universitario "Ruiz y Páez" is low, superficial mycoses are predominant, and some conditions seem to predispose to deep mycoses.

  9. Otitis externa.

    PubMed

    Wipperman, Jennifer

    2014-03-01

    Acute otitis externa (AOE) is most often infectious in origin, and can be easily treated with a combination of topical antibiotic and steroid preparations. Systemic antibiotics are rarely needed for AOE. Chronic otitis externa (COE) can be more difficult to treat, but if an underlying cause can be identified this condition can often be successfully managed. In both AOE and COE, prevention is fundamental. If patients are able to avoid precipitating factors, future episodes can often be averted. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Afebrile pneumonia (whooping cough) syndrome in infants at Hospital Universitario del Valle, Cali, 2001-2007

    PubMed Central

    Villegas, Dolly; Echandía-Villegas, Connie Alejandra

    2012-01-01

    Introduction: Afebrile pneumonia syndrome in infants, also called infant pneumonitis, pneumonia caused by atypical pathogens or whooping cough syndrome is a major cause of severe lower respiratory infection in young infants, both in developing countries and in developed countries. Objective: To describe children with afebrile pneumonia syndrome. Methods: Through a cross-sectional study, we reviewed the medical records of children diagnosed with afebrile pneumonia treated at Hospital Universitario del Valle, a reference center in southwestern Colombia, between June 2001 and December 2007. We obtained data on maternal age and origin, prenatal care, the childs birth, breastfeeding, vaccination status, symptoms, signs, diagnosis, treatment, and complications. Results: We evaluated 101 children with this entity, noting a stationary presentation: June-August and November- December. A total of 73% of the children were under 4 months of age; the most common symptoms were: cyanotic and spasmodic cough (100%), respiratory distress (70%), and unquantified fever (68%). The most common findings: rales (crackles) (50%), wheezing and expiratory stridor (37%); 66% were classified as mild and of the remaining 33%, half of them required attention in the intensive care unit. In all, there was clinical diagnosis of afebrile pneumonia syndrome in infants, but no etiologic diagnosis was made and despite this, 94% of the children received macrolides. Conclusions: These data support the hypothesis that most of these patients acquired the disease by airway, possibly caused by viral infection and did not require the indiscriminate use of macrolides. PMID:24893051

  11. Afebrile pneumonia (whooping cough) syndrome in infants at Hospital Universitario del Valle, Cali, 2001-2007.

    PubMed

    Villegas, Dolly; Echandía-Villegas, Connie Alejandra; Echandía, Carlos Armando

    2012-04-01

    Afebrile pneumonia syndrome in infants, also called infant pneumonitis, pneumonia caused by atypical pathogens or whooping cough syndrome is a major cause of severe lower respiratory infection in young infants, both in developing countries and in developed countries. To describe children with afebrile pneumonia syndrome. Through a cross-sectional study, we reviewed the medical records of children diagnosed with afebrile pneumonia treated at Hospital Universitario del Valle, a reference center in southwestern Colombia, between June 2001 and December 2007. We obtained data on maternal age and origin, prenatal care, the childs birth, breastfeeding, vaccination status, symptoms, signs, diagnosis, treatment, and complications. We evaluated 101 children with this entity, noting a stationary presentation: June-August and November- December. A total of 73% of the children were under 4 months of age; the most common symptoms were: cyanotic and spasmodic cough (100%), respiratory distress (70%), and unquantified fever (68%). The most common findings: rales (crackles) (50%), wheezing and expiratory stridor (37%); 66% were classified as mild and of the remaining 33%, half of them required attention in the intensive care unit. In all, there was clinical diagnosis of afebrile pneumonia syndrome in infants, but no etiologic diagnosis was made and despite this, 94% of the children received macrolides. These data support the hypothesis that most of these patients acquired the disease by airway, possibly caused by viral infection and did not require the indiscriminate use of macrolides.

  12. Otitis externa

    PubMed Central

    2015-01-01

    Introduction Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, in humid environments, in people with narrow ear canals, in hearing-aid users, and after mechanical trauma. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of empirical treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). Results Nine studies were included. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid, topical aluminium acetate, topical antibacterials, topical antifungals, topical corticosteroids, and combinations of these agents. PMID:26074134

  13. Otitis externa

    PubMed Central

    2010-01-01

    Introduction Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, humid environments, people with absence of ear wax or with narrow ear canals, hearing-aid users, and after mechanical trauma. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical and prophylactic treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid drops or spray, topical aluminium acetate drops, topical antibacterials, topical antifungals, topical anti-infective agents, topical corticosteroids, and water exclusion. PMID:21418684

  14. Otitis externa

    PubMed Central

    2008-01-01

    Introduction Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, humid environments, people with absence of ear wax or with narrow ear canals, hearing-aid users, and after mechanical trauma. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical and prophylactic treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid drops or spray, topical aluminium acetate drops, topical antibacterials, topical antifungals, topical anti-infective agents, topical corticosteroids, and water exclusion. PMID:19450296

  15. Acute otitis externa.

    PubMed

    Hui, Charles Ps

    2013-02-01

    Acute otitis externa, also known as 'swimmer's ear', is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  16. Acute otitis externa

    PubMed Central

    Hui, Charles PS

    2013-01-01

    Acute otitis externa, also known as ‘swimmer’s ear’, is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present. PMID:24421666

  17. [Programme review of somatropin deficit in pediatrics at the Hospital Universitario Virgen del Rocío].

    PubMed

    Lavaredas, A; de la Puerta, R; Álvarez del Vayo, C

    2013-01-01

    Objetivo: Elaborar una revisión del programa de déficit de somatropina aplicado en pediatría en el Hospital Universitario Virgen del Rocío, utilizando dos grupos de pacientes, los diagnosticados con déficit de esta hormona y los nacidos pequeños para edad gestacional, con la intención de evaluar su efectividad en el primer año de tratamiento. Método: Realización de un estudio retrospectivo de la cohorte de pacientes en tratamiento con la hormona del crecimiento bajo los diagnósticos mencionados, con metodología observacional y transversal, a los cuales se aplicó un análisis estadístico con el programa Statistical Package for Social Sciences®. Resultados: Tras inicio del tratamiento la velocidad de crecimiento y la talla aumentaron y la edad ósea se aproximó a la edad cronológica. En los dos grupos tratados, en el primer año de tratamiento fueron los pacientes del sexo femenino con edad comprendida entre los 0 a 12 años con déficit de la hormona del crecimiento que respondieron mejor a la terapéutica establecida. Conclusiones: Pudimos observar que el tratamiento instituido se presentó altamente efectivo en ambos grupos de pacientes, permitiendo obtener un aumento favorable de estatura.

  18. ALFABETIZACION EN SALUD EN PACIENTES QUE ASISTEN A UN HOSPITAL UNIVERSITARIO

    PubMed Central

    KONFINO, JONATAN; MEJIA, RAUL; MAJDALANI, MARIA PIA; PEREZ-STABLE, ELISEO J.

    2014-01-01

    Health literacy in patients attending a University Hospital. Low level of health literacy is associated with poor communication between patients and clinicians and with increased hospitalization rates, less frequent screening for cancer, poor control of diabetes, and disproportionately high rates of disease and mortality. Despite the importance of health literacy in medicine, there is no information about its prevalence in Latin America. The aim of this study was to assess the prevalence of inadequate health literacy in a random sample of patients, at a University Hospital where a descriptive study was performed during 2007. Health literacy was assessed through the Short Assessment of Health Literacy for Spanish-speaking Adults. Participants were randomly selected from the ambulatory clinic and from the medical inpatient ward during 2007.There were a total of 2345 patients potentially eligible during the time of the study, 234 were approached after random selection and 229 patients were interviewed (98% response); 54.6% of respondents were women and 62% were recruited from the ambulatory clinic. The respondents had a median age of 56 years. The prevalence of inadequate health literacy was 30.1% (69 patients). Patients with ≤ 7 years of formal education had more risk of having inadequate health literacy compared with those with > 12 years of education OR = 45.1 (IC 9.6-211.6). We found a high prevalence of inadequate health literacy, being strongly associated with the level of formal education. It is important that health care providers know the implications of health literacy and its consequences. PMID:20053602

  19. Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model

    PubMed Central

    Gregorio, Sergio Alonso y; Molina, Susana Sánchez; Gómez, Angel Tabernero; Ledo, Jesús Cisneros; Sebastián, Jesús Díez; Barthel, Jesús Javier de la Peña

    2014-01-01

    Introduction In the last decade, we have seen the advance of laparoscopic surgery in urology. All laparoscopic procedures in our department are performed by staff members and are assisted by a single resident, ensuring resident training in laparoscopic surgery. The aim of this study is to evaluate the results of the Hospital La Paz training program for residents in the field of laparoscopic surgery. Material and methods We have done a retrospective review of LRP performed by the residents in our department. We also evaluated different variables. Descriptive statistical analysis was done and the results were compared with the descriptive analysis of the initial series of our department. Results We reviewed 82 patients, with an average age of 61.6 years. Most cases were pT1c at diagnosis. Average surgical time was 288 minutes, with a transfusion rate of 9.7% and a intra and postoperative complication rates of 1.2% and 7.3%. The mean hospital stay was 3.3 days. Histological results of this series are: 76.8% of pT2 and 23.2% of pT3. The biochemical relapse rate is 15.8%. Global surgical margin rate is 20.7%. The global continence rate is 52.4%. Conclusions The outcomes of LRP performed by residents are similar to the ones reported in the initial series of our department. The fact that 84.6% of the residents formed in this period actually belong to different laparoscopic units supports the success of La Paz Hospital training model. PMID:25247081

  20. Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model.

    PubMed

    Gregorio, Sergio Alonso Y; Rivas, Juan Gómez; Molina, Susana Sánchez; Gómez, Angel Tabernero; Ledo, Jesús Cisneros; Sebastián, Jesús Díez; Barthel, Jesús Javier de la Peña

    2014-01-01

    In the last decade, we have seen the advance of laparoscopic surgery in urology.All laparoscopic procedures in our department are performed by staff members and are assisted by a single resident, ensuring resident training in laparoscopic surgery. The aim of this study is to evaluate the results of the Hospital La Paz training program for residents in the field of laparoscopic surgery. We have done a retrospective review of LRP performed by the residents in our department. We also evaluated different variables . Descriptive statistical analysis was done and the results were compared with the descriptive analysis of the initial series of our department. We reviewed 82 patients, with an average age of 61.6 years. Most cases were pT1c at diagnosis. Average surgical time was 288 minutes, with a transfusion rate of 9.7% and a intra and postoperative complication rates of 1.2% and 7.3%. The mean hospital stay was 3.3 days. Histological results of this series are: 76.8% of pT2 and 23.2% of pT3. The biochemical relapse rate is 15.8%. Global surgical margin rate is 20.7%. The global continence rate is 52.4%. The outcomes of LRP performed by residents are similar to the ones reported in the initial series of our department. The fact that 84.6% of the residents formed in this period actually belong to different laparoscopic units supports the success of La Paz Hospital training model.

  1. Twenty-five years of home parenteral nutrition outsourcing: the experience at Hospital Universitario La Paz, Madrid.

    PubMed

    Gómez-Candela, Carmen; Martín Fuentes, María; García Vázquez, Natalia; Crespo Yanguas, Marta; Lisbona Catalán, Arturo; Campos Del Portillo, Rocío; Palma Milla, Samara

    2014-12-01

    For the last 20 years, most adult patients following home parenteral nutrition (HPN) under the care of the Clinical Nutrition and Dietetics Dept. of the La Paz University Hospital (Unidad de Nutrición Clínica y Dietética del Hospital Universitario La Paz), Madrid, Spain, have received their nutrition formula via a catering system (Nutriservice) responsible for its preparation and home distribution. To assess the clinical characteristics, quality of life and degree of satisfaction with the care received, of patients undergoing HPN who received their nutrition formulae via the named catering service. The characteristics of the patients who received HPN via this service between 1992 and 2013 were retrospectively collected. Those patients still undergoing treatment completed a quality of life questionnaire, plus a survey of their satisfaction with the catering system and the care provided by our department. Seventy eight patients were examined; 57.7% were men. The mean age of the patients was 53.1±14.3 years. The most common underlying disease was cancer, both in advanced stage (33.8% of all cases) and in stages in which active treatment was being provided (34%). The most common indication for HPN was intestinal obstruction (46%). The median duration of HPN treatment was 96 [1-5334] days. The most common complication was catheter infection (72%). For the analysis of the results, the patients were divided depending on disease type: those with advanced stage cancer, those with cancer under active treatment and with a better prognosis, and those with non-oncological disease. The patients undergoing active oncological treatment believed the quality of their lives to have been improved by the Nutriservice catering system, and rated the care received by our department positively. In our experience, patients with cancer are those who most commonly receive HPN, especially those with advanced disease. Given the seriousness of their conditions, and the complexity surrounding

  2. Pattern of otitis externa in Kaduna Nigeria

    PubMed Central

    Musa, Thomas Samdi; Bemu, Alfred Nicholas; Grema, Umar Sambo; Kirfi, Abdullahi Musa

    2015-01-01

    Introduction Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both this condition has been reported to be found in all age groups. The aims and objectives were, study/determine the prevalence of Otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna, study the pattern of presentation among patients with otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna, and evaluate the choice of drug treatment for otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna. Methods Data of patients diagnosed with otitis externa between January 2009 and March 2013 were extracted from the recorded cases of ear disease seen within the same period. The ages, sex/ gender, complains(symptoms), duration of symptoms, clinical examination findings, diagnosis, mode of drug treatment, number of visits and complication records were extracted from the case notes of the patients and analyzed descriptively using SPSS (Statistical package for Social Sciences) version. Results Out of 13,328 cases of ear diseases seen within the period under review, 133 cases were diagnosed with otitis externa across all age groups. Hospital prevalence stands at 1.0%. There were 81(60.9%) males and 52(39.1%) females in ratio 1.5:1. Children age 0-15 constitute 55(41.3%) while young adults and adults were 78(58.6%). The minimum age at presentation was one year, while maximum age was 64 years. Mean age was 24 years with a standard deviation of ± 1.12 Years. Ear pain as only presenting symptom was the major complain found in this study accounting for 68(51.1%). Acute diffuse otitis externa was the commonest diagnosis accounting for 101(75.9%) and associated clinical findings ranging from tragal tenderness, hyperaemia and oedema of ear canal in 57 (54.9%). Ear swab was not routinely done and only 6(15.8%) of the discharging ears had microscopy done and the

  3. Pattern of otitis externa in Kaduna Nigeria.

    PubMed

    Musa, Thomas Samdi; Bemu, Alfred Nicholas; Grema, Umar Sambo; Kirfi, Abdullahi Musa

    2015-01-01

    Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both this condition has been reported to be found in all age groups. The aims and objectives were, study/determine the prevalence of Otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna, study the pattern of presentation among patients with otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna, and evaluate the choice of drug treatment for otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna. Data of patients diagnosed with otitis externa between January 2009 and March 2013 were extracted from the recorded cases of ear disease seen within the same period. The ages, sex/ gender, complains(symptoms), duration of symptoms, clinical examination findings, diagnosis, mode of drug treatment, number of visits and complication records were extracted from the case notes of the patients and analyzed descriptively using SPSS (Statistical package for Social Sciences) version. Out of 13,328 cases of ear diseases seen within the period under review, 133 cases were diagnosed with otitis externa across all age groups. Hospital prevalence stands at 1.0%. There were 81(60.9%) males and 52(39.1%) females in ratio 1.5:1. Children age 0-15 constitute 55(41.3%) while young adults and adults were 78(58.6%). The minimum age at presentation was one year, while maximum age was 64 years. Mean age was 24 years with a standard deviation of ± 1.12 Years. Ear pain as only presenting symptom was the major complain found in this study accounting for 68(51.1%). Acute diffuse otitis externa was the commonest diagnosis accounting for 101(75.9%) and associated clinical findings ranging from tragal tenderness, hyperaemia and oedema of ear canal in 57 (54.9%). Ear swab was not routinely done and only 6(15.8%) of the discharging ears had microscopy done and the organisms were Pseudomonas spp

  4. Multidisciplinary Approach in Hepatocellular Carcinoma in a Level II Hospital: The First Decade of Hospital Universitario Fundacion Alcorcon.

    PubMed

    Loinaz Segurola, C; LIedó Navarro, J L; Burgos, R de la Cruz; Martín Ríos, D; Ochando Cerdán, F; Alonso López, S; Martel Villagrán, J; Gutiérrez Garcia, M L; Fernandez Cebrián, J M; Fernández Rodríguez, C

    2015-06-01

    Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.

  5. Coryneform bacteria associated with canine otitis externa.

    PubMed

    Aalbæk, Bent; Bemis, David A; Schjærff, Mette; Kania, Stephen A; Frank, Linda A; Guardabassi, Luca

    2010-10-26

    This study aims to investigate the occurrence of coryneform bacteria in canine otitis externa. A combined case series and case-control study was carried out to improve the current knowledge on frequency and clinical significance of coryneform bacteria in samples from canine otitis externa. A total of 16 cases of otitis externa with involvement of coryneform bacteria were recorded at two referral veterinary hospitals in Denmark and the US, respectively. Coryneform bacteria were identified by partial 16S rRNA gene sequencing. Corynebacterium auriscanis was the most common coryneform species (10 cases). Small colony variants of this species were also observed. Other coryneform isolates were identified as Corynebacterium amycolatum (3 cases), Corynebacterium freneyi (2 cases) and an Arcanobacterium-like species (1 case). The coryneform bacteria were in all cases isolated together with other bacteria, mainly Staphylococcus pseudintermedius alone (n=5) or in combination with Malassezia pachydermatis (n=5). Some coryneform isolates displayed resistance to fusidic acid or enrofloxacin, two antimicrobial agents commonly used for the treatment of otitis externa in dogs. The frequency of isolation of coryneform bacteria was 16% among 55 cases of canine otitis externa examined at the Danish hospital during 2007. In contrast, detectable levels of coryneform bacteria were not demonstrated in samples from the acustic meatus of 35 dogs with apparently healthy ears, attending the hospital during the same year. On basis of the current knowledge, these coryneform bacteria should be regarded as potential secondary pathogens able to proliferate in the environment of an inflamed ear canal. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Incidence of otitis externa in dogs and cats in Japan.

    PubMed

    Baba, E; Fukata, T

    1981-05-02

    The incidence of otitis externa in dogs and cats admitted to the animal hospital of the University of Osaka Prefecture was investigated and the bacteria isolated were tested for antibiotic susceptibility. Of the various breeds examined, the incidence of otitis externa was highest in miniature poodles and cocker spaniels and Himalayan and Persian cats. The organisms most commonly associated with otitis externa were coagulase-negative staphylococci, followed by coagulase-positive staphylococci, streptococci and Escherichia coli. Most staphylococci were susceptible to the antibiotics tested, but 15 per cent of staphylococci were resistant to more than three antibiotics. Pseudomonas and Alcaligenes species were resistant to almost all antibiotics except gentamicin and colistin.

  7. [A study of otitis externa associated with Malassezia].

    PubMed

    Shiota, Ryoko; Kaneko, Takamasa; Yano, Hiroaki; Takeshita, Kimiko; Nishioka, Keiko; Makimura, Koichi

    2009-01-01

    Malassezia-positive smears can be recognized from otitis externa, however, there are few references in the literature to the relation between Malassezia and otitis externa. Therefore, the bacterial and clinical characteristics of 72 cases (63 patients) with otitis externa were investigated at the Department of Otorhinolaryngology, Takinomiya General Hospital to analyze this. Thirty-seven cases were bacterial otitis externa, 20 cases were fungal otitis externa, and 15 cases were etiological agents unknown in this study. The causative organisms in fungal otitis externa were the genera Aspergillus (10 cases), Malassezia (5) and Candida (5), respectively. We suspected that 5 cases were caused by Malassezia because Malassezia cell counts were greater than 10 per field (x 400), and a large number of Malassezia were isolated from all cases. In these cases, many squamous epithelial cells were observed by direct examination, and cells from the middle or basal layer of the ear canal were also recognized in three cases. Therefore, accelerated turnover of epidermal cells of the ear canal was suggested. The main symptoms were itching and fullness in the ear, with observations of redness and erosion in objective deterioration, and we felt that these conditions were similar to seborrheic dermatitis (SD). In addition, these five cases were confirmed as fungus-related otitis externa by their improvement with antifungal agents.

  8. High prevalence of Fluoroquinolone- and Methicillin-resistant Staphylococcus pseudintermedius isolates from canine pyoderma and otitis externa in veterinary teaching hospital.

    PubMed

    Yoo, Jong-Hyun; Yoon, Jang W; Lee, So-Young; Park, Hee-Myung

    2010-04-01

    Recently, a total of 74 Staphylococcus pseudintermedius isolates were collected from clinical cases of canine pyoderma and otitis externa in Korea. In this study, we examined in vitro fluoroquinolone resistance among those isolates using a standard disk diffusion technique. The results demonstrated that approximately 18.9% to 27.0% of the isolates possessed bacterial resistance to both veterinary- and human-licensed fluoroquinolones except one isolate, including moxifloxacin (18.9% resistance), levofloxacin (20.3% resistance), ofloxacin (24.3% resistance), ciprofloxacin (25.7% resistance), and enrofloxacin (27.0% resistance). Most surprisingly, 14 out of 74 (18.9%) isolates were resistant to all the five fluoroquinolones evaluated. Moreover, a PCR detection of the methicillin resistance gene (mecA) among the 74 isolates revealed that 13 out of 25 (52.0%) mecA-positive isolates, but only 7 out of 49 (14.3%) mecA-negative isolates, were resistant to one or more fluoroquinones. Taken together, our results imply that bacterial resistance to both veterinary- and human-use fluoroquinolones becomes prevalent among the S. pseudintermedius isolates from canine pyoderma and otitis externa in Korea as well as that the high prevalence of the mecA-positive S. pseudintermedius isolates carrying multiple fluoroquinolone resistance could be a potential public health problem.

  9. Malignant otitis externa.

    PubMed

    Karaman, Emin; Yilmaz, Mehmet; Ibrahimov, Metin; Haciyev, Yusuf; Enver, Ozgün

    2012-11-01

    Malignant external otitis is a severe infection of the external auditory canal and skull base, which most often affects elderly patients with diabetes mellitus. This disease is still a serious disease associated with cranial nerve complications and high morbidity-mortality rate. Malignant otitis externa requires urgent diagnosis and treatment. The most effective treatment is to control the diabetes and to fight infection with the proper antibiotic and debridement necrotic tissue; sometimes, aggressive surgical management is done. We present our 5-year institutional experience in the management of this disease. The aim of this study was to present our experience with the management of malignant otitis externa. All patients' records with malignant otitis externa during the last 5 years (2007-2012) were retrieved and reviewed. Diabetes mellitus profile, erythrocyte sedimentation rate, ear swab for culture and sensitivity, computed tomography, and scintigraphy using technetium 99 and gallium 67 were investigated for all patients. During the last 5 years (2007-2012), 10 patients with the diagnosis of malignant otitis externa were admitted to our clinic for investigation and treatment. There were 7 men and 3 women, all between 64 and 83 years of age, with severe persistent otalgia, purulent otorrhea, granulation tissue in the external auditory canal, and diffuse external otitis, and there were 4 patients with facial nerve palsy. Nine patients were confirmed to have a diabetes, and 4 of these 9 cases just had chronic renal failure and underwent dialysis; the remainder 1 case had no diabetes mellitus, but with chronic renal failure on dialysis. Ear swabs for culture and sensitivity usually revealed Pseudomonas aeruginosa. Local debridement and local and systemic antibiotic treatment were sufficient to control the disease. Facial nerve decompression was done in facial paralysis. Hyperbaric oxygen therapy was performed in facial nervy palsy cases. Malignant otitis externa is

  10. Acute kidney injury applying pRifle scale in Children of Hospital Universitario del Valle in Cali, Colombia: clinical features, management and evolution

    PubMed Central

    Mora, Julián A; Alexandre Cardona, Sergio; Marmolejo, Andrés F; Paz, Juan F; de Castaño, Iris

    2012-01-01

    Objective: To know the epidemiology of Acute Kidney Injury (AKI) in the pediatric population at Hospital Universitario del Valle (HUV), a tertiary University Hospital in Cali, Colombia. Methods: We obtained a series of cases through daily surveillance for a seven-month period (June 1 to December 31, 2009) in patients older than 30 days and under 18 years at HUV. We excluded patients with previous diagnosis of chronic renal failure. The new pRIFLE scale was used to define AKI. Results: 27 patients were detected, with mean age of 36 months. Incidence of AKI was 0.38% from pediatric admissions and 6.2% from the pediatric intensive care unit (pICU) admissions. The pRIFLE scale at study entrance was: Risk: 2 patients, Injury: 8, Failure: 17. Etiology of AKI was: pre-renal in 89%, primary renal disease in 3.7%, and post-renal in 7.4%. There was an association of AKI with sepsis in 66.7% and 48.2% progressed to septic shock. Six patients required renal replacement therapy, all required peritoneal dialysis. The AKI was multi-factorial in 59.3% and associated with systemic multi-organ failure in 59.3%. At study entry, 63% patients were in pICU. The average hospital stay was 21.3 ± 9.2 days. Six children died, 16 resolved AKI, and nine were left with renal sequelae. Conclusions: We recommended pRIFLE scale for early diagnosis of AKI in all pediatric services. Education in pRIFLE scale, prevention of AKI, and early management of sepsis and hypovolemia is recommended. PMID:24893192

  11. Acute kidney injury applying pRifle scale in Children of Hospital Universitario del Valle in Cali, Colombia: clinical features, management and evolution.

    PubMed

    Restrepo de Rovetto, Consuelo; Mora, Julián A; Alexandre Cardona, Sergio; Marmolejo, Andrés F; Paz, Juan F; de Castaño, Iris

    2012-07-01

    To know the epidemiology of Acute Kidney Injury (AKI) in the pediatric population at Hospital Universitario del Valle (HUV), a tertiary University Hospital in Cali, Colombia. We obtained a series of cases through daily surveillance for a seven-month period (June 1 to December 31, 2009) in patients older than 30 days and under 18 years at HUV. We excluded patients with previous diagnosis of chronic renal failure. The new pRIFLE scale was used to define AKI. 27 patients were detected, with mean age of 36 months. Incidence of AKI was 0.38% from pediatric admissions and 6.2% from the pediatric intensive care unit (pICU) admissions. The pRIFLE scale at study entrance was: Risk: 2 patients, Injury: 8, Failure: 17. Etiology of AKI was: pre-renal in 89%, primary renal disease in 3.7%, and post-renal in 7.4%. There was an association of AKI with sepsis in 66.7% and 48.2% progressed to septic shock. Six patients required renal replacement therapy, all required peritoneal dialysis. The AKI was multi-factorial in 59.3% and associated with systemic multi-organ failure in 59.3%. At study entry, 63% patients were in pICU. The average hospital stay was 21.3 ± 9.2 days. Six children died, 16 resolved AKI, and nine were left with renal sequelae. We recommended pRIFLE scale for early diagnosis of AKI in all pediatric services. Education in pRIFLE scale, prevention of AKI, and early management of sepsis and hypovolemia is recommended.

  12. "Swimmer's Ear" (Otitis Externa) Prevention

    MedlinePlus

    ... Submit What's this? Submit Button Healthy Water Home Ear Infections Recommend on Facebook Tweet Share Compartir Print- ... ear infections, swimmer's ear, and healthy swimming. "Swimmer's Ear" (Otitis Externa) What are the symptoms of swimmer's ...

  13. Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

    PubMed Central

    Castrejón, Isabel; Ortiz, Ana M.; Toledano, Esther; Castañeda, Santos; García-Vadillo, Alberto; Carmona, Loreto

    2016-01-01

    Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI’s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28’s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis. PMID:27603313

  14. Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis.

    PubMed

    González-Álvaro, Isidoro; Castrejón, Isabel; Ortiz, Ana M; Toledano, Esther; Castañeda, Santos; García-Vadillo, Alberto; Carmona, Loreto

    2016-01-01

    To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI's AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28's AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis.

  15. [Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011].

    PubMed

    Torres-Muñoz, Javier; Rojas, Christian; Mendoza-Urbano, Diana; Marín-Cuero, Darly; Orobio, Sandra; Echandía, Carlos

    2017-04-01

    Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

  16. The management of otitis externa in UK general practice.

    PubMed

    Pabla, L; Jindal, M; Latif, K

    2012-03-01

    Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

  17. Necrotising otitis externa: clinical profile and management protocol.

    PubMed

    Lambor, D V; Das, C P; Goel, H C; Tiwari, M; Lambor, S D; Fegade, M V

    2013-11-01

    Necrotising otitis externa, which is typically seen in elderly diabetics, is a severe infective disorder caused by Pseudomonas aeruginosa. There is lack of standard management policy for necrotising otitis externa, hence this study attempted to frame a protocol for management based on clinical parameters. A retrospective study of 27 patients with necrotising otitis externa was conducted over 6 years in a tertiary care hospital. Data were analysed with regards to demographic characteristics, clinical features, investigations, staging and treatment modalities. Out of 27 patients, 26 were diabetics. The commonest organism isolated was P aeruginosa, which was sensitive to third generation cephalosporins and fluoroquinolones. Nine patients had cranial nerve involvement. Twelve of 15 patients treated with medical therapy recovered, as did 11 of 12 patients that underwent surgery. A high index of suspicion, early diagnosis and prompt intervention are key factors to decrease morbidity and mortality. Fluoroquinolones, third generation cephalosporins and surgical debridement are the mainstay of treatment.

  18. [Teaching experience of the anesthesiology training unit at Hospital Universitario Nuestra Señora de Candelaria].

    PubMed

    Reverón Gómez, M A; Moure García, E J; Bravo García, P L; Tejera Concepción, R D; Besada Estévez, C

    2011-04-01

    Health care in Spain has improved progressively and professionals are now required to meet competency levels that safeguard the citizen's right to health protection. To achieve this, instructors in residency training programs and resident physicians themselves are calling for a common framework for training to ensure quality and consistency. Given the scarcity of articles related to training in our journal and following the First Meeting of Residency Program Instructors of the Sociedad Española de Anestesiologia y Reanimación (SEDAR), there has arisen a need to explain how SEDAR's training unit is organized. In order to facilitate the sharing of experiences of those involved in training anesthesiology medical residents, we undertook a descriptive analysis of our hospital's curriculum. The structure and operation of the department are described in this report. The results of anonymous surveys completed annually show the satisfaction of residents (9.4 out of 10) and physicians (8.7 out of 10). An audit by the Ministry of Health showed that the curriculum met 100% of the required criteria.

  19. Fungal malignant otitis externa.

    PubMed

    Bowles, Philippe Frederick; Perkins, Victoria; Schechter, Eyal

    2017-03-27

    An 89-year-old man presented to the outpatient clinic with a 2-month history of persistent unilateral left-sided otalgia, otorrhoea and reduced hearing despite oral and topical antibiotics. Treatment was protracted, requiring a 4-month hospital admission for intravenous antifungal medication as well as 3 further months of oral antifungal treatment. We describe the clinical presentation, complications and treatment of this potentially fatal condition in the context of an unusual, and easily missed, causative organism. 2017 BMJ Publishing Group Ltd.

  20. [Otitis externa and cerumen obturans].

    PubMed

    Pieren, C

    1995-11-01

    Otitis externa and cerumen obturans are two of the most frequently encountered disturbances in the external auditory canal. Both conditions can lead to hearing loss due to reduced sound transmission. Other symptoms include ear pressure, pain and secretion. Acute otitis externa occurs frequently during the swimming season. The main symptoms are local pain and secretion. Treatment consists of careful and frequent cleaning and application of topical medication to the outer ear canal and prescription of medication against pain. Systemic antibiotics are only rarely necessary and are indicated if perichondritis or lymphadenitis are present. Chronic otitis externa is often caused by eczema of the outer ear canal. Allergies, systemic diseases, such as diabetes mellitus, and manipulation by the patient must be ruled out. Therapy includes the application of topical steroid solutions. The natural pH of the skin can be reestablished by use of diluted acetic acid solutions. Blockage of the outer ear canal by cerumen [cerumen obturans] can bring the patient to the office because of sudden hearing loss. After cleaning of the ear canal, a screening hearing test should be performed to assure that the problem has been resolved.

  1. Malignant otitis externa: case series.

    PubMed

    Ali, T; Meade, K; Anari, S; ElBadawey, M R; Zammit-Maempel, I

    2010-08-01

    In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population. Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009. Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases. The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

  2. Acute otitis externa: an update.

    PubMed

    Schaefer, Paul; Baugh, Reginald F

    2012-12-01

    Acute otitis externa is a common condition involving inflammation of the ear canal. The acute form is caused primarily by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus the most common pathogens. Acute otitis externa presents with the rapid onset of ear canal inflammation, resulting in otalgia, itching, canal edema, canal erythema, and otorrhea, and often occurs following swimming or minor trauma from inappropriate cleaning. Tenderness with movement of the tragus or pinna is a classic finding. Topical antimicrobials or antibiotics such as acetic acid, aminoglycosides, polymyxin B, and quinolones are the treatment of choice in uncomplicated cases. These agents come in preparations with or without topical corticosteroids; the addition of corticosteroids may help resolve symptoms more quickly. However, there is no good evidence that any one antimicrobial or antibiotic preparation is clinically superior to another. The choice of treatment is based on a number of factors, including tympanic membrane status, adverse effect profiles, adherence issues, and cost. Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact. Oral antibiotics are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection. Chronic otitis externa is often caused by allergies or underlying inflammatory dermatologic conditions, and is treated by addressing the underlying causes.

  3. Atypical presentations of malignant otitis externa.

    PubMed

    Vourexakis, Z; Kos, M-I; Guyot, J-P

    2010-11-01

    Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical. We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis. The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

  4. Interventions for acute otitis externa.

    PubMed

    Kaushik, Vivek; Malik, Tass; Saeed, Shakeel R

    2010-01-20

    Acute otitis externa is an inflammatory condition of the ear canal, with or without infection. Symptoms include ear discomfort, itchiness, discharge and impaired hearing. It is also known as 'swimmer's ear' and can usually be treated successfully with a course of ear drops. To assess the effectiveness of interventions for acute otitis externa. Our search for published and unpublished trials included the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources. The date of the most recent search was 6 January 2009. Randomised controlled trials evaluating ear cleaning, topical medication or systemic therapy in the treatment of acute otitis externa were eligible.We excluded complicated acute otitis externa; otitis externa secondary to otitis media or chronic suppurative otitis media; chronic otitis externa; fungal otitis externa (otomycosis); eczematous otitis externa; viral otitis externa and furunculosis. Two authors assessed eligibility and quality. Nineteen randomised controlled trials with a total of 3382 participants were included. Three meta-analyses were possible. The overall quality of studies was low.Topical antimicrobials containing steroids were significantly more effective than placebo drops: OR 11 (95% CI 2.00 to 60.57; one trial).In general, no clinically meaningful differences were noted in clinical cure rates between the various topical interventions reviewed. One notable exception involved a trial of high quality which showed that acetic acid was significantly less effective when compared with antibiotic/steroid drops in terms of cure rate at two and three weeks (OR 0.29 (95% CI 0.13 to 0.62) and OR 0.25 (95% CI 0.11 to 0.58) respectively).One trial of low quality comparing quinolone with non-quinolone antibiotics did not find any difference in clinical cure rate.No trials evaluated the effectiveness of ear cleaning

  5. Otitis externa: management of the recalcitrant case.

    PubMed

    Selesnick, S H

    1994-05-01

    Most cases of otitis externa respond to routine treatment, however, there is a subset of patients who frequently develop otitis externa that is usually severe and recalcitrant to routine therapy. These patients include the immunocompromised, those with AIDS, transplant recipients, severe diabetics, patients treated with high dose steroids or chemotherapeutic agents, and those who are malnourished or are chronically ill. Local factors that lead to worsening of otitis externa include dermatitides and prior local irradiation. Patients who find topical therapy painful may be noncompliant with medications, and they too, may develop recalcitrant otitis externa. For successful treatment, a broad understanding of external auditory canal anatomy, the microbiology and pathophysiology of otitis externa, and available treatment options, including topical and systemic medications, must be attained. These topics are reviewed.

  6. Acute otitis externa in children

    PubMed Central

    McWilliams, Colin J.; Smith, Christine H.; Goldman, Ran D.

    2012-01-01

    Abstract Question In the summer months I see many children with uncomplicated acute otitis externa (AOE). I am aware of the multiple ototopical preparations. Which is the best first-line agent to treat AOE, and is there a role for an oral antibiotic? Answer There are no specific Canadian guidelines for the management of AOE. However, current American guidelines promote initial ototopical therapy without systemic antibiotics for uncomplicated AOE; suggest there is little difference between the various ototopical preparations; and recommend the choice of treatment be based on the specific clinical situation. In practice, this often results in prescribing an antibiotic-steroid formulation for 7 to 10 days. This ototopical treatment option is supported by a recent Cochrane review that has documented the superiority of an antibiotic-steroid combination when compared with placebo or acetic acid in providing clinical resolution of AOE. PMID:23152458

  7. Management of malignant (necrotising) otitis externa.

    PubMed

    Hollis, S; Evans, K

    2011-12-01

    Although malignant (necrotising) otitis externa is not a common diagnosis, there have been a number of recently reported cases with pathogens other than Pseudomonas aeruginosa as the causative organism. In addition, there are many published reports of resistance to antibiotics in cases of malignant otitis externa caused by Pseudomonas aeruginosa. This review aims to assess the cases reported and to clarify the current opinion on the diagnostic criteria and management of such cases.

  8. [Necrotizing otitis externa: report of 36 cases].

    PubMed

    Gassab, Elyes; Krifa, Nesrine; Sayah, Najoua; Khaireddine, Noura; Koubaa, Jamel; Gassab, Aicha

    2011-02-01

    Necrotizing otitis externa is a potentially lethal form of otitis externa which occurs mainly in elderly diabetic. To study the clinical, diagnostic and therapeutic aspects of necrotizing otitis externa and to describe the outcomes of this disease. We report in this retrospective study, a series of 36 patients treated in our department for necrotizing otitis externa over a period of 9 years. Our series consisted of 34 diabetics. The average age of our patients was 62 years. The diagnosis was based on clinical, biological and bacteriological data and on imaging findings. A medical treatment based on a systemic antibiotic therapy combining a third generation cephalosporin to a fluoroquinolone was prescribed in 24 cases and to an aminoglycoside in 12 cases. In addition, a local treatment was performed daily and included meticulous cleaning of the external auditory canal and topical application of antimicrobial agents. Surgical debridement of infected soft tissues and bone sequestra was indicated in 8 cases because of the lack of improvement with medical treatment. Only one patient underwent hyperbaric oxygen therapy. The cure rate was estimated at 86%. Only one death was noted. Necrotizing otitis externa is a severe infection. Its prognosis has improved markedly since the advent of antibiotics effective on Pseudomonas aeruginosa. Its management must be started without delay and its treatment must be prolonged.

  9. [Malignant otitis externa caused by Candida albicans].

    PubMed

    Elayoubi, Fahd; Lachkar, Azeddine; Aabach, Ahmed; Chouai, Mohamed; Ghailan, Mohamed Rachid

    2016-01-01

    Malignant otitis externa is also referred to as skull base osteomyelitis. Pseudomonas aeruginosa is the most common offending pathogen. However, fungal origin is not uncommon. 80-year-old patient having persistent left earache since two months despite adequate treatment. Otologic examination showed signs of inflammation in the auricular pavilion, ear canal stenosis with granulomas and purulent otorrhea. CT scan showed a filled otomastoid, extensive inflammatory process affecting the pre-auricular and retro-auricular tissues and lysis of the tympanic bulla. Given the lack of improvement, mycological examination was performed which revealed the presence of Candida Albicans. Cases of malignant otitis externa caused by Candida albicans are rarely reported. Fungal origin should be suspected in patients who have negative bacteriological samples and no improvement despite adequate antibiotic treatment. It should be confirmed by sometimes multiple mycological samples. Malignant otitis externa caused by Candida albicans is a rare potentially mortal infection.

  10. An Experimental Model for the Study of Infectious Otitis Externa.

    DTIC Science & Technology

    Through study of five small laboratory animals the guinea pig was found to be a useful experimental model for the study of otitis externa . Infection...and in disease. Data presented suggests that the presence of a normal bacterial flora is of significance in reducing the incidence of otitis externa ...aeruginosa. The data supports the concept of a multiplex etiology of otitis externa . (Author)

  11. Ear infections: otitis externa and otitis media.

    PubMed

    Lee, Hobart; Kim, Jeffrey; Nguyen, Van

    2013-09-01

    This article reviews the diagnosis and treatment of acute otitis externa and acute otitis media, and will be helpful to primary care physicians who diagnose and treat these common diseases in the clinic. The pathophysiology, microbiology, clinical features, diagnosis, treatment, prognosis, and complications are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. [The liver transplant program of the Hospital General Universitario Gregorio Marañón: an analysis of the first 100 patients].

    PubMed

    Calleja Kempin, J; Clemente Ricote, G; Pérez Ferreiroa, J; Bañares Cañizares, R; Polo Melero, J R; García Sabrido, J L; Valdecantos Montes, E; Olmedilla, L; Santos, L; Pérez Peña, J

    1995-04-01

    During a 3-year period between 1990 and 1993, 100 patients received orthotopic liver transplantation at the "Gregorio Marañón" University General Hospital. The mean age of the patients was relatively high (46.9 +/- 10 years), with an important number of cirrhotic patients (91%). The rate of primary liver failure was relatively low (4.5% of transplantations) although 12 cases with more than 55 years were included in the present series. Eleven retransplantations were performed, 8 for early failure of the graft and 3 for chronic failure. Postoperative complications of the graft were vascular in 9 cases, biliary in 17 cases, and acute rejection (cellular) in 70 patients, although only 50 of these patients required treatment with steroid boluses. Infections were diagnosed in 60 cases with 80% of major infections, 6 of them caused by Aspergillus fumigatus that were lethal in all the cases. Postoperative survival was 82%, 72%, 69% and 69% at 1 month, 6 months, 1 year and 2 years respectively.

  13. [Radiological percutaneous gastrostomy (GRP), 17 años de experiencia, serie de casos del hospital Universitario Virgen del Rocío].

    PubMed

    Navarro Falcón, Magnolia Del Carmen; Parejo Campos, Juana; Pereira Cunill, José Luis; García Luna, Pedro Pablo

    2014-10-25

    When assessing a patient nutritional support the state of the gastrointestinal tract is the most important point to consider, whenever possible we should choose the enteral nutrition (EN) over parenteral nutrition (PN) and recognized by its various advantages. The percutaneous gastrostomy (GRP) were introduced in clinical practice as an alternative to surgical gastrostomy (GQ). The speed, simplicity, low cost, low morbidity and low mortality of these techniques has allowed its rapid development.The feeding tubes types used were the balloon-retained devices catheter, the pig tail and the ballon-retained with gastropexia (gastropexia). It is a retrospective study of all patients who were placed GPR in the Virgen del Rocío University Hospital, Sevilla, between September 1996 and September 2013, which aims to study is to describe the characteristics of patients and the complications presented for different types of enteral feeding tubes used. GPR 186 were performed in 176 patients (135 males (76.70%), with an average duration of 303.6 days, the most frequent diseases were cancers of the head and neck 49.46%. The types of feeding tubes used were pigtail 118 (63.44%), balloon-retained devices 22 (11.83%), and gastropexia 46 (24.73%). The most common early complications in the pigtail group were early purulent exudate and early bleeding (2.5 and 3.4% respectively), while in the balloon catheter group the initial output of the probe was most frequent early complication (13.7%), none of these complications were observed in the group of gastropexy. The most common late complication was obstruction probe. The GPR is a safe technique with lower mortality of 1%; Low frequently of early and late complications. A better understanding of this technique can reduce the frequency of complications.

  14. Rearing Chrysoperla externa Larvae on Artificial Diets.

    PubMed

    Bezerra, C E S; Amaral, B B; Souza, B

    2017-02-01

    We tested three artificial diets for rearing larvae of Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae), aiming at reducing the production costs of this predator. Two of the diets come from studies with other species of lacewings, and the third is a modification described in this paper. All diets were based on animal protein and were supplied to 2nd and 3rd instar larvae, whereas 1st instar larvae received eggs of Anagasta kuehniella (Zeller) (Lepidoptera: Pyralidae). We evaluated the preimaginal duration and survival, adult size, longevity and fecundity, egg hatchability, and predatory capacity of larvae produced. The performance of the diets was followed for seven generations. The diet we describe showed to be the best among the artificial diets tested. Our results show that C. externa can be successfully reared on artificial diets during second and third instars, reducing in 90% the dependency on eggs of A. kuehniella.

  15. Case report: ophthalmomyiasis externa in Dallas County, Texas.

    PubMed

    Sigauke, Ellen; Beebe, Walter E; Gander, Rita M; Cavuoti, Dominick; Southern, Paul M

    2003-01-01

    Ophthalmomyiasis externa is an uncommon condition in North America. If not recognized and managed accordingly, it can be complicated by the potentially fatal condition ophthalmomyiasis interna. Ophthalmomyiasis externa is mainly caused by the sheep bot fly Oestrus ovis; thus, it is more common in farming communities. We report a case of ophthalmomyiasis externa in a young woman from Dallas County, Texas, who had no known history of contact with farm animals.

  16. Malignant otitis externa in a healthy non-diabetic patient.

    PubMed

    Liu, Xiao-Long; Peng, Hong; Mo, Ting-Ting; Liang, Yong

    2016-08-01

    A healthy 60-year-old male was initially treated for external otitis, and subsequently received multiple surgeries including abscess drainage, temporal bone debridement, canaloplasty of the external auditory meatus, and fistula excision and was treated with numerous antibiotics at another hospital over a 1-year period. He was seen at our hospital on February 14, 2014 with a complaint of a non-healing wound behind the left ear and drainage of purulent fluid. He had no history of diabetes mellitus or compromised immune function. Computed tomography (CT) and magnetic resonance imaging (MRI) studies at our hospital showed osteomyelitis involving the left temporal, occipital, and sphenoid bones, the mandible, and an epidural abscess. Routine blood testing and tests of immune function were normal, and no evidence of other infectious processes was found. He was diagnosed with malignant otitis externa (MOE). Bone debridement and incision and drainage of the epidural abscess were performed, and vancomycin was administered because culture results revealed Corynebacterium jeikeium, Corynebacterium xerosis, and Enterococcus faecalis. MOE should be considered in healthy patients with external otitis who fail initial treatment.

  17. Experimental treatment of recurrent otitis externa

    PubMed Central

    Mileva, M.H.; Pencheva, D.V.; Bryaskova, R.G.; Genova-Kalou, P.D.; Kantardjiev, T.V.

    2015-01-01

    The aim of this research is to determine the effect of the hybrid material based on polyvinyl alcohol and silver nanoparticles (PVA/AgNps) in the treatment of the otitis externa as an additional component in the commercial product “Betazon Trio”. It was established that the experimental creamy formula with silver concentration 600 mg/L is suitable for recovery of the microbial homeostasis when it is administrated once daily in dose 1 ml over a period of 14 days. PMID:26623362

  18. Assessment and management of chronic otitis externa.

    PubMed

    Kesser, Bradley W

    2011-10-01

    Chronic otitis externa (COE) remains a frustrating problem for both patient and physician. The end stage of disease, medial fibrosing otitis externa, is very challenging to repair. New and old therapies and promising approaches to the treatment of this often recalcitrant problem are presented in this review. Tacrolimus, a nonsteroidal immunosuppressant, and fluocinolone acetonide oil 0.01%, a medium-high potency steroid preparation, may offer additional therapeutic options in the struggle against this inflammatory ear canal/skin condition of often unknown cause. Relative potencies of many steroid preparations will be presented along with several treatment strategies for controlling COE. Underlying autoimmune problems such as Sjögren's disease, sarcoidosis, and amyloidosis must be searched and, if present, addressed and treated for resolution of symptoms. Cutting edge therapies, including use of bacteriophages and inflammatory proteases, will also be reviewed. No single therapy will be successful for every patient with COE. The search for an underlying cause, the removal of all possible irritants to the ear canal skin (e.g. Q-tips, water), debridement, and both topical and occasionally, systemic therapy will control (not cure …) the disease process in the vast majority of patients.

  19. Is biofilm the cause of chronic otitis externa?

    PubMed

    Fusconi, Massimo; Petrozza, Vincenzo; Taddei, Anna Rita; Vinciguerra, Vittorio; De Virgilio, Armando; Chiarini, Fernanda; Cirenza, Mirko; Gallinelli, Carmen; Conte, Michela; de Vincentiis, Marco

    2011-12-01

    This study was undertaken in two phases. In the first phase, we considered patients affected by chronic external otitis treated either by chemical ear peeling (CEP) or by antibiotic/steroid treatment to compare the clinical and microbiological outcomes. In the second phase, we compared the microscopic findings observed in the CEP samples of patients affected by chronic otitis externa's acute exacerbation or by acute otitis externa to demonstrate the role of biofilm in the pathogenesis of chronic otitis externa. Prospective, double-blind, controlled study. In phase 1 we compared clinical and microbiological data collected from two groups of 25 patients with chronic otitis externa treated by CEP or by conventional antibiotic/steroid treatment. In phase 2 we compared the results of the optical and electron microscopic analysis of specimens obtained by performing CEP in two groups of patients (25 with chronic otitis externa exacerbation and 15 with acute otitis externa). In phase 1 the disease control rate yielded markedly better results when treated with CEP. In phase 2 biofilms were identified in 23 of the 25 patients with chronic otitis externa exacerbation (92%) and in only three acute external otitis cases (20%). CEP is a simple and effective method for the treatment of chronic external otitis. The removal of the bacterial biofilm has a high correlation with a long-term clinical remission. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  20. Initial impact of the acute otitis externa clinical practice guideline on clinical care.

    PubMed

    Bhattacharyya, Neil; Kepnes, Lynn J

    2011-09-01

    Objectives. Determine the influence of the acute otitis externa clinical practice guideline on clinical care. Study Design. Cross-sectional study with historical controls. Setting. Outpatient departments in the United States. Methods. Cases of acute otitis externa occurring in 2004-2005 (before guideline publication) and 2007-2008 (after guideline publication) were extracted from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey. Prescribing rates for ototopical medications, analgesic recommendations, and oral antibiotics were determined and compared before and after guideline publication and relative to guideline recommendations. Results. An estimated 5.50 (standard error of the estimated mean, 0.38) million visits (mean age, 27.7 [1.7] years; 49.8% male) with a primary and singular coded diagnosis of acute otitis externa were studied (2.64 [0.26] million visits for 2004-2005 and 2.86 [0.28] million visits for 2007-2008). Prescribing rates for ototopical preparations were 67.2% (5.3%) and 67.6% (5.0%) before and after guideline publication, respectively (P = .955). Recommendation rates for analgesics were 14.2% (3.3%) and 20.6% (3.9%), respectively (P = .248). Prescription rates for oral antibiotics were 21.7% (4.8%) and 30.5% (3.6%), before and after, respectively (P = .166). Conclusion. Clinician behavior in the medical treatment of acute otitis externa has not significantly changed after guideline publication, despite clear, evidence-based guideline recommendations. These data have important implications for performance measures based on the guideline. Further efforts toward guideline dissemination are likely needed.

  1. Otitis externa. Management in the primary care office.

    PubMed

    Mirza, N

    1996-05-01

    Otitis externa is a widespread problem that is most commonly caused by Pseudomonas aeruginosa. Pain, ear discharge, and edema of the ear canal are the main manifestations. The presence of granulation tissue is an ominous sign that usually indicates necrotizing otitis externa or even a neoplastic process. It is important for primary care physicians to be familiar with methods of ear cleaning and use of topical medications for otitis externa. It is equally vital to be aware of the importance of a timely referral to an otolaryngologist when a serious underlying cause is suspected.

  2. Mastoiditis mimicry: retro-auricular cellulitis related to otitis externa.

    PubMed

    Block, Stan L

    2014-09-01

    Retro-auricular cellulitis associated with otitis externa is now the great mimicker of mastoiditis. It may be the most common cause of this specific cellulitis/auricular protrusion when it is associated with otitis externa. This column presents six cases of children who presented with peri-auricular redness, four of whom had protuberant ear and retro-auricular cellulitis. Copyright 2014, SLACK Incorporated.

  3. Differential diagnosis and treatments of necrotizing otitis externa: a report of 19 cases.

    PubMed

    Chen, Yen-An; Chan, Kai-Chieh; Chen, Chin-Kuo; Wu, Che-Ming

    2011-12-01

    Necrotizing otitis externa is an uncommon but potentially life-threatening infection disease of the external auditory canal and temporal bone. Its presentation and natural course had been largely altered through the years. The aim of this study was to analyze the clinical presentation, bacteriology, and treatment protocol and we compare those with the literature. A retrospective review of the archives of a tertiary referral center otolaryngology department (1995-2010) identified 19 cases of necrotizing otitis externa. The patient's epidemiologic, clinical, diagnostic and treatment data were evaluated. A total of 19 patients were collected. Their mean age was 67.3 (SD, 12.2 year; range, 38-83 year). Of them, fourteen patients had diabetes mellitus (82.3%). The facial nerve was involved in 26% of the patients. Culture isolated Pseudomonas aeruginosa in 26.7% of cases, and half of them were resistant to ciprofloxacin. Five patients (26.3%) had temporomandibular area involvement. Eight patients received surgical intervention and all of them survived in the end of treatment course. The mean duration of hospitalization of was 25.8 ± 20.5 days (8-90). Two patients died during hospitalization, both from comorbidities (one from severe GI bleeding and another from septic shock). The proportion of patients with facial palsy and diabetes in our series was comparable to those reported in the literature. But the incidence of P. aeruginosa was much lower and the rate of resistance to ciprofloxacin was high, which was supposed to result from the popularity and previous use of the quinolone ear drops before referral. And the leading cause of mortality is patient's comorbidities. Treating necrotizing otitis externa remains a great challenge even in nowadays with modern image modalities and advanced antibiotics. Physicians should have a high index of suspicion when facing patients at risk with refractory external ear infection so as to give them timely diagnosis and optimal

  4. Recurrent malignant otitis externa: management and outcome.

    PubMed

    Omran, Ahmed Amin; El Garem, Hany Farouk; Al Alem, Reyad Khalil

    2012-03-01

    Necrotizing (malignant) external otitis (NEO) is an infection involving the temporal and the adjacent bones. It is a rare type of external otitis that occurs primarily in immunocompromised persons. The present study aimed to evaluate its management and outcome in recurrent cases. Ten patients attending the ENT Department, Alexandria University were included. They had recurrence of otitis externa over a period of 6 months after-cure, as well as severe night otalgia and high ESR level. Peri-auricular soft tissue swelling, cranial nerve paralysis and trismus were the main persistent or developing presentations in recurrent cases. Extensive surgical intervention was performed in four patients with unsatisfactory outcome. On the other hand, satisfactory results were obtained with those treated with specific medical therapy after culture and sensitivity test and those who underwent minimal surgical intervention. In conclusion, NEO is an aggressive disease that necessitates conservative management and local debridement of sequestrated tissues. The ESR is a good indicator of treatment response. It is recommended to be meticulous in treatment of cases with recurrent NEO and extensive surgical interventions are discouraged.

  5. Otitis externa following aural irrigation linked to instruments contaminated with Pseudomonas aeruginosa.

    PubMed

    Bruins, M J; Wijshake, D; de Vries-van Rossum, S V; Klein Overmeen, R G J; Ruijs, G J H M

    2013-07-01

    The incidence of acute otitis externa, an infection of the external auditory canal, in general practitioners' (GP) practices in The Netherlands is about 14 per 1000 patients per year. In early 2010, one of the authors noted that some of the otitis externa patients in his GP practice had undergone cerumen removal by ear syringing a few weeks earlier. Bacterial cultures of samples taken from the instruments used showed contamination of an ear syringe by Pseudomonas aeruginosa. From then on, P. aeruginosa isolates from patients' ears were stored in the laboratory. It was assessed whether cross-contamination with P. aeruginosa between patients in the same GP practice could occur through the use of contaminated ear lavage instruments. From 17 GP practices, the otolaryngology Outpatient Department and the Out-of-Hours GP Service, instruments used for examining and cleaning the outer ear were swabbed. Strains of P. aeruginosa cultured from the instruments were genotyped together with isolates of patients registered in the same practice. In four practices where contaminated instruments were found, genotyping showed similarity between P. aeruginosa strains isolated from a patient and the ear syringe, and/or between strains of different patients in the same practice. Transmission of P. aeruginosa from ear lavage instruments to patients appears to occur with otitis externa as a result. Together with the Infection Control Unit of our hospital we have formulated recommendations for the appropriate cleaning, disinfection and storage of re-usable ear lavage instruments for the GP practices to implement. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  6. Prevalence of otitis externa in stray cats in northern Italy.

    PubMed

    Perego, Roberta; Proverbio, Daniela; Bagnagatti De Giorgi, Giada; Della Pepa, Alessandra; Spada, Eva

    2014-06-01

    Feline otitis externa is a dermatological disorder that has not been evaluated much in stray cats. One hundred and eighty-seven stray cats were randomly selected during a trap-neuter-release programme to investigate the prevalence of otitis externa in stray cat colonies in northern Italy. Swabs for cytological examination were obtained from the external ear canal of each cat. A direct otoscopic assessment of the external ear canal was made in 86/187 cats. Cytological evidence of otitis externa was present in 55.1% of cats. The influence on otitis of age, gender, habitat and season of sampling was tested, but no risk factors were found. Otodectes cynotis (as a sole agent or in combination) was the primary cause of otitis in 53.3% of cats. Cocci and rods, either alone or in combination with other agents, were perpetuating factors in 71.8% and 29.1% of cats, respectively. Pregnancy status was a risk factor for otitis caused by coccal infections. Malassezia species, alone or in combination, was the perpetuating factor in 50.5% of cats with otitis. Urban habitat and winter season were risk factors for otitis associated with Malassezia species. Demodex cati was identified as an incidental finding in two cats. There was good agreement between otoscopy and cytology with regard to the diagnosis of otitis externa. The results of this study show a high prevalence of otitis externa in stray colony cats and provide information on causal factors for feline otitis externa. © ISFM and AAFP 2013.

  7. Clinical practice guideline: acute otitis externa executive summary.

    PubMed

    Rosenfeld, Richard M; Schwartz, Seth R; Cannon, C Ron; Roland, Peter S; Simon, Geoffrey R; Kumar, Kaparaboyna Ashok; Huang, William W; Haskell, Helen W; Robertson, Peter J

    2014-02-01

    The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the updated Clinical Practice Guideline: Acute Otitis Externa, as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 8 recommendations developed address appropriate diagnosis of acute otitis externa (AOE) and the use of oral and topical antimicrobials and highlight the need for adequate pain relief. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

  8. Otitis externa due to Pseudomonas in swimming pool bathers

    PubMed Central

    Weingarten, Michael A.

    1977-01-01

    An outbreak of otitis externa was observed to affect one third of 230 swimmers using a new swimming pool within three weeks of its opening. Pseudomonas aeruginosa was grown from the water and from all of the nine swabs taken from the infected ears of the swimmers. During the same period only six other cases of otitis externa were seen in the local general practice serving 4,000 patients. The disinfection procedures were found to be defective and after they were corrected the outbreak subsided. PMID:408486

  9. Concurrent necrotising otitis externa and adenocarcinoma of the temporal bone: a diagnostic challenge

    PubMed Central

    Foden, Neil; Burgess, Christopher; Damato, Stephen; Ramsden, James

    2013-01-01

    We present a case of an 81-year-old man who was diagnosed with a necrotising (malignant) otitis externa (NOE). Initial biopsies from the external auditory canal showed scanty squamous epithelium but no evidence of malignancy. Despite an initial improvement on intravenous antibiotics and subsequent discharge from hospital, the patient returned with worsening otalgia. Following readmission to the hospital, intravenous antibiotics were restarted. Despite this, the patient developed a lower motor neurone palsy of cranial nerve VII on the ipsilateral side of the pain. He was taken to the theatre for an exploration of the left mastoid with further biopsies. Adenocarcinoma was diagnosed histologically and the patient was started on palliative radiotherapy. This case adds to the known literature on metastatic disease in the temporal bone and highlights the need to exclude malignancy in cases of NOE. PMID:24197806

  10. Concurrent necrotising otitis externa and adenocarcinoma of the temporal bone: a diagnostic challenge.

    PubMed

    Foden, Neil; Burgess, Christopher; Damato, Stephen; Ramsden, James

    2013-11-06

    We present a case of an 81-year-old man who was diagnosed with a necrotising (malignant) otitis externa (NOE). Initial biopsies from the external auditory canal showed scanty squamous epithelium but no evidence of malignancy. Despite an initial improvement on intravenous antibiotics and subsequent discharge from hospital, the patient returned with worsening otalgia. Following readmission to the hospital, intravenous antibiotics were restarted. Despite this, the patient developed a lower motor neurone palsy of cranial nerve VII on the ipsilateral side of the pain. He was taken to the theatre for an exploration of the left mastoid with further biopsies. Adenocarcinoma was diagnosed histologically and the patient was started on palliative radiotherapy. This case adds to the known literature on metastatic disease in the temporal bone and highlights the need to exclude malignancy in cases of NOE.

  11. A Modified Prophylactic Regimen for the Prevention of Otitis Externa in Saturation Divers

    DTIC Science & Technology

    2013-10-01

    Prophylactic Regimen for the Prevention of Otitis Externa in Saturation Divers Authors: DISTRIBUTION STATEMENT A. Paul C. Algra, LT, MC...May 2012 – May 2013 4. TITLE AND SUBTITLE A Modified Prophylactic Regimen for the Prevention of Otitis Externa in Saturation Divers...SUPPLEMENTARY NOTES 14. ABSTRACT To prevent acute otitis externa (AOE) in the saturation setting and to decrease the side effects

  12. Clinical practice guideline: acute otitis externa.

    PubMed

    Rosenfeld, Richard M; Schwartz, Seth R; Cannon, C Ron; Roland, Peter S; Simon, Geoffrey R; Kumar, Kaparaboyna Ashok; Huang, William W; Haskell, Helen W; Robertson, Peter J

    2014-02-01

    This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations

  13. Temporal Bone Osteomyelitis: The Relationship with Malignant Otitis Externa, the Diagnostic Dilemma, and Changing Trends

    PubMed Central

    Chen, Jia-Cheng; Yeh, Chien-Fu; Shiao, An-Suey; Tu, Tzong-Yang

    2014-01-01

    Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone. PMID:24963511

  14. Temporal bone osteomyelitis: the relationship with malignant otitis externa, the diagnostic dilemma, and changing trends.

    PubMed

    Chen, Jia-Cheng; Yeh, Chien-Fu; Shiao, An-Suey; Tu, Tzong-Yang

    2014-01-01

    Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

  15. Otitis Externa Associated with Malassezia sympodialis in Two Cats

    PubMed Central

    Crespo, M. J.; Abarca, M. L.; Cabañes, F. J.

    2000-01-01

    The lipid-dependent species Malassezia sympodialis was isolated from two cats with otitis externa. To our knowledge, this is the first report of the isolation of lipid-dependent species of the genus Malassezia associated with skin disease in domestic animals. PMID:10699037

  16. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa.

    PubMed

    Phillips, John S; Jones, Stephen E M

    2013-05-31

    Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by involvement of cranial nerves, principally the facial nerves and the contents of the jugular foramen. It is an uncommon condition mainly found in the elderly or in diabetics. To assess the effectiveness of adjunctive hyperbaric oxygen treatment for malignant otitis externa. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 4 April 2013. Randomised controlled trials, involving adults, undergoing hyperbaric oxygen therapy in malignant otitis externa. No identified articles described randomised controlled trials of hyperbaric oxygen therapy in the treatment of malignant otitis externa. Due to the lack of data we could present no results. No clear evidence exists to demonstrate the efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics and/or surgery. We found no data to compare rates of complication between the different treatment modalities. Further research is required.

  17. Comparison of steroid antibiotic pack and 10% ichthammol glycerine pack in relieving pain of acute otitis externa in children.

    PubMed

    Adhikari, Prakash; Bhatta, Rishi; Bhandari, Sukmit; Pyakurel Bhatta, Manita

    2011-04-01

    This study was carried out with the objective of comparing clinical efficacy of 10% ichthammol glycerine (IG) pack with steroid-antibiotic pack for relieving pain in cases of acute otitis externa. A prospective quasi-randomized clinical trial was completely carried out in 65 patients at Department of ENT and Head and Neck Surgery, TU Teaching Hospital, Kathmandu. Patients of less or equal to 12 years of age and both gender presenting in our outpatient department from October 2008 to December 2009 and diagnosed to have acute otitis externa was evaluated. Six patients were excluded from the study because of not meeting the inclusion criteria. Alternately IG and steroid antibiotic packing were done. For steroid antibiotic group, we use betnovate-N, a combination of betnovate sodium phosphate 0.1% and neomycin sulphate 0.5%. Before packing was carried out, pain was assessed using Wong Baker Scale. Statistical analysis was done using "Z" test of mean to compare average number of pain score and visits in two different groups. There were 33 patients in IG pack group and 32 patients in steroid antibiotic group. In less than 4 years, there were 30 children and in more than 4 years children, there were 35 children. There was male predominance in both the treatment groups and disease was most common in age group less than 4 years. There was statistical significant decrease in number of visits in steroid group in both children less than and more than 4 years. There was also significantly less pain in children with steroid antibiotic group. Use of steroid antibiotic pack in children presenting with acute otitis externa causes earlier relief of pain as well as significantly lesser number of visits. Thus, steroid antibiotic pack is better than 10% ichthammol glycerine packs in relieving pain in acute otitis externa in children. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Clinical outcome parameters for necrotizing otitis externa.

    PubMed

    Verim, Ayşegül; Naiboğlu, Bariş; Karaca, Çigdem Tepe; Seneldir, Lütfü; Külekçi, Semra; Oysu, Çağatay

    2014-02-01

    To investigate the duration of time elapsed between the onset of symptoms for necrotizing external otitis (NEO) and admission to hospital that may play a role in patient outcome. Retrospective case review. Tertiary referral center. Fourteen consecutive male patients with NEO with no improvement from the previous course of antibiotherapy and with findings of osteomyelitis on temporal bone CT, MRI, and positive detection of Tc-99m methylene diphosphonate on temporal bone, admitted as inpatients between 2008 and 2012. Medical treatment of NEO and surgical debridement. Patients were divided into 2 groups according to median time elapsed between onset of symptoms and hospitalization (<30 d or >30 d). HbA1c, fasting blood sugar, erythrocyte sedimentation rate, C-reactive protein, pain intensity, radiologic grade, improvement since diagnosis, and total time to cure were compared according to the groups. The relationships between the laboratory data were analyzed to determine the parameters associated with time to recovery. Otalgia was significantly worse in patients who were admitted to hospital greater than 30 days after symptom onset (Mann-Whitney U test, p < 0.002). Blood glucose increased related to delayed admission time (p < 0.001). CRP results were independently elevated from the admission time (p < 0.112). There was a statistically significant difference between groups according to ESR levels and recovery time (Mann-Whitney U test, p < 0.004 and p < 0.01). There was a positive correlation between HbA1c levels and recovery time in Group 1 and between ESR levels and recovery time in Group 2 (r = 0.872, p = 0.044; r = 0.630, p = 0.039). Clinical, laboratory, and outcome data worsen later than 30 days in NEO.

  19. [Bacteriology and mycology of otitis externa in dogs].

    PubMed

    Bornand, V

    1992-01-01

    The bacterial and fungal flora of 1118 ears of dogs with otitis externa and 100 ears of healthy control dogs were studied in order to isolate the causative agents. The yeast Malassezia pachydermatis (56%) was by far the most common organism in otitic dogs followed by the bacteria Staphylococcus intermedius (23%), Pseudomonas aeruginosa (12%), Proteus spp. (6%) and Streptococcus canis (5%). A statistical analysis of observed results showed that the incidence of these organisms is significant in otitic dogs. Many strains of S.intermedius, P.aeruginosa and Proteus spp. are resistant to antimicrobial agents commonly used to treat otitis externa. Therefore an antimicrobial susceptibility testing was performed using "Cobas Bact" for these bacterias. Furthermore, 80 strains of M.pachydermatis were submitted to identification-kits (API 20 CAUX, API STAPH, Cobas Micro). The observed results showed that an identification with these tests was not possible.

  20. [Malignant externa otitis: the modern principles of diagnostics and treatment].

    PubMed

    Nikiforova, G N; Svistushkin, V M; Shevchik, A E; Zolotova, A V

    The objective of the present study was to elucidate the specific features of the clinical course of malignant externa otitis in the context of the present-day concepts. A total of 5 patients presenting with the confirmed diagnosis of malignant external otitis were available for the examination. The analysis of the clinical observations provided the basis for the characteristic of pathogenesis of this condition, diagnostic principles, and treatment modalities for the management of the pathology in question. It is concluded that the patients suffering from malignant externa otitis must remain under medical care and observation during a long period and the strategy for the treatment of each concrete patient should be chosen on an individual basis taking into consideration the presence of concomitant pathologies and their adequate therapy.

  1. In vitro antimicrobial activity of plants in Acute Otitis Externa.

    PubMed

    Nogueira, Janaina Cândida Rodrigues; Diniz, Margareth de Fátima Melo; Lima, Edeltrudes O

    2008-01-01

    Acute Otitis Externa is an inflammation of the outer auditory meatus, and according to popular saying, medicinal plant extracts can be used in its treatment. to assess the in vitro antimicrobial activity of the following plants: Aleolanthus suaveolens; Caryophyllus aromaticus; Cymbopogon citratus; Matricaria chamomila; Pithecellobium avaremotemo; Plectranthus amboinicus and Ruta graveolens on the germs that cause otitis externa. the minimum inhibitory concentration of extracts and oils from these plants was obtained from otitis externa samples. Staphylococcus aureus in 10 cultures, Pseudomonas aeruginosa in 8, Pseudomonas aeruginosa and Staphylococcus aureus together in 5 cultures and Candida albicans and Candida krusei in 4 cultures. P. aeruginosa was resistant to all oils and extracts tested; extracts from A. suaveolens, P. avaremotemo and R. graveolens were inactive; the essential oil from C. aromaticus and M. chamomila were active against 3 strains of S. aureus and the Candida strains; seven of the S. aureus strains were sensitive to the P. amboinicus extract; however, the oil was inactive against 4 S. aureus strains and the Candida strains were sensitive to the R. graveolens essential oil. depending on the etiological agent, some plants presented satisfactory results, however we still need more detailed studies in order to better use these plants.

  2. Outcomes of canalplasty for chronic obliterative otitis externa.

    PubMed

    Potter, C P S; Bottrill, I D

    2012-10-01

    Chronic obliterative otitis externa is a rare cause of conductive hearing loss, characterised by stenosis of the deep ear canal secondary to chronic inflammation. A multitude of canalplasty techniques have been described, with variable success. Fourteen patients undergoing canalplasty performed by the senior author for refractory obliterative otitis externa, over an 8-year period, were included in the study. All underwent split-skin grafting of the denuded canal and meticulous post-operative aural care. Outcome measures included the Glasgow Benefit Inventory and pure tone audiology. At 3 months post-operatively, the four-tone average threshold had improved by a mean of 13.9 dB (95 per cent confidence interval -9.9 to 37.8 dB; t < 0.001) in the operated ear. The mean Glasgow Benefit Inventory score was 20 (95 per cent confidence interval -2.3 to 42.1). Significant improvements in both hearing and quality of life are achievable in patients with end-stage obliterative otitis externa treated surgically. Highly trained and competent aural care practitioners are a prerequisite for the success of the procedure, and a substantial number of patients must be prepared to submit to long-term follow-up care.

  3. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors.

    PubMed

    Loh, Shaun; Loh, Woei Shyang

    2013-06-01

    Malignant otitis externa (MOE) is a severe disease with varying outcomes. Despite advances in antibiotic treatment, a significant proportion still succumbs to this disease. We aimed to analyze the effect of clinical factors on prognosis and to review treatment outcomes in our institution. Case series with retrospective chart review of MOE cases from 2006 to 2011. Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, a tertiary referral center. Patients with MOE admitted for treatment were studied and divided into 2 outcome groups depending on response to a 6-week course of intravenous antibiotics. Demographic and disease factors were analyzed with regard to outcome. Nineteen cases were analyzed. Disease resolved in 63.2% after 6 weeks of antibiotics. Mortality was 21.1%. Age, diabetic control, duration of diagnostic delay, cranial nerve involvement, and inflammatory markers were not found to predict prognosis. Erythrocyte sedimentation rate and C-reactive protein levels correlated with disease activity and can be used to monitor progress. Clival involvement was associated with persistent disease (P = .002). Only 63.2% of cases had positive cultures. Pseudomonas aeruginosa was the main organism, and 33.3% of isolates were multidrug resistant. Outcome was not different in cases where culture-directed therapy was employed vs those where empirical ceftazidime and fluoroquinolone were used (P = .650). Malignant otitis externa remains an insidious disease with significant mortality. Involvement of the clivus portends a poorer prognosis. Combination therapy with intravenous ceftazidime and oral fluoroquinolone remains relevant despite concerns of culture-negative cases and multidrug-resistant Pseudomonas.

  4. The role of surgery in necrotizing otitis externa.

    PubMed

    Gruber, Maayan; Sela, Eyal; Doweck, Ilana; Roitman, Ariel; Uri, Nechama; Srouji, Samer; Cohen-Kerem, Raanan

    2017-01-01

    This retrospective case review describes a subset of 5 patients with necrotizing otitis externa (NOE) with a refractory disease course who underwent surgery as part of their management plan between 2008 and 2013. Surgery promoted the cure of 4 of the 5 patients, and a fungal pathogen was recovered in 4 of 5 surgical samples. We conclude that surgery may be a necessary diagnostic and treatment adjunct in selective cases of NOE, especially in patients with a refractory disease course or with a suspected fungal etiology.

  5. Bacterial Otitis Externa in Patients Attending an ENT Clinic in Babol, North of Iran.

    PubMed

    Kiakojuri, Keyvan; Mahdavi Omran, Saeid; Jalili, Bahareh; Hajiahmadi, Mahmood; Bagheri, Meghdad; Ferdousi Shahandashti, Elaheh; Rajabnia, Ramazan

    2016-02-01

    Acute otitis externa, an inflammatory condition of the external auditory canal, is a common clinical problem in general medicine. This study aimed to determine the etiology of otitis externa in patients from the Mazandaran province, north of Iran, which has a humid climate, as humidity can affect the prevalence of pathogenic microorganisms. This cross-sectional study involved 116 patients with otitis externa. Two sets of samples were collected from their ears; one set was used for slide preparations, and the other for microbial culturing. After culturing, the microorganisms were identified by conventional methods. Patients between 35 and 44 years of age were most frequently affected (25.00%) by otitis externa (average age, 43.87 ± 18.08 years). Moreover, women (54.31%) were more frequently affected than men (45.69%). Upon direct investigation, Gram-positive bacilli were the most commonly identified microorganisms (22.41%). Furthermore, Bacillus spp. and coagulase-negative staphylococci (22.41% and 19.83%, respectively), were the organisms most frequently identified from cultures of otitis externa samples. Direct examination and culture showed that a mixed infection of fungi and bacteria is the most common cause of otitis externa. The present study revealed that Bacilli spp. were the most abundant bacteria isolated from patients with otitis externa. Thus, it is recommended that both organisms should be considered as etiologic agents in protocols for treatment of otitis externa.

  6. Bacterial Otitis Externa in Patients Attending an ENT Clinic in Babol, North of Iran

    PubMed Central

    Kiakojuri, Keyvan; Mahdavi Omran, Saeid; Jalili, Bahareh; Hajiahmadi, Mahmood; Bagheri, Meghdad; Ferdousi Shahandashti, Elaheh; Rajabnia, Ramazan

    2016-01-01

    Background Acute otitis externa, an inflammatory condition of the external auditory canal, is a common clinical problem in general medicine. Objectives This study aimed to determine the etiology of otitis externa in patients from the Mazandaran province, north of Iran, which has a humid climate, as humidity can affect the prevalence of pathogenic microorganisms. Patients and Methods This cross-sectional study involved 116 patients with otitis externa. Two sets of samples were collected from their ears; one set was used for slide preparations, and the other for microbial culturing. After culturing, the microorganisms were identified by conventional methods. Results Patients between 35 and 44 years of age were most frequently affected (25.00%) by otitis externa (average age, 43.87 ± 18.08 years). Moreover, women (54.31%) were more frequently affected than men (45.69%). Upon direct investigation, Gram-positive bacilli were the most commonly identified microorganisms (22.41%). Furthermore, Bacillus spp. and coagulase-negative staphylococci (22.41% and 19.83%, respectively), were the organisms most frequently identified from cultures of otitis externa samples. Conclusions Direct examination and culture showed that a mixed infection of fungi and bacteria is the most common cause of otitis externa. The present study revealed that Bacilli spp. were the most abundant bacteria isolated from patients with otitis externa. Thus, it is recommended that both organisms should be considered as etiologic agents in protocols for treatment of otitis externa. PMID:27127584

  7. Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center.

    PubMed

    Bhat, Vadisha; Aziz, Ajaz; Bhandary, Satheesh Kumar; Aroor, Rajeshwary; Kamath P, Shrinath D; Saldanha, Marina

    2015-04-01

    Malignant otitis externa (MOE) is an uncommon but potentially fatal disease of the external auditory canal. The study aimed at evaluating the demographic profile, coexisting disabilities, clinical presentations, and management of MOE. This is a retrospective study of patients with MOE who were treated at the Otorhinolaryngology Department of our institution. The case records of patients treated between 2006 and 2013 for MOE were reviewed from the Medical Records Department of the hospital. The details were tabulated in a master chart, and the data were analyzed. Fifteen patients with MOE were treated as inpatients at the Otorhinolaryngology Department of our hospital during the study period. Of these, 12 were males and three were females. Among the 15 patients, 14 were diabetic and one was non-diabetic. Earache was the most common symptom observed in all patients; edema and granulations in the ear canal was the most common sign observed in 12 patients. Pseudomonas aeruginosa was isolated in 11 patients. All patients were managed medically with intravenous antibiotics. MOE is a rare but aggressive condition affecting the external ear, which is commonly observed in elderly diabetic individuals. Immune senescence may be the cause of MOE in elderly people. Pseudomonas is the most common causative organism isolated in this condition. Most of these patients can be managed with medical treatment; reserving surgery only for the removal of granulation tissue and for histopathological examination.

  8. Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series.

    PubMed

    Glikson, Eran; Sagiv, Doron; Wolf, Michael; Shapira, Yisgav

    2017-01-01

    We reviewed 25 cases of patients diagnosed with necrotizing otitis externa in our tertiary university-affiliated medical center between 2009 and 2015. Mean overall hospitalization duration was 14.52days, 95% of the patients showed specific seasonal incidence. Mean duration of symptoms prior to hospitalization was 6weeks and the duration correlated with outcome. Only 8% of the patients presented with cranial neuropathies; however, this presentation correlated with adverse outcome. Pseudomonas aeruginosa was the main causative organism (50%), with a 30% multidrug-resistance rate. A high rate (35%) of fungal pathogens was noted. Seventeen patients (68%) were eventually operated; however, only 5 patients needed extensive surgery under general anesthesia. Computed tomography (CT) evidence of adjacent structures' involvement correlated with adverse outcome. Eighty percent of our patients improved clinically. The overall death rate was 12% and the disease-related mortality rate was 8%. Our findings state the importance of limited surgical intervention and microbiologic cultures in disease treatment. This is particularly important in patients with cranial neuropathies and CT finding of adjacent structural involvement that correlate with adverse prognosis. A rising pseudomonal antibiotic resistance and fungal infections may challenge antibiotic treatment in the future. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Scedosporium apiospermum: a rare cause of malignant otitis externa.

    PubMed

    McLaren, Oliver; Potter, Christian

    2016-09-09

    A 79-year-old man, with a history of well-controlled diabetes mellitus, presented with left-sided otalgia. With an initial diagnosis of simple otitis externa, he was discharged on topical drops. He represented 2 months later with worsening otalgia and discharge. A diagnosis of malignant otitis externa was made based on clinical and radiological findings. Intravenous Tazocin and Gentamicin were given based on previous bacterial culture from ear swabs. The patient failed to improve and developed left-sided facial nerve palsy. His condition stabilised following a change in antimicrobial therapy and his management continued in the community on intravenous Meropenem with twice weekly aural toilet. Repeated nuclear medicine imaging failed to demonstrate resolution. A bony sequestration was removed from the external auditory canal in the outpatient clinic, which following extended culture grew Scedosporium apiospermum; his management was subsequently changed to oral Voriconazole. This led to rapid clinical improvement and disease resolution over a 6 -week period. 2016 BMJ Publishing Group Ltd.

  10. Antimicrobial susceptibility of staphylococci isolated from otitis externa in dogs.

    PubMed

    Lilenbaum, W; Veras, M; Blum, E; Souza, G N

    2000-07-01

    Samples were obtained from 65 unmedicated adult dogs, processed for isolation of Staphylococcus species and tested for susceptibility to penicillin G, gentamicin, oxacillin, tetracycline, trimethoprim-sulphamethoxazole, streptomycin, ampicillin and rifampin. Forty-four isolates were obtained, which represents 67.7% of samples. Coagulase-negative species were most commonly found, and the most frequently isolated staphylococcus species were Staph. epidermidis and Staph. aureus. Other species, such as Staph. simulans, Staph. haemolyticus, Staph. saprophyticus and Staph. intermedius were also isolated. Resistance to antibiotics was frequently observed, with 90.9% of the isolates showing resistance to at least one drug. The most active antimicrobial agents against staphylococci isolated from otitis externa of dogs were rifampin and oxacillin. Multidrug resistance was a common finding, and one strain of Staph. haemolyticus species, was resistant to all tested antimicrobial agents. Resistance to three or more different drugs was a common finding, observed in 16 strains (36.4%) of both coagulase-positive and coagulase-negative staphylococci. This study highlights the emergence of cases of otitis externa determined by coagulase-negative staphylococcus strains and once more emphasizes the need for bacterial culture with species identification and susceptibility testing of swab specimens from the ear canal in order to choose appropriate antimicrobial agents.

  11. [Dermatophytes isolated in Hospital Universitario 12 de Octubre (Madrid, Spain).].

    PubMed

    Del Palacio, A; Cuétara, M S; Valle, A; González, A; Almondarain, I; Ramos Castillo, M J; Moran Vasallo, A; Pereiro Miguens, M

    1999-06-01

    Over a 10 year period (January 1988 - December 1997), 3,241 dermatophyte strains were isolated from 18,465 specimens from patients in whom dermatophytosis was suspected clinically. This represents a 17.5% rate of isolation. Trichophyton rubrum (38.44%), Microsporum canis (28.75%), Epidermophyton floccosum (14.5%) and Trichophyton mentagrophytes (13.5%) were the dominant species, and Trichophyton tonsurans (2.09%) has emerged, whilst in the previous decade it had virtually disappeared. Our study is basically based on an out-patient selected population, and tinea corporis (30.79%), followed by tinea cruris (16.69%) and tinea unguium (16.69%) were the most prevalent clinical forms.

  12. [Drug therapy of otitis externa and otitis media].

    PubMed

    Okovityĭ, S V; Ivkin, D Iu; Malygin, S V

    2012-01-01

    The objective of the present work was to analyse the available pharmaceutical products used for treatment of otitis media. The rational application of these medications makes it possible to eliminate rapidly a variety of etiological factors, reduce the severity of inflammation, and improve the quality of life of the patients. One of the approaches to the achievement of these goals for the patients with otitis externa and otitis media consists of the use of combined preparations containing antibacterial, antimycotic, anti-inflammatory and analgetic components. Candibiotic is a four-components drug composed of chloramphenicol, clotrimazol, beclomethasone and lidocaine. The advantages of Candibiotic include high therapeutic efficacy due to its ethiotropic and pathogenetic activity and safety as its components do not have ototoxicity in the case of local application).

  13. Errors in the diagnosis and management of necrotizing otitis externa.

    PubMed

    Jacobsen, Laura M; Antonelli, Patrick J

    2010-10-01

    Necrotizing otitis externa (NOE) is a life-threatening condition that may be difficult to distinguish from other clinical entities. The purpose of this study was to assess the pitfalls associated with contemporary diagnosis and management of NOE. Case series with chart review. Tertiary referral center. Patients given the diagnosis of NOE or one of its typical presenting complaints over the past 14 years were identified by diagnostic and radiology codes. Charts were reviewed for history, findings, treatment, and outcomes. Fifty-one patients with NOE were identified. The annual case numbers rose steadily. A risk factor was known in 46 patients. Gallium single-photon emission computed tomography was accurate for the presence (44 of 46 patients) and resolution of disease. Prolonged systemic antimicrobial therapy (mean 15 weeks, range 4-59 weeks) was required. Microbial cultures influenced therapy in only 50 percent. Two diabetic men died with disease. Of the cases seen at the request of otolaryngologists, 68 percent were for indications other than NOE (e.g., chronic otitis media). With a known risk such as diabetes, the mean time to diagnosis was 6.9 months. History of and clinical appearance overlapping with benign otitis were the primary reasons for diagnostic delay. NOE remains a life-threatening condition that requires prolonged antimicrobial therapy. Its incidence may be on the rise. NOE may develop in patients with benign otitis media and externa, and must be considered in all patients with temporal bone inflammation, especially those with risk factors and those who fail to improve with more conservative measures. Copyright © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

  14. The association between the signalment, common causes of canine otitis externa and pathogens.

    PubMed

    Zur, G; Lifshitz, B; Bdolah-Abram, T

    2011-05-01

    To determine whether associations exist between pathogens, allergies, conformational abnormalities, endocrinopathies and signalment in canine otitis externa (OE). Medical records of 149 dogs which met predetermined inclusion criteria were evaluated retrospectively. Correlations between pathogens and the presence of allergy, endocrinopathy, conformational abnormalities and signalment were evaluated statistically. The shar-pei, German shepherd and cocker spaniel breeds were over-represented compared with the hospital's breed distribution (P<0·001). German shepherd dogs and cocker spaniels were statistically more prone to infection with rod-shaped organisms and Labrador retrievers less than other breeds (P=0·034). Almost all dogs that were older than five years when diagnosed with OE had cocci (P=0·01) and also had higher levels of rods (P=0·028). The incidence of rods was higher in endocrinopathies (P=0·004), while that of Malassezia spp. tended to be higher in allergies (P=0·098). There were no statistically significant differences among the groups for all the other parameters examined. OE infection is usually not influenced by primary causes or predisposing factors. Endocrinopathies may be followed by a more severe otitis, however. OE may be more severe when it affects older dogs. © 2011 British Small Animal Veterinary Association.

  15. Recent evolutionary history of Chrysoperla externa (Hagen 1861) (Neuroptera: Chrysopidae) in Brazil

    PubMed Central

    2017-01-01

    This work aimed to elucidate the distribution of Chrysoperla externa haplotypes and investigate whether it exhibits structure based on genetic composition as opposed to geographic location. The genetic diversity of C. externa, analyzed by AMOVA using the COI and 16S rRNA genes as mitochondrial markers, showed significant haplotype structure arising from genetic differences that was not associated with sampling location. This was reflected in the network grouping. Bayesian inference showed that haplotype distribution may have its origins in C. externa divergence into two distinct clades, which dispersed to various locations, and their subsequent diversification. The evolutionary history of C. externa may include multiple ancestral haplotypes differentiating within the same geographic area to generate the current broad genetic diversity, so that the earlier geographical history has been erased, and now we have highlighted its more recent genetic history. PMID:28510607

  16. [Fungus culture of the ear discharge and therapeutic effects in 60 outpatients with otitis externa].

    PubMed

    Zhou, Zizhao; Yang, Haidi; Zheng, Yiqing; Xiong, Hao; Wu, Minjian

    2015-05-01

    To assess the diagnosis and therapeutic effects for fungal otitis externa by clinical symptoms, endoscopic findings, and fungus culture of the ear discharge. Sixty outpatients diagnosed with otitis externa were enrolled in the study. All patients were treated with a thorough debridement of the ear and one antifungal medication regimens (compound resorcinol solution) in case of a positive fungus culture. One subgroup of patients treated with daub glycerol during 2 weeks of follow-up. Positive cultures were found in 42 cases. The efficacy was observed in all patients even in those who received only ear endoscopy. Fungal otitis externa could be easily diagnosed by ear endoscopy. A thorough debridement of the ear and utility of compound resorcinol solution is an easy and effective approach for treatment of fungal otitis externa.

  17. Fresh water swimming as a risk factor for otitis externa: a case-control study.

    PubMed

    Springer, G L; Shapiro, E D

    1985-01-01

    A case-control study was conducted in which the amount and sites (fresh-water lakes and rivers, chlorinated pools, or the ocean) of recent swimming by 105 patients with otitis externa were compared with that of 239 controls. Swimming during the week prior to the visit was strongly associated with otitis externa. When the 80 cases and 127 controls with a history of recent swimming were compared, otitis externa was positively associated with the amount of swimming during the preceding week. Otitis externa was also positively associated with swimming in fresh water compared with ocean or pool swimming with the magnitude of this association being more pronounced at higher levels of exposure.

  18. A rare and sinister variant of a common ailment: Fungal malignant otitis externa

    PubMed Central

    Lilic, N; Mowjood, MT; Wong, MHW

    2012-01-01

    A recent case report in this journal highlighted the pathophysiology and management of bacterial malignant otitis externa (MOE) (1). We describe the case of an elderly gentleman who had a delayed diagnosis of fungal MOE with advanced diseased at time of diagnosis. This case highlights the changing microbiology of this serious disease and the difficulty in diagnosis given the rarity of this form of otitis externa relative to its uncomplicated form. PMID:24960790

  19. Cervical internal carotid artery pseudoaneurysm complicating malignant otitis externa: first case report.

    PubMed

    Baker, Andrew; Rizk, Habib; Carroll, William; Lambert, Paul

    2015-03-01

    Pseudoaneurysm of the internal carotid artery (ICA) is a rare complication of head and neck infections. To date, three cases of petrous ICA pseudoaneurysm have been described as a complication of otogenic infection, including only one secondary to malignant otitis externa. We present here the first case of cervical ICA pseudoaneurysm as a complication of malignant otitis externa, and stress the importance of timely diagnosis to avoid fatal outcomes. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Survey of otitis externa in American Cocker Spaniels in Finland.

    PubMed

    Kaimio, Mirja; Saijonmaa-Koulumies, Leena; Laitinen-Vapaavuori, Outi

    2017-02-28

    American Cocker Spaniels are overrepresented among breeds that require surgery as a treatment of end-stage otitis externa. However, the prevalence of otitis externa (OE) in this breed remains unknown. We reviewed the year 2010 medical records of 55 private veterinary clinics in Finland to determine the prevalence of OE in American Cocker Spaniels compared with English Cocker and English and Welsh Springer Spaniels. An American Cocker Spaniel owner questionnaire was designed to identify potential risk factors for end-stage OE. From the medical records of 98,736 dogs, the prevalence of OE was highest in Welsh Springer Spaniels (149 out of 468, 31.8%, [95% confidence interval 27.6-36.0]), followed by American Cocker (89/329, 27.0%, [22.2-31.7]), English Springer (96/491, 19.6%, [16.1-23.1]) and English Cocker Spaniels (231/1467, 15.7%, [13.8-17.6]). The mean number of OE episodes in ear-diseased dogs and the number of ear surgeries were highest in American Cocker Spaniels. Owner questionnaires were received for 151 American Cocker Spaniels, 85 (56%) of which had suffered from OE. In 47% (40/85) of these dogs, OE occurred without concurrent skin lesions, 46% (33/72) displayed the first signs of OE before 1 year of age. In 24% (20/85) of the dogs, the signs of OE recurred within 1 month or continued despite treatment, 16% (14/85) required surgery (n = 11) or were euthanized (n = 5; 2 of the operated dogs and 3 others) due to severe OE. The onset of OE before the age of 1 year significantly increased the risk (OR 3.8, 95% CI 1.1-13.6) of end-stage OE. The prevalence of OE in American Cocker Spaniels in Finland was higher than previously reported in Cocker Spaniels, but the highest prevalence of OE was found in Welsh Springer Spaniels. Compared to the other Spaniels, OE was more often recurrent and more frequently surgically managed in American Cocker Spaniels. Based on the questionnaire, early onset (<1 year) of OE increased the risk of end-stage OE. In American

  1. Occurrence of Malassezia spp. in the external ear canals of dogs and cats with and without otitis externa.

    PubMed

    Crespo, M J; Abarca, M L; Cabañes, F J

    2002-04-01

    We studied the lipophilic microbiota of the external ear canals of 332 animals (264 dogs and 68 cats), with and without otitis externa, over an 11-year period from 1988 to 1999. Malassezia pachydermatis was isolated from 62.2% and 50% of dogs with and without otitis externa, respectively, and from 41.2% and 17.6% of cats with and without otitis externa, respectively. In the group of animals studied for lipid-dependent species, these yeasts were isolated from 4.5% of dogs with otitis externa and from 23.1% and 8.9% of cats with and without otitis externa, respectively. M. sympodialis and M. furfur were isolated from cats and M. furfur and M. obtusa from dogs. Our findings show that lipid-dependent Malassezia species may contribute to the etiology of otitis externa in dogs and cats.

  2. Occult middle ear and mastoid fluid in acute otitis externa.

    PubMed

    Brennan, Tara E; Saadia-Redleaf, Miriam I

    2012-09-01

    Presence of fluid in the middle ear (ME) or mastoid air cells in acute otitis externa (OE) has not been reported. We hypothesize that in patients with OE there is often otitis media (occult middle ear and mastoid fluid) and secondary fluid in the mastoid air cell system, which is not seen during a clinical examination because of edema in the external canal skin. Retrospective chart review. We reviewed the medical records of 209 patients who presented to our ear, nose, and throat (ENT) clinic with acute OE that was resolved with oral and/or topical antibiotics. Twenty-seven of the 209 patients presented with unilateral or bilateral acute OE (29 ears) and received a computed tomography (CT) scan of their temporal bones, which was ordered by the Emergency Department or ENT services. Twenty-three of 29 ears (79%) showed fluid in the ME, mastoid, or both. Nine of the 10 patients (82%), who obtained their CT scan within 1 week of symptom onset, were found to have fluid. These findings support our hypothesis and serve to inform the medical community (both ENT and primary care) that fluid is often present in the ME or mastoid in patients with acute OE whose symptoms will resolve with oral and/or topical antibiotics. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  3. Optimising the use of otowicks in otitis externa.

    PubMed

    Bola, S; Rashid, M; Hickey, S

    2017-09-01

    Otowicks are used to treat otitis externa with significant ear canal oedema. This study investigates how well drops penetrate through to reach the deep canal and whether it is safe to leave otowicks in the canal for more than 2 days. Sterile otowicks were inserted into mock ear canals and vertically over pseudomonas-seeded agar plates whilst gentamicin or ciprofloxacin drops were administered. The time taken for drops to penetrate through the otowick was recorded. Separately, pseudomonas-seeded otowicks were treated with saline or antibacterial drops. The penetrating drops were observed for bacterial growth on sterile agar. It took six drops before penetration occurred for both antibiotics. When sterile saline drops were applied to bacterially contaminated otowicks, the penetrating drops displayed bacterial growth on agar, indicating that pseudomonas penetrated through the otowick. However, when antibiotic drops were applied, penetrating drops showed no bacterial growth on the corresponding agar plate. Bacteria can penetrate otowicks but this is prevented by continuous application of antibacterial ear drops. Ear wicks need priming with six drops before starting a regimen, so that the initial dose is fully absorbed.

  4. Is laterality of malignant otitis externa related to handedness?

    PubMed

    Migirov, Lela; Lipshitz, Noga; Dagan, Elad; Wolf, Michael

    2013-07-01

    Malignant otitis externa (MOE) usually affect patients with systemic diseases, especially diabetes mellitus. MOE is a mainly unilateral disease. Given that around 90% of human adults are right-handed we hypothesized that hand preference might be one of the factors involved in the development of MOE. All 38 of the patients whom we treated for MOE between August 2009 and November 2012 (28 males and 10 females, age range 43-91 years) had poorly controlled diabetes mellitus, and all of them reported itching in the involved ear. The difference in the laterality of MOE among our right- and left-handed subjects was significant: right hand dominance was associated mostly with right-sided MOE (24/34) and left hand dominance was associated with occurrence of MOE only in the left ears (4/4, p=0.006). These findings point to an unexpectedly strong relationship between the patient's handedness and laterality of his/her MOE, leading us to hypothesize that the development of MOE might be attributable to self-inflicted local trauma to the ear canal on the same side as the dominant hand. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Deep brain stimulation in the globus pallidus externa promotes sleep.

    PubMed

    Qiu, M H; Chen, M C; Wu, J; Nelson, D; Lu, J

    2016-05-13

    The basal ganglia, a network of subcortical structures, play a critical role in movements, sleep and mental behavior. Basal ganglia disorders such as Parkinson's disease and Huntington's disease affect sleep. Deep brain stimulation (DBS) to treat motor symptoms in Parkinson's disease can ameliorate sleep disturbances. Our series of previous studies lead the hypothesis that dopamine, acting on D2 receptors on the striatopallidal terminals, enhances activity in the globus pallidus externa (GPe) and promotes sleep. Here, we tested if DBS in the GPe promotes sleep in rats. We found that unilateral DBS (180 Hz at 100 μA) in the GPe in rats significantly increased both non-rapid eye movement and rapid eye movement sleep compared to sham DBS stimulation. The EEG power spectrum of sleep induced by DBS was similar to that of the baseline sleep, and sleep latency was not affected by DBS. The GPe is potentially a better site for DBS to treat both insomnia and motor disorders caused by basal ganglia dysfunction.

  6. Septic arthritis of the temporomandibular joint caused by Aspergillus flavus infection as a complication of otitis externa.

    PubMed

    Varghese, Lalee; Chacko, Rabin; Varghese, George M; Job, Anand

    2015-03-01

    Septic arthritis of the temporomandibular joint (TMJ) is a very rare complication of otitis externa that can lead to ankylosis and destruction of the joint. We report the case of a 74-year-old man who developed aspergillosis of the TMJ following otitis externa. To the best of our knowledge, this is the first reported case of TMJ septic arthritis secondary to otitis externa caused by Aspergillus flavus. The patient was successfully managed with condylectomy, debridement, and drug treatment with voriconazole.

  7. Control region sequences indicate that multiple externae represent multiple infections by Sacculina carcini (Cirripedia: Rhizocephala)

    PubMed Central

    Rees, David; Glenner, Henrik

    2014-01-01

    The rhizocephalan barnacle, Sacculina carcini, is a common parasite of the European shore crab, Carcinus maenas, in which it causes significant detrimental physical and behavioral modifications. In the vast majority of cases, the external portion of the parasite is present in the form of a single sac-like externa; in rare cases, double or even triple externae may occur on the same individual host. Here, we use a highly variable DNA marker, the mitochondrial control region (CR), to investigate whether multiple externae in S. carcini represent infection by multiple parasites or asexual cloning developed by a single parasite individual. Sequences for multiple externae from C. maenas hosts from the Danish inlet, Limfjorden, and from the mud flates at Roscoff, France, were compared. In almost all cases, double or triple externae from an individual host yielded different haplotypes. In the few cases where identical haplotypes were identified from externae on a multiple-infected host, this always represented the most commonly found haplotype in the population. This indicates that in Sacculina carcini, the presence of multiple externae on a single host reflects infection by different individual parasites. A haplotype network of CR sequences also suggests a degree of geographical partitioning, with no shared haplotypes between the Limfjorden and Roscoff. Our data represent the first complete CR sequences for a rhizocephalan, and a unique gene order was also revealed. Although the utility of CR sequences for population-level work must be investigated further, the CR has proved a simple to use and highly variable marker for studies of S. carcini and can easily be applied to a variety of studies in this important parasite. PMID:25473481

  8. Occurrence of Malassezia species in Persian and domestic short hair cats with and without otitis externa.

    PubMed

    Shokri, Hojjatollah; Khosravi, Alireza; Rad, Mohammadali; Jamshidi, Shahram

    2010-03-01

    The yeasts of the Malassezia genus are opportunistic microorganisms in the skin and auricular canal of human and animals, mainly cats, and can cause otitis externa and dermatitis disorders. The aim of this study was to evaluate the occurrence of different species of Malassezia in the external ear canal of cats with and without otitis externa. Thirty-one normal cats and 82 animals with otitis externa were clinically examined. Sterile cotton swabs were used to collect specimens from the external ear canal and streaked onto the surface of Sabouraud dextrose agar (SDA) and modified Dixon agar. Malassezia yeasts were isolated from 95.1% and 48.4% of the cats with and without otitis externa, respectively. The rate of isolation in affected animals versus normals was highly significant (P<0.05). Out of the 137 isolates obtained from cats with otitis, 57.7% were identified as M. pachydermatis (with significant frequency; P<0.05), 15.4% as M. obtusa, 11.4% as M. globosa, 7.3% as M. slooffiae, 4.1% as M. sympodialis, 2.4% as M. furfur and 1.6% as M. restricta. Malassezia species were frequently isolated from subjects with age range from 1 to 4 years old (42.7%). Our finding of Malassezia isolates indicated that feline otitis externa can be associated with lipid-dependent Malassezia species in addition to the non lipid- dependent species M. pachydermatis.

  9. Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa.

    PubMed

    Alva, B; Prasad, K Chandra; Prasad, S Chandra; Pallavi, S

    2009-11-01

    We report an advanced presentation of osteomyelitis of the temporal bone secondary to malignant otitis externa. We present a case report and a review of the world literature concerning osteomyelitis of the temporal bone secondary to malignant otitis externa. A 60-year-old diabetic man developed osteomyelitis of the temporal bone and a temporoparietal abscess as advanced complications of malignant otitis externa. He was successfully treated in our institution using a post aural incision after draining the abscess and excising the fistula, a modified radical mastoidectomy with canal wall down procedure with sequesterectomy and debridement of surrounding area done. The terms 'osteomyelitis of the temporal bone', 'skull base osteomyelitis' and 'malignant otitis externa' have not been clearly defined, and have in the past often been used interchangeably in the literature. Osteomyelitis of the temporal bone can occur secondary to malignant otitis externa, acute otitis media, chronic suppurative otitis media or trauma. Here, we present the management of an advanced case of osteomyelitis of the temporal bone.

  10. Identification and antibiotic susceptibility of bacterial isolates from dogs with otitis externa in Australia.

    PubMed

    Bugden, D L

    2013-01-01

    To identify and quantify the five most frequently isolated significant bacterial microorganisms, and their antibiotic susceptibility, from bacterial cultures of samples taken from the ears of dogs with otitis externa. Bacterial culture and susceptibility testing data for ear swabs from dogs with presumed otitis externa were collated and evaluated. The five most frequently isolated microorganisms were: Pseudomonas aeruginosa, Staphylococcus pseudintermedius, Proteus sp., beta-haemolytic streptococci and Escherichia coli. Susceptibility to gentamicin was very high for most isolates, whereas for polymyxin B, high levels of resistance were seen. Beta-haemolytic streptococci had high levels of resistance to all of the antibiotics tested. This study provides veterinarians with Australian data to assist in cytological interpretation and initial empirical therapy of canine otitis externa. © 2012 The Author. Australian Veterinary Journal © 2012 Australian Veterinary Association.

  11. Susceptibility of bacterial isolates from chronic canine otitis externa to twenty antibiotics.

    PubMed

    Guedeja-Marrón, J; Blanco, J L; Ruperez, C; Garcia, M E

    1998-10-01

    In this paper we present the results of studies on the susceptibility to antibiotics of bacteria isolated from chronic canine otitis externa. We tested 46 bacterial strains (S. aureus, coagulase-negative staphylococci, Corynebacterium spp., and gram-negative bacilli) with 20 different antibiotics. We observed increased resistance to antibiotics of bacteria isolated from canine otitis externa as compared to the resistance reported earlier. This may be due to the indiscriminate use of some antibiotics in the last years and indicates the importance of sensitivity testing for the effective treatment of chronic otitis externa, especially that caused by gram-negative bacilli. The clinician may initiate empiric treatment with antibiotics before obtaining the sensitivity test results; the best results may be expected from a topical application of Bacitracin or Chloramphenicol, and from a systemic therapy with Cephalosporines. Therapeutical scheme for treating various bacterial groups are presented in the paper.

  12. Epidemiological study of dogs with otitis externa in Cape Breton, Nova Scotia

    PubMed Central

    Perry, Laura R.; MacLennan, Bernard; Korven, Rebecca; Rawlings, Timothy A.

    2017-01-01

    From May 2008 to December 2013, 320 cases of otitis externa were diagnosed among 2012 dogs undergoing routine physical examinations at Celtic Creatures Veterinary Clinic, Sydney River, Nova Scotia for a diagnosis frequency of 15.9% [95% confidence interval (CI): 14.3% to 17.6%]. Twenty-four percent of these dogs exhibited 1 or multiple recurrences despite initial treatment with topical antimicrobial/anti-inflammatory solutions. The frequency of diagnosis was significantly higher in breeds with pendulous ears, but was not affected by ear hairiness. There were no seasonal patterns in the frequency of diagnosis. In clinical examination of 60 dogs with otitis externa, bacteria were evident in 47% of infections. Of 10 genera cultured, Staphylococcus spp. and diptheroids were most common. In this study, analysis of clinical records provided insights into the local prevalence of otitis externa and the efficacy of treatment in routine clinical situations. PMID:28216686

  13. Epidemiological study of dogs with otitis externa in Cape Breton, Nova Scotia.

    PubMed

    Perry, Laura R; MacLennan, Bernard; Korven, Rebecca; Rawlings, Timothy A

    2017-02-01

    From May 2008 to December 2013, 320 cases of otitis externa were diagnosed among 2012 dogs undergoing routine physical examinations at Celtic Creatures Veterinary Clinic, Sydney River, Nova Scotia for a diagnosis frequency of 15.9% [95% confidence interval (CI): 14.3% to 17.6%]. Twenty-four percent of these dogs exhibited 1 or multiple recurrences despite initial treatment with topical antimicrobial/anti-inflammatory solutions. The frequency of diagnosis was significantly higher in breeds with pendulous ears, but was not affected by ear hairiness. There were no seasonal patterns in the frequency of diagnosis. In clinical examination of 60 dogs with otitis externa, bacteria were evident in 47% of infections. Of 10 genera cultured, Staphylococcus spp. and diptheroids were most common. In this study, analysis of clinical records provided insights into the local prevalence of otitis externa and the efficacy of treatment in routine clinical situations.

  14. In vitro antimicrobial resistance of Pseudomonas aeruginosa isolated from canine otitis externa in Rio de Janeiro, Brazil

    PubMed Central

    Penna, B.; Thomé, S.; Martins, R.; Martins, G.; Lilenbaum, W.

    2011-01-01

    Isolates of Pseudomonas aeruginosa (167) were obtained from 528 samples of canine otitis externa, identified by biochemical reactions and tested for susceptibility to 10 antimicrobials. The most effective drug was ciprofloxacin. The study reports alarming resistance among P. aeruginosa isolated from canine otitis externa samples in Rio de Janeiro, Brazil. PMID:24031774

  15. [Comparison of four different staining methods for ear cytology of dogs with otitis externa].

    PubMed

    Bouassiba, C; Osthold, W; Mueller, R S

    2013-01-01

    Cytological examination is crucial for the diagnosis and classification of canine otitis externa. Staining should reveal micro-organisms as perpetuating factors of otitis externa. The aim of the study was to compare four different staining methods (Diff-Quik®, Diff-Quik® after dipping in acetone, Gram Quick stain® and a commercial rapid stain for otitis externa) for ear cytology of dogs with otitis externa and to investigate the agreement of cytology and culture. In a study evaluating dogs with otitis externa, five ear swabs (one for culture and four for cytology) were taken from the horizontal part of the external auditory canal of 224 affected ears and compared semi-quantitatively. Diff-Quik® with and without prior dipping in acetone as well as the Gram Quick stain® displayed a high degree of agreement in the detection of micro-organisms (cocci p = 0.2366; rods p = 0.4832; yeasts p = 0.1574), while the commercial otitis rapid stain revealed significantly less micro-organisms (p < 0.001 for all comparisons). The results of the first three stains corresponded to the culture results by >  70%; the agreement was lower with the commercial otitis rapid stain. The quickest and easiest method was staining with Diff-Quik®. Diff-Quik® with or without prior dipping in acetone and the Gram Quick stain® had a high agreement in the detection of microorganisms and can thus be considered nearly equivalent for the diagnosis of otitis externa infectiosa. The commercial otitis rapid stain is less reliable. Based on this study Diff-Quik® can be recommended for the routine cytology of ear swabs. Additionally, a culture may be indicated and must be interpreted in the context of the cytology.

  16. Single photon emission computed tomography/computed tomography of the skull in malignant otitis externa.

    PubMed

    Chakraborty, Dhritiman; Bhattacharya, Anish; Kamaleshwaran, Koramadai Karuppusamy; Agrawal, Kanhaiyalal; Gupta, Ashok Kumar; Mittal, Bhagwant Rai

    2012-01-01

    Malignant otitis externa is a severe, rare infective condition of the external auditory canal and skull base. The diagnosis is generally made from a range of clinical, laboratory, and imaging findings. Technetium 99m methylene diphosphonate bone scintigraphy is known to detect osteomyelitis earlier than computed tomography. The authors present a patient with bilateral malignant otitis externa where the extent of skull base involvement was determined on 3-phase bone scintigraphy with single photon emission computed tomography/computed tomography. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Skull based osteomyelitis due to postsurgery malignant otitis externa presenting as stroke

    PubMed Central

    Su, Nicola; Syed, Irfan; Garth, Richard

    2011-01-01

    Malignant or necrotising otitis externa is a rare but potentially fatal disease. The classic presentation is one of severe, unremitting, throbbing otalgia, which may progress to osteomyelitis, especially in the elderly diabetic or immunocompromised patient. The case described is of a 72-year-old immunocompetent, non-diabetic man who presented with facial weakness, dysphagia and weight loss. The admitting diagnosis or impression was that of a cerebrovascular event. The eventual diagnosis was that of skull based osteomyelitis secondary to malignant otitis externa complicating mastoid surgery. PMID:22696765

  18. Comparison of Boric Acid and Combination Drug of Polymyxin, Neomycin and Hydrocortisone (polymyxin NH) in the Treatment of Acute Otitis Externa

    PubMed Central

    Moeini, Mohammad

    2016-01-01

    Introduction Acute otitis externa is an inflammation of the external auditory canal known as "swimmer’s ear". Direct costs including medical treatment, painkillers, antibiotics, steroids or both and indirect costs are also remarkable. Aim The aim of this study was to compare the effect of boric acid and polymyxin, neomycin and hydrocortisone composition in the treatment of acute otitis externa. Materials and Methods This randomized clinical trial was carried out on 80 patients aged more than 17-year-old who were referred to Kashani hospital clinic with a diagnosis of acute otitis externa by otolaryngologist. The patients were randomly allocated to two groups (A: Boric acid and B: polymyxin NH ear drops) and Painkiller was prescribed and administered orally for all patients and in the presence of fever, cellulitis around the ears and neck adenopathy, broad-spectrum systemic antibiotics were used besides topical treatment. Symptoms of patients who were evaluated by a physician includes pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching. In addition, pain was evaluated in patients and was recorded by Macgill Pain Questionnaire, in the first, third, seventh and tenth days. Results Results showed that itching on third day (p=0.007) and swelling of the ear canal in the examination of the third day (p=0.006) and the seventh day (p=0.001) in the polymyxin NH group was more than those of boric acid group. Overall mean pain based on McGill questionnaire was 11.10±1.49 in boric acid group in the examination on the first day and was 4.05±0.22 in the examination on the tenth day and in the polymyxin NH group, it was 10.9±0.99 on the first day and 4.20±0.40 on the tenth day. In both groups, pain relief was the same and there was no significant difference between two groups (p=0.075). Conclusion The findings of this study showed slight differences in the effectiveness of the boric acid drug and combination of polymyxin

  19. Comparison of Boric Acid and Combination Drug of Polymyxin, Neomycin and Hydrocortisone (polymyxin NH) in the Treatment of Acute Otitis Externa.

    PubMed

    Amani, Soroush; Moeini, Mohammad

    2016-07-01

    Acute otitis externa is an inflammation of the external auditory canal known as "swimmer's ear". Direct costs including medical treatment, painkillers, antibiotics, steroids or both and indirect costs are also remarkable. The aim of this study was to compare the effect of boric acid and polymyxin, neomycin and hydrocortisone composition in the treatment of acute otitis externa. This randomized clinical trial was carried out on 80 patients aged more than 17-year-old who were referred to Kashani hospital clinic with a diagnosis of acute otitis externa by otolaryngologist. The patients were randomly allocated to two groups (A: Boric acid and B: polymyxin NH ear drops) and Painkiller was prescribed and administered orally for all patients and in the presence of fever, cellulitis around the ears and neck adenopathy, broad-spectrum systemic antibiotics were used besides topical treatment. Symptoms of patients who were evaluated by a physician includes pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching. In addition, pain was evaluated in patients and was recorded by Macgill Pain Questionnaire, in the first, third, seventh and tenth days. Results showed that itching on third day (p=0.007) and swelling of the ear canal in the examination of the third day (p=0.006) and the seventh day (p=0.001) in the polymyxin NH group was more than those of boric acid group. Overall mean pain based on McGill questionnaire was 11.10±1.49 in boric acid group in the examination on the first day and was 4.05±0.22 in the examination on the tenth day and in the polymyxin NH group, it was 10.9±0.99 on the first day and 4.20±0.40 on the tenth day. In both groups, pain relief was the same and there was no significant difference between two groups (p=0.075). The findings of this study showed slight differences in the effectiveness of the boric acid drug and combination of polymyxin, neomycin and hydrocortisone in the treatment of patients with

  20. Risk of otitis externa after swimming in recreational fresh water lakes containing Pseudomonas aeruginosa.

    PubMed Central

    van Asperen, I. A.; de Rover, C. M.; Schijven, J. F.; Oetomo, S. B.; Schellekens, J. F.; van Leeuwen, N. J.; Collé, C.; Havelaar, A. H.; Kromhout, D.; Sprenger, M. W.

    1995-01-01

    OBJECTIVE--To determine whether an outbreak of otitis externa was due to bathing in recreational fresh water lakes and to establish whether the outbreak was caused by Pseudomonas aeruginosa in the water. DESIGN--Matched case-control study. SETTING--The Achterhoek area, the Netherlands. SUBJECTS--98 cases with otitis externa and 149 controls matched for age, sex, and place of residence. MAIN OUTCOME MEASURES--Odds ratios for type of swimming water and frequency of swimming; presence of P aeruginosa in ear swabs and fresh water lakes. RESULTS--Otitis externa was strongly associated with swimming in recreational fresh water lakes in the previous two weeks (odds ratio 15.5 (95% confidence interval) 4.9 to 49.2) compared with non-swimming). The risk increased with the number of days of swimming, and subjects with recurrent ear disease had a greatly increased risk. The lakes met the Dutch bathing water standards and those set by the European Commission for faecal pollution in the summer of 1994, but P aeruginosa was isolated from all of them, as well as from the ear swabs of 78 (83%) of the cases and 3 (4%) of the controls. CONCLUSIONS--Even when current bathing water standards are met, swimming can be associated with a substantial risk of otitis externa because of exposure to P aeruginosa. People with recurrent ear disease should take special care when swimming in waters containing P aeruginosa. PMID:8520277

  1. First report of otitis externa caused by Schizophyllum commune and review of the literature.

    PubMed

    Matos, Tadeja; Tomazin, Rok; Battelino, Saba

    2016-05-01

    Basidiomycete Schizophyllum commune is a widely distributed cellulolytic fungus that is a well-known pathogen. It can cause a wide range of different infections, and here we describe the first case of otitis externa and a molecularly based identification process.

  2. Antibacterial effect of N-acetylcysteine on common canine otitis externa isolates.

    PubMed

    May, Elizabeth R; Conklin, Katherine A; Bemis, David A

    2016-06-01

    N-Acetylcysteine (NAC) has the potential to be a useful therapeutic agent for the treatment of otitis externa due to its antimicrobial and mucolytic properties, as well as its ability to disrupt bacterial biofilm. To determine the antibacterial activity of NAC against common bacterial isolates associated with canine otitis externa. Twenty two isolates from canine clinical cases of otitis externa were identified and tested, including five Staphylococcus pseudintermedius, six Pseudomonas aeruginosa, five Corynebacterium spp. and six β-haemolytic Streptococcus spp. isolates. Each isolate was grown on blood agar for 24 h and transferred to Mueller Hinton Broth (MHB) to achieve a final concentration of 5 × 10(5)  CFU/mL. NAC was diluted in MHB to a starting concentration of 160 mg/mL and serial two-fold microdilution assays were performed in triplicate with negative controls for all isolates tested. Concentrations of NAC tested ranged from 0.125 to 80 mg/mL. A 50 μL volume of bacterial suspension was used to inoculate each well. The minimum inhibitory concentration (MIC) of NAC for all isolates tested ranged from 5 to 20 mg/mL. N-Acetylcysteine inhibits clinically relevant and drug resistant bacteria in vitro, and has potential for use as a novel agent for treatment of otitis externa. © 2016 ESVD and ACVD.

  3. Adaptation during northern range expansion in the elongate hemlock scale Fiorinia externa

    Treesearch

    Evan Preisser; Alexandra Lodge; David Orwig; Joseph Elkinton

    2007-01-01

    The elongate hemlock scale Fiorinia externa, (EHS) an invasive pest from Japan, was first found in the eastern United States in 1908. It feeds on a variety of plants, most notably the eastern hemlock Tsuga canadensis, and has been spreading slowly into southern New England. In order to examine the northern spread of EHS and the...

  4. Fungal otitis externa as a cause of tympanic membrane perforation: a case series.

    PubMed

    Song, James Eingun; Haberkamp, Thomas J; Patel, Riddhi; Redleaf, Miriam I

    2014-08-01

    We describe a series of 11 patients--8 men and 3 women, aged 18 to 70 years (mean: 46.0)--who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.

  5. Selectivity of pesticides used in integrated apple production to the lacewing, Chrysoperla externa.

    PubMed

    Moura, Alexandre Pinho; Carvalho, Geraldo Andrade; Moscardini, Valéria Fonseca; Lasmar, Olinto; Rezende, Denise Tourino; Marques, Márcio Candeias

    2010-01-01

    This research aimed to assess the toxicity of the pesticides abamectin 18 CE (0.02 g a.i. L-1), carbaryl 480 SC (1.73 g a.i. L-1), sulfur 800 GrDA (4.8 g a.i. L-1), fenitrothion 500 CE (0.75 g a.i. L-1), methidathion 400 CE (0.4 g a.i. L-1), and trichlorfon 500 SC (1.5 g a.i. L-1) as applied in integrated apple production in Brazil on the survival, oviposition capacity, and egg viability of the lacewing, Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) from Bento Gonçalves and Vacaria, Rio Grande do Sul State, Brazil. An attempt was made to study morphological changes caused by some of these chemicals, by means of ultrastructural analysis, using a scanning electronic microscope. Carbaryl, fenitrothion, and methidathion caused 100% adult mortality for both populations, avoiding evaluation of pesticides' effects on predator reproductive parameters. Abamectin and sulfur also affected the survival of these individuals with mortality rates of 10% and 6.7%, respectively, for adults from Bento Gonçalves, and were harmless to those from Vacaria at the end of evaluation. Trichlorfon was also harmless to adults from both populations. No compound reduced oviposition capacity. C. externa from Vacaria presented higher reproductive potential than those from Bento Gonçalves. In relation to egg viability, sulfur was the most damaging compound to both populations of C. externa. Ultrastructural analyses showed morphological changes in the micropyle and the chorion of eggs laid by C. externa treated with either abamectin or sulfur. The treatment may have influenced the fertilization of C. externa eggs and embryonic development. Sulfur was responsible for malformations in the end region of the abdomen and genitals of treated females. When applied to adults, abamectin, sulfur, and trichlorfon were harmless, while carbaryl, fenitrothion, and methidathion were harmful, according to the IOBC classification.

  6. Selectivity of Pesticides used in Integrated Apple Production to the Lacewing, Chrysoperla externa

    PubMed Central

    Moura, Alexandre Pinho; Carvalho, Geraldo Andrade; Moscardini, Valéria Fonseca; Lasmar, Olinto; Rezende, Denise Tourino; Marques, Márcio Candeias

    2010-01-01

    This research aimed to assess the toxicity of the pesticides abamectin 18 CE (0.02 g a.i. L-1), carbaryl 480 SC (1.73 g a.i. L-1), sulfur 800 GrDA (4.8 g a.i. L-1), fenitrothion 500 CE (0.75 g a.i. L-1), methidathion 400 CE (0.4 g a.i. L-1), and trichlorfon 500 SC (1.5 g a.i. L-1) as applied in integrated apple production in Brazil on the survival, oviposition capacity, and egg viability of the lacewing, Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) from Bento Gonçalves and Vacaria, Rio Grande do Sul State, Brazil. An attempt was made to study morphological changes caused by some of these chemicals, by means of ultrastructural analysis, using a scanning electronic microscope. Carbaryl, fenitrothion, and methidathion caused 100% adult mortality for both populations, avoiding evaluation of pesticides' effects on predator reproductive parameters. Abamectin and sulfur also affected the survival of these individuals with mortality rates of 10% and 6.7%, respectively, for adults from Bento Gonçalves, and were harmless to those from Vacaria at the end of evaluation. Trichlorfon was also harmless to adults from both populations. No compound reduced oviposition capacity. C. externa from Vacaria presented higher reproductive potential than those from Bento Gonçalves. In relation to egg viability, sulfur was the most damaging compound to both populations of C. externa. Ultrastructural analyses showed morphological changes in the micropyle and the chorion of eggs laid by C. externa treated with either abamectin or sulfur. The treatment may have influenced the fertilization of C. externa eggs and embryonic development. Sulfur was responsible for malformations in the end region of the abdomen and genitals of treated females. When applied to adults, abamectin, sulfur, and trichlorfon were harmless, while carbaryl, fenitrothion, and methidathion were harmful, according to the IOBC classification. PMID:20879916

  7. Antibiotic plasma levels in dogs with otitis externa treated routinely with various topical preparations.

    PubMed

    Voget, Michael; Armbruster, Martin; Meyer, Michael

    2012-01-01

    We aimed to determine whether, and at what levels, topical antibiotics applied to treat Otitis externa in dogs are absorbed systemically, leading to an increased risk of antibiotic resistance. 75 dogs brought to a veterinarian for Otitis externa were recruited for a non-interventional study. Selection criteria included diagnosis of Otitis externa and owner consent.The animals were divided into five groups of 15 dogs each. Each group received one of five commonly prescribed topical medications for up to 14 days according to the labeled instructions. Development and validation of low residue detection methods (HPLC-MS/MS) for all active substances studied was performed. Plasma concentrations were evaluated for gentamicin (Otomax, Easotic), marbofloxacin (Aurizon), orbifloxacin (Posatex) and polymyxin B (Surolan). Low-level plasma concentrations of the topically applied antibiotics were detected after multiple administrations. In several samples, the concentrations detected were less than the limit of detection (LOD) of the corresponding analytical method. However, at the end of the treatment period, mean plasma concentrations were in the low pmol/ml range and exceeded the LOD for gentamicin, marbofloxacin and orbifloxacin. None of the plasma samples examined for polymyxin showed levels above the LOD. After routine topical antibiotic use in the treatment of Otitis externa in dogs, low systemic plasma concentrations are likely to develop.This low-level exposure may facilitate cellular changes that lead to an increased possibility for antibiotic resistance. These findings should provoke veterinary clinicians to optimise therapy for Otitis externa in light of minimising the development of antibiotic resistance.

  8. Single photon emission computed tomography/computed tomography for malignant otitis externa: lesion not shown on planar image.

    PubMed

    Chen, Yu-Hung; Hsieh, Hung-Jen

    2013-01-01

    Malignant otitis externa is a severe and rare infection of the external acoustic meatus. Triphasic bone and (67)Ga scintigraphies are used to initial detect and follow-up the response of therapy. With single photon emission computed tomography/computed tomography images, the diagnostic sensitivity is higher. We presented a case with malignant otitis externa with initial negative planar scintigraphic finding. The lesion was detected by photon emission computed tomography/computed tomography images. We concluded that the photon emission computed tomography/computed tomography should be performed routinely for patients with suspected malignant otitis externa, even without evidence of lesion on planar images. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. [Decrease in hospitalizations due to polyvalent medical day hospital].

    PubMed

    Escobar, M A; García-Egido, A A; Carmona, R; Lucas, A; Márquez, C; Gómez, F

    2012-02-01

    The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  10. Comparative study of the microbial profile from bilateral canine otitis externa

    PubMed Central

    Oliveira, Lis C.; Leite, Carlos A.L.; Brilhante, Raimunda S.N.; Carvalho, Cibele B.M.

    2008-01-01

    Fifty dogs with bilateral otitis externa were studied over a 10-month period. The exudates of both external ears were obtained, using sterile swabs, and microorganisms were isolated according to standard microbiological techniques. Antimicrobial susceptibility testing of Staphylococcus intermedius was done by the agar diffusion method. There was bacterial and/or fungal growth in all of the samples. These were all polymicrobial infections. Anaerobic bacteria were not isolated in any sample. The most common pathogens isolated were S. intermedius and Malassezia pachydermatis. A statistically significant difference (P < 0.05) was observed in the isolation pattern between the right and left ears in 34 of the 50 animals (68%). High resistance rates of S. intermedius strains to penicillin, ampicillin, erythromycin, tetracycline, and clindamycin were found. The results suggest that in bilateral canine otitis externa, each ear should be cultured separately and considered as separate units. PMID:18978972

  11. [Clinical and pathophysiological patterns of otitis externa and overview of problematic cases].

    PubMed

    Dzepina, Davor; Ajduk, Jakov; Zurak, Kreso

    2011-01-01

    Otitis externa can sometimes present itself as a difficult clinical problem, in cases such as unsuccessful outcome of usual therapy, prolonged duration of symptoms or frequent recurrencies with local or systemic complications. In these cases more attention should be focused on possible errors made in establishing the right diagnosis, incorrect sequence of applying therapeutical measures, or presence of unrecognized problems, including individual patient factors, characteristics of the pathogen, or other. In this article we present a case report of a 84-year-old patient with complicated otitis externa, together with a short review of physiology, patophysiology, diagnostic and therapeutical measures in external otitis, and suggest a possible clinical approach in the management of problematic cases.

  12. Lemierre's syndrome - an unusual complication of otitis externa in a young, healthy female.

    PubMed

    Davidoss, N; Ha, J F; Anderson, J R; Rodrigues, S

    2015-01-01

    Lemierre's syndrome, which affects previously healthy, young adults, is a rare complication secondary to infections in the head and neck that result in septic thrombophlebitis of the internal jugular vein. This paper reports a case of a young, healthy female with malignant otitis externa, which resulted in the development of Lemierre's syndrome. A review of the relevant literature was also carried out. This involved a search of the Medline database using multiple search terms including 'Lemierre', 'septic thrombophlebitis', 'otitis externa', 'internal jugular vein thrombosis' and 'management'. The patient presented with fever, left-sided otalgia, otorrhoea, neck swelling and pain. She was subsequently diagnosed with Lemierre's syndrome and managed accordingly. Lemierre's syndrome is a potentially fatal complication associated with significant morbidity. A high index of suspicion is required for prompt recognition and the early institution of treatment.

  13. Proliferative and necrotising otitis externa in a cat without pinnal involvement: video-otoscopic features.

    PubMed

    Borio, Stefano; Massari, Federico; Abramo, Francesca; Colombo, Silvia

    2013-04-01

    Proliferative and necrotising otitis externa is a rare and recently described disease affecting the ear canals and concave pinnae of kittens. This article describes a case of proliferative and necrotising otits externa in a young adult cat. In this case, the lesions did not affected the pinnae, but both ear canals were severely involved. Video-otoscopy revealed a digitally proliferative lesion, growing at 360° all around the ear canals for their entire length, without involvement of the middle ear. Histopathological examination confirmed the diagnosis, and the cat responded completely to a once-daily application of 0.1% tacrolimus ointment diluted in mineral oil in the ear canals. Video-otoscopy findings, not described previously, were very peculiar and may help clinicians to diagnose this rare disease.

  14. Update on antimicrobial susceptibilities of bacterial isolates from canine and feline otitis externa

    PubMed Central

    Coles, Mada; Poole, Doris; Lund, Lorraine; Page, Robert

    2006-01-01

    Abstract The in vitro susceptibility of a total of 1819 bacterial isolates from canine and 103 isolates from feline otitis externa cases to 13 antimicrobial drugs over a 5-year period was evaluated. Among topically used drugs, 90% of isolates were susceptible to gentamicin. Susceptibility of Pseudomonas aeruginosa to gentamicin was 85%, and to polymyxin B 100%. For isolates other than the Pseudomonas sp., susceptibility was highest to amoxicillin-clavulanic acid. PMID:16604982

  15. Pollen Ingestion by Chrysoperla externa (Hagen) Adults in a Diversified Organic Agroecosystem.

    PubMed

    Andrade, K A; Aguiar-Menezes, E L; Gonçalves-Esteves, V; Mendonça, C B F; Vieira, G R M; Melo, S J; Magalhães, J L A; Melo, G J B

    2017-06-29

    Chrysoperla externa (Hagen) larvae prey on pest insects and mites in agroecosystems, and adults mainly feed on pollen, nectar, and honeydew. Therefore, preserving this lacewing in crop systems depends on having plants that provide these resources. The objectives of this research were to identify pollen grains ingested by Ch. externa adults collected in a diversified organic agroecosystem and to evaluate whether there is a difference in the amount of ingested pollen grains between males and females. The adults of Ch. externa were collected in four different crops during 13 months in Seropédica, state of Rio de Janeiro, Brazil, using a collecting net. The adults were killed and underwent acetolysis, in order to recover the pollen in the gut. A total of 37,441 pollen grains from 19 Angiospermae families were found, besides 16 Pteridophyte spores. Among the recognized pollen grains, those of Poaceae were the majority, both in frequency of occurrence (87.5%) and in quantity (33496), and were found and recovered in every month of collection. Females and males ingested, respectively, 71.9 and 28.1% of the total number of Angiospermae pollen grains consumed by both sexes. The highest number of Poaceae pollens was obtained from the females (72.1% of the total number of Poaceae pollen, recovered from females + males). Taken as a whole, this study showed that adults of Ch. externa find possibilities to maintain throughout the year, in different crops, but the main source of pollen to males and females was Poaceae plants.

  16. Atypical Lipid-Dependent Malassezia Species Isolated from Dogs with Otitis Externa

    PubMed Central

    Crespo, M. J.; Abarca, M. L.; Cabañes, F. J.

    2000-01-01

    During a survey of the occurrence of Malassezia species in the external ear canals of dogs with chronic otitis externa, lipid-dependent Malassezia species were isolated in three dogs. These species were identified as Malassezia furfur and M. obtusa but showed atypical assimilation patterns. To our knowledge, this is the first report of the isolation of lipid-dependent species of the genus Malassezia in association with canine otitis. PMID:10835009

  17. Identification and antimicrobial susceptibility patterns of bacteria causing otitis externa in dogs.

    PubMed

    Zamankhan Malayeri, Hamed; Jamshidi, Shahram; Zahraei Salehi, Taghi

    2010-06-01

    Bacterial agents are considered important pathogens causing external otitis in dogs. It is essential to carry out bacterial culture and antimicrobial susceptibility test in the case of otitis externa, particularly for chronic or recurring cases. Sterile swab samples were obtained from terminal part of vertical ear canals of 74 dogs with otitis externa for cytology, bacterial culture and antimicrobial susceptibility test. Cytologic smears were stained using Gram and Giemsa staining methods. Aerobic bacterial culture performed on blood agar and MacConkey agar. Among total number of 92 isolated bacteria, 68 were Staphylococcus intermedius. Other isolated bacteria included: Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli, Pasteurella canis, and six other species of coagulase-negative Staphylococcus. Antimicrobial susceptibility test were performed for all isolated bacteria using 14 antibiotics. Based on the results of this study, all isolated Staphylococcus spp. were sensitive to amikacin, enrofloxacin, and rifampin, and had low resistance to gentamicin, cephalothin and ceftriaxone. More than half of gram-positive isolates were resistant to penicillin and ampicillin. Generally, all isolated gram-negative bacteria, were sensitive to amikacin and enrofloxacin, and had low resistance to ceftriaxone and gentamicin. They were highly resistant to penicillin, eythromycin, and cephalothin. Regarding the results of this study, in cases of uncomplicated otitis externa, it is possible to select antimicrobial drugs merely based on cytology, but it is recommended to perform bacterial culture and antimicrobial susceptibility test. However, in complicated or refractory cases, antimicrobials should be selected based on bacterial culture and antimicrobial susceptibility test.

  18. Effect of Binghuang ear drop treatment on otitis externa in guinea pigs.

    PubMed

    Zhai, Suo-qiang; Yu, Ning; Guo, Wei-Wei; Zhang, Yue

    2014-12-01

    To investigate the pharmacodynamic effects of Binghuang ear drop on acute suppurative otitis externa in guinea pig model. Thirty guinea pigs were randomly divided into three groups, with ten animals in each group. Group A animals had normal ear canal and Binghuang ear drops (two drops, B.I.D) were applied in both ears for 7 days; Group B animals had induced otitis externa and received identical prescription as group A; Group C had normal ear canal and were treated with normal saline (two drops, B.I.D) for 7 days. After the treatments, the external morphology of ear canals was observed and the paraffin sections of external auditory canal were prepared and examined under the microscope. The inflammatory manifestation and cell infiltration into the skin of group B was significantly attenuated after the Binghuang ear drops treatment. In contrast, no allergy or side effects were produced by Binghuang ear drops application in the animals with normal ear canals. Binghuang ear drops could be used to treat acute otitis externa by eliciting anti-bacterial effects.

  19. First identification of methicillin-resistant Staphylococcus pseudintermedius strains among coagulase-positive staphylococci isolated from dogs with otitis externa in Trinidad, West Indies

    PubMed Central

    Dziva, Francis; Wint, Crystal; Auguste, Tennille; Heeraman, Carolyn; Dacon, Cherrelle; Yu, Priscilla; Koma, Lee M.

    2015-01-01

    Background Otitis externa is a common inflammatory ear disease in dogs caused by a variety of pathogens, and coagulase-positive staphylococci are frequently isolated from such infections. Objective To identify antimicrobial susceptibility profiles and methicillin-resistant strains among coagulase-positive staphylococci isolated from otitis externa in dogs. Methods A cross-sectional study was performed over 2 years on 114 client-owned dogs presented to the Veterinary Teaching Hospital with a primary complaint of ear infections. Swabs were obtained from both ears and cultured for staphylococci which were subsequently confirmed as coagulase-positive using rabbit plasma. Antimicrobial susceptibility assays were assessed on all isolates followed by subsequent genetic analysis for species identification and detection of the mecA gene. Results Sixty-five coagulase-positive staphylococci were isolated from 114 client-owned dogs. The isolates exhibited resistance against neomycin (58.5%), streptomycin (49.2%), penicillin (49.2%), polymyxin B (44.6%), tetracycline (36.9%), sulphamethoxazole/trimethoprim (33.8%), kanamycin (33.8%), doxycycline (32.3%), norfloxacin (23.1%), amoxicillin/clavulanate (20%), ciprofloxacin (20%), enrofloxacin (18.5%), gentamicin (16.9%), and cephalothin (9.2%). Forty (61.5%) of the isolates were resistant to at least three or more antimicrobials and 10 were sensitive to all. Using a multiplex polymerase chain reaction assay based on species-specific regions of the thermonuclease (nuc) gene, 38/65 (58.5%) isolates were classified as Staphylococcus aureus, 23/65 (35.4%) as S. pseudintermedius, 2/65 (3.1%) as S. intermedius, and 2/65 (3.1%) as S. schleiferi. Analysis for the mecA gene revealed two positive isolates of S. pseudintermedius which were oxacillin-resistant, representing a first report of such organisms in the Caribbean. Conclusion Despite the relatively high prevalence of multidrug-resistant coagulase-positive staphylococci in Trinidad

  20. First identification of methicillin-resistant Staphylococcus pseudintermedius strains among coagulase-positive staphylococci isolated from dogs with otitis externa in Trinidad, West Indies.

    PubMed

    Dziva, Francis; Wint, Crystal; Auguste, Tennille; Heeraman, Carolyn; Dacon, Cherrelle; Yu, Priscilla; Koma, Lee M

    2015-01-01

    Otitis externa is a common inflammatory ear disease in dogs caused by a variety of pathogens, and coagulase-positive staphylococci are frequently isolated from such infections. To identify antimicrobial susceptibility profiles and methicillin-resistant strains among coagulase-positive staphylococci isolated from otitis externa in dogs. A cross-sectional study was performed over 2 years on 114 client-owned dogs presented to the Veterinary Teaching Hospital with a primary complaint of ear infections. Swabs were obtained from both ears and cultured for staphylococci which were subsequently confirmed as coagulase-positive using rabbit plasma. Antimicrobial susceptibility assays were assessed on all isolates followed by subsequent genetic analysis for species identification and detection of the mecA gene. Sixty-five coagulase-positive staphylococci were isolated from 114 client-owned dogs. The isolates exhibited resistance against neomycin (58.5%), streptomycin (49.2%), penicillin (49.2%), polymyxin B (44.6%), tetracycline (36.9%), sulphamethoxazole/trimethoprim (33.8%), kanamycin (33.8%), doxycycline (32.3%), norfloxacin (23.1%), amoxicillin/clavulanate (20%), ciprofloxacin (20%), enrofloxacin (18.5%), gentamicin (16.9%), and cephalothin (9.2%). Forty (61.5%) of the isolates were resistant to at least three or more antimicrobials and 10 were sensitive to all. Using a multiplex polymerase chain reaction assay based on species-specific regions of the thermonuclease (nuc) gene, 38/65 (58.5%) isolates were classified as Staphylococcus aureus, 23/65 (35.4%) as S. pseudintermedius, 2/65 (3.1%) as S. intermedius, and 2/65 (3.1%) as S. schleiferi. Analysis for the mecA gene revealed two positive isolates of S. pseudintermedius which were oxacillin-resistant, representing a first report of such organisms in the Caribbean. Despite the relatively high prevalence of multidrug-resistant coagulase-positive staphylococci in Trinidad, these are largely susceptible to gentamicin

  1. Use of a hearing loss grading system and an owner-based hearing questionnaire to assess hearing loss in pet dogs with chronic otitis externa or otitis media.

    PubMed

    Mason, Carly L; Paterson, Susan; Cripps, Peter J

    2013-10-01

    Hearing loss is important when assessing the suitability of dogs with otitis externa/media for medical or surgical therapy. To assess an owner-completed questionnaire as an indicator of hearing loss and a canine hearing loss scoring system in chronic canine otitis. One hundred hospital population dogs referred for chronic otitis investigation. Owners completed a questionnaire to assess their dog's response to common household noises. The presence of otitis externa or media was determined and brainstem auditory-evoked response measurements were performed on each dog. The minimal hearing threshold (MHT) in decibels normal hearing level (dB NHL) was recorded and categorized according to the human World Health Organization grading system into five grades from 0 to 4 with cut-off values of ≤25 dB NHL, 26-40 dB NHL, 41-60 dB NHL, 60-80 dB NHL and ≥81 dB NHL. The questionnaire correctly determined normal hearing in grade 0 cases, but did not reliably detect unilateral or grade 1 bilateral hearing loss. For dogs with bilateral hearing loss ≥ grade 2, questionnaire sensitivity was 83% [24 of 29, 95% confidence interval, (CI) 64-94%] and specificity was 94% (67 of 71, 95% CI 86-98%). Higher grades of hearing loss were significantly associated with the presence of otitis media (P < 0.01). The questionnaire may be a useful in-practice screening tool in chronic canine otitis for moderate to severe bilateral hearing deficits (MHT ≥41 dB NHL). The hearing loss grading system may help clinicians make therapeutic decisions. Chronic otitis media may be associated with higher grades of hearing loss. © 2013 ESVD and ACVD.

  2. A randomised controlled trial comparing Triadcortyl with 10% glycerine-ichthammol in the initial treatment of severe acute otitis externa.

    PubMed

    Masood, Ajmal; Moumoulidis, Ioannis; Ray, Shalina; Chawla, Om; Panesar, Jaan

    2008-08-01

    Acute otitis externa is a common clinical condition accounting for a large proportion of patients attending the otolaryngology department, although milder cases are often managed in primary care. Treatment of the most severe forms of otitis externa involves aural toilet, followed by the application of a topical preparation, commonly in the form of an ear canal dressing. A prospective single-blind randomized controlled trial was performed to compare the efficacy of 10% glycerine-ichthammol (GI) solution and Triadcortyl (TAC) ointment, both applied as ear canal dressings, in the initial management of severe acute otitis externa. A total of 64 patients were studied. Both treatment modalities were proven efficacious in the treatment of severe acute otitis externa. Although there was a statistically significant improvement of pain parameters in the TAC group, we found no significant differences in clinical findings between the two groups. Therefore, it is recommended that GI dressing can be used instead of an antibiotic dressing as an initial treatment of severe acute otitis externa on the basis of cost, avoidance of resistance and toxicity.

  3. Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial

    PubMed Central

    van Balen, Frank A M; Smit, W Martijn; Zuithoff, Nicolaas P A; Verheij, Theo J M

    2003-01-01

    Objective To compare the clinical efficacy of ear drops containing acetic acid, corticosteroid and acetic acid, and steroid and antibiotic in acute otitis externa in primary care. Design Randomised controlled trial. Setting 79 general practices, Netherlands. Participants 213 adults with acute otitis externa. Main outcome measures Primary outcome: duration of symptoms (days) according to patient diaries. Secondary outcome: cure rate according to general practitioner completed questionnaires and recurrence of symptoms between days 21 and 42. Results Symptoms lasted for a median of 8.0 days (95% confidence interval 7.0 to 9.0) in the acetic acid group, 7.0 days (5.8 to 8.3) in the steroid and acetic acid group, and 6.0 days (5.1 to 6.9) in the steroid and antibiotic group. The overall cure rates at seven, 14, and 21 days were 38%, 68%, and 75%, respectively. Compared with the acetic acid group, significantly more patients were cured in the steroid and acetic acid group and steroid and antibiotic group at day 14 (odds ratio 2.4, 1.1 to 5.3, and 3.5, 1.6 to 7.7, respectively) and day 21 (5.3, 2.0 to 13.7, and 3.9, 1.7 to 9.1, respectively). Recurrence of symptoms between days 21 and 42 occurred in 29% (50/172) of patients and was seen significantly less in the steroid and acetic acid group (0.3, 0.1 to 0.7) and steroid and antibiotic group (0.4, 0.2 to 1.0) than in the acetic acid group. Conclusions Ear drops containing corticosteroids are more effective than acetic acid ear drops in the treatment of acute otitis externa in primary care. Steroid and acetic acid or steroid and antibiotic ear drops are equally effective. PMID:14630756

  4. Proliferative and necrotizing otitis externa in a kitten: successful treatment with intralesional and topical corticosteroid therapy

    PubMed Central

    MOMOTA, Yutaka; YASUDA, Junya; IKEZAWA, Mitsutaka; SASAKI, Jun; KATAYAMA, Masaaki; TANI, Kenji; MIYABE, Masahiro; ONOZAWA, Eri; AZAKAMI, Daigo; ISHIOKA, Katsumi; SAKO, Toshinori

    2016-01-01

    Proliferative and necrotising otitis externa (PNOE) is a very rare disease affecting the ear canals and concave pinnae of kittens. This report describes a 5-month-old cat with PNOE. Histopathological examination confirmed the diagnosis. Treatment was initiated with local injection of methylprednisolone acetate into the lesions. The cat was subsequently treated with clobetasol propionate cream, a potent topical glucocorticoid ointment. The cat showed marked improvement. While topical treatment with tacrolimus, an immunosuppressive agent, is reported to be an effective therapy, to the best of our knowledge, this is the first report to treat PNOE with local corticosteroid therapy. PMID:27570137

  5. Proliferative and necrotizing otitis externa in a kitten: successful treatment with intralesional and topical corticosteroid therapy.

    PubMed

    Momota, Yutaka; Yasuda, Junya; Ikezawa, Mitsutaka; Sasaki, Jun; Katayama, Masaaki; Tani, Kenji; Miyabe, Masahiro; Onozawa, Eri; Azakami, Daigo; Ishioka, Katsumi; Sako, Toshinori

    2017-01-10

    Proliferative and necrotising otitis externa (PNOE) is a very rare disease affecting the ear canals and concave pinnae of kittens. This report describes a 5-month-old cat with PNOE. Histopathological examination confirmed the diagnosis. Treatment was initiated with local injection of methylprednisolone acetate into the lesions. The cat was subsequently treated with clobetasol propionate cream, a potent topical glucocorticoid ointment. The cat showed marked improvement. While topical treatment with tacrolimus, an immunosuppressive agent, is reported to be an effective therapy, to the best of our knowledge, this is the first report to treat PNOE with local corticosteroid therapy.

  6. A rare case of bilateral malignant otitis externa and osteomyelitis with lower cranial nerve sequelae

    PubMed Central

    Leahy, Travis William; Sader, Chady

    2011-01-01

    The authors present the case of a 76-year-old male who presented with right-sided recurrent malignant otitis externa (MOE) and skull-base osteomyelitis. His management involved aggressive antimicrobial therapy and multiple hyperbaric oxygen treatments. After resolution of his right-sided infection, the patient returned a short time later with symptoms and findings consistent with new, left-sided MOE with involvement of the left skull-base. With repeat treatment, the patient is now cured of his infection but poses a challenge to the treating team about future management. PMID:22696730

  7. Fungal Malignant Otitis Externa with Facial Nerve Palsy: Tissue Biopsy Aids Diagnosis

    PubMed Central

    Walton, Jenny

    2014-01-01

    Fungal malignant otitis externa (FMOE) is a serious and potentially life-threatening condition that is challenging to manage. Diagnosis is often delayed due to the low sensitivity of aural swabs and many antifungal drugs have significant side effects. We present a case of FMOE, where formal tissue sampling revealed the diagnosis and the patient was successfully treated with voriconazole, in addition to an up to date review of the current literature. We would recommend tissue biopsy of the external auditory canal in all patients with suspected FMOE in addition to routine microbiology swabs. PMID:24649388

  8. A rare case of bilateral malignant otitis externa and osteomyelitis with lower cranial nerve sequelae.

    PubMed

    Leahy, Travis William; Sader, Chady

    2011-05-12

    The authors present the case of a 76-year-old male who presented with right-sided recurrent malignant otitis externa (MOE) and skull-base osteomyelitis. His management involved aggressive antimicrobial therapy and multiple hyperbaric oxygen treatments. After resolution of his right-sided infection, the patient returned a short time later with symptoms and findings consistent with new, left-sided MOE with involvement of the left skull-base. With repeat treatment, the patient is now cured of his infection but poses a challenge to the treating team about future management.

  9. Treatment of acute otitis externa with ciprofloxacin otic 0.2% antibiotic ear solution

    PubMed Central

    Mösges, R; Nematian-Samani, M; Eichel, A

    2011-01-01

    Background/objective An inflammation of the cutis and subcutis of the external auditory canal is a primary symptom in cases of acute otitis externa. It is usually treated locally, since this type of therapy ensures a high concentration of the drug and interacts at the site of inflammation with no systemic effects. This systematic review compares the efficacy of treatment using a ciprofloxacin 0.2% solution with other therapeutic options. Methods After compiling a catalog of search terms, medical databases were searched systematically for randomized, controlled studies. This search initially yielded a total of 38 studies which were then evaluated by three independent reviewers. The number of studies was subsequently reduced to 14: six studies using a ciprofloxacin 0.2% solution, and eight studies using both 0.2% and 0.3% solutions. Results The studies included in the review demonstrate the statistical equivalence between the ciprofloxacin solution (0.2%) and the reference products PNH (a combination of polymyxin B, neomycin sulfate and hydrocortisone), auriculum powder, and a ciprofloxacin foam with respect to the cure rate. The research groups consistently observed high in vitro activity of ciprofloxacin against Pseudomonas aeruginosa. Conclusion This systematic review confirms the hypothesis of ciprofloxacin’s noninferiority in the treatment of otitis externa, in terms of the cure rate and microbiological eradication. PMID:21845055

  10. Antimicrobial susceptibility of Pseudomonas aeruginosa isolates from dogs with otitis externa.

    PubMed

    Mekić, S; Matanović, K; Šeol, B

    2011-07-30

    Pseudomonas aeruginosa is a common cause of otitis externa in dogs, and treatment of these infections is becoming problematic because of the increasing number of multiresistant strains. The aim of the present study was to compare the in vitro activities of cefepime, ceftazidime, enrofloxacin, ciprofloxacin, gentamicin and ticarcillin/clavulanic acid against 104 strains of P aeruginosa isolated from dogs with otitis externa. Antimicrobial susceptibility and minimum inhibitory concentrations, in µg/ml, were evaluated by the E test (bioMérieux). The most active compound was ceftazidime, with 100 per cent efficiency. The majority of tested strains were susceptible to ticarcillin/clavulanic acid (89.4 per cent), followed by ciprofloxacin (88.5 per cent) and cefepime (60.6 per cent). The highest resistance was observed to enrofloxacin (51.9 per cent) and gentamicin (43.3 per cent). Large numbers of strains were intermediately susceptible to antibiotics registered for use in veterinary medicine in Croatia--enrofloxacin (47.1 per cent) and gentamicin (41.3 per cent).

  11. Ophthalmomyiasis externa due to the sheep botfly Oestrus ovis (Diptera: Oestridae) in southwest Germany.

    PubMed

    Grammer, J; Erb, C; Kamin, G; Wild, M; Riedinger, C; Kosmidis, P; Pleyer, U; Thiel, H J

    1995-05-01

    We present a case of ophthalmomyiasis externa in a 54-year-old man in southwest Germany (Baden-Württemberg). After the patient had been attacked by a fly, he complained of a foreign-body sensation and itching in his right eye and developed purulent conjunctivitis. Slit-lamp examination revealed the presence of translucent, rapidly moving insect larvae in the conjunctival sac and on the corneal surface. Following removal of all larvae and instillation of gentamicin, the symptoms completely resolved within 2 days. Two of the nine larvae removed were examined by light microscopy and taxonomically classified as first-instar larvae of the sheep botfly Oestrus ovis L. 1758. Although this fly is the most common causative agent of external ophthalmomyiasis in the world, infestations in central Europe have only rarely been reported. Besides the case report and a detailed description of the larvae, an overview of the literature on European cases of ophthalmomyiasis externa caused by Oestrus ovis is given.

  12. Ciprofloxacin plus fluocinolone acetonide versus ciprofloxacin alone in the treatment of diffuse otitis externa.

    PubMed

    Lorente, J; Sabater, F; Rivas, M P; Fuste, J; Risco, J; Gómez, M

    2014-07-01

    We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide (antibiotic plus corticosteroid) ear drops compared to ciprofloxacin (antibiotic) ear drops in diffuse otitis externa. This was a multicentre, randomised, parallel-group, double-blind study involving 590 patients of both sexes aged 7 years or older. The rate of clinical cure was higher (p = 0.01) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone. The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide (p = 0.005). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin. Resolution of oedema and otorrhoea (p = 0.003 and p = 0.002, respectively) was higher with ciprofloxacin plus fluocinolone acetonide, as was eradication or presumed eradication (p = 0.003). There were eight mild adverse events, three with the ciprofloxacin plus fluocinolone acetonide combination (not related to the treatment) and five when ciprofloxacin was administered alone (directly related to the treatment). Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone. The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile.

  13. Loss of genetic variability induced by Agroecosystems: Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) as a case study.

    PubMed

    Morales, A C; Lavagnini, T C; Freitas, S

    2013-02-01

    Four species of green lacewings occur in Brazil, of which Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) exhibits the widest geographical distribution. Chrysoperla externa is a predatory insect that is potentially useful as a biological control agent of agricultural pests. Studies on the genetic diversity of lacewing populations are essential to reduce the environmental and economic harm that may be caused by organisms with a low ability to adapt to the adverse and/or different environmental conditions to which they are exposed. We used the cytochrome oxidase I mitochondrial gene as a molecular marker to investigate the genetic diversity of green lacewing species collected from native and agroecosystem environments. Populations derived from native areas showed higher rates of genetic variability compared to populations from agroecosystems. Demographic changes in the form of population expansion were observed in agroecosystems, whereas populations in the native environment appeared stable over time. A statistical analysis showed significant genetic structure between each of the sampled groups, combined with its complete absence within each group, corroborating each group's identity. We infer that the loss of variability exhibited by populations from the agroecosystems is the result of genetic drift by means of the founder effect, a similar effect that has been observed in other introduced populations. Agroecosystems might therefore function as exotic areas for green lacewings, even when these areas are within the normal range of the species.

  14. Suitability of leguminous cover crop pollens as food source for the green lacewing Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae).

    PubMed

    Venzon, Madelaine; Rosado, Maria C; Euzébio, Denise E; Souza, Brígida; Schoereder, José H

    2006-01-01

    Diversification of crops with species that provide suitable pollen for predators may reduce pest population on crops by enhancing predator effectiveness. In this paper we evaluated the suitability of leguminous cover crop pollens to the predatory green lacewing Chrysoperla externa (Hagen). The predator is commonly found in coffee agroecosystems and the plant species tested were pigeon pea and sunn hemp, which are used in organic coffee systems. Newly emerged females and males of C. externa were reared on diets containing pollen of pigeon pea, sunn hemp, or castor bean, used as a control. The reproductive success of C. externa was evaluated when females fed the pollen species and when honey was added to the diets, to verify the predator need for an extra carbohydrate source. Similar intrinsic growth rates were found for females fed on pigeon pea pollen and on sunn hemp pollen but these rates increased significantly when honey was added to the diets. Females fed with pigeon pea pollen plus honey and with sunn hemp pollen plus honey had higher intrinsic growth rates than those fed with castor bean pollen plus honey. Females fed on castor bean pollen only or on honey only, did not oviposit. Leguminous pollen species were equally suitable for C. externa especially when they were complemented with honey. The results suggest that to successfully enhance predator effectiveness, organic coffee plantation should be diversified with plant providing pollen in combination with plant providing nectar.

  15. Entomopathogenic activity of a variety of the fungus, Colletotrichum acutatum, recovered from the elongate hemlock scale, Fiorinia externa.

    PubMed

    Marcelino, José A P; Gouli, Svetlana; Parker, Bruce L; Skinner, Margaret; Giordano, Rosanna

    2009-01-01

    A fungal epizootic in populations of Fiorinia externa Ferris (Hemiptera: Diaspididae) infesting hemlock trees, Tsuga canadensis (L.) Carrière (Pinales: Pinaceae) in forests of the Northeastern US has been recently detected. The current known distribution of the epizootic spans 36 sites in New York, Pennsylvania, New Jersey and Connecticut. Colletotrichum acutatum Simmonds var. fioriniae Marcelino and Gouli var. nov. inedit. (Phyllachorales: Phyllachoraceae) was the most prevalent fungus recovered from infected scales. Bioassays indicated that this C. acutatum variety is highly pathogenic to F. externa. Mortality rates of >90 and >55% were obtained for F. externa crawlers and settlers, respectively. Significantly lower mortality levels, externa epizootics in the US, and the previously reported C. gloeosporioides f. sp. ortheziidae causing Orthezia praelonga epizootics in Brazil, may constitute distinct biotypes of Colletotrichum that have attained the ability to infect insects in addition to the commonly reported plant hosts.

  16. Entomopathogenic Activity of a Variety of the Fungus, Colletotrichum acutatum, Recovered from the Elongate Hemlock Scale, Fiorinia externa

    PubMed Central

    Marcelino, José A. P.; Gouli, Svetlana; Parker, Bruce L; Skinner, Margaret; Giordano, Rosanna

    2009-01-01

    A fungal epizootic in populations of Fiorinia externa Ferris (Hemiptera: Diaspididae) infesting hemlock trees, Tsuga canadensis (L.) Carrière (Pinales: Pinaceae) in forests of the Northeastern US has been recently detected. The current known distribution of the epizootic spans 36 sites in New York, Pennsylvania, New Jersey and Connecticut. Colletotrichum acutatum Simmonds var. fioriniae Marcelino and Gouli var. nov. inedit. (Phyllachorales: Phyllachoraceae) was the most prevalent fungus recovered from infected scales. Bioassays indicated that this C. acutatum variety is highly pathogenic to F. externa. Mortality rates of >90 and >55% were obtained for F. externa crawlers and settlers, respectively. Significantly lower mortality levels, ≤ 22%, were obtained when three other species of insects were assayed. C. gleosporioides has also been shown to have pathogenic activity towards a scale insect. The data suggest that C. acutatum var. fioriniae from F. externa epizootics in the US, and the previously reported C. gloeosporioides f. sp. ortheziidae causing Orthezia praelonga epizootics in Brazil, may constitute distinct biotypes of Colletotrichum that have attained the ability to infect insects in addition to the commonly reported plant hosts. PMID:19613442

  17. Chronic granulomatous otitis externa as an initial presentation of cutaneous Crohn disease.

    PubMed

    Raynor, Eileen M

    2014-08-01

    In the limited number of Crohn disease cases involving the head and neck, there is a predilection for mucosal surfaces and rare reports of involvement in the postauricular region. To our knowledge, in all previously reported cases involving the head and neck, the patients had a known diagnosis of Crohn disease. This case describes a 10-year-old boy with a history of psoriasis and psoriasiform dermatitis who presented with bilateral chronic granulomatous otitis externa, obliteration of the external auditory canal, and fissuring, resulting in separation of the lobule from the preauricular skin. Pathologic examination results were consistent with granulomatous dermatitis concerning for cutaneous Crohn disease, and a subsequent gastroenterologic workup confirmed the diagnosis of Crohn disease. This is a report of chronic granulomatous otitis as the initial presentation of cutaneous Crohn disease in a child.

  18. Is malignant otitis externa on the increase? A retrospective review of cases.

    PubMed

    Bhasker, Diana; Hartley, Angela; Agada, Frank

    2017-02-01

    We performed a retrospective review of all patients with malignant otitis externa (MOE) treated in our center between July 2004 and December 2012 to evaluate the current epidemiology in our region and to ascertain causative factors associated with the perceived increase in the number of cases diagnosed. Eleven patients were identified (5 men and 6 women), with a mean age of 77 years (range: 38 to 97 years). Diabetes was present in 36%. Pseudomonas aeruginosa was the causative organism in 64% of cases; all pathogens were sensitive to ciprofloxacin. We noted a significant increase in the diagnostic frequency of MOE during the study period (p = 0.0027) No obvious causative factors were identified. Due to the mortality associated with this condition, further studies are required to establish national trends.

  19. Malignant Otitis Externa: A Novel Stratification Protocol for Predicting Treatment Outcomes.

    PubMed

    Stevens, Shawn M; Lambert, Paul R; Baker, Andrew B; Meyer, Ted A

    2015-09-01

    1) Stratify malignant otitis externa into severe and nonsevere disease categories. 2) Predict treatment courses and outcomes based on this stratification. Tertiary center. Retrospective review 2004 to 2014; 28 patients. Inclusion criteria are a diagnosis by senior authors, radiographic evidence of disease, admission for intravenous antibiotics/debridement, minimum 1 year of follow-up. Severe group stratification if two or more of the following: cranial nerve VII palsy, fungal positive culture, relapse, surgery performed, major radiographic findings. All other patients stratified to nonsevere group. Cure, alive/refractory disease, death by disease, death by other cause. Secondary measures are antibiotic duration and number of disease-related admissions. Forty-three percent (12 of 28) and 57% (16 of 28) of patients stratified into the severe and nonsevere groups. The severe group had significantly more adverse disease-specific outcomes than the nonsevere group (7 of 12 versus 0 of 16; p = 0.002). Disease-specific mortality was 42% and 0% in the severe and nonsevere groups, respectively. The severe group had longer antibiotic courses (12.8 versus 6.9 wk; p = 0.01) and more disease-related admissions/relapses (1.6 versus 1, p < 0.001). Only four of 12 severe group patients achieved cure. All but two nonsevere patients achieved cure, with those two dying of other causes. A subgroup of malignant otitis externa may exist that is not as susceptible to parenteral antibiotics and local debridement. A combination of clinical and radiographic findings may be useful for stratifying patients into severe/nonsevere categories. Patients with severe disease may be more likely to die of their disease and have worse treatment courses such that additional surgical intervention may be indicated.

  20. A pilot study to develop an objective clinical score for canine otitis externa.

    PubMed

    Nuttall, Tim; Bensignor, Emmanuel

    2014-12-01

    The lack of an accepted clinical scoring system in canine otitis externa makes it difficult to compare clinical trials. To develop a score that is clinically relevant, reliable and sensitive to change. Client-owned healthy dogs (n = 55) and dogs with otitis externa (n = 60). We compared 0-3 and 0-5 assessments of erythema, oedema/swelling, erosion/ulceration, exudate and pain of the ear canals with a reference 0-2 scale. Additional data included odour, pruritus scores, tympanic membrane condition, treatment outcome and neutrophil, bacterial and Malassezia counts. There were no significant differences between the vertical and horizontal canal scores (correlation coefficients >0.93). Correlation coefficients for the 0-3 and 0-5 scales were also >0.9 for all parameters, but the 0-2 scale was more variable. Pain and pruritus did not correlate well with the lesion scores and were associated with suppurative and erythroceruminous otitis, respectively. Neutrophil and microbial counts were variable and could not be used to generate cut-off values to differentiate healthy and affected ears or determine the response to therapy. Total scores ≥4 differentiated affected from healthy ears with 91.1% sensitivity and 100% specificity; scores ≤3 were 100% sensitive and 91.9% specific for clinical success. The intra- and interobserver reliability was high (intraclass correlation coefficients >0.95 and Cohen's kappa coefficients >0.65). This pilot study showed that the 0-3 Otitis Index Score (OTIS3) for erythema, oedema/swelling, erosion/ulceration and exudate is suitable for further validation by a larger group of clinicians. © 2014 ESVD and ACVD.

  1. Insecticide survival and behavioral avoidance in the lacewings Chrysoperla externa and Ceraeochrysa cubana.

    PubMed

    Cordeiro, E M G; Corrêa, A S; Venzon, M; Guedes, R N C

    2010-11-01

    Insecticide impact on non-target species, such as insect predators and parasitoids, is an ever-growing concern in agriculture and recent studies have been shifting focus from lethal to sub-lethal effects since they may prevail in field conditions, although more difficult to assess. Synthetic insecticides are the main concern, but the recent spread of biopesticide use in agriculture draws attention, particularly the main botanical insecticide currently in use - azadirachtin. Here we assessed the lethal and behavioral sub-lethal response of predatory larvae of the lacewing species Chrysoperla externa and Ceraeochrysa cubana to two frequently used synthetic insecticides, malathion and permethrin, and to the bioinsecticide azadirachtin. The recommended field concentration of the synthetic insecticides led to low survival time of lacewing larvae from both species, in contrast with azadirachtin. However, all three compounds led to 100% mortality of the lacewing larvae from both species. Insecticide repellence (i.e., avoidance without contact) was similar for both synthetic insecticides in both species, but azadirachtin was a stronger repellent for C. externa, but not C. cubana. In addition, insecticide irritability (i.e., avoidance after contact) occurred in both lacewing species to all three insecticides tested. The notion that natural compounds are safer than synthetic compounds to non-target species is refuted in the present study, which also detected significant irritability to all of the insecticides regardless of their origin, and species-specific repellence elicited particularly by azadirachtin. Therefore, bioinsecticides should not be exempted from risk assessment, and non-target sub-lethal effects should not be neglected when considering potential insecticide use in agriculture. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Traditional Mediterranean plants: characterization and use of an essential oils mixture to treat Malassezia otitis externa in atopic dogs.

    PubMed

    Nardoni, Simona; Pistelli, Luisa; Baronti, Ilenia; Najar, Basma; Pisseri, Francesca; Bandeira Reidel, Rose Vanessa; Papini, Roberto; Perrucci, Stefania; Mancianti, Francesca

    2017-08-01

    Several plants extracts from Mediterranean countries are traditionally employed in skin troubles both in humans and in animals. Malassezia pachydermatis is a lipophylic yeast responsible for otitis externa and dermatitis in dogs and for cutaneous and systemic disease in humans. Five mixtures of essential oils obtained from Mediterranean plants (Citrus paradisi, Salvia sclarea, Ocimum basilicum, Rosmarinus officinalis, Citrus limon, Anthemis nobilis, Lavandula hybrida and Thymus vulgaris) provided with antifungal and/or anti-inflammatory action assayed in vitro, were tested in vivo versus M. pachydermatis to treat once daily for 2 weeks 25 atopic dogs with Malassezia otitis externa. Mixture composed by C. limon 1%, S. sclarea 0,5%, R. officinalis 1%, A. nobilis 0,5% yielded excellent results in all treated dogs. Despite of clinical resolution after all treatments the number of blastospores did not decrease. This study confirms recent findings suggesting a multifactorial alternative approach for the management of canine Malassezia otitis.

  3. Lessons learnt from the diagnosis and antimicrobial management of necrotising (malignant) otitis externa: our experience in a tertiary referral centre.

    PubMed

    Williams, S P; Curnow, T L; Almeyda, R

    2014-01-01

    Necrotising otitis externa is an uncommon and aggressive infection of the external auditory canal with a tendency to present in the elderly and immunocompromised patient. We report a series of twenty-five patients admitted to our institution over a four-year period with this diagnosis. We review the diagnosis and antimicrobial management of these cases, and propose a treatment algorithm based on our experience.

  4. Comparison of lipid profiles of Malassezia pachydermatis strains isolated from dogs with otitis externa and without clinical symptoms of disease.

    PubMed

    Czyzewska, Urszula; Siemieniuk, Magdalena; Pyrkowska, Aleksandra; Nowakiewicz, Aneta; Bieganska, Malgorzata; Dabrowska, Iwona; Bartoszewicz, Marek; Dobrzyn, Pawel; Tylicki, Adam

    2016-01-01

    Malassezia pachydermatis can cause infections of the skin and mucous membranes, especially in animals. It becomes a problem also in medicine. It is considered that metabolic disorders as well as hormonal and immunological status of the host promote diseases caused by M. pachydermatis. Here we consider whether specific features of fungi could also favour infections. We checked whether there are differences in lipid profiles between strains obtained from dogs with otitis externa and strains obtained from healthy dogs. Lipid profiles were determined using thin layer chromatography and gas chromatography-mass spectrometry. All analyses were carried out on 32 strains derived from dogs with otitis externa and 31 strains isolated from dogs without symptoms of disease. The results show that strains isolated from dogs without symptoms of otitis externa are characterised by a higher content of fatty acids. They contain significantly more behenic and lignoceric acids on medium without addition of lipids, and more oleic acid and total monounsaturated fatty acids on medium with lipids supplementation. These strains have also a higher content of esters of ergosterol and triglycerides. Data obtained show differences which may be specific features of M. pachydermatis-specific strains related to the ability of infection, which could be not directly related of the host condition. © 2015 Blackwell Verlag GmbH.

  5. Clinical evaluation of an antiinflammatory and antioxidant diet effect in 30 dogs affected by chronic otitis externa: preliminary results.

    PubMed

    Di Cerbo, Alessandro; Centenaro, Sara; Beribè, Francesca; Laus, Fulvio; Cerquetella, Matteo; Spaterna, Andrea; Guidetti, Gianandrea; Canello, Sergio; Terrazzano, Giuseppe

    2016-03-01

    The aim of this evaluation study was to assess the possible role of a specific nutraceutical diet in relieving main clinical symptoms of chronic bilateral otitis externa (occlusion of ear canal, erythema, discharge quantity, and odor) in 30 adult dogs. Thirty dogs of different breeds (mean age ± SEM; 6.03 ± 0.15 years and mean weight ± SEM; 32.01 ± 1.17 Kg; 53.3% males, 46.6% females) with evident chronic clinical otitis symptoms were equally divided and randomly assigned to receive either the nutraceutical diet (ND group) or a standard diet (SD group) over a period of 90 days. In all cases a topical pharmacological treatment was given. The nutraceutical diet, also endowed with anti-inflammatory and antioxidant activities, significantly decreased the mean score intensity of all symptoms after 90 days of intervention (P < 0.0001) with the exception of Malassezia pachydermatis infection which was only slightly reduced. Our investigation is one of the few evidence-based results where a commercial nutraceutical diet has been proven effective, in combination with drugs, in relieving otitis externa-related symptoms. This study opens new insights into otitis externa clinical management providing evidence of efficacy of a combined therapy with drugs and a specific nutraceutical diet.

  6. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists.

    PubMed

    Chawdhary, Gaurav; Pankhania, Miran; Douglas, Susan; Bottrill, Ian

    2017-08-01

    Necrotising otitis externa (NOE) is a rare infection causing skull base osteomyelitis. The evidence regarding NOE consists mostly of case series. Hence, there is a limited evidence base to guide decision-making. This survey aims to report the experience of 221 otolaryngologists in this condition. Internet survey administered to the membership of the British Association of Otorhinolaryngology - Head and Neck Surgery (ENT UK). Respondents' detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up. Our survey provides a picture of NOE management in the UK. While there is consensus in some aspects of NOE management, other aspects attract widely differing answers. This may reflect the lack of strong evidence in the literature. Future work should aim to address this.

  7. An outbreak of otitis externa in competitive swimmers due to Pseudomonas aeruginosa.

    PubMed Central

    Reid, T. M.; Porter, I. A.

    1981-01-01

    Pseudomonas aeruginosa was isolated from the ears of 18 of the 25 members of a team of competitive swimmers who complained of painful discharging ears. This group of swimmers trained twice daily in the pool, in the early morning and late afternoon. In contrast swabbing of the ears of a similar group of 54 competitive swimmers who used the pool only in the afternoon revealed only one swimmer with P. aeruginosa. Investigation of the swimming pool revealed that chlorination was often inadequate when the first group of swimmers were training in the early morning. Strains of P. aeruginosa were isolated from various sites around the pool and from the bag of a vacuum used to clean the pool. Pyocin typing, serotyping and phage typing were performed on all isolates. The dominant strain recovered from the swimmers' ears was found to be almost identical to that from the vacuum bag and belonged to serotype 0--11 which has been particularly associated with outbreaks of P. aeruginosa infection in whirlpools in the United States. These results support the hypothesis that there is a direct correlation between the development of otitis externa and swimming in water contaminated with P. aeruginosa. PMID:6787118

  8. Clinical utility of a polymerase chain reaction assay in culture-negative necrotizing otitis externa.

    PubMed

    Gruber, Maayan; Roitman, Ariel; Doweck, Ilana; Uri, Nechama; Shaked-Mishan, Pninit; Kolop-Feldman, Aharon; Cohen-Kerem, Raanan

    2015-04-01

    This study describes a subset of necrotizing otitis externa (NOE) patients with a refractory disease and negative cultures. In these cases, we decided to use a polymerase chain reaction (PCR) assay from surgically obtained tissue under sterile conditions to improve pathogen detection sensitivity. Retrospective case review. Academic medical center. Nineteen consecutive patients diagnosed with NOE between January 2008 and January 2014 inclusive. Three patients of this cohort presented a culture-negative disease. Diagnostic. Positive detection of pathogens using a PCR assay in cases with a complicated course of NOE and clinical resolution of the disease after targeted therapy according to PCR results. Surgical samples were obtained under sterile conditions from three patients with negative cultures and a refractory disease course of NOE. PCR assays were performed using pan-bacteria and pan-fungi protocols. In all three samples, a positive result for a fungal pathogen was recorded and followed by successful empirical targeted therapy. Patients who present with a refractory culture-negative NOE should be suspected as suffering from a fungal disease. The PCR assay may be an important laboratory adjunct in detecting pathogens responsible for NOE and can aid to promote therapy and disease resolution.

  9. Corynebacterium spp. in dogs and cats with otitis externa and/or media: a retrospective study.

    PubMed

    Henneveld, Kerstin; Rosychuk, Rodney A W; Olea-Popelka, Francisco J; Hyatt, Doreene R; Zabel, Sonja

    2012-01-01

    The role of Corynebacterium spp. in the pathogenesis of canine and feline otitis externa/media and their appropriate antimicrobial therapy are unclear. The objectives of this study were to (1) better establish the pathogenicity of Corynebacterium spp. in otitis utilizing reported criteria and by assessing clinical response to antibiotic therapy and (2) to determine the antimicrobial susceptibility patterns of Corynebacterium spp. associated with otitis. The study was retrospective, targeting cultures positive for Corynebacterium spp. Corynebacterium spp. were part of mixed microbial populations in 79/81 cultures. Corynebacterium spp. pathogenicity was highly questionable because of their almost invariable presence with other microbes and the observation that Corynebacterium spp. usually disappear from the ear with resolution of other infections, even when the Corynebacterium spp. are resistant to the prescribed antibiotic(s). However, 2/81 cultures came from two canine ears wherein Corynebacterium spp. may have been pathogenic. Antimicrobial sensitivities for Corynebacterium spp. were available for 54 isolates. Most isolates were susceptible to chloramphenicol (53/54), amikacin (50/54), tetracycline (50/54), gentamicin (46/54), and enrofloxacin (32/54). Among those antibiotics available in otic products, gentamicin and enrofloxacin would be rational choices for the empirical, topical therapy of Corynebacterium spp.

  10. Otitis externa in military divers: more frequent and less harmful than reported.

    PubMed

    Wingelaar, Thijs T; van Ooij, Pieter-Jan Am; van Hulst, Rob A

    2017-03-01

    Although otitis externa (OE) is a common disease, data related to (military) divers are limited. This study aimed to determine the incidence of OE in military divers during their initial training. We also wished to consider seasonal influences on incidence and whether early detection increases completion of the diving course. From January 2011 to October 2016 the Royal Netherlands Navy Diving School trained 189 divers. Up to December 2015 we used the training records for the analyses. From January 2016 onward all divers were prospectively screened. Pearson's chi-squared 2 and Fisher's exact tests were used to analyse the data. In the 162 included divers, 30 cases of OE were identified. The incidence in 2016 was significantly higher than in 2011-2015 (17/35 (49%) versus 13/127 (10%), P < 0.001). Almost all cases developed after three weeks of diving. No influence of season was found (P = 0.354). Early diagnosis and treatment of OE does not seem to affect completion of diving courses (P = 0.28). Only in three cases did a diver have to discontinue the course due to OE. This study suggests that OE is more frequent among military divers than earlier reported, most likely caused by prolonged water exposure. Diving activities can often be continued with standard topical treatment.

  11. Efficacy of medical grade honey in the management of canine otitis externa - a pilot study.

    PubMed

    Maruhashi, Emi; Braz, Berta São; Nunes, Telmo; Pomba, Constança; Belas, Adriana; Duarte-Correia, José Henrique; Lourenço, Ana Mafalda

    2016-04-01

    The high prevalence of antimicrobial resistance within otic pathogens has created a need for alternative therapies of otitis externa (OE). Evidence suggests that medical grade honey (MGH) may be effective against drug-resistant pathogens. The efficacy of a commercial MGH compound was assessed in an open clinical trial. We hypothesized that it would be an effective alternative to conventional treatments. Client-owned dogs (n = 15) with a confirmed diagnosis of infectious OE were enrolled in this pilot study. Dogs were prescribed MGH (1 mL daily per ear) until cure was achieved or for a maximum of 21 d. Evaluation was based on weekly clinical scores, cytological progression and owner assessments of pruritus. Swab samples were submitted for culture and susceptibility testing. MGH was tested for biocidal activity against the bacterial isolates. Medical grade honey promoted rapid clinical progress, with 70% of dogs achieving clinical cure between days 7 and 14 and over 90% having resolved by Day 21. There was a decrease in clinical scores throughout the duration of the trial (P < 0.001) and owner-assessed pruritus also decreased significantly (P < 0.05). In vitro assays of the biocidal activity of MGH showed activity against all bacterial isolates, including meticillin-resistant strains of Staphylococcus pseudintermedius (MRSP) and other species of drug-resistant bacteria. Medical grade honey was successful in both clinical and laboratory settings, thus demonstrating its potential of becoming an alternative treatment for canine OE. © 2016 ESVD and ACVD.

  12. Randomized controlled trial on the treatment of otitis externa with one per cent silver nitrate gel.

    PubMed

    van Hasselt, Piet; Gudde, Hugo

    2004-02-01

    Otitis externa (OE) and especially otomycosis can be very persistent and difficult to control. In the present study the efficacy of treatment of OE with a single instillation in the ear canal of one per cent silver nitrate in three per cent hypromellose gel compared to 0.1 per cent silver nitrate gel was tested in a single-blinded randomized controlled parallel group study. The outcome measure was complete resolution of the OE after one week. Forty-four patients with refractory, bacterial as well as fungal, OE entered the study, comprising 30 ears in each treatment arm. Eight patients defaulted from follow-up, five ears in each treatment arm. A single instillation of one per cent silver nitrate gel cured 23 (92 per cent) of 25 ears with OE, whereas with 0.1 per cent silver nitrate gel seven (28 per cent) of 25 ears treated were cured (Fisher-exact test, p-exact = 0.00010). In a non-controlled series of 120 ears 93.3 per cent needed only a single instillation of one per cent silver nitrate gel while another five per cent were cured after a second instillation a week later. There were no adverse reactions. OE can be treated effectively with instillation of one per cent silver nitrate gel and is particularly useful in recalcitrant otomycosis. The treatment method saves both cost and time.

  13. Use of ticarcillin in the management of canine otitis externa complicated by Pseudomonas aeruginosa.

    PubMed

    Nuttall, T J

    1998-04-01

    Twelve dogs were referred with purulent and proliferative otitis externa. Prior treatment included fluoroquinolones, glucocorticoids and polyvalent ear drops over seven days to five months. In all cases the vertical and horizontal ear canals were inflamed and thickened, with ruptured tympanic membranes in four cases. No abnormalities were seen on radiography of the osseous bullae. Numerous rod bacilli and degenerate neutrophils were seen on cytology. Pseudomonas aeruginosa resistant to fluoroquinolones and gentamicin was cultured in all cases. Treatment was initiated with 1 to 2 mg/kg prednisolone per os once daily, and a cleansing and drying ear cleaner followed by topical administration of injectable ticarcillin solution four times daily. Cases with ruptured tympanae also received 15 to 25 mg/kg ticarcillin three times daily intravenously until the membranes had healed. All cases were anaesthetised for repeated saline ear flushes until no further discharge was evident and no rods were seen on cytology. Topical ticarcillin and the ear cleaner were continued twice daily for 14 days after clinical resolution. The duration of treatment ranged from 14 to 36 days. Treatment was withdrawn in one case which developed a drug reaction. All other cases responded well with no adverse effects.

  14. Development and Reproduction of Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) Fed on Myzus persicae (Sulzer) (Hemiptera: Aphididae) Vectoring Potato leafroll virus (PLRV).

    PubMed

    Garzón, A; Freire, B C; Carvalho, G A; Oliveira, R L; Medina, P; Budia, F

    2015-12-01

    The aim of this study was to evaluate the biological parameters of Chrysoperla externa (Hagen) while feeding on Myzus persicae (Sulzer) acting as a vector of potato leafroll virus (PLRV). In laboratory experiments, three different diets were offered ad libitum to C. externa during the larval period: M. persicae fed on PLRV-infected potato leaves, M. persicae fed on uninfected potato leaves, and eggs of the factitious prey Anagasta kuehniella (Zeller) as the control. The following parameters were studied: the developmental time and survival rate of the larval and pupal stages, the sex ratio, the proportion of fertile females, female fecundity and egg viability, and the survival curve of the first 30 days after adult emergence. PLRV-infected aphids influenced the C. externa larval developmental time and survival compared to PLRV-uninfected aphids and A. kuehniella eggs. The pupal developmental time of C. externa was shorter when fed on aphids compared to A. kuehniella eggs, but no differences were recorded between the PLRV-infected and uninfected aphid diets. Additionally, no differences were observed for pupal survival and reproduction. However, adult survival was affected by the prey type, as 75% of C. externa control adults remained alive at an age of 30 days compared to 51 and 54% for those fed on PLRV-uninfected and infected aphids, respectively.

  15. Malignant Otitis Externa: Evolving Pathogens and Implications for Diagnosis and Treatment.

    PubMed

    Hobson, Candace E; Moy, Jennifer D; Byers, Karin E; Raz, Yael; Hirsch, Barry E; McCall, Andrew A

    2014-07-01

    Malignant otitis externa (MOE) is an invasive infection of the temporal bone that is classically caused by Pseudomonas aeruginosa. Increasingly, however, nonpseudomonal cases are being reported. The goal of this study was to evaluate and compare the clinical presentation and outcomes of cases of MOE caused by Pseudomonas versus non-Pseudomonas organisms. Retrospective case series with chart review. Tertiary care institution. Adult patients with diagnoses of MOE between 1995 and 2012 were identified. Charts were reviewed for history, clinical presentation, laboratory data, treatment, and outcomes. Twenty patients diagnosed with and treated for MOE at the University of Pittsburgh Medical Center between 1995 and 2012 were identified. Nine patients (45%) had cultures that grew P aeruginosa. Three patients (15%) had cultures that grew methicillin-resistant Staphylococcus aureus (MRSA). Signs and symptoms at presentation were similar across groups. However, all of the patients with Pseudomonas had diabetes, compared with 33% of MRSA-infected patients (P = .046) and 55% of all non-Pseudomonas-infected patients (P = .04). Patients infected with MRSA were treated for an average total of 4.7 more weeks of antibiotic therapy than Pseudomonas-infected patients (P = .10). Overall, patients with non-Pseudomonas infections were treated for a total of 2.4 more weeks than Pseudomonas-infected patients (P = .25). A high index of suspicion for nonpseudomonal organisms should be maintained in patients with signs and symptoms of MOE, especially in those without diabetes. MRSA is an increasingly implicated organism in MOE. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  16. Antimicrobial and Analgesic Prescribing Patterns for Acute Otitis Externa, 2004–2010

    PubMed Central

    Collier, Sarah A.; Hlavsa, Michele C.; Piercefield, Emily W.; Beach, Michael J.

    2015-01-01

    Objective Acute otitis externa (AOE) is a common but preventable ear condition. Clinical guidelines issued in 2006 recommended topical treatments for uncomplicated AOE, but systemic antimicrobials appear to be commonly prescribed. The objective of this analysis was to describe pre- and postguideline prescribing patterns by clinician specialty and antimicrobial type and assess trends over time. Study Design Retrospective longitudinal analysis of a large insurance database. Setting Outpatient departments in the United States. Methods Initial outpatient visits in 2004 to 2010 for AOE (excluding visits with complicating conditions) were extracted from an insurance database. Prescription drug claims were linked and categorized by clinician specialty and antimicrobial type. Results The analysis included 907,261 initial outpatient visits. Use of systemic antimicrobials declined by 4.9% (95% confidence interval [CI], 4.1%, 5.7%) from 36.5% of initial visits in 2004 to 32.1% in 2010. Use of systemic antimicrobials varied by specialty. Systemic antimicrobials were prescribed in 47.1% of 2010 emergency department (ED) visits (−6.9% from 2004, 95% CI –12.3, −1.5), 25.9% of otolaryngologist visits (−1.6%, 95% CI –5.6, 2.4), and 20.4% of pediatrician visits (−6.6%, 95% CI –8.8, –4.4). Penicillins were prescribed most frequently (42.3% of systemic prescriptions in 2010), followed by cephalosporins (19.8%), erythromycin/macrolides (17.4%), and quinolones (11.1%). Opioids were prescribed in 26.4% of ED visits and 9% of outpatient visits. Conclusions Use of systemic antimicrobials declined over time, but one-third of 2010 visits resulted in systemic antimicrobials, despite exclusion of visits with complicating factors. Use of systemic antimicrobials varied by specialty. Further educational efforts and outreach to other specialties might be warranted. PMID:23131826

  17. Antimicrobial and analgesic prescribing patterns for acute otitis externa, 2004-2010.

    PubMed

    Collier, Sarah A; Hlavsa, Michele C; Piercefield, Emily W; Beach, Michael J

    2013-01-01

    Acute otitis externa (AOE) is a common but preventable ear condition. Clinical guidelines issued in 2006 recommended topical treatments for uncomplicated AOE, but systemic antimicrobials appear to be commonly prescribed. The objective of this analysis was to describe pre- and postguideline prescribing patterns by clinician specialty and antimicrobial type and assess trends over time. Retrospective longitudinal analysis of a large insurance database. Outpatient departments in the United States. Initial outpatient visits in 2004 to 2010 for AOE (excluding visits with complicating conditions) were extracted from an insurance database. Prescription drug claims were linked and categorized by clinician specialty and antimicrobial type. The analysis included 907,261 initial outpatient visits. Use of systemic antimicrobials declined by 4.9% (95% confidence interval [CI], 4.1%, 5.7%) from 36.5% of initial visits in 2004 to 32.1% in 2010. Use of systemic antimicrobials varied by specialty. Systemic antimicrobials were prescribed in 47.1% of 2010 emergency department (ED) visits (-6.9% from 2004, 95% CI -12.3, -1.5), 25.9% of otolaryngologist visits (-1.6%, 95% CI -5.6, 2.4), and 20.4% of pediatrician visits (-6.6%, 95% CI -8.8, -4.4). Penicillins were prescribed most frequently (42.3% of systemic prescriptions in 2010), followed by cephalosporins (19.8%), erythromycin/macrolides (17.4%), and quinolones (11.1%). Opioids were prescribed in 26.4% of ED visits and 9% of outpatient visits. Use of systemic antimicrobials declined over time, but one-third of 2010 visits resulted in systemic antimicrobials, despite exclusion of visits with complicating factors. Use of systemic antimicrobials varied by specialty. Further educational efforts and outreach to other specialties might be warranted.

  18. Determination of N-acylhomoserine lactones of Pseudomonas aeruginosa in clinical samples from dogs with otitis externa.

    PubMed

    Kušar, Darja; Šrimpf, Karin; Isaković, Petra; Kalšek, Lina; Hosseini, Javid; Zdovc, Irena; Kotnik, Tina; Vengušt, Modest; Tavčar-Kalcher, Gabrijela

    2016-10-18

    Bacterial intercellular communication, called quorum sensing, takes place via the production and collective response to signal molecules. In Gram-negative bacteria, like Pseudomonas aeruginosa, these signaling molecules are N-acylhomoserine lactones (AHLs). P. aeruginosa is a common cause of inflammation of the ear canal (otitis externa) in dogs. It employs quorum sensing to coordinate the expression of host tissue-damaging factors, which are largely responsible for its virulence. The treatment of P. aeruginosa-associated otitis is challenging due to a high intrinsic resistance of P. aeruginosa to several antibiotics. Attenuation of quorum sensing signals to inhibit bacterial virulence is a novel strategy for the treatment of resistant bacterial pathogens, including P. aeruginosa. Therefore, it is important to recognize and define quorum sensing signal molecules in clinical samples. To date, there are no reports on determination of AHLs in the veterinary clinical samples. The purpose of this study was to validate an analytical procedure for determination of the concentration of AHLs in the ear rinses from dogs with P. aeruginosa-associated otitis externa. Samples were obtained with rinsing the ear canals with physiological saline solution. For validation, samples from healthy dogs were spiked with none or different known amounts of the selected AHLs. With the validated procedure, AHLs were analyzed in the samples taken in weekly intervals from two dogs, receiving a standard treatment for P. aeruginosa-associated otitis externa. Validation proved that the procedure enables quantification of AHLs in non-clinical and clinical samples. In addition, a time dependent reduction of AHL concentration was detected for the treated dogs. Our results indicate that liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) is superior in detecting AHLs compared to other chromatographic techniques. This is the first report on determination of AHLs in the clinical

  19. Toxicity and Metabolism of Zeta-Cypermethrin in Field-Collected and Laboratory Strains of the Neotropical Predator Chrysoperla externa Hagen (Neuroptera: Chrysopidae).

    PubMed

    Haramboure, M; Smagghe, G; Niu, J; Christiaens, O; Spanoghe, P; Alzogaray, R A

    2017-03-09

    Resistance to pesticides has been studied in several insect pests, but information on the natural enemies of pests-including the Neotropical predator Chrysoperla externa Hagen (Neuroptera: Chrysopidae), a major biological control agent in South America-is lacking. We report here a comparative study between a field-collected strain of C. externa subjected to monthly sprayings of pyrethroids and neonicotinoids and a laboratory strain without exposure to pesticides. The tolerance of both strains against zeta-cypermethrin was similar, and addition of the synergist piperonyl butoxide increased the toxicity by 30% in both strains. Gas-chromatography analyses and mixed-function-oxidase measurements indicated similar values in both strains and also confirmed the key role of oxidative metabolism in this species. Because C. externa has maintained a tolerance to zeta-cypermethrin without previous pesticide exposure, this species could potentially be mass-reared and released in fields in the presence of pesticide pressure.

  20. Peltogasterella sensuru n. sp. (Crustacea: Cirripedia: Rhizocephala) from off Okinawa Island (Ryukyu Archipelago, Japan) with remarks on its single brood externae.

    PubMed

    Yoshida, Ryuta; Hirose, Mamiko; Hirose, Euichi

    2015-09-01

    Peltogasterella sensuru n. sp. infests Pagurixus hermit crabs inhabiting rocky shores off Okinawa Island (Ryukyu Archipelago, Japan). This species is clearly distinguishable from Peltogasterella gracilis (Boschma, 1927): the stalk emerges from the middle part of the externa in the present species and P. sulcata (Lilljeborg, 1859), while the stalk in P. gracilis emerges from the posterior end of the externae. The new species differs from P. sulcata based on the morphology of the mantle aperture. Peltogasterella sensuru n. sp. repeatedly produces single brood externae that have not been previously observed in species belonging to the suborder Kentrogonida Delage, 1884. We also determined partial sequences of the COI gene and 16S rRNA gene of the new species for use as molecular markers for species identification.

  1. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  2. Antibacterial and Antifungal Activity of Essential Oils against Pathogens Responsible for Otitis Externa in Dogs and Cats

    PubMed Central

    Ebani, Valentina V.; Nardoni, Simona; Bertelloni, Fabrizio; Najar, Basma; Pistelli, Luisa; Mancianti, Francesca

    2017-01-01

    Background: Essential oils (EOs) are recommended by some veterinarians to treat otitis externa in pets, but data about their efficacy in scientific literature are very scant. Methods: Nine commercial EOs, from roman chamomile (Anthemis nobilis L.), star anise (Illicium verum), lavender (Lavandula hybrida), litsea (Litsea cubeba (Lour.) Pers.), basil (Ocimum basilicum L.), oregano (Origanum vulgare L. subsp. hirticum), rosemary (Rosmarinus officinalis L.), clary sage (Salvia sclarea L.), and thyme (Thymus vulgaris L.) were tested against bacterial and fungal pathogens previously isolated from dogs and cats with otitis externa. In particular, the analyses were carried out against Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus pseudointermedius, Aspergillus niger, Aspergillus fumigatus, Aspergillus terreus, Candida albicans, Candida tropicalis, Trichosporon sp., and Rhodotorula sp. Results: O. vulgare and S. sclarea showed superior antibacterial activity, even if not against all the strains. Trichosporon sp., C. albicans, and A. terreus were insensitive to most Eos, while other yeasts and molds showed different degrees of sensitivity. In particular, most fungi were inhibited by O. vulgare and R. officinalis. Conclusions: The obtained results suggest that some EOs could be included in treatment as an alternative therapeutic option in bacterial otitis complicated by fungi, in association with conventional drugs. PMID:28930236

  3. Antibacterial and Antifungal Activity of Essential Oils against Pathogens Responsible for Otitis Externa in Dogs and Cats.

    PubMed

    Ebani, Valentina V; Nardoni, Simona; Bertelloni, Fabrizio; Najar, Basma; Pistelli, Luisa; Mancianti, Francesca

    2017-04-21

    Background: Essential oils (EOs) are recommended by some veterinarians to treat otitis externa in pets, but data about their efficacy in scientific literature are very scant. Methods: Nine commercial EOs, from roman chamomile (Anthemis nobilis L.), star anise (Illicium verum), lavender (Lavandula hybrida), litsea (Litsea cubeba (Lour.) Pers.), basil (Ocimum basilicum L.), oregano (Origanum vulgare L. subsp. hirticum), rosemary (Rosmarinus officinalis L.), clary sage (Salvia sclarea L.), and thyme (Thymus vulgaris L.) were tested against bacterial and fungal pathogens previously isolated from dogs and cats with otitis externa. In particular, the analyses were carried out against Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus pseudointermedius, Aspergillus niger, Aspergillus fumigatus, Aspergillus terreus, Candida albicans, Candida tropicalis, Trichosporon sp., and Rhodotorula sp. Results:O. vulgare and S. sclarea showed superior antibacterial activity, even if not against all the strains. Trichosporon sp., C. albicans, and A. terreus were insensitive to most Eos, while other yeasts and molds showed different degrees of sensitivity. In particular, most fungi were inhibited by O. vulgare and R. officinalis. Conclusions: The obtained results suggest that some EOs could be included in treatment as an alternative therapeutic option in bacterial otitis complicated by fungi, in association with conventional drugs.

  4. Otitis interna, media, and externa with destruction of the left tympanic bulla and subluxation and septic arthritis of the left temporomandibular joint in an alpaca (Vicugna pacos)

    PubMed Central

    Galvan, Noe; Middleton, John R.; Cook, Cristi; Britt, Lisa G.; Kuroki, Keiichi

    2013-01-01

    A 1.5-year-old, 37.7 kg, female alpaca was evaluated for a 2-week history of weight loss, left ear droop, and deviation of the rostral mandible to the right. Antemortem radiography and postmortem examination revealed otitis interna, media, and externa, destruction of the left tympanic bulla, and subluxation and septic arthritis of the left temporomandibular joint. PMID:23997267

  5. Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy

    PubMed Central

    Chakraborty, Dhritiman; Bhattacharya, Anish; Gupta, Ashok Kumar; Panda, Naresh Kumar; Das, Ashim; Mittal, Bhagwant Rai

    2013-01-01

    Background: Skull base osteomyelitis (SBO) refers to infection that has spread beyond the external auditory canal to the base of the skull in advanced stages of otitis externa. Clinically, it may be difficult to differentiate SBO from severe otitis externa without bony involvement. This study was performed to determine the role of three phase bone scintigraphy (TPBS) and single photon emission tomography/computed tomography (SPECT/CT) in detecting SBO. Materials and Methods: We retrospectively analyzed records of 20 patients (14 M, 6 F) with otitis externa and suspected SBO. TPBS and SPECT/CT of the skull were performed. Findings were correlated with clinical, laboratory and diagnostic CT scan findings. Results: All patients were diabetic with elevated erythrocyte sedimentation rate. A total of 18 patients had bilateral and two unilateral symptoms. Cranial nerves were involved in eight patients and microbiological culture of ear discharge fluid positive in seven. Early images showed increased temporal vascularity in nine patients and increased soft-tissue uptake in 10, while delayed images showed increased bone uptake in 19/20 patients. Localized abnormal tracer uptake was shown by SPECT/CT in the mastoid temporal (15), petrous (11), sphenoid (3) and zygomatic (1) and showed destructive changes in five. Thus, TPBS was found positive for SBO in 10/20 patients and changed the management in four. Conclusion: Our study suggests that TPBS with SPECT/CT is a useful non-invasive investigation for detection of SBO in otitis externa. PMID:24163508

  6. Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy.

    PubMed

    Chakraborty, Dhritiman; Bhattacharya, Anish; Gupta, Ashok Kumar; Panda, Naresh Kumar; Das, Ashim; Mittal, Bhagwant Rai

    2013-04-01

    Skull base osteomyelitis (SBO) refers to infection that has spread beyond the external auditory canal to the base of the skull in advanced stages of otitis externa. Clinically, it may be difficult to differentiate SBO from severe otitis externa without bony involvement. This study was performed to determine the role of three phase bone scintigraphy (TPBS) and single photon emission tomography/computed tomography (SPECT/CT) in detecting SBO. We retrospectively analyzed records of 20 patients (14 M, 6 F) with otitis externa and suspected SBO. TPBS and SPECT/CT of the skull were performed. Findings were correlated with clinical, laboratory and diagnostic CT scan findings. All patients were diabetic with elevated erythrocyte sedimentation rate. A total of 18 patients had bilateral and two unilateral symptoms. Cranial nerves were involved in eight patients and microbiological culture of ear discharge fluid positive in seven. Early images showed increased temporal vascularity in nine patients and increased soft-tissue uptake in 10, while delayed images showed increased bone uptake in 19/20 patients. Localized abnormal tracer uptake was shown by SPECT/CT in the mastoid temporal (15), petrous (11), sphenoid (3) and zygomatic (1) and showed destructive changes in five. Thus, TPBS was found positive for SBO in 10/20 patients and changed the management in four. Our study suggests that TPBS with SPECT/CT is a useful non-invasive investigation for detection of SBO in otitis externa.

  7. Evaluation of a cuprimyxin-hydrocortisone acetate suspension in the treatment of otitis externa in dogs and cats.

    PubMed

    Maestrone, G; Brandt, W

    1979-02-01

    The therapeutic efficacy of a 0.5% cuprimyxin plus 1% hydrocortisone acetate-water-base suspension was evaluated in 130 clinical cases of otitis externa in dogs and cats in various geographic areas of the United States. The otic microbial flora was studied before treatment in 125 (96%) of the dogs and cats, with multiple isolates recovered from mated from 70%, yeasts from 65%, and fungi from 5% of the animals. Evens though multiple drug reistance was frequently observed in the bacterial flora, all bacteria and yeast isolates were sensitive to cuprimyxin. Of the 130 treated animals, a statistically significant (P less than 0.01) favorable response was obtained in 84,6% and no response in 13;1%; in2.3%, the condition became worse. An adverse reaction (pain at the time of first application) was observed in 1 (0.8%) animal.

  8. In vitro antifungal susceptibility of Malassezia pachydermatis strains isolated from dogs with chronic and acute otitis externa.

    PubMed

    Chiavassa, E; Tizzani, P; Peano, A

    2014-10-01

    Malassezia pachydermatis is a yeast that is frequently involved as a secondary/perpetuating factor in canine otitis externa. Topical therapies with different antifungal agents, mainly azole compounds, are generally successful in controlling the yeast overgrowth, but treatment failure and rapid recurrences are common. This study compared the in vitro antifungal susceptibility of M. pachydermatis isolates obtained from chronic and acute cases of otitis externa. The aim was to assess the possible onset of resistance mechanisms in isolates involved in long-lasting episodes with poor response to treatment. We evaluated the in vitro susceptibility to miconazole (MCZ) and clotrimazole (CTZ) of 42 isolates of M. pachydermatis obtained from dogs with chronic (group A, n = 25) and acute otitis (group B, n = 17), using a modified CLSI M27-A3 microdilution method. All isolates were inhibited by the antifungal agents employed, but Malassezia isolates from group A were significantly associated with higher minimum inhibitory concentration (MIC) values for both agents (Median MIC values: MCZ group A 2 µg/ml, group B 1 µg/ml; CTZ group A 8 µg/ml, group B 4 µg/ml). These findings prove that these isolates had a reduced in vitro susceptibility to the antifungal agents tested. However, it is unlikely that this could have any influence on the outcome of a topical treatment. Indeed, marketed products include concentrations of the tested agents that largely exceed even the highest MICs found in this study (in most cases at least 1,000 × the MIC, or greater). In conclusion, this study suggests that isolates of M. pachydermatis involved in chronic cases of canine external otitis and exposed to repeated antifungal treatments are unlikely to develop mechanisms of resistance of clinical relevance.

  9. Consensus of microbiology reporting of ear swab results to primary care clinicians in patients with otitis externa.

    PubMed

    Geyer, M; Howell-Jones, R; Cunningham, R; McNulty, C

    2011-01-01

    Otitis externa is a ubiquitous inflammatory disease; although it arises most commonly from an infection, there is no consensus in the UK for the reporting of ear swab culture results. This study aims to review current microbiology laboratory reporting of ear swab specimens to primary care and reach an evidence-based consensus for a reporting policy. Fifty consecutive ear swab reports were reviewed from each of 12 laboratories in the South West region to determine and discuss reporting practice. The Health Protection Agency (HPA) GP Microbiology Laboratory Use Group reviewed the underlying evidence and worked towards a consensus of expert microbiology opinion for laboratory reporting of ear swab results using a modified version of the Delphi technique. A total of 487 reports from primary care were reviewed (54% female; 46% male). Cultures most commonly yielded Pseudomonas species (36%), Staphylococcus species (21%), Streptococcus species (15%) and fungi (11%). Five reporting policies were agreed: Policy 1: Common pathogens such as group A beta-haemolytic streptococci, Streptococcus pneumoniae, Staphylococcus aureus - Always reported by name with antibiotic susceptibilities. Policy 2: Pseudomonas species - Always reported, but antibiotic susceptibilities only reported in severe disease. Policy 3: Aspergillus, Candida, coliforms and Proteus species, as well as non-group A streptococci and anaerobes - Only reported if moderate numbers of colonies and it is the predominant organism present; if appropriate report antibiotic susceptibilities. Policy 4: Coagulase-negative staphylococci, diphtheroids and enterococci - Not reported by name; generic terms used and antibiotic susceptibilities not reported. Policy 5: When antibiotic susceptibilities reported these must include susceptibility to a topical antibiotic. It is suggested that laboratories should consider adopting this evidence-based reporting consensus for ear swab culture results from primary care patients with

  10. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

    Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management.

  11. Hospital diversification.

    PubMed

    Eastaugh, Steven R

    2005-01-01

    Hospital diversification and its impact on the operating ratio are studied for 168 hospitals during the period from 1999 to 2004. Diversification and the operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield a better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution lifecycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Management's attitude concerning risk and reward is considered.

  12. [Neurological health care activity in a recently created district hospital: model of high efficiency].

    PubMed

    Jiménez-Jiménez, Félix J; Plaza-Nieto, José F; Navacerrada, Francisco; Alonso-Navarro, Hortensia; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; Guillán, Marta; Calleja, Marisol; Moreno-Puertas, Dolores

    2015-03-01

    Objetivo. Analizar la actividad asistencial de un hospital comarcal de reciente creacion, con especial enfasis en los indicadores asistenciales en consultas externas y en actos medicos de pacientes ingresados. Pacientes y metodos. Describimos la actividad asistencial realizada por nuestra seccion de neurologia durante los años 2008-2013. Se comparan nuestros indicadores asistenciales de los años 2012 y 2013 (quinto y sexto año de actividad), tanto en consultas externas como en pacientes ingresados, con los de otros dos hospitales de caracteristicas similares, otros tres de nivel secundario y otros cuatro de nivel terciario. Resultados. La seccion de neurologia de nuestro hospital fue la que realizo mayor numero de primeras consultas por facultativo, tuvo el mejor indice de consultas sucesivas/primeras y el mayor porcentaje de consultas de alta resolucion, tuvo la menor estancia media en los dos grupos relacionados por el diagnostico (GRD) mas frecuentes en nuestra especialidad, y fue la segunda en ingresos por facultativo del GRD 'ictus con infarto' y la tercera en ingresos por facultativo del GRD 'otros trastornos del sistema nervioso'. Conclusiones. Los indicadores asistenciales de la seccion de neurologia de nuestro hospital muestran un modelo de muy alta eficiencia, al cual solo se aproximan los de otros dos de caracteristicas y desarrollo similares al nuestro. La implantacion gradual de modelos similares al de estos tres hospitales en los niveles secundario y terciario podria ser de utilidad en la mejora de su eficiencia asistencial.

  13. Comparative susceptibility of two Neotropical predators, Eriopis connexa and Chrysoperla externa, to acetamiprid and pyriproxyfen: Short and long-term effects after egg exposure.

    PubMed

    Rimoldi, Federico; Fogel, Marilina N; Ronco, Alicia E; Schneider, Marcela I

    2017-09-11

    Compatibility assessments between selective insecticides and the natural enemies of pests are essential for integrated-pest-management programs. Chrysoperla externa and Eriopis connexa are two principal Neotropical predators of agricultural pests whose conservation in agroecosystems requires a toxicity evaluation of pesticides to minimize the impact on those beneficial insects on the environment. The objective of this work was to evaluate the toxicity of the insecticides pyriproxyfen and acetamiprid on C. externa and E. connexa eggs exposed to the maximum recommended field concentrations of each along with three successive dilutions. The survival and the immature developmental time were assessed daily until adulthood and the mean survival time calculated over a 10-day period. The cumulative survival of E. connexa was reduced at all concentrations of both insecticides, while that of C. externa was significantly decreased by ≥50 mg L(-1) of acetamiprid and ≥37.6 mg L(-1) of pyriproxyfen. In both species, the reductions occurred principally on the eggs and first larval instar. Survival curves, in general, differed from those of the controls, with the mean survival time of E. connexa being significantly shorter in insecticides treatments than that of the controls. Certain concentrations of each of the insecticide lengthened the egg and first-larval-instar developmental periods of E. connexa and C. externa, respectively. Also, pyriproxyfen reduced the first-larval-instar period and lengthened the fourth of E. connexa. Acetamiprid was more toxic to E. connexa than to C. externa at the two highest concentrations. Conversely, at those same concentrations of pyriproxyfen, the relative toxicity to the two species was reversed. The present work represents the first investigation on the comparative susceptibility of two relevant Neotropical biological control agents to acetamiprid and pyriproxyfen. Also, it highlights the necessity of assessing long

  14. [Comparative characteristic of the local application of anti-inflammatory agents for the treatment of otitis externa and otitis media].

    PubMed

    Magomedov, M M; Starostina, A E; Magomedov, M G

    2012-01-01

    The objective of the present work was the clinical study of candibiotic exhibitic antibacterial, antimycotic, anti-inflammatory, and anesthetic properties when applied for the treatment of otitis externa and otitis media. This agent was included together with traditionally used systemic medications in the combined treatment of 26 patients. It was applied in the form of endoaural drops, transtubal administration through a catheter, and transtympanic pumping by the Politzer balloon technique (in case of perforation). In the patients with otomycosys, the preparation was used for the treatment of the external acoustic canal after the removal of fungal masses thrice daily for 1 month. Good clinical effect achieved in all the patients was manifest as the normal otoscopic picture and less frequent complaints on days 8-10 after the onset of therapy. Its maximum duration was 21 days. Positive dynamics (pain relief) was apparent within the first 2 days of the treatment. Fungal mycelium was absent after 14-16 days of the treatment in 100% of the patients initially presenting with yeast-like fungi.

  15. Serum Malassezia-specific IgE in dogs with recurrent Malassezia otitis externa without concurrent skin disease.

    PubMed

    Layne, Elizabeth A; DeBoer, Douglas J

    2016-08-01

    Immediate-type hypersensitivity (ITH), mediated by IgE, to Malassezia pachydermatis is recognized in atopic dogs with recurrent yeast dermatitis and otitis externa (OE). Malassezia-associated OE commonly occurs in dogs without other signs of atopic dermatitis (AD). The aim of this study was to detect Malassezia-specific IgE in the sera of dogs with recurrent Malassezia OE without concurrent skin disease. Sera from healthy dogs were used for comparison. An FcεRIα-based ELISA was used to measure Malassezia-specific IgE. There was no significant difference between number of positive affected dogs (6/21, 29%) and number of positive unaffected dogs (15/86, 17%) (P=0.36). There was also no significant difference in the concentrations of Malassezia-specific IgE between the two groups (P=0.97). Malassezia-specific IgE did not distinguish between patient groups so, as with other canine allergens, serum IgE reactivity for Malassezia could not be used to differentiate between diseased and healthy patients. The presence of Malassezia-specific IgE in some of the affected dogs might indicate ITH to Malassezia in those dogs. Evaluation of ITH via intradermal test reactivity and response to allergen-specific immunotherapy might clarify the role of Malassezia-associated ITH in similarly affected dogs. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa.

    PubMed

    Cherko, Matthew; Nash, Robert; Singh, Arvind; Lingam, Ravi Kumar

    2016-07-01

    To report our initial experience of diffusion-weighted magnetic resonance imaging (DW-MRI) as a novel imaging tool for assessing and monitoring treatment response in necrotizing otitis externa (NOE). Seven adults with a diagnosis of NOE on both clinical and computed tomography (CT) criteria who were subsequently monitored with at least two echoplanar DW-MRI investigations were included in this retrospective longitudinal observational study. Patients underwent magnetic resonance imaging (MRI), including echoplanar diffusion-weighted sequences, within 2 weeks of diagnosis of NOE to determine the extent of infection and to provide a baseline scan for monitoring response to treatment. Repeated imaging was undertaken after the agreed initial course of antimicrobial therapy was completed. The primary outcome measure for complete treatment response was complete resolution of high inflammatory signal on the DW-MRI apparent diffusion coefficient (ADC) map. This was correlated to clinical, biochemical, and other MRI measures of disease resolution. Baseline DW-MRI was carried out in all but one patient within 2 weeks of the initial diagnostic CT scan. Patients had between one and three further DW-MRI scans, at a mean interval of 4.4 months from the initial scan (range, 2-8 months). The decision to terminate or continue therapy correlated with ADC signal findings on DW-MRI in all cases. In comparison, conventional MRI sequences performed less well, as there was some degree of persistent residual soft tissue changes in all cases.

  17. Host Plant Associations of an Entomopathogenic Variety of the Fungus, Colletotrichum acutatum, Recovered from the Elongate Hemlock Scale, Fiorinia externa

    PubMed Central

    Marcelino, José A. P.; Gouli, Svetlana; Parker, Bruce L.; Skinner, Margaret; Schwarzberg, Lora; Giordano, Rosanna

    2009-01-01

    A fungal epizootic has been detected in populations of the scale Fiorinia externa Ferris (Hemiptera: Diaspididae) in the eastern hemlock, Tsuga canadensis (L.) Carrière (Pinales: Pinaceae), of several northeastern states. Colletotrichum acutatum Simmonds var. fioriniae Marcelino and Gouli var. nov. inedit (Phyllachorales: Phyllachoraceae), a well-known plant pathogen, was the most commonly recovered fungus from these infected scales. This is the second report of a Colletotrichum sp. infecting scale insects. In Brazil C. gloeosporioides f. sp. ortheziidae recovered from Orthezia praelonga is under development as a biopesticide for citrus production. C. acutatum was detected growing endophytically in 28 species of plants within the epizootic areas. DNA sequences of the High Mobility Box at the MAT 1–2, mating type gene indicate that Colletotrichum sp. isolates recovered from scale insects and plants within epizootic areas were identical. Results from plant bioassays showed that this entomopathogenic Colletotrichum variety grew endophytically in all of the plants tested without causing external symptoms or signs of infection, with the exception of strawberry plants where mild symptoms of infection were observed. The implications of these findings with respect to the use of this fungus as a biological control agent are discussed. PMID:19613851

  18. Host plant associations of an entomopathogenic variety of the fungus, Colletotrichum acutatum, recovered from the elongate hemlock scale, Fiorinia externa.

    PubMed

    Marcelino, José A P; Gouli, Svetlana; Parker, Bruce L; Skinner, Margaret; Schwarzberg, Lora; Giordano, Rosanna

    2009-01-01

    A fungal epizootic has been detected in populations of the scale Fiorinia externa Ferris (Hemiptera: Diaspididae) in the eastern hemlock, Tsuga canadensis (L.) Carrière (Pinales: Pinaceae), of several northeastern states. Colletotrichum acutatum Simmonds var. fioriniae Marcelino and Gouli var. nov. inedit (Phyllachorales: Phyllachoraceae), a well-known plant pathogen, was the most commonly recovered fungus from these infected scales. This is the second report of a Colletotrichum sp. infecting scale insects. In Brazil C. gloeosporioides f. sp. ortheziidae recovered from Orthezia praelonga is under development as a biopesticide for citrus production. C. acutatum was detected growing endophytically in 28 species of plants within the epizootic areas. DNA sequences of the High Mobility Box at the MAT 1-2, mating type gene indicate that Colletotrichum sp. isolates recovered from scale insects and plants within epizootic areas were identical. Results from plant bioassays showed that this entomopathogenic Colletotrichum variety grew endophytically in all of the plants tested without causing external symptoms or signs of infection, with the exception of strawberry plants where mild symptoms of infection were observed. The implications of these findings with respect to the use of this fungus as a biological control agent are discussed.

  19. Total ear canal ablation and lateral bulla osteotomy for treatment of otitis externa and media in a rabbit.

    PubMed

    Chow, Eric P; Bennett, R Avery; Whittington, Julia K

    2011-07-15

    A 7-year-old spayed female Miniature Rex European rabbit (Oryctolagus cuniculus) was evaluated because of scratching at the right ear. Physical examination revealed purulent exudate in the right ear canal. Microbial culture of the exudate yielded Pseudomonas aeruginosa susceptible to marbofloxacin; however, the infection was refractory to appropriate medical treatment. Computed tomography revealed isoattenuating material within the right tympanic bulla and external ear canal with no enhancement following IV administration of contrast medium. The left tympanic bulla appeared normal. A total ear canal ablation and lateral bulla osteotomy were performed on the right ear, and polymethylmethacrylate beads containing either gentamicin or cefazolin were placed within the bulla and surrounding tissues. Two weeks after surgery, the patient appeared comfortable with no signs of scratching at the right ear. Total ear canal ablation and lateral bulla osteotomy can be successfully performed for treatment of chronic otitis externa and media in rabbits. Cartilage plates that compose the external ear canal, a bony acoustic duct, lack of a horizontal ear canal, and thickness of the lateral aspect of the tympanic bulla are features unique to rabbits and have not been described in relation to these surgical procedures in rabbits. Rabbits also produce a caseous exudate, and it is difficult to resolve infections of bone and soft tissues. Placement of antimicrobial-impregnated polymethylmethacrylate beads is recommended to minimize the risk of recurrent infection.

  20. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols.

  1. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise.

  2. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  3. Identification of plant families associated with the predators Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) and Hippodamia convergens Guérin-Menéville (Coleoptera: Coccinelidae) using pollen grain as a natural marker.

    PubMed

    Medeiros, M A; Ribeiro, P A; Morais, H C; Castelo Branco, M; Sujii, E R; Salgado-Laboriau, M L

    2010-05-01

    The predators Hippodamia convergens Guérin-Menéville (Coleoptera: Coccinelidae) and Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae), are frequently observed on vegetable crops, especially on tomato plants, as well as on flowers of several plants around crop fields. It is well known that when predators feed on pollen and nectar they can increase their longevity and reproductive capacity. The objective of this work was to identify plants that could be a pollen source for H. convergens and C. externa in order to develop strategies to attract and keep these predators in vegetable fields like the tomato crop. Adults of C. externa (53 individuals) and H. convergens (43 individuals) were collected in fields from 2004-2005 at Embrapa Hortaliças, Brasília, Federal District. The insects were processed by the acetolysis method and pollen from them was extracted and identified. A total of 11335 grains of pollen belonging to 21 families were extracted from C. externa. A total of 46 pollen grains belonging to ten families were extracted from H. convergens. The Poaceae family was the most abundant one for C. externa while Asteraceae was the commonest pollen for H. convergens. The importance of pollen from different plant species as a food resource for each predator species gives an indication of the importance of plant community structure inside and around crop fields for the establishment of these predator populations and to enhance conservation biological control.

  4. Poor-quality water in swimming pools associated with a substantial risk of otitis externa due to Pseudomonas aeruginosa.

    PubMed

    Hajjartabar, M

    2004-01-01

    There are many large and small public outdoor and indoor swimming pools in Tehran that hundreds of people use, especially on hot summer days. The bacteriological quality of the water of some of these pools was assayed over a period of about one year (2001-2002). To assess if these swimming pools were a health risk to users, eleven public swimming pools, in the east and northeast of the city, were examined, and the exposed people were monitored. Samples of swimming-pool waters were examined for colony counts, Escherichia coli and coliforms. In addition, Pseudomonas aeruginosa was isolated from nine (81.8%) of those pools. P. aeruginosa grew in seven (63.6%) of the swimming-pool water samples. In two (18.2%) other samples, in addition to P. aeruginosa, high rates of total bacterial count, total coliforms and faecal coliform counts were also found. At the same time, users of the swimming pools were asked to complete a questionnaire. Ear swabs were collected from 179 users with a history of ear problems during the previous two weeks. An adequate control group was chosen randomly from those who never used the investigated pools. P. aeruginosa was isolated from the ear swabs of 142 (79.3%) of the cases, as well as from 4% of the controls. Results were matched for age, sex, duration of time spent in the pools, place of occurrence and other useful information. Investigation of the contaminated swimming pools revealed that chlorination was often inadequate, especially when high numbers of people led to overuse of the pools. Although the results of this research showed that otitis externa was strongly associated with the swimming pools, due to P. aeruginosa, an extensive follow-up study is needed to determine the other possible health risks associated with public pools.

  5. Hypoglycemia enhances turnover of corticotropin-releasing factor and of vasopressin in the zona externa of the rat median eminence.

    PubMed

    Berkenbosch, F; De Goeij, D C; Tilders, F J

    1989-07-01

    Insulin administration to overnight fasted rats causes a dose-dependent decline in plasma glucose concentrations and a dose-dependent increase in plasma ACTH concentrations. The ACTH response, but not the glucose response, was blocked by treatment with chlorpromazine-morphine-pentobarbital, indicating that the main factors triggering the ACTH response are of central, rather than peripheral, origin. To study whether insulin affected the turnover of CRF and vasopressin (AVP) in the zona externa of the median eminence (ZEME), we determined the rate of decline of both hypophysiotropic factors in rats with or without blockade of axonal transport by colchicine. In the ZEME, the concentrations of CRF and AVP were assessed by quantitative immunocytochemistry (QICC) in tissue sections or by RIA in median eminence extracts. QICC allows selective quantification of AVP and other peptides within the ZEME. The changes in the CRF content, as measured by QICC and RIA, were linearly correlated (r = 0.99), demonstrating that changes in peptide-staining intensity reflect changes in peptide content. Colchicine, when given intracisternally in a nontoxic dose of 5 micrograms, had no marked effect on resting plasma levels of ACTH and only slightly reduced the ACTH response to insulin-induced hypoglycemia. In the ZEME, CRF and AVP concentrations at rest were not affected by colchicine. In colchicine-treated rats insulin-induced hypoglycemia resulted in a prominent decline in CRF and AVP concentrations in the ZEME. The CRF concentration declined at a rate of 23%/h over a period of 3 h. The AVP concentration declined to a similar extent as CRF over the first hour, but tended to fall at the later time points. We conclude that hypoglycemia increases turnover of both CRF and AVP in the ZEME. However, the turnover rates of both hypophysiotropic peptides do not appear to be quantitatively coupled.

  6. Is anticoagulation required in plasmapheresis? A University Hospital Experience in Bogota, Colombia.

    PubMed

    Córdoba, Juan Pablo; Larrarte, Carolina; Ruiz, Alvaro

    2013-06-01

    Anticoagulation has been considered essential during plasmapheresis. International publications and guidelines state that anticoagulation should be administered during therapy to avoid circuit clotting and impaired effectiveness. However, anticoagulation has also been associated with bleeding, fluid and electrolyte imbalances and hematological alterations. No published studies have looked at the risk to benefit ratio of the common practice of circuit anticoagulation. We describe the experience with 367 plasmapheresis sessions, in the Hospital Universitario San Ignacio, a tertiary care center in Bogota, Colombia, where no anticoagulation is used in any case. Patient characteristics and therapy complications are described. Coagulation of circuit was never reported.

  7. The joint in vitro action of polymyxin B and miconazole against pathogens associated with canine otitis externa from three European countries.

    PubMed

    Pietschmann, Silvia; Meyer, Michael; Voget, Michael; Cieslicki, Michael

    2013-08-01

    Canine otitis externa, an inflammation of the external ear canal, can be maintained and worsened by bacterial or fungal infections. For topical treatment, combinations of anti-inflammatory and antimicrobial ingredients are mainly used. This study was conducted to elucidate the in vitro activity of polymyxin B and miconazole against clinical bacterial isolates from three European countries, to investigate possible differences in sensitivity and to assess drug interactions. Seventeen strains of Escherichia coli, 24 strains of Pseudomonas aeruginosa, 24 strains of Proteus mirabilis and 25 strains of Staphylococcus pseudintermedius from dogs with diagnosed otitis externa had been isolated in Germany, France and Italy. Drug activities were evaluated by minimal inhibitory concentration (MIC) and minimal bactericidal concentration. The potentiation of polymyxin B plus miconazole was calculated using the fractional inhibitory concentration index (FICI). An FICI ≤0.5 defined synergy. Furthermore, geographical variations in the FICI and MIC were assessed by statistical analysis. Bacterial susceptibilities were comparable in different European countries, because there were no significant MIC and FICI variations (P > 0.05). As a single agent, polymyxin B had bactericidal activity against most E. coli and P. aeruginosa strains and, in higher concentrations, against S. pseudintermedius strains. Miconazole was bactericidal against all Staphylococcus strains. Synergy was demonstrated against strains of E. coli and P. aeruginosa (FICI = 0.25 and 0.50, respectively), whereas overall there was no interaction against S. pseudintermedius strains (FICI = 1.25). Proteus mirabilis strains were not inhibited by each of the drugs individually or by their combination. In vitro synergy of polymyxin B and miconazole against E. coli and P. aeruginosa isolates indicates a rationale for applying both agents in combination to treat otitis externa when infected with these types of bacteria.

  8. Impact of a terbinafine-florfenicol-betamethasone acetate otic gel on the quality of life of dogs with acute otitis externa and their owners.

    PubMed

    Noli, Chiara; Sartori, Roberta; Cena, Tiziana

    2017-08-01

    Treatment of canine otitis externa with owner-administered products can be difficult. To evaluate otic treatment administered by a veterinarian on quality of life (QoL) of dogs with otitis externa and their owners, and on clinical and cytology parameters of otitis; compared to an owner-administered treatment. Fifty client-owned dogs randomly randomized into two groups and treated for 2 weeks. Veterinarians treated Group A dogs with a veterinary licensed otic gel on two occasions at a 1 week interval; owners treated Group B dogs once daily with a veterinary licensed otic drop based product along with twice weekly cleaning. Veterinarians evaluated otitis with the OTI-3 scale and semi-quantitative cytological examination on days 0, 7, 14 and 28. At each visit, owners assessed QoL with a validated questionnaire and pruritus with a Visual Analog Scale. Scores before and after treatment of each group, and differences between groups were analysed statistically. In both groups, all parameters improved significantly. There was a significantly higher improvement of QoL scores, for dogs and owners, in Group A, compared to Group B at all time points (P < 0.05), except for owner QoL on Day 28. There was no difference in improvement of OTI-3 between groups at any time point, whereas Group A cytology scores and pruritus improved significantly more by Day 7 (P = 0.0026 and P = 0.0294, respectively). A veterinarian-administered otic gel provided equivalent efficacy and higher QoL to dogs with otitis externa and their owners, compared to an owner-administered topical otic therapy. © 2017 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the ESVD and the ACVD.

  9. Hospital finance.

    PubMed

    Herman, M J

    1998-01-01

    This article summarizes key areas of focus for the analysis of risk in the hospital segment of the health care industry. The article is written from a commercial bank lending perspective. Both for-profit (C-corporations) and 501 (c)(3) not-for-profit segments are addressed.

  10. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  11. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  12. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  13. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  14. [In vivo-efficacy of an ear medication using gelatin powder as a vehicle for the therapy of canine otitis externa].

    PubMed

    Bouassiba, Cosima; Mueller, Ralf S

    2017-08-10

    Otitis externa is normally treated with daily topical medication. Longer application intervals may be useful to facilitate therapy. In this study, the in vivo efficacy of a gel preparation containing marbofloxacin, dexamethasone and enilconazole was compared to that of a commercial otologic agent containing marbofloxacin, dexamethasone and clotrimazole based on clinical signs, ear cytology and bacterial/fungal cultures. A gel preparation (group A) or a registered otologic agent (group B), respectively, was applied to 41 dogs. A total of 50 ears (25 per group) were analysed. The gel preparation was administered on days 0 and 5; the combination preparation was administered daily according to the manufacturer's recommendations. Dogs were reevaluated clinically and cytologically after 5 and 10 days. Initially and after 10 days, ear swabs were taken for bacterial and fungal cultures. No significant clinical or cytological differences were found between the groups. Significantly more isolates resistant to marbofloxacin were identified in group A after 10 days, although >98% of marbofloxacin was still detectable in vitro after 15 days. The clinical and cytological efficacy of a gel containing defined active agents applied twice 5 days apart was comparable to that of an authorised otologic agent applied once daily. There appears to be an increased risk with the gel in that a resistance to fluoroquinolones develops. Local adverse effects are also possible. A gelatine preparation containing active agents may be an alternative to daily topical therapy of canine otitis externa. The development of resistances is possible.

  15. Sheep botfly: ophthalmomyiasis externa.

    PubMed

    Harvey, J T

    1986-04-01

    Sheep botfly (Oestrus ovis) conjunctival infestation is rare in North America but is common in other parts of the world. The author treated 30 patients with this type of conjunctivitis in Jerusalem in 1981 and 1982. The conjunctivitis may vary from mild to severe (pseudo-orbital cellulitis). Features of the conjunctivitis include pale edema, linear superficial punctate keratopathy and the presence of larvae in the conjunctival sac. Conjunctival scrapings revealed a preponderance of polymorphonucleocytes.

  16. Malignant otitis externa

    MedlinePlus

    ... destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if ... nervous system (neurological) exam may show that the cranial nerves are affected. If there is any drainage, the ...

  17. PREJUICIO Y DISTANCIA SOCIAL HACIA PERSONAS HOMOSEXUALES POR PARTE DE JÓVENES UNIVERSITARIOS

    PubMed Central

    Fernández Rodríguez, María del C.; Squiabro, José Calderón

    2014-01-01

    Se realizó un estudio descriptivo transversal con el propósito de explorar actitudes de rechazo y distancia social hacia las personas gays y lesbianas (GL) en 565 universitarios. Se utilizó una escala para medir Prejuicio y otra escala para medir Distancia Social. Los participantes reflejaron niveles moderados de prejuicio y distancia social (DS) hacia las personas gays y lesbianas. Los varones (M=104.5, DT= 27.47) mostraron significativamente más prejuicio que las mujeres (M=98.8, DT= 23.41). Los hombres (M=22.7, DT= 7.00) mostraron significativamente mayor DS que las mujeres (M=21.1, DT= 5.41). Las personas que asisten con regularidad a la iglesia mostraron más prejuicio y DS que los que no asisten. Se analiza importancia de incluir el tema de la diversidad sexual a través del currículo para desmontar prejuicios hacia la comunidad homosexual. PMID:25606066

  18. [Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital].

    PubMed

    Canals Candela, F J; Vizcaíno Díaz, C; Ferrández Berenguer, M J; Serrano Robles, M I; Vázquez Gomis, C; Quiles Durá, J L

    2016-02-01

    Surfactant delivered using a minimally invasive technique, known as MIST (Minimally Invasive Surfactant Therapy) is a method which allows surfactant to be administered to a patient connected to non-invasive respiratory support. This is an increasingly used therapy in Neonatal Units that reduces the intubation rate and the pathology associated with intubation and allows the surfactant to be administered to the patients who clinically need it. In years 2013 and 2014 in the Hospital General Universitario de Elche surfactant was delivered using this method to 19 patients, five of whom were 28 or less weeks of gestation age at birth. A comparison is made with a historical cohort consisting of 28 patients with Respiratory Distress Syndrome treated initially with non-invasive respiratory support. No incidents were recorded that caused the interruption of the administration. A reduction in the fraction of inspired oxygen was observed in all cases after surfactant administration. Fewer intubations in the first 72 hours of life were found in the treatment group compared to the control group (42% vs. 54%). The experience recorded in the Hospital General Universitario de Elche shows that the administration of surfactant using a MIST technique is a reproducible method of treatment, which allows the surfactant distribution during spontaneous breathing with non invasive respiratory support. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  19. [Case reports of drug-induced liver injury in a reference hospital of Zulia state, Venezuela].

    PubMed

    Mengual-Moreno, Edgardo; Lizarzábal-García, Maribel; Ruiz-Soler, María; Silva-Suarez, Niniveth; Andrade-Bellido, Raúl; Lucena-González, Maribel; Bessone, Fernando; Hernández, Nelia; Sánchez, Adriana; Medina-Cáliz, Inmaculada

    2015-03-01

    Drug-induced liver injury (DILI) is an important cause of morbidity and mortality worldwide, with varied geographical differences. The aim of this prospective, descriptive, cross-sectional study was to identify and characterize cases of DILI in a hospital of Zulia state, Venezuela. Thirteen patients with a presumptive diagnosis of DILI attended by the Department of Gastroenterology, Hospital Universitario, Zulia state, Venezuela, from December-2012 to December-2013 were studied. Ibuprofen (n = 3; 23.1%), acetaminophen (n = 3; 23.1), isoniazid (n = 2; 15.4%) and Herbalife products (n = 2; 15.4%) were the main drugs involved with DILI. Acetaminophen and ibuprofen showed a mixed pattern of liver injury (n = 3; 23.1%) and isoniazid presented a hepatocellular pattern (n = 2; 15.4%). The CIOMS/RUCAMS allowed the identification of possible (n = 7; 53.9%), probable (n = 4; 30.8%) and highly-probable cases (n = 2; 15.4%) of DILI. Amoxicillin/clavulanate, isoniazid, isotretinoin, methotrexate and Herbalife nutritional products were implicated as highly-probable and probable agents. The highest percentage of DILI corresponded to mild cases that recovered after the discontinuation of the agent involved (n = 9; 69.3%). The consumption of Herbalife botanical products is associated with probable causality and fatality (n = 1; 7.7%). In conclusion, the frequency of DILI cases controlled by the Department of Gastroenterology of the Hospital Universitario of Maracaibo was low, being ibuprofen, acetaminophen, isoniazid and products Herbalife the products most commonly involved. It is recommended to continue with the prospective registration of cases, with an extended follow up monitoring period and to facilitate the incorporation of other hospitals in the Zulia State and Venezuela.

  20. Can hospitals compete on quality? Hospital competition.

    PubMed

    Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

    2015-09-01

    In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

  1. Changing hospital payments: implications for teaching hospitals.

    PubMed

    Bentley, J D

    1983-09-01

    Hospitals cannot continue to view themselves only as social institutions whose performance will be assessed on the good they do. Teaching hospitals, in particular, cannot view themselves simply as distinctive combinations of social and educational institutions. Under Medicare's prospective pricing system, the hospital's role as production system is enhanced, and all hospitals must learn to balance the new economic realities as they work with their medical staff to adapt to a changed future.

  2. Multiple Hospital Systems and the Teaching Hospital.

    ERIC Educational Resources Information Center

    Levitan, Mark S.

    1979-01-01

    Although a substantial portion of hospital beds are in institutions that are in multiple hospital systems, the possible benefits to be gained through participation in such systems do not appear to be of sufficient magnitude to either core teaching hospitals or their parent universities to persuade them to join or form a multiple system.…

  3. The joint in vitro action of polymyxin B and miconazole against pathogens associated with canine otitis externa from three European countries

    PubMed Central

    Pietschmann, Silvia; Meyer, Michael; Voget, Michael; Cieslicki, Michael

    2013-01-01

    Background Canine otitis externa, an inflammation of the external ear canal, can be maintained and worsened by bacterial or fungal infections. For topical treatment, combinations of anti-inflammatory and antimicrobial ingredients are mainly used. Hypothesis/Objectives This study was conducted to elucidate the in vitro activity of polymyxin B and miconazole against clinical bacterial isolates from three European countries, to investigate possible differences in sensitivity and to assess drug interactions. Animals Seventeen strains of Escherichia coli, 24 strains of Pseudomonas aeruginosa, 24 strains of Proteus mirabilis and 25 strains of Staphylococcus pseudintermedius from dogs with diagnosed otitis externa had been isolated in Germany, France and Italy. Methods Drug activities were evaluated by minimal inhibitory concentration (MIC) and minimal bactericidal concentration. The potentiation of polymyxin B plus miconazole was calculated using the fractional inhibitory concentration index (FICI). An FICI ≤0.5 defined synergy. Furthermore, geographical variations in the FICI and MIC were assessed by statistical analysis. Results Bacterial susceptibilities were comparable in different European countries, because there were no significant MIC and FICI variations (P > 0.05). As a single agent, polymyxin B had bactericidal activity against most E. coli and P. aeruginosa strains and, in higher concentrations, against S. pseudintermedius strains. Miconazole was bactericidal against all Staphylococcus strains. Synergy was demonstrated against strains of E. coli and P. aeruginosa (FICI = 0.25 and 0.50, respectively), whereas overall there was no interaction against S. pseudintermedius strains (FICI = 1.25). Proteus mirabilis strains were not inhibited by each of the drugs individually or by their combination. Conclusions and clinical importance In vitro synergy of polymyxin B and miconazole against E. coli and P. aeruginosa isolates indicates a rationale

  4. Critical Access Hospitals (CAH)

    MedlinePlus

    ... Access Hospital from CMS and Critical Access Hospital Finance 101 Manual from TASC. Furthermore, the Joint Commission ... Hospital Mortgage Insurance Program – helps rural healthcare facilities finance new construction, refinance debt, or purchase new equipment ...

  5. Understanding your hospital bill

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000881.htm Understanding your hospital bill To use the sharing features on this ... help you save money. Charges Listed on Your Hospital Bill A hospital bill will list the major ...

  6. Going to the Hospital

    MedlinePlus

    ... Happens in the Operating Room? Going to the Hospital KidsHealth > For Kids > Going to the Hospital Print ... you flowers, balloons, or other treats! previous continue Hospital People You'll meet lots of people in ...

  7. 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.

  8. Hospital marketing revisited.

    PubMed

    Costello, M M

    1987-05-01

    With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature.

  9. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  10. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  11. Hospital libraries in perspective.

    PubMed Central

    Holst, R

    1991-01-01

    The proliferation of hospital libraries since World War II has created a generation of librarians who take for granted the existence of libraries in hospitals. A literature review for the first half of the twentieth century presents a picture of uncertainty and struggle for identity for the hospital library. Then as now, hospital libraries reflect the institutions within which they operate. A brief history of the development of the American hospital provides a context for describing the various roles that the hospital library has played within its parent institution during the twentieth century. Some personal reflections on working in a hospital library are also presented. PMID:1998812

  12. Competition among hospitals.

    PubMed

    Noether, M

    1988-09-01

    The traditional view of hospital competition has posited that hospitals compete primarily along 'quality' dimensions, in the form of fancy equipment to attract admitting physicians and pleasant surroundings to entice patients. Price competition among hospitals is thought to be non-existent. This paper estimates the effects of various hospital market characteristics on hospital prices and expenses in an attempt to determine the form of hospital competition. The results suggest that both price and quality competition are greater in markets that are less concentrated, although the net effect of the two on prices is insignificant. It appears, therefore, that, despite important distortions, hospital markets are not immune to standard competitive forces.

  13. [Syphilis: Prevalence in a Hospital in Lisbon].

    PubMed

    Lopes, Leonor; Ferro-Rodrigues, Rita; Llobet, Samuel; Lito, Luís; Borges-Costa, João

    2016-01-01

    Introdução: A sífilis é uma doença de transmissão sexual e vertical. A sua incidência está a aumentar na Europa, particularmente em Portugal. Material e Métodos: Estudo retrospetivo baseado na análise laboratorial de testes treponémicos positivos, entre janeiro e dezembro de 2013, no Hospital de Santa Maria. Foram incluídos doentes internados, da consulta externa, do hospital dia e da urgência. Procedeu-se a caraterização epidemiológica, classificação da doença e de fatores de risco associados. Resultados: Obteve-se uma amostra de 484 doentes, após exclusão de 51 por ausência de dados clínicos nos processos e de 45 por valores falsos positivos. Verificou-se predomínio do sexo masculino (75%) e idade média de 47 anos. A maioria (59%) tinha testes serológicos compatíveis com sífilis no passado e 3,7% encontrava-se em vigilância clínica. Diagnosticou-se sífilis primária em 13doentes, secundária em 71, latente precoce em 40, latente indeterminada em 49 e latente tardia em cinco. No grupo sífilis recente, 42% (n = 124) eram seropositivos para o VIH e 8% tiveram, em simultâneo, este diagnóstico. Discussão: Salienta-se a elevada prevalência da coinfeção pelo VIH nos doentes com sífilis recente, reforçando a importância de promover a utilização de medidas preventivas. Registaram-se 11% de formas clínicas tardias, que são de notificação obrigatória desde junho de 2014. Todos os testes serológicos para o diagnóstico de sífilis apresentam limitações, o que enfatiza a importância da correlação clínico-laboratorial. Conclusão: A sífilis continua a ser um problema de saúde pública pelo que é necessário estabelecer programas de educação, rastreio e follow-up para reduzir a sua prevalência e tornar mais eficiente o rastreio dos parceiros.

  14. Antimicrobial resistance, integron carriage, and gyrA and gyrB mutations in Pseudomonas aeruginosa isolated from dogs with otitis externa and pyoderma in Brazil.

    PubMed

    Arais, Lavicie R; Barbosa, André V; Carvalho, Cristiane A; Cerqueira, Aloysio M F

    2016-04-01

    Pseudomonas aeruginosa is associated with otitis and pyoderma in dogs and is frequently resistant to several antimicrobial drugs. Resistance genes can be carried by integrons with quinolone resistance mainly due to mutations in DNA topoisomerases II and IV. To evaluate the antimicrobial susceptibility, integron carriage, and gyrA and gyrB mutations in P. aeruginosa isolates from canine otitis and pyoderma. One hundred and four P. aeruginosa strains isolated from dogs with otitis externa (n = 93) and pyoderma (n = 11). Antimicrobial susceptibility against 16 antibacterial agents was evaluated through agar diffusion tests. Integron carriage, class and gyrA and gyrB mutations were analysed by PCR, restriction fragment length polymorphism (RFLP)-PCR and genetic sequencing assays. Isolates were mostly resistant to enrofloxacin (72.2%) and ticarcillin (59.7%). Lower resistance to ciprofloxacin (7.7%), tobramycin (3.8%) and polymixin B (0.0%) was detected. Ten (9.6%) multidrug-resistant (MDR) strains were detected. Eight (7.7%) strains carried class 1 integrons and this was associated with MDR (three isolates, P ≤ 0.05). Five of the integron-carrying strains exhibited aminoglycoside resistance genes. Mutations of gyrA and gyrB were observed in 10 isolates, seven of them resistant to all fluoroquinolones tested. Enrofloxacin and ticarcilin resistance was widespread in P. aeruginosa isolated from dogs in Brazil. Pseudomonas aeruginosa carrying integrons may present a significant challenge for treatment. © 2016 ESVD and ACVD.

  15. Hospitable Classrooms: Biblical Hospitality and Inclusive Education

    ERIC Educational Resources Information Center

    Anderson, David W.

    2011-01-01

    This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

  16. The application of hospitality elements in hospitals.

    PubMed

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

    In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

  17. Assessment of the outcomes of the treatment of Cushing's disease in the hospitals of Castilla-La Mancha.

    PubMed

    Huguet, Isabel; Aguirre, Miguel; Vicente, Almudena; Alramadan, Mubarak; Quiroga, Iván; Silva, Julia; Lamas, Cristina

    2015-05-01

    Treatment of Cushing's disease poses interesting dilemmas in clinical practice. The aim of our study was to analyze the outcomes of the different treatments, the control and recurrence rates, and the complications derived from them. Data were collected from the clinical records of 22 patients over 18 years of age (86.4% women). They had been diagnosed with Cushing's disease between 2000 and 2012, and were monitored at Complejo Hospitalario Universitario-Albacete, Hospital Virgen de la Salud-Toledo Hospital General Universitario de Ciudad Real, Hospital Virgen de la Luz-Cuenca, Hospital Nuestra Señora del Prado-Talavera de la Reina, and Complejo Hospitalario la Mancha Centro-Alcázar de San Juan. Surgery was the treatment of choice in all patients. Biochemical cure was achieved in 72.2% of patients. Nine patients developed in the early postoperative period diabetes insipidus, which became in 2 patients only. Surprisingly, 3 patients with normal postoperative neurohypophyseal function later developed permanent diabetes insipidus. New hormone deficiencies occurred in 7 patients. Seventeen patients received ketoconazole before surgery (5 of them after surgery also), and 70% of them achieved normal urinary free cortisol levels. Three patients also received radiotherapy, and all of them were cured after a median follow-up of 85.5 months; they developed no tumors or other complications. Our study reports the outcomes of management of Cushing's disease in non-reference centers for this disease, possibly giving a realistic picture of standard clinical practice for the condition in Spain. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  18. Hospitals as health educators

    MedlinePlus

    ... than your local hospital. From health videos to yoga classes, many hospitals offer information families need to ... care and breastfeeding Parenting Baby sign language Baby yoga or massage Babysitting courses for teens Exercise classes ...

  19. Help prevent hospital errors

    MedlinePlus

    ... www.ncbi.nlm.nih.gov/pubmed/23330698 . The Joint Commission. Hospital: 2014 National Patient Safety Goals. www.jointcommission. ... October 24, 2014. Accessed October 27, 2016. The Joint Commission. Hospital: 2016 National Patient Safety Goals. Updated January ...

  20. Hospital Dermatology, Introduction.

    PubMed

    Fox, Lindy P

    2017-03-01

    Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.

  1. Plasma and ear tissue concentrations of enrofloxacin and its metabolite ciprofloxacin in dogs with chronic end-stage otitis externa after intravenous administration of enrofloxacin.

    PubMed

    Cole, Lynette K; Papich, Mark G; Kwochka, Kenneth W; Hillier, Andrew; Smeak, Daniel D; Lehman, Amy M

    2009-02-01

    The purpose of this study was to measure the concentrations of enrofloxacin and its metabolite ciprofloxacin following intravenous administration of enrofloxacin in the plasma and ear tissue of dogs with chronic end-stage otitis undergoing a total ear canal ablation and lateral bulla osteotomy. The goals were to determine the relationship between the dose of enrofloxacin and the concentrations of enrofloxacin and ciprofloxacin, and determine appropriate doses of enrofloxacin for treatment of chronic otitis externa and media. Thirty dogs were randomized to an enrofloxacin-treatment group (5, 10, 15 or 20 mg kg(-1)) or control group (no enrofloxacin). After surgical removal, ear tissue samples (skin, vertical ear canal, horizontal ear canal, middle ear) and a blood sample were collected. Concentrations of enrofloxacin and ciprofloxacin in the plasma and ear tissue were measured by high performance liquid chromatography. Repeated measures models were applied to log-transformed data to assess dosing trends and Pearson correlations were calculated to assess concentration associations. Ear tissue concentrations of enrofloxacin and ciprofloxacin were significantly (P < 0.05) higher than plasma concentrations. Each 5 mg kg(-1 )increase in the dose of enrofloxacin resulted in a 72% and 37% increase in enrofloxacin and ciprofloxacin concentrations, respectively. For bacteria with an minimal inhibitory concentration of 0.12-0.15 or less, 0.19-0.24, 0.31-0.39 and 0.51-0.64 microg mL(-1), enrofloxacin should be dosed at 5, 10, 15 and 20 mg kg(-1), respectively. Treatment with enrofloxacin would not be recommended for a bacterial organism intermediate or resistant in susceptibility to enrofloxacin since appropriate levels of enrofloxacin would not be attained.

  2. Positioning hospitals: a model for regional hospitals.

    PubMed

    Reddy, A C; Campbell, D P

    1993-01-01

    In an age of marketing warfare in the health care industry, hospitals need creative strategies to compete successfully. Lately, positioning concepts have been added to the health care marketer's arsenal of strategies. To blend theory with practice, the authors review basic positioning theory and present a framework for developing positioning strategies. They also evaluate the marketing strategies of a regional hospital to provide a case example.

  3. 2. View northwest of main hospital building complex, hospital building ...

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

    2. View northwest of main hospital building complex, hospital building (Building 90), administration and clinical hospital building (Building 88), and hospital building (Building 91) - National Home for Disabled Volunteer Soldiers Western Branch, 4101 South Fourth Street, Leavenworth, Leavenworth County, KS

  4. 567 Prevalence of Skin Reactivity to Blomia Tropicalis Antigen in Patients with Respiratory Allergy at Hospital Universitario De Puebla

    PubMed Central

    Martínez Villegas, Erica Marisol

    2012-01-01

    Background Published studies shows that the sensitization to Blomia tropicalis mite plays an important roll on the development of allergic diseases. The aim of our study is to determinate the prevalence to skin reactivity to Blomia tropicalis' antigen in patients with respiratory allergy. Methods We conducted a descriptive, observational, prospective and transversal study being the criteria for inclusion: male and female patients aged 2 to 58 who came for first time at our service with diagnosis of asthma, rhinitis or asthma more rhinitis. We evaluated the skin reactivity by skin prick test to Blomia tropicalis' antigen. Descriptive statistics was implemented by estimating summary measures and dispersion. Results From a total of 110 patients, their mean age was 16.25 (2–58), 50% were males, 92% were from urban areas and 7.3% from rural areas. Of the patients studied 2.7% had asthma, 73.6% had rhinitis and 23.6% both diagnoses. The prevalence of positive skin reactivity to Blomia tropicalis was 24.5%. The prevalence of positive skin reactivity for the rhinitis subgroup was 59.3% and for the asthma/rhinitis subgroup was 40.7%, while in the asthma subgroup the prevalence was 0%. Conclusions The high prevalence of skin reactivity to Blomia tropicalis indicated the importance of including Blomia tropicalis in routine diagnostic testing and immunotherapy treatment.

  5. [Dental treatment under general anesthesia offered at the Hospital Pediátrico Universitario de Puerto Rico during the years 1989-1994].

    PubMed

    Machuca, M C; Vélez, A; Machuca, G; Tormos, H L; Nieves, E; Bullón Fernández, P

    1996-12-01

    One hundred and fourteen mentally retarded (MR) and non-mentally retarded (NMR) patients were divided into two groups and categorized according to the condition presented. Age, sex, and type of procedure performed were recorded for each patient. On the MR group 32% were over 17 years of age. On the NMR group 51% were under 6 years of age. The sex distribution was similar in both groups. Exodontia was the most frequently performed dental procedure. The MR group was composed of those who presented only mental retardation (42%), cerebral palsy (17%), epilepsy (15%), syndromes (7%), endocrinopathies (7%), hydrocephalus (5%) and other conditions (7%). The NMR group was composed of those who presented cardiopathy (7%), bottle syndrome (42%), hemotopathy (11%), maxillofacial disorders (24%) and other conditions (16%).

  6. Hospital diversification strategy.

    PubMed

    Eastaugh, Steven R

    2014-01-01

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

  7. The influence of changes in hospital drug formulary on the prescription of proton pump inhibitors.

    PubMed

    Vázquez-Mourelle, Raquel; Carracedo-Martínez, Eduardo

    2017-01-01

    Objetivo: Analizar el impacto de introducir el omeprazol en el formulario del Hospital de Barbanza sobre las prescripciones intrahospitalarias y extrahospitalarias (consultas externas y atención primaria) de todos los Inhibidores de la Bomba de Protones (IBP). Material y métodos: Estudio descriptivo retrospectivo de 36 meses en un hospital de nivel I. Las unidades básicas de trabajo son las dosis-habitantes-día en el ámbito extrahospitalario y las dosis diarias definidas/estancias-día para hospitalización; como medida de eficiencia se utiliza el porcentaje de DDD de omeprazol sobre el resto de IBP. Para el análisis estadístico construimos un modelo de regresión segmentada. Resultados: En consultas externas sufren cambios estadísticamente significativos el pantoprazol y el rabeprazol; el primero, estacionado antes de la intervención, sufre una disminución inmediata; el rabeprazol, en crecimiento antes de la intervención, presenta una posterior tendencia decreciente. En atención primaria se constata un cambio estadísticamente significativo en el pantoprazol, con tendencia decreciente a largo plazo. En hospitalización se observan cambios estadísticamente significativos para el pantoprazol y el omeprazol; el primero con disminución inmediata y tendencia al decrecimiento a largo plazo; el segundo experimenta un aumento inmediato y crecimiento a largo plazo. La evolución del % de omeprazol respecto al total de IBP mostró aumentos en los tres escenarios. Conclusiones: Se observa un cambio hacia una prescripción de IBP más eficiente en todos los ámbitos asistenciales tras la introducción del omeprazol en la guía farmacoterapéutica del hospital. La inclusión de medicamentos eficientes, o la retirada de ineficientes, puede ser una herramienta potencialmente útil para mejorar los perfiles de prescripción.

  8. Measuring hospital competition.

    PubMed

    White, S L; Chirikos, T N

    1988-03-01

    This paper appraises the use of the Herfindahl market share index as an exogenous competition variable in empirical studies of the hospital sector. An analysis of cross-sectional Florida data shows that this index itself is significantly influenced by the demand and supply factors commonly included in econometric models of hospital performance. The analysis then illustrates that biased inferences about the effects of market competition on the costs of hospital care may result unless the values of the Herfindahl Index are treated endogenously in hospital cost models.

  9. Central line infections - hospitals

    MedlinePlus

    ... infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired infection - central line infection; Patient safety - central ...

  10. An optimization design proposal of automated guided vehicles for mixed type transportation in hospital environments

    PubMed Central

    González, Domingo; Espinosa, María del Mar; Domínguez, Manuel

    2017-01-01

    Aim The aim of this paper is to present an optimization proposal in the automated guided vehicles design used in hospital logistics, as well as to analyze the impact of its implementation in a real environment. Method This proposal is based on the design of those elements that would allow the vehicles to deliver an extra cart by the towing method. So, the proposal intention is to improve the productivity and the performance of the current vehicles by using a transportation method of combined carts. Results The study has been developed following concurrent engineering premises from three different viewpoints. First, the sequence of operations has been described, and second, a proposal of design of the equipment has been undertaken. Finally, the impact of the proposal has been analyzed according to real data from the Hospital Universitario Rio Hortega in Valladolid (Spain). In this particular case, by the implementation of the analyzed proposal in the hospital a reduction of over 35% of the current time of use can be achieved. This result may allow adding new tasks to the vehicles, and according to this, both a new kind of vehicle and a specific module can be developed in order to get a better performance. PMID:28562681

  11. Virtual Pediatric Hospital

    MedlinePlus

    ... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

  12. [Music in the hospital].

    PubMed

    Bouteloup, Philippe

    2010-01-01

    Occasional events, regular workshops, concerts, shows, artists in residence, cultural outings...Hospital does not necessarily have to be a place of silence and sadness. But this situation has not always been so straightforward as on the face of it, nothing is more incompatible with a hospital environment than music, which, by definition, is festive and noisy.

  13. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

    Designed for both hospital personnel interested in television and audiovisual personnel entering the medical field, this handbook is a verbal and pictorial survey of what is being done with TV within the medical profession. After an introduction which answers technical questions about medical TV posed during the American Hospital Association's…

  14. Hospitality Occupations. Curriculum Guide.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento. Bureau of Homemaking Education.

    This curriculum guide on the hospitality occupations was developed to help secondary and postsecondary home economics teachers prepare individuals for entry-level jobs in the hospitality industry. The content is in seven sections. The first section presents organizational charts of a medium-size hotel, food and beverage division, housekeeping and…

  15. Hospitality, Tourism, and Recreation.

    ERIC Educational Resources Information Center

    Novachek, James

    The Northern Arizona Hospitality Education Program is an exemplary three-year project designed to help students, mainly Indian, obtain job skills and attitudes necessary for successful employment in the hospitality industry. Nine high schools from Apache, Coconino, and Navajo Counties participated in the project. Objectives included providing an…

  16. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

  17. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

  18. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

  19. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

  20. Hospitals are dangerous places.

    PubMed

    de Richemond, Albert L

    2010-01-01

    Hospital fire dangers are real, widespread, and ever present, the article demonstrates, spelling out the locations, conditions, and ignition potentials which exist in such a setting. Knowledge of codes and standards, good maintenance practices, and frequent drills in fire prevention and suppression are among the practices recommended for keeping a hospital fire from becoming a disaster, the author says.

  1. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

    Designed for both hospital personnel interested in television and audiovisual personnel entering the medical field, this handbook is a verbal and pictorial survey of what is being done with TV within the medical profession. After an introduction which answers technical questions about medical TV posed during the American Hospital Association's…

  2. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-01-04

    Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 per day, according to the Royal College of Physicians (RCP).

  3. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-01-31

    Essential facts Falls are the most frequently reported adverse events in hospitals, especially among older patients. According to the Royal College of Physicians (RCP) more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wale.

  4. Hospitality services generate revenue.

    PubMed

    Bizouati, S

    1993-01-01

    An increasing number of hospitals are undertaking external revenue-generating activities to supplement their shrinking budgets. Written at the request of Leadership, this article outlines an example of a successful catering service -- a money-generating business that more Canadian hospitals could profitably consider.

  5. Leading a hospital closure.

    PubMed

    Lucey, Paula A

    2002-01-01

    Hospital closures have become more common. The challenges facing a nursing leader in this situation are complex and difficult. This author suggests that looking for new beginnings rather than focusing on endings created an approach to closing a public hospital. The article includes approaches to employee morale, staffing, and patient care.

  6. Hospital benefit segmentation.

    PubMed

    Finn, D W; Lamb, C W

    1986-12-01

    Market segmentation is an important topic to both health care practitioners and researchers. The authors explore the relative importance that health care consumers attach to various benefits available in a major metropolitan area hospital. The purposes of the study are to test, and provide data to illustrate, the efficacy of one approach to hospital benefit segmentation analysis.

  7. Competition among hospitals.

    PubMed

    Gaynor, Martin; Vogt, William B

    2003-01-01

    We examine competition in the hospital industry, in particular the effect of ownership type (for-profit, not-for-profit, government). We estimate a structural model of demand and pricing in the hospital industry in California, then use the estimates to simulate the effect of a merger. California hospitals in 1995 face an average price elasticity of demand of -4.85. Not-for-profit hospitals face less elastic demand and act as if they have lower marginal costs. Their prices are lower than those of for-profits, but markups are higher. We simulate the effects of the 1997 merger of two hospital chains. In San Luis Obispo County, where the merger creates a near monopoly, prices rise by up to 53%, and the predicted price increase would not be substantially smaller were the chains not-for-profit.

  8. Medication safety in hospitals.

    PubMed

    Kirke, C

    2009-01-01

    Medication error and adverse drug reactions occur frequently, leading to a high burden of patient harm in the hospital setting. Many Irish hospitals have established medication safety initiatives, designed to encourage reporting and learning to improve medication use processes and therefore patient safety. Eight Irish hospitals or hospital networks provided data from voluntary medication safety incident and near miss reporting programmes for pooled analysis of events occurring between 1st January 2006 and 30th June 2007. 6179 reports were received in total (mean 772 per hospital; range 96-1855). 95% of reports did not involve patient harm. Forty seven percent of reports related to the prescribing stage of the medication use process, 40% to the administration stage and 9% to the pharmacy dispensing stage. This data is published to increase awareness of this key patient safety issue, to share learning from these incidents and near misses and to encourage a more open patient safety culture.

  9. Quality of nursing documentation before and after the Hospital Accreditation in a university hospital.

    PubMed

    Nomura, Aline Tsuma Gaedke; Silva, Marcos Barragan da; Almeida, Miriam de Abreu

    2016-11-21

    , haciendo uso del Quality of Nursing Diagnoses, Interventions and Outcomes - Versión brasileña (Q-DIO- Versión brasileña). estudio observacional de intervenciones realizado en un hospital universitario. Los registros de enfermería de 112 historias clínicas del período anterior y 112 historias clínicas del período posterior a la acreditación hospitalaria se compararon mediante el instrumento Q-DIO - Versión brasileña. Los datos fueron analizados estadísticamente. se observó una mejora significativa de la calidad de los registros de enfermería. Cuando se evaluó la puntuación total del instrumento, se observó una mejora significativa en 24 de los 29 ítenes (82,8%). hubo un compromiso con el cambio en la cultura por medio de las intervenciones realizadas, lo que resultó en la conquista del sello de calidad garantizado por la Joint Commission International.

  10. Material Logistic Support of the Hospital Ships

    DTIC Science & Technology

    1986-12-01

    Replacement of Spectacles Only, Required 229) Otitis Externa-Moderate--All Cases 230) Otitis Media , Acute, Suppurative -Moderate-All Cases 231...operational control of the Mercy, actual operation of the ship, except the medical treatment facility, will be performed by the civilian crew. This...would also provide standard postal, ship’s store, barber shop, laundry and food services. Equipment belonging to the medical treatment facility and the

  11. Guide to Choosing a Hospital

    MedlinePlus

    ... you visit Hospital Compare, finding information about the quality of hospitals is just a few steps away: • Click on “Find and Compare Hospitals,” and decide if you want to look for hospitals by the hospital name, or by ZIP Code, City, State or Territory, or County. • Select General Search, ...

  12. Hospitality as an Environmental Metaphor.

    ERIC Educational Resources Information Center

    Horwood, Bert

    1991-01-01

    Compares stewardship and hospitality as they relate to the biosphere. Traces the origin of the word "hospitality," discusses cultural traditions of hospitality, and applies the concept of hospitality to the natural world. Considers forms of symbiosis in nature: commensals, mutualism, and parasitism. Hospitality promotes respect,…

  13. Philanthropy and hospital financing.

    PubMed Central

    Smith, D G; Clement, J P; Wheeler, J R

    1995-01-01

    OBJECTIVE. This study explores the relationships among donations to not-for-profit hospitals, the returns provided by these hospitals, and fund-raising efforts. It tests a model of hospital behavior and addresses an earlier debate regarding the supply price of donations. DATA SOURCES. The main data source is the California Office of Statewide Health Planning data tapes of hospital financial disclosure reports for fiscal years 1980/1981 through 1986/1987. Complete data were available for 160 hospitals. STUDY DESIGN. Three structural equations (donations, returns, and fund-raising) are estimated as a system using a fixed-effects, pooled cross-section, time-series least squares regression. PRINCIPAL FINDINGS. Estimation results reveal the expected positive relation between donations and returns. The reverse relation between returns and donations is insignificant. The estimated effect of fund-raising on donations is insignificantly different from zero, and the effect of donations on fund-raising is negative. Fund-raising and returns are negatively associated with one another. CONCLUSION. The empirical results presented here suggest a positive donations-returns relations and are consistent with a positive supply price for donations. Hospitals appear to view a trade-off between providing returns and soliciting donations, but donors do not respond equally to these two activities. Attempts to increase free cash flow through expansion of community returns or fund-raising activity, at least in the short run, are not likely to be highly successful financing strategies for many hospitals. PMID:8537223

  14. Hospitals' Internal Accountability

    PubMed Central

    Kraetschmer, Nancy; Jass, Janak; Woodman, Cheryl; Koo, Irene; Kromm, Seija K.; Deber, Raisa B.

    2014-01-01

    This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements. PMID:25305387

  15. Hospitalizations for pediatric anaphylaxis.

    PubMed

    Calvani, M; Di Lallo, D; Polo, A; Spinelli, A; Zappalà, D; Zicari, A M

    2008-01-01

    The aim of the study is to examine the epidemiology of anaphylaxis in hospitalized children in Lazio (Central Italy) and to evaluate the incidence and case fatality rate. We also verified the concordance of diagnosis between the Emergency Department and Ordinary hospitalizations. In order to obtain these results, we reviewed all ICD-9 codes indicative of anaphylaxis in all primary and secondary diagnoses from 2000 to 2003 in all Emergency Departments, Ordinary Hospitalizations and Day Hospitals in Lazio. We then identified 203 ICD-9 diagnoses of anaphylaxis in children aged between 0 and 17 years. Anaphylactic shock (995.0) accounted for 109 (53.7%) of cases. Food anaphylaxis (995.60 onwards) accounted for 87 (43.0%) of cases. Food anaphylaxis was more frequent in the first years of life. In fact, it decreased from 12.5/100,000 resident children/year in the first year of life to 6.1/100,000 resident children/year in the first two years of life, and less than 3/100,000 resident children/year after the seventh year (p <0.001). Only 12.5% of cases of anaphylaxis diagnosed in Ordinary Hospitalizations were subsequently diagnosed by the Emergency Department as anaphylaxis. Moreover, only 42.3% of the diagnoses of anaphylaxis made in the Emergency Department were later confirmed during ordinary hospitalization. In the four years of study, one child died from anaphylaxis. Thus, mortality was 0.038 cases/100,000 resident children/year. In conclusion, the incidence of hospitalization was highest in the first years of life, during which food anaphylaxis accounted for most hospitalizations. The inconsistency of diagnoses between Emergency Departments and Ordinary Hospitalizations suggests the need to increase awareness of anaphylaxis among health workers.

  16. Predicting hospital accounting costs

    PubMed Central

    Newhouse, Joseph P.; Cretin, Shan; Witsberger, Christina J.

    1989-01-01

    Two alternative methods to Medicare Cost Reports that provide information about hospital costs more promptly but less accurately are investigated. Both employ utilization data from current-year bills. The first attaches costs to utilization data using cost-charge ratios from the previous year's cost report; the second uses charges from current year's bills. The first method is the more accurate of the two, but even using it, only 40 percent of hospitals had predicted costs within plus or minus 5 percent of actual costs. The feasibility and cost of obtaining cost reports from a small, fast-track sample of hospitals should be investigated. PMID:10313352

  17. Hospital service recovery.

    PubMed

    Gutbezahl, Cary; Haan, Perry

    2006-01-01

    An organization's ability to correct service errors is an important factor in achieving success in today's service economy. This paper examines service recovery in hospitals in the U.S. First is a general review of service recovery theories. Next is a discussion of specific service issues related to the hospital environment. The literature on service recovery is used to make specific recommendations to hospitals for ways to improve their ability to remedy service errors when they occur. Suggestions for future research in the field of service recovery are also made.

  18. Hospital capital funding.

    PubMed

    Hebert, M

    1992-01-01

    It is critical that hospitals have a long-range plan in place to ensure that buildings and equipment are replaced when necessary. A study undertaken in British Columbia contrasted the Greater Vancouver Regional Hospital District's capital plan (past and future) to a proposed capital replacement model. The model, developed using accepted industry standards and criteria, provided an asset value that was used for comparison purposes. Building and equipment expenditures of the Surrey Memorial Hospital were also compared against the model. Findings from both studies are presented in this article.

  19. Role of the Hospital Library Within the Hospital System *†

    PubMed Central

    Lorenzi, Nancy M.

    1969-01-01

    The results of a survey of hospital administrators, attending staff and house staff physicians, librarians, library committee chairmen, and nursing staff in five Northeastern Ohio hospitals concerning the status of the hospital library within the total hospital system are related. Results indicate that hospital libraries operate in the “fringe” area of the hospital system. A concentric-circle figure indicates the present position of the majority of hospital libraries surveyed. The future relationship of the library within the hospital system has also been represented by a concentric-circle figure. PMID:5778727

  20. Hospital free cash flow.

    PubMed

    Kauer, R T; Silvers, J B

    1991-01-01

    Hospital managers may find it difficult to admit their investments have been suboptimal, but such investments often lead to poor returns and less future cash. Inappropriate use of free cash flow produces large transaction costs of exit. The relative efficiency of investor-owned and tax-exempt hospitals in the product market for hospital services is examined as the free cash flow theory is used to explore capital-market conditions of hospitals. Hypotheses concerning the current competitive conditions in the industry are set forth, and the implications of free cash flow for risk, capital-market efficiency, and the cost of capital to tax-exempt institution is compared to capital-market norms.

  1. American Hospital Association

    MedlinePlus

    ... Educational Trust HRET Main page HRET Hospital Improvement Innovation Network Equity of Care Huddle for Care The Symposium for Leaders in Healthcare Quality SLHQ Main page Research & Trends Research & Trends AHA Policy Research Reports Chartbook Financial ...

  2. General Practitioners in Hospital

    PubMed Central

    Smith, J. Weston; O'Donovan, J. B.

    1970-01-01

    An acute general hospital of 68 beds at Tamworth, a Midland town of 50,000 people, is staffed by general practitioners for both inpatient and casualty work. During the period 1967-8 there were 889 general practitioner admissions to the hospital for intermediate surgical and medical care, the average length of stay being 6·3 days and the average cost per case £44·3. Of these patients 96 were transferred to other hospitals. The patients, doctors, and standard of medical care have benefited from this kind of service. A “satellite” hospital of this type therefore has an important role in the community for carefully selected types of cases. PMID:5429111

  3. Home versus hospital confinement

    PubMed Central

    Barry, C. N.

    1980-01-01

    The case for hospital rather than home delivery has been powerfully argued, especially in and since the Report of the Peel Committee. Nevertheless, evidence of comparison with other countries, notably the Netherlands, suggests the choice is not necessarily simple. Some general practitioner units are now reporting perinatal mortality rates which are consistently lower than those of specialist units, and recent statistical analyses suggest that the presence of more high risk cases in consultant units does not explain this. The only big controlled home-versus-hospital trial did not lead to a significantly lower perinatal mortality rate in the hospital group. The onus of proof now seems to lie with those who advocate 100 per cent hospital confinement. PMID:7373581

  4. Objections to hospital philosophers.

    PubMed Central

    Ruddick, W; Finn, W

    1985-01-01

    Like morally sensitive hospital staff, philosophers resist routine simplification of morally complex cases. Like hospital clergy, they favour reflective and principled decision-making. Like hospital lawyers, they refine and extend the language we use to formulate and defend our complex decisions. But hospital philosophers are not redundant: they have a wider range of principles and categories and a sharper eye for self-serving presuppositions and implicit contradictions within our practices. As semi-outsiders, they are often best able to take an 'external point of view,' unburdened by routine, details, and departmental loyalties. Their clarifications can temporarily disrupt routine, but can eventually improve staff morale, hence team practice and patient welfare. PMID:3981573

  5. Hospital-acquired thrombocytopenia.

    PubMed

    McMahon, Christine M; Cuker, Adam

    2014-10-01

    The development of thrombocytopenia is common in hospitalized patients and is associated with increased mortality. Frequent and important causes of thrombocytopenia in hospitalized patients include etiologies related to the underlying illness for which the patient is admitted, such as infection and disseminated intravascular coagulation, and iatrogenic etiologies such as drug-induced immune thrombocytopenia, heparin-induced thrombocytopenia, posttransfusion purpura, hemodilution, major surgery, and extracorporeal circuitry. This review presents a brief discussion of the pathophysiology, distinguishing clinical features, and management of these etiologies, and provides a diagnostic approach to hospital-acquired thrombocytopenia that considers the timing and severity of the platelet count fall, the presence of hemorrhage or thrombosis, the clinical context, and the peripheral blood smear. This approach may offer guidance to clinicians in distinguishing among the various causes of hospital-acquired thrombocytopenia and providing management appropriate to the etiology.

  6. Practice Hospital Bed Safety

    MedlinePlus

    ... 1, 1985 and January 1, 2013, FDA received reports of 901 incidents of patients caught, trapped, entangled, or strangled in ... Use Todd says there have been very few reports of safety incidents with hospital beds used in private residences. "This ...

  7. Fast tracking hospital construction.

    PubMed

    Quirk, Andrew

    2013-03-01

    Hospital leaders should consider four factors in determining whether to fast track a hospital construction project: Expectations of project length, quality, and cost. Whether decisions can be made quickly as issues arise. Their own time commitment to the project, as well as that of architects, engineers, construction managers, and others. The extent to which they are willing to share with the design and construction teams how and why decisions are being made.

  8. Managing diversity in hospitals.

    PubMed

    Schwartz, R H; Sullivan, D B

    1993-01-01

    Hospital work force diversity, although potentially a source of creativity and improved problem solving, is often a source of political strife and the mistreatment of people based on their identification with one or another of the diverse groups that are employed in hospitals. Factors linked to these phenomena are discussed and are the basis for suggestions about how administrators can deal with the organizational pathologies that are often associated with unmanaged work force diversity.

  9. [Hospital organizational structure].

    PubMed

    Bittar, O J

    1994-01-01

    The basic point for an Institution to work is the existence of a definite organizational structure that puts together similar areas allowing decisions and the operationalization of different tasks. Knowledge and analysis of structures of private and public hospitals and a bibliography review about the issue is the purpose of this paper. Suggestions are given about the elaboration of small structures and the utilization of matrix management in order to accomplish the hospitals objectives.

  10. Salaries in psychiatric hospitals.

    PubMed

    Pope, D W

    1989-01-01

    The National Association of Private Psychiatric Hospitals has been surveying hospitals for the past several years. This paper focuses on the salary levels and average annual rates of increase for a few selected positions. Comparisons are made with data from surveys covering similar positions in other settings and with the Consumer Price Index. Annual rates of increase are reported for five- and ten-year periods.

  11. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-02-27

    Essential facts Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 a day, according to the Royal College of Physicians (RCP). But research shows that when nurses, doctors and therapists work together, falls can be reduced by 20-30%.

  12. Recurrent psychiatric hospitalization.

    PubMed Central

    Voineskos, G.; Denault, S.

    1978-01-01

    Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community. PMID:630483

  13. Hospital Waste Management in Nonteaching Hospitals of Lucknow City, India

    PubMed Central

    Manar, Manish Kumar; Sahu, Krishna Kumar; Singh, Shivendra Kumar

    2014-01-01

    Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW) management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices. PMID:25657950

  14. Effect of Hospital Ownership on Outcomes of Heart Failure Hospitalization.

    PubMed

    Akintoye, Emmanuel; Briasoulis, Alexandros; Egbe, Alexander; Orhurhu, Vwaire; Ibrahim, Walid; Kumar, Kartik; Alliu, Samson; Nas, Hala; Levine, Diane; Weinberger, Jarrett

    2017-09-01

    This study aimed to evaluate the impact of hospital ownership on heart failure (HF) hospitalization outcomes in the United States using data from the National Inpatient Sample of the Agency for Healthcare Research and Quality. Hospital ownership was classified into three, namely, nonfederal government, not-for-profit, and for-profit hospitals. Participants were adults hospitalized with a primary diagnosis of HF (2013 to 2014). End points included inpatient mortality, length-of-stay, cost and charge of hospitalization, and disposition at discharge. Of the estimated 1.9 million HF hospitalizations in the United States between 2013 and 2014, 73% were in not-for-profit hospitals, 15% were in for-profit hospitals, and 12% were in nonfederal government hospitals. Overall, mortality rate was 3%, mean length of stay was 5.3 days, median cost of hospitalization was USD 7,248, and median charge was USD 25,229, and among those who survived to hospital discharge, 51% had routine home discharge. There was no significant difference in inpatient mortality between hospital ownership among male patients, but there was a significant difference for female patients. Compared with government hospitals, mortality in female patients was lower in not-for-profit (odds ratio: 0.85 [95% confidence interval: 0.77 to 0.94]) and for-profit hospitals (odds ratio: 0.77 [0.68 to 0.87]). In addition, mean length of stay was highest in not-for-profit hospitals (5.4 days) and lowest in for-profit hospitals (5 days). Although cost of hospitalization was highest in not-for-profit hospitals (USD 7462) and lowest in for-profit hospitals (USD 6,290), total charge billed was highest in for-profit hospitals (USD 35,576) and lowest in government hospitals (USD 19,652). The average charge-to-cost ratio was 3:1 for government hospitals, 3.5:1 for not-for-profit hospitals, and 5.9:1 for for-profit hospitals. In conclusion, there exist significant disparities in HF hospitalization outcomes between hospital

  15. 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

  16. Hospitals look to hospitality service firms to meet TQM goals.

    PubMed

    Hard, R

    1992-05-20

    Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

  17. Oncology outside hospital: a new experience for the benefit of longer survivors.

    PubMed

    Camps, Carlos; Iranzo, Vega; Caballero, Cristina; Blasco, Ana; Godes, María José; Safont, María José; Blasco, Sergio; Mengual, Gloria; Berrocal, Alfonso; Sirera, Rafael

    2011-04-01

    In May 2007, the Consorcio Hospital General Universitario de Valencia created the position of "Liaison Oncologist". The holder of this position is responsible for coordinating specialised and primary hospital care in the geographic area of Valencia known as Health Care Department 9 to reduce the waiting time between cancer diagnosis and treatment. In this article we describe the implementation of the innovative proposal of the Liaison Oncologist's Consultation Clinic, which, apart from speeding up and directing diagnostic processes, facilitates access to treatment, prevents duplication of consultations and exploratory procedures by establishing therapeutic plans (preferential channels), gives continuity to diagnostic and therapeutic mechanisms, and permits active follow-up of patients who have finished treatment. An analysis of the results obtained shows that the clinic has allowed us to integrate the various aspects of medical oncology into one system and make it available to patients and primary and specialised care professionals. This system provides the patient with the highest quality of integrated health care, ensures the availability of continued health care to long-term survivors and establishes preferential channels between primary care and specialised cancer care to achieve a quick diagnosis.

  18. [VALIDATION OF A COMPUTER PROGRAM FOR DETECTION OF MALNUTRITION HOSPITAL AND ANALYSIS OF HOSPITAL COSTS].

    PubMed

    Fernández Valdivia, Antonia; Rodríguez Rodríguez, José María; Valero Aguilera, Beatriz; Lobo Támer, Gabriela; Pérez de la Cruz, Antonio Jesús; García Larios, José Vicente

    2015-07-01

    Introducción: uno de los métodos de diagnóstico de la desnutrición es la albúmina sérica, por la sencillez de su determinación y bajo coste. Objetivos: el objetivo principal es validar e implementar un programa informático, basado en la determinación de albúmina sérica, que permita detectar y tratar precozmente a los pacientes desnutridos o en riesgo de desnutrición, siendo otro objetivo la evaluación de costes por grupos relacionados por el diagnóstico. Métodos: el diseño del estudio es de tipo cohorte, dinámico y prospectivo, en el que se han incluido las altas hospitalarias desde noviembre del año 2012 hasta marzo del año 2014, siendo la población de estudio los pacientes mayores de 14 años que ingresen en los diversos servicios de un Hospital Médico Quirúrgico del Complejo Hospitalario Universitario de Granada, cuyas cifras de albúmina sérica sean menores de 3,5 g/dL, siendo el total de 307 pacientes. Resultados: de los 307 pacientes, 141 presentan desnutrición (sensibilidad del programa: 45,9%). El 54,7% de los pacientes son hombres y el 45,3% mujeres. La edad media es de 65,68 años. La mediana de la estancia es de 16 días. El 13,4% de los pacientes han fallecido. El coste medio de los GRD es de 5.958,30 € y dicho coste medio después de detectar la desnutrición es de 11.376,48 €. Conclusiones: el algoritmo que implementa el programa informático identifica a casi la mitad de los pacientes hospitalizados desnutridos. Es fundamental registrar el diagnóstico de desnutrición.

  19. The impact of hospital discharge on inappropriate hospital stay.

    PubMed

    Panis, Lambert J G G; Verheggen, Frank W S M; Pop, Peter; Prins, Martin H

    2004-01-01

    Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine-tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P-charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.

  20. Indirect costs associated with glioblastoma: Experience at one hospital.

    PubMed

    Undabeitia, J; Torres-Bayona, S; Samprón, N; Arrázola, M; Bollar, A; Armendariz, M; Torres, P; Ruiz, I; Caballero, M C; Egaña, L; Querejeta, A; Villanua, J; Pardo, E; Etxegoien, I; Liceaga, G; Urtasun, M; Michan, M; Emparanza, J I; Aldaz, P; Matheu, A; Úrculo, E

    2016-07-20

    Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was €11 080 762 (2015). Mean indirect cost per patient was €111 926 (2015). Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. [Marianne in hospital].

    PubMed

    Weium, Frode

    2003-12-23

    In 1948 Norwegian architect and author Odd Brochmann (1909-92) published his popular children's book Marianne in hospital (Marianne på sykehus). Two years later the book was filmed on the initiative of the Ministry of Social Affairs. This article considers the question of what were the purposes of the film. Officially, it was presented as an attempt to teach children not to be afraid of hospitals. However, in internal notes and letters the health authorities stressed that the film should be an educational film about the social benefits and health services of the welfare state. Furthermore, I will argue that the film was the result of a wish to present the nation's modern hospital care and, by way of conclusion, discuss the characterisation of the film as educational.

  2. [Stress management in hospitals].

    PubMed

    Miki, Akiko

    2002-11-01

    Job stress in employees in hospitals has been recognized as a key issue in the workplace. In this paper, characteristics of job stress in the medical profession, especially in doctors and nurses, and the effectiveness of stress management are overviewed. The important points in stress management in hospitals are summarized as follows: 1) improvement of work environment, 2) assurance of participation and autonomy, 3) education or training to reduce job stress (ex. coping behavior, self-care, relaxation), 4) career development, 5) total support among medical professions. Some reports have demonstrated that the establishment of constant meetings is an effective method of reducing job stress and improving mental health in the medical profession, but few prospective intervention studies have been carried out. Further research is necessary to evaluate the effectiveness of stress reduction and to develop effective intervention programs for medical professions in hospitals.

  3. [Standardization of hospital feeding].

    PubMed

    Caracuel García, Ángel Manuel

    2015-05-07

    Normalization can be understood as the establishing measures against repetitive situations through the development, dissemination, and application of technical design documents called standards. In Andalusia there are 45 public hospitals with 14,606 beds, and in which 11,700 full pensions / day are served. The Working Group on Hospital Food Standardization of the Andalusian Society for Clinical Nutrition and Dietetics, started in 2010, working on the certification of suppliers, product specifications, and meals technical card. - Develop a specific tool to help improving food safety through the certification of their suppliers. - Develop a standardized technical specifications of foodstuffs necessary for the development of menus established codes diets Andalusian hospitals document. - Develop a catalog of data sheets plates of hospital meals, to homogenize menus, respecting local and unifying criteria for qualitative and quantitative ingredients. - Providing documentation and studying of several public hospitals in Andalusia: • Product specifications and certification of suppliers. • International standards certification and distribution companies. • Legislation. • Data sheets for the menu items. • Specifications of different product procurement procedures. - Development of the draft standard HOSPIFOOD®, and approval of the version “0.0”. - Training course for auditors to this standard. - Development of a raw materials catalog as technical cards. - Meals Technical cards review and election of the ones which will be part of the document. After nearly three years of work, we have achieved the following products: - Standardized database of technical specifications for the production of food dietary codes for: fish, seafood, meat and meat products, meats and pates, ready meals, bread and pastries, preserves, milk and dairy products, oils, cereals, legumes , vegetables, fruits, fresh and frozen vegetables, condiments and spices. - Standardized database of

  4. Tiered hospital networks.

    PubMed

    Yegian, Jill M

    2003-01-01

    As a result of rising health care costs, health plans are experimenting with insurance products that shift greater financial responsibility for medical care to consumers and create incentives for consumers to consider cost differences when choosing among providers. Based on an October 2002 roundtable discussion, this paper discusses insurance product trends, particularly tiered hospital networks. Issues addressed include these product features' potential to reduce system costs, the effect on the hospital-health plan relationship, consumers' ability to consider cost and quality in decision making, and financial barriers to care for the chronically ill.

  5. Marketing the hospital library.

    PubMed

    Bridges, Jane

    2005-01-01

    Many librarians do not see themselves as marketers, but marketing is an essential role for hospital librarians. Library work involves education, and there are parallels between marketing and education as described in this article. It is incumbent upon hospital librarians actively to pursue ways of reminding their customers about library services. This article reinforces the idea that marketing is an element in many of the things that librarians already do, and includes a list of suggested marketing strategies intended to remind administrators, physicians, and other customers that they have libraries in their organizations.

  6. Telecommunications and the hospital.

    PubMed

    Tobias, T; Levine, J

    1986-04-01

    Telecommunications is a rapidly changing industry which currently offers the hospital administrator an opportunity to cut costs in the short run while providing for future needs. Like any important resource, this technology must be managed by skilled personnel who can recommend solutions consistent with the hospital's business philosophy and strategic plan. Three specific actions were recommended: first, consider modernizing your PBX; second, train an inhouse person or hire a telecommunications analyst to conduct the review of available systems and options and to supervise installation and operation; and third, when replacing computer systems and PBXs, develop a plan which will provide for current needs and future growth.

  7. Toward healthier hospitals.

    PubMed

    Mintzberg, H

    1997-01-01

    This article builds around a framework of cure, care, control, and community, with collaboration at the center, to consider 12 issues common to many hospitals. These include, among others, the fragmentation of efforts, confusion in mission (and in mission statements), the problems of bundling research with clinical work, selectivity in informing board members, the dangers of professional management, and the difficulties of combining external advocacy with internal reconciliation in the senior manager's job. The article concludes that hospitals could better learn how to solve systemic problems systemically, and that to do so will require not the wish lists of strategic planning and structural reorganizing, but tangible changes in their collective behavior.

  8. [Outlier patient admissions and their relationship with the emergence of clinical complications and prolonged hospital stays].

    PubMed

    Cabrera Torres, Enrique; García Iglesias, María Aránzazu; Santos Jiménez, María Teresa; González Hierro, Miguel; Diego Domínguez, María Luisa

    2017-09-21

    To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay. From a retrospective epidemiological study of a cohort of patients admitted to the Hospital Complejo Asistencial Universitario de Salamanca (Salamanca, Spain) over a six-month period, outlier and non-outlier patients were identified. This project had access to the admissions department database, the hospital's CMBD (in Spanish, Conjunto Mínimo Básico de Datos) for hospitalisation, the AP-DRG (All Patient-Diagnosis Related Groups) and ALCOR (a clinical-statistics analytics tool). It then proceeded to break down the results by DRG, looking at the five most common DRGs in that period. 8.4% of the total 11,842 admissions were medical outliers. In the overall study, the average stay was longer for outlier patients (8. 11 days) than for other patients (7.15 days). The mortality rate was, likewise, higher for outlier patients, although there was a reduced incidence of complications (7.6% for outlier patients as opposed to 8.4% for others). The analysis by DRG corroborated these results in three of the five cases investigated, showing longer average stays but fewer clinical complications in the case of outlier patients. On admission to hospital, a significant proportion of patients were allocated beds on inappropriate wards (outlier patients). It was more common to find medical patients placed on surgical wards than vice versa. The average stay of outlier patients was longer than that of patients admitted to the correct ward. The study found no significant difference between the two groupś in terms of clinical complication rates. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems.

    PubMed

    Melnick, Glenn A; Fonkych, Katya

    2016-01-01

    A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission) across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113%) than prices paid to all other California hospitals (70%). Prices were similar in both groups at the start of the period (approximately $9200 per admission). By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country. © The Author(s) 2016.

  10. Cost characteristics of hospitals.

    PubMed

    Smet, Mike

    2002-09-01

    Modern hospitals are complex multi-product organisations. The analysis of a hospital's production and/or cost structure should therefore use the appropriate techniques. Flexible functional forms based on the neo-classical theory of the firm seem to be most suitable. Using neo-classical cost functions implicitly assumes minimisation of (variable) costs given that input prices and outputs are exogenous. Local and global properties of flexible functional forms and short-run versus long-run equilibrium are further issues that require thorough investigation. In order to put the results based on econometric estimations of cost functions in the right perspective, it is important to keep these considerations in mind when using flexible functional forms. The more recent studies seem to agree that hospitals generally do not operate in their long-run equilibrium (they tend to over-invest in capital (capacity and equipment)) and that it is therefore appropriate to estimate a short-run variable cost function. However, few studies explicitly take into account the implicit assumptions and restrictions embedded in the models they use. An alternative method to explain differences in costs uses management accounting techniques to identify the cost drivers of overhead costs. Related issues such as cost-shifting and cost-adjusting behaviour of hospitals and the influence of market structure on competition, prices and costs are also discussed shortly.

  11. Hospital restructuring and burnout.

    PubMed

    Greenglass, Esther R; Burke, Ronald J

    2002-01-01

    Increasingly, organizations are experiencing changes as a result of extensive downsizing, restructuring, and merging. In Canada, government-sponsored medicine has been affected as hospitals have merged or closed, reducing essential medical services and resulting in extensive job loss for hospital workers, particularly nurses. Hospital restructuring has also resulted in greater stress and job insecurity in nurses. The escalation of stressors has created burnout in nurses. This study examines predictors of burnout in nurses experiencing hospital restructuring using the MBI-General Survey which yields scores on three scales: Emotional exhaustion, Cynicism, and Professional efficacy. Multiple regressions were conducted where each burnout scale was the criterion and stressors (e.g., amount of work, use of generic workers to do nurses' work), restructuring effects, social support, and individual resources (e.g., control coping, self-efficacy, prior organizational commitment) were predictors. There were differences in the amount of variance accounted for in the burnout components by stressors and resources. Stressors contributed most to emotional exhaustion and least to professional efficacy. Individual resources were more likely to contribute to professional efficacy and least to emotional exhaustion. Stressors and resources accounted for approximately equal amounts of variance in cynicism. Three conclusions were drawn. First, present findings parallel others by showing that individual coping patterns contribute to professional efficacy. Second, emotional exhaustion was found to be the prototype of stress. Third, prior organizational commitment, self-efficacy, and control coping resulted in lower burnout.

  12. Innovations in Hospitality Industry

    ERIC Educational Resources Information Center

    Dzhandzhugazova, Elena A.; Blinova, Ekaterina A.; Orlova, Liubov N.; Romanova, Marianna M.

    2016-01-01

    The article focuses on the study of the role and importance of innovation, its classification, the problems of its application in the hotel industry with emphasis on the application of sensory marketing tools in the development of the innovative marketing mix within the hospitality industry. The article provides an analysis of the "seven…

  13. In-hospital resuscitation.

    PubMed

    Mason, Christine

    2016-09-21

    What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article outlined the response sequence required for cardiac arrest in an in-hospital environment and discussed effective cardiopulmonary resuscitation (CPR) and defibrillation.

  14. Hospital perceived value.

    PubMed

    Moliner, Miguel A

    2006-01-01

    The creation, distribution and communication of value have been considered to be the key element of marketing (American Marketing Association, 2004, www.marketingpower.com). The aim of this article is to identify the indicators of perceived value in a hospital context. The results show that perceived quality and emotions are key dimensions of perceived value.

  15. Responsible Hospitality. Prevention Updates

    ERIC Educational Resources Information Center

    Colthurst, Tom

    2004-01-01

    Responsible Hospitality (RH)--also called Responsible Beverage Service (RBS)--encompasses a variety of strategies for reducing risks associated with the sale and service of alcoholic beverages. RH programs have three goals: (1) to prevent illegal alcohol service to minors; (2) to reduce the likelihood of drinkers becoming intoxicated; and (3) to…

  16. Speech intelligibility in hospitals.

    PubMed

    Ryherd, Erica E; Moeller, Michael; Hsu, Timothy

    2013-07-01

    Effective communication between staff members is key to patient safety in hospitals. A variety of patient care activities including admittance, evaluation, and treatment rely on oral communication. Surprisingly, published information on speech intelligibility in hospitals is extremely limited. In this study, speech intelligibility measurements and occupant evaluations were conducted in 20 units of five different U.S. hospitals. A variety of unit types and locations were studied. Results show that overall, no unit had "good" intelligibility based on the speech intelligibility index (SII > 0.75) and several locations found to have "poor" intelligibility (SII < 0.45). Further, occupied spaces were found to have 10%-15% lower SII than unoccupied spaces on average. Additionally, staff perception of communication problems at nurse stations was significantly correlated with SII ratings. In a targeted second phase, a unit treated with sound absorption had higher SII ratings for a larger percentage of time as compared to an identical untreated unit. Taken as a whole, the study provides an extensive baseline evaluation of speech intelligibility across a variety of hospitals and unit types, offers some evidence of the positive impact of absorption on intelligibility, and identifies areas for future research.

  17. Toilet privacy in hospital.

    PubMed

    Logan, Karen

    Good practice in toilet management and continence promotion can help hospital patients to maintain their dignity. This article reports on an audit that highlighted the issues important to patients and nurses in terms of improving privacy and dignity for inpatients using the toilet.

  18. Drama Therapies in Hospitals

    ERIC Educational Resources Information Center

    Goodman, Judith; Prosperi, Mario

    1976-01-01

    Explores the use of drama as a therapeutic tool at various hospitals and records specific therapy groups dialogues. Available from: The Drama Review, 51 West 4th Street, Room 300, New York, N.Y. 10012. Subscription Rates: $12.50 per year. (MH)

  19. Dying in hospital.

    PubMed

    Pearce, Lynne

    2016-06-22

    While surveys consistently show that about two thirds of people want to die at home, more than half of all deaths happen in hospitals. And in their last days, many people are cared for by generalist nursing staff who may be reticent, or even afraid, to talk about what is happening.

  20. Reengineering hospital materiel management.

    PubMed

    Giunipero, L C

    1995-08-01

    Reengineering involves significant change and dramatic rethinking of the business process. The expected result of these changed processes is dramatic improvement. Hospital cost pressures and technological change necessitate review or reengineering the process to enhance customer service at a lower cost. Three areas that yield significant results include reducing the cost of purchasing, implementing new technologies, and empowering teams to accomplish customer driven goals.

  1. Mechanical engineering in hospitals.

    PubMed

    Wallington, J W

    1980-10-01

    The design of a modern hospital owes more to engineering than the layman may realize. In this context, many engineers are in the position of laymen, being unfamiliar with the multitude of services that lies behind the impressive facade of a modern hospital. In recent years medicine and surgery themselves have taken on many of the characteristics of a technology. This has required a matching development of the services both mechanical and electrical that are required in modern health care buildings. In medical terms, if the architectural features provide the 'skin' of the hospital, the mechanical and electrical engineering services provide the nerves and sinews. If we take as an example the recently completed Freeman Hospital, Newcastle upon Tyne, (Fig. 1), which cost 10 million pounds at current cost, the service network was responsible for about half the total cost. About 400 miles (643 km) of electrical wiring and more than 40 mile (64.5 km) of copper and steel piping were used to service 3000 separate rooms. This compares with percentages of between 18 and 25 per cent for other large buildings such as office blocks, hotels and sports complexes.

  2. Measuring hospital input price increases: The rebased hospital market basket

    PubMed Central

    Freeland, Mark S.; Chulis, George S.; Brown, Aaron P.; Skellan, David; Maple, Brenda T.; Singer, Naphtale; Lemieux, Jeffrey; Arnett, Ross H.

    1991-01-01

    The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed. PMID:10113610

  3. [Leadership in the hospital].

    PubMed

    Schrappe, Matthias

    2009-01-01

    Current concepts in leadership and governance on the level of supervisory board, management and departments are often considered as insufficient to cope with the profound structural change which actually takes place in the German health care system. While vertical and horizontal disconnecting is typical of the professional bureaucracy of hospitals, transition from functional to divisional structure further increases this risk. Accordingly, medical experts are oriented towards their professional peers and patient care on the one side; on the other side the management gets isolated and looses operative and strategic control. Several studies provide evidence for the relevance of role models to serve as agents of change, which are now developed into the concept of "Clinical Governance": evidence-based medicine, guidelines, continuous quality improvement, safety culture, resource accountability and organisational learning. The present situation makes it necessary to extend this conception, which focuses on the departmental level in an organisation with divisional features, to one of "Clinical Corporate Governance". This term, which also includes supervisory structures and the management board and is relevant for the total hospital and company, respectively, is based on the corporate governance concept. Inside the hospital, the management and the heads of the departments have to agree that (1) experts really need to be integrated into the decision process, and that (2) the outcomes of the entire hospital have to be regarded as equal or superior to the aims of a single department. The public image of the hospital should be one of a strong and reliable partner in health care and health care business on a local, regional and national level. Members of the supervisory board should clearly put corporate aspects above political and other implications and pay attention to personal independence from the leaders of the medical departments.

  4. The frontline hospital.

    PubMed

    Mein, P

    1983-01-01

    This brief description of the planning process for a frontline hospital is intended as a guide only: there will be a variety of approaches depending on local conditions. However, certain of the principles raised have universal relevance for the construction of health facilities where resources are limited. In brief, these: - The changing role of the frontline hospital should not be allowed to obscure the fact that the small hospital still has a significant role to play and that future, as yet undefined, functional changes will take place necessitating generalized designs that can accommodate those changes. - The erection of new buildings is not always the appropriate solution to apparent problems with facilities. Often a more relevant course is to adapt existing buildings or to provide community-level primary health care services not based on facilities. - The development of standardized, though flexible, briefs for hospitals of different sizes is essential, since ther will, for some years to come, be a shortage of the professional manpower needed to enable completely individual designs to be produced for each facility. Standardized briefs are infinitely preferable to standard or type plans, which tend to be inflexible and lead to overbuilding. - Local involvement in the planning process is essential, not only because it provides useful knowledge but primarily because local commitment is the only way of avoiding the construction of inappropriate facilities. - Architectural expertise must be available within the health system, since very often outside consultants are unable or unwilling, because of the system of payment, to design suitable hospital buildings. - The type of construction used should be the simplest and most economical that will provide an effective environment for the health tasks to be carried out so that the limited resources available can be stretched to serve as many people as possible. - Local building materials should always be preferred- to

  5. Improving Hospital Discharge Time

    PubMed Central

    El-Eid, Ghada R.; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A.

    2015-01-01

    Abstract Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P < 0.001). A greater proportion of patients left their room before noon in the postintervention period (P < 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P < 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific. PMID:25816029

  6. [The founding of Zemun Hospital].

    PubMed

    Milanović, Jasmina; Milenković, Sanja; Pavlović, Momcilo; Stojanović, Dragos

    2014-01-01

    This year Zemun Hospital--Clinical Hospital Center Zemun celebrates 230th anniversary of continuous work, thus becoming the oldest medical facility in Serbia.The exact date of the hospital founding has been often questioned in history. Various dates appeared in the literature, but the most frequent one was 25th of February 1784. Until now, the document which confirms this has never been published. This article represents the first official publication of the document which confirms that Zemun Hospital was indeed founded on this date. The first hospitals started emerging in Zemun when the town became a part of the Habsburg Monarchy. The first sanitary facility ever formed was the"Kontumac"--a quarantine established in 1730. Soon after, two more confessional hospitals were opened.The Serbian (Orthodox) Hospital was founded before 1769, whereas the German (Catholic) Hospital started working in 1758. Both hospitals were financed, amongst others, by the Town Hall--the Magistrate. In order to improve efficiency of these hospitals, a decision was made to merge them into a single City Hospital. It was founded on 25th February 1784, when the General Command ordered the Magistrate of Zemun to merge the financess of all existing hospitals and initiate the construction of a new building. Although financially united, the hospitals continued working in separate buildings over a certain period of time.The final, physical merging of these hospitals was completed in 1795.

  7. Desarrollo de un instrumento para medir percepciones sobre el contexto de construccion del conocimiento cientifico de estudiantes universitarios de nuevo ingreso

    NASA Astrophysics Data System (ADS)

    Garcia-Ramirez, Jaime Antonio

    En esta investigacion, se desarrollo un instrumento que permite medir percepciones relacionadas al contexto de constriccion del conocimiento cientifico. Se examinaron instrumentos existentes y se encontro que el VOSTS (Views on science, technology, and society), instrumento desarrollado empiricamente en Canada por Aikenhead, Ryan y Fleming, podia traducirse y validarse en el contexto cultural puertorriqueno. El instrumento es extenso, consta de 113 reactivos, cada uno con una premisa basica relacionada a la tematica ciencia, tecnologia y sociedad y un numero de alternativas relacionadas a la premisa que oscila entre siete y trece. Se delimito su utilizacion a los quince reactivos identificados por los autores como relacionados a la construccion social del conocimiento cientifico. Metodologicamente, se procedio a utilizar el modelo de adaptacion intercultural, que permite que el instrumento desarrollado satisfaga las dimensiones de equivalencia semantica, de contenido, tecnica, de criterio y conceptual, atemperado asi al instrumento original. Se cumplio con este proposito mediante la traduccion de la version original en ingles al espanol y viceversa. Se utilizaron comites para examinar la traduccion y la retro-traduccion del instrumento. Se realizo una prueba piloto con estudiantes universitarios de nuevo ingreso, utilizando el instrumento traducido para asegurar su intelegibilidad. La confiabilidad del instrumento se determino mediante la intervencion de un panel de expertos quienes clasificaron las distintas posiciones dentro de cada reactivo en: realista, con merito e ingenua; se transformaron estas opciones en valores numericos lo que permitio establecer una escala Likert para cada una. Se suministro el instrumento a una muestra de estudiantes universitarios de nuevo ingreso con caracteristicas similares a las de la poblacion puertorriquena en cuanto a ejecucion en las pruebas de aptitud verbal y matematica del College Board. Los resultados de sus contestaciones

  8. Hospital malnutrition: a 33-hospital screening study.

    PubMed

    Kamath, S K; Lawler, M; Smith, A E; Kalat, T; Olson, R

    1986-02-01

    A collaborative study involving nutrition screening of 3,047 patients (excluding 125 pregnant women) at admission to 33 hospitals in and around the greater Chicago area was carried out to identify patients at nutritional risk. Information on sex, age, admitting diagnosis, serum albumin, hemoglobin, total lymphocyte count, and height and weight was collected from the medical chart within 48 hours of admission. Nutrition screening could not be completed for a larger number of patients (60%) because data at admission were not available. Of the remaining 40% of patients, more than 50% had below normal values for one or more of the variables studied: serum albumin, hemoglobin, and total lymphocyte count. A large number of the patients (40%) also were considered at nutritional risk as judged by the criteria of weight/height (measured only). Early nutrition intervention for high-risk patients cannot be implemented, nor can the efficacy of nutrition services be evaluated, unless nutrition screening is carried out on patients at admission.

  9. The politics of hospital payment.

    PubMed

    Feder, J; Spitz, B

    1979-01-01

    This paper analyzes the politics of hospital payment over the last decade. The authors explain how provider interests and judgments became a standard for appropriate hospital payment: the impact of that standard on hospital costs; and the political obstacles to imposing an alternative standard and controlling hospital costs. The authors draw lessons from this experience, here and in other countries, to propose an alternative approach to hospital payment that would allow policymakers, accountable to the public, to make explicit choices about the level and nature of hospital expenditures.

  10. How consumers view hospital advertising.

    PubMed

    Johns, H E; Moser, H R

    1988-01-01

    The purposes of this study were to determine: (a) consumers' attitudes toward advertising by hospitals; (b) which media consumers feel are appropriate for hospital advertising; and (c) whether consumers are seeing hospital advertisements, and if so, through which media. It was found that consumers indeed have a favorable attitude toward hospitals that advertise. It was also found that consumers feel that most media are appropriate for hospital advertising. Finally, it was found that most consumers have seen hospitals advertise their services, especially on television and radio and in the newspaper.

  11. [Hospital clinical ethics committees].

    PubMed

    Gómez Velásquez, Luis; Gómez Espinosa, Luis Néstor

    2007-01-01

    The scientific and technological advances have been surprising, more in the two last decades, but they don't go united with to the ethical values of the medical professional practice, it has been totally escaped, specially when the biological subsistence, the maintenance of the life through apparatuses and the mechanisms that prolong the existence are who undergoes an alteration that until recently time was mortal shortly lapse. It is common listening that exist a crisis in the medical profession, but what really is it of human values, which as soon and taken into nowadays, actually professional account, which gives rise to a dehumanization towards the life, the health, the disease, the suffering and the death. The ideal of the doctor to give to service to the man in its life and health, as well to be conscious that the last biological process that must fulfill is the death, and when it appears, does not have considered as a actually professional failure. It has protect to the patient as the extreme cruelty therapeutic, that it has right a worthy death. It's taking to the birth of the hospital ethics committees, they have like function to analyze, to advise and to think about the ethical dilemmas that appear actually clinical or in the biomedical investigation. In 1982 in the UEA only 1% of its hospitals had a ethics committees; by 1988, it was 67% and the 100% in 2000. In Mexico the process of the formation by these committees begins, only in the Military Central Hospital, to count the ethics committee on 1983, also the Hospital no. 14 of the IMSS in Guadalajara, it works with regularity from 1995, with internal teaching of bioethic. The Secretariat of Health has asked the formation of the bioethical committees in each hospital, and order the it was be coordinated by the National Committee of Bioética. The integration of these committees is indispensable that their members have the knowledge necessary of bioética. The Mexican Society of Ortopedia, conscious of

  12. Hospital Library Development. Hospital Library Handbooks No. 2.

    ERIC Educational Resources Information Center

    Cramer, Anne

    Addressed to the administrator of the hospital as well as the librarian, this handbook covers aspects of library service policy and long-range planning. While hospitals of all sizes are discussed, a special effort is made to cover problems of small hospitals (17 to 100 beds) in sparsely-settled regions. Contents: The library as a clinical service,…

  13. Hospital Preparedness and SARS

    PubMed Central

    Wallington, Tamara; Rutledge, Tim; Mederski, Barbara; Rose, Keith; Kwolek, Sue; McRitchie, Donna; Ali, Azra; Wolff, Bryan; White, Diane; Glassman, Edward; Ofner, Marianna; Low, Don E.; Berger, Lisa; McGeer, Allison; Wong, Tom; Baron, David; Berall, Glenn

    2004-01-01

    On May 23, 2003, Toronto experienced the second phase of a severe acute respiratory syndrome (SARS) outbreak. Ninety cases were confirmed, and >620 potential cases were managed. More than 9,000 persons had contact with confirmed or potential case-patients; many required quarantine. The main hospital involved during the second outbreak was North York General Hospital. We review this hospital’s response to, and management of, this outbreak, including such factors as building preparation and engineering, personnel, departmental workload, policies and documentation, infection control, personal protective equipment, training and education, public health, management and administration, follow-up of SARS patients, and psychological and psychosocial management and research. We also make recommendations for other institutions to prepare for future outbreaks, regardless of their origin. PMID:15200807

  14. Dementia for hospital physicians.

    PubMed

    Harwood, Rowan H

    2012-02-01

    Many people with dementia are admitted to general hospitals, yet doctors feel ill-prepared to manage them. Problems are often multiple and complex. In many cases, dementia is complicated by delirium. Medical assessment must be meticulous and requires collateral history taking, mental state examination and cognitive function testing. Hospital environments can be provocative, and the way staff interact with people with dementia can increase distress. Difficult behaviours usually represent unmet needs. The right approach by (all) staff can reduce this, including special efforts to establish reassuring, comforting relationships with patients. Try to see situations from the perspective of the person with dementia. Skilled communication is vital and family carers should be kept informed and involved. People with dementia are prone to side effects of prescribed drugs. Antipsychotic drugs are rarely the answer to difficult behaviours, but may be used in cases of psychosis or severe distress.

  15. [Homicide crimes in hospitals].

    PubMed

    Dürwald, W

    1993-02-01

    Report of some cases of willful homicide in hospitals of the former GDR. In no case the patient has wished his death. Besides compassion the cause of the homicide was a large carefully expense and in two cases the attempt to prove the incapability of the competent doctor. The patients were only means to an end. All the cases are discovered by the great number of obscure death.

  16. Children's Hospital visit

    NASA Image and Video Library

    2011-02-04

    NASA senior staff members from John C. Stennis Space Center traveled to Children's Hospital in New Orleans on Feb. 4 for a morning of educational outreach, offering interactive demonstrations and activities for children. Staff members offered cryogenic demonstrations, informative and interactive exhibits and a chance for children to take photos 'wearing' a space suit. Children also had a chance to interact with Stennis' astronaut mascot.

  17. Hospital nurses' work motivation.

    PubMed

    Toode, Kristi; Routasalo, Pirkko; Helminen, Mika; Suominen, Tarja

    2015-06-01

    The knowledge surrounding nurses' work motivation is currently insufficient, and previous studies have rarely taken into account the role of many influential background factors. This study investigates the motivation of Estonian nurses in hospitals, and how individual and organisational background factors influence their motivation to work. The study is quantitative and cross-sectional. An electronically self-reported questionnaire was used for data collection. The sample comprised of 201 Registered Nurses working in various hospital settings in Estonia. Data were analysed using descriptive statistics, two-sample Wilcoxon rank-sum (Mann-Whitney) test, Kruskal-Wallis equality-of-populations rank test and Spearman's correlation. Both extrinsic and intrinsic motivations were noted among hospital nurses. Nurses were moderately externally motivated (M = 3.63, SD = 0.89) and intrinsically strongly motivated (M = 4.98, SD = 1.03). A nurses' age and the duration of service were positively correlated with one particular area of extrinsic work motivation, namely introjected regulation (p < 0.001). Nurses who had professional training over 7 days per year had both a higher extrinsic motivation (p = 0.016) and intrinsic work motivation (p = 0.004). The findings expand current knowledge of nurses' work motivation by describing the amount and orientation of work motivation among hospital nurses and highlighting background factors which should be taken into account in order to sustain and increase their intrinsic work motivation. The instrument used in the study can be an effective tool for nurse managers to determine a nurse's reasons to work and to choose a proper motivational strategy. Further research and testing of the instrument in different countries and in different contexts of nursing is however required. © 2014 Nordic College of Caring Science.

  18. Community Hospital Telehealth Consortium

    DTIC Science & Technology

    2007-04-01

    project involving the purchase of a neonatal retinal camera . This clinic transmits images from Lake Charles Memorial Hospital to a neonatal...ophthalmologist in New Orleans and assists in diagnosing Retinopathy of prematurity ( ROP ), a potentially blinding eye disorder that primarily affects...weeks). The smaller a baby is at birth, the more likely that baby is to develop ROP . This disorder—which usually develops in both eyes—is one of

  19. Hospital labs go under microscope.

    PubMed

    Aston, Geri

    2014-05-01

    Financial pressures are hitting hospital clinical labs on both the inpatient and outpatient sides. To control expenses, hospitals are teaming up to buy supplies, centralizing services and improving blood management.

  20. Hospitals report on cancer centers.

    PubMed

    Rees, T

    2001-01-01

    Woman's Hospital, Baton Rouge, La., is first-place winner among cancer centers. Holy Cross Hospital's Michael and Dianne Bienes Comprehensive Cancer Center, Ft. Lauderdale, Fla., is named second; and, Cardinal Health System's Ball Cancer Center, Muncie, Ind., third.

  1. [Day Hospital: history and conceptualization].

    PubMed

    Stagnaro, Juan C

    2012-01-01

    The appearance of Day Hospitals operated as a model to inspire the different ways of partial time psychiatric care (night hospitals, weekend hospitals, long hour activities in hospitalization services or general hospitals, etc.) and came to complement or replace complete hospitalization in classic psychiatric hospitals. This article presents the history and origins of Day Hospitals and their initial propagation in different countries, and especially in Argentina. Social and political conditions that set their emergence as a therapeutic resource in psychiatry, their models of functioning and variants of application according to the diagnoses of patients admitted, age groups, etc., the theories put into play to report their effects, several studies and technical results, and ideological views related to mental disorders and their treatment in the society are also being studied.

  2. [Burnout syndrome among nursing staff at a hospital in Madrid].

    PubMed

    Albaladejo, Romana; Villanueva, Rosa; Ortega, Paloma; Astasio, P; Calle, M E; Domínguez, V

    2004-01-01

    The term "burnout" is related to a situation arising increasingly more often among the professionals performing their duties by way of a long-term, direct, people-to-people relationship, which includes all healthcare professionals. This study is aimed at determining the prevalence of the Burnout syndrome and of the three components involved therein (emotional exhaustion, impersonalization and lack of personal fulfillment) among the nursing staff at the "Hospital Clínico Universitario San Carlos" in Madrid and the relationship thereof to certain socio-demographic, job-related and institutional factors. A cross-sectional study was conducted among the professionals assigned to the nursing staff at the above-mentioned hospital. The variables involved were gathered by means of a questionnaire prepared by those conducting this study. The Burnout syndrome was measured by means of the Maslach Burnout Inventory, in the validated Spanish version thereof. The nursing staff is more impersonalized (p=0.004) and less fulfilled (p=0.036) than the nursing assistant/technician group. When the results of the four scales by units were analyzed, burnout was found to be greater among the nursing staff assigned to oncology and emergency care units (p=0.001), the impersonalization in the emergency rooms (p=0.007), and Burnout is once again greater in the oncology and emergency units (p=0.000). Those professionals who answered that there was little recognition of their nursing care scored worst regarding Burnout and the three aspects thereof (p =0.000). The lower the degree of on-the-job satisfaction, the higher the scores on the four scales (p=0.000). The conclusion which may be drawn from this study is that the profile of a person affected by Burnout is that of a professional with on-the-job experience who nevertheless considers very little recognition to be given to their caregiving and a high degree of dissatisfaction with the way in which their workplaces are managed.

  3. [Prevalence of seropositividad to antibodies IgG and IgM against Helicobacter pylori in the medical residents of the University Hospital of Puebla].

    PubMed

    Garza Yado, María de los Angeles; López García, Aída Inés; Paz Martínez, David; Galindo García, José Arturo; Cuevas Acuña, María Tula; Papaqui Tapia, Sergio; Arana Muñoz, Oswaldo; Pérez Fernández, María Susana

    2006-01-01

    Helicobacter pylori is a gram-negative, curved, microaerophilic, oxidase, catalase and urease positive bacillus. It lives in the gastric mucosa, and is the main etiological agent of peptic ulcer, and of atrophic and multifocal gastritis. It is associated with extraintestinal, vascular, autoimmune and cutaneous diseases. The infection by this bacteria causes a chronic inflammatory process related with the sensibilization of mast cells, which increases the incidence of allergic diseases. To estimate the seropositivity prevalence of IgG and IgM antibodies against Helicobacter pylori in medical resident personnel. A transversal, descriptive and observational study was carried out in medical residents of the Hospital Universitario de Puebla. Serum levels of IgG and IgM antibodies against Helicobacter pylori were determined by chemiluminescence. Data were analyzed applying descriptive statistics, such as: frequency, central tendency and dispersion measures. 57 residents were included, 54.4% were men. The mean age was 28.4 (SD 2.9). Seropositivity prevalence of IgG and IgM antibodies was 24.6 and 33.3%, respectively. Combined seropositivity prevalence of IgG and IgM was of 43.9%. Seropositivity prevalence of IgG and IgM antibodies against Helicobacter pylori in the medical resident personnel of the Hospital Universitario de Puebla was similar to the reported in the general population. This estimation might be considered a reference to other epidemiological and clinical studies such as those pretending to evaluate and demonstrate the relationship between infection by Helicobacter pylori and other entities, even allergies.

  4. Hospital clowning: a paediatrician's view.

    PubMed

    van Venrooij, Lennard T; Barnhoorn, Pieter C

    2017-02-01

    This study investigates the current position of hospital clowns from the perspective of paediatricians and paediatric residents. A total of 14 attending paediatricians and paediatric residents participated in two focus group sessions. Data were analysed using Atlas.ti 5.0. In general, physicians reported positive experiences regarding the interaction between hospital clowns and paediatric patients on the ward. Physicians were more interested in research on children's perception of hospital clowns than in research on the clinical efficacy of hospital clowning. No direct collaboration between physicians and hospital clowns was reported. However, physicians proposed conditions which may streamline their encounters with hospital clowns such as clear communication prior to hospital clown visits, and the condition that visits do not impede medical interventions. Overall, paediatricians and paediatric residents view the positive impact on paediatric patients as the most important aspect of hospital clown visits, rather than the clinical efficacy of hospital clowning. In light of the growing number of hospital clowns worldwide, this article provides recommendations for arranging their encounters with paediatricians and paediatric residents to maintain optimal health care. What is known: • Previous studies show a clinically significant pain- and anxiety-reducing effect of hospital clowning in paediatric patients admitted to hospitals or undergoing (invasive) medical procedures. • In general, paediatricians have positive ideas about hospital clowns, aside from personal prejudices. What is new: • This novel study gives deeper insight into day-to-day interaction between paediatricians and hospital clowns on the ward. • This study provides recommendations for clinical practice to arrange encounters between physicians and hospital clowns during hospital clown visits.

  5. The practice of hospital epidemiology.

    PubMed Central

    Hierholzer, W. J.

    1982-01-01

    The practice and methodology of hospital epidemiology in infection control have begun to mature. At the same time, there is need for an institutionally based clinical epidemiologist to assist in several other mandatory patient care-related programs in the hospital. Hospital epidemiology programs should recognize this need, the parallels in other programs, and the unique opportunity to bring to hospital in-service, teaching, and research, epidemiologic methodology as a natural extension of its present role. PMID:7180022

  6. Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals.

    PubMed Central

    Rosenthal, G. E.; Baker, D. W.; Norris, D. G.; Way, L. E.; Harper, D. L.; Snow, R. J.

    2000-01-01

    OBJECTIVE: To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices. DATA SOURCES/STUDY SETTING: A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994. DESIGN: A retrospective cohort study was conducted. DATA COLLECTION: Demographic and clinical data were collected from patients' medical records and were used to develop multivariable models that estimated the risk of in-hospital and 30-day (post-admission) mortality. Standardized mortality ratios (SMRs) for in-hospital and 30-day mortality were determined by dividing observed death rates by predicted death rates. PRINCIPAL FINDINGS: In-hospital SMRs ranged from 0.54 to 1.42, and six hospitals were classified as statistical outliers (p <.05); 30-day SMRs ranged from 0.63 to 1.73, and seven hospitals were outliers. Although the correlation between in-hospital SMRs and 30-day SMRs was substantial (R = 0.78, p < .001), outlier status changed for seven of the 30 hospitals. Nonetheless, changes in outlier status reflected relatively small differences between in-hospital and 30-day SMRs. Rates of discharge to nursing homes or other inpatient facilities varied from 5.4 percent to 34.2 percent across hospitals. However, relationships between discharge rates to such facilities and in-hospital SMRs (R = 0.08; p = .65) and early post-discharge mortality rates (R = 0.23; p = .21) were not significant. CONCLUSIONS: SMRs based on in-hospital and 30-day mortality were relatively similar, although classification of hospitals as statistical outliers often differed. However, there was no evidence that in-hospital SMRs were biased by differences in post-discharge mortality or discharge practices. PMID:10737447

  7. Library Hospitality: Some Preliminary Considerations

    ERIC Educational Resources Information Center

    Johnson, Eric D. M.; Kazmer, Michelle M.

    2011-01-01

    Library scholars and practitioners have frequently reflected on the various factors that in combination make up a hospitable library, but there has been little theoretical synthesis of the notion of the library as a place of hospitality. The hospitality industry provides a rich vein of theoretical material from which to draw definitions of…

  8. Childrens Hospital Inservice Education Curriculum.

    ERIC Educational Resources Information Center

    Lutz, Joan

    A description is provided of a 15-month, in-service nursing education program at Childrens Hospital (Los Angeles, California). The first sections of the paper describe Childrens Hospital and provide a rationale for the hospital-based program. A listing of program goals and objectives is also provided, indicating that the curriculum is designed to…

  9. Childrens Hospital Inservice Education Curriculum.

    ERIC Educational Resources Information Center

    Lutz, Joan

    A description is provided of a 15-month, in-service nursing education program at Childrens Hospital (Los Angeles, California). The first sections of the paper describe Childrens Hospital and provide a rationale for the hospital-based program. A listing of program goals and objectives is also provided, indicating that the curriculum is designed to…

  10. Hospitality Studies: Escaping the Tyranny?

    ERIC Educational Resources Information Center

    Lashley, Conrad

    2015-01-01

    Purpose: The purpose of this paper is to explore current strands in hospitality management education and research, and suggest that future programs should reflect a more social science informed content. Design/methodology/approach: The paper reviews current research in hospitality management education and in the study of hospitality and…

  11. Hospitality Services. Student Activity Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This student activity book contains pencil-and-paper activities for use in a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The activities are organized into 29 chapters on the following topics: hospitality services industry; professional ethics; organization/management structures in…

  12. Library Hospitality: Some Preliminary Considerations

    ERIC Educational Resources Information Center

    Johnson, Eric D. M.; Kazmer, Michelle M.

    2011-01-01

    Library scholars and practitioners have frequently reflected on the various factors that in combination make up a hospitable library, but there has been little theoretical synthesis of the notion of the library as a place of hospitality. The hospitality industry provides a rich vein of theoretical material from which to draw definitions of…

  13. Hospitality Services. Student Activity Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This student activity book contains pencil-and-paper activities for use in a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The activities are organized into 29 chapters on the following topics: hospitality services industry; professional ethics; organization/management structures in…

  14. Hospitality in College Composition Courses

    ERIC Educational Resources Information Center

    Haswell, Janis; Haswell, Richard; Blalock, Glenn

    2009-01-01

    There has been little discussion of hospitality as a practice in college writing courses. Possible misuses of hospitality as an educational and ethical practice are explored, and three traditional and still tenable modes of hospitality are described and historicized: Homeric, Judeo-Christian, and nomadic. Application of these modes to…

  15. Hospitality Studies: Escaping the Tyranny?

    ERIC Educational Resources Information Center

    Lashley, Conrad

    2015-01-01

    Purpose: The purpose of this paper is to explore current strands in hospitality management education and research, and suggest that future programs should reflect a more social science informed content. Design/methodology/approach: The paper reviews current research in hospitality management education and in the study of hospitality and…

  16. [Use of transcutaneous electrical nerve stimulation in the Unit of Pain Management of the Alcorcón Foundation University Hospital].

    PubMed

    Martínez, Andrea Isabel

    2014-08-08

    Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological therapy used to alleviate pain and is among the current available treatments offered by the Units of Pain Management (Unidades del Dolor) in Spanish Hospitals. The goal of this study was to identify the characteristics of portable electro-stimulator use, and its costs in the Unit of Pain Management of the Alcorcón Foundation University Hospital (Hospital Universitario Fundación Alcorcón). A retrospective descriptive study was carried out between January, 1999, and October, 2010, in the Unit of Pain Management of the Alcorcón Foundation University Hospital. The information on TENS delivery forms and its supplies was collected, and the characteristics of use and the associated costs were calculated. It was observed that the longest period of time used was less than a year. The cost of delivery for the portable equipment was 148 050 euros and the average annual cost for the use of TENS by a patient was 854 euros. From the information gathered, it can be concluded that the use of electro-analgesia is a valid option in terms of expenses for long periods of use, thereby allowing a reduction in costs and decreasing the use of other healthcare treatments.

  17. [Tuberculosis in the San José University Hospital in Popayán, Colombia, 1998-2000].

    PubMed

    Díaz, María Lilia; Muñoz, Sulma; Garcíad, Liz Betty

    2004-06-01

    TB is a public health problem in the world. In Colombia the Health 100 Law caused changes in prevention programs. The TB control program was compromised too. The actions in relation with active looking and examination of respiratory symptomatic people has been lowering. This retrospective study describes the clinical, epidemiological and medical care characteristics of tuberculosis patients attended in the Hospital Universitario San José de-Popayán. The clinical expedients and laboratory registers were investigated. 120 cases of 187 registered patients were included; finally only 89 were tuberculosis cases: 39 pulmonary (43.8%) and 50 extrapulmonary (56.2%). The extrapulmonary forms were: miliar, 39 patients; pleural, 4: of lymph nodes, 3; osteoarticular, 2, and meningitis, 2 cases. 49% of patients were 15-59 years old, 28% more than 59; males 64% and 65% coming from country areas. Ziehl Neelsen (ZN) smear was positive in 22% of 59 sputums of pulmonary TB and 20.2% of 94 extrapulmonary TB samples: mycobacteria culture positive in 14.3% of 14 pulmonary TB sputum, and 29.6% of 54 extrapulmonary TB samples. The media days into hospital/yard was 4-26 and the media days to begin tuberculosis treatment/yard was 4-8. In summary there are important request for TB medical care to universitary hospital, however the diagnosis is difficult and takes a long time while mycobacteria can be transmitted to hospital contacts. It is necessary to get a better efficiency of diagnostic tests in the hospital and appropriated survey of the cases that begin treatment.

  18. Factors associated with length of hospital stay in minor and moderate burns at Popayan, Colombia. Analysis of a cohort study.

    PubMed

    Sierra Zúñiga, Marco Fidel; Castro Delgado, Oscar Eduardo; Merchán-Galvis, Angela María; Caicedo, Juan Carlos Caicedo; Calvache, Jose Andrés; Delgado-Noguera, Mario

    2016-02-01

    To determine the independent contribution of prognostic factors to length of hospital stay of minor and moderate burn victims at the Hospital Universitario San José (HUSJ), Popayán, Colombia, 2000-2010. This was a retrospective cohort study of minor and moderate burn victims admitted between 2000 and 2010, at the burn unit (HUSJ). This is a further analysis of a same cohort previously published in Burns. The following variables were recorded and analyzed: age, gender, origin, depth and extent of burn, causal agent, length of hospital stay and mortality. The main outcome under study was length of stay. Survival analysis was done to explore the association of covariates and length of hospital stay and Cox regression model to adjust the effect of covariates in the outcome. During the study period 2000-2010, 842 of 921 (91.5%) patients treated at the Burn Unit of HUSJ that had complete data were included. There were 520 (61.8%) males and 322 (38.2%) females with a male to female ratio of 1.6:1. Their median age was 9 years (IQR 3-28). The median of percent total body surface area burned (TBSA) was 12% (IQR 7-21) and the most common degree of burn was 2nd degree with 58% (488 patients). There were 12 deaths (censored data) and 830 patients were discharged alive. After multivariate adjustment, significant associations with length of hospital stay remained for age group, burn degree and extension of the burn. The strongest relationship found was for burn degree (2nd degree superficial vs. 3rd degree hazard ratio=2.66 CI 95% [2.13-3.33]). In patients admitted with mild and moderate burns at HUSJ, the main predictors of length of stay were age, burn degree and extension of the burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  19. Hospital mergers and market overlap.

    PubMed Central

    Brooks, G R; Jones, V G

    1997-01-01

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

  20. Hospital mergers and market overlap.

    PubMed

    Brooks, G R; Jones, V G

    1997-02-01

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

  1. Mother-baby friendly hospital.

    PubMed

    Aragon-choudhury, P

    1996-01-01

    In Manila, the Philippines, the Dr. Jose Fabella Memorial Hospital has been a maternity hospital for 75 years. It averages 90 deliveries a day. Its fees are P200-P500 for a normal delivery and P800-P2000 for a cesarean section. Patients pay what they can and pay the balance when they can. The hospital provides a safe motherhood package that encompasses teaching responsible parenthood, prenatal care, labor, delivery, postpartum care, breast feeding, family planning, and child survival. In 1986, the hospital introduced innovative policies and procedures that promote, protect, and support breast feeding. It has a rooming-in policy that has saved the hospital P6.5 million so far. In the prenatal stage, hospital staff inform pregnant women that colostrum protects the newborn against infections, that suckling stimulates milk production, and that there is no basis to the claim of having insufficient breast milk. Sales representatives of milk substitutes are banned from the hospital. Staff confiscate milk bottles or formula. A lactation management team demonstrates breast feeding procedures. Mothers also receive support on the correct way of breast feeding from hospital staff, volunteers from the Catholic Women's League, consumer groups, and women lawyers. The hospital's policy is no breast milk, no discharge. This encourages mothers to motivate each other to express milk immediately after birth. The hospital has received numerous awards for its breast feeding promotion efforts. UNICEF has designated Fabella Hospital as a model of the Baby-Friendly Hospital Initiative. The hospital serves as the National Lactation Management Education Training Center. People from other developing countries have received training in lactation management here. The First Lady of the Philippines, the First Lady of the US, and the Queen of Spain have all visited the hospital. The hospital has also integrated its existing services into a women's health care center.

  2. Hospital closure and economic efficiency.

    PubMed

    Capps, Cory; Dranove, David; Lindrooth, Richard C

    2010-01-01

    We present a new framework for assessing the effects of hospital closures on social welfare and the local economy. While patient welfare necessarily declines when patients lose access to a hospital, closures also tend to reduce costs. We study five hospital closures in two states and find that urban hospital bailouts reduce aggregate social welfare: on balance, the cost savings from closures more than offset the reduction in patient welfare. However, because some of the cost savings are shared nationally, total surplus in the local community may decline following a hospital closure.

  3. An ideal hospital.

    PubMed

    Chandrasiri, Singithi Sidney

    2017-07-03

    Purpose The purpose of this paper is to explore a novel overarching strategy in tackling the key issues raised by the recent inquiry into bullying, harassment and discrimination in surgical practice and surgical training in Australian and New Zealand hospitals. Design/methodology/approach The approach taken is an analysis of the available evidence-based literature to inform the proposed viewpoint. The theoretical subject scope presented is a discussion of how and why the various strategies put forward in this paper should be integrated into and led from an overarching workforce engagement platform. Findings The key themes isolated from the Inquiry into Australian and New Zealand surgical practice ranged from abuse of power by those in leadership positions, gender inequity in the surgical workforce, opaque and corrupt complaints handling processes, excessive surgical trainee working hours to bystander silence secondary to a fear of reprisal. A workforce engagement perspective has elicited the potential to counter various impacts, that of clinical ineffectiveness, substandard quality and safety, inefficient medical workforce management outcomes, adverse economic implications and the operational profitability of a hospital. Generic strategies grounded in evidence-based literature were able to then be aligned with specific action areas to provide a new leadership framework for addressing these impacts. Originality/value To the author's knowledge, this is one of the first responses providing a framework on how medical managers and hospital executives can begin to lead a comprehensive and practical strategy for changing the existing culture of bullying, harassment and discrimination in surgical practice by using a staff engagement framework.

  4. Variations in hospital administrative costs.

    PubMed

    McKay, Niccie L; Lemak, Christy Harris; Lovett, Annesha

    2008-01-01

    Administrative costs in hospitals are substantial and can have a major effect on performance. Despite this fact, not much research has been done to better understand such costs. This study examined variations in hospital administrative costs using a data set of acute care hospitals in Florida over the period 2000 through 2004. Results indicated that inflation-adjusted total administrative costs increased from about $22 million to $28 million on average over this time period. However, the percentage of total operating costs devoted to administrative costs was quite stable over the period, averaging approximately 23 percent in each of the five years. Compared with those in rural areas, urban hospitals on average had higher administrative costs per adjusted admission but lower administrative costs as a percentage of total operating costs. Hospital administrative costs also differed by ownership: For-profit hospitals on average had higher administrative costs per adjusted admission than not-for-profit and government hospitals, but administrative costs as a percentage of total operating costs were highest for for-profit hospitals and lowest for not-for-profit hospitals, with government hospitals falling in the middle. For bed size, administrative costs as a percentage of total operating costs were highest for the smallest hospitals. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, high-quality care.

  5. Hospital Acquisitions Before Healthcare Reform.

    PubMed

    McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun

    2015-01-01

    The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

  6. [Success factors in hospital management].

    PubMed

    Heberer, M

    1998-12-01

    The hospital environment of most Western countries is currently undergoing dramatic changes. Competition among hospitals is increasing, and economic issues have become decisive factors for the allocation of medical care. Hospitals therefore require management tools to respond to these changes adequately. The balanced scorecard is a method of enabling development and implementation of a business strategy that equally respects the financial requirements, the needs of the customers, process development, and organizational learning. This method was used to derive generally valid success factors for hospital management based on an analysis of an academic hospital in Switzerland. Strategic management, the focus of medical services, customer orientation, and integration of professional groups across the hospital value chain were identified as success factors for hospital management.

  7. Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections.

    PubMed

    Maestre-Moreno, J F; Fernández-Pérez, M D; Triguero-Cueva, L; Gutiérrez-Zúñiga, R; Herrera-García, J D; Espigares-Molero, A; Mínguez-Castellanos, A

    2016-05-05

    Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital. We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS). A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (44 deaths, 7.8%) and 263 haemorrhagic stroke (52 deaths, 19.7%). Patients with haemorrhagic stroke therefore showed greater mortality rate (OR=2.9). Patients in this group died after a shorter time in hospital (median, 4 vs 7 days; mean, 6 days). However, patients with ischaemic stroke were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio (MOR) was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with ischaemic stroke and 20% of those with haemorrhagic stroke had atrial fibrillation (AF); 35% of the patients with ischaemic stroke and AF were taking anticoagulants. Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with haemorrhagic stroke showed higher mortality rates than those with ischaemic stroke. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; 2 thirds of the patients with fatal ischaemic stroke and atrial fibrillation were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  8. [Characteristics of structural injuries in pediatric patients with focal epilepsy in a Honduran hospital].

    PubMed

    Ramirez-Izcoa, A; Varela-Gonzalez, D; Fonseca, M I

    2017-08-01

    Epilepsy is the most commonly occurring neurological disorder in the world. The study of structural brain lesions is important to understand the secondary complications. In Honduras there is little information on this topic. To determine the characteristics and proportion of structural brain lesions in paediatric patients with focal epilepsy at the Hospital Escuela Universitario. A descriptive, cross-sectional, retrospective-prospective study. The study population consisted of 162 paediatric patients with focal epilepsy who were treated in the paediatric neurology outpatient department between January 2015 and June 2016. On applying the eligibility and exclusion criteria, the universe of study comprised 102 patients with focal epilepsy. 41% of the patients with focal epilepsy presented a structural lesion. The main locations of the structural lesions were the parietal lobe (12.8%), the occipital lobe (10.8%) and the frontal lobe (10.8%). An association was found between the presence of structural brain lesions and the presence of uncontrolled seizures, with statistical significance. The attributable risk was calculated and it was found that among patients with uncontrolled seizures, 67% had a structural lesion in the imaging study. The presence of uncontrolled seizures is associated to the presence of structural lesions in imaging studies, with a high attributable risk. Leukomalacia and cerebral ischaemia were the main findings that were reported. The predominant structural lesions in paediatric patients with focal epilepsy in the population studied are those related to events that take place during the peripartum period.

  9. Allergic contact dermatitis due to cosmetics: A clinical and epidemiological study in a tertiary hospital.

    PubMed

    Zaragoza-Ninet, V; Blasco Encinas, R; Vilata-Corell, J J; Pérez-Ferriols, A; Sierra-Talamantes, C; Esteve-Martínez, A; de la Cuadra-Oyanguren, J

    2016-05-01

    The incidence of allergic contact dermatitis (ACD) to cosmetics in the general population is rising with the increasing use of cosmetic products and their proliferation and diversification. The aims of this study were to determine the prevalence of ACD to cosmetics in our setting, analyze changes over time, describe the clinical and epidemiological features of this allergic reaction, and identify the allergens and cosmetics involved. We performed a prospective study at the skin allergy unit in Hospital General Universitario de Valencia in Spain between 2005 and 2013 and compared our findings with data collected retrospectively for the period 1996 to 2004. The 5419 patients who underwent patch testing during these 2 periods were included in the study. The mean prevalence of ACD to cosmetics increased from 9.8% in the first period (1996-2004) to 13.9% in the second period (2005-2013). A significant correlation was found between ACD to cosmetics and female sex but not atopy. Kathon CG (blend of methylchloroisothiazolinone and methylisothiazolinone), fragrances, and paraphenylenediamine were the most common causes of ACD to cosmetics during both study periods, and acrylates and sunscreens were identified as emerging allergens during the second period. Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  10. Hospitality and Collegial Community: An Essay.

    ERIC Educational Resources Information Center

    Bennett, John B.

    2000-01-01

    Explains a collegial ethic of hospitality as a cardinal academic virtue and suggests a way of building a "collegium," the covenantal community of academe. Discusses how academicians can develop hospitable teaching, hospitable scholarship, and hospitable service. (Author/SLD)

  11. [Satisfaction of hospitalized patients in a hospital in Apurimac, Peru].

    PubMed

    Sihuin-Tapia, Elsa Yudy; Gómez-Quispe, Oscar Elisban; Ibáñez-Quispe, Vladimiro

    2015-01-01

    In order to determine the satisfaction of hospitalized patients in the Sub-regional Hospital of Andahuaylas, 175 patients were surveyed using the Servqual multidimensional model. The estimate of variables associated with the satisfaction of the hospitalized patients was performed by using bivariate and multivariate logistic regression analysis. We found 25.0% satisfaction. Lower levels of satisfaction were associated with having a secondary level education (aOR: 0.05; 95% CI: 0.01 to 0.64) and with having been hospitalized in the surgery department (aOR 0.14, CI: 95%: 0.04 to 0.53). It was concluded that there was a low level of satisfaction with the quality of care received by hospitalized patients and this was associated with the level of education and type of hospital department.

  12. Electronic Cigarettes on Hospital Campuses

    PubMed Central

    Meernik, Clare; Baker, Hannah M.; Paci, Karina; Fischer-Brown, Isaiah; Dunlap, Daniel; Goldstein, Adam O.

    2015-01-01

    Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes) and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121) to assess what proportion of hospitals have developed e-cigarette policies, how policies have been implemented and communicated, and what motivators and barriers have influenced the development of e-cigarette regulations. Seventy-five hospitals (62%) completed the survey. Over 80% of hospitals reported the existence of a policy regulating the use of e-cigarettes on campus and roughly half of the hospitals without a current e-cigarette policy are likely to develop one within the next year. Most e-cigarette policies have been incorporated into existing tobacco-free policies with few reported barriers, though effective communication of e-cigarette policies is lacking. The majority of hospitals strongly agree that e-cigarette use on campus should be prohibited for staff, patients, and visitors. Widespread incorporation of e-cigarette policies into existing hospital smoke and tobacco-free campus policies is feasible but needs communication to staff, patients, and visitors. PMID:26729142

  13. Electronic Cigarettes on Hospital Campuses.

    PubMed

    Meernik, Clare; Baker, Hannah M; Paci, Karina; Fischer-Brown, Isaiah; Dunlap, Daniel; Goldstein, Adam O

    2015-12-29

    Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes) and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121) to assess what proportion of hospitals have developed e-cigarette policies, how policies have been implemented and communicated, and what motivators and barriers have influenced the development of e-cigarette regulations. Seventy-five hospitals (62%) completed the survey. Over 80% of hospitals reported the existence of a policy regulating the use of e-cigarettes on campus and roughly half of the hospitals without a current e-cigarette policy are likely to develop one within the next year. Most e-cigarette policies have been incorporated into existing tobacco-free policies with few reported barriers, though effective communication of e-cigarette policies is lacking. The majority of hospitals strongly agree that e-cigarette use on campus should be prohibited for staff, patients, and visitors. Widespread incorporation of e-cigarette policies into existing hospital smoke and tobacco-free campus policies is feasible but needs communication to staff, patients, and visitors.

  14. Influence of Hospital and Nursing Home Quality on Hospital Readmissions

    PubMed Central

    Thomas, Kali S.; Rahman, Momotazur; Mor, Vincent; Intrator, Orna

    2015-01-01

    Objectives To determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. Study Design Retrospective cohort study of 1,382,477 individual hospitalizations discharged to 15,356 NHs from 3683 hospitals between 2006 and 2008. Methods Data come from Medicare claims and enrollment records, Minimum Data Set, Online Survey Certification and Reporting Dataset, Hospital Compare, and the American Hospital Association Database. Cross-classified random effects models were used to test the association of hospital and NH quality measures and the likelihood of 30-day rehospitalization. Results Patients discharged from higher-quality hospitals (as indicated by higher scores on their accountability process measures and high nurse staffing levels) and patients who received care in higher-quality NHs (as indicated by high nurse staffing levels and lower deficiency scores) were less likely to be rehospitalized within 30 days. Conclusions The passage of the Affordable Care Act changed the accountability of hospitals for patients’ outcomes after discharge. This study highlights the joint accountability of hospitals and NHs for rehospitalization of patients. PMID:25730351

  15. Hospital-Readmission Risk - Isolating Hospital Effects from Patient Effects.

    PubMed

    Krumholz, Harlan M; Wang, Kun; Lin, Zhenqiu; Dharmarajan, Kumar; Horwitz, Leora I; Ross, Joseph S; Drye, Elizabeth E; Bernheim, Susannah M; Normand, Sharon-Lise T

    2017-09-14

    To isolate hospital effects on risk-standardized hospital-readmission rates, we examined readmission outcomes among patients who had multiple admissions for a similar diagnosis at more than one hospital within a given year. We divided the Centers for Medicare and Medicaid Services hospital-wide readmission measure cohort from July 2014 through June 2015 into two random samples. All the patients in the cohort were Medicare recipients who were at least 65 years of age. We used the first sample to calculate the risk-standardized readmission rate within 30 days for each hospital, and we classified hospitals into performance quartiles, with a lower readmission rate indicating better performance (performance-classification sample). The study sample (identified from the second sample) included patients who had two admissions for similar diagnoses at different hospitals that occurred more than 1 month and less than 1 year apart, and we compared the observed readmission rates among patients who had been admitted to hospitals in different performance quartiles. In the performance-classification sample, the median risk-standardized readmission rate was 15.5% (interquartile range, 15.3 to 15.8). The study sample included 37,508 patients who had two admissions for similar diagnoses at a total of 4272 different hospitals. The observed readmission rate was consistently higher among patients admitted to hospitals in a worse-performing quartile than among those admitted to hospitals in a better-performing quartile, but the only significant difference was observed when the patients were admitted to hospitals in which one was in the best-performing quartile and the other was in the worst-performing quartile (absolute difference in readmission rate, 2.0 percentage points; 95% confidence interval, 0.4 to 3.5; P=0.001). When the same patients were admitted with similar diagnoses to hospitals in the best-performing quartile as compared with the worst-performing quartile of hospital

  16. Strategies and performance in hospitals.

    PubMed

    Madorrán García, Cristina; de Val Pardo, Isabel

    2004-01-01

    Today, more than ever in the past, the variables within the health care environment (demand, costs, system deregulation) are undergoing such rapid change that hospital administrators are finding it necessary to develop and implement competitive strategies in order to survive in the increasingly competitive hospital environment. The primary aim of this paper is to answer the following question: Is it possible to transfer strategic management research from other sectors into the hospital industry? The first objective was to identify strategies in hospital management. A questionnaire was designed and sent to hospital CEOs and the data extracted were used to construct the variables needed to identify strategies and perform the subsequent analyses. The second aim was to try to identify groups of organizations using similar strategies and, finally, analyse the impact of these on hospital performance.

  17. The economics of specialty hospitals.

    PubMed

    Schneider, John E; Miller, Thomas R; Ohsfeldt, Robert L; Morrisey, Michael A; Zelner, Bennet A; Pengxiang Li

    2008-10-01

    Specialty hospitals, particularly those specializing in surgery and owned by physicians, have generated a relatively high degree of policy attention over the past several years. The main focus of policy debates has been in two areas: the extent to which specialty hospitals might compete unfairly with incumbent general hospitals and the extent to which physician ownership might be associated with higher usage. Largely absent from the debates, however, has been a discussion of the basic economic model of specialty hospitals. This article reviews existing literature, reports, and findings from site visits to explore the economic rationale for specialty hospitals. The discussion focuses on six factors associated with specialization: consumer demand, procedural operating margins, clinical efficiencies, procedural economies of scale, economies (and diseconomies) of scope, and competencies and learning. A better understanding of the economics of specialization will help policy makers evaluate the full spectrum of advantages and disadvantages of specialty hospitals.

  18. Does outsourcing affect hospital profitability?

    PubMed

    Danvers, Kreag; Nikolov, Pavel

    2010-01-01

    Organizations outsource non-core service functions to achieve cost reductions and strategic benefits, both of which can impact profitability performance. This article examines relations between managerial outsourcing decisions and profitability for a multi-state sample of non-profit hospitals, across 16 states and four regions of the United States. Overall regression results indicate that outsourcing does not necessarily improve hospital profitability. In addition, we identify no profitability impact from outsourcing for urban hospitals, but somewhat positive effects for teaching hospitals. Our regional analysis suggests that hospitals located in the Midwest maintain positive profitability effects with outsourcing, but those located in the South realize negative effects. These findings have implications for cost reduction efforts and the financial viability of non-profit hospitals.

  19. Union Density and Hospital Outcomes.

    PubMed

    Koys, Daniel J; Martin, Wm Marty; LaVan, Helen; Katz, Marsha

    2015-01-01

    The authors address the hospital outcomes of patient satisfaction, healthcare quality, and net income per bed. They define union density as the percentage of a hospital's employees who are in unions, healthcare quality as its 30-day acute myocardial infraction (AMI; heart attack) mortality rate, and patient satisfaction as its overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Using a random sample of 84 union and 84 nonunion hospitals from across the United States, multiple regression analyses show that union density is negatively related to patient satisfaction. Union density is not related to healthcare quality as measured by the AMI mortality rate or to net income per bed. This implies that unions per se are not good or bad for hospitals. The authors suggest that it is better for hospital administrators to take a Balanced Scorecard approach and be concerned about employee satisfaction, patient satisfaction, healthcare quality, and net income.

  20. Controlling hospital library theft

    PubMed Central

    Cuddy, Theresa M.; Marchok, Catherine

    2003-01-01

    At Capital Health System/Fuld Campus (formerly Helene Fuld Medical Center), the Health Sciences Library lost many books and videocassettes. These materials were listed in the catalog but were missing when staff went to the shelves. The hospital had experienced a downsizing of staff, a reorganization, and a merger. When the library staff did an inventory, $10,000 worth of materials were found to be missing. We corrected the situation through a series of steps that we believe will help other libraries control their theft. Through regularly scheduling inventories, monitoring items, advertising, and using specific security measures, we have successfully controlled the library theft. The January 2002 inventory resulted in meeting our goal of zero missing books and videocassettes. We work to maintain that goal. PMID:12883573

  1. Breath of hospitality.

    PubMed

    Škof, Lenart

    2016-12-01

    In this paper we outline the possibilities of an ethic of care based on our self-affection and subjectivity in the ethical spaces between-two. In this we first refer to three Irigarayan concepts - breath, silence and listening from the third phase of her philosophy, and discuss them within the methodological framework of an ethics of intersubjectivity and interiority. Together with attentiveness, we analyse them as four categories of our ethical becoming. Furthermore, we argue that self-affection is based on our inchoate receptivity for the needs of the other(s) and is thus dialectical in its character. In this we critically confront some epistemological views of our ethical becoming. We wind up this paper with a proposal for an ethics towards two autonomous subjects, based on care and our shared ethical becoming - both as signs of our deepest hospitality towards the other.

  2. Controlling hospital library theft.

    PubMed

    Cuddy, Theresa M; Marchok, Catherine

    2003-04-01

    At Capital Health System/Fuld Campus (formerly Helene Fuld Medical Center), the Health Sciences Library lost many books and videocassettes. These materials were listed in the catalog but were missing when staff went to the shelves. The hospital had experienced a downsizing of staff, a reorganization, and a merger. When the library staff did an inventory, $10,000 worth of materials were found to be missing. We corrected the situation through a series of steps that we believe will help other libraries control their theft. Through regularly scheduling inventories, monitoring items, advertising, and using specific security measures, we have successfully controlled the library theft. The January 2002 inventory resulted in meeting our goal of zero missing books and videocassettes. We work to maintain that goal.

  3. Accidents on hospital wards.

    PubMed Central

    Levene, S; Bonfield, G

    1991-01-01

    Eight hospitals reported 781 non-iatrogenic accidents occurring to patients and visitors under 16 years of age during an 18 month period up to October 1989. Accidents more often involved boys and children aged 3 to 5 years old. Falls from a height, slips, and striking accidents were common by day and falls by night. A total of 41% of accidents to inpatients occurred when parents were present. Only three accidents were serious. Altogether 27% involved beds and cots, and only one consequent injury was more than minor. Data collected routinely in case of medicolegal action can be presented in a form that may facilitate preventative work. Potentially remediable causes for concern include falls from beds and cots and the use of makeshift equipment. PMID:1929510

  4. [Injuries from external causes in minors (less than 18 years of age) and adults at a hospital in Colombia].

    PubMed

    Bejarano, Mónica; Rendón, Luis Fernando

    2009-03-01

    To define and compare the types of injuries from external causes in patients more than and less than 18 years of age treated by the Mario Correa Rengifo Hospital. An analysis was conducted of data retrieved from the Sistema de Vigilancia de Lesiones de Causa Externa (Surveillance System for Injuries from External Causes) maintained by the Mario Correa Rengifo Hospital in Cali, Colombia, to compare minors (less than 18 years of age) with adults during January 2004-December 2007. A total of 4 507 minors were seen, most of whom (69.3%) were boys, with unintentional injuries (75.5%); however, 88% of the intentional injuries were person-to-person and 12% were self-inflicted. Injuries had occurred most frequently in the home (44.1%) and on the street (39.5%); the most frequent activity was recreation (53.3%). The minors had more head injuries (odds ratio [OR] = 1.62; P = 0.0000) and maxillofacial injuries (OR = 1.49; P = 0.0000) than did the adults. Alcohol had been consumed in 5.8% and drugs in 2.6%, both of which increased intentional injuries (alcohol OR = 4.25 and drugs OR = 1.56). The number of patients less than 18 years of age with injuries from external causes being treated at the Mario Correa Rengifo Hospital is constantly rising. The circumstances regarding injuries seen in children and adolescents differ from those of adults in that minors tend to suffer more unintentional injuries in the home or in the street where they play regularly. It is important that special educational and structural strategies be implemented to prevent injuries of this type.

  5. [Quality and efficiency in hospitals].

    PubMed

    Paganini, J M

    1993-12-01

    The objective of this research was to study the relationship between structural characteristics of hospitals (number and types of personnel, size of hospital units, and specialization of services) and health care outcomes, as measured by in-hospital mortality and average weight gain (AWG) in children under 1 year diagnosed with acute diarrheal disease (ADD). The study was carried out at 14 nonprofit acute-care hospitals located in greater Buenos Aires. The units of analysis were 23 pediatric wards (1,718 beds). The study population included 3,434 ADD cases (15.6% of total ward discharges). Various generalized linear models were used in the analysis, and the findings were adjusted according to the patients' age, severity of illness, and nutritional status. The acuteness of the disease investigated was verified. Of the study patients, 80.4% were 6 months old or younger and 40.1% suffered from some nutritional deficiency. According to an analysis of 32% of the cases, age was inversely associated with severity of illness, grade I nutritional deficiency, and in-hospital mortality, and directly associated with AWG. The adjusted case-fatality rates for the wards studied were different. Analysis of the relationship between the structural variables and the outcomes revealed that the number of nurses was inversely related to in-hospital mortality, while ward specialization and professional experience were directly related to AWG. These associations were statistically significant. There was a direct, statistically significant relationship between number of hospital staff and in-hospital mortality. Structural variables measuring the physicians' commitment to the institution, ward size, and hospital size were not found to be related to the outcomes. These findings can provide useful support for decision-making about hospital resource allocation, as well as about hospital organization and management. There is a need for more in-depth study of the relationship between the

  6. RFID solution benefits Cambridge hospital.

    PubMed

    James, Andrew

    2013-10-01

    Keeping track of thousands of pieces of equipment in a busy hospital environment is a considerable challenge, but, according to RFID tagging and asset tracking specialist, Harland Simon, RFID technology can make the task considerably simpler. Here Andrew James, the company's RFID sales manager, describes the positive benefits the technology has brought the Medical Equipment Library (MEL) at Addenbrooke's Hospital, one of the world's most famous teaching hospitals.

  7. Determinants of Hospital Casemix Complexity

    PubMed Central

    Becker, Edmund R.; Steinwald, Bruce

    1981-01-01

    Using the Commission on Professional and Hospital Activities' Resource Need Index as a measure of casemix complexity, this paper examines the relative contributions of teaching commitment and other hospital characteristics, hospital service and insurer distributions, and area characteristics to variations in casemix complexity. The empirical estimates indicate that all three types of independent variables have a substantial influence. These results are discussed in light of recent casemix research as well as current policy implications. PMID:6799430

  8. Cross hospital bed management system.

    PubMed

    Abedian, S; Kazemi, H; Riazi, H; Bitaraf, E

    2014-01-01

    The lack of adequate numbers of hospital beds to accommodate the injured is a main problem in public hospitals. For control of occupancy of bed, we design a dynamic system that announces status of bed when it change with admission or discharge of a patient. This system provide a wide network in country for bed management, especially for ICU and CCU beds that help us to distribute injured patient in the hospitals.

  9. [Rules for psychiatric emergency hospitalization].

    PubMed

    Pichené, Catherine

    2003-06-01

    The author describe how psychiatric emergencies are dealt with in France. Emergency rooms can admit these patients 24 hours a day particularly somato-psychiatric emergencies as well as situations of existential crisis. Many psychiatric hospitals have also designed a 24 hours a day response to emergencies but with a great diversity depending on local situations. Free-will hospitalization is the most common response but some situations can require commitment to a psychiatric hospital. The author describes in details the enforcement of the law in the case of hospitalization without patients's consent.

  10. Hospital Ethics Committees in Poland.

    PubMed

    Czarkowski, Marek; Kaczmarczyk, Katarzyna; Szymańska, Beata

    2015-12-01

    According to UNESCO guidelines, one of the four forms of bioethics committees in medicine are the Hospital Ethics Committees (HECs). The purpose of this study was to evaluate how the above guidelines are implemented in real practice. There were 111 hospitals selected out of 176 Polish clinical hospitals and hospitals accredited by Center of Monitoring Quality in Health System. The study was conducted by the survey method. There were 56 (50%) hospitals that responded to the survey. The number of HECs members fluctuated between 3 and 16 members, where usually 5 (22% of HECs) members were part of the board committee. The composition of the HECs for professions other than physicians was diverse and non-standardized (nurses-in 86% of HECs, clergy-42%, lawyers-38%, psychologists-28%, hospital management-23%, rehab staff-7 %, patient representatives-3%, ethicists-2%). Only 55% of HECs had a professional set of standards. 98% of HECs had specific tasks. 62% of HECs were asked for their expertise, and 55% prepared <6.88% of the opinions were related to interpersonal relations between hospital personnel, patients and their families with emphasis on the interactions between superiors and their inferiors or hospital staff and patients and their families. Only 12% of the opinions were reported by the respondents as related to ethical dilemmas. In conclusion, few Polish hospitals have HECs, and the structure, services and workload are not always adequate. To ensure a reliable operation of HECs requires the development of relevant legislation, standard operating procedures and well trained members.

  11. Wearing gloves in the hospital

    MedlinePlus

    Infection control - wearing gloves; Patient safety - wearing gloves; Personal protective equipment - wearing gloves; PPE - wearing gloves; Nosocomial infection - wearing gloves; Hospital acquired infection - wearing gloves

  12. [Hospitals and surgeons: Madrid 1940].

    PubMed

    de Quevedo, Francisco Vázquez

    2007-01-01

    The history of the hospitals and general surgeons that best represent the centres in Madrid are here in reviewed, comprising the period between 1940 and the closure of the Hospital Clinico (1957) as well as the Hospital General (General Hospital) (1967), both in Atocha. Other hospitals which are reviewed and highlighted are: the H. de la Princesa (the Princess Hospital), the H. del Nifio Jesus (Hospital of the Child Jesus), the H. Militar (Military Hospital) and the Cruz Roja (Red Cross). Data is provided on the permanent surgeons in the following centres: H. General: J. Goyanes, J. Die, J. de la Villa, T. Rodriguez, E. Diaz, G. Bueno e H. Huerta; H. Clinico: L. de la Peña, L. Cardenal, L. Olivares, R. Argüelles, J. Estella y M. F. Zumel; H. Militar: M. G. Ulla, M. Bastos, M. G. Durán, J. S. Galindo, y A. G. Durán; Hospital de la Cruz Roja: V. M. Noguera, L. Serrada, F. Luque y L. L. Durán; H. de la Princesa: P. Cifuentes, P. G. Duarte, L. Estella y R. Aiguabella; H. del Niño Jesús: J. Garrido Lestache; H. Clinico, last time, Atocha: F. M. Lagos, R. Vara y A. de la Fuente.

  13. Engaging Chicago hospitals in the baby-friendly hospital initiative.

    PubMed

    Schoenfelder, Samantha L; Wych, Sadie; Willows, Catherine A; Harrington, Joseph; Christoffel, Katherine Kaufer; Becker, Adam B

    2013-11-01

    Breastfeeding is now widely recognized as a vital obesity prevention strategy and hospitals play a primary role in promoting, supporting and helping mothers to initiate and maintain breastfeeding. The Baby-Friendly Hospital Initiative (BFHI) provides an evidence-based model that hospitals can use to plan and implement breastfeeding quality improvement (QI) projects. Funding under Communities Putting Prevention to Work (CPPW), administered by the CDC, brought together key Chicago partners to provide individualized support and technical assistance with breastfeeding QI projects to the 19 maternity hospitals in Chicago. A community organizing approach was taken to mobilize hospital interest in breastfeeding QI projects, leading to successes, e.g. 12/19 (63 %) Chicago hospitals registered with Baby-Friendly USA, Inc. (BFUSA) to pursue official Baby-Friendly designation. Key factors that fostered this success included: involving all levels of hospital staff, financial incentives, and ongoing tailored technical assistance. To assist other communities in similar work, this article discusses the approach the project took to mobilize hospitals to improve breastfeeding support practices based on the BFHI, as well as successes and lessons learned.

  14. Closure of a home hospital program: impact on hospitalization rates.

    PubMed

    Jacobs, Jeremy M; Cohen, Aaron; Rozengarten, Ora; Meiller, Ludmila; Azoulay, Daniel; Hammerman-Rozenberg, Robert; Stessman, Jochanan

    2007-01-01

    Home hospitalization (HH), as a substitute to in-patient care, is an area of growing interest, particularly amongst the elderly. Debate nonetheless exists concerning its economic justification. This study describes a natural experiment that arose following spending cuts and closure of the 400 patient Jerusalem HH program. It examines the hypothesis that HH closure would cause increasing geriatric and general medical hospital utilization amongst the 45,000 beneficiaries of the Jerusalem Clalit Health Fund (HMO) aged 65 years and over. Hospitalization rates were measured prior to and following HH closure, and analysis of variance confirmed the significance of the differences in both geriatric (p<0.0001) and general medical hospitalization rates (p=0.02) over the study period. Linear regression analyses of the hospitalization rates prior to HH closure were performed to determine the expected trajectory of hospitalization rates following HH closure. The observed hospital utilization in the year following HH closure cost 6.2 million US dollars in excess of predicted expenditure; closure of the HH resulted in the saving of 1.3 million USdollars. The ratio of direct increased costs to savings was 5:1 thus confirming the hypothesis that HH closure would result in increased hospital utilization rates among the local elderly population.

  15. The transition to a teaching hospital: patient satisfaction before and after the introduction of medical students.

    PubMed

    Esguerra, Roberto; Toro, Jaime; Ospina, José Miguel; Porras, Alexandra; Díaz, Camilo; Reyes, Saúl

    2014-08-01

    Several studies have explored the effect of the presence of medical students on patient satisfaction. However, nearly all of these studies took place in hospitals where medical students had been involved in patient care for many years. Less is known about patients' perceptions of care in a hospital moving toward becoming a teaching facility with undergraduate students. No research has explored patient satisfaction before and after the introduction of medical students. To assess patient satisfaction as an indicator of quality of care (QoC) from the patients' perspective, before and after the presence of medical students in a general hospital setting. This observational, cross-sectional study was conducted at Hospital Universitario-Fundación Santa Fe de Bogotá (HU-FSFB) in Bogotá, Colombia. The study had two phases. In 2006, prior to HU-FSBF becoming a teaching hospital, 385 subjects were asked to fill out a closed-question questionnaire addressing patients' satisfaction and perception of QoC provided by attending physicians. During the second period in 2009, 372 patients answered the same questionnaire when medical students were involved in their care. Patients' perceptions of QoC provided by attending physicians improved in five aspects when medical students were present: friendliness (p = 0.003), competence providing medical care (p = 0.049), quality of information provided (p = 0.025), amount of time spent with the patient (p < 0.001) and availability to personally provide care (p < 0.001). Overall patient satisfaction also significantly increased (p < 0.001). The presence of medical students does not negatively affect patients' perceptions of QoC, on the contrary, these results provide evidence of improved patient satisfaction in several aspects of care when medical students were involved. The relevance of this study lies in its unique way of comparing patient satisfaction before and after the introduction of medical students. This

  16. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients.

    PubMed

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-07-28

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient.

  17. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients

    PubMed Central

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-01-01

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient. PMID:27483269

  18. Pre-hospital emergency medicine.

    PubMed

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.

  19. Steering Patients to Safer Hospitals? The Effect of a Tiered Hospital Network on Hospital Admissions

    PubMed Central

    Scanlon, Dennis P; Lindrooth, Richard C; Christianson, Jon B

    2008-01-01

    Objective To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals. Data Sources/Study Setting A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety “leaps.” The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner. Study Design Changes in hospital admissions’ patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression. Principal Findings Patients affiliated with the engineers’ union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists’ union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time. Conclusions Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear. PMID:18761676

  20. An economic analysis of inadequate prescription of antiulcer medications for in-hospital patients at a third level institution in Colombia.

    PubMed

    Machado-Alba, Jorge Enrique; Castrillón-Spitia, Juan Daniel; Londoño-Builes, Manuel José; Fernández-Cardona, Alejandra; Campo-Betancourth, Carlos Felipe; Ochoa-Orozco, Sergio Andrés; Echeverri-Cataño, Luis Felipe; Ruiz-Villa, Joaquín Octavio; Gaviria-Mendoza, Andrés

    2014-02-01

    The prescription and costs of antiulcer medications for in-hospital use have increased during recent years with reported inadequate use and underused. To determine the patterns of prescription-indication and also perform an economic analysis of the overcost caused by the non-justified use of antiulcer medications in a third level hospital in Colombia. Cross-sectional study of prescription-indication of antiulcer medications for patients hospitalized in "Hospital Universitario San Jorge" of Pereira during July of 2012. Adequate or inadequate prescription of the first antiulcer medication prescribed was determined as well as for others prescribed during the hospital stay, supported by clinical practice guidelines from the Zaragoza I sector workgroup, clinical guidelines from the Australian Health Department, and finally the American College of Gastroenterology Criteria for stress ulcer prophylaxis. Daily defined dose per bed/day was used, as well as the cost for 100 beds/day and the cost of each bed/drug. A multivariate analysis was carried out using SPSS 21.0. 778 patients were analyzed, 435 men (55.9 %) and 343 women, mean age 56.6 +/- 20.1 years. The number of patients without justification for the prescription of the first antiulcer medication was 377 (48.5 %), and during the whole in-hospital time it was 336 (43.2 %). Ranitidine was the most used medication, in 438 patients (56.3 %). The cost/month for poorly justified antiulcer medications was € 3,335.6. The annual estimated cost for inadequate prescriptions of antiulcer medications was € 16,770.0 per 100 beds. A lower inadequate prescription rate of antiulcer medications was identified compared with other studies; however it was still high and is troubling because of the major costs that these inadequate prescriptions generates for the institution.

  1. [Adverse events associated with tramadol and dipirona administration in a level III hospital].

    PubMed

    Montoya, Giovanny Alberto; Vaca, Claudia; Parra, María Fernanda

    2009-09-01

    The efficacy and safety of pharmaceutical drugs such as dipirone and tramadol must be a primary objective in the post-marketing period and as they are used in specific population groups. The frequency of adverse effects (including therapeutic failure) with the medications tramadol and dipirona were described and estimated. At the Hospital Universitario de la Samaritana, Bogotá, D.C., Colombia, adverse events associated with dipirone and tramadol were rigorously tracked in patients hospitalized in the internal medicine, as well as the orthopedics and surgery departments. For a period of six months, data were collected by means of the Instituto Nacional de Vigilancia Médica y Alimentos (INVIMA) standard report form. Direct costs of adverse event treatment to the patient were calculated. Adverse reactions were detected 213 times in 171 (8.4%) of the 2,547 patients admitted to the services (incidence rate. Of these instances, 53.4% were rated as possible for dipirone and 46.82% for tramadol. Of the total, 0.6% (16 cases) were classes as serious adverse events. The gastrointestinal system was the most affected, with the incidences of adverse events for dipirone of 27%) and tramadol of 42.9%. The total cost generated by the medical response to the 213 adverse events was estimated to be US$14,346.53. An unacceptable level of preventable adverse events was described that impacted the well-being of patients, as well as the costs associated with remedial treatment. These data recommend that institutional pharmacovigilance programs be required.

  2. Birds of Antioquia: Georeferenced database of specimens from the Colección de Ciencias Naturales del Museo Universitario de la Universidad de Antioquia (MUA).

    PubMed

    Rozo, Andrea Morales; Valencia, Fernando; Acosta, Alexis; Parra, Juan Luis

    2014-01-01

    The department of Antioquia, Colombia, lies in the northwestern corner of South America and provides a biogeographical link among divergent faunas, including Caribbean, Andean, Pacific and Amazonian. Information about the distribution of biodiversity in this area is of relevance for academic, practical and social purposes. This data paper describes the dataset containing all bird specimens deposited in the Colección de Ciencias Naturales del Museo Universitario de la Universidad de Antioquia (MUA). We curated all the information associated with the bird specimens, including the georeferences and taxonomy, and published the database through the Global Biodiversity Information Facility network. During this process we checked the species identification and existing georeferences and completed the information when possible. The collection holds 663 bird specimens collected between 1940 and 2011. Even though most specimens are from Antioquia (70%), the collection includes material from several other departments and one specimen from the United States. The collection holds specimens from three endemic and endangered species (Coeligena orina, Diglossa gloriossisima, and Hypopirrhus pyrohipogaster), and includes localities poorly represented in other collections. The information contained in the collection has been used for biodiversity modeling, conservation planning and management, and we expect to further facilitate these activities by making it publicly available.

  3. Birds of Antioquia: Georeferenced database of specimens from the Colección de Ciencias Naturales del Museo Universitario de la Universidad de Antioquia (MUA)

    PubMed Central

    Rozo, Andrea Morales; Valencia, Fernando; Acosta, Alexis; Parra, Juan Luis

    2014-01-01

    Abstract The department of Antioquia, Colombia, lies in the northwestern corner of South America and provides a biogeographical link among divergent faunas, including Caribbean, Andean, Pacific and Amazonian. Information about the distribution of biodiversity in this area is of relevance for academic, practical and social purposes. This data paper describes the dataset containing all bird specimens deposited in the Colección de Ciencias Naturales del Museo Universitario de la Universidad de Antioquia (MUA). We curated all the information associated with the bird specimens, including the georeferences and taxonomy, and published the database through the Global Biodiversity Information Facility network. During this process we checked the species identification and existing georeferences and completed the information when possible. The collection holds 663 bird specimens collected between 1940 and 2011. Even though most specimens are from Antioquia (70%), the collection includes material from several other departments and one specimen from the United States. The collection holds specimens from three endemic and endangered species (Coeligena orina, Diglossa gloriossisima, and Hypopirrhus pyrohipogaster), and includes localities poorly represented in other collections. The information contained in the collection has been used for biodiversity modeling, conservation planning and management, and we expect to further facilitate these activities by making it publicly available. PMID:24899851

  4. [Identification of emergencies for asthma and chronic obstructive pulmonary disease in the emergency rooms of a hospital. A reliability study].

    PubMed

    Merelles Tormo, A; Rivera Ortún, M f; Ballester Díez, F; Antó Boqué, J M; Oterino de la Fuente, D

    1999-01-01

    To analyse the reliability of the obtained results in the identification of cases of asthma and chronic obstructive pulmonary disease (COPD) diagnosed in the medical records of the emergency rooms of the <Hospital Clínico Universitario> of Valencia, Spain. In the context of a study on the relationship between emergency rooms for asthma and COPD and specific environmental risks, we revised all the emergency rooms medical records of people aged over 14 attended at the <Hospital Clínico Universitario> of Valencia, Spain, during 1993 and 1994. The observers were two nurses who received previous training in the identification of cases. One observer revised the year 1993 and the other one 1994. To evaluate the reliability of the results we obtained a 24 days sample for each year and we estimated the inter-observer agreement using the Proportion of Observed Agreement (POA) and the Kappa Index (KI) and the 95 % confidence intervals (95% CI). We also carried out a specific analysis for each study category estimating the specific Kappa Index and the Proportions of Specific Agreement (PSA). To assess the inter-observer agreement we used the first 59 days of 1994, to estimate the same indexes mentioned above. In the total of emergency rooms, the POA for both observers was 0.99 and the KI was 0.91 (95% CI: 0.88-0.94) for the first observer and 0.79 (0.76-0.82) for the second one. In the specific analysis the PSA for versus were 0.92 (0.75-1) and 0.48 (0.31-0. 66) respectively. For the analysis of versus the PSA were 0.78 (0.69-0.87) and 0.75 (0.64-0.86). In the inter-observer agreement study we obtained, for the overall analysis, a POA equal to 0.99 and a KI to 0.87 (0.86-0.88). In the specific study the PSA for versus were 0.64 (0.53-0. 74) and 0.82 (0.77-0.87) for versus . The consistency of the results is good for both observers, but better for the first observer, particularly for asthma. For

  5. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Hospitals subject to the hospital outpatient... FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital...

  6. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Hospitals subject to the hospital outpatient... FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital...

  7. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Hospitals subject to the hospital outpatient... FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital...

  8. [Mistreatment of students in hospitals].

    PubMed

    Auslender, Valérie; Fleury, Cynthia

    2017-09-01

    Health care students are abused and mistreated in hospital: humiliation, harassment and bullying of all sorts are daily occurrences, in a highly competitive universe and difficult working environment. It is time for the managerial policy of hospitals to consider the human factor and the well-being of employees and students. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Comparing Candidate Hospital Report Cards

    SciTech Connect

    Burr, T.L.; Rivenburgh, R.D.; Scovel, J.C.; White, J.M.

    1997-12-31

    We present graphical and analytical methods that focus on multivariate outlier detection applied to the hospital report cards data. No two methods agree which hospitals are unusually good or bad, so we also present ways to compare the agreement between two methods. We identify factors that have a significant impact on the scoring.

  10. Facts about Hospital Worker Safety

    MedlinePlus

    ... road map” to implementing a safety and health management system, featuring “success stories” and best practices from a variety of hospitals. Good recordkeeping puts powerful data at your fingertips. The first step toward solving a problem is to understand it. Fortunately, every hospital should ...

  11. Do hospital mergers reduce costs?

    PubMed

    Schmitt, Matt

    2017-03-01

    Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition. These results are robust to a variety of different control strategies, and do not appear to be easily explained by post-merger changes in service and/or patient mix. I then explore several extensions of the results to examine (a) whether the acquiring hospital/system realizes cost savings post-merger and (b) if cost savings depend on the size of the acquirer and/or the geographic overlap of the merging hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. [Obstetric analgesia in Norwegian hospitals].

    PubMed

    Dahl, V; Hagen, I E; Raeder, J C

    1998-04-30

    We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%. Epidural analgesia was much more widely used in university and regional hospitals than in local hospitals (p < 0.001). Five of the local hospitals did not offer epidural analgesia during labour at all. The combination of low-dose local anaesthetic and an opioid (either sufentanil or fentanyl) had not been introduced in nine of the hospitals (20%). The optimal use of epidural analgesia to relieve labour pain was judged to be more frequent by the anaesthetists than by the midwives (19% versus 11%, p < 0.01). In response to what factors limited the frequency of epidural analgesia, the anaesthetists specified factors related to the attitude of the midwife, and the midwives specified factors related to the anaesthetist. Only five of the hospitals provided written information on the various analgesic methods that could be employed during labour. The majority of midwives considered the analgesic methods employed on their maternity ward to be good or excellent. The frequency of Caesarean section was 12%; spinal anaesthesia was used in 55%, epidural anaesthesia in 17%, and general anaesthesia in 28% of the cases.

  13. Faculty Internships for Hospitality Instructors

    ERIC Educational Resources Information Center

    Lynn, Christine; Hales, Jonathan A; Wiener, Paul

    2007-01-01

    Internships can help hospitality faculty build industry relationships while also ensuring the best and most current training for their students. Many hospitality organizations have structured faculty internships available or are willing to work with faculty to provide individualized internship opportunities. Career and technical educators in…

  14. Segmentation in local hospital markets.

    PubMed

    Dranove, D; White, W D; Wu, L

    1993-01-01

    This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that "centers of excellence" have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.

  15. Occupational hazards to hospital personnel

    SciTech Connect

    Patterson, W.B.; Craven, D.E.; Schwartz, D.A.; Nardell, E.A.; Kasmer, J.; Noble, J.

    1985-05-01

    Hospital personnel are subject to various occupational hazards. Awareness of these risks, compliance with basic preventive measures, and adequate resources for interventions are essential components of an occupational health program. Physical, chemical, and radiation hazards; important infectious risks; and psychosocial problems prevalent in hospital workers are reviewed. A rational approach to managing and preventing these problems is offered. 370 references.

  16. Educational Costs to Hospitalized Patients

    ERIC Educational Resources Information Center

    Martz, E. Wayne; Ptakowski, Richard

    1978-01-01

    One of the less obvious costs of educational programs is the increased volume of work-ups and treatment for hospitalized patients that are ordered by residents. In a hospital with both private teaching and private nonteaching floors, a comparison shows that service charges on teaching floors are 60 percent higher than on nonteaching floors.…

  17. Management of the Hospital Environment

    ERIC Educational Resources Information Center

    Turner, Alvis G.

    1976-01-01

    Hospital studies indicate the need for an environmental/sanitarian specialist for control of nosocomial infection and maintenance of a quality environment. The author recommends these requirements for certification as a hospital environmentalist: academic studies including toxicology, epidemiology, hygiene, management, and an internship in…

  18. Suicidal Behavior in Hospitalized Schizophrenics.

    ERIC Educational Resources Information Center

    Prasad, Ashoka Jahnavi; Kumar, Nirmal

    1988-01-01

    Compared 131 hospitalized schizophrenics who had attempted suicide within past year to 70 hospitalized schizophrenics who had not attempted suicide, using the Present State Examination depressive symptoms. Found that schizophrenics who had attempted suicide had significantly higher number of symptoms indicative of a depressive disorder. (Author/NB)

  19. Hospitality Management Education and Training.

    ERIC Educational Resources Information Center

    Brotherton, Bob, Ed.; And Others

    1995-01-01

    Seven articles on hospitality management training discuss the following: computerized management games for restaurant manager training, work placement, real-life exercises, management information systems in hospitality degree programs, modular programming, service quality concepts in the curriculum, and General National Vocational Qualifications…

  20. Management of the Hospital Environment

    ERIC Educational Resources Information Center

    Turner, Alvis G.

    1976-01-01

    Hospital studies indicate the need for an environmental/sanitarian specialist for control of nosocomial infection and maintenance of a quality environment. The author recommends these requirements for certification as a hospital environmentalist: academic studies including toxicology, epidemiology, hygiene, management, and an internship in…

  1. Hospital dispensing. On auto pilot.

    PubMed

    Farrar, Keith; Slee, Ann; Yeats, Michael

    2002-10-10

    An automated dispensing system installed in an acute hospital has halved dispensing errors and released more than 30 per cent of technicians' time for other duties. Reducing medication errors can have a considerable effect on reducing pressure on hospital beds. Automation has considerable advantages in light of the continuing shortage of pharmacists and pharmacy technicians.

  2. Hospital association libraries: an overview.

    PubMed

    Poole, C

    1982-04-01

    Results of a survey conducted by the Library of the American Hospital Association to gather data about library and information services provided by other hospital associations are reported. Topics covered include staffing, funding, collection size, users, and services. The interface of these libraries with other health sciences libraries and the national Biomedical Communications Network (BCN) is discussed.

  3. Hospitality Management Education and Training.

    ERIC Educational Resources Information Center

    Brotherton, Bob, Ed.; And Others

    1995-01-01

    Seven articles on hospitality management training discuss the following: computerized management games for restaurant manager training, work placement, real-life exercises, management information systems in hospitality degree programs, modular programming, service quality concepts in the curriculum, and General National Vocational Qualifications…

  4. Faculty Internships for Hospitality Instructors

    ERIC Educational Resources Information Center

    Lynn, Christine; Hales, Jonathan A; Wiener, Paul

    2007-01-01

    Internships can help hospitality faculty build industry relationships while also ensuring the best and most current training for their students. Many hospitality organizations have structured faculty internships available or are willing to work with faculty to provide individualized internship opportunities. Career and technical educators in…

  5. Practicing Hospitality in the Classroom

    ERIC Educational Resources Information Center

    Burwell, Rebecca; Huyser, Mackenzi

    2013-01-01

    This article explores pedagogical approaches to teaching students how to practice hospitality toward the other. Using case examples from the college classroom, the authors discuss the roots of Christian hospitality and educational theory on transformative learning to explore how students experience engaging with others after they have…

  6. Practicing Hospitality in the Classroom

    ERIC Educational Resources Information Center

    Burwell, Rebecca; Huyser, Mackenzi

    2013-01-01

    This article explores pedagogical approaches to teaching students how to practice hospitality toward the other. Using case examples from the college classroom, the authors discuss the roots of Christian hospitality and educational theory on transformative learning to explore how students experience engaging with others after they have…

  7. [Hospitals as vital links].

    PubMed

    Klink, A

    2013-01-01

    The reform of the system in 2006 aimed at reducing waiting lists in an efficient manner. Performance-linked funding and regulated competition did indeed lead to improved efficiency. The other side of the coin is overtreatment, and expensive and not infrequently damaging growth in volume. In order to control costs, three strategies have been determined: agreements with an annual cap on volume; (b) collaboration of regional health-care providers with the mission of improving results in health care (with profit-sharing if costs fall); and (c) fusions reducing the number of hospitals which reduces the burden of injuries (supply no longer creates its own demand). This article comments on these strategies. The author argues for a fourth approach: if the quality of health care improves, the number of complications will fall, overtreatment will decline and the outcome will be a decrease in burden of injuries. This requires the health care insurers to modify the way they manage their contracts and methods of payment, and stimulates competition based on quality.

  8. [Medication safety in hospitals].

    PubMed

    Sleinitz, Annett; Heyde, Christian; Kloft, Charlotte

    2012-04-01

    Drug therapy is one of the most common therapeutic interventions in the medical care of in-patients. It is a complex risk-associated procedure, which is why risk prevention is of top priority in medication safety. Medical care in hospitals is organised via various forms of distribution, e.g. the traditional distribution on the ward or as computerised unit dose drug dispensing system. In order to improve medication safety, the computerised unit dose drug dispensing system was introduced in the Ruppiner Kliniken in 2009. The implementation of the system to the clinic was scientifically evaluated within the scope of a diploma thesis which focused on the examination and analysis of medication safety and its evolvement. Amongst others, medication errors were detected and classified (via DokuPIK). The thesis showed that the implementation of the computerised unit dose system had a positive impact on the reduction of consequences of common and clinically relevant medication errors, thereby enhancing medication safety for the patient.

  9. Hospital transformation and organisational learning.

    PubMed

    Ho, W

    1999-12-01

    Kwong Wah Hospital was founded by the charity organisation Tung Wah Group of Hospitals some 88 years ago, with management transfer to the Hong Kong Hospital Authority in 1991. Capitalizing both from the traditional caring culture of its founder, as well as opportunities in the new management environment, the hospital has scored remarkable successes in service quality, community partnership, organisational effectiveness, and staff development. Underpinning these transformations were Structure, Process, People, and Culture strategies. The learning imperative is heavily mandated or the success of each of these strands of development. Indeed, the embodiment of a learning organisation culture provides the impetus in sustaining the change momentum, towards achieving the Vision of becoming a 'Most Preferred Hospital' in Hong Kong.

  10. Early discharge hospital at home.

    PubMed

    Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

    2017-06-26

    Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes.   DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI

  11. Establishing a Hospital Response Network Among Children's Hospitals.

    PubMed

    Bartenfeld, Michael T; Griese, Stephanie E; Krug, Steven E; Andreadis, Joanne; Peacock, Georgina

    A timely and effective response to public health threats requires a broad-reaching infrastructure. Children's hospitals are focused on evaluating and managing some of the most vulnerable patients and thus have unique preparedness and response planning needs. A virtual forum was established specifically for children's hospitals during the 2014-15 Ebola outbreak, and it demonstrated the importance and utility of connecting these specialty hospitals to discuss their shared concerns. Developing a successful children's hospital response network could build the national infrastructure for addressing children's needs in preparedness and response and for enhancing preparedness and response to high-consequence pathogens. Using the Laboratory Response Network and tiered-hospital network as models, a network of children's hospitals could work together, and with government and nongovernment partners, to establish and refine best practices for treating children with pathogens of public health concern. This network could more evenly distribute hospital readiness and tertiary pediatric patient care capabilities for highly infectious diseases across the country, thus reducing the need to transport pediatric patients across the country and increasing the national capacity to care for children infected with high-consequence pathogens.

  12. The single-hospital county: is its hospital at risk?

    PubMed Central

    Chang, C F; Tuckman, H P

    1991-01-01

    This article focuses on a hospital group that has not received adequate attention in the literature: the sole provider of short-term, acute hospital care located in a county. In Tennessee, SPHs (single provider hospitals) are fewer in number but are present in more counties than multiprovider hospitals (MPHs). They are smaller in size, less labor and capital intensive, more likely to be a government hospital, and more likely to be in a rural area with low income and limited health care resources. SPHs operate with lower costs, charge patients less, and have lower revenue write-offs than MPHs. As a result, their cash flow is sufficient to fund their depreciation and they consistently earn modest returns. Between 1982 and 1988, a total of 16 hospitals failed in Tennessee but only 3 were SPHs. While SPHs have not been profitable enough to make them ideal candidates for takeover by major hospital systems, they are not a population that is unduly at risk. PMID:1905685

  13. [Alcoholism in the general hospital: 4 years mortality and hospitalization].

    PubMed

    Monras, Miquel; Mondon, Silvia; Ortega, Lluisa; Gual, Antoni

    2005-10-08

    We aimed to analyze the mortality, and emergency room and hospital admissions in a sample of alcohol dependent patients during the four years following their identification in a general hospital. 198 inpatients from a general hospital who where identified as alcohol dependent and referred during 1998 to the liaison-psychiatry service. 30.8% had died, at a mean age of 57.5 (11.3). Deaths had a direct relationship to the illness responsible for the initial admission to hospital. 42.6% of patients had previous admissions, and 74% had been previously attended at emergency room departments. During the 4 years of follow up, there were new hospital admissions (54.6%), emergency room visits (72.7%) and repeated liaison-psychiatry consultations (20%). Previous admissions to hospital predicted future admissions. Acceptance of alcohol treatment did not reduce the mortality rates. Mortality correlated with age, it was increased in patients with cognitive deficits and was reduced in those with psychiatric co-morbidity. Late detection of alcohol dependence leads to pour outcomes both in the treatment of alcohol dependence and the concomitant somatic diseases. Early detection strategies of hazardous and harmful alcohol consumption should be implemented in hospital settings.

  14. The single-hospital county: is its hospital at risk?

    PubMed

    Chang, C F; Tuckman, H P

    1991-06-01

    This article focuses on a hospital group that has not received adequate attention in the literature: the sole provider of short-term, acute hospital care located in a county. In Tennessee, SPHs (single provider hospitals) are fewer in number but are present in more counties than multiprovider hospitals (MPHs). They are smaller in size, less labor and capital intensive, more likely to be a government hospital, and more likely to be in a rural area with low income and limited health care resources. SPHs operate with lower costs, charge patients less, and have lower revenue write-offs than MPHs. As a result, their cash flow is sufficient to fund their depreciation and they consistently earn modest returns. Between 1982 and 1988, a total of 16 hospitals failed in Tennessee but only 3 were SPHs. While SPHs have not been profitable enough to make them ideal candidates for takeover by major hospital systems, they are not a population that is unduly at risk.

  15. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  16. Hospitals: Soft Target for Terrorism?

    PubMed

    De Cauwer, Harald; Somville, Francis; Sabbe, Marc; Mortelmans, Luc J

    2017-02-01

    In recent years, the world has been rocked repeatedly by terrorist attacks. Arguably, the most remarkable were: the series of four coordinated suicide plane attacks on September 11, 2001 on buildings in New York, Virginia, and Pennsylvania, USA; and the recent series of two coordinated attacks in Brussels (Belgium), on March 22, 2016, involving two bombings at the departure hall of Brussels International Airport and a bombing at Maalbeek Metro Station located near the European Commission headquarters in the center of Brussels. This statement paper deals with different aspects of hospital policy and disaster response planning that interface with terrorism. Research shows that the availability of necessary equipment and facilities (eg, personal protective clothing, decontamination rooms, antidotes, and anti-viral drugs) in hospitals clearly is insufficient. Emergency teams are insufficiently prepared: adequate and repetitive training remain necessary. Unfortunately, there are many examples of health care workers and physicians or hospitals being targeted in both political or religious conflicts and wars. Many health workers were kidnapped and/or killed by insurgents of various ideology. Attacks on hospitals also could cause long-term effects: hospital units could be unavailable for a long time and replacing staff could take several months, further compounding hospital operations. Both physical and psychological (eg, posttraumatic stress disorder [PTSD]) after-effects of a terrorist attack can be detrimental to health care services. On the other hand, physicians and other hospital employees have shown to be involved in terrorism. As data show that some offenders had a previous history with the location of the terror incident, the possibility of hospitals or other health care services being targeted by insiders is discussed. The purpose of this report was to consider how past terrorist incidents can inform current hospital preparedness and disaster response planning

  17. Hospital law: the changing scene.

    PubMed

    Hirsh, H L

    1978-01-01

    The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the

  18. 24 CFR 242.4 - Eligible hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Eligible hospitals. 242.4 Section... INSURANCE FOR HOSPITALS General Eligibility Requirements § 242.4 Eligible hospitals. (a) The hospital to be financed with a mortgage insured under this part shall involve the construction of a new hospital, the...

  19. 2 CFR 200.52 - Hospital.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Hospital. 200.52 Section 200.52 Grants and... AWARDS Acronyms and Definitions Acronyms § 200.52 Hospital. Hospital means a facility licensed as a hospital under the law of any state or a facility operated as a hospital by the United States, a state, or...

  20. 24 CFR 242.4 - Eligible hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Eligible hospitals. 242.4 Section... INSURANCE FOR HOSPITALS General Eligibility Requirements § 242.4 Eligible hospitals. (a) The hospital to be financed with a mortgage insured under this part shall involve the construction of a new hospital, the...

  1. Do hospitals cross-subsidize?

    PubMed

    David, Guy; Lindrooth, Richard C; Helmchen, Lorens A; Burns, Lawton R

    2014-09-01

    Despite its salience as a regulatory tool to ensure the delivery of unprofitable medical services, cross-subsidization of services within hospital systems has been notoriously difficult to detect and quantify. We use repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry by cardiac specialty hospitals, we study how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. We estimate that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose. Although entry by single-specialty hospitals may adversely affect the provision of unprofitable uncontested services, these findings warrant further evaluation of service-line cross-subsidization as a means to finance them. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

    PubMed

    Oborn, Eivor

    2008-04-01

    This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

  3. [Hospitals' evolution through the ages].

    PubMed

    de Micheli, Alfredo

    2005-01-01

    The predecessor institutions of modern hospitals--Byzantine nosocómeion, European hospitale and Islamic maristan--were dissimilar both in their patients and their aims. The first charitable organizations in West Europe (Rome) and in the East (Cesarea in Cappadocia) were rather hospices. After the collapse of the Western Roman Empire (476 A.D.), some monastic centers were prepared to provide medical assistance to religious and secular patients. Since the XI and XII Centuries in all of Christian Europe the charitable institutions, designated as hospitale, multiplied. Among the Italian ones, the Roman Santo Spirito (Holy Ghost) Hospital, built in the 1201-1204 period, reached a preeminet position. This one soon became the most important of the entire Christendom (archihospital), with a lot of affiliated hospitals in Europe and later in America. The first American hospital, Saint Nicholas Hospital, opened on December 29, 1503 in Santo Domingo, obtained in 1541 its affiliation to the Santo Spirito archihospital. Regarding continental America, the first health centers were established in Mexico: the Immaculate Conception Hospital and the Saint Lazarus Hospital, both established by Hernán Cortés. For its part, clinical teaching was systematized at the Saint Francis Hospital in Padua and by there moved to Leyden. In Mexico, the chair of medical clinics or practical medicine was established in 1806 at the Saint Andrew Hospital. During the XX century, Dr. Ignacio Chávez was the driving force behind the creation of the modern Mexican Health Institutes. These ones are dedicated to the treatment of poor patients, as well as to medical teaching and research.

  4. The status of hospital information systems in Iranian hospitals.

    PubMed

    Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

    2014-08-01

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

  5. The Status of Hospital Information Systems in Iranian Hospitals

    PubMed Central

    Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

    2014-01-01

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

  6. Potential for Hospital Based Corneal Retreival in Hassan District Hospital

    PubMed Central

    Melsakkare, Suresh Ramappa; Manipur, Sahana R.; Acharya, Pavana; Ramamurthy, Lakshmi Bomalapura

    2015-01-01

    Context In developing countries, corneal diseases are the second leading cause of blindness. This corneal blindness can be treated through corneal transplantation. Though the present infrastructure is strong enough to increase keratoplasty numbers at a required rate, India has largest corneal blind population in the world. So a constant supply of high quality donor corneal tissue is the key factor for reduction of prevalence of corneal blindness. Considering the magnitude of corneal blindness and shortage of donor cornea, there is a huge gap in the demand and supply. Aim To study the potential for hospital based retrieval of donor corneal tissue in Hassan district hospital after analysing the indicated and contraindicated causes of deaths, so that hospital corneal retrieval program in Hassan district hospital can be planned. Materials and Methods The cross-sectional, retrospective and record-based study included all hospital deaths with age group more than two years occurred during one year period (January 2014 to December 2014). Data regarding demographic profile, cause of death, treatment given and presence of any systemic diseases were collected. The causes of deaths which are contraindicated for the retrieval of corneas were analysed and noted. The contraindications were based on the NPCB guidelines for standard of eye banking in India 2009. Results Out of 855 deaths, number of deaths in males (565) was greater than females (290). Numbers of deaths were highest between 41-60 years age group (343). Deaths due to HIV, septicaemia, meningitis, encephalitis, disseminated malignancies were contraindicated for corneal retrieval. Corneas could be retrieved from 736 deaths out of 855. Potential for corneal retrieval in a period of one year in Hassan District hospital was 86%. Conclusion Hospital corneal retrieval program has got a great potential to bridge the gap between the need for the cornea and actually collected corneas which will contribute enormously in

  7. Internet connectivity for hospitals and hospital libraries: strategies.

    PubMed

    Fuller, S S

    1995-01-01

    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator.

  8. Energy audits at 48 hospitals

    NASA Astrophysics Data System (ADS)

    Hirst, E.

    1981-11-01

    Staff at the Oak Ridge Associated Universities (ORAU) conducted energy audits at 48 hospitals in four states (New York, Pennsylvania, Virginia, Tennessee) between 1978 and 1980. Staff at the Oak Ridge National Laboratory (ORNL) and ORAU developed and organized a computerized data base containing information from these audits. This paper describes the ORAU audit process; summarizes the data collected from these audits on hospital characteristics annual energy use, and the audit recommendations; and analyzes the audit data in terms of cost effectiveness, type of recommendations, and the relationship between potential energy saving and characteristics of the individual hospital.

  9. Hospitals, providers collaborate on transitions.

    PubMed

    2012-01-01

    Baystate Health, a three-hospital system with headquarters in Springfield, MA, is partnering with post-acute providers to improve transitions as patients move through the continuum of care. A multidisciplinary post-acute performance team partnered with post-acute providers to determine why patients are readmitted to the hospital and to work on ways to avoid readmissions. Facilities share information with the hospitals how they operate and what they need to ensure patients receive the care they need. The health system's director of post-acute services holds regular meetings with providers to brainstorm on improving patient care.

  10. A computerized hospital maintenance system.

    PubMed

    Kresch, E; Katz, P; Schwartz, H; Hamarman, H

    1985-01-01

    The Biomedical Instrumentation Department at Thomas Jefferson University Hospital maintains most of the clinical equipment owned by the hospital and provides support to six other hospitals, as well. In order to document these services, a computerized support system has been developed. This system maintains the inventory of equipment, documents the occurrence of repair and preventive maintenance procedures, generates lists of items due for maintenance and inspection, and prints reports and summaries of all activities performed by department staff. The system was designed for ease of use and requires a minimum of training for personnel who use it.

  11. The National Demonstration Hospitals Program.

    PubMed

    Alexander, A

    2000-01-01

    Fifty-five public hospitals in all Australian States and Territories participated in the first two phases of National Demonstration Hospitals Program (NDHP). The program was established in 1994 as part of a commitment by the then Department of Health and Family Services to reduce waiting times and improve health outcomes for patients. The program uses a collaborative approach to assist public hospitals to improve service delivery and patient care outcomes. Key results from Phases 1 and 2 of the NDHP have confirmed that identification of industry best practice, collaboration, knowledge sharing and innovation are key elements required to achieve positive health care reforms.

  12. [Adaptation of children to hospitalization].

    PubMed

    Kneist, W; Spangenberg, B

    1979-04-01

    Infants especially of about 1 to 4 years of age are opposed to an unknown environment and to unusual demands when they are admissed to hospital. Literature informes about some characteristic troubles during the first time of adaptation. In addition to those kinds of transitory adaptional difficulties, physical and mental retardation of development may appear when infants become long-time patients. The socalled psychic hospitalism has to be valued as a sign of underprotection and differs from adaptional troubles as a symptom of full strain. The survey shows adequate measures how physicians and nurses may deal with both of the problems in order to ease adaptation and to prevent psychic hospitalism.

  13. New developments in hospital management.

    PubMed

    Welch, J R; Kleiner, B H

    1995-01-01

    Changes in the health care environment over the past ten years have prompted changes in the way hospitals are being managed. The rising cost of health care has affected Medicare reimbursement, caused business to be a discerning selector of medical care, and given birth to alternative forms of health care delivery. All these conditions have resulted in decreased revenue and increased competition for hospitals. Focuses on what hospitals have done to adapt to these changing conditions: cost containment, marketing strategies, and human resource management, since these areas have undergone the most meaningful changes.

  14. A Decomposition of Hospital Profitability

    PubMed Central

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

    2015-01-01

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

  15. [Hospital governance and the structure of German hospital supervisory boards].

    PubMed

    Kuntz, L; Pulm, J; Wittland, M

    2014-06-01

    When thinking about corporate governance frequently the supervisory board comes to mind. The aim of this study is to investigate the relationship between the participation of single professions in the supervisory board and hospital financial performance. Based on governance codes, relevant professions that should be part of the supervisory board are identified. With the help of a multiple regression, the relationship between the fractions of these professions in the supervisory board and the return on assets in the year 2009 is examined. The sample consists of 182 hospitals. The study shows that participation of physicians in the supervisory board is related to a higher return on assets. Furthermore, the association between the fractions of nurses and politicians and hospitals financial performance is ­negative. The composition of the supervisory board has a significant effect on hospital performance; it is an important issue for hospital owners. The present study identifies only one positive relationship between the involvement of physicians and financial performance. Other professions could be relevant in achieving other objectives. Further studies are necessary to analyse the effects on other dimensions of hospital performance, e. g., on quality. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Logistics in hospitals: a case study of some Singapore hospitals.

    PubMed

    Pan, Zhi Xiong; Pokharel, Shaligram

    2007-01-01

    The purpose of this paper is to investigate logistics activities in Singapore hospitals. It defines various types of activities handled by a logistics division. Inventory management policy and the use of information and communication technologies (ICT) for logistics purposes are also discussed. The study identifies the nature of strategic alliances in Singapore's health care industry. This study was conducted by utilizing a framework for data collection, pre-testing the questionnaire and conducting interviews. Various relevant literature was reviewed to design the questionnaire. This study finds that logistics division carry out many related activities and some of them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered under various groups to minimize the cost of operation, including the logistics related costs. However, hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of logistics services. The findings also show that Singapore hospitals have a good stocking policy for both medical and non-medical items so that changes in patient mix can be easily handled. Singapore is continuously improving its health care industry and therefore, the findings will help hospitals in other regions to adopt some of the practices, like concentrating on local vendors, outsourcing, clustering, and maximum use of information technology as competitive factors that can improve the service and reduce the cost of operation. The paper suggests motivators and barriers to the use of ICT in logistics in the health care industry.

  17. 78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ...-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of Participation; Corrections AGENCY...

  18. 75 FR 29479 - Medicare and Medicaid Programs: Proposed Changes Affecting Hospital and Critical Access Hospital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-26

    ... Changes Affecting Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoPs... conditions of participation (CoPs) for both hospitals and critical access hospitals (CAHs). These revisions...). [[Page 29480

  19. [GeSIDA quality care indicators associated with mortality and hospital admission for the care of persons infected by HIV/AIDS].

    PubMed

    Delgado-Mejía, Elena; Frontera-Juan, Guillem; Murillas-Angoiti, Javier; Campins-Roselló, Antoni Abdon; Gil-Alonso, Leire; Peñaranda-Vera, María; Ribas Del Blanco, María Angels; Martín-Pena, María Luisa; Riera-Jaume, Melchor

    2017-02-01

    In 2010, the AIDS Study Group (Grupo de Estudio del SIDA [GESIDA]) developed 66 quality care indicators. The aim of this study is to determine which of these indicators are associated with mortality and hospital admission, and to perform a preliminary assessment of a prediction rule for mortality and hospital admission in patients on treatment and follow-up. A retrospective cohort study was conducted in the Hospital Universitario Son Espases (Palma de Mallorca, Spain). Eligible participants were patients with human immunodeficiency syndrome≥18 years old who began follow-up in the Infectious Disease Section between 1 January 2000 and 31 December 2012. A descriptive analysis was performed to evaluate anthropometric variables, and a logistic regression analysis to assess the association between GESIDA indicators and mortality/admission. The mortality probability model was built using logistic regression. A total of 1,944 adults were eligible (median age: 37 years old, 78.8% male). In the multivariate analysis, the quality of care indicators associated with mortality in the follow-up patient group were the items 7, 16 and 20, and in the group of patients on treatment were 7, 16, 20, 35, and 38. The quality of care indicators associated with hospital admissions in the follow-up patients group were the same as those in the mortality analysis, plus number 31. In the treatment group the associated quality of care indicators were items 7, 16, 20, 35, 38, and 40. Some GeSIDA quality of care indicators were associated with mortality and/or hospital admissions. These indicators are associated with delayed diagnosis, regular monitoring, prevention of infections, and control of comorbidities. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  20. CDC Vital Signs: Hospital Actions Affect Breastfeeding

    MedlinePlus

    ... Read the MMWR Science Clips Hospital Actions Affect Breastfeeding Language: English (US) Español (Spanish) Recommend on ... in many US hospitals do not fully support breastfeeding. Some of the Ten Steps on which hospitals ...

  1. Hospital Room Floors May Harbor 'Superbugs'

    MedlinePlus

    ... fullstory_163886.html Hospital Room Floors May Harbor 'Superbugs' But that area often overlooked when it comes ... Hospital room floors may be more of a "superbug" threat than many hospital staffers realize, new research ...

  2. State tort reforms and hospital malpractice costs.

    PubMed

    Ellington, Charles R; Dodoo, Martey; Phillips, Robert; Szabat, Ronald; Green, Larry; Bullock, Kim

    2010-01-01

    This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability.

  3. Improve Hospital-to-Home Transitions

    MedlinePlus

    ... to the hospital. One study found that seniors hospitalized with heart failure often have multiple medical conditions, and they have the highest hospital readmission rate of all adult patient groups. This indicates a serious breakdown during the ...

  4. [Crisis unit at the general hospital: Determinants of further hospitalization].

    PubMed

    Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

    2016-10-10

    The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

  5. Diversification in the hospital industry.

    PubMed

    Eastaugh, Steven R

    2008-01-01

    An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Hospital diversification and its impact on the operating ratio are studied for 172 hospitals during the period 2002-2007. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependant. Institutional diversification is found to yield better financial position, and the better operating profits allow the institution the wherewithal to diversify. The impact of external government planning and hospital competition is also measured. Some services are in a growth phase, like bariatric weight loss surgery and sleep disorder clinics. Management's attitude concerning risk and reward is considered.

  6. Health Hazards of Hospital Personnel

    PubMed Central

    Clever, Linda Hawes

    1981-01-01

    Health care workers historically have faced serious health problems, such as exposure to patients with tuberculosis. For hospital personnel today, a number of hazards exist. These range from toxic substance exposure to safety hazards presented by patients themselves. PMID:7281652

  7. Play for Children in Hospital

    ERIC Educational Resources Information Center

    Hardgrove, Carol; And Others

    1976-01-01

    Contains six short articles on therapeutic play. Each article is an edited version of a paper delivered at the XIV World Congress of Pediatrics in Buenos Aires on the subject of children in the hospital. (JMB)

  8. Preventing Infections in the Hospital

    MedlinePlus

    ... and your doctor discuss the best way to control your blood sugar before, during, and after your hospital stay. High blood sugar increases the risk of infection noticeably. If you are overweight, losing weight will ...

  9. Aerospace technology and hospital systems

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The use of aerospace medical techniques to improve the quality of earth health care systems is discussed. Data are focused on physiological measurements and monitoring, medical information management, clean room technology, and reliability and quality assurance for hospital equipment.

  10. Public policy regarding specialty hospitals.

    PubMed

    Dowd, Bryan E

    2008-10-01

    Why do we need "public policy" regarding specialty hospitals? What is the rationale for government involvement in decisions by the private sector to invest in specialty hospitals? Two possibilities are reduced access to services primarily by the uninsured (a fairness concern) and changes in the types of patients receiving care resulting from poor consumer information (an efficiency concern). The fairness argument faces logical and empirical difficulties, and even if it proved to be true, it is not clear that limiting the growth of specialty hospitals would be an efficient way to address the problem. However, there is some empirical evidence to support the efficiency concern, and if specialty hospitals result in the treatment of patients with lower expected net benefits from treatment, then it is possible that physician-owned facilities could result in an increasingly inefficient allocation of health care resources, higher insurance premiums, and higher rates of uninsurance.

  11. Recommendations for managing hospital closure.

    PubMed

    van der Wal, R; Bouthillette, F; Havlovic, S J

    1998-01-01

    An acute care hospital was closed by the British Columbia Ministry of Health in 1993. A research study was conducted to investigate the ways closure of the hospital affected hospital employees and to identify ways to facilitate the closure/reorganization process. Unstructured interviews were conducted with 25 employees around the time of closure and six months after the closure. In the category Living with Closure, six themes arose from the qualitative analysis. They related to (1) provision of information; (2) effect of closure on the working environment and colleagues; (3) perceived stress; (4) recognition of one's worth; (5) provision of support services; and (6) the process of having a new job. The authors offer recommendations stemming from the analysis, which are intended to assist others planning for future hospital reorganizations or closures.

  12. Standards for hospital libraries 2002

    PubMed Central

    Gluck, Jeannine Cyr; Hassig, Robin Ackley; Balogh, Leeni; Bandy, Margaret; Doyle, Jacqueline Donaldson; Kronenfeld, Michael R.; Lindner, Katherine Lois; Murray, Kathleen; Petersen, JoAn; Rand, Debra C.

    2002-01-01

    The Medical Library Association's “Standards for Hospital Libraries 2002” have been developed as a guide for hospital administrators, librarians, and accrediting bodies to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information. Specific requirements for knowledge-based information include that the library be a separate department with its own budget. Knowledge-based information in the library should be directed by a qualified librarian who functions as a department head and is a member of the Academy of Health Information Professionals. The standards define the role of the medical librarian and the links between knowledge-based information and other functions such as patient care, patient education, performance improvement, and education. In addition, the standards address the development and implementation of the knowledge-based information needs assessment and plans, the promotion and publicity of the knowledge-based information services, and the physical space and staffing requirements. The role, qualifications, and functions of a hospital library consultant are outlined. The health sciences library is positioned to play a key role in the hospital. The increasing use of the Internet and new information technologies by medical, nursing, and allied health staffs; patients; and the community require new strategies, strategic planning, allocation of adequate resources, and selection and evaluation of appropriate information resources and technologies. The Hospital Library Standards Committee has developed this document as a guideline to be used in facing these challenges. Editor's Note: The “Standards for Hospital Libraries 2002” were approved by the members of the Hospital Library Section during MLA '02 in Dallas, Texas. They were subsequently approved by Section Council and received final approval from the MLA Board of Directors in June 2002. They succeed the Standards for Hospital Libraries

  13. Hospital financial performance trends to watch.

    PubMed

    Schuhmann, Thomas M

    2008-07-01

    Hospitals may wish to compare their performance with that of their peers to identify areas for possible improvement. Comparing financial indicators over five years shows directional trends and the influence of environmental factors such as regulatory change. For-profit hospitals appear to outperform their not-for-profit counterparts. Rural hospitals generally exhibit better financial performance than urban hospitals. Nonteaching hospitals show more desirable operating margins than teaching hospitals.

  14. Facility management in German hospitals.

    PubMed

    Gudat, H

    2000-04-01

    Facility management and optimum building management offer for hospitals a chance to reduce costs and to increase quality, process sequences, employee motivation and customer satisfaction. Some years ago simple services such as cleaning, catering or laundry were outsourced. Now, German hospitals progress to more complex fields such as building and medical technology, clinical support processes such as pharmacy, central laboratory and sterilization, goods and logistics services.

  15. What's new in tent hospitals?

    PubMed

    Laufman, H

    1989-06-01

    There will always be a need for some kind of rapidly deployable, easy to assemble, temporary shelter for use in military conflicts, large-scale military disasters, industrial accidents, major construction projects in remote areas, refugee relocation centers, military hospitals, and any temporary outdoor event requiring cover. The history of tenting is essentially a history of man's ingenuity in creating portable, rapidly erected, temporary shelter. This article will be limited to the stages of development of the latest in military tent hospitals.

  16. Parenteral nutrition in hospital pharmacies.

    PubMed

    Katoue, Maram Gamal; Al-Taweel, Dalal; Matar, Kamal Mohamed; Kombian, Samuel B

    2016-07-11

    Purpose - The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service. Design/methodology/approach - A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content. Findings - Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols. Originality/value - This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.

  17. Air handling units for hospitals.

    PubMed

    Amoroso, V; Gjestvang, R

    1989-10-01

    Air handling units should provide proper quality and conditioned air to various hospital areas. Unit capacity should be able to meet limited space functionality or load changes as well as any smoke control requirements. System components should be readily accessible and appropriate for spaces served. In summary, engineers should consider the following: Environmental design criteria for area being served Components desired Unit type required Economic issues affecting design. Using this approach, design engineers can design hospital air handling units methodically and logically.

  18. [Flexibility and safety in hospitals].

    PubMed

    Fara, G M; Barni, M

    2011-01-01

    The paper explains the reasons according to which the newly-planned hospitals must adopt the concept of advanced flexibility (structural, technological, organizational, diagnostic and therapeutic), in order to avoid the risk of being already obsolete at the moment of their opening, and this due to the fact that too much time elapses in this Country between the moment of planning a new hospital and the moment of the start of its activity. Flexibility is needed at different levels: at low or medium levels for what concerns administrative spaces and also patient rooms (except, in this latter case, when differential intensity of care is adopted); at advanced levelfor what concerns diagnostic and therapeutic areas, which must be rapidly adaptable to new solutions offered by advances in technology and organization. From a different standpoint, flexibility applies also to the fact that hospital must increasingly become a node of a large net including territorial health services: the latter devoted to take care of chronicity, while hospitals should concentrate on acute pathology. Of course the territory surrounding the hospital, through its outpatient service and consultories, is in charge also for first level diagnosy and therapy, leaving the hospital to more sophisticated activities.

  19. [Redesigning the hospital discharge process].

    PubMed

    Martínez-Ramos, M; Flores-Pardo, E; Uris-Sellés, J

    2016-01-01

    The aim of this article is to show that the redesign and planning process of hospital discharge advances the departure time of the patient from a hospital environment. Quasi-experimental study conducted from January 2011 to April 2013, in a local hospital. The cases analysed were from medical and surgical nursing units. The process was redesigned to coordinate all the professionals involved in the process. The hospital discharge improvement process improvement was carried out by forming a working group, the analysis of retrospective data, identifying areas for improvement, and its redesign. The dependent variable was the time of patient administrative discharge. The sample was classified as pre-intervention, inter-intervention, and post-intervention, depending on the time point of the study. The final sample included 14,788 patients after applying the inclusion and exclusion criteria. The mean discharge release time decreased significantly by 50 min between pre-intervention and post-intervention periods. The release time in patients with planned discharge was one hour and 25 min less than in patients with unplanned discharge. Process redesign is a useful strategy to improve the process of hospital discharge. Besides planning the discharge, it is shown that the patient leaving the hospital before 12 midday is a key factor. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  20. Random output and hospital performance.

    PubMed

    Barros, Pedro Pita

    2003-11-01

    Many countries are under pressure to reform health care financing and delivery. Hospital care is one part of the health system that is under scrutiny. Private management initiatives are a possible way to increase efficiency in health care delivery. This motivates the interest in developing methodologies to assess hospital performance, recognizing hospitals as a different sort of firm. We present a simple way to describe hospital production: hospital output as a change in the distribution of survival probabilities. This output definition allows us to separate hospital production from patients' characteristics. The notion of "better performance" has a precise meaning: (first-order) stochastic dominance of a distribution of survival probabilities over another distribution. As an illustration, we compare, for an important DRG, private and public management and find that private management performs better, mainly in the range of high-survival probabilities. The measured performance difference cannot be attributed to input prices or to economies of scale and/or scope. It reflects pure technological and organisational differences.

  1. Foodborne listeriosis acquired in hospitals.

    PubMed

    Silk, Benjamin J; McCoy, Morgan H; Iwamoto, Martha; Griffin, Patricia M

    2014-08-15

    Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered to be hospital-acquired was 25% (range, 9%-67%). The median number of outbreak-related illnesses considered to be hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 of 24 (75%) reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods.

  2. Candiduria in hospitalized patients in teaching hospitals of Ahvaz.

    PubMed

    Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B

    2012-12-01

    Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.

  3. Admission avoidance hospital at home.

    PubMed

    Shepperd, Sasha; Iliffe, Steve; Doll, Helen A; Clarke, Mike J; Kalra, Lalit; Wilson, Andrew D; Gonçalves-Bradley, Daniela C

    2016-09-01

    Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review. To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, two other databases, and two trials registers on 2 March 2016. We checked the reference lists of eligible articles. We sought unpublished studies by contacting providers and researchers who were known to be involved in the field. Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data, requested individual patient data from trialists, and relied on published data when this was not available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 16 randomised controlled trials with a total of 1814 participants; three trials recruited participants with chronic obstructive pulmonary disease, two trials recruited participants recovering from a stroke, six trials recruited participants with an acute medical condition who were mainly elderly, and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. Admission avoidance hospital at home probably makes little

  4. [Evaluation of satisfaction of patients hospitalized at the Kairouan Hospital].

    PubMed

    Mtiraoui, Ali; Alouini, Borhane

    2002-03-01

    The patients' satisfaction studies are more and more utilized to underline the health centers' deficiencies and consequently set improvement action plans. Our survey aims to measure inpatients' satisfaction in its different dimensions. A survey centered around a transversal inquiry has been conducted during a period going from February to April 2000 and reached a total number of 817 patients hospitalized in six service units at kairouan hospital. The data has been gathered by structured interviews led by a previously trained social worker. The investigation tool was a standardized questionnaire prepared by a group of experts from WHO in the Oriental Mediterranean region. The main results are as follow: High satisfaction level concerning the global evaluation of the hospital service units was recorded (score = 70%). The patient who are more satisfied are those who have the feeling that their health situation has considerably improved, and who will probably recommend this hospital to their surroundings. Big proportion of the patients (77%) was expecting better services. The main reason behind their unhappiness is the information emanated whether from the nurses or the doctors, the comfort and the cleanness of waiting room, linen, room comfort, food and the emergency. These results showed that the quality of care improvements priorities, according to patient expectations are especially in relation with the quality of information, the relational aspects and the hospital stay conditions.

  5. Hospital network performance: a survey of hospital stakeholders' perspectives.

    PubMed

    Bravi, F; Gibertoni, D; Marcon, A; Sicotte, C; Minvielle, E; Rucci, P; Angelastro, A; Carradori, T; Fantini, M P

    2013-02-01

    Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders' perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders' perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers' rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. [Assessment of airborne mycoflora in critical areas of the Principal Hospital of Cumaná, state of Sucre, Venezuela].

    PubMed

    Centeno, Sara; Machado, Sandra

    2004-06-01

    The study of the nosocomial infections of fungic origin has attained importance in the last years, due to the rise in the number of patients that are inmunocompromised and susceptible to suffer this kind of infection. The objective of the present study was to evaluate the frequency of filamentous fungi and yeast, present in the environment of the Intensive Care Unit, operating and newborn children rooms of the Hospital Universitario "Antonio Patricio de Alcalá" (HUAPA) from the city of Cumaná. Suere State, Venezuela. The recount of colony forming units/plate (UCF/plate) of the filamentous fungi and yeast was done in Petri plates with Sabouraud dextrose agar, which were exposed in the different studied areas. Eventually, the fungus colonies found were isolated and identified. The area that presented the highest average of UCF/plate was the Intensive Care Unit (9 UCF/plate). The isolated genus of filamentous fungus in higher proportion were Aspergillus (46.80%), Penicillium (19.19%) and Fusarium (11.06%). The isolated species with more frequency were Aspergillus niger (24.80%), Aspergillus flavus (10.54%) and Fusarium solani (9.52%). Rhodotorula glutinis was the isolated yeast with most frequency and different species of the genus Candida and the genus Criptococcus were isolated as well.

  7. Reporting hospital adverse events using the Alfred Hospital's morbidity data.

    PubMed

    Carroll, Rhonda; McLean, Jenny; Walsh, Michael

    2003-01-01

    Hospital morbidity data were analysed to determine their usefulness for reporting adverse events. The entire ICD-10-AM classification system was reviewed in conjunction with the Australian Coding Standards to identify external cause codes and code prefixes associated with adverse events. For the 50,712 separations registered at The Alfred from July 2000-June 2001, 4,740 external cause codes were associated with adverse events. Place of occurrence code CY92.22 was considered the best indicator of the number of separations associated with adverse events. Approximately 4% of all separations were associated with adverse events occurring during an episode of care. Results suggest that hospital morbidity data are useful for monitoring adverse events at hospital level. Reliable reporting across the health care industry requires consistent reporting requirements at state and national levels and the adoption of standard code prefixes nationally.

  8. Report of the procedure of voluntary interruption of pregnancy at a university hospital in Uruguay.

    PubMed

    Bentancor, Ana; Hernández, Ana Laura; Godoy, Yamile; Dapueto, Juan J

    2016-07-04

    To describe the constitution and operation of a voluntary interruption of pregnancy team of a university hospital, from the outlook of the mental health team. In this case study, the following aspects were analyzed: 1) historical background; 2) implementation of Law 18,897 of October 22, 2012; and 3) functioning of the program at the Hospital de Clínicas of the Facultad de Medicina (Universidad de la República, Uruguay), taking into account three dimensions: structure, process, and results. Between December 2012 and November 2013, a total of 6,676 voluntary interruptions of pregnancy were reported in Uruguay; out of these, 80 were conducted at the Hospital de Clínicas. The patients' demographic data agreed with those reported at the national level: Of the total patients, 81.0% were aged over 19 years; 6.2% decided to continue with the pregnancy; and only 70.0% attended the subsequent control and received advice on contraception. In its implementation year in Uruguay, we can assess the experience as positive from the point of view of women's health. Our experience as a mental health team at the Hospital de Clínicas, inserted into the multidisciplinary voluntary interruption of pregnancy team, is in the process of assessment and reformulation of practices. Describir la conformación y funcionamiento de un equipo de interrupción voluntaria del embarazo de un hospital universitario, desde la mirada del equipo de salud mental. En este estudio de caso, se analizan los siguientes aspectos: 1) antecedentes históricos; 2) implementación de la Ley 18.897 de 22 de octubre de 2012; y 3) funcionamiento del programa en el Hospital de Clínicas de la Facultad de Medicina (Universidad de la República, Uruguay), teniendo en cuenta tres dimensiones (estructura, proceso y resultados). Entre diciembre de 2012 y noviembre de 2013, se reportaron en Uruguay un total de 6.676 interrupciones voluntarias del embarazo; de ellas, 80 se llevaron a cabo en el Hospital de Clínicas. Los

  9. Hospital readmission and parent perceptions of their child's hospital discharge.

    PubMed

    Berry, Jay G; Ziniel, Sonja I; Freeman, Linda; Kaplan, William; Antonelli, Richard; Gay, James; Coleman, Eric A; Porter, Stephanie; Goldmann, Don

    2013-10-01

    To describe parent perceptions of their child's hospital discharge and assess the relationship between these perceptions and hospital readmission. A prospective study of parents surveyed with questions adapted from the care transitions measure, an adult survey that assesses components of discharge care. Participant answers, scored on a 5-point Likert scale, were compared between children who did and did not experience a readmission using a Fisher's exact test and logistic regression that accounted for patient characteristics associated with increased readmission risk, including complex chronic condition and assistance with medical technology. A tertiary-care children's hospital. A total of 348 parents surveyed following their child's hospital discharge between March and October 2010. None. Unplanned readmission within 30 days of discharge. There were 28 children (8.1%) who experienced a readmission. Children had a lower readmission rate (4.4 vs. 11.3%, P = 0.004) and lower adjusted readmission likelihood [odds ratio 0.2 (95% confidence interval 0.1, 0.6)] when their parents strongly agreed (n = 206) with the statement, 'I felt that my child was healthy enough to leave the hospital' from the index admission. Parent perceptions relating to care management responsibilities, medications, written discharge plan, warning signs and symptoms to watch for and primary care follow-up were not associated with readmission risk in multivariate analysis. Parent perception of their child's health at discharge was associated with the risk of a subsequent, unplanned readmission. Addressing concerns with this perception prior to hospital discharge may help mitigate readmission risk in children.

  10. Hospital benchmarking: are U.S. eye hospitals ready?

    PubMed

    de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S

    2012-01-01

    Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added

  11. Internet connectivity for hospitals and hospital libraries: strategies.

    PubMed Central

    Fuller, S S

    1995-01-01

    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator. PMID:7703936

  12. Regional Hospital Input Price Indexes

    PubMed Central

    Freeland, Mark S.; Schendler, Carol Ellen; Anderson, Gerard

    1981-01-01

    This paper describes the development of regional hospital input price indexes that is consistent with the general methodology used for the National Hospital Input Price Index. The feasibility of developing regional indexes was investigated because individuals inquired whether different regions experienced different rates of increase in hospital input prices. The regional indexes incorporate variations in cost-share weights (the amount an expense category contributes to total spending) associated with hospital type and location, and variations in the rate of input price increases for various regions. We found that between 1972 and 1979 none of the regional price indexes increased at average annual rates significantly different from the national rate. For the more recent period 1977 through 1979, the increase in one Census Region was significantly below the national rate. Further analyses indicated that variations in cost-share weights for various types of hospitals produced no substantial variations in the regional price indexes relative to the national index. We consider these findings preliminary because of limitations in the availability of current, relevant, and reliable data, especially for local area wage rate increases. PMID:10309557

  13. Estimating Influenza Hospitalizations among Children

    PubMed Central

    Grijalva, Carlos G.; Craig, Allen S.; Dupont, William D.; Bridges, Carolyn B.; Schrag, Stephanie J.; Iwane, Marika K.; Schaffner, William; Edwards, Kathryn M.

    2006-01-01

    Although influenza causes more hospitalizations and deaths among American children than any other vaccine-preventable disease, deriving accurate population-based estimates of disease impact is challenging. Using 2 independent surveillance systems, we performed a capture-recapture analysis to estimate influenza-associated hospitalizations in children in Davidson County, Tennessee, during the 2003–2004 influenza season. The New Vaccine Surveillance Network (NVSN) enrolled children hospitalized with respiratory symptoms or fever and tested them for influenza. The Tennessee Emerging Infections Program (EIP) identified inpatients with positive influenza diagnostic test results through review of laboratory and infection control logs. The hospitalization rate estimated from the capture-recapture analysis in children <5 years of age was 2.4 per 1,000 (95% confidence interval 1.8–3.8). When NVSN estimates were compared with capture-recapture estimates, NVSN found 84% of community-acquired cases, EIP found 64% of cases in which an influenza rapid test was performed, and the overall sensitivity of NVSN and EIP for influenza hospitalizations was 73% and 38%, respectively. PMID:16494725

  14. Measuring nutritional risk in hospitals

    PubMed Central

    Rasmussen, Henrik H; Holst, Mette; Kondrup, Jens

    2010-01-01

    About 20%–50% of patients in hospitals are undernourished. The number varies depending on the screening tool amended and clinical setting. A large number of these patients are undernourished when admitted to the hospital, and in most of these patients, undernutrition develops further during hospital stay. The nutrition course of the patient starts by nutritional screening and is linked to the prescription of a nutrition plan and monitoring. The purpose of nutritional screening is to predict the probability of a better or worse outcome due to nutritional factors and whether nutritional treatment is likely to influence this. Most screening tools address four basic questions: recent weight loss, recent food intake, current body mass index, and disease severity. Some screening tools, moreover, include other measurements for predicting the risk of malnutrition. The usefulness of screening methods recommended is based on the aspects of predictive validity, content validity, reliability, and practicability. Various tools are recommended depending on the setting, ie, in the community, in the hospital, and among elderly in institutions. The Nutrition Risk Screening (NRS) 2002 seems to be the best validated screening tool, in terms of predictive validity ie, the clinical outcome improves when patients identified to be at risk are treated. For adult patients in hospital, thus, the NRS 2002 is recommended. PMID:21042553

  15. Report: hospitals need more sophisticated planning efforts.

    PubMed

    Anderson, H J

    1990-09-20

    Sophisticated planning efforts are increasing among hospitals. However, hospital planners and marketers still have far to go before they can match their counterparts in industry. This is according to a report on hospital planning recently released by the Society for Healthcare Planning and Marketing of the American Hospital Association, Chicago.

  16. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital space...

  17. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital space...

  18. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital space...

  19. Hospital pricing policies: the simple economics.

    PubMed

    Robison, G A; Robison, H D

    1986-10-01

    Changes in hospital reimbursement structures and the shrinking inpatient service market are forcing hospitals to reexamine their pricing strategies. This article examines historical hospital pricing, the effect of pricing in a competitive market and considerations for hospitals moving toward competitive pricing for services.

  20. A conflict of interest policy for hospitals.

    PubMed

    McClure, A E

    1993-01-01

    As the environment in which community hospitals operate becomes ever more complex, the opportunity for conflict of interest between the hospital and members of its governing board increases. This article examines the duties and responsibilities of hospital trustees and the ways in which hospitals can identify and manage conflict of interest.