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Sample records for french public hospital

  1. Managing retrenchment in French public hospitals: philosophical and regulatory constraints.

    PubMed

    Sobczak, P M; Fottler, M D; Chastagner, D

    1988-01-01

    The French hospital system is experiencing economic stresses similar to those experienced by US hospitals. Pressures for cost containment have occurred due to changes in health care funding. The public hospital system is facing unprecedented severe retrenchment. Innovative strategies for managing retrenchment have been restricted by regulatory and philosophical constraints. What is needed is to provide more autonomy for individual hospital managers together with greater accountability for achievement of results.

  2. [Patient identification vigilance in public healthcare organizations: inventory in French hospitals and proposals].

    PubMed

    Perrin, A; Morin, C

    2009-01-01

    Utilization of patients databases by the different healthcare departments, technical teams and registration clerks in care centers is becoming more and more important. Patients data exchanges within and between centers are growing, including public and private structures networks and require a complete match of the patient identification data. Because clinical chemists and pathologists are deeply involved in these exchanges, the National Clinical Chemistry College designed a survey about french hospitals practices (2007 july-2008 august) in order to secure patients identification at any stage of their stay. "Identity vigilance" term tends to emerge for designating this new risk management field. The responses from 94 hospitals are analyzed, which demonstrate an heterogeneous implementation and a very unequal concern of this issue in the different sites; 18% have not yet initiated any action. A strong involvement of the pathologists in the applying of identification safety procedures is expressed by their presence in the three executive, operative and underling levels in more than half of sites (in 84% of the sites for the operative level). Only 17% of the pathologists consider the patients database of their hospital software to be of good quality. This survey leads to become aware of local and national tasks that have to be implemented or carried on, both for identity registration at admission and identity checking before any health care. This effort has to be supported by an essential institutionalization of identity vigilance.

  3. Sources of financial pressure and up coding behavior in French public hospitals.

    PubMed

    Georgescu, Irène; Hartmann, Frank G H

    2013-05-01

    Drawing upon role theory and the literature concerning unintended consequences of financial pressure, this study investigates the effects of health care decision pressure from the hospital's administration and from the professional peer group on physician's inclination to engage in up coding. We explore two kinds of up coding, information-related and action-related, and develop hypothesis that connect these kinds of data manipulation to the sources of pressure via the intermediate effect of role conflict. Qualitative data from initial interviews with physicians and subsequent questionnaire evidence from 578 physicians in 14 French hospitals suggest that the source of pressure is a relevant predictor of physicians' inclination to engage in data-manipulation. We further find that this effect is partly explained by the extent to which these pressures create role conflict. Given the concern about up coding in treatment-based reimbursement systems worldwide, our analysis adds to understanding how the design of the hospital's management control system may enhance this undesired type of behavior.

  4. Sources of financial pressure and up coding behavior in French public hospitals.

    PubMed

    Georgescu, Irène; Hartmann, Frank G H

    2013-05-01

    Drawing upon role theory and the literature concerning unintended consequences of financial pressure, this study investigates the effects of health care decision pressure from the hospital's administration and from the professional peer group on physician's inclination to engage in up coding. We explore two kinds of up coding, information-related and action-related, and develop hypothesis that connect these kinds of data manipulation to the sources of pressure via the intermediate effect of role conflict. Qualitative data from initial interviews with physicians and subsequent questionnaire evidence from 578 physicians in 14 French hospitals suggest that the source of pressure is a relevant predictor of physicians' inclination to engage in data-manipulation. We further find that this effect is partly explained by the extent to which these pressures create role conflict. Given the concern about up coding in treatment-based reimbursement systems worldwide, our analysis adds to understanding how the design of the hospital's management control system may enhance this undesired type of behavior. PMID:23477807

  5. [Reorganization of blood watch and transfusion safety activities in the Marseille public hospital system in partnership between the French Blood Institute Alps Mediterranean Division (EFS AM)].

    PubMed

    Lassale, B; Legrand, D; Chiaroni, J

    2010-02-01

    The Marseille public hospital system (APHM) has expressed its willingness to pool its services of immunohematology and delivery of labile blood products with those of the French blood institute Alps Mediterranean division (EFS AM). An agreement setting out the terms of this partnership was signed between the two parties. The users of the APHM and EFS AM blood watch wished to preserve the channels of distribution. Implementation of this reorganization has focused on ensuring transfusional safety, reinforcing harmonization of APHM practices, and finding ways to reduce costs. Despite joint information campaigns (to medical and paramedical personnel) carried out by the APHM and EFS AM blood watch, problems have arisen during start-up and adjustments have been necessary on both sides. The success of this project hinges on the involvement of the EFS AM in our transfusional practices, deployment of a system for diffusion of information, and consolidation of physical and human resources at the level of the APHM blood watch.

  6. [French lines in Recife architecture: Pedro II Hospital].

    PubMed

    Pereira, Geraldo

    2011-12-01

    Pedro II Hospital was inaugurated in Recife in 1861 and for several decades was the leading center of its kind in the state of Pernambuco and in Northeast Brazil. Its construction followed French design, as developed by physician Jacques-René Tenon, that is, the so-called pavilion style that was the norm in Pernambuco and in Brazil for many years. After being nearly abandoned in 1982, the hospital was reformed shortly thereafter and reopened its doors to offer a variety of services, thanks to negotiations between the Instituto de Medicina Integral Professor Fernando Figueira and the Archdiocese of Olinda and Recife.

  7. Societal risk as seen by the French public

    SciTech Connect

    Karpowicz-Lazreg, C.; Mullet, E. )

    1993-06-01

    Mean risk magnitude judgments expressed by French students on 90 hazardous activities are reported and compared with findings on American, Hungarian, and Norwegian samples. In many respects, rating of perceived risk in the French sample is highly comparable to rating in American subjects. American and French people tend to share the same preoccupations to the same extent. The only major differences concern hallucinatory drugs and oral contraceptives. The Norwegians and French ratings differ much more. Norwegians and French people generally have the same preoccupations (which make Norwegian ratings the best predictor of French ratings) but not to the same extent. The French are much more concerned with a whole series of activities connected to violence, the implementation of high technology or agricultural technology. However, like the Norwegians, the French are extremely concerned about the spread of hallucinogenic drugs. The Hungarian and French ratings differ on practically all instances, except on basic activities or substances in all industrialized nations (caffeine, motorcycles, ...). Differences were observed within the French sample itself. Women more than men consider that home appliances in general and large-scale public transportation are potentially dangerous. Science students more than art students tend to fear a certain number of medical techniques and a certain number of toxic substances (e.g., smoking). 7 refs., 1 tab.

  8. Socio-emotional support in French hospitals: Effects on French nurses' and nurse aides' affective commitment.

    PubMed

    Ruiller, Caroline; Van Der Heijden, Beatrice I J M

    2016-02-01

    In spite of the differences in human resource management (HRM) practices between the non-profit health care sector and business life, the majority of health care sector research appears to be based on the HRM (for human resources management) blueprint for business life staff policy and practice. This study is aimed to better understand the impact of workplace social support in the context of French hospitals. Concrete, the first objective of this article comprises a thorough conceptualization and operationalization of workplace social support (i.e. both professional and personal social support). Data were collected in a French hospital among a sample of 62 respondents (for the qualitative part of our study), and among a sample of 171 health care professionals (nurses and nurse aids) (for the quantitative part of our study). Our outcomes indicate that, especially, personal support given by one's supervisor is strongly and positively related to nurses' and nurse aides' affective commitment. After a discussion about the outcomes, followed by some recommendations for future research, the article concludes with some practical implications for management in hospitals. PMID:26856519

  9. Socio-emotional support in French hospitals: Effects on French nurses' and nurse aides' affective commitment.

    PubMed

    Ruiller, Caroline; Van Der Heijden, Beatrice I J M

    2016-02-01

    In spite of the differences in human resource management (HRM) practices between the non-profit health care sector and business life, the majority of health care sector research appears to be based on the HRM (for human resources management) blueprint for business life staff policy and practice. This study is aimed to better understand the impact of workplace social support in the context of French hospitals. Concrete, the first objective of this article comprises a thorough conceptualization and operationalization of workplace social support (i.e. both professional and personal social support). Data were collected in a French hospital among a sample of 62 respondents (for the qualitative part of our study), and among a sample of 171 health care professionals (nurses and nurse aids) (for the quantitative part of our study). Our outcomes indicate that, especially, personal support given by one's supervisor is strongly and positively related to nurses' and nurse aides' affective commitment. After a discussion about the outcomes, followed by some recommendations for future research, the article concludes with some practical implications for management in hospitals.

  10. Assessing Greek Public Hospitals' Websites.

    PubMed

    Tsirintani, Maria; Binioris, Spyros

    2015-01-01

    Following a previous (2011) survey, this study assesses the web pages of Greek public hospitals according to specific criteria, which are included in the same web page evaluation model. Our purpose is to demonstrate the evolution of hospitals' web pages and document e-health applications trends. Using descriptive methods we found that public hospitals have made significant steps towards establishing and improving their web presence but there is still a lot of work that needs to be carried out in order to take advantage of the benefits of new technologies in the e-health ecosystem.

  11. Assessment of new public management in health care: the French case.

    PubMed

    Simonet, Daniel

    2014-01-01

    The French health care system embraced New Public Management (NPM) selectively, and crafted their own version of NPM using Diagnostic-Related-Group accounting to re-centralize the health care system. Other organizational changes include the adoption of quasi-markets, public private partnerships, and pay-for-performance schemes for General Practitioners. There is little evidence that these improved the performance of the system. Misrepresentation has remained high. With the 2009 Hospital, Patients, Health and Territories Act physician participation in hospital governance receded. Decision-making powers and health units were re-concentrated to instill greater national coherence into the health system. PMID:25283813

  12. Assessment of new public management in health care: the French case.

    PubMed

    Simonet, Daniel

    2014-01-01

    The French health care system embraced New Public Management (NPM) selectively, and crafted their own version of NPM using Diagnostic-Related-Group accounting to re-centralize the health care system. Other organizational changes include the adoption of quasi-markets, public private partnerships, and pay-for-performance schemes for General Practitioners. There is little evidence that these improved the performance of the system. Misrepresentation has remained high. With the 2009 Hospital, Patients, Health and Territories Act physician participation in hospital governance receded. Decision-making powers and health units were re-concentrated to instill greater national coherence into the health system.

  13. Clostridium difficile infection in a French university hospital

    PubMed Central

    Khanafer, Nagham; Oltra, Luc; Hulin, Monique; Dauwalder, Olivier; Vandenesch, Francois; Vanhems, Philippe

    2016-01-01

    Abstract The epidemiology of Clostridium difficile infection (CDI) has changed with an increase in incidence and severity. Prospective surveillance was therefore implemented in a French university hospital to monitor the characteristics of patients at risk and to recognize local trends. Between 2007 and 2014, all hospitalized patients (≥18 years) with CDI were included. During the survey, the mean incidence rate of CDI was 2.9 per 10,000 hospital-days. In all, 590 patients were included. Most of the episodes were healthcare-associated (76.1%). The remaining cases were community-acquired (18.1%) and unknown (5.9%). The comparison with healthcare-associated cases showed that the community-acquired group had a lower rate of antimicrobial exposure (P < 0.001), proton pump inhibitor (P < 0.001), and immunosuppressive drugs (P = 0.02). Over the study period, death occurred in 61 patients (10.3%), with 18 (29.5%) being related to CDI according to the physician in charge of the patient. Active surveillance of CDI is required to obtain an accurate picture of the real dimensions of CDI. PMID:27281101

  14. [A reaffirmed French psychiatric public sector].

    PubMed

    Petit, Marie-Noëlle

    2012-01-01

    Psychiatry in France is considered here with regard to patient care systems, long-term treatments, treatment without consent and the place of the users in the system. The implementation of the new law in 2011 relating to admission to hospital without consent will have to be revised as a result of the problems identified during its application.

  15. Strategic management of Public Hospitals' medical services.

    PubMed

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

    2016-01-01

    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction. PMID:27273960

  16. Strategic management of Public Hospitals' medical services.

    PubMed

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

    2016-01-01

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

  17. Fever in hospitalized HIV-infected patients in Western French Guiana: first think histoplasmosis.

    PubMed

    Vantilcke, Vincent; Boukhari, Rachida; Jolivet, Anne; Vautrin, Cyrille; Misslin, Caroline; Adenis, Antoine; Nacher, Mathieu

    2014-08-01

    In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 <200/mm(3)the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm(3)and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

  18. [Prescription of high-cost medicines in French Hospitals: Regulation and procedures of reimbursement].

    PubMed

    Wilkowsky, Cécile; Lenain, Adélaïde; Benbekhaled, Khaled; Le Gall, Marie-José; Vignot, Stéphane

    2016-04-01

    The high cost of several drugs or medical devices involves specific reimbursement procedures in French hospitals. Specific prescription rules have been developed and a regular survey by regional health authorities is performed. These particular funding procedures allow patients to access to innovative drugs. Some questions have recently been raised in France about the list of cancer drugs that could be concerned by an additional funding by health insurance. In this setting, this article proposes to summarize the current modalities of reimbursement of high-cost medicines in French Hospitals to enlighten the current debate. PMID:27017057

  19. Effects of publicity on a forensic hospital.

    PubMed

    Reichlin, S M; Bloom, J D

    1993-01-01

    Oregon's forensic psychiatry hospital experienced a convulsing chain of events that began with the escape of an insanity acquittee who had been hospitalized following two murders. Although the patient was arrested without reoffending, there were major repercussions in the hospital. This event and related state hospital topics became the subject of intense publicity in the local newspaper. Articles ran almost daily for over a month, the majority of which were on page one. We give here an account of the episode and examine the meaning of the media coverage in the light of administration of public mental health systems, particularly where forensic psychiatry is involved.

  20. Concurrent dengue and malaria in Cayenne Hospital, French Guiana.

    PubMed

    Carme, Bernard; Matheus, Severine; Donutil, Gerd; Raulin, Olivia; Nacher, Mathieu; Morvan, Jacques

    2009-04-01

    Dengue-malaria co-infection reports are scarce. Of 1,723 consecutive febrile patients in Cayenne Hospital, 238 had dengue (174 early dengue fever cases) and 393 had malaria (371 acute malaria); 17 had both. Diagnosis of 1 of these 2 infections should not rule out testing for the other infection.

  1. An approach toward public hospital performance assessment

    PubMed Central

    Nwagbara, Vitalis Chukwudi; Rasiah, Rajah; Aslam, Md. Mia

    2016-01-01

    Abstract Background: Public hospitals have come under heavy scrutiny across the world owing to rising expenditures. However, much of the focus has been on cutting down costs to raise efficiency levels. Although not denying the importance of efficiency measures, this article targets a performance issue that is relevant to address the quality of services rendered in public hospitals. Thus, it is important to focus on the effectiveness of resource utilization in these hospitals. Consequently, this article seeks to examine the impact of average length of stay (ALOS) and bed turnover rates (BTR) on bed occupancy rates (BOR). Methods: Public hospital inpatient utilization records during the period 2006 to 2013 were gathered from the Ministry of Health, Malaysia. A 2-step generalized method of moments (GMM) statistical method was used to analyze the data. BOR was adopted as the dependent variable, whereas BTR and ALOS were used as the explanatory variables. The logarithm of total bed count (BED), admission (ADM), and patient days (PD) was deployed as control variables. Three regression models were developed to explore the correlates of BOR as a hospital performance measure. Ethics committee approval was waived because no patients were identified in the study. Results: The statistical analyses show that ALOS and BTR are inversely correlated with BOR, with both coefficients significant at 1%. The control variables of BED, ADM, and PD had the right positive signs and they were significant in both sets of equations. Hence, reducing ALOS and BTR can help raise performance of public hospitals in Malaysia. Conclusion: In light of the robust results obtained, this study offers implications for improving public hospital performance. It shows a need to reduce ALOS and BTR in public hospitals to improve BOR. PMID:27603363

  2. Imported Dengue in French University Hospitals: a 6-year survey.

    PubMed

    Badiaga, Sékéné; Barrau, Karine; Brouqui, Philippe; Durant, Jacques; Malvy, Denis; Janbon, François; Bonnet, Eric; Bosseray, Annick; Sotto, Albert; Peyramont, Dominique; Dydymski, Serge; Cazorla, Celine; Tolou, Hervé; Durant, Jean Paul; Delmont, Jean

    2003-01-01

    Dengue fever (DF) is a mosquito-transmitted acute disease caused by any of four dengue flavivirus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) which is becoming a major public health problem in intertropical areas.1 DF is increasingly observed in febrile travelers returning from tropical areas,2 especially those returning from the Caribbean islands and Southeast Asia, but it is rarely diagnosed in travelers returning from Africa.3-8 Diagnosis is often serologic, and in most cases is not confirmed; virus isolation remains exceptional. In a retrospective study of 44 cases of imported DF diagnosed in France, we found that the epidemiologic, clinical and diagnostic characteristics of these cases were similar to those reported in other previous published studies; diagnosis was carried out with serology, and no virus isolation was reported. To draw the attention of physicians from nonendemic areas to the possible occurrence of dengue infection in febrile travelers from all tropical countries, including those in Africa, and to reinforce recommendations required to establish diagnosis with certainty, we report herein a prospective study from 1998-1999 which we compiled with our previously published data.

  3. [Canton Hospital and public health in Canton].

    PubMed

    Li, Jichou; Guo, Qiang

    2015-07-01

    Canton Hospital was not only the most influential missionary hospital in South China, but also the first one brought the concept and practice of public health to Guangzhou. In the late Qing Dynasty, it conducted free vaccination, plague treatment, health education and so on, demonstrating the importance of public health to the people. In the period of the Republic of China, it extensively cooperated with the government and social organizations in developing school health, maternal and child health, communicable disease control and epidemiological investigations to actively serve the social group. In the 1930s, its public health activities extended towards the rural areas of Guangzhou, and promoted the convergence of rural and urban medical and health services. The three-level medical system that it built provided demonstration model for the establishment of Chinese rural medical system. PMID:26815022

  4. The Public Hospital in American Medical Education

    PubMed Central

    Malaspina, Dolores; Weitzman, Michael; Goldfrank, Lewis R.

    2008-01-01

    The importance of the public hospital system to medical education is often absent from the debate about its value. Best known as a core provider of services to the underserved, the safety net hospital system also plays a critical role in the education of future physicians. Particular strengths include its ability to imbue physicians in training with core professional values, to reveal through the enormous range of clinical experience provided many of the social forces shaping health, and to foster interest in and commitment to advancing population health. Faculty teaching in the public hospital system has unusual opportunities to reveal to learners the broader meanings of their diverse and rich experiences. Now, as an alarming array of pressures bearing down on the safety net system threaten its stability, the potential negative impact on medical education, were it to shrink or be forced to change its essential mission, must be considered. As advocates of the safety net system marshal forces to rationalize its funding and support, its tremendous contribution to the training of physicians and other health care professionals must be clearly set forth to ensure that support for the public hospital system’s health is appropriately broad based. PMID:18575982

  5. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    PubMed

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  6. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    PubMed

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis. PMID:27638133

  7. Public-private partnerships for hospitals.

    PubMed Central

    McKee, Martin; Edwards, Nigel; Atun, Rifat

    2006-01-01

    While some forms of public-private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. Although experience is still very limited and rigorous evaluations lacking, four issues have emerged: cost, quality, flexibility and complexity. New facilities have, in general, been more expensive than they would have been if procured using traditional methods. Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality. The need to minimize the risk to the parties means that it is very difficult to "future-proof" facilities in a rapidly changing world. Finally, such projects are extremely, and in some cases prohibitively, complex. While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public-private partnership further complicates the already difficult task of building and operating a hospital. PMID:17143463

  8. Role of the French rescue teams in Diquini Hospital: Port-au-Prince, January 2010.

    PubMed

    Benner, Patrick; Stephan, Jérome; Renard, Aurélien; Petitjean, Frédérique; Larger, Denis; Pons, Dominique; Paklepa, Bruno; Deniel, Cécile; LeDreff, Pierre

    2012-12-01

    On January 12, 2010, Port-au-Prince, Haiti, was shattered by a violent earthquake that killed or injured thousands of its citizens. Local emergency services became overwhelmed and international assistance was required. French relief teams were deployed to assist local hospitals in caring for the victims. The medical care activity of the team at Diquini Hospital from January 17-26 was analyzed. Priority was given to surgery, leading to the creation of a pre- and post-operative area and a medical care unit. Special attention was required for infection prevention, pain relief, minor surgery, and pre-surgery triage. The continual influx of accompanied victims necessitated the creation of a receiving area. In spite of the assistance from several foreign surgical teams, some patients had to be evacuated to French or American facilities, particularly children, patients with spinal cord injuries, and those needing intensive care. Analysis of the actions undertaken highlights the importance of well-prepared and flexible medical teams and the ability to provide local and regional anesthesia, including the necessary medical supplies and equipment. Medical care activity, especially post-surgical care, was a predominant, ongoing need. The ability to provide medical care required organization and cooperation among local health care providers and other relief workers.

  9. Brazil's Mixed Public and Private Hospital System.

    PubMed

    Lewis, Maureen; Penteado, Evandro; Malik, Ana Maria

    2015-01-01

    Brazil's hospital sector is vibrant and growing. Under the 1988 Brazilian constitution all citizens have the right to health care, anticipating the global commitment to Universal Health Care. Brazil's public sector prides itself on having one of the world's largest single payer health care systems, but complementing that is a significant and larger private sector that is seeing big increase in investment, utilization and prices. This article outlines the structure of the hospital system and analyzes the nature and direction of private health sector expansion. Twenty-six percent of Brazilians have private health insurance and although coverage is concentrated in the urban areas of the Southeastern part of the country, it is growing across the nation. The disease burden shift to chronic diseases affects the nature of demand and the directly affects overall health care costs, which are rising rapidly outstripping national inflation by a factor of 3. Increasingly costs will have to be brought under control to maintain the viability of the private sector. Adaption of integrated care networks and strengthening of the public reimbursement system represent important areas for improvement.

  10. French Standards of Learning for Virginia Public Schools

    ERIC Educational Resources Information Center

    Virginia Department of Education, 2007

    2007-01-01

    The Standards of Learning in this publication represent a major development in public education in Virginia. Adopted in February 2007 by the Virginia Board of Education, these standards emphasize the importance of foreign language instruction in the Commonwealth and, therefore, are an important part of Virginia's efforts to provide challenging…

  11. [Project financing in public hospital trusts].

    PubMed

    Contarino, F; Grosso, G; Mistretta, A

    2009-01-01

    The growing debate in recent years over how to finance public works through private capital has progressively highlighted the role of project finance (PF) and publicprivate partnerships (PPP) in general. More and more European countries are turning to PF to finance their public infrastructure development. The UK, which pioneered the adoption of project finance in this field, has been followed by Italy, Spain, France, Portugal and Germany and more recently by Greece, Czech Republic and Poland. Beginning in the late 1990's, Italy has steadily amplified its use of PF and PPPs in key sectors such as healthcare as an alternative way of funding the modernisation of its health facilities and hospitals. The trend reveal an average annual growth of 10.9% since 2002 with peaks of varying intensity over the five year period. Project finance and PPPs represent an effective response to the country's infrastructure gap and support the competitiveness of local systems and the quality of public services. None of this will transpire, however without energetic new planning efforts and adequate policy at the centre. PMID:19798903

  12. Patients' characteristics and healthcare providers' perceived workload in French hospital emergency wards.

    PubMed

    Schoenenberger, Sandrine; Moulin, Pierre; Brangier, Eric; Gilibert, Daniel

    2014-01-01

    The aim of this research is to understand how patients' characteristics increase healthcare providers' perceived workload. Patients' characteristics and dependency, technical and relational complexities of care seem to increase healthcare providers' workload. As workload is multidimensional, we examine which dimensions are affected by patients' characteristics. Our methodology is based on 121 patients assessed with the NASA task load index (NASA-TLX) and a questionnaire filled in by 57 health providers in 2 emergency wards in French hospital settings, to evaluate their attitudes to different patients' characteristics. Our results show that physical demand is the dimension most affected by patients' behaviour and characteristics. Next, we observe that workload increases more due to patients' behaviour than their social characteristics. We propose that a regulation mechanism be taken into account in further research, using methodology based on observations to identify how healthcare providers might adapt their activities to compensate for workload variations caused by patients.

  13. Violent psychiatric inpatients in a public hospital.

    PubMed

    Morrison, E F

    1990-01-01

    Violence in inpatient psychiatric settings is a clinically significant and relevant problem requiring attention by the psychiatric community. Despite the prevalence of research on violent behavior, few nursing studies have been conducted that explore the components of nursing care that may influence the amount of violence occurring in inpatient psychiatric settings. The purpose of the study was to identify the characteristics of violent patients and the components of nursing care that are related to violent patient behavior. A qualitative study was conducted using participant observation and grounded theory methodology. Data were collected in a metropolitan public hospital over a 9-month period. Six categories of violent patients were identified during data analysis: (1) the user, (b) the outlaw, (c) the rebel without a cause, (d) the little big man, (e) the child, and (6) the vamp. Implications of the study for clinicians working in inpatient psychiatric settings are discussed.

  14. Understanding the acceptance factors of an Hospital Information System: evidence from a French University Hospital

    PubMed Central

    Ologeanu-Taddei, R.; Morquin, D.; Domingo, H.; Bourret, R.

    2015-01-01

    The goal of this study was to examine the perceived usefulness, the perceived ease of use and the perceived behavioral control of a Hospital Information System (HIS) for the care staff. We administrated a questionnaire composed of open-end and closed questions, based on the main concepts of Technology Acceptance Model. As results, the perceived usefulness, ease of use and behavioral control (self-efficacy and organizational support) are correlated with medical occupations. As an example, we found that a half of the medical secretaries consider the HIS is ease of use, at the opposite to the anesthesiologists, surgeons and physicians. Medical secretaries reported also the highest rate of PBC and a high rate of PU. Pharmacists reported the highest rate of PU but a low rate of PBC, which is similar to the rate of the surgeons and physicians. Content analysis of open questions highlights factors influencing these constructs: ergonomics, errors in the documenting process, insufficient compatibility with the medical department or the occupational group. Consequently, we suggest that the gap between the perceptions of the different occupational groups may be explained by the use of different modules and by interdependency of the care stare staff. PMID:26958237

  15. [French biomedical competitiveness clusters: opportunities for public-private partnerships].

    PubMed

    Vasmant, Daniel

    2009-12-01

    A "competitive cluster" is a partnership between businesses, research units and training centers, working together to generate synergies for innovative projects in a particular geographic area. Since 2005, the first five calls for cluster projects have led to the funding of 645 R&D projects involving 13,000 researchers. Together, the R&D expenditure of these projects has so far totaled nearly Euro 3.6 billion. This included public funding of Euro 1300 million, Euro 840 million of which was provided by central government. In the biomedical field, 80 R&D projects have been funded to the tune of Euro 140 million (Euro 81 million from central government and Euro 59 million from local government). A total of 288 agreements have been signed, 12% with large companies, 36% with SMEs and 49.8% with public research laboratories. Alongside the more classical biomedical research funding sources, such as the National Research Agency and government-sponsored projects (on cancer, Alzheimer's disease, rare diseases, etc.), competitive clusters provide the impetus for profound changes in research culture. They draw on the principle of professional guidance and public-private partnerships to build a bridge between the "academic" and "industrial" research arenas. By facilitating knowledge generation and sharing, competitive clusters create a climate of action-driven mutual respect and trust. PMID:20666016

  16. Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database.

    PubMed

    Abdulmalak, Caroline; Cottenet, Jonathan; Beltramo, Guillaume; Georges, Marjolaine; Camus, Philippe; Bonniaud, Philippe; Quantin, Catherine

    2015-08-01

    Haemoptysis is a serious symptom with various aetiologies. Our aim was to define the aetiologies, outcomes and associations with lung cancer in the entire population of a high-income country.This retrospective multicentre study was based on the French nationwide hospital medical information database collected over 5 years (2008-2012). We analysed haemoptysis incidence, aetiologies, geographical and seasonal distribution and mortality. We studied recurrence, association with lung cancer and mortality in a 3-year follow-up analysis.Each year, ~15 000 adult patients (mean age 62 years, male/female ratio 2/1) were admitted for haemoptysis or had haemoptysis as a complication of their hospital stay, representing 0.2% of all hospitalised patients. Haemoptysis was cryptogenic in 50% of cases. The main aetiologies were respiratory infections (22%), lung cancer (17.4%), bronchiectasis (6.8%), pulmonary oedema (4.2%), anticoagulants (3.5%), tuberculosis (2.7%), pulmonary embolism (2.6%) and aspergillosis (1.1%). Among incident cases, the 3-year recurrence rate was 16.3%. Of the initial cryptogenic haemoptysis patients, 4% were diagnosed with lung cancer within 3 years. Mortality rates during the first stay and at 1 and 3 years were 9.2%, 21.6% and 27%, respectively.This is the first epidemiological study analysing haemoptysis and its outcomes in an entire population. Haemoptysis is a life-threatening symptom unveiling potentially life-threatening underlying conditions.

  17. Using Public Reports of Patient Satisfaction for Hospital Quality Improvement

    PubMed Central

    Barr, Judith K; Giannotti, Tierney E; Sofaer, Shoshanna; Duquette, Cathy E; Waters, William J; Petrillo, Marcia K

    2006-01-01

    Objective To explore the impact of statewide public reporting of hospital patient satisfaction on hospital quality improvement (QI), using Rhode Island (RI) as a case example. Data Source Primary data collected through semi-structured interviews between September 2002 and January 2003. Study Design The design is a retrospective study of hospital executives at all 11 general and two specialty hospitals in RI. Respondents were asked about hospital QI activities at several points throughout the public reporting process, as well as about hospital structure and processes to accomplish QI. Qualitative analysis of the interview data proceeded through an iterative process to identify themes and categories in the data. Principal Findings Data from the standardized statewide patient satisfaction survey process were used by hospitals to identify and target new QI initiatives, evaluate performance, and monitor progress. While all hospitals fully participated in the public reporting process, they varied in the stage of development of their QI activities and adoption of the statewide standardized survey for ongoing monitoring of their QI programs. Most hospitals placed responsibility for QI within each department, with results reported to top management, who were perceived as giving strong support for QI. The external environment facilitated QI efforts. Conclusion Public reporting of comparative data on patient views can enhance and reinforce QI efforts in hospitals. The participation of key stakeholders facilitated successful implementation of statewide public reporting. This experience in RI offers lessons for other states or regions as they move to public reporting of hospital quality data. PMID:16704506

  18. Analysis of the medication-use process in North American hospital systems: underlining key points for adoption to improve patient safety in French hospitals.

    PubMed

    Brouard, Agnes; Fagon, Jean Yves; Daniels, Charles E

    2011-01-01

    This project was designed to underline any actions relative to medication error prevention and patient safety improvement setting up in North American hospitals which could be implemented in French Parisian hospitals. A literature research and analysis of medication-use process in the North American hospitals and a validation survey of hospital pharmacist managers in the San Diego area was performed to assess main points of hospital medication-use process. Literature analysis, survey analysis of respondents highlighted main differences between the two countries at three levels: nationwide, hospital level and pharmaceutical service level. According to this, proposal development to optimize medication-use process in the French system includes the following topics: implementation of an expanded use of information technology and robotics; increase pharmaceutical human resources allowing expansion of clinical pharmacy activities; focus on high-risk medications and high-risk patient populations; develop a collective sense of responsibility for medication error prevention in hospital settings, involving medical, pharmaceutical and administrative teams. Along with a strong emphasis that should be put on the identified topics to improve the quality and safety of hospital care in France, consideration of patient safety as a priority at a nationwide level needs to be reinforced.

  19. Clonal Diversity among Streptogramin A-Resistant Staphylococcus aureus Isolates Collected in French Hospitals

    PubMed Central

    Haroche, Julien; Morvan, Anne; Davi, Marilyne; Allignet, Jeanine; Bimet, François; El Solh, Névine

    2003-01-01

    We analyzed 62 clinical isolates of streptogramin A-resistant (SGAr) Staphylococcus aureus collected between 1981 and 2001 in 14 hospitals located in seven French cities. These isolates, including five with decreased susceptibility to glycopeptides, were distributed into 45 antibiotypes and 38 SmaI genotypes. Each of these genotypes included between 1 and 11 isolates, the SmaI patterns of which differed by no more than three bands. Although numerous clones were identified, we observed the spread of monoclonal isolates either within the same hospital or within hospitals in distinct cities and at large time intervals. Hybridization with probes directed against 10 SGAr genes (vatA, vatB, vatC, vatD, vatE, vgaA, vgaB, vgaAv, vgbA, and vgbB) revealed six patterns: vgaAv (21 isolates), vatA-vgbA (24 isolates), vgaAv-vatB-vgaB (14 isolates), vgaAv-vatA-vgbA (1 isolate), vgaAv-vatA-vgbA-vatB-vgaB (1 isolate), and vgaA (1 isolate). We detected at least one SGAr determinant in all of the tested isolates. vgaAv, which is part of the recently characterized transposon Tn5406, was found in 59.7% of the tested isolates. Of the 16 streptogramin B-susceptible isolates, 14 carried vgaAv alone and were susceptible to the mixtures of streptogramins, whereas the 2 isolates carrying vgaAv-vatB-vgaB were resistant to these mixtures. vatA-vgbA was found on plasmids of the same apparent size in 26 (42%) of the tested clinical isolates from 18 unrelated SmaI genotypes. The possible dissemination of some of the multiple clones characterized in the present study with an expected increased selective pressure of streptogramins following the recent licensing of Synercid (quinupristin-dalfopristin) must be carefully monitored. PMID:12574251

  20. Public hospitals: the legal obstacles of entering into joint ventures.

    PubMed

    Miller, J N

    1986-03-01

    Public hospitals, as public entities, are limited in many of their activities by state constitutions and statutes. One area where activity can be particularly limited is the joint venture. Constitutional and statutory limitations can influence several aspects of the joint venture: scope of activities, geographic boundaries, authority to enter into joint ventures, gift of public funds prohibition, and stock ownership. Therefore, public hospitals must be aware of possible legal obstacles and carefully consider their options.

  1. Alternate Level of Care Patients in Public General Hospital Psychiatry.

    ERIC Educational Resources Information Center

    Marcos, Luis R.; Gil, Rosa M.

    1984-01-01

    Analyzes the interaction between psychiatric services in public general hospitals and in other institutional settings. A one-day census of patients in a New York general hospital showed the hospital was providing care to a large number of patients in need of other, less intensive institutional settings. (BH)

  2. The role of public relations activities in hospital choice.

    PubMed

    Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

    2007-01-01

    Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities.

  3. The role of public relations activities in hospital choice.

    PubMed

    Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

    2007-01-01

    Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities. PMID:19042526

  4. Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

    PubMed Central

    2010-01-01

    Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals. PMID:21067580

  5. [Public and private hospital care--an economic approach (author's transl)].

    PubMed

    Lafarge, H

    1977-01-01

    In an investigation involving over 1,000 patients, the LEGOS group (Univ. de Dauphine) has studied the two sectors which co-exist in the French hospital service--the public sector and the private profit--making sector. This paper gives the economic results of the investigation. The private clinics function in a commercial framework and define a privileged area of treatment related to the "cost" of the medical activities which occur in this sector. The public hospital aims at satisfying certain needs, in particular those associated with emergencies, and economic considerations are only considered in the last resort. These conclusions are drawn from observations on medically defined situations treated in the two sectors and on medical activities occurring in them.

  6. Management challenges at the intersection of public policy environments and strategic decision making in public hospitals.

    PubMed

    Longest, Beaufort B

    2012-01-01

    Hospitals in the United States are heavily impacted by public policies that affect them. For example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). The public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments. Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. The multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals. This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.

  7. Asbestos in public hospitals: are employees at risk?

    PubMed

    Scarlett, Henroy P; Postlethwait, Edward; Delzell, Elizabeth; Sathiakumar, Nalini; Oestenstad, R Kent

    2012-01-01

    Asbestos is an established human carcinogen. Asbestos-containing building materials (ACBM) are used in surfacing materials, thermal system insulation (TSI), and miscellaneous materials, and they have been used in buildings in Jamaica in the past. The objective of the study described here was to identify ACBM, its characteristics, and its determinants in Jamaican hospitals. A walk-through survey of all hospitals was undertaken and 152 bulk samples were collected from 26 public and private hospitals. The samples were analyzed using polarized light microscopy. Sixteen (61.5%) hospitals had ACBM used mainly as TSI. The ACBM in most cases was friable and in a poor condition indicative of fiber release and contained the fibers chrysotile, amosite, and crocidolite. The age of hospitals was not associated with the presence of ACBM. Results indicated potential risk of asbestos exposure in hospitals. The hospital authorities should formulate and implement an asbestos policy for hospitals and undertake proper management of asbestos in all hospitals.

  8. Epidemiology of myelodysplastic syndromes in a French general hospital of the Basque country.

    PubMed

    Bauduer, F; Ducout, L; Dastugue, N; Capdupuy, C; Renoux, M

    1998-03-01

    Epidemiologic studies concerning myelodysplastic syndromes (MDS) are rare. The estimated incidence varies between 1 and 12.6/100,000/year. The aim of this work was to compare our own experience with these data. Our general hospital represents a structure with 1197 beds which serves a population of 290,000 individuals (French Basques). Most of the inhabitants live in a rural environnement. Twenty percent of the population are aged over 65. During a 4-year period (1993-1996), 90 new cases of MDS were diagnosed on bone marrow studies in our laboratory. Among FAB subtypes refractory anemia (RA) represented 27 cases (31%), RA with ring sideroblasts (RARS): 21 (23%), RA with excess of blasts (RAEB) and in transformation (RAEB-t): 22 (24%), chronic myelomonocytic leukemia (CMML): 10 (11%). Ten cases were unclassifiable (11%). Therapy-related MDS were seen in 8 patients. The sex ratio was 1 and the mean age of the patients was 74.3 (range: 23-96), 37% of them being 80 years or older. The calculated incidence was 7.7/100,000/year for the entire cohort and 31.4/100,000/year for people over 65.

  9. In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

    PubMed Central

    2016-01-01

    Background & Objectives The aim of this study was to assess the economic burden of hospitalisations for metastatic renal cell carcinoma (mRCC), to describe the patterns of prescribing expensive drugs and to explore the impact of geographic and socio-demographic factors on the use of these drugs. Methods We performed a retrospective analysis from the French national hospitals database. Hospital stays for mRCC between 2008 and 2013 were identified by combining the 10th revision of the International Classification of Diseases (ICD-10) codes for renal cell carcinoma (C64) and codes for metastases (C77 to C79). Incident cases were identified out of all hospital stays and followed till December 2013. Descriptive analyses were performed with a focus on hospital stays and patient characteristics. Costs were assessed from the perspective of the French National Health Insurance and were obtained from official diagnosis-related group tariffs for public and private hospitals. Results A total of 15,752 adult patients were hospitalised for mRCC, corresponding to 102,613 hospital stays. Of those patients, 68% were men and the median age at first hospitalisation was 69 years [Min-Max: 18–102]. Over the study period, the hospital mortality rate reached 37%. The annual cost of managing mRCC at hospital varied between 28M€ in 2008 and 42M€ in 2012 and was mainly driven by inpatient costs. The mean annual per capita cost of hospital management of mRCC varied across the study period from 8,993€ (SD: €8,906) in 2008 to 10,216€ (SD: €10,527) in 2012. Analysis of the determinants of prescribing expensive drugs at hospital did not show social or territorial differences in the use of these drugs. Conclusion This study is the first to investigate the in-hospital economic burden of mRCC in France. Results showed that in-hospital costs of managing mRCC are mainly driven by expensive drugs and inpatient costs. PMID:27649305

  10. The predictive value of a maculopapular rash in children hospitalized for dengue fever in Cayenne, French Guiana.

    PubMed

    Basurko, Célia; Alvarez, Emma Cuadro; Djossou, Félix; Ardillon, Vanessa; Demar, Magalie; Villeneuve, Chantal; Elenga, Narcisse; Bonnet, Philippe; Carme, Bernard; Nacher, Mathieu

    2012-12-01

    In order to determine the predictive value of a rash during dengue fever, a cohort study was conducted in children hospitalized for dengue during an epidemic in French Guiana. A rash was predictive of uncomplicated dengue: the HR of developing a severe form of disease was 0.43 (95% CI 0.21-0.88; p-value=0.021) for patients with rash.

  11. The moth Hylesia metabus and French Guiana lepidopterism: centenary of a public health concern

    PubMed Central

    Jourdain, F.; Girod, R.; Vassal, J.M.; Chandre, F.; Lagneau, C.; Fouque, F.; Guiral, D.; Raude, J.; Robert, V.

    2012-01-01

    The females of the moths Hylesia metabus have their abdomens covered by urticating hairs looking like micro-arrows and causing a puriginous dermatitis to humans known as “papillonite” in French Guiana and also called yellowtail moth dermatitis or Caripito itch. The densities of the moths show great seasonal and annual variations depending on mechanisms mostly unknown. When H. metabus infestations occur, numerous cases of dermatologic manifestations are reported from people living near the mangrove swamps where the moths are developing. One hundred years after the first “papillonite” epidemic reported from French Guiana in 1912, the data presented herein summarize the actual state of knowledge on H. metabus biology and ecology and on the lepidopterism. Some recommendations are proposed for the surveillance and warning systems of H. metabus infestations and to avoid contact with the moths. Research priorities are suggested to improve the control against this problem emerging between nuisance and public health. PMID:22550622

  12. The moth Hylesia metabus and French Guiana lepidopterism: centenary of a public health concern.

    PubMed

    Jourdain, F; Girod, R; Vassal, J M; Chandre, F; Lagneau, C; Fouque, F; Guiral, D; Raude, J; Robert, V

    2012-05-01

    The females of the moths Hylesia metabus have their abdomens covered by urticating hairs looking like micro-arrows and causing a puriginous dermatitis to humans known as "papillonite" in French Guiana and also called yellowtail moth dermatitis or Caripito itch. The densities of the moths show great seasonal and annual variations depending on mechanisms mostly unknown. When H. metabus infestations occur, numerous cases of dermatologic manifestations are reported from people living near the mangrove swamps where the moths are developing. One hundred years after the first "papillonite" epidemic reported from French Guiana in 1912, the data presented herein summarize the actual state of knowledge on H. metabus biology and ecology and on the lepidopterism. Some recommendations are proposed for the surveillance and warning systems of H. metabus infestations and to avoid contact with the moths. Research priorities are suggested to improve the control against this problem emerging between nuisance and public health.

  13. Non-specific alert system for dengue epidemic outbreaks in areas of endemic malaria. A hospital-based evaluation in Cayenne (French Guiana).

    PubMed

    Carme, B; Sobesky, M; Biard, M H; Cotellon, P; Aznar, C; Fontanella, J M

    2003-02-01

    The emergence of dengue haemorrhagic fever is a public health problem in Latin America and the Caribbean. This study, carried out in French Guiana where malaria is endemic, evaluated the value and the limitations of a non-specific alert system including all patients admitted to the emergency department of Cayenne Hospital, between 1 January 1996 and June 2001. Four indices were studied on a weekly basis: the emergency malaria negative index (EMN), the EMN thrombocytopenia index (EMNT), the dengue suspected index: EMNT/EMN ratio; and the number of hospitalized patients with dengue fever according to the Department of Medical Information. These indices were retrospectively compared with data from the Arbovirus Reference Centre at the Pasteur Institute in French Guiana. Using the non-specific indices, we were able to identify four clear epidemics, two of which were shown to be linked to dengue. Variations in the incidence of malaria had no marked effect on this alert system. We propose that this simple, cheap, sensitive and reactive alert system be used to improve the serological and virological monitoring of dengue and to facilitate adequate and timely vector control measures. It could be used in all regions at risk of dengue and malaria.

  14. The challenge of corporatisation: the experience of Portuguese public hospitals.

    PubMed

    Rego, Guilhermina; Nunes, Rui; Costa, José

    2010-08-01

    The inability of traditional state organisations to respond to new economic, technological and social challenges and the associated emerging problems has made it necessary to adopt new methods of health management. As a result, new directions have emerged in the reform of Public Administration together with the introduction of innovative models. The aim is to achieve a type of management that focuses on results as well as on effort and efficiency. We intend to analyse to what extent the adoption of business management models by hospital healthcare units can improve their performance, mainly in terms of standards of efficiency. Data envelopment analysis (DEA) was used to investigate the efficiency of a set of public Portuguese hospitals. The aim was to evaluate the impact of business management in Portuguese public hospitals with regards to efficiency, specifically taking into account the fact that lack of resources and increased health care needs are a present and future reality. From a total of 83 public hospitals, a sample of 59 hospitals was chosen, of which 21 are state-owned hospital enterprises (SA) and 38 are traditional public administration sector hospitals (SPA). This study evaluates hospital performance by calculating two efficiency measures associated with two categories of inputs. The first efficiency measures the costs associated with hospital production lines and the number of beds (representing fixed capacity) as inputs. The annual costs generated by the hospitals in the consumption of capital and work (direct and indirect costs) are used. A second measure of efficiency is calculated separately. This measure includes in the inputs the number of beds as well as the human resources available (number of doctors, number of nurses and other personnel) in each hospital. With regard to output, the variables that best reflect the hospital services rendered were considered: number of inpatient days, patients discharged, outpatient visits, emergencies

  15. Cost recovery beds in public hospitals in Indonesia.

    PubMed

    Suwandono, A; Gani, A; Purwani, S; Blas, E; Brugha, R

    2001-12-01

    A policy of allowing public hospitals to provide some better quality, higher priced hospital beds for those able to pay was introduced as government policy in Indonesia after 1993. A study was conducted in 1998 in three public hospitals in East Java to investigate if the policy objective of cost-recovery was being achieved. Hospital revenue from these commercial beds was less than both the recurrent and total costs of providing them in all three hospitals, but exceeded recurrent costs minus staff salaries in two hospitals. One reason for the low cost-recovery ratios was that between 55% and 66% of the revenue was used as staff incentives, mostly to doctors. This was more than the maximum of 40% stipulated in the policy. The high proportions of total revenue going to staff were a result of hospital management having set bed fees too low. The policy may be contributing to the retention of doctors within public sector employment; however, it is not achieving its stated objective, especially over the longer term where full recovery of salaries and investment costs needs to be considered. Public hospitals that wish to invest in commercial beds need effective management and accounting systems so as to be able to monitor and control costs and set fees at levels that recoup the costs incurred. Further research is required to determine if this form of public-private mix has negative effects on equity and access for poorer patients. PMID:11772986

  16. The French bioethics public consultation and the anonymity doctrine: empirical ethics and normative assumptions.

    PubMed

    Spranzi, Marta; Brunet, Laurence

    2015-03-01

    The French bioethics laws of 1994 contain the principles of the anonymity and non commodification of all donations of body parts and products including gametes in medically assisted reproduction. The two revisions of the law, in 2004 and 2011 have upheld the rule. In view of the latest revision process, the French government organized a large public consultation in 2009 ("Etats généraux de la bioéthique"). Within the event a "consensus conference" was held in Rennes about different aspects of assisted reproduction (access, anonymity, gratuity and surrogacy). In what follows we shall first describe the anonymity clause for gamete donations in the French law and the debates surrounding it. We shall then analyse the procedure used for the 2009 public consultation and the related consensus conference, as well as its upshot concerning the anonymity doctrine. In this respect we shall compare the citizens' own recommendations on the gamete anonymity issue and its translation in the consultation's final report drafted by a philosopher mandated by the organizing committee. Whereas the final report cited some fundamental ethical arguments as reason for upholding the provisions of the law-most notably the refusal of the 'all biological' approach to reproductive issues-citizens were more careful and tentative in their position although they also concluded that for pragmatic reasons the anonymity rule should continue to hold. We shall argue that the conservative upshot of the public consultation is due to some main underlying presuppositions concerning the citizens' role and expertise as well as to the specific design of the consensus conference. Our conclusion will be that public consultations and consensus conferences can only serve as an empirical support for devising suitable bioethics norms by using second-order normative assumptions.

  17. Selecting public relations personnel of hospitals by analytic network process.

    PubMed

    Liao, Sen-Kuei; Chang, Kuei-Lun

    2009-01-01

    This study describes the use of analytic network process (ANP) in the Taiwanese hospital public relations personnel selection process. Starting with interviewing 48 practitioners and executives in north Taiwan, we collected selection criteria. Then, we retained the 12 critical criteria that were mentioned above 40 times by theses respondents, including: interpersonal skill, experience, negotiation, language, ability to follow orders, cognitive ability, adaptation to environment, adaptation to company, emotion, loyalty, attitude, and Response. Finally, we discussed with the 20 executives to take these important criteria into three perspectives to structure the hierarchy for hospital public relations personnel selection. After discussing with practitioners and executives, we find that selecting criteria are interrelated. The ANP, which incorporates interdependence relationships, is a new approach for multi-criteria decision-making. Thus, we apply ANP to select the most optimal public relations personnel of hospitals. An empirical study of public relations personnel selection problems in Taiwan hospitals is conducted to illustrate how the selection procedure works.

  18. Comparing public and private hospital care service quality.

    PubMed

    Camilleri, D; O'Callaghan, M

    1998-01-01

    The study applies the principles behind the SERVQUAL model and uses Donabedian's framework to compare and contrast Malta's public and private hospital care service quality. Through the identification of 16 service quality indicators and the use of a Likert-type scale, two questionnaires were developed. The first questionnaire measured patient pre-admission expectations for public and private hospital service quality (in respect of one another). It also determined the weighted importance given to the different service quality indicators. The second questionnaire measured patient perceptions of provided service quality. Results showed that private hospitals are expected to offer a higher quality service, particularly in the "hotel services", but it was the public sector that was exceeding its patients' expectations by the wider margin. A number of implications for public and private hospital management and policy makers were identified.

  19. Special funding schemes for innovative medical devices in French hospitals: the pros and cons of two different approaches.

    PubMed

    Martelli, Nicolas; van den Brink, Hélène

    2014-07-01

    Financing innovative medical devices is an important challenge for national health policy makers, and a crucial issue for hospitals. However, when innovative medical devices are launched on the European market there is generally little clinical evidence regarding both efficacy and safety, both because of the flaws in the European system for regulating such devices, and because they are at an early stage of development. To manage the uncertainty surrounding the reimbursement of innovation, several European countries have set up temporary funding schemes to generate evidence about the effectiveness of devices. This article explores two different French approaches to funding innovative in-hospital devices and collecting supplementary data: the coverage with evidence development (CED) scheme introduced under Article L. 165-1-1 of the French Social Security Code; and national programs for hospital-based research. We discuss pros and cons of both approaches in the light of CED policies in Germany and the UK. The CED policies for devices share common limitations. Thus, transparency of CED processes should be enhanced and decisions need to be made in a timely way. Finally, we think that closer collaboration between manufacturers, health authorities and hospitals is essential to make CED policies more operational.

  20. Taxation as metaphor. The hospital and public responsibility.

    PubMed

    Friedman, E

    1992-01-01

    In the debate over the tax status of voluntary hospitals, most hospital executives and trustees do not seem to comprehend--or want to comprehend--the underlying issues. First, the terror of being associated with a tax hike has led many politicians to seek other "revenue enhancements" that are more ingenious than they are honest. On the other hand, many of these governments have legitimate financial problems and are seeking new sources of revenue. A second, related issue is uncertainty over what should be done about the uninsured and Medicaid populations. In the absence of an acceptable solution, we will continue to provide direct public support to public hospitals and indirect public support to private providers--including charitable tax exemptions. The third underlying issue is hospitals' curiously narrow view of their private-sector status. Most of the functions hospitals provide are not only publicly funded; they are, in fact, public functions. Finally, hospitals believe they are inherently moral organizations because they provide an inherently moral service. But hospitals grew to their present role in society almost by accident; their services are neither unique nor ethically superior. It is in how hospitals provide care that their morality can be measured, not in the fact that they provide some kind of care to somebody. An honest appraisal of these issues will help each hospital answer the basic question: As an ethical and moral matter, should this organization be paying taxes? But is this fight really about taxes? I believe society and government are using taxation as a metaphor for trust in hospitals.

  1. [Access to health care for destitute persons at Public Assistance Hospitals in Paris].

    PubMed

    Brücker, G; Nguyen, D T; Lebas, J

    1997-11-01

    All legal French residents are entitled to health care. The 1992 regulatory measures, which create a contractual agreement between the government and public medical institutions, aim at facilitating access to health care by resolving the financial obstacles to accessing health care. The Assistance Publique-Hôpitaux de Paris (AP-HP) has set up a medical reception center in several hospitals since 1993. This system is integrated in the general structure of each hospital: in some cases, there is a single and centralized unit; in other cases, all departments of the hospital, including the emergency room, are involved in caring for destitute patients. Whatever the type of the structure may be, social workers are a key element to helping the patients recover their social rights. Thirty to seventy-percent of patients visiting these centers regain access to social and health care coverage. The epidemiological survey of the active file of patients revealed that 70% are male, more than 50% are non-French nationals, half of which do not have legal immigration status in France. Homeless people represent 40 to 80% of the population. The average age is around 35. The number of medical visits varies greatly from one hospital to another and range from 20 to 60 per month. The reasons for visiting the center and the identified medical disorders are strongly related to the patients' life conditions and vary significantly with the risk factors related to the social and economic situation. The frequency of some diseases (psychiatric disorders, tuberculosis, infections by the HIV and HCV) is higher in this population than in general population. Delayed visits to the medical center represents a severity factor. The hospitals' mission statement is not only to ensure that patients facing a precarious social and professional situation have equal access to health care, but also to help such patients recover their social rights, facilitate their integration in the society and fight against

  2. Efficiency improvements of public hospitals under a capitation payment scheme.

    PubMed

    García-Lacalle, Javier; Martín, Emilio

    2013-07-01

    In a context of cost containment and demands for better quality in public health care, payment systems are used as an instrument to promote efficiency improvements in service providers. Andalusia has adopted an original type of risk-adjusted capitation payment mechanism to reimburse public hospitals. This paper presents the main characteristics of the reimbursement mechanism of the Andalusian Health Service highlighting some differences with the mechanisms adopted in other parts of Europe. The paper also explores the evolution of the efficiency and quality of the hospitals after its implementation using the Malmquist index. Results indicate that hospitals have slightly improved their efficiency, particularly urban hospitals, and these improvements are not significantly related to a negative evolution of quality. However, it is not possible to assert to what extent, improvements are the consequence of the new payment system. The organisation of the Servicio Andaluz de Salud and the limited competition between hospitals reduce the effectiveness of the reform. PMID:23343663

  3. Defining Publics in Public Relations: The Case of a Suburban Hospital

    ERIC Educational Resources Information Center

    Grunig, James E.

    1978-01-01

    Offers a behavioral definition of a public, demonstrates how the definition can be used by public relations practitioners in researching and analyzing their publics, and reports on a formulative study of a suburban hospital that can serve as a model for public relations practitioners who wish to do similar research. (Author/GW)

  4. Public hospitals in peril: factors associated with financial distress.

    PubMed

    Ramamonjiarivelo, Zo; Weech-Maldonado, Robert; Hearld, Larry; Pradhan, Rohit

    2014-01-01

    As "safety net providers," public hospitals have played a major role in health care delivery, especially in serving the indigent and the uninsured. For several decades, public hospitals have been operating in a challenging environment, and some of them have experienced financial difficulties. The purpose of this study was to explore the organizational and environmental factors associated with public hospitals' financial distress. This study used a national sample of public hospitals based on longitudinal panel data from 1997 to 2009, resulting in a sample size of 7,257 hospital-year observations. The Altman Z-score method was applied to assess hospitals' financial condition. The significant findings from a random effects logistic regression model with state and year fixed-effects indicated that higher Medicare HMO penetration was associated with financial distress. Organizational variables such as health network, size, occupancy rate, and outpatient mix decreased the odds of financial distress; and membership in a multihospital system increased the odds of financial distress. PMID:25223157

  5. Conflict and Compromise: Catholic and Public Hospital Partnerships

    PubMed Central

    Wall, Barbra Mann

    2010-01-01

    This article analyzes the tensions and uneasy negotiations, based on a case study, that occurred among Catholic sisters, administrators, bishops, physicians, and the Vatican for more than seven years at a hospital in Austin, Texas. Here, the largest health care system in the city, which was Catholic, joined with the local public, tax-supported hospital that provided the majority of reproductive health care services in the region. A clash resulted over whether the hospital could continue providing sterilization and contraceptive services to its primarily poor patients. This article examines the fierce debates that occurred, especially over emergency contraception and attempts to develop creative solutions after a hierarchical crackdown from the Vatican. The end result was a compromise that included the creation of a “hospital within a hospital.” PMID:20067093

  6. Demand uncertainty and hospital costs: an application to Portuguese public hospitals.

    PubMed

    Almeida, Alvaro Santos; Cima, Joana Ferreira

    2015-01-01

    In this paper, we evaluate the effect of demand uncertainty on hospital costs. Since hospital managers want to minimize the probability of not having enough capacity to satisfy demand, and since demand is uncertain, hospitals have to build excess capacity and incur the associated costs. Using panel data comprising information for 43 Portuguese public hospitals for the period 2007-2009, we estimate a translog cost function that relates total variable costs to the usual variables (outputs, the price of inputs, some of the hospitals' organizational characteristics) and an additional term measuring the excess capacity related to the uncertainty of demand. Demand uncertainty is measured as the difference between actual and projected demand for emergency services. Our results indicate that the cost function term associated with the uncertainty of demand is significant, which means that cost functions that do not include this type of term may be misspecified. For most of our sample, hospitals that face higher demand uncertainty have higher excess capacity and higher costs. Furthermore, we identify economies of scale in hospital costs, at least for smaller hospitals, suggesting that a policy of merging smaller hospitals would contribute to reducing hospital costs. PMID:24310509

  7. Demand uncertainty and hospital costs: an application to Portuguese public hospitals.

    PubMed

    Almeida, Alvaro Santos; Cima, Joana Ferreira

    2015-01-01

    In this paper, we evaluate the effect of demand uncertainty on hospital costs. Since hospital managers want to minimize the probability of not having enough capacity to satisfy demand, and since demand is uncertain, hospitals have to build excess capacity and incur the associated costs. Using panel data comprising information for 43 Portuguese public hospitals for the period 2007-2009, we estimate a translog cost function that relates total variable costs to the usual variables (outputs, the price of inputs, some of the hospitals' organizational characteristics) and an additional term measuring the excess capacity related to the uncertainty of demand. Demand uncertainty is measured as the difference between actual and projected demand for emergency services. Our results indicate that the cost function term associated with the uncertainty of demand is significant, which means that cost functions that do not include this type of term may be misspecified. For most of our sample, hospitals that face higher demand uncertainty have higher excess capacity and higher costs. Furthermore, we identify economies of scale in hospital costs, at least for smaller hospitals, suggesting that a policy of merging smaller hospitals would contribute to reducing hospital costs.

  8. Public-private partnerships and public hospital performance in São Paulo, Brazil.

    PubMed

    La Forgia, Gerard M; Harding, April

    2009-01-01

    Public hospitals that are directly managed by government perform poorly in many developing countries. Approaches to improving them through internal managerial reforms have failed, and effective alternatives are much needed. Policymakers are considering reforms through public-private partnerships (PPPs)--a promising but so far unevaluated approach. We present results of a successful reform in São Paulo, Brazil. The PPP model gave facility managers latitude to manage human resources--a factor critical to success. Given the prevalence of direct management of public hospitals in developing countries, the São Paulo experience has implications for policymakers seeking to improve hospital performance. PMID:19597211

  9. Public Reporting of Hospital Patient Satisfaction: The Rhode Island Experience

    PubMed Central

    Barr, Judith K.; Boni, Cathy E.; Kochurka, Kimberly A.; Nolan, Patricia; Petrillo, Marcia; Sofaer, Shoshanna; Waters, William

    2002-01-01

    This article describes a collaborative process for legislatively mandated public reporting of health care performance in Rhode Island that began with hospital patient satisfaction. The goals of the report were both quality improvement and public accountability. Key features addressed include: the legislative context for public reporting; widespread participation of stakeholders; the structure for decisionmaking; and the use of formative testing with cognitive interviews to get responses of consumers and others about the report's readability and comprehensibility. This experience and the lessons learned can guide other States considering public reporting on health care performance. PMID:12500470

  10. Improving Midwifery Care in Ugandan Public Hospitals: The Midwives’ Perspective

    PubMed Central

    Nabirye, Rose C.; Beinempaka, Florence; Okene, Cindrella; Groves, Sara

    2016-01-01

    Background A serious shortage of nurses and midwives in public hospitals has been reported in Uganda. In addition, over 80% of the nurses and midwives working in public hospitals have been found to have job stress and only 17% to be satisfied on the job. Stress and lack of job satisfaction affect quality of nursing and midwifery care and puts patients’ lives at risk. This is coupled with rampant public outcry about the deteriorating nursing and midwifery care in Ugandan public hospitals. Objective To explore factors that result in poor quality of midwifery care and strategies to improve this care from the perspective of the midwives. Method It was a qualitative exploratory design. Participants were midwives and their supervisors working in four Regional Referral hospitals in Uganda. Data was collected by FGDs and KIIs. Content analysis was used to analyze the transcribed data from the voice recordings. Results Four major themes emerged from the study. They were organizational (poor work environment and lack of materials/equipment), professional (midwives’ attitudes, lack of supervision), public/consumer issues (interference) and policy issues (remuneration, promotion and retirement). Conclusions and implications for Practice Midwives love their work but they need support to provide quality care. Continuous neglect of midwives’ serious concerns will lead to more shortages as more dissatisfied midwives leave service.

  11. An Internet supported workflow for the publication process in UMVF (French Virtual Medical University).

    PubMed

    Renard, Jean-Marie; Bourde, Annabel; Cuggia, Marc; Garcelon, Nicolas; Souf, Nathalie; Darmoni, Stephan; Beuscart, Régis; Brunetaud, Jean-Marc

    2007-01-01

    The " Université Médicale Virtuelle Francophone" (UMVF) is a federation of French medical schools. Its main goal is to share the production and use of pedagogic medical resources generated by academic medical teachers. We developed an Open-Source application based upon a workflow system, which provides an improved publication process for the UMVF. For teachers, the tool permits easy and efficient upload of new educational resources. For web masters it provides a mechanism to easily locate and validate the resources. For librarian it provide a way to improve the efficiency of indexation. For all, the utility provides a workflow system to control the publication process. On the students side, the application improves the value of the UMVF repository by facilitating the publication of new resources and by providing an easy way to find a detailed description of a resource and to check any resource from the UMVF to ascertain its quality and integrity, even if the resource is an old deprecated version. The server tier of the application is used to implement the main workflow functionalities and is deployed on certified UMVF servers using the PHP language, an LDAP directory and an SQL database. The client tier of the application provides both the workflow and the search and check functionalities. A unique signature for each resource, was needed to provide security functionality and is implemented using a Digest algorithm. The testing performed by Rennes and Lille verified the functionality and conformity with our specifications. PMID:17344092

  12. Transfusion monitoring: care practice analysis in a public teaching hospital

    PubMed Central

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

    2016-01-01

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

  13. [The organizational culture of a Brazilian public hospital].

    PubMed

    Rocha, Fernanda Ludmilla Rossi; Marziale, Maria Helena Palucci; de Carvalho, Michele Cristina; Cardeal Id, Samira de Fátima; de Campos, Monica Chiodi Toscano

    2014-04-01

    The objective of this research was to analyze the organizational culture of a Brazilian public hospital. It is a descriptive study with quantitative approach of data, developed in a public hospital of São Paulo State, Brazil. The sample was composed by 52 nurses and 146 nursing technicians and auxiliaries. Data were collected from January to June 2011 using the Brazilian Instrument for Assessing Organizational Culture - IBACO. The analysis of the organizational values showed the existence of hierarchical rigidity and centralization of power within the institution, as well as individualism and competition, which hinders teamwork. The values concerning workers' well-being, satisfaction and motivation were not highly valued. In regard to organizational practices, the promotion of interpersonal relationship, continuous education, and rewarding practices were not valued either. It becomes apparent that traditional models of work organization support work practices and determine the organizational culture of the hospital. PMID:24918891

  14. [Harassment in the public sector].

    PubMed

    Puech, Paloma; Pitcho, Benjamin

    2013-01-01

    The French Labour Code, which provides full protection against moral and sexual harassment, is not applicable to public sector workers. The public hospital is however not exempt from such behaviour, which could go unpunished. Public sector workers are therefore protected by the French General Civil Service Regulations and the penal code.

  15. Assessing Governance Alternatives for University-Owned Public Teaching Hospitals.

    ERIC Educational Resources Information Center

    Whitley, Evangeline L.

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

  16. Selecting public relations personnel of hospitals by analytic network process.

    PubMed

    Liao, Sen-Kuei; Chang, Kuei-Lun

    2009-01-01

    This study describes the use of analytic network process (ANP) in the Taiwanese hospital public relations personnel selection process. Starting with interviewing 48 practitioners and executives in north Taiwan, we collected selection criteria. Then, we retained the 12 critical criteria that were mentioned above 40 times by theses respondents, including: interpersonal skill, experience, negotiation, language, ability to follow orders, cognitive ability, adaptation to environment, adaptation to company, emotion, loyalty, attitude, and Response. Finally, we discussed with the 20 executives to take these important criteria into three perspectives to structure the hierarchy for hospital public relations personnel selection. After discussing with practitioners and executives, we find that selecting criteria are interrelated. The ANP, which incorporates interdependence relationships, is a new approach for multi-criteria decision-making. Thus, we apply ANP to select the most optimal public relations personnel of hospitals. An empirical study of public relations personnel selection problems in Taiwan hospitals is conducted to illustrate how the selection procedure works. PMID:19197656

  17. Depression among hospitalized and non-hospitalized gonadal cancer patients in tertiary care public hospitals in Karachi.

    PubMed

    Yousaf, Tahira; Zadeh, Zainab Fotowwat

    2015-03-01

    The study aimed at determining the differences in the levels of depression between hospitalized and non-hospitalized Gonadal cancer patients in tertiary care public hospitals in Karachi. The present study was conducted at the Jinnah Postgraduate Medical Centre and Civil Hospital, Karachi, from July to October 2009. One hundred adult patients diagnosed with Gonadal cancer volunteered for the study. Cases with any other co-morbidity were excluded. Urdu version of Siddiqui Shah Depression Scale (SSDS) was administered. Purposive and snowball sampling methods were used for data collection. The ages of participants in the sample ranged from 20 to 27 years with the mean age of 23.85 years. The participants belonged to the lower and middle classes. Out of the 30 hospitalized gonadal cancer patients 40% were moderately depressed and 60% were severely depressed, whereas out of 70 non-hospitalized gonadal cancer patients 74.3% were mildly depressed, 24.3% were moderately depressed and only 1.4% were severely depressed, which clearly indicated that the depression level of hospitalized gonadal cancer patients was high as compared to non-hospitalized gonadal cancer patients.

  18. Cost estimate of hospital stays for premature newborns of adolescent mothers in a Brazilian public hospital

    PubMed Central

    Mwamakamba, Lutufyo Witson; Zucchi, Paola

    2014-01-01

    ABSTRACT Objective: To estimate the direct costs of hospital stay for premature newborns of adolescent mothers, in a public hospital. Methods: A cost estimate study conducted between 2009 and 2011, in which direct hospital costs were estimated for premature newborns of adolescent mothers, with 22 to 36 6/7 gestational weeks, and treated at the neonatal unit of the hospital. Results: In 2006, there were 5,180 deliveries at this hospital, and 17.8% (922) were newborns of adolescent mothers, of which 19.63% (181) were admitted to the neonatal unit. Out of the 181 neonates, 58% (105) were premature and 80% (84) of them were included in this study. These 84 neonates had a total of 1,633 days in-patient hospital care at a total cost of US$195,609.00. Approximately 72% of this total cost (US$141,323.00) accounted for hospital services. The mean daily costs ranged from US$97.00 to US$157.00. Conclusion: This study demonstrated that the average cost of premature newborns from adolescent mothers was US$2,328.00 and varied according to birth weight. For those weighing <1,000g at birth, the mean direct cost was US$8,930.00 per stay as opposed to a cost of US$642.00 for those with birth weight >2,000g. The overall estimated direct cost for the 84 neonates in the study totaled US$195,609.00. PMID:25003930

  19. Inter-hospital variations in caesarean sections. A risk adjusted comparison in the Valencia public hospitals

    PubMed Central

    Librero, J.; Peiro, S.; Calderon, S. M.

    2000-01-01

    BACKGROUND—The aim of this study was to describe the variability in caesarean rates in the public hospitals in the Valencia Region, Spain, and to analyse the association between caesarean sections and clinical and extra-clinical factors.
METHODS—Analysis of data contained in the Minimum Basic Data Set (MBDS) compiled for all births in 11 public hospitals in Valencia during 1994-1995 (n=36 819). Bivariate and multivariate analyses were used to evaluate the association between caesarean section rates and specific risk factors. The multivariate model was used to construct predictions about caesarean rates for each hospital, for comparison with rates observed.
RESULTS—Caesarean rates were 17.6% (inter-hospital range: 14.7% to 25.0%), with ample variability between hospitals in the diagnosis of maternal-fetal risk factors (particularly dystocia and fetal distress), and the indication for caesarean in the presence of these factors. Multivariate analysis showed that maternal-fetal risk factors correlated strongly with caesarean section, although extra-clinical factors, such as the day of the week, also correlated positively. After adjusting for the risk factors, the inter-hospital variation in caesarean rates persisted.
CONCLUSIONS—Although certain limitations (imprecision of some diagnoses and information biases in the MBDS) make it impossible to establish unequivocal conclusions, results show a high degree of variability among hospitals when opting for caesarean section. This variability cannot be justified by differences in obstetric risks.


Keywords: hospital utilisation; medical practice variation; caesarean section; administrative databases PMID:10890876

  20. Participation of French Hospital Physicians to Continuing Medical Education Events: A Survey with 300 Physicians to Assess Duration, Methods, Financing, and Needs

    ERIC Educational Resources Information Center

    Maisonneuve, Herve; Touboul, Chantal; Bonnelye, Genevieve; Bertrand, Dominique

    2009-01-01

    Introduction: Little data on the educational needs and practices of French hospital physicians have been obtained through surveys. Given that continuing medical education (CME) information is now available on http://www.cnfmc.fr and providers are accredited, we investigated CME practices and knowledge of the CME system with the use of a…

  1. Cost accounting and public reimbursement schemes in Spanish hospitals.

    PubMed

    Sánchez-Martínez, Fernando; Abellán-Perpiñán, José-María; Martínez-Pérez, Jorge-Eduardo; Puig-Junoy, Jaume

    2006-08-01

    The objective of this paper is to provide a description and analysis of the main costing and pricing (reimbursement) systems employed by hospitals in the Spanish National Health System (NHS). Hospitals cost calculations are mostly based on a full costing approach as opposite to other systems like direct costing or activity based costing. Regional and hospital differences arise on the method used to allocate indirect costs to cost centres and also on the approach used to measure resource consumption. Costs are typically calculated by disaggregating expenditure and allocating it to cost centres, and then to patients and DRGs. Regarding public reimbursement systems, the impression is that unit costs are ignored, except for certain type of high technology processes and treatments.

  2. Theoretical and perceived balance of power inside Spanish public hospitals

    PubMed Central

    2001-01-01

    Background The hierarchical pyramid inside Spanish public hospitals was radically changed by the Health Reform Law promulgated in 1986. According to it, the manpower of the hospitals was divided into three divisions (Medical, Nursing, General Services/Administration), which from then on occupied the same level, only subject to the general manager. Ten years after the implementation of the law, the present study was designed in order to investigate if the legal changes had indeed produced a real change in the balance of power inside the hospitals, as perceived by the different workers within them. Materials and Methods A questionnaire was administered to 1,027 workers from four different public hospitals (two university-based and two district hospitals). The participants belonged to all divisions, and to all three operative levels (staff, supervisory and managerial) within them. The questionnaire inquired about the perceived power inside each division and hierarchical level, as well as about that of the other divisions and hierarchical levels. Results Every division attributed the least power to itself. The Nursing and the Administrative division attributed the highest power to the physicians, and these attributed the highest power to the General Services/Administrative division. All hierarchical levels (including the formal top of the pyramid) attributed significantly more power to the other than to them. Conclusions More than ten years after the implementation of the new law, the majority of workers still perceive that the real power within the hospitals is held by the physicians (whereas these feel that it has shifted to the administrators). No division or hierarchical level believes it holds any significant degree of power, and this carries with it the danger of also not accepting any responsibility. PMID:11574049

  3. Prioritizing Public- Private Partnership Models for Public Hospitals of Iran Based on Performance Indicators

    PubMed Central

    Gholamzadeh Nikjoo, Raana; Jabbari Beyrami, Hossein; Jannati, Ali; Asghari Jaafarabadi, Mohammad

    2012-01-01

    Background: The present study was conducted to scrutinize Public- Private Partnership (PPP) models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals. Methods: In this mixed (quantitative-qualitative) study, systematic review and expert panel has been done to identify varied models of PPP as well as performance indicators. In the second step we prioritized performance indicator and PPP models based on selected performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software’s. Results: In quality – effectiveness area, indicators like the rate of hospital infections (100%), hospital accidents prevalence rate (73%), pure rate of hospital mortality (63%), patient satisfaction percentage (53%), in accessibility equity area indicators such as average inpatient waiting time (100%) and average outpatient waiting time (74%), and in financial – efficiency area, indicators including average length of stay (100%), bed occupation ratio (99%), specific income to total cost ratio (97%) have been chosen to be the most key performance indicators. In the pri¬oritization of the PPP models clinical outsourcing, management, privatization, BOO (build, own, operate) and non-clinical outsourcing models, achieved high priority for various performance in¬dicator areas. Conclusion: This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different. PMID:24688942

  4. Hospital Bed Occupancy and HIV/AIDS in three Major Public Hospitals of Addis Ababa, Ethiopia

    PubMed Central

    Tamiru, Melesse; Haidar, Jemal

    2010-01-01

    Background: In countries like Ethiopia where the spread of HIV infection is extensive, health services are faced with an increased demand for care. The most obvious reflection of this increased demand is through patient load, longer bed occupancy perhaps to the exclusion of patients with other ailments. Objective: The purpose of this study was to describe the bed occupancy rate and the average length of stay of HIV/AIDS inpatients of three major public hospitals. Methods: A Retrospective Cross-sectional study was conducted in three major hospitals of Addis Ababa namely Zewditu Memorial Hospital, Tikure Anbessa Hospital and Saint Paul’s Hospital from February to March 2004. Results: Of the total 453 sampled inpatients, 293 (65 %) were HIV positives. Over half (55.0%) were Males. The most affected age group was between 24 and 56 years. The majority (85.8%) were from Addis Ababa and over half (57.7%) was married. Housewives constituted about a quarter (26.3%) of all the admitted cases. The most common co-morbidities resulted in admission to the medical wards among the HIV-positive cases were Tuberculosis (73.0%) and jirovicii pneumonia (70.3%), and their occurrence was significantly higher among HIV+ than their counter parts (p=0.001). Although numbers of patients admitted in Tikur Anbesa hospital was more than Saint Paul’s and Zewditu Memorial hospitals (ZMH), the proportion of HIV positive cases admitted to ZMH however was higher (49.0%) than Tikur Anbessa (14.0%) and Saint Paul’s hospitals (18.0%). Likewise the number of inpatient days was also higher in ZMH (n=7765) than the other hospitals. The bed occupancy rate was however, higher in ZMH (53.0%) than Tikur Anbessa (12.0%) and Saint Paul’s (12.0%) hospitals. Conclusion: One of the most obvious consequences of HIV/AIDS patients are the increased occupancy of hospitals beds suggesting that only 81.1 % of the beds are for all other afflictions in the hospitals. It appears that there is a lot of concern that

  5. Prioritizing lean management practices in public and private hospitals.

    PubMed

    Hussain, Matloub; Malik, Mohsin

    2016-05-16

    Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

  6. Prioritizing lean management practices in public and private hospitals.

    PubMed

    Hussain, Matloub; Malik, Mohsin

    2016-05-16

    Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management. PMID:27119397

  7. Epidemiology of atrial fibrillation in France: extrapolation of international epidemiological data to France and analysis of French hospitalization data.

    PubMed

    Charlemagne, Agnès; Blacher, Jacques; Cohen, Ariel; Collet, Jean-Philippe; Diévart, François; de Groote, Pascal; Hanon, Olivier; Leenhardt, Antoine; Pinel, Jean-François; Pisica-Donose, George; Le Heuzey, Jean-Yves

    2011-02-01

    The prevalence of atrial fibrillation is steadily increasing throughout the world because of ageing populations and better management of coronary heart disease. An international literature review was conducted to estimate the prevalence and incidence of atrial fibrillation in France. A review of the literature on comorbidities was also performed. Finally, French mortality and hospitalization data were analysed using the PMSI database. The prevalence of atrial fibrillation is estimated to be between 600,000 and 1 million people; of these, two-thirds are aged >75 years. The incidence is estimated at between 110,000 and 230,000 new cases per year. In 2008, 412,000 hospitalized patients had a diagnosis of atrial fibrillation; this figure increased by 26% in the 3-year period between 2005 and 2008. These findings highlight the importance of targeting therapy, of upstream therapy, and of therapy that provides clear clinical and economic advantages over the well-established reductions already achieved in atrial fibrillation morbidity, mortality and cost. In addition, new prevention strategies should be developed, particularly secondary prevention strategies in patients with cardiovascular diseases. PMID:21402346

  8. Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals.

    PubMed

    Lepelletier, D; Pinaud, V; Le Conte, P; Bourigault, C; Asseray, N; Ballereau, F; Caillon, J; Ferron, C; Righini, C; Batard, E; Potel, G

    2016-05-01

    The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009-2012 describing 412 patients. Median age was 29 year (range, 2-84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity.

  9. Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals.

    PubMed

    Lepelletier, D; Pinaud, V; Le Conte, P; Bourigault, C; Asseray, N; Ballereau, F; Caillon, J; Ferron, C; Righini, C; Batard, E; Potel, G

    2016-05-01

    The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009-2012 describing 412 patients. Median age was 29 year (range, 2-84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity. PMID:26942743

  10. Consumption of benzodiazepines in a French university hospital between 1980 and 1991.

    PubMed

    Alran, C; Damase-Michel, C; Celotto, N; Durand, M C; Montastruc, J L

    1993-01-01

    The consumption of benzodiazepines in the Toulouse university hospital from 1980 to 1991 was investigated. During this period, total annual consumption of benzodiazepines as anxiolytics remained stable, whereas their prescription as hypnotics fell (-70%). Moreover, short half-life benzodiazepines as hypnotics were preferred to long half-life ones. In parallel, there was an enhancement in new (zopiclone, zolpidem, buspirone) and old (alimemazine, hydroxyzine) drugs' consumption, the ratio benefits/risks of which have not yet been well defined. PMID:8104854

  11. Carbapenem use in French hospitals: A nationwide survey at the patient level.

    PubMed

    Gauzit, Rémy; Pean, Yves; Alfandari, Serge; Bru, Jean-Pierre; Bedos, Jean-Pierre; Rabaud, Christian; Robert, Jérôme

    2015-12-01

    The objective of this study was to evaluate the characteristics of carbapenem use in French healthcare settings in order to guide future actions. Healthcare facilities voluntarily participated in a nationwide cross-sectional survey in 2011. Medical data and reasons for carbapenem treatment (CPR) and discontinuation were recorded for all patients treated with carbapenems. A total of 2338 patients were recorded by 207 facilities. The median duration of CPR was 8 days, and 31.4% of patients received CPR for >10 days. An antibiotic consultant was involved in the initial choice of CPR in 36.8% of cases. CPR was chosen on an empirical (EP) basis for 1229 patients (52.6%), mainly because of severe sepsis (48.6%) or a perceived risk of bacterial resistance (33.7%). Among EP patients, de-escalation was more frequent in the case of intervention of an antibiotic consultant (35.1%) than without intervention (22.9%) (P<0.01). Among the 1109 patients receiving CPR initially based on bacteriological results, 607 (54.7%) had ESBL-producing Enterobacteriaceae and 397 (35.8%) had Gram-negative bacilli susceptible to at least one β-lactam other than carbapenems or to fluoroquinolones. Among the latter, de-escalation was performed in 59 cases (14.9%). The intervention of an antibiotic consultant did not favour de-escalation in this group. In conclusion, carbapenems are frequently used for treating suspected or confirmed multidrug-resistant bacteria, and overall CPR duration is long. De-escalation is frequently not implemented despite isolates being susceptible to other drugs. More frequent antibiotic consultant intervention may help to decrease carbapenem use in the case of EP treatment.

  12. Occurrence of qnrA-positive clinical isolates in French teaching hospitals during 2002-2005.

    PubMed

    Cambau, E; Lascols, C; Sougakoff, W; Bébéar, C; Bonnet, R; Cavallo, J-D; Gutmann, L; Ploy, M-C; Jarlier, V; Soussy, C-J; Robert, J

    2006-10-01

    Bacteria harbouring the novel qnrA plasmid-mediated mechanism of quinolone resistance have been described in different countries, but the frequency of their occurrence has not been investigated. In total, 1,468 clinical isolates of Enterobacteriaceae with quinolone resistance or extended-spectrum beta-lactamase (ESBL) phenotypes were collected from eight teaching hospitals in France during 2002-2005 and screened for qnrA. Overall, 28 isolates (22 Enterobacter cloacae, three Klebsiella pneumoniae, one Citrobacter freundii, one Klebsiella oxytoca and one Proteus mirabilis) were positive for qnrA, representing 1.9% of all isolates, 3.3% of ESBL-producing isolates (22% of the E. cloacae isolates) and 0% of non-ESBL-producing isolates. The prevalence of qnrA among consecutive ESBL-producing isolates in 2004 from the eight hospitals was 2.8% (18/639). Of the qnrA-positive isolates, 100% were intermediately-resistant or resistant to nalidixic acid, and 75% to ciprofloxacin. Twenty-one of the 22 qnrA-positive E. cloacae isolates were obtained from two hospitals in the Paris area, and molecular typing and plasmid content analysis showed clonal relationships for five, three and two isolates, respectively. The qnrA genetic environment was similar to that of the In36 integron. The remaining two isolates had qnrA variants (30 and 29 nucleotide differences, respectively, compared with the original sequence) and an unknown genetic environment. The ESBL gene associated with qnrA was bla(SHV-12) in most of the isolates, but bla(PER-1) and bla(SHV-2a) were found in two isolates. In France, it appears that qnrA-positive isolates are predominantly E. cloacae isolates producing SHV-12, and may be associated with the dissemination of an In36-like integron. PMID:16961639

  13. Public-private partnerships: a Canadian hospital's perspective.

    PubMed

    Philpott, Thomas G

    2007-01-01

    The McGill University Health Centre (MUHC) is undergoing a $1.579 billion redevelopment project, placing it amongst the largest hospital redevelopment projects in the world. As the Quebec government and the MUHC were considering the Public-Private Partnership (PPP) procurement alternative, the MUHC embarked upon an investigation of various jurisdictions' experiences with PPPs. The studies concluded that there are various frameworks available and that the specific characteristics of a project should be considered when determining which model to use. PMID:18399267

  14. Cultural circumcision in EU public hospitals--an ethical discussion.

    PubMed

    Brusa, Margherita; Barilan, Y Michael

    2009-10-01

    The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system. We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation. From the unique structure of patient-medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support a utilitarian argument that finds hospital based circumcision safer than non-medicalized alternatives. The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation PMID:19076127

  15. A cost and performance comparison of Public Private Partnership and public hospitals in Spain.

    PubMed

    Caballer-Tarazona, Maria; Clemente-Collado, Antonio; Vivas-Consuelo, David

    2016-12-01

    Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to traditional public health systems, with the intention of making them more efficient.There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts with the private, up to the complete privatisation of the service. As such, we may say the involvement of the private sector embraces the development, financing and provision of public infrastructures and delivery services.In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin American countries is evaluated for first time: the integrated healthcare delivery Alzira model.Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the PPP experience in five hospitals is evaluated to identify the influence of private management in the results.Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the average, but not always better than those directly managed. It is necessary to conduct studies with a greater number of PPP hospitals to obtain conclusive results. PMID:27180236

  16. Postgraduate training in public health medicine: St George's Hospital Medical School Library public health information service.

    PubMed

    Rook, R; Adshead, F

    2001-03-01

    This article examines the development of the St George's Hospital Medical School Library public health information service. Begun in 1997 as a pilot project to support Public Health Specialist Registrars in South Thames West, it is now an established part of postgraduate training in the region. An outline of the service is described, including the evolution of the post of Public Health Librarian. Issues influencing the development of the service, and the establishment of the Librarian as part of the public health network are discussed. This is a transferable model of public health information provision, which as a centralized resource makes best use of available funding. As a LIS model it is an effective and efficient way of maximizing resources, and delivering a service to a specialist user group that is spread across a wide geographical area. PMID:11260291

  17. Elements de correction phonetique du francais (Elements of Phonetic Correction of French). Publication B-53.

    ERIC Educational Resources Information Center

    LeBel, Jean-Guy

    Three essays are presented that deal with phonetic correction and that are intended specifically for Anglophones. They deal with the following topics: (1) methods and processes useful in phonetic correction with students called "false intermediates"; (2) a synthesis and a methodology of methods of phonetic correction of the "French R" with…

  18. Explaining local authority choices on public hospital provision in the 1930s: a public policy hypothesis.

    PubMed

    Neville, Julia

    2012-01-01

    This article summarises the findings of recent work on local authority public hospital services in England and Wales in the inter-war years and identifies the lack of a robust hypothesis to explain the variations found, particularly one that would explain the actions of county councils as well as county boroughs. Using public policy techniques on a group of local authorities in the far South West it proposes that variations can be explained by an understanding of the deep core beliefs of councillors, their previous experience of 'commissioner' and 'provider' roles, and the availability or otherwise of a dedicated policy entrepreneur to promote change. PMID:23752983

  19. Explaining Local Authority Choices on Public Hospital Provision in the 1930s: A Public Policy Hypothesis

    PubMed Central

    Neville, Julia

    2012-01-01

    This article summarises the findings of recent work on local authority public hospital services in England and Wales in the inter-war years and identifies the lack of a robust hypothesis to explain the variations found, particularly one that would explain the actions of county councils as well as county boroughs. Using public policy techniques on a group of local authorities in the far South West it proposes that variations can be explained by an understanding of the deep core beliefs of councillors, their previous experience of ‘commissioner’ and ‘provider’ roles, and the availability or otherwise of a dedicated policy entrepreneur to promote change. PMID:23752983

  20. Working together: collaboration between midwives and doctors in public hospitals.

    PubMed

    Reiger, Kerreen M; Lane, Karen L

    2009-05-01

    While collaborative, multidisciplinary teamwork is widely espoused as the goal of contemporary hospitals, it is hard to achieve. In maternity care especially, professional rivalries and deep-seated philosophical differences over childbirth generate significant tensions. This article draws on qualitative research in several Victorian public maternity units to consider the challenges to inter-professional collaboration. It reports what doctors and midwives looked for in colleagues they liked to work with - the attributes of a "good doctor" or a "good midwife". Although their ideals did not entirely match, both groups respected skill and hard work and sought mutual trust, respect and accountability. Yet effective working together is limited both by tensions over role boundaries and power and by incivility that is intensified by increasing workloads and a fragmented labour force. The skills and qualities that form the basis of "professional courtesy" need to be recognised as essential to good collaborative practice. PMID:19563323

  1. The new health insurance rebate: an inefficient way of assisting public hospitals.

    PubMed

    Duckett, S J; Jackson, T J

    2000-05-01

    Private health insurance subsidy is now estimated to cost $2.19 billion; government support for private health care includes a further $1.2 billion of Medicare benefits expenditure in hospitals. The subsidy cannot be justified on efficiency grounds, as, on the basis of available evidence and taking casemix into account, public hospitals are more efficient than private hospitals. The original stated objective of the subsidy was to "take pressure off public hospitals". If the insurance subsidy and the Medicare Benefit Schedule rebate expenditure were applied to purchasing public hospital treatment at full average cost, 58% of current private sector demand could be accommodated. If 10% of the demand were met at marginal cost, this would increase to 65%. The objective of "taking pressure off public hospitals" could be more efficiently achieved by direct funding of public hospitals rather than through subsidies for private health insurance. PMID:10870538

  2. Faecal carriage of extended-spectrum β-lactamase-producing enterobacteria among soldiers at admission in a French military hospital after aeromedical evacuation from overseas.

    PubMed

    Janvier, F; Delacour, H; Tessé, S; Larréché, S; Sanmartin, N; Ollat, D; Rapp, C; Mérens, A

    2014-10-01

    The aim of this study was to assess the faecal carriage of carbapenemase-producing enterobacteria (CPE) and extended-spectrum β-lactamase (ESBL)-producing enterobacteria among soldiers at admission in a French military hospital after aeromedical evacuation from overseas. During a period of 1 year, 83 rectal swabs collected in French soldiers at admission were screened for multidrug-resistant enterobacteria with a chromogenic medium. ESBL detection was performed with the double-disc synergy test in the absence or presence of cloxacillin. The genotypic characterisation of resistance mechanisms, sequence typing and phylotyping was performed by polymerase chain reaction (PCR) and sequencing with bacterial DNA extracted from isolates. No CPE was detected. Eleven ESBL Escherichia coli isolates belonging to four phylogenetic groups were detected, including ten CTX-M-15 and one CTX-M-14. The overall gut colonisation with ESBL-producing bacteria (13.25 %) was 6-fold higher than that reported in soldiers in the suburbs of Paris in 2009. ESBL faecal carriage was particularly high (34.48 %) in soldiers repatriated from Afghanistan (risk ratio = 18.62; p = 0.0001). This study highlights the importance of systematic additional contact precautions and CPE/ESBL screening in soldiers repatriated from overseas in French hospitals.

  3. A conceptual framework for selecting the most appropriate variables for measuring hospital efficiency with a focus on Iranian public hospitals.

    PubMed

    Afzali, Hossein Haji Ali; Moss, John R; Mahmood, Mohammad Afzal

    2009-05-01

    Over the past few decades, there has been an increasing interest in the measurement of hospital efficiency in developing countries and in Iran. While the choice of measurement methods in hospital efficiency assessment has been widely argued in the literature, few authors have offered a framework to specify variables that reflect different hospital functions, the quality of the process of care and the effectiveness of hospital services. However, without the knowledge of hospital objectives and all relevant functions, efficiency studies run the risk of making biased comparisons, particularly against hospitals that provide higher quality services requiring the use of more resources. Undertaking an in-depth investigation regarding the multi-product nature of hospitals, various hospital functions and the values of various stakeholders (patient, staff and community) with a focus on the Iranian public hospitals, this study has proposed a conceptual framework to select the most appropriate variables for measuring hospital efficiency using frontier-based techniques. This paper contributes to hospital efficiency studies by proposing a conceptual framework and incorporating a broader set of variables in Iran. This can enhance the validity of hospital efficiency studies using frontier-based methods in developing countries.

  4. Preparedness actions towards seismic risk mitigation for the general public in Martinique, French Lesser Antilles: a mid-term appraisal

    NASA Astrophysics Data System (ADS)

    Audru, J. C.; Vernier, J. L.; Capdeville, B.; Salindre, J. J.; Mouly, É.

    2013-08-01

    Martinique is a French island in the Lesser Antilles, with a high seismic hazard. In 2006, Martinican stakeholders involved in seismic safety formed the "Réplik" working group ("Aftershock" in French), the first of its kind in this region. This paper addresses a mid-term appraisal of the first seismic awareness campaign organised by Réplik from 2006 to 2011, and how it has modified, or not, local earthquake and tsunami preparedness. Despite efforts from Réplik to assess its efficiency through surveys, a growing gap is noted between the observed awareness and the actual preparedness of the public. As usual, gender, age, educational level, then boredom and saturation contribute to this discrepancy; strong cultural items may also influence the perception of actions. To remain efficient and respond to the public's expectations, Réplik must redirect its actions towards a cultural congruence of information: consideration of religion and local beliefs, comprehensive messages on TV and radio, use of the Creole language, participatory experiences and drills, and a little science. With this, the Réplik stakeholders can hope to increase Martinicans' involvement into the preparedness process, to cope quickly with a strong earthquake and this know-how can be shared with other seismically active islands in the Caribbean.

  5. Comparing Academic Library Spending with Public Libraries, Public K-12 Schools, Higher Education Public Institutions, and Public Hospitals between 1998-2008

    ERIC Educational Resources Information Center

    Regazzi, John J.

    2012-01-01

    This study compares the overall spending trends and patterns of growth of Academic Libraries with Public Libraries, K-12 schools, higher education institutions, and hospitals in the period of 1998 to 2008. Academic Libraries, while showing a growth of 13% over inflation for the period, far underperformed the growth of the other public institutions…

  6. Attitudes and beliefs of the French public about schizophrenia and major depression: results from a vignette-based population survey

    PubMed Central

    2013-01-01

    Background In their study ‘Mental Health in the General Population: Images and Realities’ Jean-Luc Roelandt et al. found a huge divide between the French public’s conceptualizations of insanity and depression. The study aims to examine whether such differences can be replicated using modern operationalized diagnostic criteria for schizophrenia and major depressive disorder. Methods In 2012, an online survey was conducted using a representative sample drawn from the adult French population (N = 1600). After presentation of a case-vignette depicting a person with either schizophrenia or major depressive disorder a fully structured interview was carried out. Results Despite some similarities marked differences between both disorders emerge regarding beliefs and attitudes. While respondents presented with the schizophrenia vignette more frequently defined symptoms as the expression of an illness with a stronger biological component and a less favorable prognosis, demanding psychiatric treatment, respondents presented with the depression vignette considered the occurrence of symptoms more frequently as the consequence of current psychosocial stress, benefitting not only from established but also from alternative treatments. People with schizophrenia were more frequently perceived as unpredictable and dangerous, there was a stronger need to separate one-self from them, they were more frequently met with fear and less frequently reacted to with pro-social feelings, and they also faced more rejection. Conclusions The French public draws a clear line between schizophrenia and major depressive disorder. This applies equally to beliefs about both disorders and to attitudes towards the persons afflicted. There is a need for interventions trying to reduce existing misconceptions in order to improve the care of patients. PMID:24252540

  7. Comparison of childbirth care models in public hospitals, Brazil

    PubMed Central

    Vogt, Sibylle Emilie; da Silva, Kátia Silveira; Dias, Marcos Augusto Bastos

    2014-01-01

    OBJECTIVE To compare collaborative and traditional childbirth care models. METHODS Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. RESULTS Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. CONCLUSIONS The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes. PMID:24897052

  8. Stress level of people with psoriasis at a public hospital*

    PubMed Central

    Leovigildo, Érida Silva; David, Rose Ana Rios; Mendes, Andreia Santos

    2016-01-01

    Background Psoriasis is a chronic dermatosis of unknown etiology with a tendency to relapse after treatment. The disease is frequently linked to psychological stress due to the embarrassment caused by the lesions. Objective To analyze the stress level presented by psoriasis patients followed at the Dermatology Service of a public hospital in Salvador, Bahia state, Brazil. Methods A cross-sectional study of a consecutive convenience sample composed of 60 participants. We used Lipp's Stress Symptoms Inventory for Adults to assess stress levels. The questionnaire identifies and classifies physical and psychological symptoms according to three stages of stress: alarming, resistance, and exhaustion. We also collected socio-demographic and clinical data that could be associated with psoriasis. Results 85% of the participants presented stress. Lipp's questionnaire results revealed that 48% were in the resistance stage and 37% in the exhaustion stage. Women presented higher levels of stress. Of the total 28 women, 64% were in exhaustion stage, 29% in the resistance stage, and only 7% presented no stress symptoms. Of the total 32 men, 44% were in resistance stage, 34% in exhaustion stage, and 22% presented no stress symptoms. Regarding physical and psychological symptoms, psychological symptomatology was prevalent (55%). Conclusions Based on the number of patients in exhaustion stage, we can conclude that stress levels of the participants were high regardless the type of psoriasis and treatment duration. PMID:27579739

  9. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... hospital care authorized under 38 U.S.C. 1703 and 38 CFR 17.52 of this part or under 38 U.S.C. 1728 and 38... shall pay the transferring hospital an amount calculated by the HCFA PRICER for each patient day of care... public or private hospital care. 17.55 Section 17.55 Pensions, Bonuses, and Veterans' Relief...

  10. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... hospital care authorized under 38 U.S.C. 1703 and 38 CFR 17.52 of this part or under 38 U.S.C. 1728 and 38... shall pay the transferring hospital an amount calculated by the HCFA PRICER for each patient day of care... public or private hospital care. 17.55 Section 17.55 Pensions, Bonuses, and Veterans' Relief...

  11. Specialist payment schemes and patient selection in private and public hospitals.

    PubMed

    Wright, Donald J

    2007-09-01

    It has been observed that specialist physicians who work in private hospitals are usually paid by fee-for-service while specialist physicians who work in public hospitals are usually paid by salary. This paper provides an explanation for this observation. Essentially, fee-for-service aligns the interests of income preferring specialists with profit maximizing private hospitals and results in private hospitals treating a high proportion of short stay patients. On the other hand, salary aligns the interests of fairness preferring specialists with benevolent public hospitals that commit to admit all patients irrespective of their expected length of stay. PMID:17379336

  12. Handwashing compliance in a French university hospital: new perspective with the introduction of hand-rubbing with a waterless alcohol-based solution.

    PubMed

    Girou, E; Oppein, F

    2001-08-01

    The baseline compliance with handwashing in a French university hospital was as low as the compliance rates reported in other countries, i.e., less than 50%. By introducing the use of hand-rubbing with an alcoholic solution, as a substitution method for both handwashing with soap and handwashing with an antiseptic agent, we significantly improved hand-cleansing compliance. Despite these encouraging results, mainly due to the accessibility of these non-aqueous products, three major obstacles remain before a wide acceptance by healthcare workers: distrust in terms of efficacy, distrust in terms of skin tolerance and lack of knowledge on hand-cleansing indications.

  13. Handwashing compliance in a French university hospital: new perspective with the introduction of hand-rubbing with a waterless alcohol-based solution.

    PubMed

    Girou, E; Oppein, F

    2001-08-01

    The baseline compliance with handwashing in a French university hospital was as low as the compliance rates reported in other countries, i.e., less than 50%. By introducing the use of hand-rubbing with an alcoholic solution, as a substitution method for both handwashing with soap and handwashing with an antiseptic agent, we significantly improved hand-cleansing compliance. Despite these encouraging results, mainly due to the accessibility of these non-aqueous products, three major obstacles remain before a wide acceptance by healthcare workers: distrust in terms of efficacy, distrust in terms of skin tolerance and lack of knowledge on hand-cleansing indications. PMID:11759028

  14. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... hospital care under 38 U.S.C. 1710 or 38 CFR 17.46. Use of Public or Private Hospitals ... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public...

  15. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... hospital care under 38 U.S.C. 1710 or 38 CFR 17.46. Use of Public or Private Hospitals ... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public...

  16. Hospital Libraries and the Public Library System in France: How Can They Work Together?

    ERIC Educational Resources Information Center

    Guerin, Claudie

    This paper discusses cooperation between hospital and public libraries in France. The first section provides an overview of hospital libraries, including historical and regulatory background, as well as the current situation. The second section considers the network of public libraries, including increasing awareness of the duty to provide all…

  17. The effect of increased private health insurance coverage on Victorian public hospitals.

    PubMed

    Powers, Neil; Sundararajan, Vijaya; Gillett, Steve; Marshall, Ric

    2003-01-01

    It was anticipated that the recent reforms to private health insurance arrangements would reduce the demand pressures on Australian public hospitals. However, this has not been demonstrated by trends in elective surgery waiting lists in Victorian public hospitals. Moreover, it appears that the increased caseload assumed by Victorian private hospitals since the reforms took effect mainly reflects an increase in low cost same day episodes.

  18. CAESAR, French Probative Public Service for In-Orbit Collision Avoidance

    NASA Astrophysics Data System (ADS)

    Laporte, Francois; Moury, Monique

    2013-08-01

    This paper starts by describing the conjunction analysis which has to be performed using CSM data provided by JSpOC. This description not only demonstrates that Collision Avoidance is a 2-step process (close approach detection followed by risk evaluation for collision avoidance decision) but also leads to the conclusion that there is a need for Middle Man role. After describing the Middle Man concept, it introduces the French response CAESAR and the need for collaborative work environment which is implied by Middle Man concept. It includes a description of the environment put in place for CAESAR (secure website and dedicated tools), the content of the service, the condition for the distribution of the CNES software JAC and the advantages for subscribers.

  19. Incidence of and risk factors for hospital-acquired diarrhea in three tertiary care public hospitals in Bangladesh.

    PubMed

    Bhuiyan, Mejbah Uddin; Luby, Stephen P; Zaman, Rashid Uz; Rahman, M Waliur; Sharker, M A Yushuf; Hossain, M Jahangir; Rasul, Choudhury H; Ekram, A R M Saifuddin; Rahman, Mahmudur; Sturm-Ramirez, Katharine; Azziz-Baumgartner, Eduardo; Gurley, Emily S

    2014-07-01

    During April 2007-April 2010, surveillance physicians in adult and pediatric medicine wards of three tertiary public hospitals in Bangladesh identified patients who developed hospital-acquired diarrhea. We calculated incidence of hospital-acquired diarrhea. To identify risk factors, we compared these patients to randomly selected patients from the same wards who were admitted > 72 hours without having diarrhea. The incidence of hospital-acquired diarrhea was 4.8 cases per 1,000 patient-days. Children < 1 year of age were more likely to develop hospital-acquired diarrhea than older children. The risk of developing hospital-acquired diarrhea increased for each additional day of hospitalization beyond 72 hours, whereas exposure to antibiotics within 72 hours of admission decreased the risk. There were three deaths among case-patients; all were infants. Patients, particularly young children, are at risk for hospital-acquired diarrhea and associated deaths in Bangladeshi hospitals. Further research to identify the responsible organisms and transmission routes could inform prevention strategies.

  20. Comparative Study of Three Commonly Used Methods for Hospital Efficiency Analysis in Beijing Tertiary Public Hospitals, China

    PubMed Central

    Xu, Guo-Chao; Zheng, Jian; Zhou, Zi-Jun; Zhou, Chuan-Kun; Zhao, Yang

    2015-01-01

    Background: Tertiary hospitals serve as the medical service center within the region and play an important role in the medical and health service system. They are also the key targets of public hospital reform in the new era in China. Through the reform of health system, the public hospital efficiency has changed remarkably. Therefore, this study aimed to provide some advice for efficiency assessment of public hospitals in China by comparing and analyzing the consistency of results obtained by three commonly used methods for examining hospital efficiency, that is, ratio analysis (RA), stochastic frontier analysis (SFA), and data envelopment analysis (DEA). Methods: The theoretical basis, operational processes, and the application status of RA, SFA, and DEA were learned through literature analysis. Then, the empirical analysis was conducted based on measured data from 51 tertiary public hospitals in Beijing from 2009 to 2011. Results: The average values of hospital efficiency calculated by SFA with index screening and principal component analysis (PCA) results and those calculated by DEA with index screening results were relatively stable. The efficiency of specialized hospitals was higher than that of general hospitals and that of traditional Chinese medicine hospitals. The results obtained by SFA with index screening results and the results obtained by SFA with PCA results showed a relatively high correlation (r-value in 2009, 2010, and 2011 were 0.869, 0.753, and 0.842, respectively, P < 0.01). The correlation between results obtained by DEA with index screening results and PCA results and results obtained by other methods showed statistical significance, but the correlation between results obtained by DEA with index screening results and PCA results was lower than that between results obtained by SFA with index screening results and PCA results. Conclusions: RA is not suitable for multi-index evaluation of hospital efficiency. In the given conditions, SFA is a

  1. Narratives of change and reform processes: global and local transactions in French psychiatric hospital reform after the Second World War.

    PubMed

    Henckes, Nicolas

    2009-02-01

    As with the rest of biomedicine, psychiatry has, since the Second World War, developed under the strong influence of the transnational accumulation of a whole series of practices and knowledge. Anthropology has taught us to pay attention to the transactions between local-level actors and those operating at the global level in the construction of this new world of medicine. This article examines the role played by the recommendations of the WHO Expert Committee of Mental Health in the reform of the French mental health system during the 1950s. Rooted in the experience of practitioners and administrators participating in the process of reforming local psychiatric systems, the recommendations of the WHO Expert Committee developed a new vision of regulating psychiatry, based on professionalism and an idea of a normativity of the doctor-patient relation. This article shows how, by mobilizing the WHO reports' recommendations, French administrators and doctors succeeded in creating a typically French object: "the psychiatric sector", founded on elaborating a new mandate for the psychiatric profession. The article thus questions the deinstitutionalization model as an explanation of transformations of the structure of the French psychiatry system in the post-war period.

  2. Invited commentary: how research on public school closures can inform research on public hospital closures.

    PubMed

    Cohen, Alison K; Ahern, Jennifer

    2014-08-01

    The literature on social capital and civic engagement as they relate to health and health services outcomes is nuanced and sometimes conflicting, and has been a topic of much investigation in the pages of Social Science and Medicine. Ko et al. (2014) add to this research by considering two health services outcomes: the closure and privatization of public hospitals. We draw from education research on the role of community/civic engagement in public school closures to identify areas for future research to better understand these nuances. Qualitative research on school closures suggest that there are both well-managed and poorly managed closure decisions, and there are diverse community groups with interests in the decision who can interact with each other in nuanced ways. Furthermore, across stakeholder groups, there is not always agreement as to if closure would help or harm their students' education. We encourage health and health services researchers to glean insights from education research and other disciplines disparate but related and relevant to public health when developing research questions and considering alternative methodologies.

  3. Is the pro-competition policy an effective solution for China's public hospital reform?

    PubMed

    Pan, Jay; Qin, Xuezheng; Hsieh, Chee-Ruey

    2016-10-01

    The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts - competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition - mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China's hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.

  4. Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil

    PubMed Central

    Desgualdo, Claudia Maria; Riera, Rachel; Zucchi, Paola

    2011-01-01

    OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasíndice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased. PMID:22012050

  5. E-Procurement, from Project to Practice: Empirical Evidence from the French Public Sector

    NASA Astrophysics Data System (ADS)

    Beauvallet, Godefroy; Boughzala, Younès; Assar, Saïd

    Public procurement constitutes a significant portion of national PIB in all countries and electronic platforms for supporting public transactions are an important application of e-government. In France, new regulations since 2005 are pushing public and private actors to adopt electronic means for handling all steps of the purchase process in public organisations. Based on quantitative and qualitative surveys made between 2005 and 2008, this chapter presents the general topic of e-procurement and specifically discusses the problem of e-procurement adoption in public institutions in France. The conclusions of these investigations spanning a three years period, are that public e-procurement is constantly progressing, although difficulties related to insufficient technical skills and the complexity of the juridical context hinder seriously its full adoption. They also show that a digital and an organisational divide is appearing between big administrations which have the adequate resources and skills to fully adopt e-procurement, and small administration (i.e. local authorities) which are still reluctant or unable to conduct a purchase in a digital manner.

  6. Auditing and accountability within the public hospital system: the need for structural reforms.

    PubMed

    Malley, A; Forde, K

    1993-01-01

    A recent report by the Independent Commission Against Corruption (ICAC) in NSW highlighted that some accounting controls for cash handling in public hospitals are inadequate. Given the number of public hospitals in Australia and the amount of cash being handled, it is essential that efficient accounting and auditing systems are established for these activities. This paper examines several major shortcomings in cash-handling methods used by NSW public hospitals and outlines how the system may be improved. The authors are currently developing a national survey to extend this analysis.

  7. Comparison of Services of Public, Private and Foreign Hospitals from the Perspective of Bangladeshi Patients

    PubMed Central

    Siddiqui, Nazlee; Khandaker, Shahjahan Ali

    2007-01-01

    Despite recent developments in the Bangladesh healthcare sector, there is still great concern about the quality of healthcare services in the country. This study compared the quality of healthcare services by different types of institutions, i.e. public and private hospitals, from the perspective of Bangladeshi patients to identify the relevant areas for development. A survey was conducted among Bangladeshi citizens who were in-patients in public or private hospitals in Dhaka city or in hospitals abroad within the last one year. About 400 exit-interviews were conducted using a structured questionnaire that addressed the probable factors of the quality of healthcare services in 5-point interval scales. The results gave an overview of the perspectives of Bangladeshi patients on the quality of service in three types of hospitals. The quality of service in private hospitals scored higher than that in public hospitals for nursing care, tangible hospital matters, i.e. cleanliness, supply of utilities, and availability of drugs. The overall quality of service was better in the foreign hospitals compared to that in the private hospitals in Bangladesh in all factors, even the ‘perceived cost’ factor. This paper provides insights into the specific factors of the quality of hospital services that need to be addressed to meet the needs of Bangladeshi patients. PMID:17985824

  8. Treatment of forensic patients: an expanding role for public psychiatric hospitals.

    PubMed

    Linhorst, D M; Turner, M A

    1999-02-01

    This article explores the increased role of state-operated public psychiatric hospitals in treating forensic patients. Patients with a forensic legal status have a mental illness and are involved with the criminal justice system. Using data from Missouri's forensic system, the article compares the characteristics of voluntary hospital patients with those of the largest hospitalized group of forensic patients--those found not guilty by reason of insanity (NGRI). Overall, NGRI patients tended to be higher functioning, less likely to have committed assaultive acts, and more likely to have substance abuse and personality disorder diagnoses. The article explores the treatment needs of forensic patients who reside in public psychiatric hospitals and discusses the effect of the strong presence of forensic patients in public psychiatric hospitals on social work practice, including clinical work with forensic patients, social work administration, and social work advocacy.

  9. Reserve capacity of public and private hospitals in response to demand uncertainty.

    PubMed

    Rodriguez-Alvarez, Ana; Roibás, David; Wall, Alan

    2012-07-01

    A feature of hospitals is that they face uncertain demand for the services they offer. To cover fluctuations in demand, they need to maintain reserve service capacity in the form of beds, equipment, personnel, etc. to minimize the probability of excess queuing or turning away patients, creating a trade-off between reserve service capacity and economic costs. Using a simple theoretical framework, we show how the reserve capacity established depends on institutional characteristics that can affect the objective of the hospital. In particular, we show that private and public hospitals may provide different levels of reserve capacity. In an empirical application using a panel data set of Spanish hospitals over the period 1996-2006, we model reserve service capacity using a distance frontier approach. Our results show that private hospitals generally react to a lesser extent to demand uncertainty than public hospitals.

  10. America's Tolerance for French Radicalism

    ERIC Educational Resources Information Center

    Wolin, Richard

    2008-01-01

    The publication of Francois Cusset's "French Theory" raises a series of fascinating questions concerning the trans-Atlantic transmission and circulation of ideas. Most important, it impels everyone to inquire why for a time French thought managed to flourish in American universities while French intellectuals rapidly abandoned the entire paradigm.…

  11. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  12. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  13. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  14. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  15. Management practices in Australian healthcare: can NSW public hospitals do better?

    PubMed

    Agarwal, Renu; Green, Roy; Agarwal, Neeru; Randhawa, Krithika

    2016-05-16

    Purpose - The purpose of this paper is to investigate the determinants of best management practices in an Australian state-run healthcare system, namely New South Wales (NSW), and studies the impact of a range of hospital factors in driving best management practices as a means of enhancing healthcare delivery. Design/methodology/approach - This study adapts a unique survey instrument globally tested to quantify the multi-dimensional nature of hospital management practices in 42 acute care public hospitals of NSW. The authors then analysed the role of hospital-specific characteristics in driving best management practices, namely hospital size (measured by the number of hospital beds, employees and doctors), level of skill and education, degree of hospital manager autonomy and organisational hierarchy. Findings - The findings of this study show the areas of strength and potential areas of improvement in NSW hospitals. The authors find a positive association between the adoption of better management practices and hospital size (measured by the number of hospital beds and employees), level of skills and education, degree of hospital manager autonomy and organisational hierarchy. However, hospital size as measured by the number of doctors did not have a statistically significant relationship. Practical implications - This paper is of interest to both hospital administrators, clinical doctors and healthcare policy-makers who want to improve and develop strategies for better management in the healthcare sector. Originality/value - This study provides an internationally comparable robust measure of management capability in public hospitals, and contributes to the evidence-base of management practices and performance in hospitals. PMID:27119390

  16. Management practices in Australian healthcare: can NSW public hospitals do better?

    PubMed

    Agarwal, Renu; Green, Roy; Agarwal, Neeru; Randhawa, Krithika

    2016-05-16

    Purpose - The purpose of this paper is to investigate the determinants of best management practices in an Australian state-run healthcare system, namely New South Wales (NSW), and studies the impact of a range of hospital factors in driving best management practices as a means of enhancing healthcare delivery. Design/methodology/approach - This study adapts a unique survey instrument globally tested to quantify the multi-dimensional nature of hospital management practices in 42 acute care public hospitals of NSW. The authors then analysed the role of hospital-specific characteristics in driving best management practices, namely hospital size (measured by the number of hospital beds, employees and doctors), level of skill and education, degree of hospital manager autonomy and organisational hierarchy. Findings - The findings of this study show the areas of strength and potential areas of improvement in NSW hospitals. The authors find a positive association between the adoption of better management practices and hospital size (measured by the number of hospital beds and employees), level of skills and education, degree of hospital manager autonomy and organisational hierarchy. However, hospital size as measured by the number of doctors did not have a statistically significant relationship. Practical implications - This paper is of interest to both hospital administrators, clinical doctors and healthcare policy-makers who want to improve and develop strategies for better management in the healthcare sector. Originality/value - This study provides an internationally comparable robust measure of management capability in public hospitals, and contributes to the evidence-base of management practices and performance in hospitals.

  17. Performance evaluation of hospitals that provide care in the public health system, Brazil.

    PubMed

    Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

    2015-01-01

    OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals. PMID:26247385

  18. Performance evaluation of hospitals that provide care in the public health system, Brazil

    PubMed Central

    Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

    2015-01-01

    OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimento s de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals. PMID:26247385

  19. Performance evaluation of hospitals that provide care in the public health system, Brazil.

    PubMed

    Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

    2015-01-01

    OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

  20. Funding Victoria's public hospitals: the casemix policy of 2000-2001.

    PubMed

    McNair, Peter; Duckett, Stephen

    2002-01-01

    On 1 July 1993 Victoria became the first Australian state to use casemix information to set budgets for its public hospitals commencing with casemix funding for inpatient services. Victoria's casemix funding approach now embraces inpatient, outpatient and rehabilitation services.

  1. The future of public hospitals in a globalized world: corporate governance, corporatization or privatization?

    PubMed

    Mordelet, Patrick

    2008-01-01

    This paper contributes to research in health systems and hospitals governance by examining the reasons and expected outcomes of the generalization of corporate governance rules in both public and private non-profit hospitals, all over the world, in order to achieve its clinical, quality and financial objectives. PMID:18549030

  2. The future of public hospitals in a globalized world: corporate governance, corporatization or privatization?

    PubMed

    Mordelet, Patrick

    2008-01-01

    This paper contributes to research in health systems and hospitals governance by examining the reasons and expected outcomes of the generalization of corporate governance rules in both public and private non-profit hospitals, all over the world, in order to achieve its clinical, quality and financial objectives.

  3. Behavioural Indicators of Perceived Managerial and Leadership Effectiveness within Romanian and British Public Sector Hospitals

    ERIC Educational Resources Information Center

    Hamlin, Robert G.; Patel, Taran

    2012-01-01

    Purpose: This paper aims to report the results of a replication study of perceived managerial and leadership effectiveness within a Romanian public sector hospital, and to discuss the extent to which they are similar to and different from findings from equivalent studies carried out in two British NHS Trust hospitals. Design/methodology/approach:…

  4. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    PubMed Central

    Zhang, Xing; Oyama, Tatsuo

    2016-01-01

    Japan’s health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. PMID:27051323

  5. Investigating the health care delivery system in Japan and reviewing the local public hospital reform.

    PubMed

    Zhang, Xing; Oyama, Tatsuo

    2016-01-01

    Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. PMID:27051323

  6. [Review of the utilization of a Portuguese public hospital].

    PubMed

    Almeida, Anabela; Serrasqueiro, Zélia; Rogerio, Ana

    2006-01-01

    This paper reports on some important findings of a study conducted in Covilhã/Portugal on appropriateness of hospital admission and in-hospital days in a Portuguese hospital using an adapted version of the Appropriateness Evaluation Protocol--a review tool for hospital utilization. This analysis showed a significant rate of inappropriateness in admission (24.6%) and days of stay (37.4%) and it also suggested a low rate of use of the override options. It was possible to identify the conservative attitude as the most common cause of inappropriate admissions and days of stay. This study demonstrates that a high proportion of admissions and days of stay are related to patients who could have been attended at other levels of the health care system such as outpatient consultations. The analysis made it possible to identify and to explore some variables correlated to the levels of inappropriateness and to the causes of inappropriateness or levels of health care required by the patients.

  7. What Could We Learn from the Influence of Age on Perceptions of a CIS by the Clinical Staff of a French Hospital?

    PubMed

    Ologeanu-Taddei, Roxana; Vitari, Claudio; Morquin, David

    2016-01-01

    Previous research highlighted generation and age effects on the perceptions and uses of technology. The goal of this study was to examine the relationship between age and perceptions of a Clinical Information System (CIS) for the clinical staff (especially physicians, nurses, medical secretaries). A survey was conducted in September 2015 in a French Teaching Hospital, based on a questionnaire consisting of items on the Likert scale. As results, the impact of age has a strong impact on Perceived Ease of Use, anxiety and Self-Efficacy. The result related to Perceived Ease of Use is unexpected. Younger staff reported to be less comfortable with technology than older staff. This result is not consistent with literature. We propose an explanation consisting in the importance of clinical process and organization knowledge and skills while general technology skills of young generations may be less significant. PMID:27577331

  8. Factors affecting the informal payments in public and teaching hospitals

    PubMed Central

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

    2016-01-01

    Background: Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences. Methods: In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly; then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests. Results: The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals’ housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status. Conclusion: Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals’ staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments. PMID:27390685

  9. Impact on public hospitals if private health insurance rates in Victoria declined.

    PubMed

    Hanning, Brian W T

    2004-12-13

    The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased. PMID:15595916

  10. Private medical services in the Italian public hospitals: the case for improving HRM.

    PubMed

    De Pietro, Carlo

    2006-08-22

    This study explores how Italian public hospitals can use private medical activities run by their employed physicians as a human resources management (HRM) tool. It is based on field research in two acute-care hospitals and a review of Italian literature and laws. The Italian National Health Service (NHS) allows employed physicians to run private, patient-funded activities ("private beds", surgical operations, hospital outpatient clinics, etc.). Basic regulation is set at the national level, but it can be greatly improved at the hospital level. Private activities, if poorly managed, can damage efficiency, equity, quality of care, and public trust in the NHS. On the other hand, hospitals can also use them as leverage to improve HRM, with special attention to three issues: (1) professional evaluation, development, and training; (2) compensation policies; (3) competition for, and retention of, professionals in short supply. The two case studies presented here show great differences between the two hospitals in terms of regulation and organizational solutions that have been adopted to deal with such activities. However, in both hospitals, private activities do not seem to benefit HRM. Private activities are not systematically considered in compensation policies. Moreover, private revenues are strongly concentrated in a few physicians. Hospitals use very little of the information provided by the private activities to improve knowledge management, career development, or training planning. Finally, hospitals do not use private activities management as a tool for competing in the labor market for health professionals who are in short supply. PMID:16253384

  11. Quality of Public Hospitals Websites: A Cross-Sectional Analytical Study in Iran

    PubMed Central

    Salarvand, Shahin; Samadbeik, Mahnaz; Tarrahi, Mohammad Javad; Salarvand, Hamed

    2016-01-01

    Introduction: Nowadays, hospitals have turned increasingly towards the Internet and develop their own web presence. Hospital Websites could be operating as effective web resources of information and interactive communication mediums to enhance hospital services to the public. Aim: Therefore, the aim of this study was to assess the quality of websites in Tehran’s public hospitals. Material and methods: This cross-sectional analysis involved all public hospitals in Iran’s capital city, Tehran, with a working website or subsites between April and June, 2014 (N=59). The websites were evaluated using three validated instruments: a localized checklist, Google page rank, and the Alexa traffic ranking. The mentioned checklist consisted of 112 items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. Data were analyzed using descriptive and analytical statistics. Results: The mean website evaluation score was 45.7 out of 224 for selected public hospitals. All the studied websites were in the weak category based on the earned quality scores. There was no statistically significant association between the website evaluation score with Google page rank (P=0.092), Alexa global traffic rank and Alexa traffic rank in Iran (P>0.05). The hospital websites had a lower quality score in the interactive online services and external activities criteria in comparing to other criteria. Due to the low quality level of the studied websites and the importance of hospital portals in providing information and services on the Internet, the authorities should do precise planning for the appreciable improvement in the quality of hospital websites. PMID:27147806

  12. The Community Health Information Network: A Model for Hospital and Public Library Cooperation

    ERIC Educational Resources Information Center

    Gartenfeld, Ellen

    1978-01-01

    The Community Health Information Network, a cooperative library network established between a community hospital and six public libraries, is described. This model program provides health education and information services to patient/consumers and library services to health personnel through their public libraries. Funding, factors leading to the…

  13. [Hospitals and the Public-Private Combination in the Portuguese Health System].

    PubMed

    Fernandes, Adalberto Campos; Nunes, Alexandre Morais

    2016-03-01

    The Portuguese health system has been characterized by the existence of a constant relationship between public and private sector, both in providing and financing health care. In recent decades, the private sector increased their responsiveness of care, extending the engagement in the relationship with the public sector. This relationship stems from the legal framework set out in the law, developing agreements, conventions and more recently through the model of public-private partnerships. In hospital network, this new dynamic relationship contributed, in the last two decades, to accentuate the mixed characteristics of the system, through a clear strengthening of the private component in the hospital network, particularly by investing in differentiated units.

  14. [ACADEMY AND PUBLIC HOSPITALS - MUTUALLY BENEFICIAL AND SYNERGISTIC RELATIONSHIP].

    PubMed

    Zarka, Salman

    2016-04-01

    Modern medicine deals with the combined quality of the profession and the medical service. The first rule of medicine is Primum non nocere" (first, do no harm). However, the essence of this unique profession cannot be confined by this basic message phrased by negation, but should be based on the principle of doing one's best to save the patient's life and to cure him. In this academic and dynamic profession, the physician keeps asking himself frequently whether the provided treatment is the best one possible. The internal need to answer this question and the concomitant curiosity, create the necessary critical integration between the physician and the researcher. Medical research is essential for the promotion of the profession, and it is a vital tool that leads to excellence in healthcare services. Throughout recent years the hospitals in Israel's Northern District, from Nazareth and Nahariya to Ziv, are in a continuous process of development and advancement with the aim to provide modern and available medical services of the highest quality to the residents of the area, tourists, IDF soldiers and even for those who arrive from across the border. This growth and development is reflected in the provision of new services, alongside the improvement of existing resources, and is based on collaboration between experienced and new staff transferred from various regions in Israel. The Medical Faculty of Bar Ilan University in Safed plays a significant and dominant part in this change. The affiliation of the hospitals to the faculty, the establishment of new research laboratories in hospitals, additional educational services for students, such as the pathology laboratory in Ziv, and, of course, the medical students studying in different departments - all of these constitute a thriving engine for the academy, combining teaching with promotion of research. Researchers and physicians from the hospitals are integrated in the medical school, in teaching, research and mentoring

  15. [ACADEMY AND PUBLIC HOSPITALS - MUTUALLY BENEFICIAL AND SYNERGISTIC RELATIONSHIP].

    PubMed

    Zarka, Salman

    2016-04-01

    Modern medicine deals with the combined quality of the profession and the medical service. The first rule of medicine is Primum non nocere" (first, do no harm). However, the essence of this unique profession cannot be confined by this basic message phrased by negation, but should be based on the principle of doing one's best to save the patient's life and to cure him. In this academic and dynamic profession, the physician keeps asking himself frequently whether the provided treatment is the best one possible. The internal need to answer this question and the concomitant curiosity, create the necessary critical integration between the physician and the researcher. Medical research is essential for the promotion of the profession, and it is a vital tool that leads to excellence in healthcare services. Throughout recent years the hospitals in Israel's Northern District, from Nazareth and Nahariya to Ziv, are in a continuous process of development and advancement with the aim to provide modern and available medical services of the highest quality to the residents of the area, tourists, IDF soldiers and even for those who arrive from across the border. This growth and development is reflected in the provision of new services, alongside the improvement of existing resources, and is based on collaboration between experienced and new staff transferred from various regions in Israel. The Medical Faculty of Bar Ilan University in Safed plays a significant and dominant part in this change. The affiliation of the hospitals to the faculty, the establishment of new research laboratories in hospitals, additional educational services for students, such as the pathology laboratory in Ziv, and, of course, the medical students studying in different departments - all of these constitute a thriving engine for the academy, combining teaching with promotion of research. Researchers and physicians from the hospitals are integrated in the medical school, in teaching, research and mentoring

  16. [The national union for private hospital oncology].

    PubMed

    Parmentier, Gérard

    2013-06-01

    In the French health system, social security is the same for both public and private hospitals regardless of their status. In terms of number of patients screened, diagnosed, or treated, independant medicine is the most important sector in the French oncology. The multitude of organizations representing private hospitals or independant oncologists, physicians, radiologists or pathologists have a common organization, the National Union for Private Hospital Oncology (UNHPC). It bases its action on two founding postulates to ensure the quality of the oncology practice : the medical and managerial cultures are complementary and should be articulated ; the quality of organizations is as important as professional competence.

  17. Outbreak of extended-spectrum beta-lactamase VEB-1-producing isolates of Acinetobacter baumannii in a French hospital.

    PubMed

    Poirel, Laurent; Menuteau, Olivier; Agoli, Nathalie; Cattoen, Christian; Nordmann, Patrice

    2003-08-01

    Twelve clonally related and multidrug-resistant Acinetobacter baumannii isolates were recovered during a 4-month period from 12 patients hospitalized at the Valenciennes Hospital in France. Antibiograms determined by the double-disk diffusion technique on cloxacillin-containing plates detected a clavulanic acid-inhibited extended-spectrum beta-lactamase (ESBL). PCR and sequencing identified the gene encoding the Ambler class A ESBL VEB-1. This gene was located on the chromosome and was part of a class 1 integron identical to that previously identified in Pseudomonas aeruginosa isolates from Thailand. Additionally, seven clonally related bla(VEB-1)-positive A. baumannii strains were identified in the immediate environment of the hospitalized patients. This is the first report of the ESBL VEB-1 in Acinetobacter spp. and the first description of VEB-1-producing strains as a source of an outbreak occurring outside Southeast Asia. This report underlines the difficulty of the identification of ESBLs in A. baumannii.

  18. [The chief surgeon Claude Louis Sommé (1772-1855) French military physician, surgeon of Antwerp hospital].

    PubMed

    Tricot, Jean-pierre

    2015-01-01

    Claude Louis Sommé was born in Paris in 1772. After surgical studies between 1790 and 1792, he successfully embraced a military career in the armies of Napoleon at different fronts and in several hospitals. In 1806 he submitted his doctoral thesis at the Special Medical School of Strasburg, Dissertation upon Pain. The same year he presented his dismissal from he imperial armies and became chief-surgeon at the St Elisabeth hospital of Antwerp where he stayed on duty until his death in 1855. Sommé wrote a lot of medical books: surgical, anatomical and physiological. After the battle of Waterloo one third of the injured soldiers were transferred to Antwerp and were attended in his department. He also played an important role as a professor at the Primary Medical School of Antwerp. Sommé also created the botanical garden of Antwerp, close to the hospital. PMID:27029134

  19. Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil.

    PubMed

    Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

    2015-01-01

    OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil.METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness.RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients.CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

  20. Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

    PubMed Central

    Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

    2015-01-01

    OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil. METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness. RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients. CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil. PMID:26465661

  1. Is the Colombian health system reform improving the performance of public hospitals in Bogotá?

    PubMed

    McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena

    2003-06-01

    Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data

  2. Diversity of Acinetobacter baumannii in Four French Military Hospitals, as Assessed by Multiple Locus Variable Number of Tandem Repeats Analysis

    PubMed Central

    Hauck, Yolande; Soler, Charles; Jault, Patrick; Mérens, Audrey; Gérome, Patrick; Nab, Christine Mac; Trueba, François; Bargues, Laurent; Thien, Hoang Vu; Vergnaud, Gilles; Pourcel, Christine

    2012-01-01

    Background Infections by A. calcoaceticus-A. baumannii (ACB) complex isolates represent a serious threat for wounded and burn patients. Three international multidrug-resistant (MDR) clones (EU clone I-III) are responsible for a large proportion of nosocomial infections with A. baumannii but other emerging strains with high epidemic potential also occur. Methodology/Principal Findings We automatized a Multiple locus variable number of tandem repeats (VNTR) analysis (MLVA) protocol and used it to investigate the genetic diversity of 136 ACB isolates from four military hospitals and one childrens hospital. Acinetobacter sp other than baumannii isolates represented 22.6% (31/137) with a majority being A. pittii. The genotyping protocol designed for A.baumannii was also efficient to cluster A. pittii isolates. Fifty-five percent of A. baumannii isolates belonged to the two international clones I and II, and we identified new clones which members were found in the different hospitals. Analysis of two CRISPR-cas systems helped define two clonal complexes and provided phylogenetic information to help trace back their emergence. Conclusions/Significance The increasing occurrence of A. baumannii infections in the hospital calls for measures to rapidly characterize the isolates and identify emerging clones. The automatized MLVA protocol can be the instrument for such surveys. In addition, the investigation of CRISPR/cas systems may give important keys to understand the evolution of some highly successful clonal complexes. PMID:22984530

  3. Public hospital care: equal for all or equal for some? Evidence from the Philippines.

    PubMed

    James, Chris D; Peabody, John; Hanson, Kara; Solon, Orville

    2015-03-01

    In low- and middle-income countries, government budgets are rarely sufficient to cover a public hospital's operating costs. Shortfalls are typically financed through a combination of health insurance contributions and user charges. The mixed nature of this financing arrangement potentially creates financial incentives to treat patients with equal health need unequally. Using data from the Philippines, the authors analyzed whether doctors respond to such incentives. After controlling for a patient's condition, they found that patients using insurance, paying more for hospital accommodation, and being treated in externally monitored hospitals were likely to receive more care. This highlights the worrying possibility that public hospital patients with equal health needs are not always equally treated.

  4. Crisis & Commitment: 150 Years of Service by Los Angeles County Public Hospitals

    PubMed Central

    Cousineau, Michael R.; Tranquada, Robert E.

    2007-01-01

    The Los Angeles County University of Southern California Medical Center will open soon, replacing the county’s current 74-year-old facility with a modern, although smaller, facility. Los Angeles County has provided hospital care to the indigent since 1858, during which time, the operation of public hospitals has shifted from a state-mandated welfare responsibility to a preeminent part of the county’s public health mission. As this shift occurred, the financing of Los Angeles County hospitals changed from primarily county support to state and federal government sources, particularly Medicaid. The success of the new hospital will depend on whether government leaders at all levels provide the reforms needed to help the county and its partners stabilize its funding base. PMID:17329642

  5. Residential segregation and the survival of U.S. urban public hospitals.

    PubMed

    Ko, Michelle; Needleman, Jack; Derose, Kathryn Pitkin; Laugesen, Miriam J; Ponce, Ninez A

    2014-06-01

    Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found that a high level of residential segregation moderated the protective effects of Black population composition, such that a high level of residential segregation, in combination with a high percentage of poor residents, conferred a higher likelihood of hospital closure. More segregated and poorer communities face disadvantages in access to care that may be compounded as a result of instability in the health care safety net. Policy makers should consider the influence of social factors such as residential segregation on the allocation of the safety net resources.

  6. Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals

    PubMed Central

    Cortada, Aline Pinheiro dos Santos; da Silva, Telma Gomes; da Silva, André Campos; Golmia, Ricardo Prado; Guerra, Renata Leborato; Takemoto, Maíra Libertad Soligo; Monteiro, Roberta Dyonisio Canaveira; Scheinberg, Morton Aaron

    2015-01-01

    Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system. Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization). Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively. Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio. PMID:26313439

  7. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health... the Public Health Service (or any other agency of the U.S. Government) which do not have...

  8. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health... the Public Health Service (or any other agency of the U.S. Government) which do not have...

  9. Factors affecting decision-making of patients choosing acupuncture in a public hospital

    PubMed Central

    Koh, Thean Howe Bryan; Kong, Keng He; Low, Yin Peng

    2015-01-01

    Background With increasing evidence to support its practice, acupuncture has been integrated within many hospitals around the world. The purpose of this study is to understand the factors affecting decision making of patients as they select acupuncture treatment for their medical conditions and symptoms within a public hospital. Methods A qualitative study consisting of in depth interviews with 14 patients was conducted. All patients attended an acupuncture clinic within a public hospital. Data collected was analysed via thematic analysis. Results Four main factor groups affecting decision making of patients were identified- factors affecting the level and value of patient-centric care, the confidence and trust patients place within the acupuncture service, the presence of collaborative efforts between acupuncturists and Western medicine practitioners, and the knowledge, culture and belief society has regarding the role of acupuncture and Western medicine. All participants interviewed had more than one factor group present as enablers toward their eventual selection of acupuncture for ailment management. It was also noted that although the majority of participants had sufficient knowledge regarding acupuncture, there were a select few who had misperceptions or no knowledge regarding certain aspects of acupuncture. Conclusions There may be certain patterns in the way patients choose to utilise acupuncture services in public hospitals. Further studies should also be carried out in other public hospitals to analyse the factor groups identified further. PMID:26697443

  10. Redistribution of Emergency Department Patients After Disaster-Related Closures of a Public Versus Private Hospital in New York City.

    PubMed

    Lee, David C; Smith, Silas W; Carr, Brendan G; Goldfrank, Lewis R; Polsky, Daniel

    2015-06-01

    Sudden hospital closures displace patients from usual sources of care and force them to access facilities that lack their prior medical records. For patients with complex needs and for nearby hospitals already strained by high volume, disaster-related hospital closures induce a public health emergency. Our objective was to analyze responses of patients from public versus private emergency departments after closure of their usual hospital after Hurricane Sandy. Using a statewide database of emergency visits, we followed patients with an established pattern of accessing 1 of 2 hospitals that closed after Hurricane Sandy: Bellevue Hospital Center and NYU Langone Medical Center. We determined how these patients redistributed for emergency care after the storm. We found that proximity strongly predicted patient redistribution to nearby open hospitals. However, for patients from the closed public hospital, this redistribution was also influenced by hospital ownership, because patients redistributed to other public hospitals at rates higher than expected by proximity alone. This differential response to hospital closures demonstrates significant differences in how public and private patients respond to changes in health care access during disasters. Public health response must consider these differences to meet the needs of all patients affected by disasters and other public health emergencies.

  11. [Hospital governance: between crisis management and implementation of public health policy].

    PubMed

    Bréchat, Pierre-Henri; Antoine, Leenhardt; Mathieu-Grenouilleau, Marie-Christine; Rymer, Roland; Matisse, François; Baraille, Denis; Beaufils, Philippe

    2010-01-01

    The implementation of the recent act to amend the law on hospitals, patient health and territories (HPST Law) completes the reform of the organization and governance of health facilities, which was announced in 2002 by the "Hospital 2007" plan. What kind of assessments and perspectives can be considered and envisaged for these Hospital Activity Poles? We compared our experience with a review of the professional and scientific literature in order to stimulate answers to these questions for advocacy purposes prior to the Act's implementation. The hospital's cluster of activities should reinforce--not call into question the core activities and the financial stability of the facility, while respecting the contract on agreed objectives and the necessary means and resources to meet the health needs of the catchment population as well as national priorities. Although significant, but limited, successes exist, five obstacles to hospital reorganization can be identified. These include, for example: lack of delegation of management and centralization of decisions, the heterogeneity of numerous Hospital Activity Poles or problems related to timing. These obstacles may cause strain, or put the Hospital Activity Poles and the health facilities in a difficult situation with respect to their dynamics. This may show that the State and social health insurance should steer and direct public health policy and that the delegation of management roles and responsibilities to the Hospital Activity Poles should be addressed.

  12. Prospective Survey of β-Lactamases Produced by Ceftazidime- Resistant Pseudomonas aeruginosa Isolated in a French Hospital in 2000

    PubMed Central

    De Champs, Christophe; Poirel, Laurent; Bonnet, Richard; Sirot, Danielle; Chanal, Catherine; Sirot, Jacques; Nordmann, Patrice

    2002-01-01

    In 2000, at the Université d'Auvergne teaching hospital in Clermont-Ferrand, France, 44 (6.2%) strains of Pseudomonas aeruginosa were found to be resistant to ceftazidime. After genotyping, 34 strains were selected. Nine had an additional β-lactamase: OXA-21 (n = 6), PSE-1 (CARB-2) (n = 2), or PER-1 (n = 1). Ceftazidime resistance was related solely to the overproduction of the cephalosporinase in 30 strains. Sequencing of five blaAmpC genes encoding cephalosporinases with different pIs showed 99% identity with the ampC gene of P. aeruginosa PAO1. PMID:12183264

  13. Limited access to HIV prevention in French prisons (ANRS PRI2DE): implications for public health and drug policy

    PubMed Central

    2011-01-01

    Background Overpopulation, poor hygiene and disease prevention conditions in prisons are major structural determinants of increased infectious risk within prison settings but evidence-based national and WHO guidelines provide clear indications on how to reduce this risk. We sought to estimate the level of infectious risk by measuring how French prisons adhere to national and WHO guidelines. Methods A nationwide survey targeting the heads of medical (all French prisons) and psychiatric (26 French prisons) units was conducted using a postal questionnaire and a phone interview mainly focusing on access to prevention interventions, i.e. bleach, opioid substitution treatment (OST), HBV vaccination and post-exposure prophylaxis (PEP) for French prisoners. Two scores were built reflecting adherence to national and WHO international guidelines, ranging from 0 (no adherence) to 10 (maximum adherence) and 0 to 9 respectively. Results A majority (N = 113 (66%)) of the 171 prisons answered the questionnaires, representing 74% coverage (46,786 prisoners) of the French prison population: 108 were medical units and 12 were psychiatric units. Inmate access to prevention was poor. The median[IQR] score measuring adherence to national guidelines was quite low (4.5[2.5; 5.5]) but adherence to WHO guidelines was even lower 2.5[1.5; 3.5]; PEP was absent despite reported risky practices. Unsuitable OST delivery practices were frequently observed. Conclusions A wide gap exists between HIV prevention policies and their application in prisons. Similar assessments in other countries may be needed to guide a global policy reform in prison settings. Adequate funding together with innovative interventions able to remove structural and ideological barriers to HIV prevention are now needed to motivate those in charge of prison health, to improve their working environment and to relieve French prisoners from their currently debilitating conditions. PMID:21619573

  14. Does language matter? A case study of epidemiological and public health journals, databases and professional education in French, German and Italian

    PubMed Central

    Baussano, Iacopo; Brzoska, Patrick; Fedeli, Ugo; Larouche, Claudia; Razum, Oliver; Fung, Isaac C-H

    2008-01-01

    Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native tongue and having a restricted circulation among a local readership. This paper discusses the historical development of epidemiology and the current scene of epidemiological and public health journals, databases and professional education in three Western European languages: French, German and Italian, and examines the dynamics and struggles they have today. PMID:18826570

  15. Does language matter? A case study of epidemiological and public health journals, databases and professional education in French, German and Italian.

    PubMed

    Baussano, Iacopo; Brzoska, Patrick; Fedeli, Ugo; Larouche, Claudia; Razum, Oliver; Fung, Isaac C-H

    2008-01-01

    Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native tongue and having a restricted circulation among a local readership. This paper discusses the historical development of epidemiology and the current scene of epidemiological and public health journals, databases and professional education in three Western European languages: French, German and Italian, and examines the dynamics and struggles they have today. PMID:18826570

  16. Does language matter? A case study of epidemiological and public health journals, databases and professional education in French, German and Italian.

    PubMed

    Baussano, Iacopo; Brzoska, Patrick; Fedeli, Ugo; Larouche, Claudia; Razum, Oliver; Fung, Isaac C-H

    2008-01-01

    Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native tongue and having a restricted circulation among a local readership. This paper discusses the historical development of epidemiology and the current scene of epidemiological and public health journals, databases and professional education in three Western European languages: French, German and Italian, and examines the dynamics and struggles they have today.

  17. Can cost sharing measures improve the function of outpatient departments of public hospitals: the opinions of administrative directors.

    PubMed

    Tsirona, Christina; Siskou, Olga; Galanis, Peter; Kaitelidou, Daphne; Tsavalias, Konstantinos; Ragkousi, Argyro; Semertziadi, Maria; Anagnostopoulou, Ioanna; Vafiadis, John; Liaropoulos, Lycourgos

    2013-01-01

    This paper describes a study aiming to investigate the opinions of administrative personnel concerning the effectiveness of a cost sharing mechanism (of euro 5/visit) at public hospitals' outpatient departments. Data was derived through a structured questionnaire (developed by the researchers) which appealed to 112 administrative directors of public hospitals. Results highlighted a positive attitude concerning the function of the cost - sharing mechanism at public hospitals, a rather fair measure for the users (vulnerable groups are excluded) which probably is enhancing the monetary flow in public hospitals.

  18. [Hospital pharmacist has a rule for best practice use and French hospital activity tariffs. Example of a pharmaceutical quality control for drugs reimbursed in addition of DRGs].

    PubMed

    Hedoux, S; Dode, X; Pivot, C; Couray-Targe, S; Aulagner, G

    2012-07-01

    The best practice contract has given a new objective to the hospital pharmacists for the reimbursement in addition to Diagnosis Related Groups' (DRGs) tariffs. We built our pharmaceutical quality control for the administration traceability follow-up regarding the DRGs and the cost of care, for two reasons: the nominal drugs dispensation in link with the prescription made by pharmacist and the important expenditure of these drugs. Our organization depends on the development level of the informatized drugs circuit and minimizes the risk of financial shortfalls or wrong benefits, possible causes of economic penalties for our hospital. On the basis of this follow-up, we highlighted our activity and identified problems of management and drugs circuit organization. The quality of the administration traceability impacts directly on the quality of the medical records and the reimbursements of the expensive drugs. A better knowledge of prescription software is also required for a better quality and security of the medical data used in the medical informatic systems. The drugs management and the personal treatment in and between the care units need to be improved too. We have to continue and improve our organization with the future financial model for ATU drugs and the FIDES project. The health personnel awareness and the development of best informatic tools are also required. PMID:22818260

  19. Policy and Practice Model of Public-Private Partnership in Public Hospitals during the New Medical Reform Period.

    PubMed

    Zhang, Ju-Yang; Long, Ru-Yin; Yan, Hai; Yang, Qing; Yang, Bo

    2016-01-01

    Purpose: Since the beginning of the new health care reform in 2009, the state has illustrated the top design and health care improvement strategy of "encouraging social capital to participate in the reform of public hospitals", in accordance with the program's general objective. All areas have been explored on this matter and the results obtained are very interesting, not to mention the acquisition of significant experience. At present, the existing business models in China are mainly the following: Rebuild-Operate-Transfer (ROT), franchise business model, Build-Own-Operate-Transfer (BOOT) model, mixed ownership model and business insurance model. This paper introduces a variety of alternative models, and provides a simple analysis of the advantages and disadvantages. Moreover, for the reform of public hospitals, the government shares should go into franchise mode or mixed ownership, and all property rights should be transferred to the government to ensure the conservation and proliferation of state-owned assets. PMID:27273961

  20. Policy and Practice Model of Public-Private Partnership in Public Hospitals during the New Medical Reform Period.

    PubMed

    Zhang, Ju-Yang; Long, Ru-Yin; Yan, Hai; Yang, Qing; Yang, Bo

    2016-01-01

    Purpose: Since the beginning of the new health care reform in 2009, the state has illustrated the top design and health care improvement strategy of "encouraging social capital to participate in the reform of public hospitals", in accordance with the program's general objective. All areas have been explored on this matter and the results obtained are very interesting, not to mention the acquisition of significant experience. At present, the existing business models in China are mainly the following: Rebuild-Operate-Transfer (ROT), franchise business model, Build-Own-Operate-Transfer (BOOT) model, mixed ownership model and business insurance model. This paper introduces a variety of alternative models, and provides a simple analysis of the advantages and disadvantages. Moreover, for the reform of public hospitals, the government shares should go into franchise mode or mixed ownership, and all property rights should be transferred to the government to ensure the conservation and proliferation of state-owned assets.

  1. Financing and planning of public and private not-for-profit hospitals in the European Union.

    PubMed

    Thompson, Ceri R; McKee, Martin

    2004-03-01

    While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.

  2. Financing and planning of public and private not-for-profit hospitals in the European Union.

    PubMed

    Thompson, Ceri R; McKee, Martin

    2004-03-01

    While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing. PMID:15036816

  3. Tobacco industry manipulation of the hospitality industry to maintain smoking in public places

    PubMed Central

    Dearlove, J; Bialous, S; Glantz, S

    2002-01-01

    Objective: To describe how the tobacco industry used the "accommodation" message to mount an aggressive and effective worldwide campaign to recruit hospitality associations, such as restaurant associations, to serve as the tobacco industry's surrogate in fighting against smoke-free environments. Methods: We analysed tobacco industry documents publicly available on the internet as a result of litigation in the USA. Documents were accessed between January and November 2001. Results: The tobacco industry, led by Philip Morris, made financial contributions to existing hospitality associations or, when it did not find an association willing to work for tobacco interests, created its own "association" in order to prevent the growth of smoke-free environments. The industry also used hospitality associations as a vehicle for programmes promoting "accommodation" of smokers and non-smokers, which ignore the health risks of second hand smoke for employees and patrons of hospitality venues. Conclusion: Through the myth of lost profits, the tobacco industry has fooled the hospitality industry into embracing expensive ventilation equipment, while in reality 100% smoke-free laws have been shown to have no effect on business revenues, or even to improve them. The tobacco industry has effectively turned the hospitality industry into its de facto lobbying arm on clean indoor air. Public health advocates need to understand that, with rare exceptions, when they talk to organised restaurant associations they are effectively talking to the tobacco industry and must act accordingly. PMID:12034999

  4. Fewer Hospitalizations for Chronic Obstructive Pulmonary Disease in Communities With Smoke-Free Public Policies

    PubMed Central

    Rayens, Mary Kay; Adkins, Sarah; Simpson, Nick; Frazier, Susan; Mannino, David M.

    2014-01-01

    Objectives. We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD). Methods. We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region. Results. Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban–rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate–weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws. Conclusions. Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs. PMID:24825207

  5. The Milwaukee story: a public hospital's resistance to the Supreme Court abortion rulings.

    PubMed

    Ambrose, L

    1975-08-01

    A pregnancy was terminated at Milwaukee County General Hospital on March 12, 1975, 2 years after the Supreme Court decision on abortion and almost 8 months after a federal judge directly ordered the hospital to provide abortion services. In order for that abortion to be performed, there had to be Supreme Court action, extensive litigation in lower corts, related actions in state courts, supplementary court orders, and threatened fines and citations for contempt of court for principal hospital and county officials. Yet, the basic issues of this controversy continue. The test of a public hospital's responsibility to provide abortion services offers a case study of the way in which leadership decisions, community pressures, personal beliefs, and professional predispositions can intefere with implementation of the Supreme Court's standards on abortion rights. The hospital's rule 26(b) allows abortion only when pregnancy continuation is life-threatening to the mother. Following the Supreme Court decision, the medical staff of Milwaukee County General supported changing this aborion policy, but the director of the obstetrics and gynecology department strongly opposed any policy change. Among the tactics used to maintian the policy was the claim that there was no doctor at the hospital willing to perform an abortion along with the prohibition of payment of county funds for abortions at either the public hospital or at private hospitals by the County Board of Supervisors. It also appears that religious principles might be at work in influencing public policy decisions. Until 1967 the hospital was part of Marquette University, a private Catholic institution, and the corporation counsel representing the county is known for his opposition to abortion. To a certain extent the obstructionist attitudes that are prevalent reveal the "right to life" element at work in Milwaukee. There is no indication that Milwaukee citizens are uniformly opposed to abortion despite the rhetoric

  6. The Milwaukee story: a public hospital's resistance to the Supreme Court abortion rulings.

    PubMed

    Ambrose, L

    1975-08-01

    A pregnancy was terminated at Milwaukee County General Hospital on March 12, 1975, 2 years after the Supreme Court decision on abortion and almost 8 months after a federal judge directly ordered the hospital to provide abortion services. In order for that abortion to be performed, there had to be Supreme Court action, extensive litigation in lower corts, related actions in state courts, supplementary court orders, and threatened fines and citations for contempt of court for principal hospital and county officials. Yet, the basic issues of this controversy continue. The test of a public hospital's responsibility to provide abortion services offers a case study of the way in which leadership decisions, community pressures, personal beliefs, and professional predispositions can intefere with implementation of the Supreme Court's standards on abortion rights. The hospital's rule 26(b) allows abortion only when pregnancy continuation is life-threatening to the mother. Following the Supreme Court decision, the medical staff of Milwaukee County General supported changing this aborion policy, but the director of the obstetrics and gynecology department strongly opposed any policy change. Among the tactics used to maintian the policy was the claim that there was no doctor at the hospital willing to perform an abortion along with the prohibition of payment of county funds for abortions at either the public hospital or at private hospitals by the County Board of Supervisors. It also appears that religious principles might be at work in influencing public policy decisions. Until 1967 the hospital was part of Marquette University, a private Catholic institution, and the corporation counsel representing the county is known for his opposition to abortion. To a certain extent the obstructionist attitudes that are prevalent reveal the "right to life" element at work in Milwaukee. There is no indication that Milwaukee citizens are uniformly opposed to abortion despite the rhetoric

  7. Power and trust in organizational relations: an empirical study in Turkish public hospitals.

    PubMed

    Bozaykut, Tuba; Gurbuz, F Gulruh

    2015-01-01

    Given the salience of the interplay between trust and power relations in organizational settings, this paper examines the perceptions of social power and its effects on trust in supervisors within the context of public hospitals. Following the theoretical background from which the study model is developed, the recent situation of hospitals within Turkish healthcare system is discussed to further elucidate the working conditions of physicians. Sample data were collected employing a structured questionnaire that was distributed to physicians working at seven different public hospitals. The statistical analyses indicate that perceptions of supervisors' social power affect subordinates' trust in supervisors. Although coercive power is found to have the greatest impact on trust in supervisors, the influence of the power base is weak. In addition, the results show that perceptions of social power differ between genders. However, the results do not support any of the hypotheses regarding the relations between trust in supervisors and the examined demographic variables.

  8. Author! author!: creating a digital archive of publications in a hospital library setting.

    PubMed

    Rourke, Diane; Samsundar, Devica Ramjit; Shalini, Channapatna

    2005-01-01

    Baptist Hospital of Miami has been honoring its staff authors annually during National Library Week since 1979, at the time the library was relocated. Upon "doing the math" and realizing that twenty-five years had passed, a special event was planned to celebrate the occasion in 2004. A merger of four hospitals in 1995 to form Baptist Health South Florida, and an addition of a fifth hospital in 2003 added into the complexity of these publications. Organizing the event led to the conclusion that there had to be a "better way" to manage the publication archive. This paper will include a look back at the event's past, present efforts to develop an archival database, and future plans to make articles available electronically to users, copyright permitting.

  9. Public versus private hospital maternity length of stay: a gamma mixture modelling approach.

    PubMed

    Lee, A H; Xiao, J; Codde, J P; Ng, A S K

    2002-02-01

    Application of a gamma mixture model to obstetrical diagnosis-related groups (DRGs) revealed heterogeneity of maternity length of stay (LOS). The proportion of long-stay subgroups identified, which can account for 30% of admissions, varied between DRGs. The burden of long-stay patients borne was estimated to be much higher in private hospitals than public hospitals for normal delivery, but vice versa for Caesarean section. Such differences highlights the impact of DRG-based casemix funding on inpatient LOS and have significant implications for health insurance companies to integrate casemix funding across the public and private sectors. The analysis also benefits hospital administrators and managers to budget expenditures accordingly. PMID:11854995

  10. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003).

    PubMed

    Peretti-Watel, P; Spire, B; Pierret, J; Lert, F; Obadia, Y

    2006-04-01

    This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences.

  11. Sense of place, organizational context and the strategic management of publicly funded hospitals.

    PubMed

    Hanlon, N T

    2001-11-01

    An era of managerialism in health care delivery systems is now well ensconced throughout the nations of the OECD. This development has occurred, in large part, as a response to funding pressures in institutionally based health care delivery imposed by principal third party insurers. In the case of publicly funded hospitals, the more traditional concerns for stewardship and appeasement of professional groups is being replaced by a greater emphasis on cost consciousness and corporate-style leadership as these organizations seek to reposition themselves in new funding and regulatory environments. While institutional theory and strategic management perspectives help illuminate these issues, this paper argues that a place-based perspective is also needed to understand the changes currently underway in health care delivery and publicly funded human services more generally. This is illustrated with reference to developments in the strategic management of public hospitals in the province of Ontario. Evidence from a survey of senior administrators of public hospitals, distributed at the height of these policy reform initiatives, is examined to shed light on local level management responses to changing policy and fiscal pressures. The data suggest that the latest policy directions in the province of Ontario will 'encourage' hospital executives in particular community settings to steer their organizations in very unfamiliar directions. The findings suggest a need for greater attention to context and setting in health services research and policy.

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

    PubMed

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

    2002-01-01

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

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

    PubMed

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

    2002-01-01

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

  14. Conflict management in public university hospitals in Turkey: a pilot study.

    PubMed

    Tengilimoglu, Dilaver; Kisa, Adnan

    2005-01-01

    By nature, hospitals are extremely complex organizations, combining many different professional groups within an intricate administrative structure. Conflicts therefore expectedly arise between individuals, groups, and departments. It is in the interest of health care administrators to periodically assess the major factors giving rise to these conflicts. In this study, a questionnaire designed to measure sources of conflict in the workplace was completed by 204 staff members at Gazi University Hospital. Of the participants, 30.9% were physicians, and 12.5% were administrators at various levels; 61.5% were female, and 38.5% were male. In terms of work experience, 52.6% of participants had worked less than 5 years at the hospital. The results of the study show that educational differences among the hospital staff were a major barrier to good communication and information flow between groups. Professionals in the same specialties experienced fewer conflicts. Another source of conflict was that resource allocation was considered unfair across departments. Although the hospital management provided an ombudsman for staff concerns, staff rarely resorted to the ombudsman because of the stigma associated with complaining. A lack of opportunity for career advancement was mentioned by 52% of the participants as a source of conflict. At present, job performance and rewards are not closely related in public university hospitals in Turkey because promotions and pay raises are strictly limited by law. Bureaucracy was also perceived to be a source of conflict, with 48.4% of participants saying that their performance was less than optimal because of the presence of multiple supervisors. This pilot study suggests that in Turkey, legislative reform is needed to give public university hospitals more flexibility regarding work incentives, open-door policies at the administrative level, and social interactions to improve teamwork among hospital staff.

  15. Conflict management in public university hospitals in Turkey: a pilot study.

    PubMed

    Tengilimoglu, Dilaver; Kisa, Adnan

    2005-01-01

    By nature, hospitals are extremely complex organizations, combining many different professional groups within an intricate administrative structure. Conflicts therefore expectedly arise between individuals, groups, and departments. It is in the interest of health care administrators to periodically assess the major factors giving rise to these conflicts. In this study, a questionnaire designed to measure sources of conflict in the workplace was completed by 204 staff members at Gazi University Hospital. Of the participants, 30.9% were physicians, and 12.5% were administrators at various levels; 61.5% were female, and 38.5% were male. In terms of work experience, 52.6% of participants had worked less than 5 years at the hospital. The results of the study show that educational differences among the hospital staff were a major barrier to good communication and information flow between groups. Professionals in the same specialties experienced fewer conflicts. Another source of conflict was that resource allocation was considered unfair across departments. Although the hospital management provided an ombudsman for staff concerns, staff rarely resorted to the ombudsman because of the stigma associated with complaining. A lack of opportunity for career advancement was mentioned by 52% of the participants as a source of conflict. At present, job performance and rewards are not closely related in public university hospitals in Turkey because promotions and pay raises are strictly limited by law. Bureaucracy was also perceived to be a source of conflict, with 48.4% of participants saying that their performance was less than optimal because of the presence of multiple supervisors. This pilot study suggests that in Turkey, legislative reform is needed to give public university hospitals more flexibility regarding work incentives, open-door policies at the administrative level, and social interactions to improve teamwork among hospital staff. PMID:15825820

  16. Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison

    PubMed Central

    2014-01-01

    Background In view of the current economic crisis and the resulting austerity measures being implemented by governments across Europe, public expenditure for substance abuse treatment has increasingly become a subject of discussion. An EU cross-country comparison would allow an estimation of the total amount of public resources spent on substance abuse treatment, compare various substance abuse treatment funding options, and evaluate the division of expenditures between alcohol and illegal drugs. The purpose of this study is to estimate the public spending of EU countries for alcohol and illegal drug abuse treatment in hospitals. Methods Our study uses a uniform methodology in order to enable valid cross-national comparisons. Our data are drawn from the Eurostat database, which provides anno 2010 data on government spending for the treatment of illegal drug and alcohol abuse in 21 EU member states. The cross-country comparison is restricted to hospitals, since data were unavailable for other types of treatment providers. The systematic registration of in- and outpatient data is essential to monitoring public expenditures on substance abuse treatment using international databases. Results Total public spending for hospital-based treatment of illegal drug and alcohol abuse in the 21 EU member states studied is estimated to be 7.6 billion euros. Per capita expenditures for treatment of illegal drug abuse vary, ranging from 0.1 euros in Romania to 13 euros in Sweden. For alcohol abuse, that figure varied from 0.9 euros in Bulgaria to 24 euros in Austria. These results confirm other studies indicating that public expenditures for alcohol treatment exceed that for illegal drug treatment. Conclusions Multiple factors may influence the number of hospital days for alcohol or illegal substance abuse treatment, and expenditures fluctuate accordingly. In this respect, we found a strong correlation between gross domestic product (GDP) per capita and public expenditures per

  17. An empirical analysis of the public's attitudes toward advertising hospital services: a comparative cross-sectional study.

    PubMed

    Moser, H Ronald; Freeman, Gordon L

    2014-01-01

    This study investigates current opinions about hospital advertising and compares them to the attitudes expressed 25 years ago. It replicates a survey done in 1985, using the same questionnaire and population to compare responses longitudinally. The study indicates some changes in the public's opinions of hospital advertising. Although the image of hospitals remains positive, most of the 2010 respondents' opinions were rather mixed regarding whether it is proper for hospitals to advertise. The study also confirmed that the quality of service and reputation of hospitals remain more important to the public than price. PMID:24617720

  18. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective.

    PubMed

    Zailani, Suhaiza; Gilani, Mina Sayyah; Nikbin, Davoud; Iranmanesh, Mohammad

    2014-09-01

    The purpose of this study is to explore the determinants of telemedicine acceptance in selected public hospitals in Malaysia and to investigate the effect of health culture on the relationship between these determinants and telemedicine acceptance. Data were gathered by means of a survey of physicians and nurses as the main group of users of telemedicine technology from hospitals that are currently using telemedicine technology. The results indicated that government policies, top management support, perception of usefulness and computer self-efficiency have a positive and significant impact on telemedicine acceptance by public hospitals in Malaysia. The results also confirmed the moderating role of health culture on the relationship between government policies as well as perceived usefulness on telemedicine acceptance by Malaysian hospitals. The results are useful for decision-makers as well as managers to recognize the potential role of telemedicine and assist in the process of implementation, adoption and utilization, and, therefore, spread the usage of telemedicine technology in more hospitals in the country. PMID:25038891

  19. Family caregivers in public tertiary care hospitals in Bangladesh: Risks and opportunities for infection control

    PubMed Central

    Islam, M. Saiful; Luby, Stephen P.; Sultana, Rebeca; Rimi, Nadia Ali; Zaman, Rashid Uz; Uddin, Main; Nahar, Nazmun; Rahman, Mahmudur; Hossain, M. Jahangir; Gurley, Emily S.

    2015-01-01

    Background Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers’ activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Methods Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Results Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Conclusion Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers’ knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers. PMID:24406254

  20. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Emergency use of Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51...

  1. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... eligible under 38 U.S.C. 1710 or 38 CFR 17.44. Care in a Federal facility not operated by the Department of... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  2. Wage Inequity: Within-Market Comparative Analysis of Salary for Public Health Nurses and Hospital Nurses.

    PubMed

    Issel, L Michele; Lurie, Christine Fitzpatrick; Bekemeier, Betty

    2016-01-01

    The labor market perspective focuses on supply and demand for registered nurses (RNs) as employees. This perspective contrasts with beliefs in the public health sector that RNs working in local health departments (LHD) as public health nurses (PHNs) accept lower wages because of factors other than market demand. This study sought to describe the extent to which hourly wages of RNs working in LHDs are competitive with hospital RN wages within the same county market. A repeated measures survey design was used in collecting 2010 and 2014 data. The unit of analysis was the county, as an RN labor market for LHDs and hospitals. Survey questions captured factors common in human resources benefits and wage packages, such as differential pay, hourly rate pay based on years of experience, components of benefit packages (eg, sick and vacation leave), and reimbursement for education. Within each county, the LHD and all hospitals constituted a "market," yielding a potential 12 markets in our study sample. Human resources representatives from each of the 12 LHDs and from all hospitals within those 12 counties were invited to participate. We conducted comparisons with survey data using t test of mean differences on mean RN wages across years of experience. On average, LHDs paid significantly less than hospitals in their markets, at all levels of RN experience, and this gap increased with RN experience in the sample markets. Salary compression was evident in 2010 and worsened for PHNs in 2014, when compared with hospital RNs. In 2014, 100% of the sample LHDs offered reimbursements for continuing education for PHNs compared with 89% of hospitals providing this benefit. This study contributes to our understanding of the human resources challenges faced by LHDs and provides evidence elucidating resources issues that need to be addressed in order to improve recruitment and retention of PHNs. PMID:27682725

  3. Wage Inequity: Within-Market Comparative Analysis of Salary for Public Health Nurses and Hospital Nurses.

    PubMed

    Issel, L Michele; Lurie, Christine Fitzpatrick; Bekemeier, Betty

    2016-01-01

    The labor market perspective focuses on supply and demand for registered nurses (RNs) as employees. This perspective contrasts with beliefs in the public health sector that RNs working in local health departments (LHD) as public health nurses (PHNs) accept lower wages because of factors other than market demand. This study sought to describe the extent to which hourly wages of RNs working in LHDs are competitive with hospital RN wages within the same county market. A repeated measures survey design was used in collecting 2010 and 2014 data. The unit of analysis was the county, as an RN labor market for LHDs and hospitals. Survey questions captured factors common in human resources benefits and wage packages, such as differential pay, hourly rate pay based on years of experience, components of benefit packages (eg, sick and vacation leave), and reimbursement for education. Within each county, the LHD and all hospitals constituted a "market," yielding a potential 12 markets in our study sample. Human resources representatives from each of the 12 LHDs and from all hospitals within those 12 counties were invited to participate. We conducted comparisons with survey data using t test of mean differences on mean RN wages across years of experience. On average, LHDs paid significantly less than hospitals in their markets, at all levels of RN experience, and this gap increased with RN experience in the sample markets. Salary compression was evident in 2010 and worsened for PHNs in 2014, when compared with hospital RNs. In 2014, 100% of the sample LHDs offered reimbursements for continuing education for PHNs compared with 89% of hospitals providing this benefit. This study contributes to our understanding of the human resources challenges faced by LHDs and provides evidence elucidating resources issues that need to be addressed in order to improve recruitment and retention of PHNs.

  4. French for Journalists: Classroom Techniques.

    ERIC Educational Resources Information Center

    Rodina, Herta

    The use of authentic materials for an advanced French course for students of journalism and communication has the drawback that authentic French sources assume a regular, informed readership sharing the same culture and history. A solution found at Ohio University is to use a publication that bridges the two cultures, such as the "Journal francais…

  5. Relative efficiency and productivity: a preliminary exploration of public hospitals in Beijing, China

    PubMed Central

    2014-01-01

    Background Third-grade hospitals in Beijing have been rapidly developing in capacity and scale for many years. These hospitals receive a large number of patients, and ensuring their efficient operation is crucial in meeting people’s healthcare needs. In this context, a study of their relative efficiency and productivity would be helpful to identify the driving factors and further improve their performance. Methods After a review of literature, the current numbers of open beds and employees were selected as input variables. The number of outpatient and emergency visits and the number of discharged patients were selected as output variables. A total of 12 third-grade Class A general public hospitals in Beijing were selected for a preliminary study. The panel data from 2006–2009 were collected by the National Institute of Hospital Administration, Ministry of Health of P.R. China. Descriptive analysis and data envelopment analysis were used to analyze the data using Stata 10.0 and DEAP(V2.1) software. Results In the 2006–2009 period, descriptive results show that sample hospitals continuously expanded their capacity and scale, with growth rate of total revenue being the highest among all variables. The DEA results show that the average annual growth rate of productivity was 26.7%, and the rates were 47.3%, 21.3% and 13.8% respectively for two consecutive years. The average annual growth rate of technological change was 28.3%, and the rates were 49.4%, 21.5% and 16.4% respectively for two consecutive years. The average annual growth rate of technical efficiency change was -1.3%, and the rates were -1.4%, -0.02% and -2.2% respectively for two consecutive years. Conclusions The sample hospitals in Beijing experienced substantial productivity growth, but annual growth rates were declining. Substantial technological change was the main contributor to the growth. Although some hospitals exhibited improvements in technical efficiency, there was a slight decline in

  6. Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan

    PubMed Central

    2010-01-01

    Background Public hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services. Methods This hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery) admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers. Results The average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees) and from the patient's perspective was 79 US$ (5278 rupees). The average cost for a Caesarean section from the hospital side was 162 US$ (10868 rupees) and 204 US$ (13678 rupees) from the patient's side. Average monthly household income was 141 ± 87 US$ for spontaneous vaginal delivery and 168 ± 97 US$ for Caesarean section. Three fourth (74%) of households had a monthly income of less than 149 US$ (10000 rupees). Conclusion The apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare. PMID:20085662

  7. Technical and scale efficiency of public community hospitals in Eritrea: an exploratory study

    PubMed Central

    2013-01-01

    Background Eritrean gross national income of Int$610 per capita is lower than the average for Africa (Int$1620) and considerably lower than the global average (Int$6977). It is therefore imperative that the country’s resources, including those specifically allocated to the health sector, are put to optimal use. The objectives of this study were (a) to estimate the relative technical and scale efficiency of public secondary level community hospitals in Eritrea, based on data generated in 2007, (b) to estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient, and (c) to estimate using Tobit regression analysis the impact of institutional and contextual/environmental variables on hospital inefficiencies. Methods A two-stage Data Envelopment Analysis (DEA) method is used to estimate efficiency of hospitals and to explain the inefficiencies. In the first stage, the efficient frontier and the hospital-level efficiency scores are first estimated using DEA. In the second stage, the estimated DEA efficiency scores are regressed on some institutional and contextual/environmental variables using a Tobit model. In 2007 there were a total of 20 secondary public community hospitals in Eritrea, nineteen of which generated data that could be included in the study. The input and output data were obtained from the Ministry of Health (MOH) annual health service activity report of 2007. Since our study employs data that are five years old, the results are not meant to uncritically inform current decision-making processes, but rather to illustrate the potential value of such efficiency analyses. Results The key findings were as follows: (i) the average constant returns to scale technical efficiency score was 90.3%; (ii) the average variable returns to scale technical efficiency score was 96.9%; and (iii) the average scale efficiency score was 93.3%. In 2007, the inefficient hospitals could

  8. Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

    NASA Astrophysics Data System (ADS)

    Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

    2014-09-01

    Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

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

    PubMed Central

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

    2005-01-01

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

  10. Cost analysis for efficient management: diabetes treatment at a public district hospital in Thailand.

    PubMed

    Riewpaiboon, Arthorn; Chatterjee, Susmita; Piyauthakit, Piyanuch

    2011-10-01

    OBJECTIVE  The study estimated cost of illness from the provider's perspective for diabetic patients who received treatment during the fiscal year 2008 at Waritchaphum Hospital, a 30-bed public district hospital in Sakhon Nakhon province in northeastern Thailand. METHODS  This retrospective, prevalence-based cost-of-illness study looked at 475 randomly selected diabetic patients, identified by the World Health Organization's International Classification of Diseases, 10th revision, codes E10-E14. Data were collected from the hospital financial records and medical records of each participant and were analysed with a stepwise multiple regression. KEY FINDINGS  The study found that the average public treatment cost per patient per year was US$94.71 at 2008 prices. Drug cost was the highest cost component (25% of total cost), followed by inpatient cost (24%) and outpatient visit cost (17%). A cost forecasting model showed that length of stay, hospitalization, visits to the provincial hospital, duration of disease and presence of diabetic complications (e.g. diabetic foot complications and nephropathy) were the significant predictor variables (adjusted R(2) = 0.689). CONCLUSIONS  According to the fitted model, avoiding nephropathy and foot complications would save US$19 386 and US$39 134 respectively per year. However, these savings are missed savings for the study year and the study hospital only and not projected savings, as that would depend on the number of diabetic patients managed in the year, the ratio of complicated to non-complicated cases and effectiveness of the prevention programmes. Nonetheless, given the high avoidable cost associated with complications of diabetes, healthcare providers in Thailand should focus on initiatives that delay the progression of complications in diabetic patients.

  11. The involvement of a consumer council in organizational decision making in a public psychiatric hospital.

    PubMed

    Linhorst, D M; Eckert, A; Hamilton, G; Young, E

    2001-11-01

    This article describes a consumer group within a public psychiatric hospital that serves primarily a forensic population. Some barriers to participation included the severity of some clients' mental illness, an organizational culture that does not fully support participation, the lack of clients' awareness of problems or alternative actions, and inherent power imbalances between clients and staff. Despite these barriers, the consumer group has made improvements for facility clients. Some factors associated with this success included strong administrative support, the allocation of a highly qualified staff liaison to work with the group, and the integration of the group into the facility's formal decision-making structure. Lessons are offered for the development of similar groups within public psychiatric hospitals and community-based mental health agencies.

  12. Levels of career commitment and career entrenchment of nurses from public and private hospitals1

    PubMed Central

    Lima, Mauren Pimentel; Costa, Vânia Medianeira Flores; Lopes, Luis Felipe Dias; Balsan, Laércio André Gassen; dos Santos, Andressa Schaurich; Tomazzoni, Gean Carlos

    2015-01-01

    Objective: to determine the prevalence of the types of relations to career - commitment and entrenchment - of nurses from public and private hospitals. Methods: field survey with a quantitative approach. A total of 237 nurses participated in the survey through a questionnaire with 43 questions about sociodemographic data, occupation, and relation to career. Descriptive statistics, frequency analysis, and Mann-Whitney U test were used for data analysis. Results: nurses from public and private hospitals have a high level of career commitment and a median level of career entrenchment. Conclusions: nurses have a stronger relation of affection and identification to career than a relation of stagnation, maintained primarily due to investments, followed by emotional costs and lack of alternatives. This fact is associated with individuals continuing in nursing and having a strong commitment to activities. PMID:26625993

  13. Distinctiveness of management in a university psychiatric hospital as a public health institution.

    PubMed

    Koncina, Miroslav

    2008-06-01

    The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values.

  14. Distinctiveness of management in a university psychiatric hospital as a public health institution.

    PubMed

    Koncina, Miroslav

    2008-06-01

    The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values. PMID:18587280

  15. A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

    PubMed

    McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

    2015-06-01

    Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. PMID:26056200

  16. A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

    PubMed

    McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

    2015-06-01

    Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes.

  17. State action antitrust immunity for public hospitals: it depends on what you mean by "foreseeable".

    PubMed

    Ward, P C

    2000-01-01

    The Supreme Court's refusal to hear an appeal from the Fifth Circuit's ruling on the application of state action antitrust immunity doctrine leaves a split in the circuits as to the proper test to apply to determine antitrust immunity for public hospitals. The circuits have either adopted a "foreseeable conduct from state policy" approach or a "policy from foreseeable conduct" approach. This Article analyzes the approaches and demonstrates that the "foreseeable conduct from state policy" approach is the better of the two methods.

  18. The productivity and its barriers in public hospitals: case study of ran

    PubMed Central

    Nabilou, Bahram; Yusefzadeh, Hassan; Rezapour, Aziz; Ebadi Fard Azar, Farbod; Salem Safi, Parviz; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal

    2016-01-01

    Background: Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study. Methods: In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, inputoriented and variable return to scale assumptions were applied and Deap2.1 software was used. Results: The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked. Conclusion: Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful. PMID:27390686

  19. Teaching Materials for French.

    ERIC Educational Resources Information Center

    Brown, E. W., Comp.

    The materials described are designed for use in all areas of French language teaching and are obtainable in the United Kingdom. Sources may be located in the book through a subject-area index and through an alphabetically arranged title index. Included in each of the 687 entries are the entry's number, author's name, title of the publication,…

  20. The moral economy of contemporary working-class adolescence: managing symbolic capital in a French public 'Adolescent Centre'.

    PubMed

    Coutant, Isabelle; Eideliman, Jean-Sébastien

    2013-06-01

    Working-class adolescents of French urban peripheries are key figures in a new social debate that reactivates the nineteenth century spectre of 'dangerous' classes to be controlled. Since the 1990s, French social counselling has privileged two modalities of response: taking account of suffering and government by listening and speech. We hypothesize that the contemporary moral economy allows for social interactions that go beyond social control and institutional domination. This is partly because professionals engaged in this moral undertaking may keep a critical distance, and partly because the concerned populations aren't necessarily devoid of resources to advance their interests or incapable of resistance. The concept of moral economy, coupled with the ethnographic method, is heuristic for fully comprehending the complexity of these issues and their stakes. Our fieldwork was centred on a French Adolescent Centre in an impoverished commune in Paris's periphery, from January 2010 through March 2011. These institutions were established in the early 2000s to respond to adolescent 'suffering' by crossing social work and psychiatry. Adolescents, parents, and other institutions (especially schools) solicit the professionally diverse staff for assistance, which in turn may take on cases and/or make referrals to other support institutions. By paying attention to all the scenes upon which the story of a counselled adolescent evolves, and bearing more general social evolutions in mind by applying the concept of moral economy, we can consider the multiplicity of seemingly contradictory processes as a whole. We see the destabilization of parents and their loss of symbolic capital, partly due to the norms of contemporary parenthood and partly due to the stigmatization of working-class adolescence. But we also discern possibilities for expressing sentiments of injustice and humiliation, for increasing symbolic capital, and in some cases a reappropriation of the system

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2014-04-01

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

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

    PubMed

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

    2014-04-01

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

  4. Hypoglycemia hospitalization frequency in patients with type 2 diabetes mellitus: a comparison of dipeptidyl peptidase 4 inhibitors and insulin secretagogues using the French health insurance database

    PubMed Central

    Detournay, Bruno; Halimi, Serge; Robert, Julien; Deschaseaux, Céline; Dejager, Sylvie

    2015-01-01

    Aim We aimed to compare the frequency of severe hypoglycemia leading to hospitalization (HH) and emergency visits (EV) for any cause in patients with type 2 diabetes mellitus exposed to dipeptidyl peptidase 4 (DPP4) inhibitors (DPP4-i) versus those exposed to insulin secretagogues (IS; sulfonylureas or glinides). Methods Data were extracted from the EGB (Echantillon Généraliste des Bénéficiaires) database, comprising a representative sample of ~1% of patients registered in the French National Health Insurance System (~600,000 patients). Type 2 diabetes mellitus patients exposed to regimens containing either a DPP4-i (excluding treatment with IS, insulin, or glucagon-like peptide 1 analog) or IS (excluding treatment with insulin and any incretin therapy) between 2009 and 2012 were selected. HH and EV during the exposure periods were identified in both cohorts. A similar analysis was conducted considering vildagliptin alone versus IS. Comparative analyses adjusting for covariates within the model (subjects matched for key characteristics) and using multinomial regression models were performed. Results Overall, 7,152 patients exposed to any DPP4-i and 1,440 patients exposed to vildagliptin were compared to 10,019 patients exposed to IS. Eight patients (0.11%) from the DPP4-i cohort and none from the vildagliptin cohort (0.0%) were hospitalized for hypoglycemia versus 130 patients (1.30%) from the IS cohort (138 hospitalizations) (P=0.02 and P<0.0001, respectively). Crude rates of HH/1,000 patient-years were 1.4 (95% CI: 0.7; 2.4) in the DPP4-i cohort, 0.0 in the vildagliptin cohort (95% CI: 0.0; 4.0), versus 5.6 (95% CI, 4.7; 6.6) in the IS cohort (P<0.0001). After adjustments, rates per 1,000 patient-years of HH were 1.4 (95% CI: 0.7; 2.4) with DPP4-i versus 7.5 (95% CI: 6.0; 9.2) with IS (P<0.0001), and 0.0 (95% CI: 0.0; 4.0) with vildagliptin versus 13.6 (95% CI: 10.4; 17.5) with IS (P<0.0001). Adjusted EV rates were also significantly lower with all DPP4-i or

  5. Establishment of national laboratory standards in public and private hospital laboratories.

    PubMed

    Anjarani, Soghra; Safadel, Nooshafarin; Dahim, Parisa; Amini, Rana; Mahdavi, Saeed; Mirab Samiee, Siamak

    2013-01-01

    In September 2007 national standard manual was finalized and officially announced as the minimal quality requirements for all medical laboratories in the country. Apart from auditing laboratories, Reference Health Laboratory has performed benchmarking auditing of medical laboratory network (surveys) in provinces. 12(th) benchmarks performed in Tehran and Alborz provinces, Iran in 2010 in three stages. We tried to compare different processes, their quality and accordance with national standard measures between public and private hospital laboratories. The assessment tool was a standardized checklist consists of 164 questions. Analyzing process show although in most cases implementing the standard requirements are more prominent in private laboratories, there is still a long way to complete fulfillment of requirements, and it takes a lot of effort. Differences between laboratories in public and private sectors especially in laboratory personnel and management process are significant. Probably lack of motivation, plays a key role in obtaining less desirable results in laboratories in public sectors.

  6. Association Rules and Data Mining in Hospital Infection Control and Public Health Surveillance

    PubMed Central

    Brossette, Stephen E.; Sprague, Alan P.; Hardin, J. Michael; Waites, Ken B.; Jones, Warren T.; Moser, Stephen A.

    1998-01-01

    Abstract Objectives: The authors consider the problem of identifying new, unexpected, and interesting patterns in hospital infection control and public health surveillance data and present a new data analysis process and system based on association rules to address this problem. Design: The authors first illustrate the need for automated pattern discovery and data mining in hospital infection control and public health surveillance. Next, they define association rules, explain how those rules can be used in surveillance, and present a novel process and system—the Data Mining Surveillance System (DMSS)—that utilize association rules to identify new and interesting patterns in surveillance data. Results: Experimental results were obtained using DMSS to analyze Pseudomonas aeruginosa infection control data collected over one year (1996) at University of Alabama at Birmingham Hospital. Experiments using one-, three-, and six-month time partitions yielded 34, 57, and 28 statistically significant events, respectively. Although not all statistically significant events are clinically significant, a subset of events generated in each analysis indicated potentially significant shifts in the occurrence of infection or antimicrobial resistance patterns of P. aeruginosa. Conclusion: The new process and system are efficient and effective in identifying new, unexpected, and interesting patterns in surveillance data. The clinical relevance and utility of this process await the results of prospective studies currently in progress. PMID:9670134

  7. Spatial distribution and accessibility to public sector tertiary care teaching hospitals in Karachi: A Geographic Information Systems application.

    PubMed

    Shaikh, Masood Ali; Ali, Mir Shabbar

    2016-07-01

    Optimal utilization of specialized curative healthcare services is contingent on spatial access to tertiary-care hospitals by the targeted population. The objectives of this study were to determine the spatial distribution of public sector tertiary-care teaching hospitals in Karachi, and to use GIS and network analysis for modeling the accessibility to these hospitals for Karachi residents. Maps of three, six, and nine kilometer buffers were created around the five selected hospitals to determine which towns of Karachi are either entirely or partially covered/accessible. Most of the towns in Karachi were covered either partially or completely by the three buffers and service areas of 3,6, and 9 kilometers around the five selected hospitals. This study highlights the limitations of using publicly available data for road network, and the need for creating and making available in public domain, comprehensive road network vector dataset in conjunction with population breakdowns by administrative subdivisions. PMID:27427142

  8. Spatial distribution and accessibility to public sector tertiary care teaching hospitals in Karachi: A Geographic Information Systems application.

    PubMed

    Shaikh, Masood Ali; Ali, Mir Shabbar

    2016-07-01

    Optimal utilization of specialized curative healthcare services is contingent on spatial access to tertiary-care hospitals by the targeted population. The objectives of this study were to determine the spatial distribution of public sector tertiary-care teaching hospitals in Karachi, and to use GIS and network analysis for modeling the accessibility to these hospitals for Karachi residents. Maps of three, six, and nine kilometer buffers were created around the five selected hospitals to determine which towns of Karachi are either entirely or partially covered/accessible. Most of the towns in Karachi were covered either partially or completely by the three buffers and service areas of 3,6, and 9 kilometers around the five selected hospitals. This study highlights the limitations of using publicly available data for road network, and the need for creating and making available in public domain, comprehensive road network vector dataset in conjunction with population breakdowns by administrative subdivisions.

  9. FREQUENCY AND ANTIMICROBIAL SUSCEPTIBILITY OF PATHOGENS AT TERTIARY PUBLIC HOSPITAL, SAO PAULO, BRAZIL.

    PubMed

    Prestes-Carneiro, Luiz Euribel; Azevedo, Alexandre Mario; Nakashima, Myriam Amemiya; Xavier, José Murilo Buzato Villaron; Cabral, Claudete

    2015-03-01

    Nosocomial infections are one of the leading causes of morbidity and mortality. This study determined both prevalence and antimicrobial susceptibility of microorganisms identified during January to December 2012 at a tertiary public hospital, Sao Paulo, Brazil. Data, hospital length of stay, age, identity of microorganisms, and antimicrobial susceptibilities were obtained from patients' records. A total of 724 positive strains were obtained from different body sites. Gram-negative microorganisms are significantly more prevalent than gram-positive microorganisms (p = 0.001). In all clinics analyzed, coagulase-negative Staphylococcus (CoNS) was the most prevalent microorganism isolated (21.6%), followed by Pseudomonas aeruginosa (12.4%). Extended spectrum β-lactamase Klebsiella pneumoniae was present in 62.7% of the strains and 18.9% were resistant to carbapenem/meropenem. Acinetobacter baumannii showed multidrug resistance. The majority of Escherichia coli isolates were obtained from positive urinary tract cultures (63.4%), with 27.5% resistant against cefepime. Elderly patients, long periods of hospital stay and continuous usage of a single antibiotic should be kept in mind of possible causes for infection of A. baumannii, ESBL and carbapenem-resistant K. pneumoniae and the worrisome E. coli with increased resistance to cefepime. The data allowed us to implement monitoring programs as part of the prevention strategy against pathogens prevalence and antibiotic resistance burden at Ipiranga Hospital, Sao Paulo, Brazil.

  10. Technical and organisational aspects in enterprise resource planning systems implementation: lessons from a Spanish public hospital

    NASA Astrophysics Data System (ADS)

    Escobar-Rodriguez, Tomas; Escobar-Pérez, Bernabe; Monge-Lozano, Pedro

    2014-09-01

    Public resources should always be managed efficiently, more so in times of crisis. Due to the specific characteristics of the healthcare sector, there is a need for special attention, especially in regards to hospitals. Administrators need useful tools to be able to efficiently manage available resources, such as enterprise resource planning (ERP) systems. Therefore, an analysis of the effects of their implementation and use in hospitals is valuable. This study has two purposes. One is to analyse the role ERP systems play in aiding the integration of hospital data, with focus on user satisfaction as well as possible resistance to change. The other purpose is to analyse the effects of implanting and using ERP systems in the hospital environment and identifying how certain variables influence the process, especially the existence of different organisational cultures. Results indicate that clinical information has become notably more integrated, despite the lack of flow in the economic-financial area. The heterogeneous nature of the different groups, clinical (Medical, Nursing) and non-clinical (Economic-Financial, Accounting), had a negative influence on the implementation process, and limited the integration of information as well as the system's performance.

  11. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda.

    PubMed

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  12. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda

    PubMed Central

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  13. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda.

    PubMed

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  14. Access to hospitals in the wake of terrorism: challenges and needs for maintaining public confidence.

    PubMed

    May, Thomas; Aulisio, Mark P

    2006-01-01

    The problem of surge capacity in the wake of a terror-related emergency has lead to a number of interesting proposals designed to mitigate the effects of crowds as well as deficiencies in patient care capacities. The most controversial of these is a proposal to close hospital doors in the wake of a mass casualty terror event. However, several specific challenges posed by mass casualty events make closing hospitals doors undesirable. These include the need for efficient movement of resources, maintenance of social order, and providing the moral reassurance needed by the general public in times of crisis. Importantly, these challenges are related to features of terrorist events that distinguish such events from circumstances of "normal" surge that might result in, for example, closure of emergency rooms. PMID:16904615

  15. Kodamaea (Pichia) ohmeri fungemia in a pediatric patient admitted in a public hospital.

    PubMed

    De Barros, Jadson Duque; Do Nascimento, Suerda Maria Nogueira; De Araújo, Fernanda Janaína Silva; Braz, Regina De Fátima Dos Santos; Andrade, Vania Sousa; Theelen, Bart; Boekhout, Teun; Illnait-Zaragozi, Maria Teresa; Gouveia, Maria Narriman Guimarães; Fernandes, Maria Conceição; Monteiro, Maria Goretti Lins; De Oliveira, Maria Tereza Barreto

    2009-11-01

    Kodamaea (Pichia) ohmeri is a yeast species that has not been reported to be a frequent cause of human infections. The current report describes a case of fungemia caused by K. ohmeri in a 3-year-old female patient hospitalized in the public hospital Maria Alice Fernandes, Natal, RN, Brazil. The patient had previously received antimicrobial therapy due to a peritoneal infection and nosocomial pneumonia, and had a central venous catheter implanted. Kodamaea ohmeri was isolated from blood and the tip of the catheter, 48 h after its implantation. The yeast was identified by standard microbiological methods and sequence analysis of the D1/D2 domains and the ITS 1 + 2 spacer regions of the ribosomal DNA. On CHROMagar Candida medium, the isolate showed a color change from pink to blue. The yeast was susceptible to amphotericin B, and liposomal AmB was used successfully to clear the infection. PMID:19888811

  16. Financial expense incurred by medical leaves of health professionals in Rondonia public hospitals, Brazil.

    PubMed

    Junkes, Maria Bernadete; Pessoa, Valdir Filgueiras

    2010-01-01

    The study investigates the additional payroll expense caused by absenteeism due to illness among nursing professionals and physicians at two public hospitals at Cacoal, Rondonia, Brazil. Non-programmed absences of up to 15 days which occurred at the hospital units between 2004 to 2007 were verified in the database of the institutions human resource sector. From 1,704 non-programmed absences, 1,486 were justified by medical declarations. It was verified that absenteeism caused by illness was responsible for 87.2% of all non-programmed absences. When these data are grouped by professional categories, it was observed that the nurse absenteeism due to illness reached 83.3%, when compared with 16.7% for physicians. The general absenteeism index, adding up nurses and physicians, corresponded to 0.85%, resulting in an additional payroll expense of 5.2% and 7.4% in the salaries of nursing professionals and physicians, respectively. PMID:20721430

  17. Incorporation of public hospitals: a "silver bullet" against overcapacity, managerial bottlenecks and resource constraints? Case studies from Austria and Estonia.

    PubMed

    Fidler, Armin H; Haslinger, Reinhard R; Hofmarcher, Maria M; Jesse, Maris; Palu, Toomas

    2007-05-01

    This paper presents a new approach for incorporating public hospitals by contrasting the experience from an "old" EU country (Austria) with a new EU member state (Estonia). In the EU (including the new member states) hospital overcapacity is a serious problem, from a technical, fiscal and political perspective. Few countries have succeeded in establishing an appropriate framework for resource management and for guaranteeing long-term financial viability of their hospital network. Many countries are in search of effective policies for improved hospital management and more cost-effective resource use in the health sector. Over the past decade, experiences in Austria and Estonia have emerged as innovative examples which may provide lessons for other EU countries and beyond. This paper describes the evolution of public hospitals from public budgetary units and public management to incorporated autonomous organizations under private corporate law, resulting in a contractual relationship between (public) owners and private hospital management. Outdated and inefficient public sector structures were replaced by more agile corporate management. The arrangement allows for investments, operating costs and budgeting according to strategic business goals as opposed to political "fiat". Shielding hospitals from local political influence is an important aspect of this concept. Horizontal integration through networking of public hospitals and introducing private management helps create a new corporate culture, allowing for more flexibility to achieve efficiencies through downsizing and economies of scale. Based on contracts the new balance between ownership and managerial functions create strong incentives for a more business-like, results-oriented and consumer-friendly management. This was achieved both in Austria and Estonia in a politically sensitive way, adopting a long-term vision and by protecting the interests of hospital owners and staff. PMID:16919838

  18. Incorporation of public hospitals: a "silver bullet" against overcapacity, managerial bottlenecks and resource constraints? Case studies from Austria and Estonia.

    PubMed

    Fidler, Armin H; Haslinger, Reinhard R; Hofmarcher, Maria M; Jesse, Maris; Palu, Toomas

    2007-05-01

    This paper presents a new approach for incorporating public hospitals by contrasting the experience from an "old" EU country (Austria) with a new EU member state (Estonia). In the EU (including the new member states) hospital overcapacity is a serious problem, from a technical, fiscal and political perspective. Few countries have succeeded in establishing an appropriate framework for resource management and for guaranteeing long-term financial viability of their hospital network. Many countries are in search of effective policies for improved hospital management and more cost-effective resource use in the health sector. Over the past decade, experiences in Austria and Estonia have emerged as innovative examples which may provide lessons for other EU countries and beyond. This paper describes the evolution of public hospitals from public budgetary units and public management to incorporated autonomous organizations under private corporate law, resulting in a contractual relationship between (public) owners and private hospital management. Outdated and inefficient public sector structures were replaced by more agile corporate management. The arrangement allows for investments, operating costs and budgeting according to strategic business goals as opposed to political "fiat". Shielding hospitals from local political influence is an important aspect of this concept. Horizontal integration through networking of public hospitals and introducing private management helps create a new corporate culture, allowing for more flexibility to achieve efficiencies through downsizing and economies of scale. Based on contracts the new balance between ownership and managerial functions create strong incentives for a more business-like, results-oriented and consumer-friendly management. This was achieved both in Austria and Estonia in a politically sensitive way, adopting a long-term vision and by protecting the interests of hospital owners and staff.

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  20. Geographic variation of failure-to-rescue in public acute hospitals in New South Wales, Australia.

    PubMed

    Assareh, Hassan; Ou, Lixin; Chen, Jack; Hillman, Kenneth; Flabouris, Arthas; Hollis, Stephanie J

    2014-01-01

    Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002-2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system. PMID:25310260

  1. Motivation of health workers and associated factors in public hospitals of West Amhara, Northwest Ethiopia

    PubMed Central

    Weldegebriel, Zemichael; Ejigu, Yohannes; Weldegebreal, Fitsum; Woldie, Mirkuzie

    2016-01-01

    Background Health professionals’ motivation reflects the interaction between health professionals and their work environment. It can potentially affect the provision of health services; however, this important attribute of the workplace climate in public hospitals is not usually given serious attention to the desired level. For this reason, the authors of this study have assessed the level of motivation of health professionals and associated factors in public hospitals of West Amhara, Northwest Ethiopia. Methods A facility based cross-sectional study was conducted in eight public hospitals of West Amhara from June 1 to July 30, 2013. A total of 304 health professionals were included in this study. The collected data were analyzed using SPSS software version 20. The reliability of the instrument was assessed through Cronbach’s α. Factor scores were generated for the items found to represent the scales (eigenvalue greater than one in varimax rotation) used in the measurement of the variables. The scores were further analyzed using one-way analysis of variance, t-tests, Pearson’s correlation, and hierarchical multiple linear regression analyses. The cut-off point for the regression analysis to determine significance was set at β (95% confidence interval, P<0.05). Results Mean motivation scores (as the percentage of maximum scale scores) were 58.6% for the overall motivation score, 71.0% for the conscientiousness scale, 52.8% for the organizational commitment scale, 58.3% for the intrinsic motivation scale, and 64.0% for organizational burnout scale. Professional category, age, type of the hospital, nonfinancial motivators like performance evaluation and management, staffing and work schedule, staff development and promotion, availability of necessary resources, and ease of communication were found to be strong predictors of health worker motivation. Across the hospitals and professional categories, health workers’ overall level of motivation with absolute

  2. Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals.

    PubMed

    Weinberg, L; Tay, S; Aykanat, V; Segal, R; Tan, C O; Peyton, P; McNicol, L; Story, D A

    2014-09-01

    Evidence-based choices of volatile agents can increase health cost efficiencies. In this pharmaco-economic study, we evaluated the trends and costs of volatile agent use in Australian public hospitals. The total number of volatile agent (isoflurane, sevoflurane and desflurane) bottles ordered and inflation-adjusted costs were collected from 65 Victorian public hospitals from 2005 to 2011. Environmental costs were measured through the 100-year global warming potential index as carbon dioxide equivalents. During this time period, the aggregate inflation-adjusted expenditure was $39,209,878. Time series analysis showed that bottles of isoflurane ordered decreased by 419/year (99% confidence interval (CI): -603 to -235); costs decreased by $56,017/year (99% CI: -$93,243 to -$18,791). Bottles of sevoflurane increased by 1,330/year (99% CI: 1141 to 1,519); costs decreased by $423,3573/year (99% CI: -$720,030 to -112,783). Bottles of desflurane increased by 726/year (99% CI: 288 to 1,164); costs increased by $171,578/year (99% CI: $136,951 to $206,205). The amount of calculated greenhouse gas emissions released into the atmosphere over this period was 37,000 tonnes of carbon dioxide equivalents, with isoflurane contributing 6%, sevoflurane 17%, and desflurane 77% of this total. In conclusion, isoflurane is no longer being used in the majority of Victorian public hospitals, with sevoflurane and desflurane remaining as the primary volatile agents, utilised respectively at a ratio of 2.2 to 1, and costs at 0.8 to 1.

  3. Sleeping porch through french doors off master bedroom (southern unit) ...

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

    Sleeping porch through french doors off master bedroom (southern unit) - Fitzsimons General Hospital, Officers' Quarters, West Charlie Kelly Boulevard & South Hutton Street, Southwest Corner, Aurora, Adams County, CO

  4. Species distribution and susceptibility profile of Candida species in a Brazilian public tertiary hospital

    PubMed Central

    2010-01-01

    Background Species identification and antifungal susceptibility tests were carried out on 212 Candida isolates obtained from bloodstream infections, urinary tract infections and dialysis-associated peritonitis, from cases attended at a Brazilian public tertiary hospital from January 1998 to January 2005. Findings Candida albicans represented 33% of the isolates, Candida parapsilosis 31.1%, Candida tropicalis 17.9%,Candida glabrata 11.8%, and others species 6.2%. In blood culture, C. parapsilosis was the most frequently encountered species (48%). The resistance levels to the antifungal azoles were relatively low for the several species, except for C. tropicalis and C. glabrata. Amphotericin B resistance was observed in 1 isolate of C. parapsilosis. Conclusions The species distribution and antifungal susceptibility herein observed presented several epidemiological features common to other tertiary hospitals in Latin American countries. It also exhibited some peculiarity, such as a very high frequency of C. parapsilosis both in bloodstream infections and dialysis-associated peritonitis. C. albicans also occurred in an important number of case infections, in all evaluated clinical sources. C. glabrata presented a high proportion of resistant isolates. The data emphasize the necessity to carry out the correct species identification accompanied by the susceptibility tests in all tertiary hospitals. PMID:20044935

  5. Orthopedics nursing patients' profile of a public hospital in Salvador-Bahia

    PubMed Central

    de Castro, Renata Reis Matutino; Ribeiro, Natália Fonseca; de Andrade, Aline Mendonça; Jaques, Bruno Dórea

    2013-01-01

    OBJECTIVES: To describe the profile of patients treated in the trauma and orthopedics nursing of a trauma care referral public hospital of in the state of Bahia. METHODS: Cross-sectional study in which data were collected from medical records of patients in the period from July to December 2008. RESULTS: The profile of the patients involved was formed by subjects mostly male young subjects, victims of trauma from accidents, especially those with motorcycles or car runover. On the other hand,the most frequent traumas associated with urban violence were perforations by gunshot and stab wounds. The primary injury presented by these individuals was exposed fracture of the femur and the most common treatment was external fixation. The most frequent in-hospital complication was wound infection, which required another surgical approach. Most inpatients were discharged and only one death was reported during this period. CONCLUSION: The results of this study corroborate those from other institutions in the country, which may contribute to elaborate public policies for accidents and violence prevention. Level of Evidence IV, Case Series. PMID:24453666

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

    PubMed

    Yang, Ming-Chin; Tung, Yu-Chi

    2006-01-01

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

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

    PubMed

    Yang, Ming-Chin; Tung, Yu-Chi

    2006-01-01

    Examining whether the causal relationships among the performance indicators of the balanced scorecard (BSC) framework exist in hospitals is the aim of this article. Data were collected from all twenty-one general hospitals in a public hospital system and their supervising agency for the 3-year period, 2000-2002. The results of the path analyses identified significant causal relationships among four perspectives in the BSC model. We also verified the relationships among indicators within each perspective, some of which varied as time changed. We conclude that hospital administrators can use path analysis to help them identify and manage leading indicators when adopting the BSC model. However, they should also validate causal relationships between leading and lagging indicators periodically because the management environment changes constantly. PMID:17077702

  8. Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

    PubMed Central

    Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S.; Tozan, Yeşim

    2016-01-01

    Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. PMID:26910907

  9. [French national health insurance. The current situation].

    PubMed

    Huguier, Michel; Lagrave, Michel; Marcelli, Aline; Rossignol, Claude; Tillement, Jean-Paul

    2010-06-01

    An audit of the French national health insurance system would be justified by economic considerations alone, but this would risk overlooking the notions of solidarity and freedom to which the French are rightly attached. European comparisons suggest, however, that our system could be made more efficient without undermining public health. The national health insurance system allows each member of the population to receive high-quality medical care. Practitioners have near-total freedom of prescription and practice. Medical care contributes to the ongoing increase in life expectancy, which is currently 73 years and second only to Japan. Healthcare is also a source of a million jobs. Macro-economic spending controls have failed, owing to medical progress and population aging, and also to medical consumerism favored by an unprecedented range of examinations and treatments, the increasing reimbursement of medical care, and the extension of direct payment by the insurer. Many ineffective measures have been implemented, such as tarification according to activity, and hospital certification. Health spending is also increased unnecessarily by bureaucratisation of healthcare spending and the transfer of professionals to posts for which they are not qualified. Some controversial medical prescriptions are not adequately controlled by the health service. Many reforms are based on over-optimistic economic predictions that fail to take related overheads into account. Lobbying by special interests groups undermines reform and the public interest. Too many independent administrative bodies have been created, and many are less efficient than the public structures they replaced. In sum, the French national health insurance system has become less and less efficient over the years. PMID:21513139

  10. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012

    PubMed Central

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-01-01

    Objectives Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. Setting and design A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to ‘top hospital’, best hospital’, and ‘hospital quality’, as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. Primary outcome measures (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. Results National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Conclusions Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by

  11. Prediction of Hospital Acute Myocardial Infarction and Heart Failure 30-Day Mortality Rates Using Publicly Reported Performance Measures

    PubMed Central

    Aaronson, David S.; Bardach, Naomi S.; Lin, Grace A.; Chattopadhyay, Arpita; Goldman, L. Elizabeth; Dudley, R. Adams

    2014-01-01

    Objective To identify an approach to summarizing publicly reported hospital performance data for acute myocardial infarction (AMI) or heart failure (HF) that best predicts current year hospital mortality rates. Setting A total of 1,868 U.S. hospitals reporting process and outcome measures for AMI and HF to the Centers for Medicare and Medicaid Services (CMS) from July 2005 to June 2006 (Year 0) and July 2006 to June 2007 (Year 1). Design Observational cohort study measuring the percentage variation in Year 1 hospital 30-day risk-adjusted mortality rate explained by denominator-based weighted composite scores summarizing hospital Year 0 performance. Data Collection Data were prospectively collected from hospitalcompare.gov. Results Percentage variation in Year 1 mortality was best explained by mortality rate alone in Year 0 over other composites including process performance. If only Year 0 mortality rates were reported, and consumers using hospitals in the highest decile of mortality instead chose hospitals in the lowest decile of mortality rate, the number of deaths at 30 days that potentially could have been avoided was 1.31 per 100 patients for AMI and 2.12 for HF (p < .001). Conclusion Public reports focused on 30-day risk-adjusted mortality rate may more directly address policymakers’ goals of facilitating consumer identification of hospitals with better outcomes. PMID:22093186

  12. The Effects of Competition from Private Schooling on French Public School Districts in the Province of Quebec

    ERIC Educational Resources Information Center

    Caldas, Stephen J.; Bernier, Sylvain

    2012-01-01

    The Province of Quebec subsidizes nearly 50% of private education, and at the same time heavily regulates private schools. To date, no studies have been done to determine the effect of the unique nature of competition from K-12 private schools on public school education of the sort found in Quebec. The authors used multiple regression to determine…

  13. Whose social capital matters? The case of U.S. urban public hospital closures and conversions to private ownership.

    PubMed

    Ko, Michelle; Derose, Kathryn Pitkin; Needleman, Jack; Ponce, Ninez A

    2014-08-01

    Prior literature on social capital and health has predominantly focused on health outcomes and individual access to healthcare services. It is not known to what degree, if any, community social capital influences the performance or behaviors of public hospitals, a key source of healthcare for disadvantaged communities in the United States. In this study we developed measures of community bridging social capital - horizontal social networks between heterogeneous groups of similar social position - and linking social capital - vertical networks across the status hierarchy - relevant to public hospitals. We examined associations between social capital, and U.S. urban public hospital closures and conversions to private ownership from 1987 to 2007. We found that higher voting participation was associated with a greater hazard of public hospital closure over time (p < 0.01), whereas the number of business, professional and political organizations per 10,000 residents was associated a greater hazard of conversion (p < 0.05). Additional measures of bridging and linking social capital were not associated with either outcome. Taken together, our findings suggest that, at least historically, horizontal forms of social capital among more privileged groups (e.g., business, professional, and political associations) bear influence on public hospital outcomes. Specific efforts to increase engagement of disadvantaged groups and connect them with decision-makers may be needed to fully realize the potential of linking social capital to influence local healthcare policy promoting social protection.

  14. Are managers' and the general public's perceptions of risk communication needs in line? A French alpine valley case study

    NASA Astrophysics Data System (ADS)

    Charrière, Marie; Sprague, Teresa; Bogaard, Thom; Greiving, Stefan; Malet, Jean-Philippe; Mostert, Erik

    2013-04-01

    Risk communication is a crucial element of risk management. It contributes to social capacity building by influencing the knowledge, attitude, behavior, psychology, as well as social and organizational aspects1,2. It is globally recognized that effective risk communication should address needs and requirements of targeted audiences, especially those of the public. This study compares needs and requirements related to risk communication as seen by the risk managers, with the needs and requirements as expressed by the general public. Two surveys were conducted in a mountainous region facing multi-hazards, the Ubaye valley (France). The first survey, conducted within the context of the Marie Curie Research and Training Network 'Mountain Risk', was addressed to the local community. It aimed at gathering perceptions, needs and requirements of the general public (344 respondents) on risk communication3. The second survey, conducted in the context of the Marie Curie Initial Training Network 'CHANGES', targeted risk managers (16 stakeholders of the authorities, technical services and emergency units) at both the local and the regional scale to evaluate their perceptions regarding risk communication with the general public. The needs and requirements were analyzed with respect to several dimensions: 1) the information provided to the public, 2) the legal requirements for communication, 3) the level of trust the population has in risk managers, 4) insights on awareness and preparedness, and 5) information on the media used in past communication efforts. Results of the analysis concerning the last dimension reveal that, while the general public mentioned press, official reports and technical reports as the top three media by which they received information, the risk managers cited the press but in contrast also selected radio and television. Other results indicate that a potential mismatch exists as more than 80% of the respondents of the population find all listed topics

  15. Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

    PubMed

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-01-01

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

  16. Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

    PubMed Central

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-01-01

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

  17. Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

    PubMed

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-06-24

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

  18. Acute myocardial infarction in the Brazilian State of São Paulo. In-hospital deaths from 1979 to 1996 and hospital fatality from 1984 to 1998 in the public health system.

    PubMed

    Marcopito; Goldfeder; Schenkman

    2000-01-01

    OBJECTIVE: To determine the following parameters in the Brazilian State of São Paulo: 1) the percentage of deaths due to acute myocardial infarction (AMI) occurring in hospitals; 2) the percentage of deaths due to AMI occurring in public health system hospitals as compared with all in-hospital deaths due to AMI between 1979 and 1996; 3) the fatality due to AMI in public health system hospitals from 1984 to 1998. METHODS: Data were available on the Datasus Web site (the health information agency of the Brazilian Department of Health) that provided the following: a) number of deaths resulting from AMI in hospitals; b) number of deaths resulting from AMI in public health system hospitals; c) number of hospital admissions due to AMI in public health system hospitals. RESULTS: The percentage of in-hospital deaths due to AMI increased from 54.9 in 1979 to 68.6 in 1996. The percentage contribution of the public health system to total number of deaths due to AMI occurring in hospitals decreased from 22.9 in 1984 to 13.7 in 1996; fatality due to AMI occurring in public health system hospitals had an irregular evolution from 1984 to 1992 and showed a slight trend for increased frequency from 1993 to 1998. CONCLUSION: The percentage of in-hospital deaths due to AMI has been increasing. Deaths resulting from AMI in public health system hospitals have decreased when compared with the total number of deaths due to AMI in all hospitals. Fatality due to AMI in public health system hospitals did not decrease from 1992 to 1998.

  19. Acute myocardial infarction in the Brazilian State of Sao Paulo. In-hospital deaths from 1979 to 1996 and hospital fatality from 1984 to 1998 in the public health system

    PubMed

    Marcopito; Goldfeder; Schenkman

    2000-01-01

    OBJECTIVE: To determine the following parameters in the Brazilian State of Sao Paulo: 1) the percentage of deaths due to acute myocardial infarction (AMI) occurring in hospitals; 2) the percentage of deaths due to AMI occurring in public health system hospitals as compared with all in-hospital deaths due to AMI between 1979 and 1996; 3) the fatality due to AMI in public health system hospitals from 1984 to 1998. METHODS: Data were available on the Datasus Web site (the health information agency of the Brazilian Department of Health) that provided the following: a) number of deaths resulting from AMI in hospitals; b) number of deaths resulting from AMI in public health system hospitals; c) number of hospital admissions due to AMI in public health system hospitals. RESULTS: The percentage of in-hospital deaths due to AMI increased from 54.9 in 1979 to 68.6 in 1996. The percentage contribution of the public health system to total number of deaths due to AMI occurring in hospitals decreased from 22.9 in 1984 to 13.7 in 1996; fatality due to AMI occurring in public health system hospitals had an irregular evolution from 1984 to 1992 and showed a slight trend for increased frequency from 1993 to 1998. CONCLUSION: The percentage of in-hospital deaths due to AMI has been increasing. Deaths resulting from AMI in public health system hospitals have decreased when compared with the total number of deaths due to AMI in all hospitals. Fatality due to AMI in public health system hospitals did not decrease from 1992 to 1998.

  20. [Optimizing French scientific and economic performance: the Cifre system of public-private partnership in doctoral research and Servier's contribution].

    PubMed

    Canet, Emmanuel; Grassy, Gérard

    2006-01-01

    The European Union has set itself the daunting target of becoming the world's most competitive and dynamic knowledge-based economy by 2010. Any hope of success against the United States and the Asian tiger economies lies in the quality of scientific and technological research. In France, postgraduate training has long labored under a deep academia/industry divide. Although the universities have introduced supervised 3 year doctoral courses along the lines of the English-speaking countries, they still produce too many postdocs with little experience or understanding of, and little taste for, the private sector. This ignores career realities: the public sector can offer employment to only half the postdocs it produces. The rest must fall back on positions in the private sector, in some cases with a sense of failure, ill suiting them to drive the intellectual economy forwards compared to their international competitors. To combat the divide and emphasize the quality of the research training available within industry, the public/private National Association for Technical Research (ANRT), acting on behalf of the Ministry of Research, created the Industrial Research Training Agreement (Cifre) scheme in 1981. Higher education laboratories and private companies combine to offer doctoral students the opportunity to undertake their 3 year course in a mixed public/private environment (the exact ratio is not defined but in the case of the Servier Research Group, an early and active participant in the scheme, at least one third of the course is spent in the private sector). The doctoral thesis is thereby transformed into a meaningful career qualification. Funded by the Ministry, with maintenance grants to the students and compensatory payments to the companies, the Cifre scheme, which is currently being expanded, has produced 12,000 postdocs personally and intellectually equipped for careers transiting seamlessly between the public and private sectors, to the enrichment of each.

  1. WHO Safety Surgical Checklist implementation evaluation in public hospitals in the Brazilian Federal District.

    PubMed

    Santana, Heiko T; de Freitas, Marise R; Ferraz, Edmundo M; Evangelista, Maria S N

    2016-01-01

    The World Health Organization (WHO) created the WHO Surgical Safety Checklist to prevent adverse events in operating rooms. The aim of this study was to analyze WHO checklist implementation in three operating rooms of public hospitals in the Brazilian Federal District. A prospective cross-sectional study was performed with pre- (Period I) and post (Period II)-checklist intervention evaluations. A total of 1141 patients and 1052 patients were studied in Periods I and II for a total of 2193 patients. Period I took place from December 2012 to March 2013, and Period II took place from April 2013 to August 2014. Regarding the pre-operatory items, most surgeries were classified as clean-contaminated in both phases, and team attire improved from 19.2% to 71.0% in Period II. Regarding checklist adherence in Period II, "Patient identification" significantly improved in the stage "Before induction of anesthesia". "Allergy verification", "Airway obstruction verification", and "Risk of blood loss assessment" had low adherence in all three hospitals. The items in the stage "Before surgical incision" showed greater than 90.0% adherence with the exception of "Anticipated critical events: Anesthesia team review" (86.7%) and "Essential imaging display" (80.0%). Low adherence was noted in "Instrument counts" and "Equipment problems" in the stage "Before patient leaves operating room". Complications and deaths were low in both periods. Despite the variability in checklist item compliance in the surveyed hospitals, WHO checklist implementation as an intervention tool showed good adherence to the majority of the items on the list. Nevertheless, motivation to use the instrument by the surgical team with the intent of improving surgical patient safety continues to be crucial. PMID:26924253

  2. Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

    PubMed Central

    Cawich, Shamir O; Harding, Hyacinth E; Crandon, Ivor W; McGaw, Clarence D; Barnett, Alan T; Tennant, Ingrid; Evans, Necia R; Martin, Allie C; Simpson, Lindberg K; Johnson, Peter

    2013-01-01

    The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica. Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys. PMID:24355903

  3. Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya.

    PubMed

    Binanay, Cynthia A; Akwanalo, Constantine O; Aruasa, Wilson; Barasa, Felix A; Corey, G Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak D; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J; Bloomfield, Gerald S

    2015-12-01

    Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings. PMID:26653630

  4. Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya.

    PubMed

    Binanay, Cynthia A; Akwanalo, Constantine O; Aruasa, Wilson; Barasa, Felix A; Corey, G Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak D; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J; Bloomfield, Gerald S

    2015-12-01

    Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings.

  5. [Environmental impact of a public hospital in the city of Lima, Peru].

    PubMed

    Bambarén-Alatrista, Celso; Alatrista-Gutiérrez de Bambarén, María del Socorro

    2014-01-01

    The operation of hospitals produces negative effects on the environment which contributes to air pollution and climate change. The institution in this study is a category III health care facility located in the city of Lima. It generates 4.89 kg/bed/day of solid waste, and consumes 1.36 m3/bed/day of water; 25.22 kWh/bed/day of electricity, and 2.76 liters/bed/day of fuel. The level of PM10 and measured parameters of disposal to the public network are within legal limits, while mobile source noise exceeds the maximum allowable limit. The institution releases into the atmosphere 2,291 tons of CO2 equivalents per year. In conclusion, the institution studied generates a negative impact on the environment. PMID:25597723

  6. Performance Evaluation of Public Hospital Information Systems by the Information System Success Model

    PubMed Central

    Cho, Kyoung Won; Bae, Sung-Kwon; Ryu, Ji-Hye; Kim, Kyeong Na; An, Chang-Ho

    2015-01-01

    Objectives This study was to evaluate the performance of the newly developed information system (IS) implemented on July 1, 2014 at three public hospitals in Korea. Methods User satisfaction scores of twelve key performance indicators of six IS success factors based on the DeLone and McLean IS Success Model were utilized to evaluate IS performance before and after the newly developed system was introduced. Results All scores increased after system introduction except for the completeness of medical records and impact on the clinical environment. The relationships among six IS factors were also analyzed to identify the important factors influencing three IS success factors (Intention to Use, User Satisfaction, and Net Benefits). All relationships were significant except for the relationships among Service Quality, Intention to Use, and Net Benefits. Conclusions The results suggest that hospitals should not only focus on systems and information quality; rather, they should also continuously improve service quality to improve user satisfaction and eventually reach full the potential of IS performance. PMID:25705557

  7. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru.

    PubMed

    Eza, Dominique; Cerrillo, Gustavo; Moore, David A J; Castro, Cecilia; Ticona, Eduardo; Morales, Domingo; Cabanillas, Jose; Barrantes, Fernando; Alfaro, Alejandro; Benavides, Alejandro; Rafael, Arturo; Valladares, Gilberto; Arevalo, Fernando; Evans, Carlton A; Gilman, Robert H

    2006-01-01

    There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed. PMID:16979302

  8. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru

    PubMed Central

    Eza, Dominique; Cerrillo, Gustavo; Moore, David A.J.; Castro, Cecilia; Ticona, Eduardo; Morales, Domingo; Cabanillas, Jose; Barrantes, Fernando; Alfaro, Alejandro; Benavides, Alejandro; Rafael, Arturo; Valladares, Gilberto; Arevalo, Fernando; Evans, Carlton A.; Gilman, Robert H.

    2010-01-01

    There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed. PMID:16979302

  9. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru.

    PubMed

    Eza, Dominique; Cerrillo, Gustavo; Moore, David A J; Castro, Cecilia; Ticona, Eduardo; Morales, Domingo; Cabanillas, Jose; Barrantes, Fernando; Alfaro, Alejandro; Benavides, Alejandro; Rafael, Arturo; Valladares, Gilberto; Arevalo, Fernando; Evans, Carlton A; Gilman, Robert H

    2006-01-01

    There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed.

  10. Trend and forecasting rate of cancer deaths at a public university hospital using univariate modeling

    NASA Astrophysics Data System (ADS)

    Ismail, A.; Hassan, Noor I.

    2013-09-01

    Cancer is one of the principal causes of death in Malaysia. This study was performed to determine the pattern of rate of cancer deaths at a public hospital in Malaysia over an 11 year period from year 2001 to 2011, to determine the best fitted model of forecasting the rate of cancer deaths using Univariate Modeling and to forecast the rates for the next two years (2012 to 2013). The medical records of the death of patients with cancer admitted at this Hospital over 11 year's period were reviewed, with a total of 663 cases. The cancers were classified according to 10th Revision International Classification of Diseases (ICD-10). Data collected include socio-demographic background of patients such as registration number, age, gender, ethnicity, ward and diagnosis. Data entry and analysis was accomplished using SPSS 19.0 and Minitab 16.0. The five Univariate Models used were Naïve with Trend Model, Average Percent Change Model (ACPM), Single Exponential Smoothing, Double Exponential Smoothing and Holt's Method. The overall 11 years rate of cancer deaths showed that at this hospital, Malay patients have the highest percentage (88.10%) compared to other ethnic groups with males (51.30%) higher than females. Lung and breast cancer have the most number of cancer deaths among gender. About 29.60% of the patients who died due to cancer were aged 61 years old and above. The best Univariate Model used for forecasting the rate of cancer deaths is Single Exponential Smoothing Technique with alpha of 0.10. The forecast for the rate of cancer deaths shows a horizontally or flat value. The forecasted mortality trend remains at 6.84% from January 2012 to December 2013. All the government and private sectors and non-governmental organizations need to highlight issues on cancer especially lung and breast cancers to the public through campaigns using mass media, media electronics, posters and pamphlets in the attempt to decrease the rate of cancer deaths in Malaysia.

  11. Q fever in French Guiana.

    PubMed

    Eldin, Carole; Mahamat, Aba; Demar, Magalie; Abboud, Philippe; Djossou, Félix; Raoult, Didier

    2014-10-01

    Coxiella burnetii, the causative agent of Q fever, is present worldwide. Recent studies have shown that this bacterium is an emerging pathogen in French Guiana and has a high prevalence (24% of community-acquired pneumonia). In this review, we focus on the peculiar epidemiology of Q fever in French Guiana. We place it in the context of the epidemiology of the disease in the surrounding countries of South America. We also review the clinical features of Q fever in this region, which has severe initial presentation but low mortality rates. These characteristics seem to be linked to a unique genotype (genotype 17). Finally, we discuss the issue of the animal reservoir of C. burnetii in French Guiana, which is still unknown. Further studies are necessary to identify this reservoir. Identification of this reservoir will improve the understanding of the Q fever epidemic in French Guiana and will provide new tools to control this public health problem.

  12. Poor standards of care in small, private hospitals in Maharashtra, India: implications for public-private partnerships for maternity care.

    PubMed

    Bhate-Deosthali, Padma; Khatri, Ritu; Wagle, Suchitra

    2011-05-01

    The private health sector in India is generally unregulated. Maharashtra is among the few states which require registration of private hospitals. This paper reports on a study of standards of care in small, private hospitals (less than 30 beds) in Maharashtra state, India, with a focus on maternity care, based on interviews with the hospitals' owners or senior staff, and observation. In the absence of reliable information on the number of private hospitals in the state, a physical listing was carried out in 11 districts and an estimate drawn up; 10% of hospitals found in each location were included in the study sample. We found poor standards of care in many cases, and few or no qualified nurses or a duty medical officer in attendance. Of the 261 hospitals visited, 146 provided maternity services yet 137 did not have a qualified midwife, and though most claimed they provided emergency care, including caesarean section, only three had a blood bank and eight had an ambulance. Government plans to promote public-private partnerships with such hospitals, including for maternity services, create concern, given our findings. The need to enforce existing regulations and collect information on health outcomes and quality of care before the state involves these hospitals further in provision of maternity care is called for. PMID:21555084

  13. Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines

    PubMed Central

    Vieira Machado, Alessandra A.; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

    2014-01-01

    Background Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. Methods and Results To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). Conclusion The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care. PMID:25188295

  14. Extent, Nature, and Risk Factors of Workplace Violence in Public Tertiary Hospitals in China: A Cross-Sectional Survey

    PubMed Central

    Liu, He; Zhao, Siqi; Jiao, Mingli; Wang, Jingtao; Peters, David H.; Qiao, Hong; Zhao, Yuchong; Li, Ye; Song, Lei; Xing, Kai; Lu, Yan; Wu, Qunhong

    2015-01-01

    Using a cross-sectional survey design from 11 public tertiary hospitals (a specialist hospital, four Chinese medicine hospitals, and six general hospitals) in the urban areas of Heilongjiang, we determined the nature of workplace violence that medical staff have encountered in Chinese hospitals and identified factors associated with those experiences of violence. A total of 1129 health workers participated. The specialist hospital had the highest prevalence of physical violence (35.4%), while the general hospitals had the highest prevalence of non-physical violence (76%). Inexperienced medical staff (p < 0.001) were more likely to suffer non-physical violence than physical violence in Chinese medicine hospitals compared to experienced staff. Medical units (p = 0.001) had a high risk of non-physical violence, while surgical units (p = 0.005) had a high risk of physical violence. In general hospitals, staff with higher levels of anxiety about workplace violence were more vulnerable to both physical violence (1.67, 95% CI 1.36–2.10) and non-physical violence (1.309, 95% CI 1.136–1.508) compared to those with lower levels of anxiety, while rotating shift workers had a higher odds of physical violence (2.2, 95% CI 1.21–4.17) and non-physical violence (1.65, 95% CI 1.13–2.41) compared to fixed day shift workers. Thus, prevention should focus not only on high-risk sections of hospitals, but also on the nature of the hospital itself. PMID:26086703

  15. The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

    PubMed Central

    Rispel, Laetitia C.; Moorman, Julia

    2015-01-01

    Background Globally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals. Objective The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). Results In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion Hospital managers and

  16. Factors influencing inpatients’ satisfaction with hospitalization service in public hospitals in Shanghai, People’s Republic of China

    PubMed Central

    Chen, Haiping; Li, Meina; Wang, Jingrui; Xue, Chen; Ding, Tao; Nong, Xin; Liu, Yuan; Zhang, Lulu

    2016-01-01

    Objective The aim of this study was to observe the current status of inpatient satisfaction and analyze the possible factors influencing patient satisfaction during hospitalization. Methods A cross-sectional investigation was conducted to obtain basic information about inpatient satisfaction, and statistical methods were used to describe and analyze the data. A total of 878 questionnaires were included in this study. A 5-point Likert scale rating was employed to assess items related to hospitalization care. Nonparametric tests and ordinal logistic analysis were used to explore the relationship between predictors and the patients’ overall satisfaction. Results Among the respondents, 89.75% were satisfied overall with the service they received during hospitalization, while 0.57% reported dissatisfaction. Inpatient demographic characteristics such as sex of the patients, occupation, age, and residence had significant associations with satisfaction, while monthly income and marital status did not. Additionally, the statistical outcome indicated that doctors’ and nurses’ service attitudes, and expenditure and environment were found to have an impact on the inpatient satisfaction ratings, with odds ratio of 2.43, 3.19, and 2.72, respectively. Conclusion This study emphasizes the influence of sex of the patients, the service attitudes of the doctors and nurses, and expenditure and environment on inpatient satisfaction. An increase in satisfaction ratings concerning the areas of doctors’ and nurses’ service attitudes, and expenditure and environment can improve the overall satisfaction levels. Responsible health management departments should pay attention to patient satisfaction and improve the quality of relevant health services, thus ultimately enhancing inpatients’ hospitalization experiences. PMID:27110101

  17. [The French Revolution and mental troubles 1789-1799].

    PubMed

    Sournia, J C

    1997-12-01

    Are wars and political strife factors in the cause of mental diseases? For instance what do we know about the French Revolution? Contemporary writers of memoirs are untrustworthy, whether opponents or supporters. We have neither morbiditiy nor mortality statistics nor accurate diagnostics, for the patients in public hospitals or private mental homes. A few cases are described for some mystical or political lunatic women, and some Jacobin leaders. The "psychiatrists" of that time have not noticed any increasing of insanity: a revolution is not enough to provoke mental disease, but it may reveal it.

  18. Patient expectations and their satisfaction in the context of public hospitals

    PubMed Central

    Berhane, Adugnaw; Enquselassie, Fikre

    2016-01-01

    Background Patient expectations have been recognized as a factor for patient satisfaction in medical consultations. Although various studies explored the relationship between patient expectations and patient satisfaction in developed countries, there is a lack of research evidence in Ethiopia where the meeting of patient expectations could relate to satisfaction. Objective To assess the relationship between patients’ expectations and their satisfaction in the consultation of patients at the outpatient department. Study design Data were collected regarding preconsultation expectations and postconsultation experiences of adult patients attending nine public hospitals. A systematic random sampling method was used where every fifth patient attending an outpatient department was selected. The patients were interviewed before consultation and after consultation to assess whether their pre-consultation expectations were met and to assess how satisfied they were with the consultation. Cronbach’s alpha statistic was used to assess the reliability of the expectation questionnaires, and paired t-test was used to assess any differences between previsit expectations and postvisit experiences. Logistic regression techniques were used to assess variables considered as independent factors for patient satisfaction. Results A total of 776 patients were interviewed, giving a response rate of 92.3%. About 93.7% mentioned a diagnosis for their condition as a reason for their current hospital visits. There is a significant difference between preconsultation expectation and postconsultation expectation. Postconsultation expectation, perceived health status, and perceived control on health were factors identified as increasing patient satisfaction. In addition, the presence of any disappointments or worries, previous experience in health care, and extent of influence on the consultation had a negative influence on satisfaction. Conclusion Postconsultation expectation impacts patient

  19. Deaths Rates in Public Hospitals of Eastern Cape Province of South Africa

    PubMed Central

    Buso, DL; Longo-Mbenza, B; Bovet, P; van den Borne, B; Okwe, A Nge; Mzingelwa, M

    2012-01-01

    Background: South Africa (SA) is experiencing a rapid epidemiologic transition as a consequence of political, economic and social changes. In this study we described, based on hospital data, the mortality patterns of Non communicable Diseases (NCD), Communicable Diseases (CD), the NCD/CD ratios, and the trends of deaths. Methods: We conducted a cross-sectional survey of all deaths occurring in several public hospitals in the Eastern Cape Province of SA between 2002 and 2006. Causes of deaths were coded according to the ICD 10 Edition. Results: A total of 107380 admissions responded to the inclusion criteria between 2002 and 2006. The crude death rate was 4.3% (n=4566) with a mean age of 46±21 years and a sex ratio of 3.1 men (n=3453): 1 woman (n=1113). Out of all deaths, there were 62.9% NCD (n=2872) vs. 37.1% CD (n=1694) with NCD/CD ratio of 1.7. The ratio NCD/CD deaths in men was 1.3 (n=1951/1502) vs. NCD/CD deaths in women of 1.9 (n=735/378). The peak of deaths was observed in winter season. The majority of NCD deaths were at age of 30–64 years, whereas the highest rate of CD deaths was at age< 30 years. The trend of deaths including the majority of NCD, increased from 2002 to 2006. There was a tendency of increase in tuberculosis deaths, but a tendency of decrease in HIV/AIDS deaths was from 2002 to 2006. Conclusion: Non-communicable diseases are the leading causes of deaths in rural Eastern Cape province of SA facing Post-epidemiologic transition stages. We recommend overarching priority actions for the response to the Non-communicable Diseases: policy change, prevention, treatment, international cooperation, research, monitoring, accountability, and re-orientation of health systems. PMID:23641386

  20. Prevalence and risk factors for gastroschisis in a public hospital from west México.

    PubMed

    Robledo-Aceves, Mireya; Bobadilla-Morales, Lucina; Mellín-Sánchez, Estrella Lizbeth; Corona-Rivera, Alfredo; Pérez-Molina, J Jesús; Cárdenas-Ruiz Velasco, Juan José; Corona-Rivera, Jorge Román

    2015-05-01

    Mexico is recognized as a country with a high prevalence of gastroschisis, although the cause of this remains unclear. We define the prevalence and potential risk factors for gastroschisis in a public hospital from west México. A case-control study was conducted among 270 newborns, including 90 patients with nonsyndromic gastroschisis (cases) and 180 infants without birth defects (controls), born all during the period 2009 to 2013 at the Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" (Guadalajara, Mexico), from a total of 51,145 live births. Potential maternal risk factors for gastroschisis were compared using multivariate logistic regression analysis to evaluate the deviance explained by different variables of interest. The overall prevalence of gastroschisis in live births was 17.6 per 10,000 births (95% confidence interval [CI] 14.0-21.2), whereas in offspring of women ≤ 19 years old was 29.9 per 10,000 births (95% CI 21.9-38.0). Mothers ≤ 19 years (adjusted odds ratio [aOR] 2.8: 95% CI 1.5-5.1), anemia during pregnancy (aOR 10.7; 95% CI 2.0-56.9), first-trimester exposure to hormonal contraceptives (aOR 3.7; 95% CI 1.0-13.0), and first-trimester alcohol consumption (aOR 3.4; 95% CI 1.6-7.3), were associated with gastroschisis. Contrarily, adjusted OR for pre-pregnancy body mass index ≥ 25 kg/m(2) has protective odds (aOR 0.2; 95% CI 0.1-0.5). Our results suggest an increased risk for gastroschisis among mothers under the age of 20, with anemia during pregnancy, and those who used hormonal contraceptives or consumed alcohol during early pregnancy, whereas, pre-pregnancy overweight has a protective OR, and they are discussed as clues in its pathogenesis.

  1. Submerged discontent and patterns of accommodation: a case study of doctors' pay in two public hospitals in China.

    PubMed

    Cao, Xuebing

    2014-01-01

    The article evaluates submerged discontent among Chinese public hospital doctors (Note1) regarding their pay and patterns of accommodation, including doctors' responses through formal and informal actions in the context of health service marketization. On the basis of a case study of two public hospitals, the article illustrates the dynamical impact of marketization on Chinese doctors' pay-related dissatisfaction and health service employment relationship. Because of the authoritarian management and compliant trade unions, the conflict between doctors and hospitals is unable to be accommodated through collective methods. Instead, doctors' discontent is often channelled through informal, individual and subtle activities. Meanwhile, doctors' professional society is gradually influential, showing its potential of developing doctors' group identity and protecting members' interests in future. PMID:23737394

  2. Training Needs of Nurses in Public Hospitals in Australia: Review of Current Practices and Future Research Agenda

    ERIC Educational Resources Information Center

    Carlisle, Joanna; Bhanugopan, Ramudu; Fish, Alan

    2011-01-01

    Purpose: This paper seeks to provide an overview of the concept of training needs analysis (TNA), current practice, models and the impact that training needs analysis currently has on nurses in public hospitals in Australia. Thus, the paper should aid future research in the area of TNA of nurses through helping researchers to clarify the…

  3. Comparison of patients’ and nurses’ viewpoints about responsiveness among a sample from public and private hospitals of Isfahan

    PubMed Central

    Javadi, Marzieh; Karimi, Saeed; Raiesi, Ahmadreza; Yaghoubi, Maryam; Kaveh, Keyvan

    2011-01-01

    BACKGROUND: Health systems search for ways of making their services more responsive to patients and the public The new framework of the World Health Organization (WHO) for assessment of health system performance has determined health, responsiveness and fairness of financing as the main goals. This study aimed to compare patients’ and nurses’ view points about responsiveness among a sample of public and private hospitals of Isfahan, Iran. METHODS: A descriptive study was conducted on 160 nurses and also equal number of patients. Data were collected by a valid and reliable questionnaire designed by WHO. Data were analyzed using SPSS software. Scores were reported as mean (standard deviation). RESULTS: Mean score of responsiveness was 2.4(0.58) in nurses and 2.3(0.54) in patients but the difference was not statistically significant (out of a maximum of 4). The corresponding figures were significantly different (p = 0.009) regarding patients’ viewpoints in public [2.2(0.4)] and private hospitals [2.3(0.5)]. CONCLUSIONS: Proper satisfaction about responsiveness was not provided in studied hospitals, based on the nurses’ and patients’ points of view. Public hospitals, in spite of their high costs, had a worse situation about responsiveness; the improvement of this situation necessitates managerial policies. PMID:23450853

  4. Discussion on a Public Hospital's Practice in Culture Shaping and Innovative Development.

    PubMed

    Zhang, Peiying

    2015-05-01

    Culture shaping is an important part of a hospital's quality management to enhance its medical service, improve doctor-patient relations, and cement its brand image (Jianping and Hong in Chinese Hospital Management 29(1):36-37, 2009). First built in 1953, Xuzhou Central Hospital is a tertiary general hospital in the Huaihai Economic Zone and has won a series of honorary titles for its reforms, innovations, and the level of medical services provided. In recent years, the hospital has increased its efforts in culture shaping through the construction of special departments, medical services, hospital culture, and professional ethics. This has resulted in substantial progress in the hospital's medical capabilities and service quality, and laid a solid foundation to achieve its ambitious goal of becoming a nationally prestigious hospital, among the best in Jiangsu and a regional healthcare center in the Huaihai Economic Zone. PMID:25534489

  5. Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

    PubMed

    Brockopp, Dorothy; Hill, Karen; Moe, Krista; Wright, Lonnie

    2016-01-01

    Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings.

  6. Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

    PubMed

    Brockopp, Dorothy; Hill, Karen; Moe, Krista; Wright, Lonnie

    2016-01-01

    Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings. PMID:26641469

  7. Implementing chronic disease management in the public healthcare sector in Singapore: the role of hospitals.

    PubMed

    Cheah, J; Heng, B H

    2001-01-01

    The public health care delivery system in Singapore faces the challenges of a rapidly ageing population, an increasing chronic disease burden, increasing healthcare cost, rising expectations and demand for better health services, and shortage of resources. It is also fragmented, resulting in duplication and lack of coordination between institutions. A disease management approach has been adopted by the National Healthcare Group (NHG) as a critical strategy to provide holistic, cost-effective, seamless and well-coordinated care across the continuum. The framework in the development of the disease management plan included identifying the diseases and defining the target population, organizing a multi-disciplinary team lead by a clinician champion, defining the core components, treatment protocols and evaluation methods, defining the goals, and measuring and managing the outcomes. As disease management and case management for chronic diseases are new approaches adopted in the healthcare delivery system, there is a lack of understanding by healthcare professionals. The leadership and participation of hospital physicians was sought in the planning, design and outcomes monitoring to ensure their 'buy-in' and the successful implementation and effectiveness of the program. The episodic diagnosis related group (DRG)-based framework of funding and subvention for healthcare, and the shortage of step-care care facilities, have been recognized by the Ministry of Health as an impediments to the implementation, and these are currently being addressed.

  8. Frequency of Magnetic Resonance Imaging patterns of tuberculous spondylitis in a public sector hospital

    PubMed Central

    Tabassum, Sumera; Haider, Shahbaz

    2016-01-01

    Objective: To determine frequencies of different MRI patterns of tuberculous spondylitisin a public sector hospital in Karachi. Methods: This descriptive multidisciplinary case series study was done from October 25, 2011 to May 28, 2012 in Radiology Department and Department of Medicine in the Jinnah Postgraduate Medical Center Karachi. MRI scans (dorsal / lumbosacral spine) of the Patients presenting with backache in Medical OPD, were performed in Radiology Department. Axial and sagittal images of T1 weighted, T2 weighted and STIR sequences of the affected region were taken. A total of 140 patients who were diagnosed as having tuberculous spondylitis were further evaluated and analyzed for having different patterns of involvement of the spine and compared with similar studies. Results: Among frequencies of different MRI pattern of tuberculous spondylitis, contiguous vertebral involvement was 100%, discal involvement 98.6%, paravertebral abscess 92.1% cases, epidural abscess 91.4%, spinal cord / thecal sac compression 89.3%, vertebral collapse 72.9%, gibbus deformity 42.9% and psoas abscess 36.4%. Conclusion: Contiguous vertebral involvement was commonest MRI pattern, followed by disk involvement, paravertebral & epidural abscesses, thecal sac compression and vertebral collapse. PMID:27022369

  9. Oncogenetics service and the Brazilian public health system: the experience of a reference Cancer Hospital

    PubMed Central

    Palmero, Edenir I.; Galvão, Henrique C.R.; Fernandes, Gabriela C.; de Paula, André E.; Oliveira, Junea C.; Souza, Cristiano P.; Andrade, Carlos E.; Romagnolo, Luis G.C.; Volc, Sahlua; C., Maximiliano; Sabato, Cristina; Grasel, Rebeca; Mauad, Edmundo; Reis, Rui M.; Michelli, Rodrigo A.D.

    2016-01-01

    Abstract The identification of families at-risk for hereditary cancer is extremely important due to the prevention potential in those families. However, the number of Brazilian genetic services providing oncogenetic care is extremely low for the continental dimension of the country and its population. Therefore, at-risk patients do not receive appropriate assistance. This report describes the creation, structure and management of a cancer genetics service in a reference center for cancer prevention and treatment, the Barretos Cancer Hospital (BCH). The Oncogenetics Department (OD) of BCH offers, free of charge, to all patients/relatives with clinical criteria, the possibility to perform i) genetic counseling, ii) preventive examinations and iii) genetic testing with the best quality standards. The OD has a multidisciplinary team and is integrated with all specialties. The genetic counseling process consists (mostly) of two visits. In 2014, 614 individuals (371 families) were seen by the OD. To date, over 800 families were referred by the OD for genetic testing. The support provided by the Oncogenetics team is crucial to identify at-risk individuals and to develop preventive and personalized behaviors for each situation, not only to the upper-middle class population, but also to the people whose only possibility is the public health system. PMID:27192127

  10. [Generating health elicits illness? The contradictions of work performed in emergency care units of public hospitals].

    PubMed

    Rosado, Iana Vasconcelos Moreira; Russo, Gláucia Helena Araújo; Maia, Eulália Maria Chaves

    2015-10-01

    In general terms, health is influenced and generated by the interaction of biological, social, economic, political and cultural factors. From this standpoint, the scope of this paper was to analyze the relationship between working in emergency care units of public hospitals and the health/sickness of the professionals who work in them. It involved a quantitative and qualitative survey, in which 240 health professionals (doctors, nurses, social workers, psychologists, dentists, nutritionists, audiologists, physiotherapists and occupational therapists) filled out a questionnaire. All the results acknowledged the importance of work to ensure favorable conditions for good health. However, they highlighted its deleterious physical and mental effects on workers, which included stress, lack of a healthy life-style, high blood pressure and musculoskeletal, gastrointestinal and sleep disorders. It is therefore important to tackle this reality in order to enhance the health of professionals and, consequently, the quality of care provided to the user, since illnesses among health workers are strongly linked to the existing health model in society. PMID:26465845

  11. [Public hospital emergency department visits due to burns in Brazil, 2009].

    PubMed

    Gawryszewski, Vilma Pinheiro; Bernal, Regina Tomie Ivata; Silva, Nilza Nunes da; Morais Neto, Otaliba Libânio de; Silva, Marta Maria Alves da; Mascarenhas, Márcio Dênis Medeiros; Sá, Naíza Nayla Bandeira de; Monteiro, Rosane Aparecida; Malta, Deborah Carvalho

    2012-04-01

    The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED) and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%), and the most prevalent age brackets were 30-49 years (23.1%) and 0-4 years (23%). Most burns occurred at home (62.1%), especially among females and children, and in commerce/services/industry/construction (19.1%), mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6%) and exposure to fire and flames (24.2%); among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with injuries at home, contact with heat and hot substances, and subsequent hospitalization; burns in the 15-49-year bracket were associated with exposure to fire/flames and electrical current, injuries occurring in public places, and outpatient treatment and discharge. The study highlights the importance of burn prevention strategies targeting children and workers.

  12. [Public hospital emergency department visits due to burns in Brazil, 2009].

    PubMed

    Gawryszewski, Vilma Pinheiro; Bernal, Regina Tomie Ivata; Silva, Nilza Nunes da; Morais Neto, Otaliba Libânio de; Silva, Marta Maria Alves da; Mascarenhas, Márcio Dênis Medeiros; Sá, Naíza Nayla Bandeira de; Monteiro, Rosane Aparecida; Malta, Deborah Carvalho

    2012-04-01

    The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED) and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%), and the most prevalent age brackets were 30-49 years (23.1%) and 0-4 years (23%). Most burns occurred at home (62.1%), especially among females and children, and in commerce/services/industry/construction (19.1%), mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6%) and exposure to fire and flames (24.2%); among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with injuries at home, contact with heat and hot substances, and subsequent hospitalization; burns in the 15-49-year bracket were associated with exposure to fire/flames and electrical current, injuries occurring in public places, and outpatient treatment and discharge. The study highlights the importance of burn prevention strategies targeting children and workers. PMID:22488309

  13. Knowledge about breast cancer and hereditary breast cancer among nurses in a public hospital 1

    PubMed Central

    Prolla, Carmen Maria Dornelles; da Silva, Patrícia Santos; Netto, Cristina Brinckmann Oliveira; Goldim, José Roberto; Ashton-Prolla, Patricia

    2015-01-01

    OBJECTIVE: To assess the knowledge of nurses involved in the care of oncology patients in a public university hospital, regarding breast cancer and hereditary breast cancer, and to verify the use of such knowledge in their daily practice. METHODS: This is a descriptive cross-sectional study. Data were obtained through a structured, self-administered questionnaire. Out of 154 nurses, 137 (88.9%) agreed to participate in the study. Two questionnaires were excluded such that 135 questionnaires were analyzed. RESULTS: The global percentage of correct answers was not associated with age (p=0.173) or degree/specialization (p=0.815). Questions were classified into categories. In categories involving knowledge of established breast cancer risk factors and indicators of hereditary breast cancer, the rate of correct answers was 65.8% and 66.4%, respectively. On the practice of genetic counseling, 40.7% of those interviewed were not sure about the definition of genetic counseling and 78.5% reported never having identified or referred a patient at genetic risk for specialized risk assessment. Practice of educational actions regarding this subject was reported by 48.5% of those interviewed. CONCLUSION: This study reinforces the need to develop qualifying actions for nurses, so that strategies to control breast cancer become effective in their health care practice. PMID:25806636

  14. Satellite teaching hospitals and public-private collaborations in veterinary medical clinical education.

    PubMed

    Lloyd, James W; Fingland, Roger; Arighi, Mimi; Thompson, James; de Laforcade, Armelle; McManus, Joseph

    2008-01-01

    Veterinary teaching hospitals (VTHs) are facing more and greater challenges than at any time in the past. Changes in demand, expanding information, improving technology, an evolving workforce, declining state support, and an increasingly diverse consumer base have combined to render many traditional VTH modes of operation obsolete. In pursuit of continued success in achieving their academic mission, VTHs are exploring new business models, including innovative collaborations with the private sector. This report provides details on existing models for public-private collaboration at several colleges and schools of veterinary medicine, including those at Kansas State University, Purdue University, the University of Florida, and Tufts University. Although each of these institutions' models is unique, several commonalities exist, related to expansion of the case load available for teaching, the potential positive impact on recruitment and retention of clinical faculty, and the potential for easing financial pressures on the associated VTH. These new models represent innovative approaches that work to meet many of the key emerging challenges facing VTHs today.

  15. French Neurologists during World War I.

    PubMed

    Walusinski, Olivier; Tatu, Laurent; Bogousslavsky, Julien

    2016-01-01

    The Great War accelerated the development of neurological knowledge. Many neurological signs and syndromes, as well as new nosological entities such as war psychoneuroses, were described during the conflict. The period between 1914 and 1918 was the first time in which many neurologists were concentrated in wartime neurology centres and confronted with a number of neurological patients never seen before. This concentration led to the publication of papers concerning all fields of neurological sciences, and these reports pervaded scientific journals during the conflict and the post-war years. The careers of French neurologists during the war were highly varied. Some were mobilised, whilst others enlisted voluntarily. They worked as regiment physicians at the front or in wartime neurology centres at the front or at the rear. Others were academics who were already authoritative names in the field of neurology. Whilst they were too old to be officially mobilised, they nevertheless worked in their militarised neurology departments of civil hospitals. We present here the careers of a few French neurologists during the Great War, including Charles Foix (1882-1927), René Cruchet (1875-1959), Georges Guillain (1876-1961), Jean Lhermitte (1877-1959), Clovis Vincent (1879-1947), Gustave Roussy (1874-1948), and Paul Sollier (1861-1933).

  16. French Neurologists during World War I.

    PubMed

    Walusinski, Olivier; Tatu, Laurent; Bogousslavsky, Julien

    2016-01-01

    The Great War accelerated the development of neurological knowledge. Many neurological signs and syndromes, as well as new nosological entities such as war psychoneuroses, were described during the conflict. The period between 1914 and 1918 was the first time in which many neurologists were concentrated in wartime neurology centres and confronted with a number of neurological patients never seen before. This concentration led to the publication of papers concerning all fields of neurological sciences, and these reports pervaded scientific journals during the conflict and the post-war years. The careers of French neurologists during the war were highly varied. Some were mobilised, whilst others enlisted voluntarily. They worked as regiment physicians at the front or in wartime neurology centres at the front or at the rear. Others were academics who were already authoritative names in the field of neurology. Whilst they were too old to be officially mobilised, they nevertheless worked in their militarised neurology departments of civil hospitals. We present here the careers of a few French neurologists during the Great War, including Charles Foix (1882-1927), René Cruchet (1875-1959), Georges Guillain (1876-1961), Jean Lhermitte (1877-1959), Clovis Vincent (1879-1947), Gustave Roussy (1874-1948), and Paul Sollier (1861-1933). PMID:27035726

  17. Public-private settlement and hospital mortality per sources of payment

    PubMed Central

    Machado, Juliana Pires; Martins, Mônica; Leite, Iuri da Costa

    2016-01-01

    ABSTRACT OBJECTIVE To analyze if the adjusted hospital mortality varies according to source of payment of hospital admissions, legal nature, and financing settlement of hospitals. METHODS Cros-ssectional study with information source in administrative databases. Specific hospital admission reasons were selected considering the volume of hospital admissions and the list of quality indicators proposed by the North-American Agency for Healthcare Research and Quality (AHRQ). Were analyzed 852,864 hospital admissions of adults, occurred in 789 hospitals between 2008 and 2010, in Sao Paulo and Rio Grande do Sul, applying multilevel logistic regression. RESULTS At hospital admission level, showed higher chances of death male patients in more advanced age groups, with comorbidity, who used intensive care unit, and had the Brazilian Unified Health System as source of payment. At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System. This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%. CONCLUSIONS In addition to structural characteristics of the hospitals and the profile of the patients, interventions aimed at improving care should also consider the coverage of the population by health plans, the network shared between beneficiaries of plans and users of the Brazilian Unified Health System, the standard of care to the various sources of payment by hospitals and, most importantly, how these factors influence the clinical performance. PMID:27463256

  18. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study

    PubMed Central

    Pell, Jill P; Sirel, Jane M; Marsden, Andrew K; Ford, Ian; Walker, Nicola L; Cobbe, Stuart M

    2002-01-01

    Objective To estimate the potential impact of public access defibrillators on overall survival after out of hospital cardiac arrest. Design Retrospective cohort study using data from an electronic register. A statistical model was used to estimate the effect on survival of placing public access defibrillators at suitable or possibly suitable sites. Setting Scottish Ambulance Service. Subjects Records of all out of hospital cardiac arrests due to heart disease in Scotland in 1991-8. Main outcome measures Observed and predicted survival to discharge from hospital. Results Of 15 189 arrests, 12 004 (79.0%) occurred in sites not suitable for the location of public access defibrillators, 453 (3.0%) in sites where they may be suitable, and 2732 (18.0%) in suitable sites. Defibrillation was given in 67.9% of arrests that occurred in possibly suitable sites for locating defibrillators and in 72.9% of arrests that occurred in suitable sites. Compared with an actual overall survival of 744 (5.0%), the predicted survival with public access defibrillators ranged from 942 (6.3%) to 959 (6.5%), depending on the assumptions made regarding defibrillator coverage. Conclusions The predicted increase in survival from targeted provision of public access defibrillators is less than the increase achievable through expansion of first responder defibrillation to non-ambulance personnel, such as police or firefighters, or of bystander cardiopulmonary resuscitation. Additional resources for wide scale coverage of public access defibrillators are probably not justified by the marginal improvement in survival. What is already known on this topicThree quarters of all deaths from acute coronary events occur before the patient reaches a hospitalDefibrillation is an independent predictor of survival from out of hospital cardiac arrestThe probability of a rhythm being amenable to defibrillation declines with timeInterest in providing public access defibrillators to reduce the time to

  19. The change in capacity and service delivery at public and private hospitals in Turkey: A closer look at regional differences

    PubMed Central

    2010-01-01

    Background Substantial regional health inequalities have been shown to exist in Turkey for major health indicators. Turkish data on hospitals deserves a closer examination with a special emphasis on the regional differences in the context of the rapid privatization of the secondary or tertiary level health services. This study aims to evaluate the change in capacity and service delivery at public and private hospitals in Turkey between 2001-2006 and to determine the regional differences. Methods Data for this retrospective study was provided from Statistical Almanacs of Inpatient Services (2001-2006). Hospitals in each of the 81 provinces were grouped into two categories: public and private. Provinces were grouped into six regions according to a development index composed by the State Planning Organisation. The number of facilities, hospital beds, outpatient admissions, inpatient admissions (per 100 000), number of deliveries and surgical operations (per 10 000) were calculated for public and private hospitals in each province and region. Regional comparisons were based on calculation of ratios for Region 1(R1) to Region 6(R6). Results Public facilities had a fundamental role in service delivery. However, private sector grew rapidly in Turkey between 2001-2006 in capacity and service delivery. In public sector, there were 2.3 fold increase in the number of beds in R1 to R6 in 2001. This ratio was 69.9 fold for private sector. The substantial regional inequalities in public and private sector decreased for the private sector enormously while a little decrease was observed for the public sector. In 2001 in R1, big surgical operations were performed six times more than R6 at the public sector whereas the difference was 117.7 fold for the same operations in the same regions for the private sector. These ratios decreased to 3.6 for the public sector and 13.9 for the private sector in 2006. Conclusions The private health sector has grown enormously between 2001-2006 in

  20. The effect of internal marketing on job satisfaction in health services: a pilot study in public hospitals in Northern Greece

    PubMed Central

    2011-01-01

    Background The purpose of this study was to explore the effect of internal marketing on job satisfaction in health services, particularly in public hospitals in Northern Greece. Methods A questionnaire with three sections was used. The first one referred to internal marketing by using Foreman and Money's scale, while the second one contained questions on job satisfaction based on Stamps and Piermonte's work. The last section included demographic questions. Three categories of health care professionals, nurses, doctors and paramedic personnel working in public hospitals have participated. Results Doctors tend to be more satisfied with their job than nurses in the same hospitals. Male personnel also tend to be more satisfied with their job than female. Time-defined work contract personnel have a greater level of job satisfaction than permanent personnel. Marital status, position, and educational level have no statistically significant impact on job satisfaction. A slight decline in job satisfaction occurs as the personnel age. Conclusions Internal marketing has a positive effect on the job satisfaction of hospital staff in Northern Greece. Also, doctors and male personnel seem to have greater levels of job satisfaction. Staff with time-defined work contracts with the hospital are more satisfied than permanent staff, and as the staff age, there is a slight decline in job satisfaction. PMID:21981753

  1. Measuring and Benchmarking Technical Efficiency of Public Hospitals in Tianjin, China: A Bootstrap-Data Envelopment Analysis Approach.

    PubMed

    Li, Hao; Dong, Siping

    2015-01-01

    China has long been stuck in applying traditional data envelopment analysis (DEA) models to measure technical efficiency of public hospitals without bias correction of efficiency scores. In this article, we have introduced the Bootstrap-DEA approach from the international literature to analyze the technical efficiency of public hospitals in Tianjin (China) and tried to improve the application of this method for benchmarking and inter-organizational learning. It is found that the bias corrected efficiency scores of Bootstrap-DEA differ significantly from those of the traditional Banker, Charnes, and Cooper (BCC) model, which means that Chinese researchers need to update their DEA models for more scientific calculation of hospital efficiency scores. Our research has helped shorten the gap between China and the international world in relative efficiency measurement and improvement of hospitals. It is suggested that Bootstrap-DEA be widely applied into afterward research to measure relative efficiency and productivity of Chinese hospitals so as to better serve for efficiency improvement and related decision making.

  2. French on the Advanced Level.

    ERIC Educational Resources Information Center

    Pawlik, Teresa Wilkinson

    1969-01-01

    Presented in this article is an outline of some of the special interest course work included in the curriculum guidelines being developed in the Atlanta Public Schools System for advanced secondary school French classes. Titles of the audiolingually-oriented courses described are--(1) "Teenagers and Teenage Life in France Today," (2) "The Arts in…

  3. [Update on the epidemiology of malaria in French Guiana].

    PubMed

    Carme, B; Ardillon, V; Girod, R; Grenier, C; Joubert, M; Djossou, F; Ravachol, F

    2009-02-01

    The last study describing the epidemiology of malaria in French Guiana was published 20 years ago. Yet French Guiana in the Americas along with Mayotte in the Indian Ocean is the only French territory with persisting endemic malaria. The purpose of this study is to provide an update based on official malaria surveillance data as well as on information from hospital records and various field surveys that have been carried out in recent years. Due to recurrent problems in collecting thorough, continuous, and consistent data, exact determination of incidence by plasmodium species has always been difficult in French Guiana. These problems include not only the remote location of endemic areas and intense unpredictable migration patterns but also poor data collection methods that do not always ensure consistency and homogeneity. Another factor hindering thorough collection of conventional epidemiological data is the requirement for rapid effective treatment in remote regions. The overall incidence of malaria in French Guiana appears to have remained stable since the beginning of the decade with an average of 3,920 case reports per year for an incidence rate of 20 per thousand, noting that three fourths of the 206,000 inhabitants of French Guiana live outside of endemic areas. Overall involvement of P. falciparum and P. vivax appears to be equal with P. malariae accounting for only 2.6% of cases. Trends in recent years indicate an increase in the number of cases involving P. vivax especially in the eastern zones, i.e. in the Oyapock focus where annual incidences in children have reached up to 500 per thousand and in the whole region located between Saint Georges and Cayenne. Conversely a decrease in endemic levels has been observed in western areas, especially for P. falciparum in the upper and middle focuses of the Maroni. Most zones now causing problems are located near migration points, particularly in relation with clandestine gold panning activities. In the coastal

  4. Discharge against medical advice: a case study in a public teaching hospital in Tehran, Iran in 2012.

    PubMed

    Bahadori, Mohammadkarim; Raadabadi, Mehdi; Salimi, Mohammad; Ravangard, Ramin

    2013-11-01

     Discharging against medical advice is to leave the hospital despite the advice of the doctor, which can result in complications and readmissions. This study aimed to examine the prevalence of patients' discharge against medical advice (DAMA) and their reasons in a public teaching hospital in Tehran, Iran in 2012. This was an applied and cross-sectional study in which all patients (2601 patients) who had been discharged against medical advice from the studied hospital in 2012 were studied. Required data were collected using a data collection form. Collected data were analyzed using SPSS 18.0 and descriptive and analytical tests including Frequencies and Fisher's Exact Test. The most and least common reasons for DAMA were, respectively, feeling complete recovery by patients (45.4%) and financial problems (1.3%). The results showed that there were significant differences between DAMA prevalence and patients' sex and age (P<0.001). The prevalence of DAMA in the studied hospital was high and according to the existence of social work units in every hospital, it is recommended that patients' consultation with the hospital social workers should be considered as an obligatory stage of the discharge against medical advice process in order to inform patients about its complications and adverse consequences.

  5. Income, location, and the demand for health care from public, nonprofit, and for-profit hospitals.

    PubMed

    Brown, H S

    2001-01-01

    Although, empirically, for-profit hospitals serve few poor and indigent patients, they may be able to shift capital more quickly than hospitals of other ownership types, thereby spatially avoiding poor patients. However, in a market with a relatively high proportion of for-profit hospitals, spatial avoidance of poor patients is not possible because spatial competition will exist in non-poor areas. The study examines hospital choice for maternity care in a market with many for-profits using a gravity model or conditional logit. The analysis shows that poor and Medicaid populations choose for-profit hospitals overall. Income, along with distance, is an important factor in hospital choice. PMID:11434711

  6. Moving beyond ward based treatment: a public mental health hospital's transition to a treatment mall.

    PubMed

    Holland, Joy; Vidoni-Clark, Clotilde; Prandoni, Jogues R; Fain, Michael R; Richardson, E Jacqueline; Montalbano, Paul

    2005-01-01

    Saint Elizabeths Hospital in Washington D.C. implemented a treatment mall in 2002. The authors place the mall's development within the context of the Hospital's problems associated with ward-based treatment. They describe objectives in developing the mall, steps taken to prepare staff and hospitalized persons, and the mall's structure and programs. Providing treatment in a mall setting increased active treatment, expanded opportunities for trainees and staff, and improved monitoring of treatment activities.

  7. Seroepidemiology of Toxoplasma gondii infection in pregnant women in a public hospital in northern Mexico

    PubMed Central

    Alvarado-Esquivel, Cosme; Sifuentes-Álvarez, Antonio; Narro-Duarte, Sergio Guadalupe; Estrada-Martínez, Sergio; Díaz-García, Juan Humberto; Liesenfeld, Oliver; Martínez-García, Sergio Arturo; Canales-Molina, Arturo

    2006-01-01

    Background Toxoplasma gondii (T. gondii) infection in pregnant women represents a risk for congenital disease. There is scarce information about the epidemiology of T. gondii infection in pregnant women in Mexico. Therefore, we sought to determine the prevalence of T. gondii infection and associated socio-demographic, clinical and behavioural characteristics in a population of pregnant women of Durango City, Mexico. Methods Three hundred and forty three women seeking prenatal care in a public hospital of Durango City in Mexico were examined for T. gondii infection. All women were tested for anti-T. gondii IgM and IgG antibodies by using IMx Toxo IgM and IMx Toxo IgG 2.0 kits (Abbott Laboratories, Abbott Park, IL, USA), respectively. Socio-demographic, clinical and behavioural characteristics from each participant were also obtained. Results Twenty one out of the 343 (6.1%) women had IgG anti-T. gondii antibodies. None of the 343 women had IgM anti-T. gondii antibodies. Multivariate analysis using logic regression showed that T. gondii infection was associated with living in a house with soil floor (adjusted OR = 7.16; 95% CI: 1.39–36.84), residing outside of Durango State (adjusted OR = 4.25; 95% CI: 1.72–10.49), and turkey meat consumption (adjusted OR = 3.85; 95% CI: 1.30–11.44). Other characteristics as cat contact, gardening, and food preferences did not show any association with T. gondii infection. Conclusion The prevalence of T. gondii infection in pregnant women of Durango City is low as compared with those reported in other regions of Mexico and the majority of other countries. Poor housing conditions as soil floors, residing in other Mexican States, and turkey meat consumption might contribute to acquire T. gondii infection. PMID:16839423

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

    PubMed

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

    2016-01-01

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

  9. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia.

    PubMed

    Brown, Laurie; Barnett, J Ross

    2004-01-01

    A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied 'pride of place'. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of 'public' and 'private'. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised 'health care' space. This space is neither private nor public but a reflection of the economic, political and social processes underlying this transformation. PMID:14604626

  10. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia.

    PubMed

    Brown, Laurie; Barnett, J Ross

    2004-01-01

    A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied 'pride of place'. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of 'public' and 'private'. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised 'health care' space. This space is neither private nor public but a reflection of the economic, political and social processes underlying this transformation.

  11. Library Services to Hospital Patients and Handicapped Readers Section. Libraries Serving the General Public Division. Papers.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    Papers on library services to hospital personnel, hospital patients, and housebound or handicapped persons, which were presented at the 1983 International Federation of Library Associations (IFLA) conference, include: (1) "Education and Training for Health Care Librarianship," in which Antonia J. Bunch (United Kingdom) discusses the scope of and…

  12. Transfer between an Algerian and a French hospital of four multi-drug resistant bacterial strains together via a single patient

    PubMed Central

    Moissenet, Didier; Richard, Patrick; Granados, Maria; Mérens, Audrey; Fournier, Damien; Fines-Guyon, Marguerite; Arlet, Guillaume; Vu-Thien, Hoang

    2015-01-01

    A 5 years-old girl, seriously burnt with fire, was first hospitalized during four days in an hospital at Alger, and then transferred to our hospital at Paris. Admitted in our intensive care burns unit, she was third degree burnt on 78% of total body surface area, already treated with imipenem and vancomycin at her arrival. Clinical aggravation was rapidly observed and death occurred within 24 hours. Cultures of blood and multiple wound swabs yielded 3 multi-drug resistant bacterial strains: Acinetobacter baumannii with carbapenemase OXA-23, Pseudomonas aeruginosa serotype O11 with metallo-ß-lactamase VIM-4 and Klebsiella pneumoniae with CTX-M-15 extended-spectrum ß-lactamase. Culture of a rectal swab showed colonization by Enterococcus faecium with vanA glycopeptides resistance. Patients colonized with one or two multi-drug-resistant strains were not rare in our burns unit, especially those transferred from Algeria, but this case of a single patient harboring four multi-drug-resistant strains is exceptional. PMID:26550534

  13. Transfer between an Algerian and a French hospital of four multi-drug resistant bacterial strains together via a single patient.

    PubMed

    Moissenet, Didier; Richard, Patrick; Granados, Maria; Mérens, Audrey; Fournier, Damien; Fines-Guyon, Marguerite; Arlet, Guillaume; Vu-Thien, Hoang

    2015-01-01

    A 5 years-old girl, seriously burnt with fire, was first hospitalized during four days in an hospital at Alger, and then transferred to our hospital at Paris. Admitted in our intensive care burns unit, she was third degree burnt on 78% of total body surface area, already treated with imipenem and vancomycin at her arrival. Clinical aggravation was rapidly observed and death occurred within 24 hours. Cultures of blood and multiple wound swabs yielded 3 multi-drug resistant bacterial strains: Acinetobacter baumannii with carbapenemase OXA-23, Pseudomonas aeruginosa serotype O11 with metallo-ß-lactamase VIM-4 and Klebsiella pneumoniae with CTX-M-15 extended-spectrum ß-lactamase. Culture of a rectal swab showed colonization by Enterococcus faecium with vanA glycopeptides resistance. Patients colonized with one or two multi-drug-resistant strains were not rare in our burns unit, especially those transferred from Algeria, but this case of a single patient harboring four multi-drug-resistant strains is exceptional. PMID:26550534

  14. Implementation of smoking ban: a survey in a public hospital setting.

    PubMed

    Principe, Rosastella; Paone, Gregorino; Damante, Salvatore; Fuselli, Sergio; Palermo, Patrizio; De Marchis, Laura; Massafra, Simonetta; Zuccaro, Piergiorgio

    2014-06-01

    Smoking in hospitals is banned in most of European countries; nevertheless, implementing a total smoking ban is particularly difficult and policy breaches are frequent. Aim of our study was to monitor the compliance with the smoke-free policy within a hospital district by measuring particulate matters (PM2.5). We designed an observational study and identified six sensitive locations within the hospitals: surgical units, administrative offices, hall, outdoor main entrances and as controls an outdoor and an indoor area. To rule out potential confounders we included in the evaluation the roadways surrounding the hospital district. PM2.5 median concentrations observed in outdoor main entrances and in hall were significantly higher (16.4 and 13.4 µg m(-3)), as compared with the other settings (P < 0.0001). This data warrant an implementation of current policies to protect patients, visitors and employees from passive second-hand smoke leading to a smoking prohibition in any hospital surroundings.

  15. [Orthogeriatric activity in public hospitals of Castilla y León: description and review of the literature].

    PubMed

    Sáez López, Pilar; Martín Perez, Encarnación; González Ramírez, Alfonso; Pablos Hernández, Carmen; Jiménez Mola, Sonia; Vuelta Calzada, Esther; Cerón Fernández, Ana; Guerrero Díaz, Maria Teresa; del Pozo Tagarro, Pilar; Andrés Sáinz, Ana Isabel; Pereira de Castro Juez, Nieves; Cervera Díaz, Carmen; Muñoz Pascual, Angélica; Idoate Gil, Javier; Collado Díaz, Teresa; Perez-Jara Carrera, Javier; Vazquez Pedrezuela, Carmen; Prado Esteban, Florentino

    2014-01-01

    The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides.

  16. Molecular breast cancer subtypes and therapies in a public hospital of Northeastern Brazil

    PubMed Central

    2014-01-01

    Background The frequencies of molecular breast cancer subtypes vary among different human populations. The Northeastern region of Brazil has a mixed population of African, Indigenous and European ancestry. This retrospective study investigated breast cancer subtypes and applied therapies in a public hospital of Northeastern Brazil. Methods Data of 633 patients with invasive breast cancer from 2005 to 2011 were obtained from medical records. Status of hormone receptor (HR), HER2 and Ki67 expression index of 269 out of 633 patients were used to define subtypes of Luminal A and B, HER2 and triple negative (TN) breast cancer. Expression index of Ki67 ≥ 14% was applied to distinguish Luminal A from Luminal B subtypes. Results Overall, 185 (68.77%) and 132 (49.07%) patients showed positive hormone receptor (HR+) and positive HER2 (HER2+) tumors. The mean age ranged from 53.33 to 58.25 years for patients with tumors of Luminal B and Luminal A subtypes, respectively (p = 0.0182). In general, 67.39% of patients with TN tumors aged over 50 and 19.57% aged between 31 and 40 years (p = 0.0046). The rate of small tumors (T1: ≤ 2.0 cm) varied from 22.73% to 52.46% for TN and Luminal A subtypes (p = 0.0088). The rate of high graded (G3) tumors was increased for HER2 and TN subtypes (35.29% and 34.28%) compared to Luminal A and Luminal B subtypes (3.92% and 12.62%), respectively (p < 0.0001). The five-year survival rate ranged from 92.86% to 75.00%, for Luminal A, HER2 and TN subtypes, respectively (HR: 0.260 to 1.015; 95% CI: 0.043 to 3.594; p = 0.2589). Patients with HER2 positive (HER2+) breast tumors did not receive immunotherapy and chemotherapy application varied from 54.84% to 86.49% for Luminal A and HER2 subtypes, respectively (p = 0.0131). Conclusions The results of this study revealed a high percentage of HER2+ breast tumors and an increased rate of patients with TN tumors aged over 50 years. This emphasizes the need for establishing

  17. Public-private partnerships in the Canadian environment: options for hospital pharmacies.

    PubMed

    Uddin, Z; Bear, R A

    1997-01-01

    This brief report explores the direction being pursued by hospitals interested in outsourcing non-core activities within the pharmacy department. Private sector logistics companies are looking to position themselves in the drug product supply chain to facilitate seamless transfers of drug products, ordering information and payments between drug manufacturers and hospitals. Opportunities for implementing consolidated purchasing, unit dosing, just-in-time inventory and electronic commerce systems are discussed. PMID:10179076

  18. Assessing performance of Botswana’s public hospital system: the use of the World Health Organization Health System Performance Assessment Framework

    PubMed Central

    Seitio-Kgokgwe, Onalenna; Gauld, Robin DC; Hill, Philip C; Barnett, Pauline

    2014-01-01

    Background: Very few studies have assessed performance of Botswana public hospitals. We draw from a large research study assessing performance of the Botswana Ministry of Health (MoH) to evaluate the performance of public hospital system using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF). We aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the potential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing performance of hospital systems in a developing country. Methods: This article is based on data collected from document analysis, 54 key informants comprising senior managers and staff of the MoH (N= 40) and senior officers from stakeholder organizations (N= 14), and surveys of 42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and thematic analysis while data analysis for surveys was descriptive determining proportions and percentages. Results: The organizational structure of the Botswana’s public hospital system, authority and decision-making are highly centralized. Overall physical access to health services is high. However, challenges in the distribution of facilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals to deliver services is limited by inadequate resources. There are significant challenges with the quality of care. Conclusion: While Botswana invested considerably in building hospitals around the country resulting in high physical access to services, the organization and governance of the hospital system, and inadequate resources limit service delivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited. The WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively new, this approach proved useful in this

  19. Prevalence of β-Lactamases among 1,072 Clinical Strains of Proteus mirabilis: a 2-Year Survey in a French Hospital

    PubMed Central

    Chanal, C.; Bonnet, R.; De Champs, C.; Sirot, D.; Labia, R.; Sirot, J.

    2000-01-01

    β-Lactam resistance was studied in 1,072 consecutive P. mirabilis clinical strains isolated at the Clermont-Ferrand teaching hospital between April 1996 and March 1998. The frequency of amoxicillin resistance was 48.5%. Among the 520 amoxicillin-resistant isolates, three resistance phenotypes were detected: penicillinase (407 strains [78.3%]), extended-spectrum β-lactamase (74 strains [14.2%]), and inhibitor resistance (39 strains [7.5%]). The penicillinase phenotype isolates were divided into three groups according to the level of resistance to β-lactams, which was shown to be related to the strength of the promoter. The characterization of the different β-lactamases showed that amoxicillin resistance in P. mirabilis was almost always (97%) associated with TEM or TEM-derived β-lactamases, most of which evolved via TEM-2. PMID:10858357

  20. Strained local and state government finances among current realities that threaten public hospitals' profitability.

    PubMed

    Kane, Nancy M; Singer, Sara J; Clark, Jonathan R; Eeckloo, Kristof; Valentine, Melissa

    2012-08-01

    This study demonstrates that some safety-net hospitals--those that provide a large share of the care to low-income, uninsured, and Medicaid populations--survived and even thrived before the recent recession. We analyzed the financial performance and governance of 150 hospitals during 2003-07. We found, counterintuitively, that those directly governed by elected officials and in highly competitive markets were more profitable than other safety-net hospitals. They were financially healthy primarily because they obtained subsidies from state and local governments, such as property tax transfers or supplemental Medicaid payments, including disproportionate share payments. However, safety-net hospitals now face a new market reality. The economic downturn, slow recovery, and politics of deficit reduction have eroded the ability of local governments to support the safety net. Many safety-net hospitals have not focused on effective management, cost control, quality improvement, or services that attract insured patients. As a result, and coupled with new uncertainties regarding Medicaid expansion stemming from the recent Supreme Court decision on the Affordable Care Act, many are likely to face increasing financial and competitive pressures that may threaten their survival.

  1. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

    PubMed Central

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-01-01

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  2. Hospital respiratory protection practices in 6 U.S. states: A public health evaluation study

    PubMed Central

    Peterson, Kristina; Novak, Debra; Stradtman, Lindsay; Wilson, David; Couzens, Lance

    2015-01-01

    Background Lessons learned from the influenza A (H1N1) virus revealed a need to better understand hospitals’ respiratory protection programmatic practice gaps. This article reports findings from a multistate assessment of hospitals’ adherence to the Occupational Safety and Health Administration’s respiratory protection program (RPP) requirements and the Centers for Disease Control and Prevention’s infection control guidance. Methods Onsite surveys were conducted in 98 acute care hospitals in 6 U.S. states, including >1,500 hospital managers, unit managers, and health care workers. Descriptive statistics were used to assess hospital adherence. Results Most acute care hospitals adhere to requirements for initial medical evaluations, fit testing, training, and recommended respiratory protection when in close contact with patients who have suspected or confirmed seasonal influenza. Low hospital adherence was found for respiratory protection with infectious diseases requiring airborne precautions, aerosol-generating procedures with seasonal influenza, and checking of the respirator’s user seal. Hospitals’ adherence was also low with follow-up program evaluations, medical re-evaluations, and respirator maintenance. Conclusion Efforts should be made to closely examine ways of strengthening hospitals’ RPPs to ensure the program’s ongoing effectiveness and workers’ proper selection and use of respiratory protection. Implications for improved RPPs and practice are discussed. PMID:25564126

  3. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014.

    PubMed

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-08-11

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  4. Strained local and state government finances among current realities that threaten public hospitals' profitability.

    PubMed

    Kane, Nancy M; Singer, Sara J; Clark, Jonathan R; Eeckloo, Kristof; Valentine, Melissa

    2012-08-01

    This study demonstrates that some safety-net hospitals--those that provide a large share of the care to low-income, uninsured, and Medicaid populations--survived and even thrived before the recent recession. We analyzed the financial performance and governance of 150 hospitals during 2003-07. We found, counterintuitively, that those directly governed by elected officials and in highly competitive markets were more profitable than other safety-net hospitals. They were financially healthy primarily because they obtained subsidies from state and local governments, such as property tax transfers or supplemental Medicaid payments, including disproportionate share payments. However, safety-net hospitals now face a new market reality. The economic downturn, slow recovery, and politics of deficit reduction have eroded the ability of local governments to support the safety net. Many safety-net hospitals have not focused on effective management, cost control, quality improvement, or services that attract insured patients. As a result, and coupled with new uncertainties regarding Medicaid expansion stemming from the recent Supreme Court decision on the Affordable Care Act, many are likely to face increasing financial and competitive pressures that may threaten their survival. PMID:22869645

  5. Cost Convergence between Public and For-Profit Hospitals under Prospective Payment and High Competition in Taiwan

    PubMed Central

    Xirasagar, Sudha; Lin, Herng-Ching

    2004-01-01

    Objective To test the hypotheses that: (1) average adjusted costs per discharge are higher in high-competition relative to low-competition markets, and (2) increased competition is associated with cost convergence between public and for-profit (FP) hospitals for case payment diagnoses, but not for cost-plus reimbursed diagnoses. Data Sources Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost-based payment). Study Design Retrospective population-based, cross-sectional study. Data Analysis Diagnosis-wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics. Principal Findings Adjusted costs per discharge are higher for all diagnoses in high-competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost-based diagnoses. Conclusions We find that the empirical evidence supports both our hypotheses. PMID:15544646

  6. Explaining medical disputes in Chinese public hospitals: the doctor-patient relationship and its implications for health policy reforms.

    PubMed

    He, Alex Jingwei; Qian, Jiwei

    2016-10-01

    In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform.

  7. Explaining medical disputes in Chinese public hospitals: the doctor-patient relationship and its implications for health policy reforms.

    PubMed

    He, Alex Jingwei; Qian, Jiwei

    2016-10-01

    In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform. PMID:27018911

  8. French Computer Terminology.

    ERIC Educational Resources Information Center

    Gray, Eugene F.

    1985-01-01

    Characteristics, idiosyncrasies, borrowings, and other aspects of the French terminology for computers and computer-related matters are discussed and placed in the context of French computer use. A glossary provides French equivalent terms or translations of English computer terminology. (MSE)

  9. Recorded categories of non-principal diagnoses in Victorian public hospital transient ischaemic attack and stroke admissions.

    PubMed

    Nadathur, Shymala G

    2008-01-01

    Information about the number and types of non-principal diagnoses (NPDs) would make an important contribution to prediction of outcome and hence patient management. The study reported here is based on analysis of three fiscal years of the Victorian public hospital transient ischaemic attack (TIA) and stroke admissions. The incidence of NPDs and co-occurrence of NPD-associated prefix categories (that identify the onset or relevance of each condition to the episode) are described in each of the broad stroke subtypes. The distributions of length of stay and in-hospital deaths in the cohorts without and with NPDs and in the various prefix categories are determined. The study also compares the age and gender distribution in the various subpopulations of interest. The importance of collecting complete and accurate data on nature of NPDs and its potential in describing the complexity of presentation are discussed. PMID:18941264

  10. Interior, first floor southeast side of building, showing french doors ...

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

    Interior, first floor southeast side of building, showing french doors and interior windows - Fitzsimons General Hospital, Open Air Tuberculosis Ward, West Pennington Avenue & North Hickey Street Southwest Corner, Aurora, Adams County, CO

  11. Assessment of Adverse Drug Reactions Based on Spontaneous Signals at Secondary Care Public Hospital.

    PubMed

    Ponnusankar, S; Tejaswini, M; Chaitanya, M

    2015-01-01

    Adverse drug reactions are considered to be among the leading causes of morbidity and mortality. Approximately 5-25% of hospital admissions are due to adverse drug reactions and 6-15% of hospitalized patients experience serious adverse drug reactions, causing significant prolongation of hospital stay. Thus this study was aimed at determining adverse drug reactions by conducting spontaneous reporting in secondary care Govt. District Head Quarters Hospital at Ooty. A prospective Spontaneous Adverse Drug Reaction reporting study was conducted over a period of 12 months from July 2012 to June 2013. The assessment, categorization, causality, severity and preventability were assessed using standard criteria. A total of 47 suspected adverse drug reactions were reported during the study period. Over all incidences was 1.29% among the study population. Antibiotics (31.91%) were the class of drug most commonly involved, while ciprofloxacin (14.89%) was the most frequently reported. Type H (Hypersensitivity) reactions (51.06%) accounted for majority of the reports and a greater share of the adverse drug reactions are probable (89.36%) based on causality assessment. Mild reactions accounted 82.97% based on modified Hartwig and Siegel severity scale. In 76.59% of the reports, the reaction was considered to be preventable based on Schumock and Thornton preventability scale. The implementation of monitoring based on spontaneous reporting will be useful for the detection and evaluation is associated with increase in morbidity and duration of hospitalization. This study also has established the vital role of clinical pharmacist in the adverse drug reaction monitoring program. PMID:26664067

  12. Heterosexual practices of women and men living with HIV attending hospital outpatient services (ANRS-VESPA2 survey): a French comparative study with the general population (CSF survey).

    PubMed

    Boyer, V; Vilotitch, A; Panjo, H; Sagaon-Teyssier, L; Marcellin, F; Dray-Spira, R; Spire, B; Bajos, N

    2016-11-01

    HAART has improved the well-being of many people living with HIV (PLWH). This study aimed at (i) comparing heterosexual practices between PLWH and the general population by gender, and (ii) identifying factors associated with sexual practices and at-risk behaviors in the two populations. Self-reported data were collected among PLWH attending hospitals (VESPA2 survey; n = 3022) and the general population (CSF survey; n = 10,280). Significant differences between the two samples were corrected for by implementing propensity score matching on both socio-demographic characteristics and sexual behavior in terms of number of partners. Men not reporting heterosexual intercourse were excluded. After matching, 61% of women (out of 707) and 68% of men (out of 709) were sexually active in both populations. PLWH practiced oral sex less than the general population and used condoms more consistently over the previous 12-month period, irrespective of having multiple sexual partners or not. For women living with HIV: those with several sexual partners and those consuming drugs over the previous 12 months were more likely to practice oral sex; those living in a couple for at least 6 years and migrants were less likely to practice anal intercourse. For men living with HIV: those reporting bisexual relationships and those with multiple sexual partners over the previous 12 months were more likely to practice anal heterosexual intercourse; migrants reported less oral sex, irrespective of HIV status. Error term correlations showed that anal intercourse was not linked to condom use for women or men from either population. Our results show that PLWH had a lower rate of heterosexual practices compared with the general population, and used condoms more often, irrespective of the number of sexual partners and strong cultural background (e.g., for Sub-Saharan African women). Further preventive information needs to be disseminated on the risk of infection transmission through

  13. Cytotoxics compounded sterile preparation control by HPLC during a 16-month assessment in a French university hospital: importance of the mixing bags step.

    PubMed

    Castagne, Vincent; Habert, Hélène; Abbara, Chadi; Rudant, Eric; Bonhomme-Faivre, Laurence

    2011-09-01

    The Centralized Chemotherapy Reconstitution Unit (CCRU) of Paul Brousse Hospital Pharmacy Department assessed the reliability of its Cytotoxics Compounded Sterile Products (CCSP) preparation method in order to improve its CCSP quality assurance system. Five cytotoxic drugs - gemcitabine, 5-fluorouracil, docetaxel, paclitaxel, and oxaliplatin - were assayed by high performance liquid chromatography (HPLC) to determine CCSP concentration. During the observation period, 23,892 CCSP were prepared. Overall, 12,964 preparations contained one of the five analyzed drugs; 7382 (56.9%) out of 12,964 CCSP were analyzed by HPLC; 646 (8.8%) out of 7382 concentrations were outside ± 20% of the prescribed dose; 544 (84.2%) out of 646 were post-administration results and could not be verified. Out of 102 (15.8%) pre-administration results that were re-tested after re-shaking, 94 (92.2%) were found to be acceptable upon re-testing, and 8 (7.8%) were confirmed to be unacceptable and needed to be re-compounded. The 8.8% of tested CCSP were outside ± 20% of the prescribed dose, but extrapolating the results on re-tested CCSP, we can say that our CCSP preparation is reliable with an estimation of only 0.7% of 7382 CCSP analyzed, confirmed as being ± 20% outside the prescribed dose. Nevertheless, this ± 20% magnitude of error should be reduced. Based on pre-administration results, the primary cause of concentration errors appeared to be insufficient mixing of the finished product. Most CCSP dosages occurred after it had been administered, the organization should, therefore, be improved to include testing all CCSP prior to administration. Pharmaceutical companies should endeavor to manufacture compounded injectible drugs in a 'ready to use' form and provide vehicles in accurate volumes in order to improve compounding precision.

  14. Heterosexual practices of women and men living with HIV attending hospital outpatient services (ANRS-VESPA2 survey): a French comparative study with the general population (CSF survey).

    PubMed

    Boyer, V; Vilotitch, A; Panjo, H; Sagaon-Teyssier, L; Marcellin, F; Dray-Spira, R; Spire, B; Bajos, N

    2016-11-01

    HAART has improved the well-being of many people living with HIV (PLWH). This study aimed at (i) comparing heterosexual practices between PLWH and the general population by gender, and (ii) identifying factors associated with sexual practices and at-risk behaviors in the two populations. Self-reported data were collected among PLWH attending hospitals (VESPA2 survey; n = 3022) and the general population (CSF survey; n = 10,280). Significant differences between the two samples were corrected for by implementing propensity score matching on both socio-demographic characteristics and sexual behavior in terms of number of partners. Men not reporting heterosexual intercourse were excluded. After matching, 61% of women (out of 707) and 68% of men (out of 709) were sexually active in both populations. PLWH practiced oral sex less than the general population and used condoms more consistently over the previous 12-month period, irrespective of having multiple sexual partners or not. For women living with HIV: those with several sexual partners and those consuming drugs over the previous 12 months were more likely to practice oral sex; those living in a couple for at least 6 years and migrants were less likely to practice anal intercourse. For men living with HIV: those reporting bisexual relationships and those with multiple sexual partners over the previous 12 months were more likely to practice anal heterosexual intercourse; migrants reported less oral sex, irrespective of HIV status. Error term correlations showed that anal intercourse was not linked to condom use for women or men from either population. Our results show that PLWH had a lower rate of heterosexual practices compared with the general population, and used condoms more often, irrespective of the number of sexual partners and strong cultural background (e.g., for Sub-Saharan African women). Further preventive information needs to be disseminated on the risk of infection transmission through

  15. Performance Evaluation of Public Non-Profit Hospitals Using a BP Artificial Neural Network: The Case of Hubei Province in China

    PubMed Central

    Li, Chunhui; Yu, Chuanhua

    2013-01-01

    To provide a reference for evaluating public non-profit hospitals in the new environment of medical reform, we established a performance evaluation system for public non-profit hospitals. The new “input-output” performance model for public non-profit hospitals is based on four primary indexes (input, process, output and effect) that include 11 sub-indexes and 41 items. The indicator weights were determined using the analytic hierarchy process (AHP) and entropy weight method. The BP neural network was applied to evaluate the performance of 14 level-3 public non-profit hospitals located in Hubei Province. The most stable BP neural network was produced by comparing different numbers of neurons in the hidden layer and using the “Leave-one-out” Cross Validation method. The performance evaluation system we established for public non-profit hospitals could reflect the basic goal of the new medical health system reform in China. Compared with PLSR, the result indicated that the BP neural network could be used effectively for evaluating the performance public non-profit hospitals. PMID:23955238

  16. Performance evaluation of public non-profit hospitals using a BP artificial neural network: the case of Hubei Province in China.

    PubMed

    Li, Chunhui; Yu, Chuanhua

    2013-08-15

    To provide a reference for evaluating public non-profit hospitals in the new environment of medical reform, we established a performance evaluation system for public non-profit hospitals. The new "input-output" performance model for public non-profit hospitals is based on four primary indexes (input, process, output and effect) that include 11 sub-indexes and 41 items. The indicator weights were determined using the analytic hierarchy process (AHP) and entropy weight method. The BP neural network was applied to evaluate the performance of 14 level-3 public non-profit hospitals located in Hubei Province. The most stable BP neural network was produced by comparing different numbers of neurons in the hidden layer and using the "Leave-one-out" Cross Validation method. The performance evaluation system we established for public non-profit hospitals could reflect the basic goal of the new medical health system reform in China. Compared with PLSR, the result indicated that the BP neural network could be used effectively for evaluating the performance public non-profit hospitals.

  17. Entrance surface dose and image quality: comparison of adult chest and abdominal X-ray examinations in general practitioner clinics, public and private hospitals in Malaysia.

    PubMed

    Hambali, Ahmad Shariff; Ng, Kwan-Hoong; Abdullah, Basri Johan Jeet; Wang, Hwee-Beng; Jamal, Noriah; Spelic, David C; Suleiman, Orhan H

    2009-01-01

    This study was undertaken to compare the entrance surface dose (ESD) and image quality of adult chest and abdominal X-ray examinations conducted at general practitioner (GP) clinics, and public and private hospitals in Malaysia. The surveyed facilities were randomly selected within a given category (28 GP clinics, 20 public hospitals and 15 private hospitals). Only departmental X-ray units were involved in the survey. Chest examinations were done at all facilities, while only hospitals performed abdominal examinations. This study used the x-ray attenuation phantoms and protocols developed for the Nationwide Evaluation of X-ray Trends (NEXT) survey program in the United States. The ESD was calculated from measurements of exposure and clinical geometry. An image quality test tool was used to evaluate the low-contrast detectability and high-contrast detail performance under typical clinical conditions. The median ESD value for the adult chest X-ray examination was the highest (0.25 mGy) at GP clinics, followed by private hospitals (0.22 mGy) and public hospitals (0.17 mGy). The median ESD for the adult abdominal X-ray examination at public hospitals (3.35 mGy) was higher than that for private hospitals (2.81 mGy). Results of image quality assessment for the chest X-ray examination show that all facility types have a similar median spatial resolution and low-contrast detectability. For the abdominal X-ray examination, public hospitals have a similar median spatial resolution but larger low-contrast detectability compared with private hospitals. The results of this survey clearly show that there is room for further improvement in performing chest and abdominal X-ray examinations in Malaysia.

  18. The skills gap in hospital management: a comparative analysis of hospital managers in the public and private sectors in South Africa.

    PubMed

    Pillay, Rubin

    2010-02-01

    A lack of management capacity has been identified as the key stumbling block to attaining the goals of health for all in South Africa. As part of the overall management development process, this research aims to identify the skills that are important for health services management and to evaluate managers' self-assessed proficiency in each of these skills. We also examined the impact of past training on perceived competency levels. A cross-sectional survey using a self-administered questionnaire was conducted among 404 hospital managers in the South African public and private sectors. Respondents were asked to rate the level of importance that each proposed competency had in their job and to indicate their proficiency in each skill. Both public and private sector managers rated competencies related to 'people management', 'self-management' and 'task-related skills' highest followed by 'strategic planning' and 'health delivery', respectively. The largest differences between mean importance rating and mean skill rating for public sector managers were for people management skills, task-related skills and self-management skills. The largest deficits for private sector managers were for people management skills, self-management skills and health delivery skills. Informal management development programmes were found to be more valuable in improving management skills. These findings reflect the reality of the local health service environment and the need of health managers. It will be useful in the conceptualization, design and delivery of health management programmes aimed at enhancing current and future management and leadership capacity in the health sector in South Africa.

  19. Publication of the OIG compliance program guidance for hospitals--OIG. Notice.

    PubMed

    1998-02-23

    This Federal Register notice sets forth the recently issued compliance program guidance for hospitals developed by the Office of Inspector General (OIG) in cooperation with, and with input from, several provider groups and industry representatives. Many providers and provider organizations have expressed an interest in better protecting their operations from fraud and abuse through the adoption of voluntary compliance programs. The first compliance guidance, addressing clinical laboratories, was prepared by the OIG and published in the Federal Register on March 3, 1997. We believe the development of this second program guidance, for hospitals, will continue as a positive step towards promoting a higher level of ethical and lawful conduct throughout the health care industry.

  20. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... hospital care authorized under 38 U.S.C. 1703 and 38 CFR 17.52 of this part or under 38 U.S.C. 1728 and 38 CFR 17.120 of this part shall be based on a prospective payment system similar to that used in the... discharge, as determined according to the methodology in subparts D and G of 42 CFR part 412, as...

  1. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... hospital care authorized under 38 U.S.C. 1703 and 38 CFR 17.52 of this part or under 38 U.S.C. 1728 and 38 CFR 17.120 of this part shall be based on a prospective payment system similar to that used in the... discharge, as determined according to the methodology in subparts D and G of 42 CFR part 412, as...

  2. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... hospital care authorized under 38 U.S.C. 1703 and 38 CFR 17.52 of this part or under 38 U.S.C. 1728 and 38 CFR 17.120 of this part shall be based on a prospective payment system similar to that used in the... discharge, as determined according to the methodology in subparts D and G of 42 CFR part 412, as...

  3. Burden of isolation for multidrug-resistant organisms in a tertiary public hospital in Southern Brazil.

    PubMed

    Pereira, Patrícia R; Isaakidis, Petros; Hinderaker, Sven G; Ali, Engy; van den Boogaard, Wilma; Viana, Karen S; Cassol, Renato; Falci, Diego Rodrigues

    2015-02-01

    We aimed to describe the use of isolation beds between September 2011 and August 2013 at a tertiary hospital located in Southern Brazil. The main cause for isolation was gram-negative carbapenem-resistant bacteria. Huge costs were associated with isolation practices. Considering the high burden on the isolation ward, practice of surveillance cultures and contact isolation should be balanced with other infection control practices.

  4. Public hospitals and substance abuse services for pregnant women and mothers: implications for managed-care programs and Medicaid.

    PubMed

    Andrulis, D; Hopkins, S

    2001-03-01

    Although an increasing proportion of the US population receives health services through managed care, pregnant women and mothers eligible for Medicaid who are involved with alcohol or other drugs are often excluded from these programs due in large part to lack of information on costs, service needs, and service use. To develop such information policy, service settings, and managed-care plans, the project conducted a national survey using a provider group with experience in caring for this population, the member universe of the National Association of Public Hospitals and Health Systems. The survey requested detailed information on hospital system information, current managed-care arrangements, outcome measurements, financing, service priorities, and service availability. The 81% response rate (n = 95) identified 35 hospital systems providing services to an average of 998 women in 1997. The majority of these systems (69%) reported coordinating care for these patients, but only 26% reported they computerize patient charts. Most use at least one indicator to measure effectiveness, and 50% use at least four. Counseling/education and transportation were seen as key support services, but many acknowledge they are not reimbursed for critical services such as nutrition education. The discussion highlights the need to provide formal support for core support services, to assist in care coordination and provide incentives for developing more sophisticated information, and to specify related services in the state Medicaid contract language.

  5. Role of overcrowding in meticillin-resistant Staphylococcus aureus transmission: Bayesian network analysis for a single public hospital.

    PubMed

    Waterhouse, M; Morton, A; Mengersen, K; Cook, D; Playford, G

    2011-06-01

    The transmission of multiple antibiotic-resistant organisms (MROs) in hospitals is affected by many inter-related factors. These include the background prevalence of the organism (burden), hand hygiene, the efficiency of patient screening, the isolation or cohorting of carriers, the quality of hospital cleaning, and bed occupancy. In addition, the prevalence of one MRO may influence the transmission of another by occupying isolation beds, and thus reducing isolation resources for the latter. For example, the overuse of third generation cephalosporin antibiotics can increase extended-spectrum β-lactamase-producing Klebsiella pneumoniae, thus indirectly influencing the transmission of meticillin-resistant Staphylococcus aureus (MRSA). In order to study this complex system of interrelationships, we have employed a Bayesian network. We report results of the first two years of analysis for a single public hospital. We conclude that, within this institution, the association between high bed occupancy and increased transmission of MRSA may be subject to a dynamic multidimensional threshold and tipping point. This may be influenced by other factors such as MRSA burden and whether the high bed occupancy interferes with preparation and cleaning of beds for new patients and with hand hygiene and efforts to isolate or cohort carriers.

  6. Incentivising effort in governance of public hospitals: Development of a delegation-based alternative to activity-based remuneration.

    PubMed

    Søgaard, Rikke; Kristensen, Søren Rud; Bech, Mickael

    2015-08-01

    This paper is a first examination of the development of an alternative to activity-based remuneration in public hospitals, which is currently being tested at nine hospital departments in a Danish region. The objective is to examine the process of delegating the authority of designing new incentive schemes from the principal (the regional government) to the agents (the hospital departments). We adopt a theoretical framework where, when deciding about delegation, the principal should trade off an initiative effect against the potential cost of loss of control. The initiative effect is evaluated by studying the development process and the resulting incentive schemes for each of the departments. Similarly, the potential cost of loss of control is evaluated by assessing the congruence between focus of the new incentive schemes and the principal's objectives. We observe a high impact of the effort incentive in the form of innovative and ambitious selection of projects by the agents, leading to nine very different solutions across departments. However, we also observe some incongruence between the principal's stated objectives and the revealed private interests of the agents. Although this is a baseline study involving high uncertainty about the future, the findings point at some issues with the delegation approach that could lead to inefficient outcomes.

  7. Methicillin-resistant Staphylococcus aureus in raw meats and prepared foods in public hospitals in salvador, Bahia, Brazil.

    PubMed

    Costa, Wellington Luis Reis; Ferreira, Jeane dos Santos; Carvalho, Joelza Silva; Cerqueira, Ellayne Souza; Oliveira, Lucimara Cardoso; Almeida, Rogeria Comastri de Castro

    2015-01-01

    This study investigated the presence of methicillin-resistant Staphylococcus aureus (MRSA) in raw meat and fish and foods prepared from them for patient consumption in public hospitals in Salvador, Bahia, in northeastern Brazil. A total of 114 samples of raw meat and fish (chicken, n = 30; beef, n = 30; pork, n = 24; and fish, n = 30) and 63 samples of prepared foods (made with chicken, n = 15; beef, n = 15; pork, n = 15; and fish, n = 18) were collected from the kitchens of 10 different hospitals. Of the 114 investigated raw meat and fish samples, 28.1% were positive for MRSA, which comprised 23.3% beef, 23.3% chicken, 37.5% pork, and 30% fish samples. Of the prepared foods, 9.5% were positive for MRSA, which comprised 5.6% chicken products, 6.7% pork products, and 22.2% fish products. MRSA contamination was not detected in prepared beef dishes. A statistical analysis showed no association between the presence of MRSA and the type of raw food (P > 0.05). The high prevalence of MRSA among the raw foods tested and the presence of the microorganism in prepared foods emphasizes the necessity of enforcing hygienic practices within hospital kitchens.

  8. Early Mobilization in Ischemic Stroke: A Pilot Randomized Trial of Safety and Feasibility in a Public Hospital in Brazil

    PubMed Central

    Poletto, Simone Rosa; Rebello, Letícia Costa; Valença, Maria Júlia Monteiro; Rossato, Daniele; Almeida, Andrea Garcia; Brondani, Rosane; Chaves, Márcia Lorena Fagundes; Nasi, Luiz Antônio; Martins, Sheila Cristina Ouriques

    2015-01-01

    Background The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant

  9. War outside, ceasefire inside: An analysis of the performance appraisal system of a public hospital in a zone of conflict.

    PubMed

    Giangreco, Antonio; Carugati, Andrea; Sebastiano, Antonio; Tamimi, Hadeel Al

    2012-02-01

    Our study examines the use of the performance appraisal system at Hebron Public Hospital (Palestine) during the second intifada, started in 2000. The aim of the article is to shed light on the reasons behind the use of performance appraisal systems in organizations operating in zones of conflicts, an area relatively neglected by HR scholars. To create the theoretical fundament we draw on mainstream literature on performance appraisal, contextualizing it to the Middle-Eastern context. From the literature analysis, we identify five guiding logics for the implementation and use of performance appraisal systems (Appendix A). We use a multi-method approach, qualitative and quantitative, to analyze the longitudinal performance evaluation data over the period 2000-2002 for about 250 individuals. These data are complemented with interviews and observations in the field. Our analysis shows that the trends evidenced in the quantitative analysis are similar to trends evident in Western contexts. However, these trends were not the consequence of the same five Western logics found in the literature. The qualitative study allows us to identify two additional logics for making sense of the performance appraisal system at Hebron Public Hospital: the need to find peace within the organization (organizational peacefulness logic); and the need to maintain order through the acceptance of the status quo (dominance logic). These results allow us to draw conclusions for theory and practice of HR management and to identify useful criteria for doing research in areas of conflicts.

  10. Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data

    PubMed Central

    Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M. E.; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

    2014-01-01

    Background Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. Objective To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. Design A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. Results The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. Conclusions We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health

  11. Physicians’ engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study

    PubMed Central

    2014-01-01

    Background Physician dual practice, a combination of public and private practice, has attracted attention due to fear of reduced work supply and a lack of key personnel in the public system, increase in low priority treatments, and conflicts of interest for physicians who may be competing for their own patients when working for private suppliers. In this article, we analyze both choice of dual practice among hospital physicians and the dual practices’ effect on work supply in public hospitals. Methods The sample consisted of 12,399 Norwegian hospital physicians working in public hospitals between 2001 and 2009. We linked hospital registry data on salaries and hospital working hours with data from national income and other registries covering non-hospital income, including income from dual work, cohabiting status, childbirths and socioeconomic characteristics. Our dataset also included hospital variables describing i.e. workload. We estimated odds ratio for choosing dual practice and the effects of dual practice on public working hours using different versions of mixed models. Results The percentage of physicians engaged in dual practice fell from 35.1% for men and 17.6% for women in 2001 to 25.0% and 14.2%, respectively, in 2009. For both genders, financial debt and interest payments were positively correlated and having a newborn baby was negatively correlated with engaging in dual practice. Larger family size and being cohabitating increased the odds ratio of dual practice among men but reduced it for women. The most significant internal hospital factor for choosing dual practice was high wages for extended working hours, which significantly reduced the odds ratio for dual practice. The total working hours in public hospitals were similar for both those who did and did not engage in dual practice; however, dual practice reduced public working hours in some specialties. Conclusion Economic factors followed by family variables are significant elements influencing

  12. Escalation of Oncologic Services at the End of Life Among Patients With Gynecologic Cancer at an Urban, Public Hospital

    PubMed Central

    Wu, Eijean; Rogers, Anna; Ji, Lingyun; Sposto, Richard; Church, Terry; Roman, Lynda; Tripathy, Debu; Lin, Yvonne G.

    2015-01-01

    Purpose: Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital. Methods: Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries. Results: Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P < .001), with the most dramatic changes occurring during the last 2 months. Patients with longer duration of continuity of care used significantly fewer resources toward the end of life. Conclusion: To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period. PMID:25604595

  13. Developing of the Appropriateness Evaluation Protocol for Public Hospitals in Iran

    PubMed Central

    Esmaili, Anvar; Ravaghi, Hamid; Seyedin, Hesam; Delgoshaei, Bahram; Salehi, Masoud

    2015-01-01

    Background: Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems. Objectives: This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran. Patients and Methods: The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients’ medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses. Results: Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively. Conclusions: The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context. PMID:26019898

  14. Genetic diversity of clinical Pseudomonas aeruginosa isolates in a public hospital in Spain

    PubMed Central

    2013-01-01

    Background Pseudomonas aeruginosa is an important nosocomial pathogen that exhibits multiple resistances to antibiotics with increasing frequency, making patient treatment more difficult. The aim of the study is to ascertain the population structure of this clinical pathogen in the Hospital Son Llàtzer, Spain. Results A significant set (56) of randomly selected clinical P. aeruginosa isolates, including multidrug and non-multidrug resistant isolates, were assigned to sequence types (STs) and compared them with their antibiotic susceptibility profile classified as follows: extensively drug resistant (XDR), multidrug resistant (MDR) and non-multidrug resistant (non-MDR). The genetic diversity was assessed by applying the multilocus sequence typing (MLST) scheme developed by Curran and collaborators, and by the phylogenetic analysis of a concatenated tree. The analysis of seven loci, acsA, aroE, guaA, mutL, nuoD, ppsA and trpE, demonstrated that the prevalent STs were ST-175, ST-235 and ST-253. The majority of the XDR and MDR isolates were included in ST-175 and ST-235. ST-253 is the third in frequency and included non-MDR isolates. The 26 singleton sequence types corresponded mainly to non-MDR isolates. Twenty-two isolates corresponded to new sequence types (not previously defined) of which 12 isolates were non-MDR and 10 isolates were MDR or XDR. Conclusions The population structure of clinical P. aeruginosa present in our hospital indicates the coexistence of nonresistant and resistant isolates with the same sequence type. The multiresistant isolates studied are grouped in the prevalent sequence types found in other Spanish hospitals and at the international level, and the susceptible isolates correspond mainly to singleton sequence types. PMID:23773707

  15. Study--The Feasibility, Practicability and Cost of the Soundproofing of Schools, Hospitals, and Public Health Facilities Located Near Airports. Report to Congress.

    ERIC Educational Resources Information Center

    Federal Aviation Administration (DOT), Washington, DC.

    This report fulfills the requirement of Public Law 94-353 that requires the Secretary of Transportation to report to the Congress with respect to the feasibility, practicability, and cost of soundproofing noise-impacted schools, hospitals, and public health facilities, in order to reduce the possible adverse effects of aircraft noise. A survey of…

  16. The First Seventy Years: Bryan Memorial Hospital School of Nursing and Bryan Memorial Hospital, 1926-1996. A Seventieth Anniversary Publication.

    ERIC Educational Resources Information Center

    Vontz, Marilyn J.

    Celebrating the 70th anniversary of Bryan Memorial Hospital School of Nursing (BMHSN) and Bryan Memorial Hospital, in Nebraska, this monograph reviews the development and achievements of the school and hospital. Chapter 1 (1900-1919) provides a history of nursing in the early 20th century, while chapter 2 (1920-1929) describes the establishment of…

  17. [Core principles for the regulation of placement subject to public law in psychiatric hospitals - with explanations].

    PubMed

    2016-03-01

    While the provisions of the highest courts concerning the involuntary commitment and treatment in psychiatric hospitals of people unable to give their consent are being implemented, in many federal states corresponding adjustments to the rules governing involuntary commitment in accordance with the mental health laws and laws on involuntary commitment are still pending. In states where new regulations do exist, legal experts express doubts that they conform to the Constitution and the UN Convention on the Rights of Persons with Disabilities. The DGPPN has formulated key parameters for involuntary commitment from a clinical perspective, which should be taken into account in the new regulations of the individual federal states. PMID:26868108

  18. [From the medieval hospitals hospices to modern National public Health Institutes].

    PubMed

    de Micheli, Alfredo

    2016-01-01

    Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the xvii century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez. PMID:25862293

  19. [From the medieval hospitals hospices to modern National public Health Institutes].

    PubMed

    de Micheli, Alfredo

    2016-01-01

    Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the xvii century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez.

  20. A structured approach to transforming a large public hospital emergency department via lean methodologies.

    PubMed

    Naik, Trushar; Duroseau, Yves; Zehtabchi, Shahriar; Rinnert, Stephan; Payne, Rosamond; McKenzie, Michele; Legome, Eric

    2012-01-01

    Emergency Departments (EDs) face significant challenges in providing efficient, quality, safe, cost-effective care. Lean methodologies are a proposed framework to redesign ED practices and processes to meet these challenges. We outline a systematic way that lean principles can be applied across the entire ED patient experience to transform a high volume ED in a safety net hospital. We review the change in ED performance metrics prior to and after lean implementation. We discuss critical insights and key lessons learned from our lean transformation to date. The steps to implementing lean principles across the patient's ED experience are described with specific attention to executive planning of rapid improvement experiments and the subsequent roll-out of lean transformation over an 18-month time frame. Basic ED performance data were compared to the year prior. Results of the exploratory analysis (using median and interquartile ranges and nonparametric tests for group comparisons) have shown improvement in several performance metrics after initiating lean transformation. The approach, lessons learned, and early data of our transformation can provide critical insights for EDs seeking to incorporate continuous improvement strategies. Key lessons and unique challenges encountered in safety net hospitals are discussed.

  1. Good governance and budget reform in Lesotho Public Hospitals: performance, root causes and reality.

    PubMed

    Vian, Taryn; Bicknell, William J

    2014-09-01

    Lesotho has been implementing financial management reforms, including performance-based budgeting (PBB) since 2005 in an effort to increase accountability, transparency and effectiveness in governance, yet little is known about how these efforts are affecting the health sector. Supported by several development partners and $24 million in external resources, the PBB reform is intended to strengthen government capacity to manage aid funds directly and to target assistance to pressing social priorities. This study designed and tested a methodology for measuring implementation progress for PBB reform in the hospital sector in Lesotho. We found that despite some efforts on the national level to promote and support reform implementation, staff at the hospital level were largely unaware of the purpose of the reform and had made almost no progress in transforming institutions and systems to fully realize reform goals. Problems can be traced to a complex reform design, inadequate personnel and capacity to implement, professional boundaries between financial and clinical personnel and weak leadership. The Lesotho reform experience suggests that less complex designs for budget reform, better adapted to the context and realities of health sectors in developing countries, may be needed to improve governance. It also highlights the importance of measuring reform implementation at the sectoral level. PMID:23293099

  2. A proposed simulation optimization model framework for emergency department problems in public hospital

    NASA Astrophysics Data System (ADS)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2015-12-01

    The Emergency Department (ED) is a very complex system with limited resources to support increase in demand. ED services are considered as good quality if they can meet the patient's expectation. Long waiting times and length of stay is always the main problem faced by the management. The management of ED should give greater emphasis on their capacity of resources in order to increase the quality of services, which conforms to patient satisfaction. This paper is a review of work in progress of a study being conducted in a government hospital in Selangor, Malaysia. This paper proposed a simulation optimization model framework which is used to study ED operations and problems as well as to find an optimal solution to the problems. The integration of simulation and optimization is hoped can assist management in decision making process regarding their resource capacity planning in order to improve current and future ED operations.

  3. [Clinical characteristics of patients treated with electroconvulsive therapy in a public hospital in Peru].

    PubMed

    Cortez-Vergara, Carla; Cruzado, Lizardo; Rojas-Rojas, Ira Galia; Sánchez-Fernández, Miguel; Ladd-Huarachi, Guillermo

    2016-03-01

    With the purpose of describe the profile of use of electroconvulsive therapy (ECT) on hospitalized patients at "Honorio Delgado - Hideyo Noguchi" National Institute of Mental Health in Lima, Peru, the medical records of patients receiving ECT between 2001 and 2011 were reviewed. The main findings were: four hundred and nineteen ECT courses were applied to 372 patients, with a total of 5439 applications the most common diagnosis was paranoid schizophrenia (70.7%), the most common indication was resistance to treatment (80.7%), also the clinical response to ECT was good in 70.1% of cases while side effects were generally transient and mild. The use of ECT decreased over the period of the study but it was tolerable and safe, especially in the modified version, and it had a high response rate so remains as a first-line psychiatric treatment. PMID:27384628

  4. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

    PubMed Central

    2010-01-01

    Background The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance. Methods A previously developed and validated instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) was used. Two categories of health care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and motivation and job satisfaction was compared across socio-demographic and occupational variables. Results The survey revealed that achievements was ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater mean scores (p < 0.005). The medical staff showed statistically significantly lower job satisfaction compared to the nursing staff. Surgical sector nurses and those >55 years of age reported higher job satisfaction when compared to the other groups. Conclusions The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested. PMID:21080954

  5. Elementary Rehabilitation Nursing Care; a Manual for Nurses and Ancillary Workers in Nursing Homes, Hospitals, Convalescent Facilities, and Public Health Agencies. Public Health Service Publication No. 1436.

    ERIC Educational Resources Information Center

    Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.

    This guide for teacher and student use presents a comprehensive program of physical rehabilitation for aged and physically disabled patients. Developed by the Public Health Nursing Section, the manual was tested by state health department personnel and persons doing inservice teaching in their respective nursing homes. The program is designed to…

  6. Latent Tuberculosis Infection and Occupational Protection among Health Care Workers in Two Types of Public Hospitals in China

    PubMed Central

    Zhou, Feng; Zhang, Li; Gao, Lei; Hao, Yibin; Zhao, Xianli; Liu, Jianmin; Lu, Jie; Li, Xiangwei; Yang, Yu; Chen, Junguo; Deng, Ying

    2014-01-01

    Objective To determine the impact factors of latent tuberculosis infection (LTBI) and the knowledge of TB prevention and treatment policy among health care workers (HCWs) in different types of hospitals and explore the strategies for improving TB prevention and control in medical institutions in China. Methods A cross-sectional study was carried out to evaluate the risk of TB infection and personnel occupational protection among HCWs who directly engage in medical duties in one of two public hospitals. Each potential participant completed a structured questionnaire and performed a tuberculin skin test (TST). Factors associated with LTBI were identified by logistic regression analysis. Results Seven hundred twelve HCWs completed questionnaires and 74.3% (n = 529) took the TST or had previous positive results. The TST-positive prevalence was 58.0% (n = 127) in the infectious disease hospital and 33.9% (n = 105) in the non-TB hospital. The duration of employment in the healthcare profession (6–10 years vs. ≤5 years [OR = 1.89; 95% CI = 1.10, 3.25] and>10 vs. ≤5[OR = 1.80; 95% CI = 1.20, 2.68]), type of hospital (OR = 2.40; 95% CI = 1.59, 3.62), and ever-employment in a HIV clinic or ward (OR = 1.87; 95% CI = 1.08, 3.26)were significantly associated with LTBI. The main reasons for an unwillingness to accept TST were previous positive TST results (70.2%) and concerns about skin reaction (31.9%). Conclusion A high prevalence of TB infections was observed among HCWs working in high-risk settings and with long professional experiences in Henan Province in China. Comprehensive guidelines should be developed for different types of medical institutions to reduce TB transmission and ensure the health of HCWs. PMID:25157814

  7. Relationship between Psychosocial Risk Factors and Work-Related Musculoskeletal Disorders among Public Hospital Nurses in Malaysia

    PubMed Central

    2014-01-01

    Objective This study examined the relationships between psychosocial work factors and risk of WRMSDs among public hospital nurses in the Klang Valley, Malaysia. Methods We conducted a cross-sectional study among 660 public hospital nurses. A self-administered questionnaire was used to collect data on the occurrence of WRMSDs according to body regions, socio-demographic profiles, occupational information and psychosocial risk factors. 468 questionnaires were returned (response rate of 71%), and 376 questionnaires qualified for subsequent analysis. Univariate analyses were applied to test for mean and categorical differences across the WRMSDs; multiple logistic regression was applied to predict WRMSDs based on the Job Strain Model’s psychosocial risk factors. Results Over two thirds of the sample of nurses experienced discomfort or pain in at least one site of the musculoskeletal system within the last year. The neck was the most prevalent site (48.94%), followed by the feet (47.20%), the upper back (40.69%) and the lower back (35.28%). More than 50% of the nurses complained of having discomfort in region one (neck, shoulders and upperback) and region four (hips, knees, ankles, and feet). The results also revealed that psychological job demands, job strain and iso-strain ratio demonstrated statistically significant mean differences (p < 0.05) between nurses with and without WRMSDs. According to univariate logistic regression, all psychosocial risk factors illustrated significant association with the occurrence of WRMSDs in various regions of the body (OR: 1.52–2.14). Multiple logistic regression showed all psychosocial risk factors were significantly associated with WRMSDs across body regions (OR: 1.03–1.19) except for region 1 (neck, shoulders and upper back) and region 4 (hips, knees, ankles, and feet). All demographic variables except for years of employment were statistically and significantly associated with WRMSDs (p < 0.05). Conclusions The findings

  8. Five-year outbreak of community- and hospital-acquired Mycobacterium porcinum infections related to public water supplies.

    PubMed

    Brown-Elliott, Barbara A; Wallace, Richard J; Tichindelean, Carmen; Sarria, Juan C; McNulty, Steven; Vasireddy, Ravikaran; Bridge, Linda; Mayhall, C Glenn; Turenne, Christine; Loeffelholz, Michael

    2011-12-01

    Mycobacterium porcinum is a rarely encountered rapidly growing Mycobacterium (RGM). We identified M. porcinum from 24 patients at a Galveston university hospital (University of Texas Medical Branch) over a 5-year period. M. porcinum was considered a pathogen in 11 (46%) of 24 infected patients, including 4 patients with community-acquired disease. Retrospective patient data were collected, and water samples were cultured. Molecular analysis of water isolates, clustered clinical isolates, and 15 unrelated control strains of M. porcinum was performed. Among samples of hospital ice and tap water, 63% were positive for RGM, 50% of which were M. porcinum. Among samples of water from the city of Galveston, four of five households (80%) were positive for M. porcinum. By pulsed-field gel electrophoresis (PFGE), 8 of 10 environmental M. porcinum were determined to belong to two closely related clones. A total of 26 of 29 clinical isolates subjected to PFGE (including isolates from all positive patients) were clonal with the water patterns, including patients with community-acquired disease. Fifteen control strains of M. porcinum had unique profiles. Sequencing of hsp65, recA, and rpoB revealed the PFGE outbreak clones to have identical sequences, while unrelated strains exhibited multiple sequence variants. M. porcinum from 22 (92%) of 24 patients were clonal, matched hospital- and household water-acquired isolates, and differed from epidemiologically unrelated strains. M. porcinum can be a drinking water contaminant, serve as a long-term reservoir (years) for patient contamination (especially sputum), and be a source of clinical disease. This study expands concern about public health issues regarding nontuberculous mycobacteria. Multilocus gene sequencing helped define clonal populations.

  9. A socio-technical analytical framework on the EHR-organizational innovation interplay: Insights from a public hospital in Greece.

    PubMed

    Emmanouilidou, Maria

    2015-01-01

    The healthcare sector globally is confronted with increasing internal and external pressures that urge for a radical reform of health systems' status quo. The role of technological innovations such as Electronic Health Records (EHR) is recognized as instrumental in this transition process as it is expected to accelerate organizational innovations. This is why the widespread uptake of EHR systems is a top priority in the global healthcare agenda. The successful co-deployment though of EHR systems and organizational innovations within the context of secondary healthcare institutions is a complex and multifaceted issue. Existing research in the field has made little progress thus emphasizing the need for further research contribution that will incorporate a holistic perspective. This paper presents insights about the EHR-organizational innovation interplay from a public hospital in Greece into a socio-technical analytical framework providing a multilevel set of action points for the eHealth roadmap with worldwide relevance. PMID:25991259

  10. A socio-technical analytical framework on the EHR-organizational innovation interplay: Insights from a public hospital in Greece.

    PubMed

    Emmanouilidou, Maria

    2015-01-01

    The healthcare sector globally is confronted with increasing internal and external pressures that urge for a radical reform of health systems' status quo. The role of technological innovations such as Electronic Health Records (EHR) is recognized as instrumental in this transition process as it is expected to accelerate organizational innovations. This is why the widespread uptake of EHR systems is a top priority in the global healthcare agenda. The successful co-deployment though of EHR systems and organizational innovations within the context of secondary healthcare institutions is a complex and multifaceted issue. Existing research in the field has made little progress thus emphasizing the need for further research contribution that will incorporate a holistic perspective. This paper presents insights about the EHR-organizational innovation interplay from a public hospital in Greece into a socio-technical analytical framework providing a multilevel set of action points for the eHealth roadmap with worldwide relevance.

  11. Safety culture in the operating room of a public hospital in the perception of healthcare professionals1

    PubMed Central

    Carvalho, Paloma Aparecida; Göttems, Leila Bernarda Donato; Pires, Maria Raquel Gomes Maia; de Oliveira, Maria Liz Cunha

    2015-01-01

    Objective: to evaluate the perception of healthcare professionals about the safety culture in the operating room of a public hospital, large-sized, according to the domains of the Safety Attitudes Questionnaire (SAQ). Method: descriptive, cross-sectional and quantitative research, with the application of the SAQ to 226 professionals. Descriptive data analysis, instrument consistency and exploratory factor analysis. Results: participants were distributed homogeneously between females (49.6%) and males (50.4%); mean age of 39.6 (SD±9.9) years and length of professional experience of 9.9 (SD±9.2) years. And Cronbach's ( of 0.84. It was identified six domains proposed in the questionnaire: stress perception (74.5) and job satisfaction (70.7) showed satisfactory results; teamwork environment (59.1) and climate of security (48.9) presented scores below the minimum recommended (75); unit's management perceptions (44.5), hospital management perceptions (34.9) and working conditions (41.9) presented the lowest averages. Conclusions: the results showed that, from the perspective of the professionals, there is weakness in the values, attitudes, skills and behaviors that determine the safety culture in a healthcare organization. PMID:26625994

  12. Professional nurses' perception of the implementation of quality circle programme in a public hospital in the Eastern Cape Province.

    PubMed

    Mbovane, M M; Mavundla, T R; Roos, J H

    2007-03-01

    A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the professional nurses' perception of the implementation of a quality circle programme in a public hospital in the Eastern Cape Province. The data-collection techniques were individual semi-structured interviews and field notes. The sample was drawn from a population of 425 Xhosa-speaking professional nurses employed in this institution. The sample comprised eight (8) professional nurses all of whom volunteered for in-depth individual semi-structured interviews. All the respondents answered one question: How do you perceive the implementation of the quality circle programme in your hospital? During data collection and analysis only one theme emerged, namely the perception of quality circle as a forum for discussing patient care problems and future plans. There were four broad categories in this theme, namely. Staff empowerment. Teambuilding in the nursing discipline. Maintenance of standards by nurses. Challenges to the momentum of a quality circle programme. It is recommended that all three tiers of nursing management be involved in the quality circle programme to improve interpersonal, interdepartmental and intradepartmental communication and concomitantly the nursing care.

  13. Supporting management of medical equipment for inpatient service in public hospitals: a case study.

    PubMed

    Figueroa, Rosa L; Vallejos, Guido E

    2013-01-01

    This work presents a study of medical equipment availability in the short and long term. The work is divided in two parts. The first part is an analysis of the medical equipment inventory for the institution of study. We consider the replacement, maintenance, and reinforcement of the available medical equipment by considering local guidelines and surveying clinical personnel appreciation. The resulting recommendation is to upgrade the current equipment inventory if necessary. The second part considered a demand analysis in the short and medium term. We predicted the future demand with a 5-year horizon using Holt-Winters models. Inventory analysis showed that 27% of the medical equipment in stock was not functional. Due to this poor performance result we suggested that the hospital gradually addresses this situation by replacing 29 non-functional equipment items, reinforcing stock with 40 new items, and adding 11 items not available in the inventory but suggested by the national guidelines. The results suggest that general medicine inpatient demand has a tendency to increase within the time e.g. for general medicine inpatient service the highest increment is obtained by respiratory (12%, RMSE=8%) and genitourinary diseases (20%, RMSE=9%). This increment did not involve any further upgrading of the proposed inventory.

  14. French in Gabon.

    ERIC Educational Resources Information Center

    Ogden, John

    1984-01-01

    Discusses the usage of French in Gabon. As in other nations of francophone Africa, French is the language of upward social mobility in Gabon, and it offers access to the international community. However, one factor peculiar to Gabon is the virtual absence of a Gabonese national language, which promotes a greater dependency upon a mastery of the…

  15. French in Quebec.

    ERIC Educational Resources Information Center

    d'Anglejan, Alison

    1979-01-01

    Discusses language legislation in Canada where French and English are both official languages, and in Quebec province where French has been declared the sole official language. Outlines the conflicts and the impact of these differing laws on Quebec, its population, and its relations with the rest of Canada. (JMF)

  16. Skiing in French.

    ERIC Educational Resources Information Center

    Moeller, Paulette

    1984-01-01

    A high school French program conducted entirely in French on local ski slopes is based on the philosophy that language is a social tool for communicative purposes and can best be learned in social interaction. The successful program uses teamwork, an open attitude toward language learning, non-stressful evaluation, and innovative techniques. (MSE)

  17. Quality care, public perception and quick-fix service management: a Delphi study on stressors of hospital doctors in Ireland

    PubMed Central

    Hayes, Blanaid; Fitzgerald, Deirdre; Doherty, Sally; Walsh, Gillian

    2015-01-01

    Objectives To identify and rank the most significant workplace stressors to which consultants and trainees are exposed within the publicly funded health sector in Ireland. Design Following a preliminary semistructured telephone interview, a Delphi technique with 3 rounds of reiterative questionnaires was used to obtain consensus. Conducted in Spring 2014, doctors were purposively selected by their college faculty or specialty training body. Setting Consultants and higher specialist trainees who were engaged at a collegiate level with their faculty or professional training body. All were employed in the Irish publicly funded health sector by the Health Services Executive. Participants 49 doctors: 30 consultants (13 male, 17 female) and 19 trainees (7 male, 12 female). Consultants and trainees were from a wide range of hospital specialties including anaesthetics, radiology and psychiatry. Results Consultants are most concerned with the quality of healthcare management and its impact on service. They are also concerned about the quality of care they provide. They feel undervalued within the negative sociocultural environment that they work. Trainees also feel undervalued with an uncertain future and they also perceive their sociocultural environment as negative. They echo concerns regarding the quality of care they provide. They struggle with the interface between career demands and personal life. Conclusions This Delphi study sought to explore the working life of doctors in Irish hospitals at a time when resources are scarce. It identified both common and distinct concerns regarding sources of stress for 2 groups of doctors. Its identification of key stressors should guide managers and clinicians towards solutions for improving the quality of patient care and the health of care providers. PMID:26700286

  18. An interdisciplinary approach to controlling chikungunya outbreaks on French islands in the south-west Indian ocean.

    PubMed

    Flahault, A; Aumont, G; Boisson, V; de Lamballerie, X; Favier, F; Fontenille, D; Journeaux, S; Lotteau, V; Paupy, C; Sanquer, M A; Setbon, M; Gaüzere, B A

    2012-03-01

    The outbreak of chikungunya that occurred on French Island territories in the southwest Indian Ocean in 2005 and 2006 caused severe morbidity and mortality. In the aftermath, French authorities set up a scientific task force including experts in epidemiology, public health, entomology, virology, immunology, sociology, animal health, community and hospital medicine. The mission of the task force was to conceive and propose research programs needed to increase understanding of the disease and epidemic and to help public health officials in improving epidemic response measures. The purpose of this article is to describe the findings of the task force at the end of its two-year existence and initial outcomes in the the areas studied. Discussion emphasizes topics requiring further study.

  19. An interdisciplinary approach to controlling chikungunya outbreaks on French islands in the south-west Indian ocean.

    PubMed

    Flahault, A; Aumont, G; Boisson, V; de Lamballerie, X; Favier, F; Fontenille, D; Journeaux, S; Lotteau, V; Paupy, C; Sanquer, M A; Setbon, M; Gaüzere, B A

    2012-03-01

    The outbreak of chikungunya that occurred on French Island territories in the southwest Indian Ocean in 2005 and 2006 caused severe morbidity and mortality. In the aftermath, French authorities set up a scientific task force including experts in epidemiology, public health, entomology, virology, immunology, sociology, animal health, community and hospital medicine. The mission of the task force was to conceive and propose research programs needed to increase understanding of the disease and epidemic and to help public health officials in improving epidemic response measures. The purpose of this article is to describe the findings of the task force at the end of its two-year existence and initial outcomes in the the areas studied. Discussion emphasizes topics requiring further study. PMID:22693932

  20. Serum Retinol Concentrations in Mothers and Newborns at Delivery in a Public Maternity Hospital in Recife, Northeast Brazil

    PubMed Central

    Andreto, Luciana Marques; Vieira, Carmina Silva dos Santos; de Arruda, Ilma Kruze Grande; Diniz, Alcides da Silva

    2014-01-01

    Serum retinol concentrations were compared in a consecutive series of 65 mother-newborn pairs at delivery in a public maternity hospital in Recife, Brazil, from January to August 2008 and examined their association with biological, socioeconomic, environmental and obstetrical characteristics. Serum retinol concentrations of the newborns (umbilical cord) and mothers (brachial venipuncture) were analyzed by high-performance liquid chromatography. Prevalence of low (<0.70 µmol/L) and inadequate (<1.05 µmol/L) serum retinol concentrations were observed in 23.1% (95% CI 13.9-35.5) and 23.0% (95% CI 13.5-35.8) among newborns and mothers respectively. The serum retinol distribution was lower in male than female infants (-0.4 µmol/L, p=0.01) and, across both sexes, concentrations in paired newborn and mother were correlated (r=0.27, p=0.04). Further, maternal status explains only 7% of the variance in retinol concentrations in newborn's cord plasma. Among mothers delivering in public facilities in Recife, hypovitaminosis may exist. PMID:24847590

  1. Nutritional status of patients with gastrointestinal cancer receiving care in a public hospital; 2010-2011.

    PubMed

    Dias do Prado, Corina; Alvares Duarte Bonini Campos, Juliana

    2013-01-01

    Objetivo: Identificar el estado nutricional de los pacientes con cáncer gastrointestinal y verificar su asociación con características demográficas y clínicas. Métodos: Se realizó un estudio transversal, con un diseño de muestreo no probabilístico. Los participantes fueron 143 pacientes adultos con cáncer gastrointestinal, que reciben atención en el Hospital Amaral Carvalho (Jaú-SP, Brasil) entre noviembre de 2010 y octubre de 2011. Se realizó una encuesta para recoger información con el fin de caracterización demográfica y clínica. Para identificar el estado nutricional se aplico la Valoración Subjetiva Global - Generada por el Paciente Score (VSGGP score). La razón de prevalencia (RP) fue estimada. El nivel de significancia adoptado fue de 5%. Resultados: La edad media de los pacientes fue de 57,45 (DE = 9,62) AÑOs, con los estadíos III y IV de la enfermedad es la más frecuente (39,2% y 35,0%). Había 44,8% de prevalencia de la malnutrición. La persona desnutrida tenía problemas más frecuentes para comer. La estadística descriptiva y la prueba de Chi-cuadrado (< 0,001), presentaron menor deseo de comer (p < 0,001), más náuseas (p = 0,001), vómitos (p = 0,006), estreñimiento (p < 0,001) y dolor (p < 0,001) que los pacientes eutróficos y se declararon enfermos por el olor de los alimentos (p = 0,012), dificultad para tragar (p = 0,002) y la saciedad precoz (p = 0,020) com más frecuencia. En cuanto a la proporción de prevalencia, se observó una probabilidad mayor de individuos desnutridos expuestos a una porción más grande de los síntomas relacionados en la puntuación VSG-GP score. Conclusión: La alta prevalencia de desnutrición se observó en pacientes con cáncer gastrointestinal, con asociación significativa con los síntomas clínicos directamente relacionados con el proceso de alimentación.

  2. [The case for a new French public health law at the service of a fairer and more effective national health policy].

    PubMed

    Cambon, Linda; Alla, François; Lombrail, Pierre

    2012-01-01

    The next public health law in France will need to address a number of issues. A?series of recent reports have highlighted both sharp disparities in health status ? with high rates of premature death and increasing social inequalities in health ? and the need to organize public health. The incoherence of public health policies, the lack of inter-ministerial coordination (a prerequisite for the reduction of health inequalities) and the lack of structure and evaluation in the area of prevention are major weaknesses that the new public health law will need to address. Beyond the inevitable core measures, the new law will also need to promote deep structural reforms, including a unified national policy refocused on key priorities and incorporating non-health sectors, the development of a more effective and coherent prevention policy and, finally, a focus on the issue of inequalities requiring clearly defined integrated measures, not only as a stated principle but as an outcome to be achieved by all health policies. The next public health law will need to be a vehicle for an inevitable and long overdue structuring of public health policy. PMID:23043699

  3. French Antilles and Guiana.

    PubMed

    1989-01-01

    Attention in this discussion of French Antilles and Guiana is directed to the following: geography; the people; history; government; political conditions; the economy; and relations with the US. In 1988, the population of Martinique, the official name, numbered 351,105 with an annual growth rate in 1988 of 1.71%. The population of Guadeloupe, the official name, numbered 337,524 in January 1988 with an annual growth rate in 1987 of 1.2%. French Guiana, Guadeloupe, and Martinique, as overseas departments of France since 1946, are integral parts of the French Republic. In 1972, the metropolitan departments of France were combined into 22 regions, with an elected regional council for each region. As integral parts of the French Republic, the political systems of the 3 French Caribbean departments are essentially extensions of those of metropolitan France. Guadeloupe and Martinique owed their colonial prosperity to agriculture, primarily sugar. Martinique no longer exports sugar, but sugar still accounts for 20% of Guadeloupe's export earnings. In Martinique, sugar has been replaced as an export crop by bananas and pineapples. Bananas now account for almost 50% of Guadeloupe's total export earnings. In French Guiana, the impact of the French National Space Agency's Guiana Space Center has been great. US policy toward these overseas departments is inseparable from its overall policy of friendly relations with France.

  4. Linguistic Effects of Globalization: A Case Study of French for Specific Purposes (FSP) in Kenyan Vocational Schools

    ERIC Educational Resources Information Center

    Mulenda, Mubalama

    2013-01-01

    The study of French for Specific Purposes (FSP) is a topical subject in this era of globalization. Kenya requires people who can communicate in French in the various specialized areas. It has become crucial in Kenya to respond to the French language needs of students learning tourism and hospitality among other domains which have already shown an…

  5. The French Lesson: The Right to Culture

    ERIC Educational Resources Information Center

    Gagnon, Paul

    1975-01-01

    Noting that "career education is only the latest in the grand parade of American learning fads," the author points out that despite the proliferation of technology in France and the habit of accepting American fads, the French still consider education to have three aims--for work, for public life, for private life. (JT)

  6. French as a Second Language Handbook.

    ERIC Educational Resources Information Center

    Lazaruk, Walter A.; And Others

    The handbook is a service publication for teachers of French as a second language. Each of five articles addresses a specific issue. "Teaching and Learning Strategies" (Walter A. Lazaruk) reviews the four skills approach used in second language learning. A communication model of teaching, used alongside study of the language itself, is…

  7. French and English Together: An "Additive" Experience

    ERIC Educational Resources Information Center

    Wiltshire, Jessica; Harbon, Lesley

    2010-01-01

    This paper examines the nature of the "additive" experience of a bilingual French-English curriculum at Killarney Heights Public School in New South Wales. Predictably, the well-supported "additive" nature of the languages program model elicited positive reactions regarding educational success. The paper also explores issues for administration,…

  8. Le Francais Courant: Part V, French.

    ERIC Educational Resources Information Center

    Dade County Public Schools, Miami, FL.

    Instructional objectives of the Dade County Public Schools Quinmester Program in French for use with "Le Francais Courant: Part 5" focus on the development of mastery of the basic numbering system and other grammatical structures. Structures include the formation of the present tense of the irregular verbs "vouloir,""pouvoir," and "venir,"…

  9. Le Francais Moderne: Part I, French.

    ERIC Educational Resources Information Center

    Dade County Public Schools, Miami, FL.

    Instructional objectives of the Dade County Public Schools Quinmester Program in French for use with "Le Francais Moderne: Part 1" focus on the development of vocabulary and mastery of grammatical structures. The formation of the passe compose with "avoir," object pronouns, the present tense of regular "-ir" verbs, and the irregular verbs…

  10. Sequential Outbreaks of Infections by Distinct Acinetobacter baumannii Strains in a Public Teaching Hospital in Houston, Texas▿

    PubMed Central

    Shelburne, Samuel A.; Singh, Kavindra V.; White, A. Clinton; Byrne, Laura; Carmer, Alexis; Austin, Celest; Graviss, Edward; Stager, Charles; Murray, Barbara E.; Atmar, Robert L.

    2008-01-01

    Invasive disease due to Acinetobacter baumannii is an increasing problem in health care settings worldwide. Whether certain clones of A. baumannii are more likely to cause invasive disease in hospitalized patients is unknown. We studied all patients at a public teaching hospital in Houston, Texas, from whom the Acinetobacter calcoaceticus-Acinetobacter baumannii complex was isolated over a 14-month period in 2005 to 2006. One hundred seven unique patient isolates were identified, with 87 of the strains classified as being A. baumannii, the majority of which were multidrug resistant. The A. baumannii isolates were comprised of 18 unique pulsed-field types, with strains of clone A and clone B accounting for 66 of the 87 isolates. Epidemiologic analysis showed the predominance of the two A. baumannii clones at distinct time periods, with the remainder of the A. baumannii and non-A. baumannii strains being evenly distributed. Patients from whom clone A strains were isolated were more likely to be bacteremic than were patients with other A. baumannii isolates. Conversely, clone B strains were more likely to be isolated from patients with tertiary peritonitis. Patients from whom clone A was isolated had a significantly higher rate of mortality. Multilocus sequence typing demonstrated that clones A and B are related to each other and to A. baumannii strains previously isolated in Western Europe, sharing five of seven alleles. Taken together, we conclude that the outbreak of the A. calcoaceticus-A. baumannii complex in our institution was due to two distinct A. baumannii clones that were associated with significantly different patient outcomes. PMID:18003801

  11. French Expansion in North America.

    ERIC Educational Resources Information Center

    Jaenen, Cornelius J.

    2001-01-01

    Explores the French colonization in North America. Presents background information on New France, focusing on the French in Canada. Covers topics, such as how the French became interested in North American expansion, the French in Louisiana, colonial economics, and the reasons for the collapse of New France. Includes a bibliography. (CMK)

  12. French Dictionaries. Series: Specialised Bibliographies.

    ERIC Educational Resources Information Center

    Klaar, R. M.

    This is a list of French monolingual, French-English and English-French dictionaries available in December 1975. Dictionaries of etymology, phonetics, place names, proper names, and slang are included, as well as dictionaries for children and dictionaries of Belgian, Canadian, and Swiss French. Most other specialized dictionaries, encyclopedias,…

  13. Fewer Mistakes in French.

    ERIC Educational Resources Information Center

    Horan, Ron

    1990-01-01

    Discusses the government-approved simplification of French spelling, and describes rectifications of spelling problems frequently found in forming or using accents, verbs, hyphens, noun plurals, and other anomalies. (CB)

  14. French Tape Catalog.

    ERIC Educational Resources Information Center

    Blaney, Robert, Comp.

    This tape catalog is a complete list of all French-related titles appearing in the National Center for Audio Tapes 1974-76 catalog. Wherever possible, each tape is briefly described. Price and ordering information is included. (PMP)

  15. French Vocabulary Lists

    ERIC Educational Resources Information Center

    Reed, J.

    1970-01-01

    Reviews French vocabulary lists and bilingual dictionaries and evaluates their usefulness for the preparation of materials for the language laboratory as well as for any programed approach to vocabulary teaching. (FB)

  16. The Effects of Temporary Services and Contracting Out on Low-Skilled Workers: Evidence from Auto Suppliers, Hospitals, and Public Schools. Staff Working Paper.

    ERIC Educational Resources Information Center

    Erickcek, George; Houseman, Susan; Kalleberg, Arne

    A study examined why employers use temporary agency and contract company workers and implications of these practices for wages, benefits, and working conditions of workers in low-skilled labor markets. Case studies in manufacturing (automotive supply), services (hospitals), and public sector (primary and secondary schools) industries defined the…

  17. [The Sino-French emergency and disaster medicine training center].

    PubMed

    Pourriat, Jean-Louis; Dahan, Benjamin; Lapandry, Claude

    2012-01-01

    French (AP-HP) and Chinese (Beijing Health Office) hospitals, with support from the French company Total, collaborated in order to improve Chinese doctors' knowledge of emergency and disaster medicine prior to the Beijing Olympic Games. A Sino-French emergency and disaster medicine training center was subsequently opened in Beijing in 2008, with the aim of providing high-level continuous medical training for Chinese specialists in emergency medicine. Teaching in the management of critical situations was based on the use of a latest-generation simulator (Sim 3G; Laerdal). This collaboration has had both pedagogical and diplomatic benefits. PMID:23550459

  18. Hospitals for sale.

    PubMed

    Costello, Michael M; West, Daniel J; Ramirez, Bernardo

    2011-01-01

    The pace of hospital merger and acquisition activity reflects the economic theory of supply and demand: Publicly traded hospital companies, private equity funds, and large nonprofit hospital systems are investing capital to purchase and operate freestanding community hospitals at a time when many of those hospitals find themselves short of capital reserves and certain forms of management expertise. But the sale of those community hospitals also raises questions about the impact of absentee ownership on the communities which those hospitals serve.

  19. Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

    PubMed Central

    Lukin, Bill; Fan, Li-jun; Zhao, Jing-zhou; Sun, Jian-dong; Dingle, Kaeleen; Purtill, Rhonda; Tapp, Sam; Hou, Xiang-yu

    2016-01-01

    BACKGROUND: Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007]. CONCLUSION: The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI. PMID:27547277

  20. Operationalization of the Ghanaian Patients’ Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients

    PubMed Central

    Yarney, Lily; Buabeng, Thomas; Baidoo, Diana; Bawole, Justice Nyigmah

    2016-01-01

    Background: Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients’ Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients’ rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana’s Patients Charter in a peri-urban public hospital. Methods: Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. Results: The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients’ Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. Conclusion: Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients’ rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter.

  1. Operationalization of the Ghanaian Patients’ Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients

    PubMed Central

    Yarney, Lily; Buabeng, Thomas; Baidoo, Diana; Bawole, Justice Nyigmah

    2016-01-01

    Background: Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients’ Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients’ rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana’s Patients Charter in a peri-urban public hospital. Methods: Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. Results: The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients’ Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. Conclusion: Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients’ rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter. PMID:27694679

  2. Compulsory removal to and detention in hospital in the case of notifiable disease: a survey of public health doctors.

    PubMed

    Kaur, B; Bingham, P

    1993-05-01

    Compulsory detention of an individual in hospital, because they have a notifiable disease, is controversial. Difficulties experienced by the authors in applying Sections 37 and 38 of the Public Health (Control of Disease) Act 1984 led them to conduct a postal survey of the experience of Consultants in Communicable Disease Control/Medical Officers of Environmental Health (CCDC/MOEH) currently in post in England. Out of 138 respondents (80% response rate), 48 respondents (34.8%) had dealt with 'non-compliant' individuals posing an infectious risk to the community. Of the 48, 13 respondents achieved compliance by threatening to use Section 37/38 and only 6 respondents resorted to using Section 37/38, equivalent to less than one use of the sections for every hundred years of CCDC/MOEH experience. In most cases the notifiable disease in question was tuberculosis. In contrast to our experience and previously reported cases, the survey suggests generally satisfactory experience of Section 37/38 amongst CCDC/MOEH currently in post. Recommended guidelines for the use of Section 37/38 are given.

  3. [Practice in situations of legal abortion from the perspective of health professionals at Fernando Magalhães public hospital].

    PubMed

    Farias, Rejane Santos; Cavalcanti, Ludmila Fontenele

    2012-07-01

    The scope of this study was to analyze perceptions of health professionals at Fernando Magalhães Public Hospital regarding situations involving the practice of legal abortion. With this in mind, we sought to characterize the professionals interviewed, understand the qualifying process for assistance of women requiring abortion and identify the perceptions of the professionals regarding the practice of legal abortion. The quantitative and qualitative approach in terms of methodology was adopted. The instruments used were analysis of institutional documentation and semi-structured interviews based on a script with informed consent. The results of this research revealed: the inappropriate use of the right to conscientious objection by health professionals; the existence of difficulties faced by professionals in construction of a posture that ensures access to legally sanctioned abortion; and the interference of ethical and religious values as an important element in professional attitudes that discourage the practice of legal abortion. Measures for the ongoing education of professionals and the monitoring of actions applied to technical norms are recommended.

  4. A Gateway to Health Careers for Urban High School Students: Collaborative Front-Line and Allied Workforce Development Program among High Schools, Public Hospitals and Public Colleges. Program Results Report

    ERIC Educational Resources Information Center

    Jablow, Paul

    2012-01-01

    From 2005 to 2011, the Gateway Institute for Pre-College Education partnered with three public entities in New York City--the Department of Education, the City University of New York and the Health and Hospitals Corporation--to introduce, educate, and prepare urban high school students for careers in the health professions. Gateway was launched in…

  5. Publications

    Cancer.gov

    Information about NCI publications including PDQ cancer information for patients and health professionals, patient-education publications, fact sheets, dictionaries, NCI blogs and newsletters and major reports.

  6. French Antilles and Guiana.

    PubMed

    1983-11-01

    This discussion of French Antilles and Guiana cover the following: the people, geography, history, government, political conditions, economy, and relations with the US. In 1983 the population totaled 303,000 with an annual growth rate of 0.09%. The infant mortality rate (1981) was 12.6/1000 and life expectancy 68 years. About 98% of the people of Martinique are of Afro European or Afro European Indian descent. The remainder are the old planter families and a sizable number of metropolitan French. Most of the work force are employed in agriculture or food processing and associated industries. Most permanent residents of Guadeloupe are of mixed Afro European descent. A few thousand Metropolitan French reside there. Most French Guianese live along the coast, about 1/2 of them in the capital. Martinique is the northernmost of the Windward Islands, which are part of the Lesser Antilles chain in the Caribbean Sea southeast of Puerto Rico. Guadeloupe comprises 2 of the Leeward Islands, which are also part of the Lesser Antilles chain. French Guiana is located on the northern coast of South America, a few degrees north of the Equator. Indians were the 1st known indigenous inhabitants of French Guiana and the French Antilles. Columbus sighted Guadeloupe in 1493, Martinique in 1493 or 1502, and the Guiana coast probably during his 3rd voyage in 1498. French Guiana, Guadeloupe, and Martinique, as overseas departments of France since 1946, are integral parts of the French Republic. Their relationship to Metropolitan France is somewhat similar to that of Alaska and Hawaii to the counterminous US. Each department has a general council composed of 1 representative elected by each canton. Guadeloupe and Martinique each elect 2 senators to the French Senate and 3 deputies to the National Assembly. French Guiana elects 1 senator and 1 deputy. In each of the 3 departments exist individuals and small political parties that advocate immediate independence, but their adherents form only

  7. Contraceptive practices among women seeking termination of pregnancy in one public hospital in Eastern Cape, South Africa

    PubMed Central

    Oluwole, Ebenezer O.

    2016-01-01

    Background There is significantly high contraceptive knowledge in South Africa, but the uptake of contraceptives is average to low with resultant soaring of unplanned pregnancy and rising statistics of termination of pregnancy (TOP) services. This study aimed to establish the contraceptive practices among women in the South African population seeking TOP in one public hospital in Eastern Cape, South Africa. Methods A cross-sectional study was carried out among women seeking TOP in a women’s clinic. Self-administered questionnaires were used as data collection tool, and the data collected were entered into SPSS software for analysis, using descriptive statistics to calculate frequencies and percentages while chi-square test was used to determine the associations between the socio-demography and contraceptive practices of the participants. Results Majority of the women were aged between 20 and 29 years, had secondary education, unemployed, single and resided in townships. Contraceptive uptake prior to termination of pregnancy (CTOP) among them was 44.1%, but 85.8% had good contraceptives knowledge. Their contraceptive practices are determined by partner’s opinion, source and availability of contraceptives, previous CTOP, side effect of contraceptives and having children. Age group, educational level and employment status were found to be related to the contraceptive practices of the participants but were not statistically significant. Conclusion To reduce unplanned pregnancies and subsequent number of women seeking CTOP, the socio-economic factors associated with contraceptive practices as well as the programmes, policies and guidelines of contraceptives need to be improved on for any improvement on the factors determining contraceptive practices. PMID:27608676

  8. An assessment of the quality indicators of operative and non-operative times in a public university hospital

    PubMed Central

    Costa, Altair da Silva; Leão, Luiz Eduardo Villaça; de Novais, Maykon Anderson Pires; Zucchi, Paola

    2015-01-01

    ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency. PMID:26761557

  9. [SIGAPS: a software package for the evaluation of medical publications].

    PubMed

    Derancourt, C; Devos, P; Moore, N; Rouvillain, J-L

    2014-01-01

    The "système d'interrogation, de gestion et d'analyse des publications scientifiques" (System for Identification, Management and Analysis of Scientific Publications), or SIGAPS, is an innovative tool of French design that enables the identification and analysis of bibliographic references produced by a given researcher or unit using the Medline database (PubMed). This evaluation takes into account the author's rank of signature and the impact factor of the journal of publication within the discipline in question. The limits are those of the impact factor. Analyses produced by SIGAPS enable financial assessment to be made by hospitals.

  10. French for Marketing. Using French in Media and Communications.

    ERIC Educational Resources Information Center

    Batchelor, R. E.; Chebli-Saadi, M.

    The textbook, entirely in French, is designed to help prepare anglophone students for French language usage in the media and telecommunications. It is organized according to two major themes. The first part addresses the French of advertising; chapter topics include the actors in advertising (agencies, announcers, supports), forms of advertising,…

  11. Comparing Written Competency in Core French and French Immersion Graduates

    ERIC Educational Resources Information Center

    Lappin-Fortin, Kerry

    2014-01-01

    Few studies have compared the written competency of French immersion students and their core French peers, and research on these learners at a postsecondary level is even scarcer. My corpus consists of writing samples from 255 students from both backgrounds beginning a university course in French language. The writing proficiency of core French…

  12. [An opinion survey among French physicians in independent practice (Winter 2007-Spring 2008)].

    PubMed

    Doan, Bui Dang Ha; Lévy, Danièle; Teitelbaum, Juan; Allemand, Hélène

    2009-01-01

    In the French health care system, most of the ambulatory health services are provided by independent practitioners, GP's and specialists, paid on a fee-for-service basis. Nearly all French residents are enrolled in a public sickness insurance fund. The fund pays directly to the doctor (or reimburse to the patient) on the basis of a honorarium-scale, negotiated by the fund and the medical associations. The specialists working in a private hospital (called "clinique") are considered physicians in independent practice and paid on a fee-for-service basis, whereas the specialists working in public (or para-public) hospitals are salaried. In early 2008, approximately 60 percent of all the medical profession were in independent practice. Out of 100 independent practitioners, 52 declared that their workload was "normal" and 44 that their own was "too heavy". Only 2 percent declared that their workload was "insufficient". The survey showed no correlation between the number of independent physicians working in an area and the average workload of each of them. The competition among medical offices was rather low. At the time of the survey, the French health system was dominated by a wide feeling of medical workforce shortage. However, only one quarter of the independent physicians were convinced that shortage existed in their own area. Difficulties and problems arisen from the relationship with partners were mentioned by a great number of independent practitioners: exaggerate requests from the patients (mentioned by 62%), bureaucratic approaches from the sickness insurance fund (32%), working ties with the public or para-public hospitals (23%)...During the period 2005-2008, the proportion of practitioners having difficulties in their professional relations has increased, in particular among specialists. However, during the same period, there was a change in the mood of the medical profession. The proportion of independent physicians who estimated that their standards of

  13. Collective response to public health emergencies and large-scale disasters: putting hospitals at the core of community resilience.

    PubMed

    Paturas, James L; Smith, Deborah; Smith, Stewart; Albanese, Joseph

    2010-07-01

    Healthcare organisations are a critical part of a community's resilience and play a prominent role as the backbone of medical response to natural and manmade disasters. The importance of healthcare organisations, in particular hospitals, to remain operational extends beyond the necessity to sustain uninterrupted medical services for the community, in the aftermath of a large-scale disaster. Hospitals are viewed as safe havens where affected individuals go for shelter, food, water and psychosocial assistance, as well as to obtain information about missing family members or learn of impending dangers related to the incident. The ability of hospitals to respond effectively to high-consequence incidents producing a massive arrival of patients that disrupt daily operations requires surge capacity and capability. The activation of hospital emergency support functions provides an approach by which hospitals manage a short-term shortfall of hospital personnel through the reallocation of hospital employees, thereby obviating the reliance on external qualified volunteers for surge capacity and capability. Recent revisions to the Joint Commission's hospital emergency preparedness standard have impelled healthcare facilities to participate actively in community-wide planning, rather than confining planning exclusively to a single healthcare facility, in order to harmonise disaster management strategies and effectively coordinate the allocation of community resources and expertise across all local response agencies.

  14. The Real Cost of "Cosmetic Tourism" Cost Analysis Study of "Cosmetic Tourism" Complications Presenting to a Public Hospital.

    PubMed

    Livingston, Ryan; Berlund, Paul; Eccles-Smith, Jade; Sawhney, Raja

    2015-01-01

    "Cosmetic Tourism," the process of traveling overseas for cosmetic procedures, is an expanding global phenomenon. The model of care by which these services are delivered can limit perioperative assessment and postoperative follow-up. Our aim was to establish the number and type of complications being treated by a secondary referral hospital resulting from "cosmetic tourism" and the cost that has been incurred by the hospital in a 1-year period. Retrospective cost analysis and chart review of patients admitted to the hospital between the financial year of 2012 and 2013 were performed. Twelve "cosmetic tourism" patients presented to the hospital, requiring admission during the study period. Breast augmentation was the most common procedure and infected prosthesis was the most common complication (n = 4). Complications ranged from infection, pulmonary embolism to penile necrosis. The average cost of treating these patients was $AUD 12 597.71. The overall financial burden of the complication to the hospital was AUD$151 172.52. The "cosmetic tourism" model of care appears to be, in some cases, suboptimal for patients and their regional hospitals. In the cases presented in this study, it appears that care falls on the patient local hospital and home country to deal with the complications from their surgery abroad. This incurs a financial cost to that hospital in addition to redirecting medical resources that would otherwise be utilized for treating noncosmetic complications, without any remuneration to the local provider.

  15. Teaching French via American Football

    ERIC Educational Resources Information Center

    Berwald, Jean-Pierre

    1974-01-01

    Outlines the methods of using football in teaching French in the American classroom by using French Canadian newspapers and other visual media available in the United States, in addition to specific language activities. (LG)

  16. Social Studies in French Schools

    ERIC Educational Resources Information Center

    Dumas, Wayne; Lee, William B.

    1978-01-01

    Examines current educational goals, curricula, and methodology of French social studies education. Investigates influences of the student riots of 1968, and considers what effect these reforms will have on the future of French education. (Author/JK)

  17. Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study

    PubMed Central

    Gerdin, Martin; Roy, Nobhojit; Khajanchi, Monty; Kumar, Vineet; Dharap, Satish; Felländer-Tsai, Li; Petzold, Max; Bhoi, Sanjeev; Saha, Makhan Lal; von Schreeb, Johan

    2014-01-01

    Background In India alone, more than one million people die yearly due to trauma. Identification of patients at risk of early mortality is crucial to guide clinical management and explain prognosis. Prediction models can support clinical judgement, but existing models have methodological limitations. The aim of this study was to derive a vital sign based prediction model for early mortality among adult trauma patients admitted to three public university hospitals in urban India. Methods We conducted a prospective cohort study of adult trauma patients admitted to three urban university hospitals in India between October 2013 and January 2014. The outcome measure was mortality within 24 hours. We used logistic regression with restricted cubic splines to derive our model. We assessed model performance in terms of discrimination, calibration, and optimism. Results A total of 1629 patients were included. Median age was 35, 80% were males. Mortality between admission and 24 hours was 6%. Our final model included systolic blood pressure, heart rate, and Glasgow coma scale. Our model displayed good discrimination, with an area under the receiver operating characteristics curve (AUROCC) of 0.85. Predicted mortality corresponded well with observed mortality, indicating good calibration. Conclusion This study showed that routinely recorded systolic blood pressure, heart rate, and Glasgow coma scale predicted early hospital mortality in trauma patients admitted to three public university hospitals in urban India. Our model needs to be externally validated before it can be applied in the clinical setting. PMID:25180494

  18. Publications.

    ERIC Educational Resources Information Center

    Aviation/Space, 1980

    1980-01-01

    Presents a variety of publications available from government and nongovernment sources. The government publications are from the Federal Aviation Administration (FAA) and the National Aeronautics and Space Administration (NASA) and are designed for educators, students, and the public. (Author/SA)

  19. Teaching French as a Second Language for the Health Professions: Description of the Design Process.

    ERIC Educational Resources Information Center

    Mery-Gorrie, Rose

    The Children's Hospital of Eastern Ontario, whose stated objective is to provide bilingual French-English services, has established a training program in French as a second language for health care professionals. The program was designed to provide health care providers with a minimum level of communicative competence in specific job-related…

  20. French validation of the critical care family needs inventory.

    PubMed

    Coutu-Wakulczyk, G; Chartier, L

    1990-03-01

    This study is a contribution to the French validation of Molter and Leske Critical Care Family Needs Inventory (CCFNI). The importance of this validation study is based on the presumption that evaluation of family needs relies on the use of measures that are reliable and valid for a specific population. The preliminary validation of the French text of the CCFNI was carried out by back translation method of the French form into English by three translators. Then the final French version was selected. The study was conducted in the surgical intensive care unit of the University Hospital in Sherbrooke, Canada. The sample consisted of 207 voluntary subjects selected from adult members of the immediate family visiting a patient in the intensive care unit. The data collection was spread over a 10-week period. The French version of the CCFNI was given to subjects for self-reporting at the end of a 15-minute face-to-face interview. The reliability of the French version yielded 0.91 as Cronbach alpha coefficient. The Spearman-Brown split-half coefficient was 0.89, and the Guttman split-half coefficient was 0.88. Principal-component analysis and factorial matrices were used to examine the clustering structure of the French version of this instrument.

  1. Strategies to develop and promote public-private partnerships (PPPs) in the provision of hospital services in Iran: a qualitative study

    PubMed Central

    Sadeghi, Ahmad; Barati, Omid; Bastani, Peivand; Daneshjafari, Davood; Etemadian, Masoud

    2016-01-01

    Introduction Public-Private Partnerships (PPPs) have been constructively considered in recent years to reform health sectors in many countries. This study aimed at explaining the strategies to develop and promote PPPs in the provision of hospital services in Iran. Methods This qualitative study was conducted in 2015. The study population consisted of experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran that were selected through purposeful sampling, and semi-structured interviews were used for data collection. To this end, 18 experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran were selected. The data were analyzed and classified using MAXQDA10 software and content analysis, respectively. Results According to the results of this study, four main themes and 20 subthemes in terms of strategies to develop and promote PPPs in the provision of hospital services in Iran were identified, including changes in policies and laws, socio-cultural changes, improvement of mechanisms and current processes, and financial and capital capacity building. Conclusion To develop and promote PPPs in the provision of hospital services, there is a need to consider prerequisites and measures to help such partnerships to be effective and produce valuable results. PMID:27279993

  2. Know Your Laws. French.

    ERIC Educational Resources Information Center

    Watson, Joan Q.; Ledun, Andree

    This French language version of "Know Your Laws" consists of 24 self-contained modules designed to acquaint the Florida adult student with laws she/he will meet in everyday life; fundamentals of local, state, and federal governments; and the criminal and juvenile justice systems. (The 130 objectives are categorized in the first three levels of the…

  3. Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province

    PubMed Central

    Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

    2015-01-01

    Background High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. Methods A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Results Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. Conclusion The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This

  4. Multi-Country Evaluation of Safety of Dihydroartemisinin/Piperaquine Post-Licensure in African Public Hospitals with Electrocardiograms

    PubMed Central

    Baiden, Rita; Ali, Ali M.; Mahende, Muhidin K.; Ogutu, Bernhards R.; Oduro, Abraham; Tinto, Halidou; Gyapong, Margaret; Sie, Ali; Sevene, Esperanca; Macete, Eusebio; Owusu-Agyei, Seth; Adjei, Alex; Compaoré, Guillaume; Valea, Innocent; Osei, Isaac; Yawson, Abena; Adjuik, Martin; Akparibo, Raymond; Kakolwa, Mwaka A.; Abdulla, Salim; Binka, Fred

    2016-01-01

    The antimalarial drug piperaquine is associated with delayed ventricular depolarization, causing prolonged QT interval (time taken for ventricular de-polarisation and re-polarisation). There is a lack of safety data regarding dihydroartemisinin/piperaquine (DHA/PPQ) for the treatment of uncomplicated malaria, which has limited its use. We created a platform where electrocardiograms (ECG) were performed in public hospitals for the safety assessment of DHA/PPQ, at baseline before the use of dihydroartemisinin/piperaquine (Eurartesim®), and on day 3 (before and after administration of the final dose) and day 7 post-administration. Laboratory analyses included haematology and clinical chemistry. The main objective of the ECG assessment in this study was to evaluate the effect of administration of DHA/PPQ on QTc intervals and the association of QTc intervals with changes in blood biochemistry, full and differential blood count over time after the DHA/PPQ administration. A total of 1315 patients gave consent and were enrolled of which 1147 (87%) had complete information for analyses. Of the enrolled patients 488 (42%), 323 (28%), 213 (19%) and 123 (11%) were from Ghana, Burkina Faso, Tanzania and Mozambique, respectively. Median (lower—upper quartile) age was 8 (5–14) years and a quarter of the patients were children under five years of age (n = 287). Changes in blood biochemistry, full and differential blood count were temporal which remained within clinical thresholds and did not require any intervention. The mean QTcF values were significantly higher than on day 1 when measured on day 3 before and after administration of the treatment as well as on day 7, four days after completion of treatment (12, 22 and 4 higher, p < 0.001). In all age groups the values of QT, QTcF and QTcB were highest on day 3 after drug intake. The mean extreme QTcF prolongation from baseline was lowest on day 3 before drug intake (33 ms, SD = 19) and highest on day 3 after the last dose

  5. Barriers to HIV counseling and testing uptake by health workers in three public hospitals in Free State Province, South Africa.

    PubMed

    Khan, Rabia; Yassi, Annalee; Engelbrecht, Michelle C; Nophale, Letshego; van Rensburg, André J; Spiegel, Jerry

    2015-01-01

    Recent WHO/ILO/UNAIDS guidelines recommend priority access to HIV services for health care workers (HCWs), in order to retain and support HCWs, especially those at risk of occupationally acquired tuberculosis (TB). The purpose of this study was to identify barriers to uptake of HIV counselling and testing (HCT) services for HCWs receiving HCT within occupational health units (OHUs). Questions were included within a larger occupational health survey of a 20% quota sample of HCWs from three public hospitals in Free State Province, South Africa. Of the 978 respondents, nearly 65% believed that their co-workers would not want to know their HIV status. Barriers to accessing HCT at the OHU included ambiguity over whether antiretroviral treatment was available at the OHU (only 51.1% knew), or whether TB treatment was available (55.5% knew). Nearly 40% of respondents perceived that stigma as a barrier. When controlling for age and race, the odds of perceiving HIV stigma in the workplace among patient-care health care workers (PCHWs) were 2.4 times that for non-PCHWs [95% confidence interval (CI): 1.80-3.15]. Of the 692 survey respondents who indicated a reason for not using HIV services at the OHU, 38.9% felt that confidentiality was the reason cited. Among PCHWs, the adjusted odds of expressing concern that confidentiality may not be maintained in the OHU were 2.4 times (95% CI: 1.8-3.2) that of non-PCHWs and were higher among Black [odds ratio (OR): 2.7, CI: 1.7-4.2] and Coloured HCWs (OR: 3.0, 95% CI: 1.6-5.6) as compared to White HCWs, suggesting that stigma and confidentiality concerns are still barriers to uptake of HCT. Campaigns to improve awareness of HCT and TB services offered in the OHUs, address stigma and ensure that the workforce is aware of the confidentiality provisions that are in place are warranted. PMID:25174842

  6. Molecular Genotyping of Giardia duodenalis Isolates from Symptomatic Individuals Attending Two Major Public Hospitals in Madrid, Spain

    PubMed Central

    Bailo, Begoña; Aguilera, María; Fuentes, Isabel; Carmena, David

    2015-01-01

    Background The flagellate protozoan Giardia duodenalis is an enteric parasite causing human giardiasis, a major gastrointestinal disease of global distribution affecting both developing and industrialised countries. In Spain, sporadic cases of giardiasis have been regularly identified, particularly in pediatric and immigrant populations. However, there is limited information on the genetic variability of circulating G. duodenalis isolates in the country. Methods In this longitudinal molecular epidemiological study we report the diversity and frequency of the G. duodenalis assemblages and sub-assemblages identified in 199 stool samples collected from 184 individual with symptoms compatible with giardiasis presenting to two major public hospitals in Madrid for the period December 2013–January 2015. G. duodenalis cysts were initially detected by conventional microscopy and/or immunochomatography on stool samples. Confirmation of the infection was performed by direct immunofluorescence and real-time PCR methods. G. duodenalis assemblages and sub-assemblages were determined by multi-locus genotyping of the glutamate dehydrogenase (GDH) and β-giardin (BG) genes of the parasite. Sociodemographic and clinical features of patients infected with G. duodenalis were also analysed. Principal findings Of 188 confirmed positive samples from 178 giardiasis cases a total of 124 G. duodenalis isolates were successfully typed at the GDH and/or the BG loci, revealing the presence of sub-assemblages BIV (62.1%), AII (15.3%), BIII (4.0%), AI (0.8%), and AIII (0.8%). Additionally, 6.5% of the isolates were only characterised at the assemblage level, being all of them assigned to assemblage B. Discordant genotype results AII/AIII or BIII/BIV were also observed in 10.5% of DNA isolates. A large number of multi-locus genotypes were identified in G. duodenalis assemblage B, but not assemblage A, isolates at both the GDH and BG loci, confirming the high degree of genetic variability

  7. From living room through french doors toward room in southeast ...

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

    From living room through french doors toward room in southeast corner of south unit - Fitzsimons General Hospital, Civilian Employees' Quarters, North Hickey Street, West side, 150 feet North of intersection of North Hickey Street & West Loosley Avenue, Aurora, Adams County, CO

  8. Availability and use of emergency obstetric care services in public hospitals in Laos PDR: a systems analysis.

    PubMed

    Douangphachanh, Xaysomphou; Ali, Moazzam; Outavong, Phathammavong; Alongkon, Phengsavanh; Sing, Menorath; Chushi, Kuroiwa

    2010-12-01

    The maternal mortality ratio in Laos in 2005 was 660 per 100,000 lives birth which was the third highest in Asia-Pacific Region. The objective was to determine the availability and use of emergency obstetric care (EmOC) in provincial and district hospitals in Borikhamxay, Khammouane, and Savannakhet provinces using UN guidelines. A hospital-based cross sectional survey was conducted from January to March 2008. All district (30) and provincial hospitals (3) from three provinces were included. Analysis was based on hospital records reflecting 12 months of facility data. Data indicates that only 14 hospitals (42.4%) were providing EmOC services, i.e., 9 basic, 5 comprehensive services. The proportion of births in EmOC facilities was only 11.2%, the met need was a very low 14.5%, and the cesarean section rate was only 0.9%. The case fatality rate in Borikhanxay province was 2.8%; in Khammouane and in Savannakhet provinces it was less than 1%. Record keeping at hospitals was poor. Signal functions provided in the last three months showed only 48.5% of the facilities performed assisted vaginal delivery. This is the first study in Lao PDR to assess EmOC services. Almost all the indicators were below the UN recommendations. Health planners must take evidence-based decisions to rectify and improve the situation in the hospitals regarding EmOC services. These data can therefore help government to assign and allocate budgets appropriately, and help policymakers and planners to identify systemic bottlenecks and prioritize solutions and will help in improving maternal health. PMID:21248430

  9. Deinstitutionalization of American public hospitals for the mentally ill before and after the introduction of antipsychotic medications.

    PubMed

    Pow, Joni Lee; Baumeister, Alan A; Hawkins, Mike F; Cohen, Alex S; Garand, James C

    2015-01-01

    Deinstitutionalization following the introduction of antipsychotic medications in 1954 has received much attention as a major narrative in psychiatry. Little attention has been given, however, to deinstitutionalization before 1954. Using United States census data on discharge and readmission rates of US mental hospitals from 1935 to 1964, this article analyzes deinstitutionalization using an interrupted time-series model, with particular attention to the statistical significance of trends before and after the advent of antipsychotics. Discharge rates significantly increased in the period before antipsychotics, indicating that deinstitutionalization began before 1954, although readmissions during that same period increased at the same rate as discharges. A reasonable inference is that patients discharged in the pre-antipsychotic period were unable to live independently outside the hospital. After 1954, both discharges and readmissions increased significantly, but due to a continuing increase in admissions, no significant decrease in mental hospital populations occurred during the seven-year period after 1954. The decline began in 1961 and coincided with changes in federal policy. The fate of mental patients discharged from hospitals during this second period of deinstitutionalization is examined. The central conclusions are (1) the overall reduction in the population of mental hospitals did not coincide with the 1954 introduction of antipsychotic medications, and (2) deinstitutionalization before and after drugs has been met with inadequate community-based care. PMID:25839642

  10. Resveratrol: French Paradox Revisited

    PubMed Central

    Catalgol, Betul; Batirel, Saime; Taga, Yavuz; Ozer, Nesrin Kartal

    2012-01-01

    Resveratrol is a polyphenol that plays a potentially important role in many disorders and has been studied in different diseases. The research on this chemical started through the “French paradox,” which describes improved cardiovascular outcomes despite a high-fat diet in French people. Since then, resveratrol has been broadly studied and shown to have antioxidant, anti-inflammatory, anti-proliferative, and anti-angiogenic effects, with those on oxidative stress possibly being most important and underlying some of the others, but many signaling pathways are among the molecular targets of resveratrol. In concert they may be beneficial in many disorders, particularly in diseases where oxidative stress plays an important role. The main focus of this review will be the pathways affected by resveratrol. Based on these mechanistic considerations, the involvement of resveratrol especially in cardiovascular diseases, cancer, neurodegenerative diseases, and possibly in longevity will be is addressed. PMID:22822401

  11. [Hospitality workers' exposure to environmental tobacco smoke before and after implementation of smoking ban in public places: a review of epidemiological studies].

    PubMed

    Polańska, Kinga; Hanke, Wojciech; Konieczko, Katarzyna

    2011-01-01

    Environmental tobacco smoke (ETS) exposure induces serious negative health consequences, of which the increased risk of cardiovascular diseases, cancer, respiratory symptoms and poor pregnancy outcomes appear to be most important. Taking into account those health consequences of ETS exposure most countries have introduced legislation to ban or restrict smoking in public places. In this paper the effectiveness of the introduced legislation was analyzed with regard to the protection of hospitality workers from ETS exposure in the workplace. The analysis of 12 papers published after 2000 covered the year of publication, type of legislation, study population, hospitality venue (pub, bar, restaurant, disco) and type of markers or self-reported perception of exposure to ETS. The analysis indicates that the legislation to ban smoking in hospitality venues protects workers from ETS exposure when the venues are 100% tobacco smoke free. The reduction of the cotinine level in biological samples after the implementation of smoke free law was 57-89%, comparing to the biomarker level in the samples taken before the new law was introduced. About 90% of reduction in nicotine and PM levels was also noted. In addition, the positive self perception reported by workers proved the effectiveness of new legislation protecting them from ETS exposure.

  12. Incidence of adverse drug events in public and private hospitals in Riyadh, Saudi Arabia: the (ADESA) prospective cohort study

    PubMed Central

    Aljadhey, Hisham; Mahmoud, Mansour A; Ahmed, Yusuf; Sultana, Razia; Zouein, Salah; Alshanawani, Sulafah; Mayet, Ahmed; Alshaikh, Mashael K; Kalagi, Nora; Al Tawil, Esraa; El Kinge, Abdul Rahman; Arwadi, Abdulmajid; Alyahya, Maha; Murray, Michael D; Bates, David

    2016-01-01

    Objectives To determine the incidence of adverse drug events (ADEs) and assess their severity and preventability in four Saudi hospitals. Design Prospective cohort study. Setting The study included patients admitted to medical, surgical and intensive care units (ICUs) of four hospitals in Saudi Arabia. These hospitals include a 900-bed tertiary teaching hospital, a 400-bed private hospital, a 1400-bed large government hospital and a 350-bed small government hospital. Participants All patients (≥12 years) admitted to the study units over 4 months. Primary and secondary outcome measures Incidents were collected by pharmacists and reviewed by independent clinicians. Reviewers classified the identified incidents as ADEs, potential ADEs (PADEs) or medication errors and then determined their severity and preventability. Results We followed 4041 patients from admission to discharge. Of these, 3985 patients had complete data for analysis. The mean±SD age of patients in the analysed cohort was 43.4±19.0 years. A total of 1676 ADEs were identified by pharmacists during the medical chart review. Clinician reviewers accepted 1531 (91.4%) of the incidents identified by the pharmacists (245 ADEs, 677 PADEs and 609 medication errors with low risk of causing harm). The incidence of ADEs was 6.1 (95% CI 5.4 to 6.9) per 100 admissions and 7.9 (95% CI 6.9 to 8.9) per 1000 patient-days. The occurrence of ADEs was most common in ICUs (149 (60.8%)) followed by medical (67 (27.3%)) and surgical (29 (11.8%)) units. In terms of severity, 129 (52.7%) of the ADEs were significant, 91 (37.1%) were serious, 22 (9%) were life-threatening and three (1.2%) were fatal. Conclusions We found that ADEs were common in Saudi hospitals, especially in ICUs, causing significant morbidity and mortality. Future studies should focus on investigating the root causes of ADEs at the prescribing stage, and development and testing of interventions to minimise harm from medications. PMID:27406640

  13. [The origins of the French neurosurgery].

    PubMed

    Brunon, J

    2016-06-01

    Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette. PMID:27234912

  14. [The origins of the French neurosurgery].

    PubMed

    Brunon, J

    2016-06-01

    Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette.

  15. “I'm Sitting Here By Myself …”: Experiences of Patients with Serious Illness at an Urban Public Hospital

    PubMed Central

    Cimino, Jenica W.; Adler, Shelley R.; Wong, Piera; Anderson, Wendy G.

    2010-01-01

    Abstract Objective To describe experiences of serious illness including concerns, preferences, and perspectives on improving end-of-life (EOL) care in underserved inpatients. Methods Qualitative analysis of 1-hour interviews with inpatients at a public hospital whose physician “would not be surprised” by the patient's death or intensive care unit (ICU) admission within a year. Patients who were non-English speaking, lacked mental capacity, or had uncontrolled symptoms were excluded. A semistructured interview guide was developed and used for all interviews. We digitally recorded, transcribed, and conducted a thematic analysis of the interviews. Results Twenty patients participated. Difficult events such as estrangement, homelessness, substance abuse, and imprisonment shaped patients' approaches to serious illness. This influence manifested in interpersonal relationships, conceptualizations of death and concerns about dying, and approaches to coping with EOL. Because patients lacked social support, providers played significant roles at EOL. Patients preferred honest communication with providers and sharing in medical decision-making. A prolonged dying process was feared more than sudden death. Concerns included pain, dying in the hospital, and feeling unwelcome in the hospital. Patients coped by advocating for their own care, engaging with religion/spirituality, and viewing illness as similar to past trauma. Participants suggested that providers listen to their concerns and requested accessible chaplaincy and home-based services. Conclusions Providers should consider that difficult life events influence underserved patients' approaches to dying. Attention to patients' specific preferences and palliative care in public hospitals and locations identified as home may improve care for patients who lack social support. PMID:20568968

  16. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

    SciTech Connect

    Crowhurst, James A; Whitby, Mark; Thiele, David; Halligan, Toni; Westerink, Adam; Crown, Suzanne; Milne, Jillian

    2014-09-15

    Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median K{sub AR} = 581 mGy (374–876). Median P{sub KA} = 3908 uGym{sup 2} (2489–5865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median K{sub AR} = 1501 mGy (928–2224). Median P{sub KA} = 8736 uGym{sup 2} (5449–12,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

  17. Does labour epidural slow the progress of labour and lead to complications? Obstetricians’ perception working in private and public sector teaching hospitals in a developing country

    PubMed Central

    Sohaib, Muhammad; Ismail, Samina

    2015-01-01

    Background and Aims: Obstetricians play a major role in the decision making for provision of analgesia for the woman in labour. As epidural analgesia (EA) is the most preferred technique, it is important to know obstetricians' perception regarding its effect on progress of labour and associated complications. Methods: The 6 months cross-sectional study included 114 obstetricians from teaching hospitals. After informed consent, obstetricians were asked to fill a predesigned questionnaire containing 13 close ended questions regarding their perception on the effect of EA on progress of labour, EA complications and whether they would recommend EA to their patients or not. Other variables included age, gender, training in EA, practice type and hospital settings (private or public sector). Results: Majority of the obstetricians had the perception of EA prolonging the first stage (89.5%) and second stage (98.2%) of labour, increasing the rate of caesarean section (87.7%), instrumental delivery (58.8%) and increasing the incidence of backache (85.5%). None of the obstetricians received any formal training in EA. Majority (84.2%) were not sure if they would recommend EA to their patients. When these responses were compared between public and private sector, a statistically higher percentage (P < 0.001) of public sector obstetricians had negative perception of EA. Conclusion: Perception of obstetrician regarding EA is contrary to the current evidence. There is a need to introduce formal curriculum on EA in obstetric training program and conduct regular refresher courses. PMID:26903670

  18. Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China

    PubMed Central

    He, Zhifei; Cheng, Zhaohui; Fu, Hang; Tang, Shangfeng; Fu, Qian; Fang, Haiqing; Xian, Yue; Ming, Hui; Feng, Zhanchun

    2015-01-01

    Purpose: This study aimed to explore the competencies of public health workers (PHWs) of township hospitals in Chongqing Municipality (China), and determine the related impact factors of the competencies of PHWs; Methods: A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China), from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA) method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. Results: (1) Results of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 < 0.05) and the majors of PHWs (p = 0.045 < 0.05); (2) In terms of the self-evaluation competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3) By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 < 0.05), age (p = 0.000 < 0.05), years of working (p = 0.000 < 0.05) and title of PHWs (p = 0.000 < 0.05); (4) Stepwise regression analysis was used to determine the impact factors of the competencies of PHWs in township hospitals, including the economic level (p = 0.000 < 0.001), years of working (p = 0.000 < 0.001), title (p = 0.001 < 0.005), and public health major (p = 0.007 < 0.01). Conclusions: The competencies of the township hospital staff in Chongqing Municipality (China), are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial

  19. Health-care waste incineration and related dangers to public health: case study of the two teaching and referral hospitals in Kenya.

    PubMed

    Njagi, Nkonge A; Oloo, Mayabi A; Kithinji, J; Kithinji, Magambo J

    2012-12-01

    There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level, [2006] for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units.

  20. The French Space Operation Act: Technical Regulations

    NASA Astrophysics Data System (ADS)

    Trinchero, J. P.; Lazare, B.

    2010-09-01

    The French Space Operation Act(FSOA) stipulates that a prime objective of the National technical regulations is to protect people, property, public health and the environment. Compliance with these technical regulations is mandatory as of 10 December 2010 for space operations by French space operators and for space operations from French territory. The space safety requirements and regulations governing procedures are based on national and international best practices and experience. A critical design review of the space system and procedures shall be carried out by the applicant, in order to verify compliance with the Technical Regulations. An independent technical assessment of the operation is delegated to CNES. The principles applied when drafting technical regulations are as follows: requirements must as far as possible establish the rules according to the objective to be obtained, rather than how it is to be achieved; requirements must give preference to international standards recognised as being the state of the art; requirements must take previous experience into account. Technical regulations are divided into three sections covering common requirements for the launch, control and return of a space object. A dedicated section will cover specific rules to be applied at the Guiana Space Centre. The main topics addressed by the technical regulations are: operator safety management system; study of risks to people, property, public health and the Earth’s environment; impact study on the outer space environment: space debris generated by the operation; planetary protection.

  1. French nuclear power charges in future

    SciTech Connect

    Catz, H.

    1996-07-01

    Electric rates in France are one of the best bargains in Europe, thanks largely to its state-run nuclear program. Since Charles DeGaulle created the French Atomic Energy Agency (CEA) in the late 1940`s, that agency and Elecricite de France (EdF) have put France well on the road to energy independence, says Henri Catz, director of Environment and Energy Policy at Confederation Francaise Democratique du Travail in France. {open_quotes}Nuclear power generates more than 75 percent of the electricity that France consumes,{close_quotes} Catz says. However, the French nuclear establishment has been slow to respond to the public`s environmental and safety concerns. In addition, Catz finds that CEA and EdF have no particular incentive to promote energy conservation. {open_quotes}French electricity is cheap and abundant. EdF has responded to this energy glut by encouraging its consumers to use more electricity, while simultaneously exporting excess power to France`s neighbors.

  2. French perspectives on psychiatric classification.

    PubMed

    Crocq, Marc-Antoine

    2015-03-01

    This article reviews the role of the French schools in the development of psychiatric nosology. Boissier de Sauvages published the first French treatise on medical nosology in 1763. Until the 1880s, French schools held a pre-eminent position in the development of psychiatric concepts. From the 1880s until World War I, German-speaking schools exerted the most influence, featuring the work of major figures such as Emil Kraepelin and Eugen Bleuler. French schools were probably hampered by excessive administrative and cultural centralization. Between the 1880s and the 1930s, French schools developed diagnostic categories that set them apart from international classifications. The main examples are Bouffée Délirante, and the complex set of chronic delusional psychoses (CDPs), including chronic hallucinatory psychosis. CDPs were distinguished from schizophrenia by the lack of cognitive deterioration during evolution. Modern French psychiatry is now coming into line with international classification, such as DSM-5 and the upcoming ICD-11.

  3. Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

    PubMed Central

    2012-01-01

    Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254), and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers. PMID:23270463

  4. The roles of users personal characteristics and organisational support in the attitude towards using ERP systems in a Spanish public hospital.

    PubMed

    Escobar-Rodriguez, Tomas; Bartual-Sopena, Lourdes

    2013-01-01

    Enterprise resources planning (ERP) systems enable central and integrative control over all processes throughout an organisation by ensuring one data entry point and the use of a common database. T his paper analyses the attitude of healthcare personnel towards the use of an ERP system in a Spanish public hospital, identifying influencing factors. This research is based on a regression analysis of latent variables using the optimisation technique of partial least squares. We propose a research model including possible relationships among different constructs using the technology acceptance model. Our results show that the personal characteristics of potential users are key factors in explaining attitude towards using ERP systems.

  5. [From the French Society of Plastic and Reconstructive Surgery to the French Society of Plastic Reconstructive and Aesthetic Surgery].

    PubMed

    Glicenstein, J

    2004-04-01

    (The) 3rd December 1952, 11 surgeons and other specialists found the French Society of Plastic and Reconstructive Surgery (SFCPR) which was officially published on (the) 28 September 1953. The first congress was during October 1953 and the first president as Maurice Aubry. The first secretary was Daniel Morel Fatio. The symposiums were after about three of four times each year and the thematic subjects were initially according the reconstructive surgery. The review "Annales de chirurgie plastique" was free in 1956. The members of the Society were about 30 initially, but their plastic surgery in the big hospitals at Paris and other big towns in France. The "specialty" of plastic surgery was created in 1971. On "syndicate", one French board of plastic reconstructive and aesthetic surgery, the increasing of departments of plastic surgery were the front of increasing of the plastic surgery in French and of the number of the French Society of Plastic Reconstructive surgery (580 in 2003). The French Society organized the International Congress of Plastic Surgery in 1975. The society SFCPR became the French Society of plastic reconstruction and Aesthetic Surgery (SFCPRE) in 1983 and the "logo" (front view) was in the 1994 SOF.CPRE.

  6. French Pro/Am collaborations in exoplanet

    NASA Astrophysics Data System (ADS)

    Santerne, A.; Moutou, C.; Vanhuysse, M.; Bouchy, F.; Buil, C.; Cochard, F.; Thizy, O.; Martinez, P.; Desnoux, V.; Pujol, M.; Colas, F.

    2011-10-01

    Amateur astronomers have access to huge telescope time and can reach photometric precision up to a few mmag as well as radial velocity precision up to ˜ 50m.s-1 on brightest stars. We will first present some results of french amateur astronomers in transit photometry and radial velocity and then, we will present an over-view of all the collaborations which can be done between professional and amateur astronomers in the competitive exoplanet domain, and especially the current collaboration between french Pro & Am astronomers which was used in publication in A&A. Finally, we will present a new internet wiki page which goal is to develop such collaboration in different countries.

  7. [The congress of the French Society of Pharmacology and Therapeutics celebrate in Nancy, 20 April 2016, 40 years of French Regional Pharmacovigilance Centres!].

    PubMed

    Jonville-Béra, Annie-Pierre; Mallaret, Michel; Sgro, Catherine

    2016-09-01

    In 1976, the Regional Pharmacovigilance Centres were created in France to collect and analyze adverse drug reactions. Even if they have, to date, managed and transmitted more than 583,000 adverse drug reactions to the French and international health authorities, the missions of these university hospital structures supervised by clinical pharmacologists are not limited to this activity. They also provide a consulting and diagnostic aid for drug diseases. Their other main mission is information about drugs and their proper use for health professionals and patients on any matter relating to medicines. These queries are used to adjust and focus the training of health professionals in prevention of drug risks and improvement of drug use. Beside signal detection and identification of alerts, the 31 Regional Pharmacovigilance Centres collaborate with the French Drug Agency (Agence nationale de sécurité du medicament et des produits de santé [ANSM]) by achieving expertise on drugs and participation in various working groups and committees. Finally, Regional Pharmacovigilance Centres participate in scientific advancement through research and publication activities.

  8. [French immigration policy].

    PubMed

    Weil, P

    1994-01-01

    From the late nineteenth century through 1974, France permitted immigration to furnish workers and to compensate for the low level of fertility. Intense immigration from North Africa, the economic crisis of the 1970s, and other factors led to policy changes in 1974. French immigration policy since 1974 has fluctuated between guaranteeing foreigners equal rights regardless of their religion, race, culture, or national origin, and attempting to differentiate among immigrants depending on their degree of assimilability to French culture. From 1974 to 1988, France had five different policies regarding whether to permit new immigration and what to do about illegal immigrants. In July 1984, the four major political parties unanimously supported a measure in Parliament that definitively guaranteed the stay in France of legal immigrants, whose assimilation thus assumed priority. Aid for return to the homeland was no longer to be widely offered, and immigration of unskilled workers was to be terminated except for those originating in European Community countries. Major changes of government in 1988 and 1993 affected only the modalities of applying these principles. The number of immigrants has fluctuated since 1974. Unskilled workers, the only category whose entrance was specifically controlled by the 1984 measures, have declined from 174,000 in 1970 to 25,000 in the early 1990s. The number of requests for political asylum declined from 60,000 in 1989 to 27,000 in 1993, and in 1991, 15,467 persons were granted refugee status. The number of immigrants of all types permitted to remain in France declined from 250,000 or 3000 per year in the early 1970s to around 110,000 at present. Although the decline is significant, it appears insufficient to the government in power since 1993. Although migratory flows are often explained as the product of imbalance in the labor market or in demographic growth, the French experience suggests that government policies, both in the sending and

  9. A Public-Private Partnership Develops and Externally Validates a 30-Day Hospital Readmission Risk Prediction Model

    PubMed Central

    Choudhry, Shahid A.; Li, Jing; Davis, Darcy; Erdmann, Cole; Sikka, Rishi; Sutariya, Bharat

    2013-01-01

    Introduction: Preventing the occurrence of hospital readmissions is needed to improve quality of care and foster population health across the care continuum. Hospitals are being held accountable for improving transitions of care to avert unnecessary readmissions. Advocate Health Care in Chicago and Cerner (ACC) collaborated to develop all-cause, 30-day hospital readmission risk prediction models to identify patients that need interventional resources. Ideally, prediction models should encompass several qualities: they should have high predictive ability; use reliable and clinically relevant data; use vigorous performance metrics to assess the models; be validated in populations where they are applied; and be scalable in heterogeneous populations. However, a systematic review of prediction models for hospital readmission risk determined that most performed poorly (average C-statistic of 0.66) and efforts to improve their performance are needed for widespread usage. Methods: The ACC team incorporated electronic health record data, utilized a mixed-method approach to evaluate risk factors, and externally validated their prediction models for generalizability. Inclusion and exclusion criteria were applied on the patient cohort and then split for derivation and internal validation. Stepwise logistic regression was performed to develop two predictive models: one for admission and one for discharge. The prediction models were assessed for discrimination ability, calibration, overall performance, and then externally validated. Results: The ACC Admission and Discharge Models demonstrated modest discrimination ability during derivation, internal and external validation post-recalibration (C-statistic of 0.76 and 0.78, respectively), and reasonable model fit during external validation for utility in heterogeneous populations. Conclusions: The ACC Admission and Discharge Models embody the design qualities of ideal prediction models. The ACC plans to continue its partnership to

  10. Prevalence of potentially pathogenic free-living amoebae from Acanthamoeba and Naegleria genera in non-hospital, public, internal environments from the city of Santos, Brazil.

    PubMed

    Teixeira, Lais Helena; Rocha, Silvana; Pinto, Rosa Maria Ferreiro; Caseiro, Marcos Montani; Costa, Sergio Olavo Pinto da

    2009-12-01

    Acanthamoeba and Naegleria species are free-living amoebae (FLA) found in a large variety of natural habitats. The prevalence of such amoebae was determined from dust samples taken from public non-hospital internal environments with good standards of cleanliness from two campuses of the same University in the city of Santos (SP), Brazil, and where young and apparently healthy people circulate. The frequency of free-living amoebae in both campuses was 39% and 17% respectively, with predominance of the genus Acanthamoeba. On the campus with a much larger number of circulating individuals, the observed frequency of free-living amoebae was 2.29 times larger (P< 0.00005). Two trophozoite forms of Naegleria fowleri, are the only species of this genus known to cause primary amoebian meningoencephalitis, a rare and non-opportunistic infection. We assume that the high frequency of these organisms in different internal locations represents some kind of public health risk.

  11. The French Revolution on Film: American and French Perspectives

    ERIC Educational Resources Information Center

    Harison, Casey

    2005-01-01

    It is not hard to locate negative or condescending images of the French Revolution in aspects of popular American culture, including film. Despite a handful of instances where nuanced or ambiguous "messages" may be identified, the number of American film interpretations of the French Revolution that might be judged historically "valid" is…

  12. Invitation Refusals in Cameroon French and Hexagonal French

    ERIC Educational Resources Information Center

    Farenkia, Bernard Mulo

    2015-01-01

    Descriptions of regional pragmatic variation in French are lacking to date the focus has been on a limited range of speech acts, including apologies, requests, compliments and responses to compliments. The present paper, a systematic analysis of invitation refusals across regional varieties of French, is designed to add to the research on…

  13. MMPI-2 Profile of French Transsexuals: The Role of Sociodemographic and Clinical Factors. A cross-sectional design

    PubMed Central

    Bonierbale, Mireille; Baumstarck, Karine; Maquigneau, Aurélie; Gorin-Lazard, Audrey; Boyer, Laurent; Loundou, Anderson; Auquier, Pascal; Lançon, Christophe

    2016-01-01

    The assessment of co-existing psychological and psychiatric disorders is advocated in the Standards of Care for the health of transsexual people. This study aimed to determine the psychopathological characteristics of transsexuals based on a large sample of French individuals and to identify whether these characteristics differed according to the individual’s sociodemographic or clinical characteristics. The aim of this study was to determine the psychopathological characteristics of transsexuals from a large sample of French individuals and whether these differed by sociodemographic or clinical characteristics. This cross-sectional study was conducted in a French public university hospital. The inclusion criteria were 18 years or older, diagnosis of gender dysphoria, and eligibility for a standardized sex reassignment procedure. Personality characteristics were assessed using the Minnesota Multiphasic Personality Inventory 2 (MMPI-2). A total of 108 individuals provided a valid MMPI-2 between January 2007 and December 2010. The final sample had a median age of 31 years and included 54 (50%) Female-to-Male individuals. In multivariate models, hormonal therapy status was significantly related to the scales of MMPI-2 (Psychasthenia and Masculinity/Femininity). Personality assessment can help a multidisciplinary gender dysphoria team detect potential psychopathological factors of vulnerability. PMID:27068099

  14. MMPI-2 Profile of French Transsexuals: The Role of Sociodemographic and Clinical Factors. A cross-sectional design.

    PubMed

    Bonierbale, Mireille; Baumstarck, Karine; Maquigneau, Aurélie; Gorin-Lazard, Audrey; Boyer, Laurent; Loundou, Anderson; Auquier, Pascal; Lançon, Christophe

    2016-04-12

    The assessment of co-existing psychological and psychiatric disorders is advocated in the Standards of Care for the health of transsexual people. This study aimed to determine the psychopathological characteristics of transsexuals based on a large sample of French individuals and to identify whether these characteristics differed according to the individual's sociodemographic or clinical characteristics. The aim of this study was to determine the psychopathological characteristics of transsexuals from a large sample of French individuals and whether these differed by sociodemographic or clinical characteristics. This cross-sectional study was conducted in a French public university hospital. The inclusion criteria were 18 years or older, diagnosis of gender dysphoria, and eligibility for a standardized sex reassignment procedure. Personality characteristics were assessed using the Minnesota Multiphasic Personality Inventory 2 (MMPI-2). A total of 108 individuals provided a valid MMPI-2 between January 2007 and December 2010. The final sample had a median age of 31 years and included 54 (50%) Female-to-Male individuals. In multivariate models, hormonal therapy status was significantly related to the scales of MMPI-2 (Psychasthenia and Masculinity/Femininity). Personality assessment can help a multidisciplinary gender dysphoria team detect potential psychopathological factors of vulnerability.

  15. French intensive truck garden

    SciTech Connect

    Edwards, T D

    1983-01-01

    The French Intensive approach to truck gardening has the potential to provide substantially higher yields and lower per acre costs than do conventional farming techniques. It was the intent of this grant to show that there is the potential to accomplish the gains that the French Intensive method has to offer. It is obvious that locally grown food can greatly reduce transportation energy costs but when there is the consideration of higher efficiencies there will also be energy cost reductions due to lower fertilizer and pesticide useage. As with any farming technique, there is a substantial time interval for complete soil recovery after there have been made substantial soil modifications. There were major crop improvements even though there was such a short time since the soil had been greatly disturbed. It was also the intent of this grant to accomplish two other major objectives: first, the garden was managed under organic techniques which meant that there were no chemical fertilizers or synthetic pesticides to be used. Second, the garden was constructed so that a handicapped person in a wheelchair could manage and have a higher degree of self sufficiency with the garden. As an overall result, I would say that the garden has taken the first step of success and each year should become better.

  16. Spotlight: French Polynesia.

    PubMed

    May, J F

    1988-01-01

    French Polynesia is a group of 4 archipelagos in the South Pacific with an estimated 1987 population of 176,600. Its people are mainly Tahitians, Polynesians, Chinese, Europeans, and persons of mixed heritage. More than half of the population live in the Society Islands. About half of the population is less than 20 years old and slightly more than 5% is older than 60. Due to a recent decline in fertility, the rate of natural increase is moderate--about 2.5% annually. In the early 1980s, about two thirds of women in Tahiti aged 15-49 used a modern method of contraception. It remains to be seen whether this pattern will spread to the entire area. Projections by the World Bank, assuming little decline in mortality, yield a total population of 400,000 by the year 2030. The major challenge for French Polynesia is to develop the many small islands spread across an ocean territory half the size of the contiguous 48 states of the U.S. Tourist-related activities have replaced traditional income-generating such as production of coconuts, mother-of-pearl, and vanilla. The value of exports from the area make up only 5% of the value of imports. To extract the potentially huge food and mineral resources from the ocean, enormous infusions of capital will be necessary.

  17. Questionnaire survey about use of an online appointment booking system in one large tertiary public hospital outpatient service center in China

    PubMed Central

    2014-01-01

    Background As a part of nationwide healthcare reforms, the Chinese government launched web-based appointment systems (WAS) to provide a solution to problems around outpatient appointments and services. These have been in place in all Chinese public tertiary hospitals since 2009. Methods Questionnaires were collected from both patients and doctors in one large tertiary public hospital in Shanghai, China.Data were analyzed to measure their satisfaction and views about the WAS. Results The 1000 outpatients randomly selected for the survey were least satisfied about the waiting time to see a doctor. Even though the WAS provided a much more convenient booking method, only 17% of patients used it. Of the 197 doctors surveyed, over 90% thought it was necessary to provide alternative forms of appointment booking systems for outpatients. However, about 80% of those doctors who were not associated professors would like to provide an ‘on-the-spot’ appointment option, which would lead to longer waits for patients. Conclusions Patients were least satisfied about the waiting times. To effectively reduce appointment-waiting times is therefore an urgent issue. Despite the benefits of using the WAS, most patients still registered via the usual method of queuing, suggesting that hospitals and health service providers should promote and encourage the use of the WAS. Furthermore, Chinese health providers need to help doctors to take others’ opinions or feedback into consideration when treating patients to minimize the gap between patients’ and doctors’ opinions. These findings may provide useful information for both practitioners and regulators, and improve recognition of this efficient and useful booking system, which may have far-reaching and positive implications for China’s ongoing reforms. PMID:24912568

  18. Perceived Nurse—Physician Communication in Patient Care and Associated Factors in Public Hospitals of Jimma Zone, South West Ethiopia: Cross Sectional Study

    PubMed Central

    Hailu, Fikadu Balcha; Kassahun, Chanyalew Worku; Kerie, Mirkuzie Woldie

    2016-01-01

    Background Nurse–physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims. Objective The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia. Methods Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians working in public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire; entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant. Results The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication. Age, salary and organizational factors were statistically significant predictors for perceived respect and satisfaction. Whereas sex, working hospital, work attitude individual factors and organizational factors were significant predictors of perceived openness and sharing of patient information in nurse-physician communication during patient care. Conclusion Perceived level of nurse-physician communication mean score was low among nurses than physicians and it is attention seeking gap. Hence, the finding of our study suggests the need for

  19. French in the Ivory Coast.

    ERIC Educational Resources Information Center

    Djite, Paulin G.

    1989-01-01

    Overviews the Ivory Coast's sociolinguistic situation. Standard French, restricted to the elite, is threatened by the local lingua franca. The spread and functional allocations of Dyula and Popular French support the point that the pervasive use of a language does not always lead to its adoption as a national language. (CB)

  20. French Basic Course. Area Studies.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This volume provides the prescribed cultural background that is part of the final phase of the Basic Course in French. The texts provide the basis for discussions and personal research through which students become acquainted with various aspects of the French-speaking world and learn the referential meaning of words and expressions as they are…

  1. Incremental analysis of the reengineering of an outpatient billing process: an empirical study in a public hospital

    PubMed Central

    2013-01-01

    Background A smartcard is an integrated circuit card that provides identification, authentication, data storage, and application processing. Among other functions, smartcards can serve as credit and ATM cards and can be used to pay various invoices using a ‘reader’. This study looks at the unit cost and activity time of both a traditional cash billing service and a newly introduced smartcard billing service in an outpatient department in a hospital in Taipei, Taiwan. Methods The activity time required in using the cash billing service was determined via a time and motion study. A cost analysis was used to compare the unit costs of the two services. A sensitivity analysis was also performed to determine the effect of smartcard use and number of cashier windows on incremental cost and waiting time. Results Overall, the smartcard system had a higher unit cost because of the additional service fees and business tax, but it reduced patient waiting time by at least 8 minutes. Thus, it is a convenient service for patients. In addition, if half of all outpatients used smartcards to pay their invoices, along with four cashier windows for cash payments, then the waiting time of cash service users could be reduced by approximately 3 minutes and the incremental cost would be close to breaking even (even though it has a higher overall unit cost that the traditional service). Conclusions Traditional cash billing services are time consuming and require patients to carry large sums of money. Smartcard services enable patients to pay their bill immediately in the outpatient clinic and offer greater security and convenience. The idle time of nurses could also be reduced as they help to process smartcard payments. A reduction in idle time reduces hospital costs. However, the cost of the smartcard service is higher than the cash service and, as such, hospital administrators must weigh the costs and benefits of introducing a smartcard service. In addition to the obvious benefits

  2. The French Lycees de jeunes filles in International Perspective, 1878-1910

    ERIC Educational Resources Information Center

    Albisetti, James C.

    2004-01-01

    In preparing the law that established the French system of public secondary schools for girls, Camille See and his supporters conducted a major survey of female education in other countries. Yet they used the information gathered much more to demonstrate French backwardness than to provide guidelines for the new schools; with regard to the …

  3. Monetizing French Distance Education: A Field Enquiry on Higher Education Value(s)

    ERIC Educational Resources Information Center

    Olivier, Marty

    2014-01-01

    A field enquiry in French distance education allows us to analyze the evolution of a specific institution towards new public management: Parallel to a trend of free courseware and open education, there is a paradoxical reality of distance education monetization. Whereas history shows how traditional French education is a state controlled public…

  4. The Manitoba School Act of 1890: An Insult to the French Roman Catholics.

    ERIC Educational Resources Information Center

    Smith, Robert B.

    The Manitoba School Act of 1890 was an insult to the French Canadian culture and religion. New settlers in Manitoba brought with them the model of the Ontario school system, and as the new majority of Manitoba, they, through the Manitoba government, abolished French as an official language. At the same time, single, tax supported public schools…

  5. Six-Year French Program. Curriculum Guide, Grades 7-12.

    ERIC Educational Resources Information Center

    Alberta Dept. of Education, Edmonton. Language Services Branch.

    The curriculum guide for a six-year French language sequence in Alberta public schools outlines: (1) a set of objectives reflecting the basic educational goals of the system along with the rationale to support the inclusion of French in school programs; (2) specific minimum expectations for each language skill (listening, speaking, reading, and…

  6. The French language virtual medical university.

    PubMed

    Morin, A; Benhamou, A C; Spector, M; Bonnin, A; Debry, C

    2004-01-01

    The work program of the French Language Virtual Medical University started about 2 years ago, and entered into a real active phase of development and implementation in 2002. Various national programs and organizational initiatives should accelerate and facilitate further appropriation of modem pedagogical approaches by knowledge providers and all users of the FSVMU, so as to advance on the way of virtual education. The French Language Virtual Medical University under the auspices of both the National Conference of Deans of Medical Schools and the International Conference of Deans of French-Speaking Medical Schools has been developed to create a major Internet portal for French-speaking distance medical learning and teaching. This construct should be representative of all medical schools in France and French-speaking countries. Contents will also be translated into English, Spanish and Arabic. All medical disciplines with their various levels of teaching are to be included. Cross-related fields are also going to be present in order to offer full range programs. The latter are intended to provide both initial and continuing education for medical students as well as all other categories of health professionals and medical and scientific research workers. To develop the appropriate technology and make such a portal, on one hand correspond to the specific educational requirements and proper training for health professionals, and on the other hand provide a general access to e-learning in all schools of medicine; in keeping with such goals, the following approaches should be stressed upon. To build a virtual space where individual patients, their families, patient associations as well as the general public, can obtain medical information of good quality for the purposes of both education and prevention. Providing such categories with reliable and validated sources of information, and offering an ethical basis for the increasing practice of e-medicine, represent in today

  7. Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines.

    PubMed

    Pearson, M G; Ryland, I; Harrison, B D

    1996-10-01

    This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the inpatient care of acute severe asthma in the U.K. A criterion-based audit of all acute asthma admissions during August and September 1990 (immediately before) and in 1991 (1 yr after publication of the Guidelines) using eight criteria of process and outcome was performed. Thirty-six teaching and district general hospitals in England, Scotland and Wales took part. In total, 766 patients admitted in 1990, and 900 patients admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respiratory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory physicians were significantly more likely to provide patients with a written management plan in 1991. General physicians' performance was significantly lower in both years, but overall there was a very small, but just significant, improvement in their performance in 1991. Some hospitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than general physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficient time for the Guidelines to be incorporated into practice; inaccessibility of the Guidelines to general physicians; failure to accept responsibility for implementing the good practice reflected in the Guidelines; and an explicit need for strategies to implement the Guidelines beyond publication in a widely-read general medical journal.

  8. FRIPON, the French fireball network

    NASA Astrophysics Data System (ADS)

    Colas, F.; Zanda, B.; Bouley, S.; Vaubaillon, J.; Marmo, C.; Audureau, Y.; Kwon, M. K.; Rault, J. L.; Caminade, S.; Vernazza, P.; Gattacceca, J.; Birlan, M.; Maquet, L.; Egal, A.; Rotaru, M.; Gruson-Daniel, Y.; Birnbaum, C.; Cochard, F.; Thizy, O.

    2015-10-01

    FRIPON (Fireball Recovery and InterPlanetary Observation Network) [4](Colas et al, 2014) was recently founded by ANR (Agence Nationale de la Recherche). Its aim is to connect meteoritical science with asteroidal and cometary science in order to better understand solar system formation and evolution. The main idea is to set up an observation network covering all the French territory to collect a large number of meteorites (one or two per year) with accurate orbits, allowing us to pinpoint possible parent bodies. 100 all-sky cameras will be installed at the end of 2015 forming a dense network with an average distance of 100km between stations. To maximize the accuracy of orbit determination, we will mix our optical data with radar data from the GRAVES beacon received by 25 stations [5](Rault et al, 2015). As both the setting up of the network and the creation of search teams for meteorites will need manpower beyond our small team of professionals, we are developing a citizen science network called Vigie-Ciel [6](Zanda et al, 2015). The public at large will thus be able to simply use our data, participate in search campaigns or even setup their own cameras.

  9. Perceived Managerial and Leadership Effectiveness within Mexican and British Public Sector Hospitals: A Cross-Nation Comparative Analysis

    ERIC Educational Resources Information Center

    Hamlin, Robert G.; Ruiz, Carlos E.; Wang, Jia

    2011-01-01

    Stephen M. Shortell, dean of the School of Public Health, distinguished professor of health policy and management, and professor of organization behavior in the Haas School of Business, University of California-Berkeley, has argued that evidence-based management needs to be married with evidence-based medicine if sustainable improvement in the…

  10. Status of French reactors

    SciTech Connect

    Ballagny, A.

    1997-08-01

    The status of French reactors is reviewed. The ORPHEE and RHF reactors can not be operated with a LEU fuel which would be limited to 4.8 g U/cm{sup 3}. The OSIRIS reactor has already been converted to LEU. It will use U{sub 3}Si{sub 2} as soon as its present stock of UO{sub 2} fuel is used up, at the end of 1994. The decision to close down the SILOE reactor in the near future is not propitious for the start of a conversion process. The REX 2000 reactor, which is expected to be commissioned in 2005, will use LEU (except if the fast neutrons core option is selected). Concerning the end of the HEU fuel cycle, the best option is reprocessing followed by conversion of the reprocessed uranium to LEU.

  11. Isolation, pathogenicity and disinfection of Staphylococcus aureus carried by insects in two public hospitals of Vitória da Conquista, Bahia, Brazil.

    PubMed

    Oliveira, Pollianna S; Souza, Simone G; Campos, Guilherme B; da Silva, Danilo C C; Sousa, Daniel S; Araújo, Suerda P F; Ferreira, Laiziane P; Santos, Verena M; Amorim, Aline T; Santos, Angelita M O G; Timenetsky, Jorge; Cruz, Mariluze P; Yatsuda, Regiane; Marques, Lucas M

    2014-01-01

    Currently, hospital infection is a serious public health problem, and several factors may influence the occurrence of these infections, including the presence of insects, which are carriers of multidrug-resistant bacterial species. The aim of this study was to isolate staphylococci carried by insects in two public hospitals of Vitoria da Conquista, Bahia and to identify the resistance profile, pathogenicity and efficacy of disinfection of the premises. A total of 91 insects were collected in 21 strategic points of these hospitals, and 32 isolated strains of Staphylococcus aureus were isolated. Based on antibiogram and Minimum Inhibitory Concentration results, 95% of these strains were susceptible to oxacillin. These strains were also evaluated for the presence of resistance genes encoding resistance to oxacillin/methicillin by polymerase chain reaction, but the sample was negative for this gene. Pathogenicity tests were performed in vitro biofilm formation induced by glucose, where it was found that eight (27.58%) strains were classified as biofilm producers and 21 (72.4%) as stronger producers. In addition, we performed PCR for their virulence genes: Sea (enterotoxin A), SEB (B), Sec (C), PVL (Panton-Valentine Leukocidin), ClfA (clumping factor A) and Spa (protein A). Of these, Sea, Spa PVL were positive in 7 (21.8%), 2 (6.3%) and 1 (3.1%) samples, respectively. The analysis of cytokine induction in the inflammatory response of J774 macrophages by isolates from the two hospitals did not show statistical difference at the levels of IL-6, TNF-α, IL-1 and IL-10 production. In addition, we verified the antimicrobial activity of disinfecting agents on these strains, quaternary ammonium, 0.5% sodium hypochlorite, 1% sodium hypochlorite, 2% sodium hypochlorite, 2% glutaraldehyde, Lysoform(®), 70% alcohol solution of chlorhexidine digluconate, 2% peracetic acid, and 100% vinegar. Resistance was seen in only for the following two disinfectants: 70% alcohol in 31 (96

  12. Babies who die from labour-related intrapartum hypoxia: a confidential enquiry in South African public hospitals.

    PubMed

    Buchmann, E J; Pattinson, R C

    2006-01-01

    Seventeen hospitals, from a range of health-care environments, participated in confidential enquiries of perinatal deaths resulting from labour-related intrapartum hypoxia. There were 102 deaths, including 22 stillbirths and 80 neonatal deaths. The mean birthweight was 3021 g. The active phase of the first stage of labour was prolonged beyond 12 h in six cases, and oxytocin was used for induction or augmentation in 10 women. Fetal heart decelerations were detected in 39 (49%) of the babies that went on to die in the neonatal period, and meconium passage was evident in 50 (63%). There were six breech presentations, and seven cases of cord prolapse. The majority of these deaths occurred in low-risk women with apparently uncomplicated labour. There appears to be a failure to detect or respond to evidence of fetal distress. Intrapartum care for all women in labour requires close attention to detail in monitoring fetal health.

  13. [Dengue in French Guiana. History and present status].

    PubMed

    Reynes, J M

    1996-01-01

    The evolution of dengue in French Guiana has the same trend as in most tropical American countries, with emergence of dengue hemorrhagic fever (DHF) and endemicity of the disease. During the 1940's, several dengue-like outbreaks were reported from French Guiana. Then, the only dengue vector, Aedes aegypti, was eradicated between 1950 and 1963, when it started to reinfest the country. By the end of the 1960's, new dengue epidemics with serological confirmation were described. After 1970, the first dengue strains were isolated, firstly dengue-2 strains, then dengue-1 and dengue-4 strains. Between 1970 and 1990, several dengue outbreaks struck French Guiana with 2 to 6 years intervals. In July 1991, started the first DHF outbreak in French Guiana which spread in all the most important towns until October 1992. About 3,000 cases were reported, that is almost 3% of the population, from which about 1/3 had serological confirmation; more than 300 people were hospitalized and some 80 with hemorrhages. Finally 6 deaths were reported, 5 of which had hemorrhages but could not be included into DHF cases according to WHO criteria. The dengue-2 strain responsible for this outbreak is close to the Jamaïcan topotype known to be particularly virulent. Since the beginning of 1993 and actually, dengue is still circulating in French Guiana, but at low level and dengue-1 and dengue-4 strains are occasionally isolated.

  14. The french educational satellite arsene

    NASA Astrophysics Data System (ADS)

    Danvel, M.; Escudier, B.

    ARSENE (Ariane, Radio-amateur, Satellite pour l'ENseignement de l'Espace) is a telecommunications satellite for Amateur Space Service. Its main feature is that more than 100 students from French engineering schools and universities have been working since 1979 for definition phase and satellite development. The highest IAF awards has been obtained by "ARSENE students" in Tokyo (1980) and Rome (1981). The French space agency, CNES and French aerospace industries are supporting the program. The European Space Agency offered to place ARSENE in orbit on the first Ariane mark IV launch late 1985.

  15. "What Are We Black Men Who Are Called French?"

    ERIC Educational Resources Information Center

    LeSeur, Geta J.

    This teachers guide for an eight-week unit on 20th century French African literature, is intended for use with heterogeneously grouped juniors and seniors. The unit is one in a series by the Public Education Religion Studies Center at Wright State University. The guide represents a thematic approach to literature well suited to team teaching with…

  16. Work-related stress and associated factors among nurses working in public hospitals of Addis Ababa, Ethiopia: a cross-sectional study.

    PubMed

    Salilih, Selamawit Zewdu; Abajobir, Amanuel Alemu

    2014-08-01

    Work-related stress is a pattern of reactions to work demands unmatched to nurses' knowledge, skills, or abilities; these challenges exceed their ability to cope, resulting in burnout, turnover, and low quality patient care. An institution-based cross-sectional study of 343 nurses was conducted in public hospitals of Addis Ababa in 2012. Data were collected by pretested and self-administered questionnaires using a nursing stress scale. One hundred twenty-one (37.8%) (95% confidence interval: 34.3 to 39.1) nurses reported experiencing occupational stress. Significant associations were found between nurses' stress and gender, work shift, illness, marital status, and worksite or unit. Prevalence of work-related stress was higher than expected and opportunities exist for stake holders to design stress reduction and management programs for nurses.

  17. Reducing the Time From Diagnosis to Treatment of Patients With Stage II/III Rectal Cancer at a Large Public Hospital

    PubMed Central

    Leslie, Lori A.; Jacobs, Ryan W.; Millas, Stefanos; Surabhi, Venkateswar; Mok, Henry; Jhaveri, Pavan; Kott, Marylee M.; Jackson, Lymesia; Rieber, Alyssa; Bhadkamkar, Nishin A.

    2016-01-01

    Curative-intent therapy for stage II/III rectal cancer is necessarily complex. Current guidelines by the National Comprehensive Cancer Network recommend preoperative concurrent chemoradiation followed by resection and additional adjuvant chemotherapy. We used standard quality improvement methodology to implement a cost-effective intervention that reduced the time from diagnosis to treatment of patients with stage II/III rectal cancer by approximately 30% in a large public hospital in Houston, Texas. Implementation of the program resulted in a reduction in time from pathologic diagnosis to treatment of 29% overall, from 62 to 44 days. These gains were cost neutral and resulted from improvements in scheduling and coordination of care alone. Our results suggest that: (1) quality improvement methodology can be successfully applied to multidisciplinary cancer care, (2) effective interventions can be cost neutral, and (3) effective strategies can overcome complexities such as having multiple sites of care, high staff turnover, and resource limitations. PMID:26869658

  18. The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.

    PubMed Central

    Mandelblatt, J; Freeman, H; Winczewski, D; Cagney, K; Williams, S; Trowers, R; Tang, J; Gold, K; Lin, T H; Kerner, J

    1997-01-01

    OBJECTIVES: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. METHODS: Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. RESULTS: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. CONCLUSIONS: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs. PMID:9240110

  19. FUNGEMIA CAUSED BY Candida SPECIES IN A CHILDREN'S PUBLIC HOSPITAL IN THE CITY OF SÃO PAULO, BRAZIL: STUDY IN THE PERIOD 2007-2010

    PubMed Central

    Oliveira, Vanessa Kummer Perinazzo; Ruiz, Luciana da Silva; Oliveira, Nélio Alessandro Jesus; Moreira, Débora; Hahn, Rosane Christine; Melo, Analy Salles de Azevedo; Nishikaku, Angela Satie; Paula, Claudete Rodrigues

    2014-01-01

    Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment. PMID:25076430

  20. Teaching for Content: Greek Mythology in French.

    ERIC Educational Resources Information Center

    Giauque, Gerald S.

    An intermediate-level university French course in Greek mythology was developed to (1) improve student skills in reading, writing, speaking, and comprehending French, (2) familiarize students with Greek mythology, and (3) prepare students to deal better with allusions to Greek mythology in French literature. The texts used are a French translation…

  1. 7 CFR 993.7 - French prunes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false French prunes. 993.7 Section 993.7 Agriculture... Order Regulating Handling Definitions § 993.7 French prunes. French prunes means: (a) Prunes produced from plums of the following varieties of plums: French (Prune d'Agen, Petite Prune d'Agen), Coates...

  2. 7 CFR 993.7 - French prunes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Order Regulating Handling Definitions § 993.7 French prunes. French prunes means: (a) Prunes produced from plums of the following varieties of plums: French (Prune d'Agen, Petite Prune d'Agen), Coates (Cox... 7 Agriculture 8 2011-01-01 2011-01-01 false French prunes. 993.7 Section 993.7...

  3. Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

    PubMed Central

    Dasgupta, Sugata; Singh, Shipti Shradha; Chaudhuri, Arunima; Bhattacharya, Dipasri; Choudhury, Sourav Das

    2016-01-01

    Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications. Aims: To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India. Methods: Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed. Results: The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001). Conclusions: The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs. PMID:27076709

  4. Unhappiness with the Fetal Gender is associated with Depression in Adult Pregnant Women Attending Prenatal Care in a Public Hospital in Durango, Mexico.

    PubMed

    Alvarado-Esquivel, Cosme; Sifuentes-Alvarez, Antonio; Salas-Martinez, Carlos

    2016-03-01

    Depression during pregnancy has been scantily studied in Mexican women. We aimed to determine the prevalence and correlates of depression in adult pregnant women attending a public hospital in the northern Mexican city of Durango, Mexico. Through a cross-sectional study design, we assessed depression in 270 adult pregnant women attended for prenatal care in a public hospital using a validated Mexican version of the Edinburg Postnatal Depression Scale in pregnancy and further confirmation by a psychiatric evaluation using the DSM-IV criteria for depression. Prevalence association with socio-demographic, clinical and psychosocial characteristics of the pregnant women was also investigated. Of the 270 pregnant women studied, 101 (37.4%) had EPDS scores equal to or higher than nine. Depression was confirmed in 56 (20.7%) women. Of them, 42 suffered from minor depression and 14 from major depression. Multivariate analysis of socio-demographic, clinical and psychosocial characteristics of the women showed that depression was associated with depression before pregnancy (OR = 3.36; 95% CI: 1.20-9.40; P=0.02), anxiety during pregnancy (OR = 9.38; 95% CI: 1.87-46.96; P=0.006), smoking (OR = 25.05; 95% CI: 1.77-353.07; P=0.01), unhappy with the fetal sex (OR = 8.53; 95% CI: 2.46-29.48; P<0.001), and unintended pregnancy (OR = 2.90; 95% CI: 1.07-7.86; P=0.03). Results indicate that about one fifth of the pregnant women studied had confirmed depression. This is the first report of an association of prenatal depression with unhappiness with the fetal sex. Factors associated with prenatal depression found in this study may help for the optimal design of preventive measures against prenatal depression.

  5. Dialect Effects in Speech Perception: The Role of Vowel Duration in Parisian French and Swiss French

    ERIC Educational Resources Information Center

    Miller, Joanne L.; Mondini, Michele; Grosjean, Francois; Dommergues, Jean-Yves

    2011-01-01

    The current experiments examined how native Parisian French and native Swiss French listeners use vowel duration in perceiving the /[openo]/-/o/ contrast. In both Parisian and Swiss French /o/ is longer than /[openo]/, but the difference is relatively large in Swiss French and quite small in Parisian French. In Experiment 1 we found a parallel…

  6. "Dans le sillon des voyageurs": Thunder Bay's Experiment in French Community Television

    ERIC Educational Resources Information Center

    Lewis, David W. P.

    1976-01-01

    Thunder Bay French Television was begun as an experiment in amateur community television designed to appeal to francophones, elementary school pupils, students, and the public at large. Organization and programming are described. (RM)

  7. French Basic Course. Grammatical Index.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This index is intended for use with Volumes 1 through 8 of the French Basic Course. It facilitates the finding of grammatical references in those volumes. The items are cross-referenced and arranged in alphabetical order. (Author/AMH)

  8. The French Space Operations Act: Technical Regulations

    NASA Astrophysics Data System (ADS)

    Lazare, B.

    2013-12-01

    The French Space Operations Act (FSOA) [1] stipulates that one of the National Technical Regulations' prime objectives is to protect people, property, public health and the environment. Compliance with these Technical Regulations has been mandatory since 10 December, 2010 for space operations by French space operators and for space operations conducted on French territory. The space safety requirements and regulations governing procedures are based on national and international best practices and experience. A critical design review of the space system and procedures shall be carried out by applicant space operators, in order to verify compliance with the Technical Regulations. An independent technical assessment of the operation is delegated to CNES. The principles applied when drafting the Technical Regulations are as follows: requirements must, as far as possible, establish the rules according to the objective to be obtained, rather than how it is to be achieved; requirements must give preference to international standards recognised as being state of the art; requirements must take previous experience into account. The Technical Regulations are divided into three sections covering requirements common to the launch, control and return of a space object. A special section will cover specific rules to be applied at the Guiana Space Centre. The main topics addressed by the Technical Regulations are: operator safety management system; study of risks to people, property, public health and the Earth's environment; impact study on the outer space environment: space debris generated by the operation; planetary protection. The first version of the Technical Regulations [2], issued in March 2011, is dedicated to unmanned space systems.

  9. Hospital service offerings: does Catholic ownership matter?

    PubMed

    White, Kenneth R; Begun, James W; Tian, Wenqiang

    2006-01-01

    Controlling for market and organizational characteristics, Catholic hospitals in 2001 offered more stigmatized and compassionate care services than investor-owned hospitals, and more stigmatized services than public hospitals. There were no differences between Catholic hospitals and other nonprofit hospitals, however, in the number of compassionate, stigmatized, and access services offered. This may reflect growing isomorphism in the nonprofit hospital sector.

  10. [Evaluation of the socioeconomic costs of cutaneous leishmaniasis in French Guiana].

    PubMed

    Dedet, J P; Pillot, B; Gentilini, M

    1991-01-01

    The socio-economic cost of leishmaniasis in French Guiana was estimated using a retrospective survey spreading over a period of one year: 1979-80. The financial cost elements taken into account were the following: dermatological consultations, biological tests, treatments and hospitalisation days. Other elements were not evaluated, such as days of military hospital stays, work days suspended and unavailability of service. The cost of leishmaniasis represented 0.13% of the general budget of French Guiana and 0.43% of the global budget of the French Guiana Social Security. PMID:1866479

  11. The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals

    PubMed Central

    2014-01-01

    Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. Methods An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach’s alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann–Whitney U-test for independent variables to calculate group differences. The level of significance was set at p < 0.05. Results Return rates were: D: TE 89/215 (41.39%), TR 78/184 (42.39%); CH: TE 19/25 (76%), TR 22/30 (73.33%). Cronbach’s alpha values for TE scales were >0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction

  12. French fireball network FRIPON

    NASA Astrophysics Data System (ADS)

    Colas, F.; Zanda, B.; Vaubaillon, J.; Bouley, S.; Marmo, C.; Audureau, Y.; Kwon, M. K.; Rault, J.-L.; Caminade, S.; Vernazza, P.; Gattacceca, J.; Birlan, M.; Maquet, L.; Egal, A.; Rotaru, M.; Birnbaum, C.; Cochard, F.; Thizy, O.

    2015-01-01

    FRIPON (Fireball Recovery and Interplanetary Observation Network) was recently founded by ANR (Agence Nationale de la Recherche), its aim being to connect meteoritical science with asteroidal and cometary sciences, in order to better understand our solar system formation and evolution. The main idea is to cover all the French territory to collect a large number of meteorites (one or two per year) with an accurate orbit determination, allowing to pinpoint possible parent bodies. 100 all-sky cameras will be installed at the end of 2015, creating a dense network with an average distance of 100 km between the stations. To maximize the accuracy of the orbit determination, we will mix our optical data with radar data from the GRAVES transmitter received by 25 stations (Rault et al., 2015). As the network installation and the creation of research teams for meteorites involves many persons, at least many more than our small team of professionals, we will develop a participative science network for amateurs called Vigie-Ciel (Zanda et al., 2015). It will be possible to simply use our data, participate in research campaigns or even add cameras to the FRIPON network.

  13. The French proposal for a health identification number.

    PubMed

    Quantin, Catherine; Cohen, Olivier; Riandey, Benoît; Allaert, François-André

    2006-01-01

    The French ministry of Health is setting up the personal medical record (PMR or DMP for Dossier Medical Personnel in French). This innovating tool is highly expected and will be extremely useful for the therapeutic follow-up as well as for epidemiological studies on which public health policies are based. Therefore the currently planned identifying process should prevent any epidemiological use of these data. Numerous scientific organisations have alerted government powers about the threat that this impairment represents, and they wish to promote some secure procedures that exist, which have already proved their efficiency at the national and international level.

  14. French perspectives on psychiatric classification

    PubMed Central

    Crocq, Marc-Antoine

    2015-01-01

    This article reviews the role of the French schools in the development of psychiatric nosology. Boissier de Sauvages published the first French treatise on medical nosology in 1763. Until the 1880s, French schools held a pre-eminent position in the development of psychiatric concepts. From the 1880s until World War I, German-speaking schools exerted the most influence, featuring the work of major figures such as Emil Kraepelin and Eugen Bleuler. French schools were probably hampered by excessive administrative and cultural centralization. Between the 1880s and the 1930s, French schools developed diagnostic categories that set them apart from international classifications. The main examples are Bouffée Délirante, and the complex set of chronic delusional psychoses (CDPs), including chronic hallucinatory psychosis. CDPs were distinguished from schizophrenia by the lack of cognitive deterioration during evolution. Modern French psychiatry is now coming into line with international classification, such as DSM-5 and the upcoming ICD-11. PMID:25987863

  15. The French Technical Vaccination Committee (CTV).

    PubMed

    Floret, Daniel; Deutsch, Paule

    2010-04-19

    This article describes the make-up and activities of the Technical Vaccination Committee (CTV) that serves as the National Immunization Technical Advisory Group (NITAG) in France. Comprised of a variety of technical experts, the CTV makes recommendations concerning vaccination. The committee functions as an independent expert advisory committee, and its proceedings are confidential, although its recommendations are made public. It helps to make decisions about using new vaccines, as well as re-examining guidelines for vaccines already in use. It obtains technical expertise from a variety of sources, including specialized national centres. Although it is not obliged to do so, in most cases, the French government implements CTV recommendations. Information regarding CTV activities is disseminated through publications, its website, and letters to health officials. Efforts need to be enhanced in order to avoid creating a gap between the issuing of complex vaccination policies and their understanding by general practitioners who are responsible for the administration of over 80% of all vaccines.

  16. Outbreak of malaria among policemen in French Guiana.

    PubMed

    Michel, Rémy; Ollivier, Lénaïck; Meynard, Jean-Baptiste; Guette, Christian; Migliani, René; Boutin, Jean-Paul

    2007-09-01

    An outbreak of malaria occurred among 62 policemen following an operation against illegal gold panning in French Guiana. A retrospective cohort study was conducted. The objectives were to describe the outbreak and to identify factors related to the cases. The total number of initial cases was 37. Both Plasmodium falciparum and Plasmodium vivax were detected. Twenty-seven policemen presented with one to four recurrences. In bivariate analysis, factors related to malaria were a "medium to high" level of mosquito bites pollution at night, late washing in the evening and wearing a nonimpregnated Battle Dress Uniform (BDU). This investigation confirmed the low level of compliance with chemoprophylaxis among individuals on long-term assignment in French Guiana. Compliance with mosquito protection measures was satisfactory except for the use of impregnated BDU. Several recommendations were provided. Therefore, this outbreak reminds us that malaria remains a public health problem in French Guiana.

  17. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Hospital providers of NF services (swing-bed hospitals). 447.280 Section 447.280 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers...

  18. Perspective view of span over French Creek and east abutment, ...

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

    Perspective view of span over French Creek and east abutment, looking NW. - Pennsylvania Railroad, French Creek Trestle, Spanning French Creek, north of Paradise Street, Phoenixville, Chester County, PA

  19. Exploiting the potential of intranet for managing drug spectrum a web base publication in a Tertiary Care Hospital in Mumbai

    PubMed Central

    Shetty, Yashashri Chandrakant; Patel, Tejal Chetan; Parmar, Urwashi Indrakumar

    2015-01-01

    Objective: The study surveyed the availability of the intranet in campus and also the knowledge related to drug spectrum an intranet publication. Materials and Methods: Institutional ethics committee permission was obtained. Verbal consent was taken from the faculty and resident doctors of departments where all the facilities were available. Universal sampling method was used for recruitment. Pre-validated questionnaires were given to approximately 100 faculty and 500 resident doctors in the year 2012-2013. The questionnaire contained 15 items. Content analysis was done. The study questionnaire focused on a survey to obtain participants feedback on the use of the intranet and to evaluate the use of intranet as a source of knowledge. It also dealt on the relevance of the drug spectrum in the context of their subject. The responses were taken after giving the participants sufficient time. Data was entered into an Excel 2003 spread sheet and analyzed by using descriptive statistics. Results: The total number of respondents who participated in our study was 134 including faculty and residents from various departments. A total of 117 (89.66%) respondents stated that their departments have access to the internet. Departments having access to intranet was 103 (76.29%). 67 (49.62%) respondents have accessed. 67 (49.62%) did not have the time to visit intranet site whereas 67 (49.62%) have not accessed intranet. 89 (65.92%) respondents were not aware of the drug spectrum. 101 (74.81%) respondents felt that drug spectrum is a useful activity on intranet. 45 (33.33%) knew about the intranet periodical drug spectrum, but most of the respondents (33.33%) explained the meaning of the word drug spectrum according to their understanding, but never knew about the online intranet journal drug spectrum. Conclusion: The study found that the intranet is available in the campus, but it is not being utilized. The awareness and knowledge regarding drug spectrum is lacking, but the

  20. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia.

    PubMed

    Ebissa, Getachew; Deyessa, Negusse; Biadgilign, Sibhatu

    2015-01-01

    Highly active antiretroviral therapy (HAART) is the breakthrough in care and treatment of people living with HIV, leading to a reduction in mortality and an improvement in the quality of life. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday. So the objective of this study is to determine the mortality and associated factors in a cohort of HIV-infected children receiving ART in Ethiopia. A multicentre facility-based retrospective cohort study was done in selected pediatric ART units in hospitals found in Addis Ababa, Ethiopia. The probability of survival was estimated using the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards regression models was conducted to determine the independent predictor of survival. A total of 556 children were included in this study. Of the total children, 10.4% were died in the overall cohort. More deaths (70%) occurred in the first 6 months of ART initiation, and the remaining others were still on follow-up at different hospitals. Underweight (moderate and severe; HR: 10.10; 95% CI: 2.08, 28.00; P = 0.004; and HR: 46.69; 95% CI: 9.26, 200.45; P < 0.01, respectively), advanced disease stage (WHO clinical stages III and IV; HR: 10.13: 95% CI: 2.25, 45.58; P = 0.003), poor ART adherence (HR: 11.72; 95% CI: 1.60, 48.44; P = 0.015), and hemoglobin level less than 7 g/dl (HR: 4.08: 95% CI: 1.33, 12.56; P = 0.014) were confirmed as significant independent predictors of death after controlling for other factors. Underweight, advanced disease stage, poor adherence to ART, and anemia appear to be independent predictor of survival in HIV-infected children receiving HAART at the pediatric units of public hospitals in Ethiopia. Nutritional supplementations, early initiation of HAART, close supervision, and monitoring of patients during the first 6 months, the follow up period is recommended.