Knowledge and attitude of guardians towards eye health of primary school pupils in Ilorin, Nigeria.

PubMed

Ayanniyi, A A; Olatunji, F O; Mahmoud, A O; Ayanniyi, R O

2010-03-01

To determine guardians' knowledge and attitude towards pupils' eye health and draw implication for designing children-oriented ocular health messages. A survey of 1,393 guardians selected through multistage random sampling in Ilorin, Nigeria. Using structured questionnaire, information sought included guardians' demographic characteristics, relationship to pupils, occupation, awareness of eye specialists, perception of normal vision, pupils' eye complaints, and ways of treating children eye conditions. Data analysis was done with SPSS 12.0.1. The test of significance was performed using Chi square test and significance was taken at p < 0.05. Guardians comprised 689 (49.4%) males and 704 (50.6%) females, mean age 43.61 SD 11.45. Most (88.54%) were pupils' parents and (11.46%) were relations (n=1,318); (55.15%) were in low-paying occupations (n=1,311); (87.92%) were aware of eye specialists, (12.08%) unaware, (n=1192); (97.27%) adjudged normal vision at least important, (2.73%) not important (n=1,174). Pupils' eye complaints (n=914) included pain (26.04%), itching (24.73%), redness (21.12%), discharge (8.53%), blur vision (8.21%), photophobia (7.33%) and lacrimation (4.05%). Guardians (n=1,069) managed pupils' eye diseases using hospital treatment (61.65%), neglect (21.33%), self medication (9.26%) and traditional medication (7.76%). There were no significant associations between guardians' ways of managing pupils' eye diseases and their views on normal vision (p = 0.940); awareness of eye care specialists (p = 0.952); and economic occupational grouping (p = 0.959). The negative implications of neglecting eye diseases and use of self and harmful traditional eye-medications by some of the guardians need to be discouraged by appropriate eye health education.

Association Between Teaching Status and Mortality in US Hospitals

PubMed Central

Burke, Laura G.; Frakt, Austin B.; Khullar, Dhruv; Orav, E. John

2017-01-01

Importance Few studies have analyzed contemporary data on outcomes at US teaching hospitals vs nonteaching hospitals. Objective To examine risk-adjusted outcomes for patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions. Design, Setting, and Participants Use of national Medicare data to compare mortality rates in US teaching and nonteaching hospitals for all hospitalizations and for common medical and surgical conditions among Medicare beneficiaries 65 years and older. Exposures Hospital teaching status: major teaching hospitals (members of the Council of Teaching Hospitals), minor teaching hospitals (other hospitals with medical school affiliation), and nonteaching hospitals (remaining hospitals). Main Outcomes and Measures Primary outcome was 30-day mortality rate for all hospitalizations and for 15 common medical and 6 surgical conditions. Secondary outcomes included 30-day mortality stratified by hospital size and 7-day mortality and 90-day mortality for all hospitalizations as well as for individual medical and surgical conditions. Results The sample consisted of 21 451 824 total hospitalizations at 4483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3339 (74.3%) were nonteaching hospitals. Unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at nonteaching hospitals, with a 1.5% (95% CI, 1.3%-1.7%; P < .001) mortality difference between major teaching hospitals and nonteaching hospitals. After adjusting for patient and hospital characteristics, the same pattern persisted (8.3% mortality at major teaching vs 9.2% at minor teaching and 9.5% at nonteaching), but the difference in mortality between major and nonteaching hospitals was smaller (1.2% [95% CI, 1.0%-1.4%]; P < .001). After stratifying by hospital size, 187 large (≥400 beds) major teaching hospitals had lower adjusted overall 30-day mortality relative to 76 large nonteaching hospitals (8.1% vs 9.4%; 1.2% difference [95% CI, 0.9%-1.5%]; P < .001). This same pattern of lower overall 30-day mortality at teaching hospitals was observed for medium-sized (100-399 beds) hospitals (8.6% vs 9.3% and 9.4%; 0.8% difference between 61 major and 1207 nonteaching hospitals [95% CI, 0.4%-1.3%]; P = .003). Among small (≤99 beds) hospitals, 187 minor teaching hospitals had lower overall 30-day mortality relative to 2056 nonteaching hospitals (9.5% vs 9.9%; 0.4% difference [95% CI, 0.1%-0.7%]; P = .01). Conclusions and Relevance Among hospitalizations for US Medicare beneficiaries, major teaching hospital status was associated with lower mortality rates for common conditions compared with nonteaching hospitals. Further study is needed to understand the reasons for these differences. PMID:28535236

Industrial noise level study in a wheat processing factory in ilorin, nigeria

NASA Astrophysics Data System (ADS)

Ibrahim, I.; Ajao, K. R.; Aremu, S. A.

2016-05-01

An industrial process such as wheat processing generates significant noise which can cause adverse effects on workers and the general public. This study assessed the noise level at a wheat processing mill in Ilorin, Nigeria. A portable digital sound level meter HD600 manufactured by Extech Inc., USA was used to determine the noise level around various machines, sections and offices in the factory at pre-determined distances. Subjective assessment was also mode using a World Health Organization (WHO) standard questionnaire to obtain information regarding noise ratings, effect of noise on personnel and noise preventive measures. The result of the study shows that the highest noise of 99.4 dBA was recorded at a pressure blower when compared to other machines. WHO Class-4 hearing protector is recommended for workers on the shop floor and room acoustics should be upgraded to absorb some sounds transmitted to offices.

Determinants of utilization of traditional bone setters in Ilorin, north central Nigeria.

PubMed

Aderibigbe, S A; Agaja, S R; Bamidele, J O

2013-03-01

Traditional bone setting (TBS) practice is an important part of health care delivery in many developing countries and has been in Nigeria for long. Despite the complications that arise from the cultural practice, TBS services is still in high demand by a significant number of people. This study was conducted to determine the factors that influence the utilization of TBS practice. A descriptive cross-sectional study was carried out using a semi structured questionnaire to gather information from 400 randomly selected residents of ilorin West LGA in north central Nigeria. Multistage sampling technique was used in selecting the respondents. The respondents were between the ages of 18-72 years with a mean age of 36.3 +/- 12.3. Three hundred and three (77.3%) of the respondents know of TBS practice as a way of getting treatment for bone injuries. More than two third 210 (69.3%) of the respondents who know TBS practice as a form of treatment for bone injuries think that TBS therapy is preferable to Orthodox medicine in handling bone injuries. Reasons for preference are that it is cheap 134 (63.8%), acceptable 123 (58.6%) and accessible 109 (51.9%) to them. More than half(52.3%) of the respondents had patronized TBS treatment at one time or the other. Main reason for patronage of TBS was influence from family members and friends (53.6%). However, factors that influence the respondents decision to utilize TBS treatment include attitude of health workers 310 (77.5%), delay in hospitals 284(71.0%) fear of amputation 272 (54.35) and fear of operation 217(54.3%) in hospitals. There was a statistically significant (p < 0.05) relationship between respondents age, sex, marital status, occupation, ethnicity as well as the income level of the respondents and the utilization of TBS. Utilisation of TBS is quite popular among the studied population because it is believed to be cheap, acceptable and accessible to them and a high proportion of the respondents utilize TBS notwithstanding that they live in a community where they have better access to orthodox medical care. Influence from family and friends is the main reason for consulting TBS. Regulations should be made concerning the advertisement of TBS practice by relevant agencies and the public should be made aware through health education on the dangers of TBS treatment.

Incidence of iatrogenic pneumothorax in the United States in teaching vs. non-teaching hospitals from 2000 to 2012.

PubMed

John, Jason; Seifi, Ali

2016-08-01

Iatrogenic pneumothorax is a patient safety indicator (PSI) representing a complication of procedures such as transthoracic needle aspiration, subclavicular needle stick, thoracentesis, transbronchial biopsy, pleural biopsy, and positive pressure ventilation. This study examined whether there was a significant difference in rate of iatrogenic pneumothorax in teaching hospitals compared to non-teaching hospitals from 2000 to 2012. We performed a retrospective cohort study on iatrogenic pneumothorax incidence from 2000 to 2012 using the Healthcare Cost and Utilization Project (HCUP) database. Pairwise t tests were performed. Odds ratios and P values were calculated, using a Bonferroni-adjusted α threshold, to examine differences in iatrogenic pneumothorax incidence in teaching vs. non-teaching hospitals. Our study revealed that after the year 2000, teaching hospitals had significantly greater iatrogenic pneumothorax incidence compared to non-teaching hospitals in every year of the study period (P<.001). Iatrogenic pneumothorax occurred with significantly greater incidence in teaching hospitals compared to non-teaching hospitals from 2000 to 2012. This trend may have been enhanced by the residency duty-hour regulations implemented in 2003 in teaching institutions, or due to higher rates of procedures in teaching institutions due to the nature of a tertiary center. Iatrogenic pneumothorax was more prevalent in teaching hospitals compared to non-teaching hospitals after the year 2000. Further randomized control studies are warranted to evaluate the etiology of this finding. Published by Elsevier Inc.

Is Hospital Teaching Status a Key Factor in Hospital Charge for Children with Hip Fractures?

PubMed Central

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C.

2013-01-01

OBJECTIVE Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teaching hospital vs non-teaching hospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selec-tion bias. METHODS The 2006 Healthcare Cost and Uti-lization Project (HCUP) Kids’ Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classifi-cation of Diseases, 9th Revision, Clinical Modifica-tion codes 820.0, 820.2 and 820.8 under Section “Injury and Poisoning (800-999)” with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospital teaching status were assessed via two propensity score based methods. RESULTS In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based ad-justment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Conclusions Hospital teaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at identifying factors associated with variations in hospital charge and length of stay. PMID:24027472

Is hospital teaching status a key factor in hospital charge for children with hip fractures?: preliminary findings from KID database.

PubMed

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C

2013-01-01

Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teaching hospital vs non-teaching hospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selection bias. The 2006 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820.0, 820.2 and 820.8 under Section "Injury and Poisoning (800-999)" with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospital teaching status were assessed via two propensity score based methods. In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based adjustment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Hospital teaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at identifying factors associated with variations in hospital charge and length of stay.

A comparison of medical students' perceptions of their initial basic clinical training placements in 'new' and established teaching hospitals.

PubMed

Mathers, Jonathan; Parry, Jayne; Scully, Edward; Popovic, Celia

2006-05-01

This study has examined students' perceptions of the factors influencing learning during initial hospital placements and whether differences in perceived experiences were evident between students attending new and established teaching hospitals. Five focus groups were conducted with Year III students at the University of Birmingham Medical School (UBMS): three with students attending three established teaching hospitals and two with students attached to a new teaching hospital (designated as part of the UBMS expansion programme). Extensive variation in student perception of hospital experiences was evident at the level of teaching hospital, teaching firm and individual teacher. Emergent themes were split into two main categories: 'students' perceptions of teaching and the teaching environment' and 'the new hospital learner'. Themes emerging that related to variation in student experience included the amount of structured teaching, enthusiasm of teachers, grade of teachers, specialty of designated firms and the number of students. The new teaching hospital was generally looked upon favourably by students in comparison to established teaching hospitals. Many of the factors influencing student experience relate to themes grouped under the 'new hospital learner', describing the period of adjustment experienced by students during their first encounter with this new learning environment. Interventions to improve student experience might be aimed at organisations and individuals delivering teaching. However, factors contributing to the student experience, such as the competing demand to teaching of heavy clinical workloads, are outside the scope of medical school intervention. In the absence of fundamental change, mechanisms to equip students with 'survival skills' as self-directed hospital learners should also be considered.

Did recent changes in Medicare reimbursement hit teaching hospitals harder?

PubMed

Konetzka, R Tamara; Zhu, Jingsan; Volpp, Kevin G

2005-11-01

To inform the policy debate on Medicare reimbursement by examining the financial effects of the Balanced Budget Act of 1997 (BBA) and subsequent adjustments on major academic medical centers, minor teaching hospitals, and nonteaching hospitals. The authors simulated the impacts of BBA and subsequent BBA adjustments to predict the independent effects of changes in Medicare reimbursement on hospital revenues using 1997-2001 Medicare Cost Reports for all short-term acute-care hospitals in the United States. The authors also calculated actual (nonsimulated) operating and total margins among major teaching, minor teaching, and nonteaching hospitals to account for hospital response to the changes. The BBA and subsequent refinements reduced Medicare revenues to a greater degree in major teaching hospitals, but the fact that such hospitals had a smaller proportion of Medicare patients meant that the BBA reduced overall revenues by similar percentages across major, minor, and nonteaching hospitals. Consistently lower margins may have made teaching hospitals more vulnerable to cuts in Medicare support. Recent Medicare changes affected revenues at teaching and nonteaching hospitals more similarly than is commonly believed. However, the Medicare cuts under the BBA probably exacerbated preexisting financial strain on major teaching hospitals, and increased Medicare funding may not suffice to eliminate the strain. This report's findings are consistent with recent calls to support needed services of teaching hospitals through all-payer or general funds.

Psychological and social adjustment to blindness: understanding from two groups of blind people in Ilorin, Nigeria.

PubMed

Tunde-Ayinmode, Mosunmola F; Akande, Tanimola M; Ademola-Popoola, Dupe S

2011-01-01

Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often personalized and depends on nature and quality of prevailing psychosocial support and rehabilitation opportunities. This study was aimed at identifying the pattern of psychosocial adjustment in a group of relatively secluded and under-reached totally blind people in Ilorin, thus sensitizing eye doctors to psychosocial morbidity and care in the blind. A cross-sectional descriptive study using 20-item Self-Reporting Questionnaire (SRQ) and a pro forma designed by the authors to assess the psychosocial problems and risk factors in some blind people in Ilorin metropolis. The study revealed that most of the blind people were reasonably adjusted in key areas of social interaction, marriage, and family. Majority were considered to be poorly adjusted in the areas of education, vocational training, employment, and mobility. Many were also considered to be psychologically maladjusted based on the high rate of probable psychological disorder of 51%, as determined by SRQ. Factors identified as risk factors of probable psychological disorder were poor educational background and the presence of another medical disorder. Most of the blind had no access to formal education or rehabilitation system, which may have contributed to their maladjustment in the domains identified. Although their prevailing psychosocial situation would have been better prevented yet, real opportunity still exists to help this group of people in the area of social and physical rehabilitation, meeting medical needs, preventive psychiatry, preventive ophthalmology, and community health. This will require the joint efforts of medical community, government and nongovernment organizations to provide the framework for delivery of these services directly to the communities.

A comparative study of noise pollution levels in some selected areas in Ilorin Metropolis, Nigeria.

PubMed

Oyedepo, Olayinka S; Saadu, Abdullahi A

2009-11-01

The noise pollution is a major problem for the quality of life in urban areas. This study was conducted to compare the noise pollution levels at busy roads/road junctions, passengers loading parks, commercial, industrial and residential areas in Ilorin metropolis. A total number of 47-locations were selected within the metropolis. Statistical analysis shows significant difference (P < 0.05) in noise pollution levels between industrial areas and low density residential areas, industrial areas and high density areas, industrial areas and passengers loading parks, industrial areas and commercial areas, busy roads/road junctions and low density areas, passengers loading parks and commercial areas and commercial areas and low density areas. There is no significant difference (P > 0.05) in noise pollution levels between industrial areas and busy roads/road junctions, busy roads/road junctions and high density areas, busy roads/road junctions and passengers loading parks, busy roads/road junctions and commercial areas, passengers loading parks and high density areas, passengers loading parks and commercial areas and commercial areas and high density areas. The results show that Industrial areas have the highest noise pollution levels (110.2 dB(A)) followed by busy roads/Road junctions (91.5 dB(A)), Passengers loading parks (87.8 dB(A)) and Commercial areas (84.4 dB(A)). The noise pollution levels in Ilorin metropolis exceeded the recommended level by WHO at 34 of 47 measuring points. It can be concluded that the city is environmentally noise polluted and road traffic and industrial machineries are the major sources of it. Noting the noise emission standards, technical control measures, planning and promoting the citizens awareness about the high noise risk may help to relieve the noise problem in the metropolis.

The Epidemiology of Primary and Revision Total Hip Arthroplasty in Teaching and Nonteaching Hospitals in the United States.

PubMed

Kowalik, Thomas D; DeHart, Matthew; Gehling, Hanne; Gehling, Paxton; Schabel, Kathryn; Duwelius, Paul; Mirza, Amer

2016-06-01

The purpose of this study was to examine the epidemiology of primary and revision total hip arthroplasty (THA) in teaching and nonteaching hospitals. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2006 to 2010 to identify primary and revision THAs at teaching and nonteaching hospitals. A total of 1,336,396 primary and 223,520 revision procedures were identified. Forty-six percent of all primary and 54% of all revision procedures were performed at teaching hospitals. Teaching hospitals performed 17% of their THAs as revisions; nonteaching hospitals performed 12% as revisions. For primary and revision THAs, teaching hospitals had fewer patients aged >65 years, fewer Medicare patients, similar gender rates, more nonwhite patients, and more patients in the highest income quartile compared with nonteaching hospitals. Costs, length of stay, and Charlson Comorbidity Index scores were similar; however, the mortality rate was lower at teaching hospitals. This study found small but significant differences in key epidemiologic and outcome variables in examining primary and revision THA at teaching and nonteaching hospitals. Level III.

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria.

PubMed

Babatunde, Oluwole Adeyemi; Ibirongbe, Demilade Olusola; Omede, Owen; Babatunde, Olubukola Oluwakemi; Durowade, Kabir Adekunle; Salaudeen, Adekunle Ganiyu; Akande, Tanimola Makanjuola

2016-01-01

Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception. This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value <0.05 was considered statistically significant. 27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928). Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

PubMed Central

Babatunde, Oluwole Adeyemi; Ibirongbe, Demilade Olusola; Omede, Owen; Babatunde, Olubukola Oluwakemi; Durowade, Kabir Adekunle; Salaudeen, Adekunle Ganiyu; Akande, Tanimola Makanjuola

2016-01-01

Introduction Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception. Methods This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value <0.05 was considered statistically significant. Results 27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928). Conclusion Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents. PMID:27217897

Forceps Delivery Volumes in Teaching and Nonteaching Hospitals: Are Volumes Sufficient for Physicians to Acquire and Maintain Competence?

PubMed Central

Kyser, Kathy L.; Lu, Xin; Santillan, Donna; Santillan, Mark; Caughey, Aaron B.; Wilson, Mark C.; Cram, Peter

2015-01-01

Purpose The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined: (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence. Method The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories. Results The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries. Conclusions Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures. PMID:24280847

Indirect costs of teaching in Canadian hospitals.

PubMed Central

MacKenzie, T A; Willan, A R; Cox, M A; Green, A

1991-01-01

We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

Maternal request CS--role of hospital teaching status and for-profit ownership.

PubMed

Xirasagar, Sudha; Lin, Herng-Ching

2007-05-01

To examine whether hospitals' for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively. Retrospective, cross-sectional, population-based study of Taiwan's National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997-2000, using multiple logistic regression analyses. Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5-2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively). Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals' preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure.

Mortality among high-risk patients with acute myocardial infarction admitted to U.S. teaching-intensive hospitals in July: a retrospective observational study.

PubMed

Jena, Anupam B; Sun, Eric C; Romley, John A

2013-12-24

Studies of whether inpatient mortality in US teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (July effect) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect. Using the US Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention rates, and bleeding complication rates, for high- and low-risk patients with acute myocardial infarction admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted acute myocardial infarction mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.8% in May, 22.7% in July, P<0.01), but similar in non-teaching-intensive hospitals (22.5% in May, 22.8% in July, P=0.70). Among patients in the lowest three quartiles of predicted acute myocardial infarction mortality (low risk), adjusted mortality was similar in May and July in both teaching-intensive hospitals (2.1% in May, 1.9% in July, P=0.45) and non-teaching-intensive hospitals (2.7% in May, 2.8% in July, P=0.21). Differences in percutaneous coronary intervention and bleeding complication rates could not explain the observed July mortality effect among high risk patients. High-risk acute myocardial infarction patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low-risk patients experience no such July effect in teaching-intensive hospitals.

Mortality among High Risk Patients with Acute Myocardial Infarction Admitted to U.S. Teaching-Intensive Hospitals in July: A Retrospective Observational Study

PubMed Central

Jena, Anupam B.; Sun, Eric C.; Romley, John A.

2014-01-01

Background Studies of whether inpatient mortality in U.S. teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (‘July effect’) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect. Methods and Results Using the U.S. Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention (PCI) rates, and bleeding complication rates, for high and low risk patients with acute myocardial infarction (AMI) admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted AMI mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.8% in May, 22.7% in July, p<0.01), but similar in non-teaching-intensive hospitals (22.5% in May, 22.8% in July, p=0.70). Among patients in the lowest three quartiles of predicted AMI mortality (low risk), adjusted mortality was similar in May and July in both teaching-intensive hospitals (2.1% in May, 1.9% in July, p=0.45) and non-teaching-intensive hospitals (2.7% in May, 2.8% in July, p=0.21). Differences in PCI and bleeding complication rates could not explain the observed July mortality effect among high risk patients. Conclusions High risk AMI patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low risk patients experience no such “July effect” in teaching-intensive hospitals. PMID:24152859

The incentive effects of the Medicare indirect medical education policy.

PubMed

Nicholson, S; Song, D

2001-11-01

Medicare provided teaching hospitals with US$ 5.9 billion in supplemental graduate medical education (GME) payments in 1998. These payments distort input and output prices and provide teaching hospitals with incentives to hire residents, close beds, and admit more Medicare patients. The structure of the GME payment policy creates substantial variation in input and output prices between teaching hospitals. We examine the extent to which hospitals responded to these financial incentives using a panel data set of 3,900 hospitals, including over 900 teaching hospitals. We find that teaching hospitals did hire residents and close beds in response to the Medicare policy, but did not increase Medicare admissions or alter their use of registered nurses (RNs).

Comparison of Surgical Outcomes Between Teaching and Nonteaching Hospitals in the Department of Veterans Affairs

PubMed Central

Khuri, Shukri F.; Najjar, Samer F.; Daley, Jennifer; Krasnicka, Barbara; Hossain, Monir; Henderson, William G.; Aust, J. Bradley; Bass, Barbara; Bishop, Michael J.; Demakis, John; DePalma, Ralph; Fabri, Peter J.; Fink, Aaron; Gibbs, James; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Neumayer, Leigh; Roswell, Robert H.; Spencer, Jeannette; Turnage, Richard H.

2001-01-01

Objective To determine whether the investment in postgraduate education and training places patients at risk for worse outcomes and higher costs than if medical and surgical care was delivered in nonteaching settings. Summary Background Data The Veterans Health Administration (VA) plays a major role in the training of medical students, residents, and fellows. Methods The database of the VA National Surgical Quality Improvement Program was analyzed for all major noncardiac operations performed during fiscal years 1997, 1998, and 1999. Teaching status of a hospital was determined on the basis of a background and structure questionnaire that was independently verified by a research fellow. Stepwise logistic regression was used to construct separate models predictive of 30-day mortality and morbidity for each of seven surgical specialties and eight operations. Based on these models, a severity index for each patient was calculated. Hierarchical logistic regression models were then created to examine the relationship between teaching versus nonteaching hospitals and 30-day postoperative mortality and morbidity, after adjusting for patient severity. Results Teaching hospitals performed 81% of the total surgical workload and 90% of the major surgery workload. In most specialties in teaching hospitals, the residents were the primary surgeons in more than 90% of the operations. Compared with nonteaching hospitals, the patient populations in teaching hospitals had a higher prevalence of risk factors, underwent more complex operations, and had longer operation times. Risk-adjusted mortality rates were not different between the teaching and nonteaching hospitals in the specialties and operations studied. The unadjusted complication rate was higher in teaching hospitals in six of seven specialties and four of eight operations. Risk adjustment did not eliminate completely these differences, probably reflecting the relatively poor predictive validity of some of the risk adjustment models for morbidity. Length of stay after major operations was not consistently different between teaching and nonteaching hospitals. Conclusion Compared with nonteaching hospitals, teaching hospitals in the VA perform the majority of complex and high-risk major procedures, with comparable risk-adjusted 30-day mortality rates. Risk-adjusted 30-day morbidity rates in teaching hospitals are higher in some specialties and operations than in nonteaching hospitals. Although this may reflect the weak predictive validity of some of the risk adjustment models for morbidity, it may also represent suboptimal processes and structures of care that are unique to teaching hospitals. Despite good quality of care in teaching hospitals, as evidenced by the 30-day mortality data, efforts should be made to examine further the structures and processes of surgical care prevailing in these hospitals. PMID:11524590

Epidemiology and resource utilization in pediatric facial fractures.

PubMed

Soleimani, Tahereh; Greathouse, Shawn Travis; Sood, Rajiv; Tahiri, Youssef H; Tholpady, Sunil S

2016-02-01

Pediatric facial fractures, although uncommon, have a significant impact on public health and the US economy by the coexistence of other injuries and developmental deformities. Violence is one of the most frequent mechanisms leading to facial fracture. Teaching hospitals, while educating future medical professionals, have been linked to greater resource utilization in differing scenarios. This study was designed to compare the differences in patient characteristics and outcomes between teaching and non-teaching hospitals for violence-related pediatric facial fractures. Using the 2000-2009 Kids' Inpatient Database, 3881 patients younger than 18 years were identified with facial fracture and external cause of injury code for assault, fight, or abuse. Patients admitted at teaching hospitals were compared to those admitted at non-teaching hospitals in terms of demographics, injuries, and outcomes. Overall, 76.2% of patients had been treated at teaching hospitals. Compared to those treated at non-teaching hospitals, these patients were more likely to be younger, non-white, covered by Medicaid, from lower income zip codes, and have thoracic injuries; but mortality rate was not significantly different. After adjusting for potential confounders, teaching status of the hospital was not found as a predictor of either longer lengths of stay (LOS) or charges. There is an insignificant difference between LOS and charges at teaching and non-teaching hospitals after controlling for patient demographics. This suggests that the longer LOS observed at teaching hospitals is related to these institutions being more often involved in the care of underserved populations and patients with more severe injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.

PubMed

Korst, Lisa M; Feldman, Daniele S; Bollman, D Lisa; Fridman, Moshe; El Haj Ibrahim, Samia; Fink, Arlene; Wyatt, Lacey; Gregory, Kimberly D

2015-10-01

The objective of the study was to describe the resources and activities associated with childbirth services. We adapted models for assessing the quality of healthcare to generate a conceptual framework hypothesizing that childbirth hospital resources and activities contributed to maternal and neonatal outcomes. We used this framework to guide development of a survey, which we administered by telephone to hospital labor and delivery nurse managers in California. We describe the findings by hospital type (ie, integrated delivery system [IDS], teaching, and other [community] hospitals). Of 248 nonmilitary childbirth hospitals in California, 239 (96%)responded; 187 community, 27 teaching, and 25 IDS hospitals reported. The context of services varied across hospital types, with community hospitals more likely to have for-profit ownership, be in a rural or isolated location, and have fewer annual deliveries per hospital. Results included the findings of the following: (1) 24 hour anesthesia availability in 50% of community vs 100% of IDS and teaching hospitals (P < .001); (2) 24 hour in-house labor and delivery physician coverage in 5% of community vs 100% of IDS and 48% of teaching hospitals (P < .001); (3) 24 hour blood bank availability in 88% of community vs 96% of IDS and 100% of teaching hospitals (P = .092); (4) adult subspecialty intensive care unit availability in 33% of community vs 36% of IDS and 82% of teaching hospitals (P < .001); (5) ability to perform emergency cesarean delivery in 30 minutes 100% of the time in 56% of community vs 100% of IDS and 85% of teaching hospitals (P < .001); (6) pediatric care available both day and night in 54% of community vs 63% of IDS vs 76% of teaching hospitals (P = .087); and (7) no neonatal intensive care unit in 44% of community vs 12% of IDS and 4% of teaching hospitals (P < .001). Childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women and set the groundwork for identifying criteria for the provision of maternal risk-appropriate care. Copyright © 2015 Elsevier Inc. All rights reserved.

Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals.

PubMed

Amarneh, Basil Hameed

2017-01-29

The concept of "work stressors" has been well studied. However, in the field of nursing, studies concerning social support behaviors are limited. The aim of this study was to compare nurse work stressors, social support behaviors, and predictors of these variables among nurses in Jordanian teaching and non-teaching hospitals. A convenience sampling technique and a comparative quantitative research design were used in the current study. Two hundred and ninety-one nurses were recruited from five teaching hospitals, and 172 were recruited from eight non-teaching hospitals in Jordan. The Nursing Stress Scale (NSS) and the Inventory of Social Supportive Behaviors (ISSB) were used to collect data. The studied variables differed across hospitals. In some subscales, as well as in some individual items of the scales, nurse work stressors and social support behaviors differed between teaching and non-teaching hospitals. In teaching hospitals, the work shift was the only predictor of nurses' work stressors, whereas the work shift and model of nursing care were predictors of social support behaviors. In non-teaching hospitals, the work shift, level of education, and model of nursing care were predictors of nurse work stressors. Predictors of social support behaviors were marital status, model of nursing, and organizational structure. Regardless of the type of hospital, nurse stressors should be assessed and, once identified, managed by providing various social support behaviors. By turning a work environment into a healthy workplace, researchers and nurse leaders believe that improvements can be realized in recruitment and patient safety and quality.

Social Support Behaviors and Work Stressors among Nurses: A Comparative Study between Teaching and Non-Teaching Hospitals

PubMed Central

Amarneh, Basil Hameed

2017-01-01

Purpose: The concept of “work stressors” has been well studied. However, in the field of nursing, studies concerning social support behaviors are limited. The aim of this study was to compare nurse work stressors, social support behaviors, and predictors of these variables among nurses in Jordanian teaching and non-teaching hospitals. Design: A convenience sampling technique and a comparative quantitative research design were used in the current study. Two hundred and ninety-one nurses were recruited from five teaching hospitals, and 172 were recruited from eight non-teaching hospitals in Jordan. Methods: The Nursing Stress Scale (NSS) and the Inventory of Social Supportive Behaviors (ISSB) were used to collect data. Results: The studied variables differed across hospitals. In some subscales, as well as in some individual items of the scales, nurse work stressors and social support behaviors differed between teaching and non-teaching hospitals. In teaching hospitals, the work shift was the only predictor of nurses’ work stressors, whereas the work shift and model of nursing care were predictors of social support behaviors. In non-teaching hospitals, the work shift, level of education, and model of nursing care were predictors of nurse work stressors. Predictors of social support behaviors were marital status, model of nursing, and organizational structure. Conclusions: Regardless of the type of hospital, nurse stressors should be assessed and, once identified, managed by providing various social support behaviors. Clinical relevance: By turning a work environment into a healthy workplace, researchers and nurse leaders believe that improvements can be realized in recruitment and patient safety and quality. PMID:28146045

Changes in Teaching Hospitals' Community Benefit Spending After Implementation of the Affordable Care Act.

PubMed

Alberti, Philip M; Sutton, Karey M; Baker, Matthew

2018-05-22

U.S. teaching hospitals that qualify as 501(c)(3) organizations (a not-for-profit designation) are required to demonstrate community benefit annually. Increases in health insurance access driven by Affordable Care Act (ACA) implementation, along with new regulations, research opportunities, and educational expectations, may be changing hospitals' allocations of community benefit dollars. This study aimed to describe changes in teaching hospitals' community benefit spending between 2012 (pre-ACA implementation) and 2015 (post-ACA implementation), and to explore differences in spending changes between hospitals in Medicaid expansion and non-expansion states. In 2017, for each teaching hospital member of the Association of American Medical Colleges' (AAMC's) Council of Teaching Hospitals and Health Systems required to submit Form 990s to the Internal Revenue Service, the authors sought community benefit spending data for 2012 and 2015 as reported on Schedule H. The analysis included 169 pairs of Form 990s representing 184 AAMC member teaching hospitals (93% of 198 eligible hospitals). Compared with 2012, hospitals in 2015 spent $3.1 billion (20.14%) more on community benefit despite spending $804 million (16.17%) less on charity care. Hospitals in Medicaid expansion states increased spending on subsidized health services and Medicaid shortfalls at rates higher than hospitals in non-expansion states. The latter increased spending at higher rates on community health improvement and cash/in-kind contributions. After ACA implementation, teaching hospitals increased their overall community benefit spending while their charity care spending declined. Changes in community benefit spending differed according to states' Medicaid expansion status, demonstrating hospitals' responsiveness to state and local realities.

Lessons from the implementation of LLIN distribution campaign in Ilorin Kwara State, Nigeria.

PubMed

Obembe, Abiodun; Anyaele, Okorie Okogbue; Oduola, Adedayo Olatunbosun

2014-05-28

Studies implemented to evaluate the success of Long-lasting insecticidal nets (LLIN) distribution campaigns are often limited to ownership and utilization rates, neglecting other factors that directly affect the efficacy of the tool in malaria control. This study investigates sleeping habits and net maintenance behaviour in addition to LLIN ownership, utilization and the challenges associated with LLIN use among residents in Ilorin City where the tool has been massively distributed. A cross-sectional survey was conducted using pre-tested interviewer-administered questionnaire to obtain information from randomly selected household respondents in Ilorin, the Kwara State Capital. The study was conducted in July 2012, about sixteen months after the March 2011 distribution of LLIN in the locality. The results were analyzed using the EPI INFO 2007 version. LLIN ownership (85%) and utilization (37%) rates improved compared to earlier reports, though 29% of net users have noticed holes in the nets even as 26% claimed to have actually experienced mosquito bites under it. Most (92%) of the respondents who slept under LLIN the previous night before the study spent the first five hours of the night (19.00-23.00 hr) outdoors while 88% also engage in inappropriate net washing practices. All the LLIN users claimed to have experienced at least one malaria episode while 43% have had two or more episodes within the past twelve months. The use of LLIN among the respondents in this study was accompanied by chancy sleeping habits, inappropriate net maintenance practices and repeated experience of mosquito bites under the nets. This shows the need to sustain the will and confidence of LLIN users in this area through frequent monitoring and surveillance visits targeted at enlightening the people on habits that increase malaria exposure risks as well as proper use and maintenance of LLIN for maximum malaria vector control benefits.

42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN...

42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS...

42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN...

42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS...

42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... services furnished in a teaching hospital. (g) Aggregate per diem methods of apportionment—(1) For the... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS...

Effect of Male Partner's Support on Spousal Modern Contraception in a Low Resource Setting.

PubMed

Balogun, Olayinka; Adeniran, Abiodun; Fawole, Adegboyega; Adesina, Kikelomo; Aboyeji, Abiodun; Adeniran, Peace

2016-09-01

As efforts continue to increase contraceptive uptake, male partner support remains important in spousal modern contraceptive use. A prospective cross-sectional survey involving women on modern contraception was conducted at the family planning clinic of the University of Ilorin Teaching Hospital, Nigeria, between December 2013 and April 2014. All consenting participants completed a self-administered questionnaire designed for the study, and statistical analysis was done with SPSS version 20.0 using with chi square test and logistic regression; p value <0.05 was significant. There were 305 participants: 208(68.2%) were multipara, the commonest current and previous contraceptives used were IUD and injectables while male partner was responsible for discontinuation in 30(23.3%) of previous users. Covert contraceptive use was 22(7.2%), male partner support was 209(68.5%) as payment for the contraceptives (203; 66.6%) or transportation to the clinic (198; 64.9%). Also, 55(18.0%) women failed to comply with contraception recently due to male partner hindrance (25; 45.5%) or inability to pay for contraceptive (11; 20%) or transportation to the clinic (8; 14.5%). Male partners hindered contraception by reporting the woman to relatives/friends (8; 32%) or denying her money for feeding allowance (6; 24%); 277(90.8%) women want contraception to be couple decision while 261(85.6%) want contraception administered only if both partners consented. The significant predictors of male partner support were awareness about the contraceptive use (p<0.001, OR0.114; CI0.041-0.319), level of education (p0.007, OR1.488; CI1.114-1.9870) and social class (p0.029, OR0.690; CI0.495-0.963). Male partner hindrances and costs of contraceptive or transportation to clinic are important in noncompliance. Male partner education, subsidized/free contraceptives and mobile/community services will improve compliance.

Finding Low-Cost Medical Care (For Teens)

MedlinePlus

... your insurance company before you go to one. Teaching Hospitals and Medical Centers Teaching hospitals and medical centers are the final step ... mentioned may offer specialist care at set times. Teaching hospitals and medical schools usually have clinics for ...

Developing marketing strategies for university teaching hospitals.

PubMed

Fink, D J

1980-07-01

University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, a rising tide of consumerism, and in many cases a declining urban population base. These problems, which may threaten the teaching hospital's ability to continue tertiary care, teaching, and research functions, may be solved with the aid of new marketing strategies. In developing its marketing strategy, a hospital must assess its strengths and weaknesses, specify its goals in measurable terms, implement tactics to achieve these goals, and evaluate its marketing program. The strategies should be directed toward achieving better relationships with institutions, practitioners, and surrounding communities and increasing patient, visitor, and employee satisfaction. A wide variety of programs can be used to reach these goals and to help teaching hospitals meet the competitive challenges of this decade.

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions of payment: Assistants at surgery in... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based on...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions of payment: Assistants at surgery in... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based on...

Financial, Resource Utilization and Mortality Impacts of Teaching Hospital Status on Pediatric Patients Admitted for Sepsis.

PubMed

Hsu, Benson S; Meyer, Benjamin D; Lakhani, Saquib A

2017-08-01

With the changing healthcare landscape in the United States, teaching hospitals face increasing pressure to provide medical education as well as cost-effective care. Our study investigated the financial, resource utilization and mortality impact of teaching hospital status on pediatric patients admitted with sepsis. We conducted a retrospective, weighted statistical analysis of hospitalized children with the diagnosis of sepsis. The Agency for Healthcare Research and Quality 2009 Kids' Inpatient Database provided the data for analysis. Diagnosis of sepsis and severity of illness levels were based on All Patient Refined Diagnosis-Related Groups of 720: Septicemia and Disseminated Infections. Teaching hospital status was based on presence of training programs. Statistical analysis was conducted using STATA 12.1 (Stata Corporation, College Station, TX). Weighted analysis revealed 17,461 patients with sepsis-9982 in teaching and 7479 in nonteaching hospitals. When comparing all patients, length of stay (8.2 vs. 4.8, P < 0.001), number of procedures received (2.03 vs. 0.87, P < 0.001), mortality (4.7% vs. 1.6%, P < 0.001), costs per day ($2326 vs. $1736, P < 0.001) and total costs ($20,428 vs. $7960, P < 0.001) were higher in teaching hospitals. Even when stratified by severity classes, length of stay, number of procedures received and total costs were higher in teaching hospitals with no difference in mortality. Our study suggested that teaching hospitals provide pediatric inpatient care for sepsis at greater costs and resource utilization without a clear improvement in overall mortality rates in comparison with nonteaching hospitals.

A Pilot Study of the Challenges and Prospects of Continuous Assessment Implementation in Nigeria

ERIC Educational Resources Information Center

Owolabi, Henry O.; Onuka, Adams O. U.

2010-01-01

This study obtained basic information from teachers and students on the challenges and prospects of implementing continuous assessment (CA) in the Nigerian school system. Secondary Schools in Ilorin, the capital city of Kwara State, located in the central region of Nigeria were sampled for use in the study. It employed survey research design…

Effects of Computer Animation Instructional Package on Students' Achievement in Practical Biology

ERIC Educational Resources Information Center

Hamzat, Abdulrasaq; Bello, Ganiyu; Abimbola, Isaac Olakanmi

2017-01-01

This study examined the effects of computer animation instructional package on secondary school students' achievement in practical biology in Ilorin, Nigeria. The study adopted a pre-test, post-test, control group, non-randomised and nonequivalent quasi-experimental design, with a 2x2x3 factorial design. Two intact classes from two secondary…

Assessment of Utilization of Internet Facilities among Pre-Service Teachers in University of Ilorin, Nigeria

ERIC Educational Resources Information Center

Ogunlade, Oyeronke Olufunmilola; Fagbola, Oluwafunmilayo Faith; Ogunlade, Amos Akindele; Amosa, Abdulganiyu Alasela

2015-01-01

The use of the Internet can further equip teachers by providing them with the latest information on their discipline. The purpose of technology in teacher training is to provide pre-service teachers with the capability of integrating computer technologies into curriculum and instructional activities.This study therefore assessed the internet…

Conceptions of the Nature of Biology Held by Senior Secondary School Biology Teachers in Ilorin, Kwara State, Nigeria

ERIC Educational Resources Information Center

Adegboye, Motunrayo Catherine; Bello, Ganiyu; Abimbola, Isaac O.

2017-01-01

There is a sustained public outcry against the persistent abysmal performance of students in biology and other science subjects at the Senior School Certificate Examinations conducted by the West African Examinations Council (WAEC) and the National Examinations Council (NECO). Biology is a unique science discipline with peculiar philosophical…

Case Mix Complexity Differences between Teaching and Nonteaching Hospitals.

ERIC Educational Resources Information Center

Ament, Richard P.; And Others

1981-01-01

The differences between teaching and nonteaching hospitals in complexity and variety of cases seen are described. The results show that teaching hospitals could be expected to cost somewhat more per patient even if case mix were the only factor. (Author/MLW)

Competitive strategy in turbulent healthcare markets: an analysis of financially effective teaching hospitals.

PubMed

Langabeer, J

1998-01-01

As the healthcare marketplace, characterized by declining revenues and heavy price competition, continues to evolve toward managed care, teaching hospitals are being forced to act more like traditional industrial organizations. Profit-oriented behavior, including emphases on market strategies and competitive advantage, is now a necessity if these hospitals are going to survive the transition to managed care. To help teaching hospitals evaluate strategic options that maximize financial effectiveness, this study examined the financial and operating data for 100 major U.S. teaching hospitals to determine relationships among competitive strategy, market environment, and financial return on invested capital. Results should help major hospitals formulate more effective strategies to combat environmental turbulence.

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety?

PubMed

Pingleton, Susan K; Horak, Bernard J; Davis, David A; Goldmann, Donald A; Keroack, Mark A; Dickler, Robert M

2009-11-01

The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist. The authors used qualitative research methodology with purposeful sampling. They gathered data from individual structured interviews with residents and key educational and quality leaders in six medical schools and teaching hospitals, which represented a range of quality performance rankings, geographic regions, and public or private status. No relationship emerged between a hospital's quality status, residents' curriculum, and the residents' understanding of quality. Residents' definitions of quality and safety and their knowledge of the practice-based learning and systems-based practice competencies were indistinguishable between hospitals. Residents in all programs had extensive patient safety knowledge acquired through an informal curriculum in the hospital setting. A formal curriculum existed in only two programs, both of them ambulatory settings. Residents' learning about quality and patient safety is extensive, largely through a positive informal curriculum in the teaching hospital and, less frequently, via a formal curriculum. No relationship was found between the quality performance of the teaching hospital and the residents' curriculum or understanding of quality or safety. Residents seem to learn through an informal curriculum provided by hospital initiatives and resources, and thus these data suggest the importance of major teaching hospitals in quality education.

Developing 21st century accreditation standards for teaching hospitals: the Taiwan experience.

PubMed

Huang, Chung-I; Wung, Cathy; Yang, Che-Ming

2009-12-15

The purpose of this study is to establish teaching hospital accreditation standards anew with the hope that Taiwan's teaching hospitals can live up to the expectations of our society and ensure quality teaching. The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second on drafting the new standards with expert focus groups, and the third on a pilot study and subsequent revision. Our new teaching hospital accreditation standards have six categories and 95 standards as follows: educational resources (20 items), teaching and training plans and outcomes (42 items), research and results (9 items), development of clinical faculty and continuing education (8 items), academic exchanges and community education (8 items), and administration (8 items). The new standards have proven feasible and posed reasonable challenges in the pilot study. We hope the new standards will strengthen teaching and research, and improve the quality of hospital services at the same time.

A survey of staff attitudes to increasing medical undergraduate education in a district general hospital.

PubMed

Macdonald, John

2005-07-01

Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching--their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching--as both student numbers and service workloads continue to rise. Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative.

Effect of Peer Tutoring on Students' Academic Performance in Economics in Ilorin South, Nigeria

ERIC Educational Resources Information Center

AbdulRaheem, Yusuf; Yusuf, Hamdallat T.; Odutayo, Adesegun O.

2017-01-01

Peer tutoring has generated a great deal of scholarly interest in the field of education. It is viewed as an essential instructional strategy for inclusive education because it constitutes one of the strongholds of cooperative learning. This study examines the effect of peer tutoring and the moderating effect of gender on the academic performance…

Analysis of Errors Committed by Physics Students in Secondary Schools in Ilorin Metropolis, Nigeria

ERIC Educational Resources Information Center

Omosewo, Esther Ore; Akanbi, Abdulrasaq Oladimeji

2013-01-01

The study attempt to find out the types of error committed and influence of gender on the type of error committed by senior secondary school physics students in metropolis. Six (6) schools were purposively chosen for the study. One hundred and fifty five students' scripts were randomly sampled for the study. Joint Mock physics essay questions…

Enhancement of Pedagogical Skills in Nigerian Schools through Information and Communication Technology (ICT): Issues for the Future

ERIC Educational Resources Information Center

Aluede, Oyaziwo

2013-01-01

The history of information and communication technology (ICT) in Nigerian schools is patchy. The first experience of Internet services started about 1990 with University of Ilorin through the assistance of McMaster University in Canada. Currently, though, many staff members of universities in Nigeria have email accounts, and over forty-four…

Perception and practice of contraception among male soldiers in Sobi barracks, Ilorin, Nigeria.

PubMed

Hussain, N A; Akande, T M; Osagbemi, G K; Olasupo, S T; Salawu, K Y; Adebayo, E T

2013-06-01

There is a popular belief among the general population that Nigerian soldiers tend to have large families but this has not been substantiated with evidence-based research. The Nigerian military health authority implements female-targetted contraception strategies, with less focus on their husbands; who are the dominant fertility determinants. To determine the perception and practice of contraception among male soldiers of Sobi Cantonment, Ilorin, Nigeria, with a view to instituting male-targeted contraceptive/family planning strategies. A cross-sectional survey of 334 male soldiers using multistage sampling technique and pre-tested interviewer administered questionnaires. The respondents' approval of contraception (73.6%) and willingness to discuss it with their spouses/partners (71.6%) were high. Fear of wives/partner's sexual promiscuity (55.7%), cultural and religious beliefs (43.2%), fear of the side effects of contraceptives (29.5%) and the desire for more children (21.6%) were reported reasons for the non-approval of contraception. The prevalence of contraceptive use among the respondents was low (12.3%). There was a significant relationship between the respondents' educational level and contraceptive use (p< 0.05). The study revealed a high approval and willingness to discuss contraception with their spouses/partners but low contraceptive use.

One Strategy for Controlling Costs in University Teaching Hospitals

ERIC Educational Resources Information Center

Thompson, John D.; And Others

1978-01-01

A methodology is outlined that can be used by teaching hospitals in determining their costs of treating patients with a complex mix of diagnoses. It is not held that case mix alone explains all cost differences between teaching and nonteaching hospitals, but that factor must be isolated before examining other variables. (Author/LBH)

Wiring a medical school and teaching hospital for telemedicine.

PubMed

Hjelm, N M; Lee, J C K; Cheng, D; Chui, C

2002-06-01

The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching.

Wiring a medical school and teaching hospital for telemedicine.

PubMed

Hjelm, N M; Lee, J C; Cheng, D; Chui, C

2001-05-01

The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching.

Comparison of resource utilization and clinical outcomes between teaching and nonteaching medical services.

PubMed

Khaliq, Amir A; Huang, Chiung-Yu; Ganti, Apar Kishor; Invie, Kristie; Smego, Raymond A

2007-05-01

To compare the resource utilization and clinical outcomes of medical care delivered on general internal medicine inpatient services at teaching and nonteaching services at an academic hospital. From February to October 2002, 2189 patients admitted to a 450-bed university-affiliated community hospital were assigned either to a resident-staffed teaching service (n = 1637) or to a hospitalist- or clinic-based internist nonteaching service (n = 552). We compared total hospital costs per patient, length of hospital stay (LOS), hospital readmission within 30 days, in-hospital mortality, and costs for pharmacy, laboratory, radiology, and others between teaching and nonteaching services. Care on a teaching service was not associated with increased overall patient care costs ($5572 vs. $5576; P = .99), LOS (4.92 days vs. 5.10 days; P = .43), readmission rate (12.3% vs. 10.3%; P = .21), or in-hospital mortality (3.7% vs. 4.5%; P = .40). Mean laboratory and radiology costs were higher on the teaching service, but costs for the pharmacy and for speech therapy, occupational therapy, physical therapy, respiratory therapy, pulmonary function testing, and GI endoscopy procedures were not statistically different between the 2 services, and residents did not order more tests or procedures. Case mix and illness severity, as reflected by the distribution of the most frequent DRGs and mean number of secondary diagnoses per patient and DRG-specific LOS, were similar on the 2 services. At our academic hospital, admission to a general internal medicine teaching service resulted in patient care costs and clinical outcomes comparable to those admitted to a nonteaching service. (c) 2007 Society of Hospital Medicine.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

PubMed Central

Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI ± $437). CONCLUSIONS Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability. PMID:11251744

General Practice Teaching--Within the Hospital

ERIC Educational Resources Information Center

Drury, M.

1976-01-01

A program of integrated teaching by consultants and general practitioners is described. The teaching took place in the hospitals used for the purpose by the Medical Faculty of the University of Birmingham. (Author)

[Scientific output of orthopaedic hospitals in the Netherlands: not all hospitals meet the requirements of the Dutch orthopaedic residency programme].

PubMed

Eshuis, Rienk; Verheyen, Cees C P M; de Gast, Arthur

2011-01-01

To evaluate the feasibility of the requirements for scientific participation in the Dutch orthopaedic residency programme by assessing the numbers of articles published by orthopaedic teaching hospitals. Descriptive. All 29 orthopaedic teaching hospitals in the Netherlands were asked to draw up a list of articles published from 2004 to 2009. The publications were subdivided into papers indexed in PubMed and papers published in the Nederlands Tijdschrift voor Orthopedie (NTvO, Netherlands Journal of Orthopaedics) and the Nederlands Tijdschrift voor Traumatologie (NTvT, Netherlands Journal of Traumatology). There was an overall response rate of 72% (21/29). For the 8 non-responders a search of PubMed and the NTvO-NTvT journal databases was used to compile a list of their publications. The university teaching hospitals (n = 8) published 1150 articles, 1118 of which were indexed in PubMed, 19 published in the NTvO and 13 in the NTvT. Peripheral teaching hospitals (n = 21) published 689 articles: 590 indexed in PubMed, 77 published in the NTvO and 22 in the NTvT. In the peripheral teaching hospitals there was a positive correlation between the number of orthopaedic surgeons and PhD students and the number of published articles. Of the 29 teaching hospitals, 9 (31%) did not meet the requirements for publication specified in the Dutch orthopaedic residency programme guidelines. The number of published articles is related to the numbers of orthopaedic surgeons and PhD students in peripheral teaching hospitals. The requirements for the minimum number of publications could therefore be revised to reflect the proportion of orthopaedic surgeons in each teaching hospital. The introduction of a weighting factor that accounts for the quality of the publications would also result in a more balanced assessment.

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

PubMed Central

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

2017-01-01

Objective Although the number of intensive care beds in the United States is increasing, little is known about the hospitals responsible for this growth. We sought to better characterize national growth in intensive care beds by identifying hospital-level factors associated with increasing numbers of intensive care beds over time. Design We performed a repeated-measures time series analysis of hospital-level intensive care bed supply using data from Centers for Medicare and Medicaid Services. Setting All United States acute care hospitals with adult intensive care beds over the years 1996 to 2011. Measurements & Main Results We described the number of beds, teaching status, ownership, intensive care occupancy and urbanicity for each hospital in each year of the study. We then examined the relationship between increasing intensive care beds and these characteristics, controlling for other factors. The study included 4,457 hospitals and 55,865 hospital-years. Overall, the majority of intensive care bed growth occurred in teaching hospitals (net +13,471 beds, 72.1% of total growth), hospitals with 250 or more beds (net +18,327 beds, 91.8% of total growth) and hospitals in the highest quartile of occupancy (net +10,157 beds, 54.0% of total growth). In a longitudinal multivariable model, larger hospital size, teaching status, and high intensive care occupancy were associated with subsequent-year growth. Furthermore, the effects of hospital size and teaching status were modified by occupancy: the greatest odds of increasing intensive care unit beds were in hospitals with 500 or more beds in the highest quartile of occupancy (adjusted OR: 18.9; 95% CI: 14.0 – 25.5; p<0.01) and large teaching hospitals in the highest quartile of occupancy (adjusted OR: 7.3; 95% CI: 5.3 – 9.9; p<0.01). Conclusions Increasingly, intensive care bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high intensive care unit occupancy. PMID:27661861

Efficacy of Client-Centred and Rational-Emotive Behaviour Therapies in Reducing Bullying Behaviour among In-School Adolescents in Ilorin, Nigeria

ERIC Educational Resources Information Center

Alabi, Yahaya Lasiele; Lami, Mustapha Mulikat

2015-01-01

Bullying behaviour refers to repeated negative behaviour displayed by one or more person (s) with the intention of hurting the feeling, personality and power of the victim. The objective of this study therefore was to find out the efficacy of Client-Centred and Rational-Emotive Behaviour Therapies in reducing bullying behaviour among in-school…

[Clinical research outside of teaching hospitals: Current situation in north-eastern France].

PubMed

Goetz, C; Dupoux, A; Déloy, L; Hertz, C; Jeanmaire, T; Parneix, N

2015-04-01

Most clinical research in France takes place in teaching hospitals. There are, however, many advantages to developing it in other hospitals: access to innovative treatments, improvement in healthcare quality, attractiveness of hospitals, increased trial inclusion rates and reduced selection bias. The objectives of our study were to report on the current situation of clinical research outside teaching hospitals. A three-stage survey was conducted between January 2012 and May 2013 in non-teaching hospitals of north-eastern France. First, questionnaires were sent to administrative and medical boards of all hospitals with more than 100 beds, then to head doctors of every department in hospitals with more than 300 beds and finally meetings were organized with members of 20 selected hospitals. The administrative and medical boards of 85 hospitals participated in the first stage of the survey; half of these hospitals were engaged in clinical research activities and for 10 the internal structuring was cross-disciplinary. Answers from 178 departments were obtained during the second stage; 47% reported a clinical research activity. Meetings with research teams in 20 hospitals allowed us to identify difficulties concerning research funding, transversal organization and sponsoring. Clinical research existed in more than half of the respondent non-teaching hospitals. Obstacles to its development can be grouped in three categories: 1) internal structuring of clinical research, 2) access to information and knowledge of how clinical research functions and to interlocutors outside the hospital and 3) access to skills necessary to sponsor clinical research. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Council of Teaching Hospitals: Survey of Housestaff Stipends, Benefits and Funding, 1992.

ERIC Educational Resources Information Center

Evans, Alison

This report presents the results of an annual survey of housestaff stipends, benefits, and funding for physicians at teaching hospitals in 1992. The data, presented in 48 tables and 4 figures, are based on responses from 325 members of the Council of Teaching Hospitals (COTH), an 83 percent response rate to the survey. Chapter I contains stipend…

Does outsourcing paramedical departments of teaching hospitals affect educational status of the students?

PubMed

Moslehi, Shandiz; Atefimanesh, Pezhman; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal; Kafaeimehr, Mohamadhosein; Emamgholizadeh, Saeid

2016-01-01

There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences. This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used. No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05). Based on the students' perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered.

Lucinda Huffaker and the Hospitality of the Wabash Center

ERIC Educational Resources Information Center

Placher, William C.

2007-01-01

As associate director and then director of the Wabash Center for Teaching and Learning in Theology and Religion, Lucinda Huffaker has been a key factor in the Center's reputation for hospitality. The Center's work presupposes that reflection on teaching improves teaching and learning, and good reflection on one's teaching requires taking risks and…

The Hospitalist Huddle: a 1-year experience of teaching Hospital Medicine utilizing the concept of peer teaching in medical education.

PubMed

Elhassan, Mohammed

2017-01-01

The relatively new specialty of Hospital Medicine in the USA is one of the fastest growing fields in internal medicine. Academic hospitalists are largely involved in the medical education of postgraduate residents and medical students. Little is known about the effectiveness of peer-to-peer teaching in internal medicine residency training programs and how the medical residents perceive its educational value in learning Hospital Medicine. The Hospitalist Huddle is a weekly educational activity newly established by our Hospitalist Division to facilitate the concept of peer-to-peer teaching. It requires medical residents to teach and educate their peers about the clinical topics related to Hospital Medicine. Faculty hospitalists serve as facilitators during the teaching sessions. A survey disseminated at the end of the first year of its implementation examined the residents' perception of the educational value of this new teaching activity. Most residents reported that they see the Huddle as a useful educational forum which may improve their skills in teaching, create a better educational and learning environment during their inpatient rotation, and improve their understanding of Hospital Medicine. Most residents also prefer that their peers, rather than faculty hospitalists, run the activity and do the teaching. The survey results support the notion that teaching and learning with flat hierarchies can be an appealing educational method to medical residents to help them understand Hospital Medicine during their medical wards rotation. Some areas need to be improved and others need to be continued and emphasized in order to make this novel educational activity grow and flourish in terms of its educational value and residents' satisfaction.

Creative payment strategy helps ensure a future for teaching hospitals.

PubMed

Vancil, D R; Shroyer, A L

1998-11-01

The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

Social Determinants of Depression: Social Cohesion, Negative Life Events, and Depression Among People Living with HIV/Aids in Nigeria, West Africa.

PubMed

Shittu, Rasaki O; Issa, Baba A; Olanrewaju, Ganiyu T; Mahmoud, Abdulraheem O; Odeigah, Louis O; Sule, Abdullateef G

2014-01-01

People Living with HIV/AIDS (PLWHA) continue to face persistent and deep rooted social barriers. Incidentally, studies in social determinants of depression are very limited, necessitating this study, which examined social determinants of depression and the impact of these determinants on depression. This was a hospital based, cross sectional descriptive study of three hundred adult HIV/AIDS patients, attending the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria. Depressive symptoms were measured by the PHQ-9 rating scale. Three variables of social determinants of depression: socio-economic status (years of school and self-reported economic status of family), social cohesion, and negative life events were examined. The self-reported economic status of the family varied from good 35(11.7%), average 162(54%), and poor among 103(34.3%) of the respondents. Social cohesion was low in 199(66.3%), fair in 65(21.7%) and high among 36(12%) of the respondents. There was significant association between social cohesion, negative life events, and depression. Income was the most significant socio-economic determinant. Majority had very low social cohesion and more negative life events, while those with below average years of schooling were more depressed. These are statistically significant. Social determinants of depression should be given a lot of emphasis, when addressing the issue of depression, if we are to meaningfully tackle this increasing scourge in our society.

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital. This...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital. This...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital. This...

Exposure to coarse and fine particulate matter at and around major intra-urban traffic intersections of Ilorin metropolis, Nigeria

NASA Astrophysics Data System (ADS)

Adeniran, J. A.; Yusuf, R. O.; Olajire, A. A.

2017-10-01

This study aims to determine the seasonal variations and composition of suspended particulate matter in different sizes PM1.0, PM2.5, PM10 and the total suspended particles (TSP) emitted at major intra-urban traffic intersections (TIs) of Ilorin metropolis. The concentration levels of PM (PM1.0, PM2.5, PM10) obtained at the TIs during the rush hours (45.1, 77.9, and 513 μg/m3) are higher than the levels obtained for the non-rush hour periods (42.3, 62.7, and 390 μg/m3). The average on-road respiratory deposition dose (RDD) rates of PM1.0, PM2.5 and PM10 during the dry period at TIs types was found to be about 24%, 9% and 25% higher than those obtained during the wet period. Based on EF values calculated, Pb and Zn were anthropogenically-derived while Fe, Mn, Cr, Cu and Mg were of crustal source. Principal component analysis (PCA) has been applied to a set of PM data in order to determine the contribution of different sources. It was found that the main principal factors extracted from particulate emission data were related to exhaust and non-exhaust emissions such as tyre wears, oil and fuel combustion sources.

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

PubMed Central

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

2016-01-01

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

Does outsourcing paramedical departments of teaching hospitals affect educational status of the students?

PubMed Central

Moslehi, Shandiz; Atefimanesh, Pezhman; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal; Kafaeimehr, Mohamadhosein; Emamgholizadeh, Saeid

2016-01-01

Background: There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences. Methods: This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used. Results: No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05). Conclusion: Based on the students’ perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered. PMID:27683645

The Effect of Outpatient Visit Volume on Inpatient Teaching Services.

ERIC Educational Resources Information Center

Deyo, Richard A.

1984-01-01

Administrative changes causing a planned decrease in outpatient services offered at a teaching hospital resulted in adverse effects on teaching programs and hospital finances. These results emphasize the important of vertical integration of services to the survival of academic health centers. (Author/MSE)

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

PubMed

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

2009-03-01

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

Undergraduate radiology education in private and public teaching hospitals in Karachi, Pakistan: teaching duties, methodologies, and rewards

PubMed Central

Nadeem, Naila; Khawaja, Ranish Deedar Ali; Beg, Madiha; Naeem, Muhammad; Majid, Zain

2013-01-01

Background In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study has been conducted in Pakistan to demonstrate an academic framework of medical radiology education at an undergraduate level. Therefore, we aimed to document and compare the current level of teaching duties, teaching methodologies, and teaching rewards among radiologists and residents in private and public teaching hospitals in Karachi, Pakistan. Methods A survey was conducted among 121 radiologists and residents in two private and two public teaching hospitals in Karachi, Pakistan. Radiologists who were nationally registered with the Pakistan Medical and Dental Council either part-time or full-time were included. Radiology residents and fellows who were nationally registered with the Pakistan Medical and Dental Council were also included. Self-administered questionnaires addressing teaching duties, methods, and rewards were collected from 95 participants. Results The overall response rate was 78.51% (95/121). All of the radiologists were involved in teaching residents and medical students, but only 36% reported formal training in teaching skills. Although most of the respondents (76%) agreed that medical students appeared enthusiastic about learning radiology, the time spent on teaching medical students was less than five hours per week annually (82%). Only 37% of the respondents preferred dedicated clerkships over distributed clerkships (41%). The most common preferred teaching methodology overall was one-on-one interaction. Tutorials, teaching rounds, and problem-based learning sessions were less favored by radiologists than by residents. Teaching via radiology films (86%) was the most frequent mode of instruction. Salary (59%) was the most commonly cited teaching reward. The majority of respondents (88%) were not satisfied with their current level of teaching rewards. Conclusion All radiologists and residents working in an academic radiology department are involved in teaching undergraduate students at multiple levels. The most valued teaching methodology involves use of images, with one-on-one interaction between the trainer and trainee. The monetary reward for teaching is inbuilt into the salary. The methodology adopted for teaching purposes was significantly different between respondents from private hospitals and those from public teaching hospitals. Because of low satisfaction among the respondents, efforts should be made to provide satisfying teaching rewards. PMID:23745098

Cost implications of ACGME's 2011 changes to resident duty hours and the training environment.

PubMed

Nuckols, Teryl K; Escarce, José J

2012-02-01

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) will implemented stricter duty-hour limits and related changes to the training environment. This may affect preventable adverse event (PAE) rates. To estimate direct costs under various implementation approaches, and examine net costs to teaching hospitals and cost-effectiveness to society across a range of hypothetical changes in PAEs. A decision-analytical model represented direct costs and PAE rates, mortality, and costs. Published literature and publicly available data. Patients admitted to hospitals with ACGME-accredited programs. One year. All teaching hospitals, major teaching hospitals, society. ACGME's 2011 Common Program Requirements. Direct annual costs (all accredited hospitals), net cost (major teaching hospitals), cost per death averted (society). RESULTS OF BASE-ANALYSIS: Nationwide, duty-hour changes would cost $177 million annually if interns maintain current productivity, vs. up to $982 million if they transfer work to a mixture of substitutes; training-environment changes will cost $204 million. If PAEs decline by 7.2-25.8%, net costs to major teaching hospitals will be zero. If PAEs fall by 3%, the cost to society per death averted would be -$523,000 (95%-confidence interval: -$1.82 million to $685,000) to $2.44 million ($271,000 to $6.91 million). If PAEs rise, the policy will be cost-increasing for teaching hospitals and society. The total direct annual cost nationwide would be up to $1.34 billion using nurse practitioners/physician assistants, $1.64 billion using attending physicians, $820 million hiring additional residents, vs. 1.42 billion using mixed substitutes. The effect on PAEs is unknown. Data were limited for some model parameters. Implementation decisions greatly affect the cost. Unless PAEs decline substantially, teaching hospitals will lose money. If PAEs decline modestly, the requirements might be cost-saving or cost-effective to society.

Where are lengths of stay longer and total charges higher for pediatric burn patients?

PubMed

Myers, John; Lehna, Carlee

2014-01-01

Treatment of pediatric burn patients is costly and may require long length of stay in the hospital (LOS). Establishing where these LOS and charges are highest is warranted. The current study investigated whether pediatric burn patients had higher total charges and longer LOS when seen at teaching hospitals, when compared with nonteaching hospitals. The study reviewed inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 by using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 940-947 were used to define burn injury, LOS, total charges, and type of hospital. The authors tested for differences between the LOS and total charges between children seen at three types of hospitals (pediatric, nonpediatric/teaching, nonpediatric/nonteaching) while adjusting for traditional risk factors (eg age, total burn surface area) by using generalized linear mixed-effects modeling. A total of N=28,777 children had burn injuries (n=16,115, 56.0% seen at pediatric hospitals; n=9353, 32.5% seen at nonpediatric/teaching hospitals; and n=3309, 11.5% seen at nonpediatric/nonteaching hospitals). Pediatric burn patients seen at pediatric hospitals, unadjusted, have significantly longer LOS (5.54 days vs 4.25 days and 4.00 days, P<.001) and more total charges in 2009 dollars ($31,319 vs $24,413 and $21,499, P<.001). In addition, patients seen at pediatric hospitals had significantly more total burn surface area (P<.001), more comorbidities (P=.021), and were younger (P<.001). After adjusting for total burn surface area, number of comorbidities, and age, no differences existed between teaching and nonteaching hospitals for LOS (P=.481) or total charges (P=.758). Although pediatric burn patients may have increased LOS and total charges when seen at teaching hospitals, when taking an unadjusted perspective, this may be an artifact that teaching hospitals see pediatric burn patients who are younger, have more comorbidities, and have more total burn surface area. As such, after adjustment, type of hospital may have no influence on LOS and total charges.

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

PubMed

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

2017-06-01

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

Highlights of the COTH (Council of Teaching Hospitals) Survey of House Staff Policy, 1973

ERIC Educational Resources Information Center

Journal of Medical Education, 1973

1973-01-01

The Council of Teaching Hospitals (COTH) of the Association of American Medical Colleges has surveyed its member hospitals on the following subjects: trends in stipends, benefits, budget allocations, funding sources, extra-curricular employment, and night/weekend duty. (Author/PG)

Examining non-structural retrofitting status of teaching hospitals in Kerman against disasters.

PubMed

Moghadam, Mahmood Nekooi; Moradi, Seyed Mobin; Amiresmaili, Mohammadreza

2017-05-01

Continuous services provision of a hospital before and after a disaster is one of the most prominent issues that all people, especially the authorities must take into huge consideration. Concerning the experiences of previous earthquakes, the role and importance of nonstructural components becomes increasingly clear in the uninterrupted services of hospitals. In this study, non-structural retrofitting status of Kerman teaching hospitals was evaluated against natural disasters. This cross-sectional study was carried out in the second half of 2014 on the teaching hospitals in Kerman (Iran). The study population consisted of all Kerman teaching hospitals. The research instrument was World Health Organization/Pan American Health Organization (WHO/PAHO) standard checklist. Data analysis was carried out using descriptive statistics through SPSS 19. One hospital had a low retrofitting level, two hospitals had an average level and one had a high level. In the examined hospitals in this study, the medical gas section had the lowest preparedness against natural disasters, while the office, warehouse and furniture section had the highest resistance. Generally, the non-structural retrofitting status was 50% in one hospital and was between 65% and 85% in other hospitals. Generally, the retrofitting status of hospitals was not at the ideal condition, most hospitals were in average condition. Concerning the high risk of hospitals in disasters, it is necessary that senior executives and managers of Kerman Province and Kerman University of Medical Sciences take some measures to retrofit these buildings and to reduce the risk of vulnerability.

Some correlates of electronic health information management system success in nigerian teaching hospitals.

PubMed

Ojo, Adebowale I; Popoola, Sunday O

2015-01-01

Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS's success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals.

Implementing Medical Teaching Policy in University Hospitals

ERIC Educational Resources Information Center

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

2017-01-01

Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

The reported preparedness and disposition by students in a Nigerian university towards the use of information technology for medical education.

PubMed

Fadeyi, A; Desalu, O O; Ameen, A; Adeboye, A N Muhammed

2010-01-01

The computer and information technology (IT) revolution have transformed modern health care systems in the areas of communication, storage, retrieval of medical information and teaching, but little is known about IT skill and use in most developing nations. The aim of this study has been to evaluate the reported preparedness and disposition by medical students in a Nigerian university toward the use of IT for medical education. A self-administered structured questionnaire containing 24 items was used to obtain information from medical students in the University of Ilorin, Nigeria on their level of computer usage, knowledge of computer software and hardware, availability and access to computer, possession of personal computer and e-mail address, preferred method of medical education and the use of computer as a supplement to medical education. Out of 479 medical students, 179 (37.4%) had basic computer skills, 209 (43.6%) had intermediate skills and 58(12.1%) had advanced computer skills. Three hundred and thirty (68.9%) have access to computer and 451(94.2%) have e-mail addresses. For medical teaching, majority (83.09%), preferred live lecture, 56.78% lecture videos, 35.1% lecture handout on web site and 410 (85.6%) wants computer as a supplement to live lectures. Less than half (39.5%) wants laptop acquisition to be mandatory. Students with advanced computer skills were well prepared and disposed to IT than those with basic computer skill. The findings revealed that the medical students with advanced computer skills were well prepared and disposed to IT based medical education. Therefore, high level of computer skill is required for them to be prepared and favorably disposed to IT based medical education.

Ten thousand steps: a pedometer study of junior dentists in a major British teaching hospital and a district general hospital.

PubMed

Keat, R M; Thomas, M; McKechnie, A

2017-05-01

Sedentary behaviour is widely associated with deleterious health outcomes that in modern medicine have similar connotations to smoking tobacco and alcohol misuse. The integration of e-portfolio, e-logbook, British National Formulary (BNF) and encrypted emails has made smartphones a necessity for trainees. Smartphones also have the ability to record the amount of exercise taken, which allows activity at work to be monitored. The aim of this study to compare the activity of the same group of dental core trainees when they worked within a large multisite teaching hospital and a smaller district general hospital, to find out if supplementary activity was needed outside work. Data were collected from smartphones. To ensure continuity, data were collected only from those who had calibrated iPhones (n=10). At the teaching hospital six of the trainees walked over 10 000 steps a day while working (mean (SD) 10 004 (639)). At the district hospital none of the trainees walked 10 000 steps. The mean (SD) number of steps completed by all trainees was 6265 (119). Walking at work provides the full quota of recommended daily exercise most of the time for those working in the teaching hospital, but additional exercise is occasionally required. While working at the district hospital they walk less, meaning that they should try to increase their activity outside work. Trainees working in the teaching hospital walk significantly more steps than in the district hospital. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Experiences of clinical teaching for dental core trainees working in hospital.

PubMed

Mannion, C J; Brotherton, P

2014-07-11

There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching.

Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students

PubMed Central

Hill, Andrew G.; Srinivasa, Sanket; Hawken, Susan J.; Barrow, Mark; Farrell, Susan E.; Hattie, John; Yu, Tzu-Chieh

2012-01-01

Background Residents and interns are recognized as important clinical teachers and mentors. Resident-as-teacher training programs are known to improve resident attitudes and perceptions toward teaching, as well as their theoretical knowledge, skills, and teaching behavior. The effect of resident-as-teacher programs on learning outcomes of medical students, however, remains unknown. An intervention cohort study was conducted to prospectively investigate the effects of a teacher-training workshop on teaching behavior of participating interns and on the clerkship learning outcomes of instructed fourth-year medical students. Methods The House Officer-as-Teacher Training Workshop was implemented in November 2009 over 1.5 days and attended by all 34 interns from one teaching hospital. Subsequently, between February and August 2010, 124 fourth-year medical students rated the observable teaching behavior of interns during 6-week general surgery clerkships at this intervention hospital as well as at 2 comparable hospitals serving as control sites. Ratings were collected using an anonymous 15-item Intern Clinical Teaching Effectiveness Instrument. Student achievement of clerkship learning outcomes during this period was evaluated using a validated and centralized objective structured clinical examination. Results Medical students completed 101 intern clinical teaching effectiveness instruments. Intern teaching behavior at the intervention hospital was found to be significantly more positive, compared with observed behavior at the control hospitals. Objective structured clinical examination results, however, did not demonstrate any significant intersite differences in student achievement of general surgery clerkship learning outcomes. Conclusions The House Officer-as-Teacher Training Workshop noticeably improved teaching behavior of surgical interns during general surgery clerkships. This improvement did not, however, translate into improved achievement of clerkship learning outcomes by medical students during the study period. PMID:23451304

Early Impact of the 2011 ACGME Duty Hour Regulations on Surgical Outcomes

PubMed Central

Scally, Christopher P.; Ryan, Andrew M.; Thumma, Jyothi R.; Gauger, Paul G.; Dimick, Justin B.

2015-01-01

Background In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented additional restrictions on resident work hours. While the impact of these restrictions on the education of surgical trainees has been examined, the effect on patient safety remains poorly understood. Methods We used national Medicare Claims data for patients undergoing general (n = 1,223,815) and vascular (n = 475,262) surgery procedures in the 3 years preceding the duty hour changes (January, 2009 – June, 2011) and the 18 months following (July, 2011 - December, 2012). Hospitals were stratified into quintiles by teaching intensity using a resident to bed ratio. We utilized a difference-in-differences analytic technique, using non-teaching hospitals as a control group, to compare risk adjusted 30-day mortality, serious morbidity, readmission, and failure to rescue (FTR) rates before and after the duty hour changes. Results Following duty hour reform, no significant changes were seen in the measured outcomes when comparing teaching to non-teaching hospitals. Even when stratifying by teaching intensity there were no differences. For example, at the highest intensity teaching hospitals (resident/bed ratio ≥ .6), mortality rates before and after the duty hour changes were 4.2% and 4.0%, compared to 4.7% and 4.4% for non-teaching hospitals (RR .98, 95% CI .89-1.07). Similarly, serious complication (RR 1.02, 95% CI .98-1.06), FTR (RR .95, 95% CI .87-1.04), and readmission (OR 1.00, 95% CI .96-1.03) rates were unchanged. Conclusions In Medicare beneficiaries undergoing surgery at teaching hospitals, outcomes have not improved since the 2011 ACGME duty hour regulations. PMID:26054323

In-hospital mortality for children with hypoplastic left heart syndrome after stage I surgical palliation: teaching versus nonteaching hospitals.

PubMed

Berry, Jay G; Cowley, Collin G; Hoff, Charles J; Srivastava, Rajendu

2006-04-01

Teaching hospitals are perceived to provide a higher quality of care for the treatment of rare disease and complex patients. A substantial proportion of stage I palliation for hypoplastic left heart syndrome (HLHS) may be performed in nonteaching hospitals. This study compares the in-hospital mortality of stage I palliation between teaching and nonteaching hospitals. The authors conducted a retrospective cohort study using the Kids' Inpatient Database 1997 and 2000. Patients with HLHS undergoing stage I palliation were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. Seven hundred fifty-four and 880 discharges of children with HLHS undergoing stage I palliation in 1997 and 2000, respectively, were identified. The in-hospital mortality for the study population was 28% in 1997 and 24% in 2000. Twenty percent of stage I palliation operations were performed in nonteaching hospitals in 1997. Two percent of operations were performed in nonteaching hospitals in 2000. In 1997 only, in-hospital mortality remained higher in nonteaching hospitals after controlling for stage I palliation hospital volume and condition-severity diagnoses. Low-volume hospitals performing stage I palliation were associated with increased in-hospital mortality in 1997 and 2000. Patients with HLHS undergoing stage I palliation in nonteaching hospitals experienced increased in-hospital mortality in 1997. A significant reduction in the number of stage I palliation procedures performed in nonteaching hospitals occurred between 1997 and 2000. This centralization of stage I palliation into teaching hospitals, along with advances in postoperative medical and surgical care for these children, was associated with a decrease in mortality. Patients in low-volume hospitals performing stage I palliation continued to experience increased mortality in 2000.

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

PubMed

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

2014-01-01

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

Severity of Illness and the Teaching Hospital.

ERIC Educational Resources Information Center

Berman, Richard A.; And Others

1986-01-01

The Medicare prospective payment system does not adequately account for severity of illness. Whether teaching hospitals treat a case mix of patients with more severe illness than do nonteaching hospitals was tested in a study using two severity measures, Horn's severity of illness index and Gonnnella's "disease staging." (Author/MLW)

Hospitals Productivity Measurement Using Data Envelopment Analysis Technique.

PubMed

Torabipour, Amin; Najarzadeh, Maryam; Arab, Mohammad; Farzianpour, Freshteh; Ghasemzadeh, Roya

2014-11-01

This study aimed to measure the hospital productivity using data envelopment analysis (DEA) technique and Malmquist indices. This is a cross sectional study in which the panel data were used in a 4 year period from 2007 to 2010. The research was implemented in 12 teaching and non-teaching hospitals of Ahvaz County. Data envelopment analysis technique and the Malmquist indices with an input-orientation approach, was used to analyze the data and estimation of productivity. Data were analyzed using the SPSS.18 and DEAP.2 software. Six hospitals (50%) had a value lower than 1, which represents an increase in total productivity and other hospitals were non-productive. the average of total productivity factor (TPF) was 1.024 for all hospitals, which represents a decrease in efficiency by 2.4% from 2007 to 2010. The average technical, technologic, scale and managerial efficiency change was 0.989, 1.008, 1.028, and 0.996 respectively. There was not a significant difference in mean productivity changes among teaching and non-teaching hospitals (P>0.05) (except in 2009 years). Productivity rate of hospitals had an increasing trend generally. However, the total average of productivity was decreased in hospitals. Besides, between the several components of total productivity, variation of technological efficiency had the highest impact on reduce of total average of productivity.

What do students actually do on an internal medicine clerkship? A log diary study.

PubMed

Murray, E; Alderman, P; Coppola, W; Grol, R; Bouhuijs, P; van der Vleuten, C

2001-12-01

There are limited data on the amount of time students spend on teaching and learning while on internal medicine clerkships, and existing data suggest a wide international variation. Community-based teaching of internal medicine is now widespread; but its strengths and weaknesses compared to traditional hospital based teaching are still unclear. To determine the proportion of time students spend on different activities on an internal medicine clerkship, and to determine whether this differs in general practice and in hospital. In addition we aimed to determine students' views on the educational value and enjoyment of various activities. Prospective completion of log diaries recording student activities. Each student was asked to complete the diary for two separate weeks of their internal medicine clerkship: one week of general practice-based teaching and one week of hospital-based teaching. The response rate was 68% (88/130). Students spent approximately 5.5 h per day on teaching and learning activities in both environments, with more time (50 min vs. 30 min, P = 0.007) on unsupervised interaction with patients in hospital than in general practice, and more time (53 min vs. 21 min, P < 0.001) undergoingassessment in general practice than in hospital. Standard deviations were wide, demonstrating the heterogeneous nature of the data. Students perceived supervised interaction with patients and teaching by doctors as the most educational activities in both environments, but found it even more educationally valuable and enjoyable in general practice than in hospital (mean score for educational value: 4.27 in general practice, 3.88 in hospital, P = 0.048; mean score for enjoyment 4.13 in general practice, 3.66 in hospital, P = 0.03). Students greatly value interactions with patients, perceiving these as both educational and enjoyable. Curriculum planners must continue to place patient-based learning at the centre of undergraduate medical education. The heterogeneity of the data suggests that individual students have very different experiences, despite apparently similar timetables.

The medical education funding gap. One hospital's perspective.

PubMed

Ling, Louis J; Meier, Gerhardt

2003-02-01

Graduate medical education (GME) is a complex and expensive enterprise in which costs are borne by the teaching institution. With teaching hospitals under increasing financial stress due to an expansion of managed care and shrinking governmental support of medical education, there is a growing gap between GME costs and funding. This article describes GME costs and revenues at Hennepin County Medical Center, a teaching hospital in Minneapolis, where in the calendar year 2000, GME costs exceeded GME funds by $21 million.

Factors associated with Salmonella shedding among equine colic patients at a veterinary teaching hospital.

PubMed

Kim, L M; Morley, P S; Traub-Dargatz, J L; Salman, M D; Gentry-Weeks, C

2001-03-01

To evaluate factors potentially associated with fecal Salmonella shedding among equine patients hospitalized for colic at a veterinary teaching hospital and to determine the effects of probiotic treatment on fecal Salmonella shedding and clinical signs. Longitudinal study and controlled trial. 246 equine colic patients. History and medical information were obtained from patient records. Fecal and environmental samples were submitted for aerobic bacterial culture for Salmonella enterica. Fifty-one patients were treated with a commercially available probiotic; 46 were treated with a placebo. Logistic regression was used to evaluate data. Salmonella organisms were detected in feces from 23 (9%) patients at least once during hospitalization. Patients were more likely to shed Salmonella organisms if diarrhea was evident < or = 6 hours after hospitalization and duration of hospitalization exceeded 8 days (odds ratio [OR], 20.3), laminitis developed during hospitalization (OR, 12.0), results of nasogastric intubation were abnormal (OR, 4.9), leukopenia was evident < or =6 hours after hospitalization (OR, 4.6), or travel time to the teaching hospital exceeded 1 hour (OR, 3.5). Horses treated with the probiotic did not differ from control horses in regard to likelihood of fecal Salmonella shedding (OR, 1.5) or prevalence of clinical signs. Results suggest that certain risk factors are associated with fecal shedding of S enterica among equine patients hospitalized at a veterinary teaching hospital because of colic and that pathogen monitoring in patients and the hospital environment and use of barrier nursing precautions for equine colic patients are beneficial.

The Balanced Budget Act of 1997 and the financial health of teaching hospitals.

PubMed

Phillips, Robert L; Fryer, George E; Chen, Frederick M; Morgan, Sarah E; Green, Larry A; Valente, Ernest; Miyoshi, Thomas J

2004-01-01

We wanted to evaluate the most recent, complete data related to the specific effects of the Balanced Budget Act of 1997 relative to the overall financial health of teaching hospitals. We also define cost report variables and calculations necessary for continued impact monitoring. We undertook a descriptive analysis of hospital cost report variables for 1996, 1998, and 1999, using simple calculations of total, Medicare, prospective payment system, graduate medical education (GME), and bad debt margins, as well as the proportion with negative total operating margins. Nearly 35% of teaching hospitals had negative operating margins in 1999. Teaching hospital total margins fell by nearly 50% between 1996 and 1999, while Medicare margins remained relatively stable. GME margins have fallen by nearly 24%, however, even as reported education costs have risen by nearly 12%. Medicare + Choice GME payments were less than 10% of those projected. Teaching hospitals realized deep cuts in profitability between 1996 and 1999; however, these cuts were not entirely attributable to the Balanced Budget Act of 1997. Medicare payments remain an important financial cushion for teaching hospitals, more than one third of which operated in the red. The role of Medicare in supporting GME has been substantially reduced and needs special attention in the overall debate. Medicare + Choice support of the medical education enterprise is 90% less than baseline projections and should be thoroughly investigated. The Medicare Payment Advisory Commission, which has a critical role in evaluating the effects of Medicare policy changes, should be more transparent in its methods.

Large Variability in the Diversity of Physiologically Complex Surgical Procedures Exists Nationwide Among All Hospitals Including Among Large Teaching Hospitals.

PubMed

Dexter, Franklin; Epstein, Richard H; Thenuwara, Kokila; Lubarsky, David A

2017-11-22

Multiple previous studies have shown that having a large diversity of procedures has a substantial impact on quality management of hospital surgical suites. At hospitals with substantial diversity, unless sophisticated statistical methods suitable for rare events are used, anesthesiologists working in surgical suites will have inaccurate predictions of surgical blood usage, case durations, cost accounting and price transparency, times remaining in late running cases, and use of intraoperative equipment. What is unknown is whether large diversity is a feature of only a few very unique set of hospitals nationwide (eg, the largest hospitals in each state or province). The 2013 United States Nationwide Readmissions Database was used to study heterogeneity among 1981 hospitals in their diversities of physiologically complex surgical procedures (ie, the procedure codes). The diversity of surgical procedures performed at each hospital was quantified using a summary measure, the number of different physiologically complex surgical procedures commonly performed at the hospital (ie, 1/Herfindahl). A total of 53.9% of all hospitals commonly performed <10 physiologically complex procedures (lower 99% confidence limit [CL], 51.3%). A total of 14.2% (lower 99% CL, 12.4%) of hospitals had >3-fold larger diversity (ie, >30 commonly performed physiologically complex procedures). Larger hospitals had greater diversity than the small- and medium-sized hospitals (P < .0001). Teaching hospitals had greater diversity than did the rural and urban nonteaching hospitals (P < .0001). A total of 80.0% of the 170 large teaching hospitals commonly performed >30 procedures (lower 99% CL, 71.9% of hospitals). However, there was considerable variability among the large teaching hospitals in their diversity (interquartile range of the numbers of commonly performed physiologically complex procedures = 19.3; lower 99% CL, 12.8 procedures). The diversity of procedures represents a substantive differentiator among hospitals. Thus, the usefulness of statistical methods for operating room management should be expected to be heterogeneous among hospitals. Our results also show that "large teaching hospital" alone is an insufficient description for accurate prediction of the extent to which a hospital sustains the operational and financial consequences of performing a wide diversity of surgical procedures. Future research can evaluate the extent to which hospitals with very large diversity are indispensable in their catchment area.

Association of the 2011 ACGME resident duty hour reforms with mortality and readmissions among hospitalized Medicare patients.

PubMed

Patel, Mitesh S; Volpp, Kevin G; Small, Dylan S; Hill, Alexander S; Even-Shoshan, Orit; Rosenbaum, Lisa; Ross, Richard N; Bellini, Lisa; Zhu, Jingsan; Silber, Jeffrey H

2014-12-10

Patient outcomes associated with the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reforms have not been evaluated at a national level. To evaluate the association of the 2011 ACGME duty hour reforms with mortality and readmissions. Observational study of Medicare patient admissions (6,384,273 admissions from 2,790,356 patients) to short-term, acute care, nonfederal hospitals (n = 3104) with principal medical diagnoses of acute myocardial infarction, stroke, gastrointestinal bleeding, or congestive heart failure or a Diagnosis Related Group classification of general, orthopedic, or vascular surgery. Of the hospitals, 96 (3.1%) were very major teaching, 138 (4.4%) major teaching, 442 (14.2%) minor teaching, 443 (14.3%) very minor teaching, and 1985 (64.0%) nonteaching. Resident-to-bed ratio as a continuous measure of hospital teaching intensity. Change in 30-day all-location mortality and 30-day all-cause readmission, comparing patients in more intensive relative to less intensive teaching hospitals before (July 1, 2009-June 30, 2011) and after (July 1, 2011-June 30, 2012) duty hour reforms, adjusting for patient comorbidities, time trends, and hospital site. In the 2 years before duty hour reforms, there were 4,325,854 admissions with 288,422 deaths and 602,380 readmissions. In the first year after the reforms, accounting for teaching hospital intensity, there were 2,058,419 admissions with 133,547 deaths and 272,938 readmissions. There were no significant postreform differences in mortality accounting for teaching hospital intensity for combined medical conditions (odds ratio [OR], 1.00; 95% CI, 0.96-1.03), combined surgical categories (OR, 0.99; 95% CI, 0.94-1.04), or any of the individual medical conditions or surgical categories. There were no significant postreform differences in readmissions for combined medical conditions (OR, 1.00; 95% CI, 0.97-1.02) or combined surgical categories (OR, 1.00; 95% CI, 0.98-1.03). For the medical condition of stroke, there were higher odds of readmissions in the postreform period (OR, 1.06; 95% CI, 1.001-1.13). However, this finding was not supported by sensitivity analyses and there were no significant postreform differences for readmissions for any other individual medical condition or surgical category. Among Medicare beneficiaries, there were no significant differences in the change in 30-day mortality rates or 30-day all-cause readmission rates for those hospitalized in more intensive relative to less intensive teaching hospitals in the year after implementation of the 2011 ACGME duty hour reforms compared with those hospitalized in the 2 years before implementation.

Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients

PubMed Central

Patel, Mitesh S.; Volpp, Kevin G.; Small, Dylan S.; Hill, Alexander S.; Even-Shoshan, Orit; Rosenbaum, Lisa; Ross, Richard N.; Bellini, Lisa; Zhu, Jingsan; Silber, Jeffrey H.

2017-01-01

IMPORTANCE Patient outcomes associated with the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reforms have not been evaluated at a national level. OBJECTIVE To evaluate the association of the 2011 ACGME duty hour reforms with mortality and readmissions. DESIGN, SETTING, AND PARTICIPANTS Observational study of Medicare patient admissions (6 384 273 admissions from 2 790 356 patients) to short-term, acute care, nonfederal hospitals (n = 3104) with principal medical diagnoses of acute myocardial infarction, stroke, gastrointestinal bleeding, or congestive heart failure or a Diagnosis Related Group classification of general, orthopedic, or vascular surgery. Of the hospitals, 96 (3.1%) were very major teaching, 138 (4.4%) major teaching, 442 (14.2%) minor teaching, 443 (14.3%) very minor teaching, and 1985 (64.0%) nonteaching. EXPOSURE Resident-to-bed ratio as a continuous measure of hospital teaching intensity. MAIN OUTCOMES AND MEASURES Change in 30-day all-location mortality and 30-day all-cause readmission, comparing patients in more intensive relative to less intensive teaching hospitals before (July 1, 2009–June 30, 2011) and after (July 1, 2011–June 30, 2012) duty hour reforms, adjusting for patient comorbidities, time trends, and hospital site. RESULTS In the 2 years before duty hour reforms, there were 4 325 854 admissions with 288 422 deaths and 602 380 readmissions. In the first year after the reforms, accounting for teaching hospital intensity, there were 2 058 419 admissions with 133 547 deaths and 272 938 readmissions. There were no significant postreform differences in mortality accounting for teaching hospital intensity for combined medical conditions (odds ratio [OR], 1.00; 95% CI, 0.96–1.03), combined surgical categories (OR, 0.99; 95% CI, 0.94–1.04), or any of the individual medical conditions or surgical categories. There were no significant postreform differences in readmissions for combined medical conditions (OR, 1.00; 95% CI, 0.97–1.02) or combined surgical categories (OR, 1.00; 95% CI, 0.98–1.03). For the medical condition of stroke, there were higher odds of readmissions in the postreform period (OR, 1.06; 95% CI, 1.001–1.13). However, this finding was not supported by sensitivity analyses and there were no significant postreform differences for readmissions for any other individual medical condition or surgical category. CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries, there were no significant differences in the change in 30-day mortality rates or 30-day all-cause readmission rates for those hospitalized in more intensive relative to less intensive teaching hospitals in the year after implementation of the 2011 ACGME duty hour reforms compared with those hospitalized in the 2 years before implementation. PMID:25490327

Examining non-structural retrofitting status of teaching hospitals in Kerman against disasters

PubMed Central

Moghadam, Mahmood Nekooi; Moradi, Seyed Mobin; Amiresmaili, Mohammadreza

2017-01-01

Background and objective Continuous services provision of a hospital before and after a disaster is one of the most prominent issues that all people, especially the authorities must take into huge consideration. Concerning the experiences of previous earthquakes, the role and importance of nonstructural components becomes increasingly clear in the uninterrupted services of hospitals. In this study, non-structural retrofitting status of Kerman teaching hospitals was evaluated against natural disasters. Methods This cross-sectional study was carried out in the second half of 2014 on the teaching hospitals in Kerman (Iran). The study population consisted of all Kerman teaching hospitals. The research instrument was World Health Organization/Pan American Health Organization (WHO/PAHO) standard checklist. Data analysis was carried out using descriptive statistics through SPSS 19. Results One hospital had a low retrofitting level, two hospitals had an average level and one had a high level. In the examined hospitals in this study, the medical gas section had the lowest preparedness against natural disasters, while the office, warehouse and furniture section had the highest resistance. Generally, the non-structural retrofitting status was 50% in one hospital and was between 65% and 85% in other hospitals. Conclusions Generally, the retrofitting status of hospitals was not at the ideal condition, most hospitals were in average condition. Concerning the high risk of hospitals in disasters, it is necessary that senior executives and managers of Kerman Province and Kerman University of Medical Sciences take some measures to retrofit these buildings and to reduce the risk of vulnerability. PMID:28713518

Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses.

PubMed

Logsdon, M Cynthia; Foltz, Melissa Pinto; Scheetz, James; Myers, John A

2010-01-01

Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses.

Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience.

PubMed

Norsidah, A M; Yahya, N; Adeeb, N; Lim, A L

2001-03-01

Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.

Hospitable Kinship in Theological Education: Cross-Cultural Perspectives on Teaching and Learning as Gift Exchange

ERIC Educational Resources Information Center

Wimberly, Anne E. Streaty

2004-01-01

Using an autobiographical approach for pedagogical reflection, the author raises questions about how to include "hospitable kinship" and "gift exchange" in teaching and learning. Her experience with a Zimbabwean community circle of hospitable kinship has prompted her to consider how this method of community formation might be…

78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1459-N... Slots AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice announces the closure of two teaching hospitals and the initiation of an application process where hospitals...

Bridging the Gap: A Framework and Strategies for Integrating the Quality and Safety Mission of Teaching Hospitals and Graduate Medical Education.

PubMed

Tess, Anjala; Vidyarthi, Arpana; Yang, Julius; Myers, Jennifer S

2015-09-01

Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described.In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework-organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals.

Equatorial Scintillation Study at Ilorin and Nsukka, Nigeria during Year 2011-2012

NASA Astrophysics Data System (ADS)

Akala, A.

2017-12-01

This study presents GNSS scintillations over Ilorin (8.48 oN, 4.54 oE, and mag lat: 1.83oS) and Nsukka (6.84 oN, 7.37 oE, and mag lat: 2.94oS), Nigeria during year 2011-2012. The two stations are located within the inner flank of the equatorial ionization anomaly. Firstly, we investigated the climatology of equatorial scintillations at the two stations. We suppressed multipath effects on the data by imposing a 300 elevation masking on the data. In addition, we investigated scintillation occurrences at the two locations on a satellite-by-satellite basis at varying elevation angles. The source of scintillation records at low-elevation angle is attributed to multipath, while that at high-elevation angle is attributed to ionospheric irregularities. Seasonally, scintillations recorded highest occurrences during March equinox, and the least during June solstice. The trend of scintillations, at both low- and high-elevation angles at the two stations were almost the same. EGNOS satellites signals scintillated at the two locations during the time intervals when GPS satellites signals experienced scintillations. These results could support the development of scintillation models for equatorial Africa, and could also be of benefit to GPS and EGNOS service providers and designers, with a view to providing robust services for GNSS user community in Africa.

[Impact of the funding reform of teaching hospitals in Brazil].

PubMed

Lobo, M S C; Silva, A C M; Lins, M P E; Fiszman, R

2009-06-01

To assess the impact of funding reform on the productivity of teaching hospitals. Based on the Information System of Federal University Hospitals of Brazil, 2003 and 2006 efficiency and productivity were measured using frontier methods with a linear programming technique, data envelopment analysis, and input-oriented variable returns to scale model. The Malmquist index was calculated to detect changes during the study period: 'technical efficiency change,' or the relative variation of the efficiency of each unit; and 'technological change' after frontier shift. There was 51% mean budget increase and improvement of technical efficiency of teaching hospitals (previously 11, 17 hospitals reached the empirical efficiency frontier) but the same was not seen for the technology frontier. Data envelopment analysis set benchmark scores for each inefficient unit (before and after reform) and there was a positive correlation between technical efficiency and teaching intensity and dedication. The reform promoted management improvements but there is a need of further follow-up to assess the effectiveness of funding changes.

Some Correlates of Electronic Health Information Management System Success in Nigerian Teaching Hospitals

PubMed Central

Ojo, Adebowale I; Popoola, Sunday O

2015-01-01

Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS’s success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. PMID:25983557

National Incidence of Medication Error in Surgical Patients Before and After Accreditation Council for Graduate Medical Education Duty-Hour Reform.

PubMed

Vadera, Sumeet; Griffith, Sandra D; Rosenbaum, Benjamin P; Chan, Alvin Y; Thompson, Nicolas R; Kshettry, Varun R; Kelly, Michael L; Weil, Robert J; Bingaman, William; Jehi, Lara

2015-01-01

The Accreditation Council for Graduate Medical Education (ACGME) established duty-hour regulations for accredited residency programs on July 1, 2003. It is unclear what changes occurred in the national incidence of medication errors in surgical patients before and after ACGME regulations. Patient and hospital characteristics for pre- and post-duty-hour reform were evaluated, comparing teaching and nonteaching hospitals. A difference-in-differences study design was used to assess the association between duty-hour reform and medication errors in teaching hospitals. We used the Nationwide Inpatient Sample database, which consists of approximately annual 20% stratified sample of all the United States nonfederal hospital inpatient admissions. A query of the database, including 4 years before (2000-2003) and 8 years after (2003-2011) the ACGME duty-hour reform of July 2003, was performed to extract surgical inpatient hospitalizations (N = 13,933,326). The years 2003 and 2004 were discarded in the analysis to allow for a wash-out period during duty-hour reform (though we still provide medication error rates). The Nationwide Inpatient Sample estimated the total national surgical inpatients (N = 135,092,013) in nonfederal hospitals during these time periods with 68,736,863 patients in teaching hospitals and 66,355,150 in nonteaching hospitals. Shortly after duty-hour reform (2004 and 2006), teaching hospitals had a statistically significant increase in rate of medication error (p = 0.019 and 0.006, respectively) when compared with nonteaching hospitals even after accounting for trends across all hospitals during this period. After 2007, no further statistically significant difference was noted. After ACGME duty-hour reform, medication error rates increased in teaching hospitals, which diminished over time. This decrease in errors may be related to changes in training program structure to accommodate duty-hour reform. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Mortality and treatment patterns among patients hospitalized with acute cardiovascular conditions during dates of national cardiology meetings.

PubMed

Jena, Anupam B; Prasad, Vinay; Goldman, Dana P; Romley, John

2015-02-01

Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57,471 during 492 nonmeeting days; heart failure, 19,282 during meeting days and 11,4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low- and high-risk patients. Differences in treatment utilization were assessed. Hospitalization during cardiology meeting dates. Thirty-day mortality, procedure rates, charges, length of stay. Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P < .001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs 69.4% [95% CI, 66.2%-72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%-46.6%] vs 38.5% [95% CI, 35.0%-42.0%]; P = .86), although adjusted percutaneous coronary intervention (PCI) rates were lower during meetings (20.8% vs 28.2%; P = .02). No mortality or utilization differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals. In sensitivity analyses, cardiac mortality was not affected by hospitalization during oncology, gastroenterology, and orthopedics meetings, nor was gastrointestinal hemorrhage or hip fracture mortality affected by hospitalization during cardiology meetings. High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with AMI admitted to teaching hospitals during meetings were less likely to receive PCI, without any mortality effect.

Teaching Quality, Learning Satisfaction, and Academic Performance among Hospitality Students in Taiwan

ERIC Educational Resources Information Center

Ko, Wen-Hwa; Chung, Feng-Ming

2014-01-01

The purpose of this study is to examine the effect of the teaching quality of culinary arts teachers and student learning satisfaction on the academic performance of hospitality students. This study surveys the students in hospitality departments at universities in Taiwan. A total of 406 (81.2%) valid questionnaires were received. Research results…

The costs of acute readmissions to a different hospital - Does the effect vary across provider types?

PubMed

Møller Dahl, Christian; Planck Kongstad, Line

2017-06-01

Treatment costs are found to vary substantially and systematically within DRGs. Several factors have been shown to contribute to the variation in costs within DRGs. We argue that readmissions might also explain part of the observed variation in costs. A substantial number of all readmissions occur to a different hospital. The change in hospital indicates that a progression of the illness has occurred since the initial hospitalisation. As a result, different-hospital readmissions might be more costly compared to same-hospital admissions. The aim of this paper is twofold. Firstly, to analyse differences in costs between different-hospital readmissions and same-hospital readmissions within the same DRG. Secondly, to investigate whether the effect of different-hospital readmission on costs vary depending of provider type (general versus teaching hospital). We use a rich Danish patient-level administrative data set covering inpatient stays in the period 2008-2010. We exploit the fact that some patients are readmitted within the same DRG and that some of these readmissions occur at different hospitals in a propensity score difference-in-difference design. The estimates are based on a restricted sample of n = 328 patients. Our results show that the costs of different-hospital readmissions are significantly higher relative to the costs of same-hospital readmission (approx. €777). Furthermore, the cost difference is found to be almost twice the size for patients readmitted to a teaching hospital (approx. €1016) (P < 0.10) compared to patients readmitted to a different general hospital (approx. €511) (P < 0.10). The results suggest that hospitals in general face a potential risk by treating different-hospital readmissions, and that the financial consequences are highest among teaching hospitals. If teaching hospitals are not compensated for the additional costs of treating different-hospital readmission patients, they might be unfairly funded under a DRG-based payment scheme. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hospital diversification strategy.

PubMed

Eastaugh, Steven R

2014-01-01

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

How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?

PubMed

Jilg, Stefanie; Möltner, Andreas; Berberat, Pascal; Fischer, Martin R; Breckwoldt, Jan

2015-01-01

In German-speaking countries, the physicians' roles framework of the "Canadian Medical Education Directives for Specialists" (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called "Practical Year" (PY). Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training. 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: "relevance for your personal daily work", "importance for teaching during PY", and "implementation into actual PY teaching". In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training. The roles "Communicator", "Medical Expert", and "Collaborator" were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals. Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the CanMEDS framework as a conceptual element of PY training.

Teaching efficacy of nurses in clinical practice education: A cross-sectional study.

PubMed

Kim, Eun-Kyeung; Shin, Sujin

2017-07-01

Clinical nurses play a vital role in clinical practice education; thus, it is necessary to help clinical nurses have teaching efficacy through the development and application of systematic education programs. To identify nurses' teaching efficacy for clinical education and analyze the influencing factors of teaching efficacy. The study used a cross-sectional design. We used a convenience sample of 263 nurses from two hospitals. Teaching efficacy, general characteristics, and perception of clinical practice education were collected via self-reported questionnaires. Teaching efficacy was measured using Hwang's (2006) questionnaire, while perception of clinical practice education was measured using the Clinical Nurse Teacher Survey developed by Nishioka et al. (2014). Participants completed the questionnaire directly. The collected data were then analyzed using descriptive statistics, t-tests, ANOVAs, and multiple regression analysis with PASW Statistics 18.0. The mean total score of teaching efficacy was 72.5 (range 21-105). The leadership for students subscale had the highest score (3.56±0.59). The factors influencing teaching efficacy were length of clinical career (β=0.26, p<0.001) and perceptions of work satisfaction (β=0.20, p=.005), clinical supervisory relationship (β=0.18, p=.010), and nursing at the hospital ward (β=0.13, p=.029). Altogether, these variables explained 28% of the variance in teaching efficacy in nurses. Based on these results, nursing educators might need to develop greater confidence in their knowledge and enhance control of their teaching strategies. Nursing schools and hospitals might need to provide greater support and educational opportunities to nurse clinical practice instructors. Furthermore, constructing a system of cooperation between these colleges and educational hospitals, developing programs to enhance teaching efficacy, and identifying the clinical instructor's role are all necessary to promote clinical practice education. Copyright © 2017. Published by Elsevier Ltd.

A comparison of congestive heart failure readmissions among teaching and nonteaching hospital services.

PubMed

Palacio, Carlos; House, Jeffrey; Ibrahim, Saif; Touchan, Jean N; Mooradian, Ariana

2014-08-01

Heart failure (HF) is a leading cause of hospitalization in the United States. With the population trend shifting to a higher volume of elderly adults, the efficient management of HF will become increasingly essential. The development and implementation of The Patient Protection and Affordable Care Act and subsequent changes in reimbursement practices have made 30-day readmission rates a topic of much interest and relevance. The aim of the study was to compare rates of readmission among teaching and nonteaching hospitals. The authors gathered retrospective data on HF quality measures and readmission rates between August 2011 and July 2012, extracted from the institution's managerial accounting database. These data were compared among teaching and nonteaching hospitals. Patient demographics, readmission rates, readmission diagnoses, severity of illness, patient disposition, medications prescribed, cost of services, and mortality were reviewed. Analysis of variance was used for continuous variables; χ(2) analysis was used for evaluating categorical variables. A higher proportion of patients on the cardiology teaching service were men than on either the medicine teaching service or the medicine nonteaching service. Length of stay, case costs, and care costs were lowest for the cardiology teaching service; however, patient illness severity was lower on this service than on the other two services. Overall, readmissions and mortality were similar among all groups, but readmission for the same diagnosis was more likely on the cardiology service than on the medicine teaching and nonteaching services. Studies comparing teaching and nonteaching providers for an HF diagnosis are needed. Hospital readmission and mortality rates were similar across services and compared favorably with national data. Opportunities that target cost reduction and length of stay may be leveraged.

Income Analysis of University-Owned Teaching Hospitals.

ERIC Educational Resources Information Center

Isaacs, Joseph C.

1979-01-01

The annual survey, undertaken by the Association of American Medical Colleges, of income, expense and general operating information for university-owned teaching hospitals is discussed. Focus is on sources of income, including state funds, Medicare, and insurance companies. (JMD)

[Costs of serious adverse events in a community teaching hospital, in Mexico].

PubMed

Gutiérrez-Mendoza, Luis Meave; Torres-Montes, Abraham; Soria-Orozco, Manuel; Padrón-Salas, Aldanely; Ramírez-Hernández, María Elizabeth

2015-01-01

Serious adverse events during hospital care are a worldwide reality and threaten the safety of the hospitalised patient. To identify serious adverse events related to healthcare and direct hospital costs in a Teaching Hospital in México. A study was conducted in a 250-bed Teaching Hospital in San Luis Potosi, Mexico. Data were obtained from the Quality and Patient Safety Department based on 2012 incidents report. Every event was reviewed and analysed by an expert team using the "fish bone" tool. The costs were calculated since the event took place until discharge or death of the patient. A total of 34 serious adverse events were identified. The average cost was $117,440.89 Mexican pesos (approx. €7,000). The great majority (82.35%) were largely preventable and related to the process of care. Undergraduate medical staff were involved in 58.82%, and 14.7% of patients had suffered adverse events in other hospitals. Serious adverse events in a Teaching Hospital setting need to be analysed to learn and deploy interventions to prevent and improve patient safety. The direct costs of these events are similar to those reported in developed countries. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Educating Children in the Midst of Health Crises: A Phenomenological Study of Teachers in Children's Hospital Schools

ERIC Educational Resources Information Center

Burns, Johnna N.

2013-01-01

Purpose, Scope, and Method of Study: Hospital school teachers are a unique population of educators highly qualified and experienced in teaching students who are facing health crises. The purpose of this phenomenological study was to describe the lived experience of teaching seriously ill students in the hospital school setting. The study was…

Maternity and parental leave policies at COTH hospitals: an update. Council of Teaching Hospitals.

PubMed

Philibert, I; Bickel, J

1995-11-01

Because residents' demands for parental leave are increasing, updated information about maternity and paternity leave policies was solicited from hospitals that are members of the Council of Teaching Hospitals (COTH) of the AAMC. A 20-item questionnaire, combining forced-choice categories and open-ended questions, was faxed to 405 COTH hospitals in October 1994; 45% responded. A total of 77% of the respondents reported having written policies for maternity and/or parental leave; in 1989, only 52% of COTH hospitals had reported having such policies. Forty-one percent of the 1994 responding hospitals offered dedicated paid maternity leave, with a mean of 42 days allowed. Twenty-five percent of the respondents offered paternity leave, and 15% offered adoption leave. It is encouraging that the majority of the teaching hospitals that responded to the survey had adopted written policies, but the 23% without written policies remain a source of concern. Well-defined policies for maternity, paternity, and adoption leave can reduce stress and foster equity both for trainees requiring leave and for their colleagues.

Current national incidence, trends, and health care resource utilization of cleft lip-cleft palate.

PubMed

Basseri, Benjamin; Kianmahd, Benjamin D; Roostaeian, Jason; Kohan, Emil; Wasson, Kristy L; Basseri, Robert J; Bradley, James P

2011-03-01

Available reports on the epidemiology of cleft lip, cleft palate, and cleft lip-cleft palate have been numerous yet inconsistent, and have originated only from institutional or regional studies. The need for current national data and the recognition of recent trends exists. The authors examined the Kids' Inpatient Database to obtain national information on pediatric orofacial cleft discharges from 1997 to 2007. The authors examined patient and hospital characteristics to discern differences in use of care, hospital charges, type of hospital, untoward events, and other variables among various groups. A detailed investigation searching for significant trends during the 6-year study period was also conducted. Trends appreciated from 1997 to 2007 included (1) an increase in cleft operations performed at teaching hospitals compared with nonteaching hospitals (teaching increased 13.4 percent and nonteaching decreased 15.8 percent); (2) an increase in the mean overall charges (74.5 percent increase; p < 0.001) and a rate of rise higher than that of aggregate charges (60 percent; p < 0.001); and (3) a lower rate of perioperative complications in teaching hospitals from 2000 to 2007, ranging from 14 to 27 percent less than in nonteaching hospitals. The authors' data show that there is a current trend of cleft patients receiving treatment at teaching hospitals, with higher costs and decreasing complications. An understanding of such trends and disparities in resource use among various patient, hospital, and geographic settings is important for physicians and policy makers.

Presentation of Preauricular Sinus and Preauricular Sinus Abscess in Southwest Nigeria

PubMed Central

Adegbiji, W. A.; Alabi, B. S.; Olajuyin, O. A.; Nwawolo, C. C.

2013-01-01

BACKGROUND AND AIM: Preauricular sinus abscess is a common congenital external ear disease. This abscess is usually misdiagnosed because it is commonly overlooked during physical examination. In Nigeria, the prevalence was 9.3% in Ilorin, north central Nigeria This study is to determine the distribution and clinical presentation of the preauricular sinus abscess in Ekiti, south west Nigeria. MATERIALS AND METHODS: This is a prospective hospital based study of all patients with diagnosis of preauricular sinus abscess seen in our clinic carried out between April 2008 to March 2010. Detailed clinical history, administered interviewer’s assisted questionnaires full examination and. Data obtained were collated and analysed. RESULTS: Preauricular sinus were noticed in 184 (4.4%) out of 4170 patients seen during the study period. Preauricular sinus abscess were noticed in 21 (11.4%) of the preauricular sinuses especially in children. Unilateral preauricular sinus abscess accounted for 90.5%. Common presenting complaints were preauricular swelling (81.0%), 90.5% with recurrent earaches, 76.2% with ear discharges. All patients had antibiotic / analgesic while 17 out of 21 (81.0%) had surgical excisions. CONCLUSION: Preauricular sinus abscess were noticed among 11.4% of the preauricular sinuses especially in children, unilateral preauricular sinus abscess accounted for 90.5%. Common complaints were otorrhoea, earaches, and swelling and they were mostly managed surgically. PMID:24711764

THE EFFECT OF OUTPATIENT SERVICE QUALITY ON PATIENT SATISFACTION IN TEACHING HOSPITALS IN IRAN

PubMed Central

Pouragha, Behrouz; Zarei, Ehsan

2016-01-01

Aim: The quality of services plays a primary role in achieving patient satisfaction. The main purpose of this study was to explore the effect of outpatient service quality on patient satisfaction in teaching hospitals in Iran. Methods: this cross-sectional study was conducted in 2014. The study sample included 500 patients were selected with systematic random method from the outpatient departments (clinics) of four teaching hospitals in Tehran. The survey instrument was a questionnaire consisted of 44 items, which were confirmed its reliability and validity. The data were analyzed by using descriptive statistics, Pearson’s correlation, and multivariate regression methods with the SPSS.18 software. Results: According to the findings of this study, the majority of patients had a positive experience in the outpatient departments of the teaching hospitals and thus evaluated the services as good. Perceived service costs, physician consultation, physical environment, and information to patient were found to be the most important determinants of outpatient satisfaction. Conclusion: The results suggest that improving the quality of consultation, providing information to the patients during examination and consultation, creating value for patients by reducing costs or improving service quality, and enhancing the physical environment quality of the clinic can be regarded as effective strategies for the management of teaching hospitals toward increasing outpatient satisfaction. PMID:27047262

Resident versus no resident: a single institutional study on operative complications, mortality, and cost.

PubMed

Hwang, Christine S; Pagano, Christina R; Wichterman, Keith A; Dunnington, Gary L; Alfrey, Edward J

2008-08-01

Previous studies have demonstrated an increase in surgical morbidity, mortality, duration of stay, and costs in teaching hospitals. These studies are confounded by many variables. Controlling for these variables, we studied the effect of surgical residents on these outcomes during rotations with non-academic-based teaching faculty at a teaching hospital. Patients received care at a single teaching hospital from a group of 8 surgeons. Four surgeons did not have resident coverage (group 1) and the other 4 had coverage (group 2). Continuous severity adjusted complications, mortality, length of stay, cost, and hospital margin data were collected and compared. Five common procedures were examined: bowel resection, laparoscopic cholecystectomy, hernia, mastectomy, and appendectomy. Comparing all procedures together, there were no differences in complications between the groups, although there was greater mortality, a greater duration of stay, and higher costs in group 2. When comparing the 5 most common procedures individually, there was no difference in complications or mortality, although a greater length of stay and higher costs in group 2. Comparing the most common procedures performed individually, patients cared for by surgeons with surgical residents at a teaching hospital have an increase in duration of stay and cost, although no difference in complications or mortality compared to surgeons without residents.

THE EFFECT OF OUTPATIENT SERVICE QUALITY ON PATIENT SATISFACTION IN TEACHING HOSPITALS IN IRAN.

PubMed

Pouragha, Behrouz; Zarei, Ehsan

2016-02-01

The quality of services plays a primary role in achieving patient satisfaction. The main purpose of this study was to explore the effect of outpatient service quality on patient satisfaction in teaching hospitals in Iran. this cross-sectional study was conducted in 2014. The study sample included 500 patients were selected with systematic random method from the outpatient departments (clinics) of four teaching hospitals in Tehran. The survey instrument was a questionnaire consisted of 44 items, which were confirmed its reliability and validity. The data were analyzed by using descriptive statistics, Pearson's correlation, and multivariate regression methods with the SPSS.18 software. According to the findings of this study, the majority of patients had a positive experience in the outpatient departments of the teaching hospitals and thus evaluated the services as good. Perceived service costs, physician consultation, physical environment, and information to patient were found to be the most important determinants of outpatient satisfaction. The results suggest that improving the quality of consultation, providing information to the patients during examination and consultation, creating value for patients by reducing costs or improving service quality, and enhancing the physical environment quality of the clinic can be regarded as effective strategies for the management of teaching hospitals toward increasing outpatient satisfaction.

Incidence and risk factors of workplace violence against nurses in a Chinese top-level teaching hospital: A cross-sectional study.

PubMed

Chen, Xiaoming; Lv, Ming; Wang, Min; Wang, Xiufeng; Liu, Junyan; Zheng, Nan; Liu, Chunlan

2018-04-01

To investigate the incidence of workplace violence involving nurses and to identify related risk factors in a high-quality Chinese teaching hospital. A cross-sectional study design was used. The final sample comprised responses from 1831 registered nurses collected with a whole-hospital survey from June 1 to June 15, 2016. The demographic characteristics of the nurses who had experienced any form of violence were collected, and logistic regression analysis was applied to evaluate the risk factors for nurses related to workplace violence. Out of the total number of nurses surveyed, 904 (49.4%) nurses reported having experienced any type of violence in the past year. The frequencies of exposure to physical and non-physical violence were 6.3% (116) and 49.0% (897), respectively. All the incidence rates of violence were lower than those of other studies based on regional hospitals in China and were at the same level found in developed countries and districts. Binary logistic regression analysis revealed that nurses at levels 2 to 4 and female nurses in clinical departments were the most vulnerable to non-physical violence. For physical violence, the two independent risk factors were working in an emergency department and having 6-10 years of work experience. Workplace violence directly threatens nurses from high-quality Chinese teaching hospitals. However, the incidence of WPV against nurses in this teaching hospital was better than that in regional hospitals. This study also provides reference material to identify areas where nurses encounter relatively high levels of workplace violence in high-quality Chinese teaching hospitals. Copyright © 2018 Elsevier Inc. All rights reserved.

The real world of blood glucose point-of-care testing (POCT) system running in China teaching hospital.

PubMed

Li, Feng-Fei; Xie, Yun; Shi, Bing-Yin; Niu, Min; Guo, Hui; Cao, Yan; Liu, Bing-Li; Yan, Reng-Na; Su, Xiao-Fei; Wu, Jin-Dan; Zhang, Dan-Feng; Chen, Li-Ming; Ma, Jian-Hua

2018-06-01

 The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China. The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting. A total of 170 subjects were included from 4 hospitals, which included nursing staff, nurse unit managers, employees from the department of medical instruments, and staff members employed by the clinical laboratories in the Tianjin Metabolism Hospital, Nanjing First Hospital, First Affiliated Hospital of Dalian Medical University, and the First hospital affiliated with the Xi'an Transportation University. The average score for the four hospitals surveyed in this study was 66.6, which varied from 46.1 to 79.7. The main factors influencing the scores were the multiple choices of blood-glucose meters, and the quality control assessment. Our data indicates that the real world use of the POCT system in hospital settings in China needs more closer adherence to a quality management framework.

The internal organization of hospitals: a descriptive study.

PubMed Central

Sloan, F A

1980-01-01

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

High rate of burnout among anaesthesiologists in Belgrade teaching hospitals: Results of a cross-sectional survey.

PubMed

Milenović, Miodrag; Matejić, Bojana; Vasić, Vladimir; Frost, Elizabeth; Petrović, Nataša; Simić, Dušica

2016-03-01

Decisions by anaesthesiologists directly impact the treatment, safety, recovery and quality of life of patients. Physical or mental collapse due to overwork or stress (burnout) in anaesthesiologists may, therefore, be expected to negatively affect patients, departments, healthcare facilities and families. To evaluate the prevalence of burnout among anaesthesiologists in Belgrade public teaching hospitals. A cross-sectional survey. Anaesthesiologists in 10 Belgrade teaching hospitals. Burnout was assessed using Maslach Burnout Inventory-Human Services Survey. The response rate was 76.2% (205/272) with the majority of respondents women (70.7%). The prevalence of total burnout among anaesthesiologists in Belgrade teaching hospitals was 6.34%. Measured level of burnout as assessed by high emotional exhaustion, high depersonalisation and low personal accomplishment was 52.7, 12.2 and 28.8%, respectively. More than a quarter of the studied population responded in each category with symptoms of moderate burnout. We detected that sex, additional academic education, marital status and working conditions were risk factors for emotional exhaustion and depersonalisation. Ageing increased the likelihood of burnout by 21.3% with each additional year. Shorter professional experience and increased educational accomplishment increased the risk of total burnout by 272%. Burnout rates in Belgrade teaching hospitals among anaesthesiologists are higher than in foreign hospitals. Emotional and/or physical breakdowns can have serious effects when these individuals care for patients in extremely stressed situations that may occur perioperatively. Causes for burnout should be examined more closely and means implemented to reverse this process.

Evaluation of the medical records system in an upcoming teaching hospital-a project for improvisation.

PubMed

Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S

2012-08-01

The medical records system of an upcoming teaching hospital in a developing nation was evaluated for its accessibility, completeness, physician satisfaction, presence of any lacunae, suggestion of necessary steps for improvisation and to emphasize the importance of Medical records system in education and research work. The salient aspects of the medical records department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from Medical Records Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medical record system. 92.5% were of the opinion that upgradation of the present system is necessary. The need of the hour in the present teaching hospital is the implementation of a hospital-wide patient registration and medical records re-engineering process in the form of electronic medical records system and regular review by the audit commission.

Risk adjustment policy options for casemix funding: international lessons in financing reform.

PubMed

Antioch, Kathryn M; Ellis, Randall P; Gillett, Steve; Borovnicar, Daniel; Marshall, Ric P

2007-09-01

This paper explores modified hospital casemix payment formulae that would refine the diagnosis-related group (DRG) system in Victoria, Australia, which already makes adjustments for teaching, severity and demographics. We estimate alternative casemix funding methods using multiple regressions for individual hospital episodes from 2001 to 2003 on 70 high-deficit DRGs, focussing on teaching hospitals where the largest deficits have occurred. Our casemix variables are diagnosis- and procedure-based severity markers, counts of diagnoses and procedures, disease types, complexity, day outliers, emergency admission and "transfers in." The results are presented for four policy options that vary according to whether all of the dollars or only some are reallocated, whether all or some hospitals are used and whether the alternatives augment or replace existing payments. While our approach identifies variables that help explain patient cost variations, hospital-level simulations suggest that the approaches explored would only reduce teaching hospital underpayment by about 10%. The implications of various policy options are discussed.

Pharmaceuticals in Australia: priorities in a teaching hospital.

PubMed

Kearney, B J

1993-01-01

In spite of rigorous government programs for control of the pricing and dissemination of pharmaceutical products in Australia, the list of new drugs continues to grow and prices to increase. To regain control over drug usage at Royal Adelaide Hospital, the Hospital Drug Committee developed a rating method that judged drugs on the basis of their cost-benefit to patients. The ratio of a total quality score to a total cost score becomes the determinant of additions to the hospital formulary. The background for the Australian approach to pharmaceuticals and the new evaluation technique at the teaching hospital are described in this report.

How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?

PubMed Central

Jilg, Stefanie; Möltner, Andreas; Berberat, Pascal; Fischer, Martin R.; Breckwoldt, Jan

2015-01-01

Background and aim: In German-speaking countries, the physicians’ roles framework of the “Canadian Medical Education Directives for Specialists” (CanMEDS) is increasingly used to conceptualize postgraduate medical education. It is however unclear, whether it may also be applied to the final year of undergraduate education within clinical clerkships, called “Practical Year” (PY). Therefore, the aim of this study was to explore how clinically active physicians at a university hospital and at associated teaching hospitals judge the relevance of the seven CanMEDS roles (and their (role-defining) key competencies) in respect to their clinical work and as learning content for PY training. Furthermore, these physicians were asked whether the key competencies were actually taught during PY training. Methods: 124 physicians from internal medicine and surgery rated the relevance of the 28 key competencies of the CanMEDS framework using a questionnaire. For each competency, following three aspects were rated: “relevance for your personal daily work”, “importance for teaching during PY”, and “implementation into actual PY teaching”. Results: In respect to the main study objective, all questionnaires could be included into analysis. All seven CanMEDS roles were rated as relevant for personal daily work, and also as important for teaching during PY. Furthermore, all roles were stated to be taught during actual PY training. The roles “Communicator”, “Medical Expert”, and “Collaborator” were rated as significantly more important than the other roles, for all three sub-questions. No differences were found between the two disciplines internal medicine and surgery, nor between the university hospital and associated teaching hospitals. Conclusion: Participating physicians rated all key competencies of the CanMEDS model to be relevant for their personal daily work, and for teaching during PY. These findings support the suitability of the CanMEDS framework as a conceptual element of PY training. PMID:26413171

Climatological Aspects of the Optical Properties of Fine/Coarse Mode Aerosol Mixtures

NASA Technical Reports Server (NTRS)

Eck, T. F.; Holben, B. N.; Sinyuk, A.; Pinker, R. T.; Goloub, P.; Chen, H.; Chatenet, B.; Li, Z.; Singh, R. P.; Tripathi, S.N.;

Utilization of alternative medical services by people of a north central city of Nigeria.

PubMed

Abodunrin, O L; Omojasola, T; Rojugbokan, O O

2011-06-01

The use of alternative therapies is becoming more popular in the recent times especially due to the increasing cost, distrust and limitations of modern western medical care. There is a universal trend toward naturalness and herbal medicine is now being modernized and being accepted by people who would not have used them. This community based study seeks to assess the prevalence, pattern, behaviour and determinants of AT use. It was a cross-sectional descriptive survey among adults in the Ilorin city of Nigeria. Participants were selected by multistage sampling and information obtained by the use of semi-structured questionnaire. Total prevalence AT use was 67.7% while total prevalence of indigenous and foreign AT use was 44.8 and 30.4% respectively. Among indigenous AT users, 87.5% will use both conventional and modernized type while 12.5% will use only the modernized type. More than 10% were new users of AT. Respondents use AT for promotive, preventive and curative purposes. Only 3.5% were considered as safe users according to 9-point items. The male respondents and the never married ones practice a safer use of alternative therapy (p<0.05). Similarly, the respondents with higher educational status also have a safer practice of AT use (p<0.05). There is high prevalence but unsafe AT use in Ilorin. There should be intensification of regulation of advertisement and sales of unwholesome herbal medicines. Further research to integrate the practice into modern healthcare is recommended.

Knowledge and prevalence of risk factors for arterial hypertension and blood pressure pattern among bankers and traffic wardens in Ilorin, Nigeria.

PubMed

Salaudeen, A G; Musa, O I; Babatunde, O A; Atoyebi, O A; Durowade, K A; Omokanye, L O

2014-09-01

High job strain, mental stress, sedentary lifestyle, increase in BMI are among the factors associated with significantly higher incidence of hypertension. The job of bank employees is both sedentary in nature and accompanies high mental stress. The aim of this study is to assess the level of knowledge of risk factors among respondents and to compare the blood pressure pattern of bankers and traffic wardens. The study design is a descriptive cross-sectional conducted among bankers and traffic wardens in Ilorin to determine the pattern and knowledge of blood pressure. Self-administered questionnaires, weighing scale (Omron Digital scale), stadiometer and sphygmomanometer were used as the research instruments. Simple random sampling was used to select respondents involved in the study. The prevalence of hypertension in this study was 34.4% in bankers and 22.2% in traffic wardens. The risk factors the bankers commonly had knowledge of are alcohol, obesity, high salt intake, certain drugs, stress, emotional problems and family history while the traffic wardens commonly had knowledge of all these in addition to cigarette smoking. Also, more bankers (32.2%) than traffic wardens (13.3%) were smoking cigarette and more of these cigarette smokers that are bankers (17.8%) had elevated blood pressure compared to the traffic wardens (3.3%). Workers in the banking industry as well as traffic wardens should be better educated about the risk factors of hypertension and bankers should be encouraged to create time for exercise.

Simultaneous response of NmF2 and GPS-TEC to storm events at Ilorin

NASA Astrophysics Data System (ADS)

Joshua, B. W.; Adeniyi, J. O.; Oladipo, O. A.; Doherty, P. H.; Adimula, I. A.; Olawepo, A. O.; Adebiyi, S. J.

2018-06-01

A comparative study of both TEC and NmF2 variations during quiet and disturbed conditions has been investigated using simultaneous measurements from dual frequency Global Positioning System (GPS) receiver and a DPS-4 Digisonde co-located at Ilorin (Geog. Lat. 8.50°N, Long. 4.50°E, dip. - 7.9°). The results of the quiet time variations of the two parameters show some similarities as well as differences in their structures. The values of both parameters generally increase during the sunrise period attaining a peak around the noon and then decaying towards the night time. The onset time of the sunrise growth is observed to be earlier in TEC than in NmF2. The rate of decay of TEC was observed to be faster than that of the NmF2 in most cases. Also, the noon 'bite-outs', leading to the formation of pre-noon and post-noon peaks, are prominent in the NmF2 structure and was hardly noticed in TEC. Results of the variations of both TEC and NmF2 during the 5 April, 10 May and 3 August 2010 geomagnetic storm events showed a simultaneous deviations of both parameters from the quiet time behavior. The magnitude of the deviations is however most pronounced in NmF2 structure than in TEC. We also found that the enhancement observed in the two parameters during the storm events generally corresponds to decrease in hmF2.

Ionospheric Scintillation Activity Over Ilorin, Nigeria

NASA Astrophysics Data System (ADS)

Oladipo, O. A.; Adeniyi, J. O.; Doherty, P. H.; Radicella, S. M.; Adimula, I. A.; Olawepo, A. O.

2018-02-01

Scintillation of radio waves in the L-band frequency is a regular occurrence at the equatorial and auroral regions at night most especially during high solar activity periods. Scintillation is caused by plasma density irregularities, and this could cause loss of lock of Global Navigation Satellite System (GNSS) signals leading to impairment of the applications that rely on this system. A study on the occurrence of scintillation activity over Ilorin (latitude = 8.48°N, longitude = 4.67°W, and geomagnetic latitude = 1.89°S), Nigeria was done using S4 index data from NovAtel GPStation-2 receiver (2009-2012) and NovAtel GPStation-6 receiver (August 2013 to December 2016) which are both located at this station. The solar maximum period of the solar cycle 24 is located well within the period of this investigation; hence, this study provides opportunity to see the occurrence pattern of scintillation during different seasons as well as the pattern from low solar activity to solar maximum. The results obtained showed that scintillation occurs between 21:00 LT and 04:00 LT at the peak of the occurrence in 2014. The time window of occurrence decreases with decrease in solar activity. Similarly, scintillation activity was observed to be more regular during high solar activity and it has two peaks of occurrence in March and October. A solar activity trend was observed in scintillation occurrence; scintillation activity increases with increase in the level of solar activity.

Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study.

PubMed

Lee, Kun Yun; Wan Ahmad, Wan Azman; Low, Ee Vien; Liau, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng-Bang; Mohd Ali, Rosli B; Ismail, Omar; Ong, Tiong Kiam; Said, Mas Ayu; Dahlui, Maznah

2017-01-01

The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). This cross-sectional study was conducted from the healthcare providers' perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients' comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.

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

PubMed

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

2006-05-24

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

Integrating the hospital library with patient care, teaching and research: model and Web 2.0 tools to create a social and collaborative community of clinical research in a hospital setting.

PubMed

Montano, Blanca San José; Garcia Carretero, Rafael; Varela Entrecanales, Manuel; Pozuelo, Paz Martin

2010-09-01

Research in hospital settings faces several difficulties. Information technologies and certain Web 2.0 tools may provide new models to tackle these problems, allowing for a collaborative approach and bridging the gap between clinical practice, teaching and research. We aim to gather a community of researchers involved in the development of a network of learning and investigation resources in a hospital setting. A multi-disciplinary work group analysed the needs of the research community. We studied the opportunities provided by Web 2.0 tools and finally we defined the spaces that would be developed, describing their elements, members and different access levels. WIKINVESTIGACION is a collaborative web space with the aim of integrating the management of all the hospital's teaching and research resources. It is composed of five spaces, with different access privileges. The spaces are: Research Group Space 'wiki for each individual research group', Learning Resources Centre devoted to the Library, News Space, Forum and Repositories. The Internet, and most notably the Web 2.0 movement, is introducing some overwhelming changes in our society. Research and teaching in the hospital setting will join this current and take advantage of these tools to socialise and improve knowledge management.

Applying the Balanced Scorecard approach in teaching hospitals: a literature review and conceptual framework.

PubMed

Trotta, Annarita; Cardamone, Emma; Cavallaro, Giusy; Mauro, Marianna

2013-01-01

Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs. Copyright © 2012 John Wiley & Sons, Ltd.

Evidence for a link between mortality in acute COPD and hospital type and resources.

PubMed

Roberts, C M; Barnes, S; Lowe, D; Pearson, M G

2003-11-01

The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme. Thirty hospitals in England and Wales were randomly selected by geographical region and hospital type (teaching, large district general hospital (DGH), small DGH). Data on process and outcome of care (death and length of stay) were collected retrospectively at 90 days on all prospectively identified COPD admissions over an 8 week period. Each centre completed a questionnaire relating to organisation and resources available for the care of COPD patients. Eleven teaching hospitals, nine large DGHs, and 10 small DGHs provided data on 1274 cases. Mortality was high (14%) with wide variation between centres (IQR 9-19%). Small DGHs had a higher mortality (17.5%) than teaching hospitals (11.9%) and large DGHs (11.2%). When corrected for confounding factors, an excess of deaths in small DGHs was still observed (OR 1.56 (CI 1.04 to 2.35)) v teaching hospitals. Analysis of resource and organisational factors suggested higher mortality was associated with fewer doctors (OR 1.5) and with fewer patients being under the care of a specialist physician (OR 1.8). Small DGHs had fewest resources. Significant differences in mortality may exist between hospital types. The findings justify further study in a proposed national audit.

Evidence for a link between mortality in acute COPD and hospital type and resources

PubMed Central

Roberts, C; Barnes, S; Lowe, D; Pearson, M

2003-01-01

Background: The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme. Methods: Thirty hospitals in England and Wales were randomly selected by geographical region and hospital type (teaching, large district general hospital (DGH), small DGH). Data on process and outcome of care (death and length of stay) were collected retrospectively at 90 days on all prospectively identified COPD admissions over an 8 week period. Each centre completed a questionnaire relating to organisation and resources available for the care of COPD patients. Results: Eleven teaching hospitals, nine large DGHs, and 10 small DGHs provided data on 1274 cases. Mortality was high (14%) with wide variation between centres (IQR 9–19%). Small DGHs had a higher mortality (17.5%) than teaching hospitals (11.9%) and large DGHs (11.2%). When corrected for confounding factors, an excess of deaths in small DGHs was still observed (OR 1.56 (CI 1.04 to 2.35)) v teaching hospitals. Analysis of resource and organisational factors suggested higher mortality was associated with fewer doctors (OR 1.5) and with fewer patients being under the care of a specialist physician (OR 1.8). Small DGHs had fewest resources. Conclusion: Significant differences in mortality may exist between hospital types. The findings justify further study in a proposed national audit. PMID:14586045

Factors affecting length of stay in teaching hospitals of a middle-income country

PubMed Central

Khosravizadeh, Omid; Vatankhah, Soudabeh; Bastani, Peivand; Kalhor, Rohollah; Alirezaei, Samira; Doosty, Farzane

2016-01-01

Introduction The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence. Methods In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05. Results The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p<0.05). Other factors, including gender, place of residence, and type of admission, did not affect LOS. Conclusion Because hospitals consume a perceptible part of resources in a health system, controlled and optimized use of its resources help to save a lot. Therefore, this study showed many clinical and nonclinical factors affect LOS in evaluating these factors, which may reduce inappropriate hospital stays and decrease costs. PMID:27957301

Pediatric facial fractures: current national incidence, distribution, and health care resource use.

PubMed

Vyas, Raj M; Dickinson, Brian P; Wasson, Kristy L; Roostaeian, Jason; Bradley, James P

2008-03-01

To date, reports on the incidence and distribution of pediatric facial fractures have been inconsistent and have originated only from institutional studies. The need for current national data exists. We examined the Kids' Inpatient Database and the Nationwide Inpatient Sample to obtain national information on facial fracture discharges from 1997 to 2003. Data showed that pediatric patients (age, 0-17 years) make up 14.7% of all facial fractures, with children aged 1 to 4 years comprising only 5.6% of the total and children 15 to 17 years old making up more than half the group. The male-to-female ratio was 2.5. Significantly lengthier hospitalizations were observed with female patients, Medicaid insurance, teaching hospitals, government hospitals, and metropolitan hospitals. Significantly higher charges were associated with patients aged 1 to 4 years, Medicaid insurance, Western US geography, teaching hospitals, metropolitan hospitals, and children's hospitals. During the 6-year period of this study, there was a trend toward (1) increased hospital charges (with stable costs), (2) more patients treated at teaching hospitals, and (3) a convergence in length of stay between hospitals with differing ownerships (with government hospitals having progressively shorter hospitalizations, whereas private for-profit hospitals have progressively lengthier hospitalizations). The incidence of facial fractures in children is small yet significant and has remained stable during the past few decades. Certain patient populations are prone to facial fractures, and various patient and hospital factors are associated with lengthier and more expensive hospitalizations. An understanding of disparities in resource use among various patient, hospital, and geographic settings is critical for physicians and policy makers.

High frequency of methicillin-resistant Staphylococcus aureus (MRSA) with SCCmec type III and spa type t030 in Karaj's teaching hospitals, Iran.

PubMed

Bayat, Bahareh; Zade, Masoumeh Hallaj; Mansouri, Samaneh; Kalantar, Enayat; Kabir, Kourosh; Zahmatkesh, Ehsan; Sepehr, Mohammad Noori; Naseri, Mohammmad Hassan; Darban-Sarokhalil, Davood

2017-09-01

Methicillin-resistant Staphylococcus aureus (MRSA) has been one of the most important antibiotic-resistant pathogen in many parts of the world over the past decades. This cross-sectional study was conducted to investigate MRSA isolated between July 2013 and July 2014 in Karaj, Iran. All tested isolates were collected in teaching hospitals from personnel, patients, and surfaces and each MRSA was analyzed by SCCmec and spa typing. Antibiotic susceptibility testing was accomplished by disk diffusion method. Out of 49 MRSA isolates from the Karaj's teaching hospitals, 82%, 10%, and 6% of the isolates were SCCmec types III, II, and I, respectively. The main spa type in this study was spa t030 with frequency as high as 75.5% from intensive care unit (ICU) of the hospitals and high rate of resistance to rifampicin (53%) was found in MRSA isolates. In conclusion, high frequency of spa t030 with SCCmec type III and MRSA phenotype illustrated circulating of one of the antibiotic-resistant strains in ICU of Karaj's teaching hospitals and emphasizes the need for ongoing molecular surveillance, antibiotic susceptibility monitoring, and infection control.

A "Prepaid Package" for Obstetrics: Effect on Teaching and Patient Care in a University Hospital

ERIC Educational Resources Information Center

Young, Philip E.

1976-01-01

The changing social milieu has removed the charity patient but not the need for a teaching population. The University Hospital's program is described, in which patients prepaid a fixed, single fee for all obstetrics-related care through the third post partum day. (LBH)

A Teaching Hospital Medical Clinic: Secondary Rather than Primary Care.

ERIC Educational Resources Information Center

Fletcher, Suzanne; And Others

1979-01-01

A review of 287 patient visits to a teaching hospital polyclinic shows that most patients had multiple problems that required the help of subspecialists. However, the patients' needs for accessibility, comprehensiveness, coordination, and continuity are as great as those of patients receiving primary care. Implications for academic internal…

Innovative Model for Information Assurance Curriculum: A Teaching Hospital

ERIC Educational Resources Information Center

Goel, Sanjay; Pon, Damira; Bloniarz, Peter; Bangert-Drowns, Robert; Berg, George; Delio, Vince; Iwan, Laura; Hurbanek, Thomas; Schuman, Sandoor P.; Gangolly, Jagdish; Baykal, Adnan; Hobbs, Jon

2006-01-01

A novel idea for information security education created by the New York State Center for Information Forensics and Assurance (CIFA) is presented. This new approach incorporates a teaching hospital model originally developed for medical training. In this model, information security problems from industry and government are solved and abstracted…

Hospitality and Embodied Encounters in Educational Spaces

ERIC Educational Resources Information Center

Ruitenberg, Claudia W.

2018-01-01

This short paper responds to the essays by Shilpi Sinha, Shaireen Rasheed, and Lyudmila Bryzzheva. It considers how racial inequality between teachers and students affects the possibilities of educational hospitality, both in cases of white teachers teaching racialized students and in cases of racialized teachers teaching white students. The…

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…

Worse outcomes for patients undergoing brain tumor and cerebrovascular procedures following the ACGME resident duty-hour restrictions

PubMed Central

Babu, Ranjith; Thomas, Steven; Hazzard, Matthew A.; Friedman, Allan H.; Sampson, John H.; Adamson, Cory; Zomorodi, Ali R.; Haglund, Michael M.; Patil, Chirag G.; Boakye, Maxwell; Lad, Shivanand P.

2015-01-01

Object On July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions for resident physicians due to concerns for patient and resident safety. Though duty-hour restrictions have increased resident quality of life, studies have shown mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay, and charges in patients who underwent brain tumor and cerebrovascular procedures. Methods The Nationwide Inpatient Sample was used to evaluate the effect of duty-hour restrictions on complications, mortality, length of stay, and charges by comparing the pre-reform (2000–2002) and post-reform (2005–2008) periods. Outcomes were compared between nonteaching and teaching hospitals using a difference-in-differences (DID) method. Results A total of 90,648 patients were included in the analysis. The overall complication rate was 11.7%, with the rates not significantly differing between the pre –and post–duty hour eras (p = 0.26). Examination of hospital teaching status revealed that complication rates decreased in nonteaching hospitals (12.1% vs 10.4%, p = 0.0004) and remained stable in teaching institutions (11.8% vs 11.9%, p = 0.73) in the post-reform era. Multivariate analysis demonstrated a significantly higher complication risk in teaching institutions (OR 1.33 [95% CI 1.11–1.59], p = 0.0022), with no significant change in nonteaching hospitals (OR 1.11 [95% CI 0.91–1.37], p = 0.31). A DID analysis to compare the magnitude in change between teaching and nonteaching institutions revealed that teaching hospitals had a significantly greater increase in complications during the post-reform era than nonteaching hospitals (p = 0.040). The overall mortality rate was 3.0%, with a significant decrease occurring in the post-reform era in both nonteaching (5.0% vs 3.2%, p < 0.0001) and teaching (3.2% vs 2.3%, p < 0.0001) hospitals. DID analysis to compare the changes in mortality between groups did not reveal a significant difference (p = 0.40). The mean length of stay for all patients was 8.7 days, with hospital stay decreasing from 9.2 days to 8.3 days in the post-reform era (p < 0.0001). The DID analysis revealed a greater length of stay decrease in nonteaching hospitals than teaching institutions, which approached significance (p = 0.055). Patient charges significantly increased in the post-reform era for all patients, increasing from $70,900 to $96,100 (p < 0.0001). The DID analysis did not reveal a significant difference between the changes in charges between teaching and nonteaching hospitals (p = 0.17). Conclusions The implementation of duty-hour restrictions correlated with an increased risk of postoperative complications for patients undergoing brain tumor and cerebrovascular neurosurgical procedures. Duty-hour reform may therefore be associated with worse patient outcomes, contrary to its intended purpose. Due to the critical condition of many neurosurgical patients, this patient population is most sensitive and likely to be negatively affected by proposed future increased restrictions. PMID:24926647

Worse outcomes for patients undergoing brain tumor and cerebrovascular procedures following the ACGME resident duty-hour restrictions.

PubMed

Babu, Ranjith; Thomas, Steven; Hazzard, Matthew A; Friedman, Allan H; Sampson, John H; Adamson, Cory; Zomorodi, Ali R; Haglund, Michael M; Patil, Chirag G; Boakye, Maxwell; Lad, Shivanand P

2014-08-01

On July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions for resident physicians due to concerns for patient and resident safety. Though duty-hour restrictions have increased resident quality of life, studies have shown mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay, and charges in patients who underwent brain tumor and cerebrovascular procedures. The Nationwide Inpatient Sample was used to evaluate the effect of duty-hour restrictions on complications, mortality, length of stay, and charges by comparing the pre-reform (2000-2002) and post-reform (2005-2008) periods. Outcomes were compared between nonteaching and teaching hospitals using a difference-in-differences (DID) method. A total of 90,648 patients were included in the analysis. The overall complication rate was 11.7%, with the rates not significantly differing between the pre- and post-duty hour eras (p = 0.26). Examination of hospital teaching status revealed that complication rates decreased in nonteaching hospitals (12.1% vs 10.4%, p = 0.0004) and remained stable in teaching institutions (11.8% vs 11.9%, p = 0.73) in the post-reform era. Multivariate analysis demonstrated a significantly higher complication risk in teaching institutions (OR 1.33 [95% CI 1.11-1.59], p = 0.0022), with no significant change in nonteaching hospitals (OR 1.11 [95% CI 0.91-1.37], p = 0.31). A DID analysis to compare the magnitude in change between teaching and nonteaching institutions revealed that teaching hospitals had a significantly greater increase in complications during the post-reform era than nonteaching hospitals (p = 0.040). The overall mortality rate was 3.0%, with a significant decrease occurring in the post-reform era in both nonteaching (5.0% vs 3.2%, p < 0.0001) and teaching (3.2% vs 2.3%, p < 0.0001) hospitals. DID analysis to compare the changes in mortality between groups did not reveal a significant difference (p = 0.40). The mean length of stay for all patients was 8.7 days, with hospital stay decreasing from 9.2 days to 8.3 days in the post-reform era (p < 0.0001). The DID analysis revealed a greater length of stay decrease in nonteaching hospitals than teaching institutions, which approached significance (p = 0.055). Patient charges significantly increased in the post-reform era for all patients, increasing from $70,900 to $96,100 (p < 0.0001). The DID analysis did not reveal a significant difference between the changes in charges between teaching and nonteaching hospitals (p = 0.17). The implementation of duty-hour restrictions correlated with an increased risk of postoperative complications for patients undergoing brain tumor and cerebrovascular neurosurgical procedures. Duty-hour reform may therefore be associated with worse patient outcomes, contrary to its intended purpose. Due to the critical condition of many neurosurgical patients, this patient population is most sensitive and likely to be negatively affected by proposed future increased restrictions.

The intricate relationship between a medical school and a teaching hospital: A case study in Uganda.

PubMed

Mubuuke, Aloysius Gonzaga; Businge, Francis; Mukule, Emmanuel

2014-01-01

The relationship between medical schools and teaching hospitals is full of opportunities but also challenges even though they have complementary goals that could enhance each other. Although medical schools and teaching hospitals may face some similar challenges around the world, there could be context-specific observations that differ in resource-rich versus resource-limited settings. The purpose of this study was to investigate factors that are perceived to have influenced the relationship between a medical school and a teaching hospital in Uganda, a resource-limited setting. This was a cross-sectional, descriptive study in which key informant individual interviews were conducted with senior administrators and senior staff members of the Mulago Hospital and Makerere University Medical School. The interviews explored factors perceived to have favoured the working relationship between the two institutions, challenges faced and likely future opportunities. Both quantitative and qualitative data were generated. Thematic analysis was used with the qualitative data. Respondents reported a strained relationship between the two institutions, with unfavourable factors far outweighing the favourable factors influencing the relationship. Key negative reported factors included having different administrative set-ups, limited opportunities to share funds and to forge research collaborations, unexploited potential of sharing human resources to address staff shortages, as well as a lack of a memorandum of understanding between the two institutions. This study identifies barriers in the existing relationship between a teaching hospital and medical college in a resource-poor country. It proposes a collaborative model, rather than competitive model, for the two institutions that may work in both resource-limited and resource-rich settings.

Construction of the radiation oncology teaching files system for charged particle radiotherapy.

PubMed

Masami, Mukai; Yutaka, Ando; Yasuo, Okuda; Naoto, Takahashi; Yoshihisa, Yoda; Hiroshi, Tsuji; Tadashi, Kamada

2013-01-01

Our hospital started the charged particle therapy since 1996. New institutions for charged particle therapy are planned in the world. Our hospital are accepting many visitors from those newly planned medical institutions and having many opportunities to provide with the training to them. Based upon our experiences, we have developed the radiation oncology teaching files system for charged particle therapy. We adopted the PowerPoint of Microsoft as a basic framework of our teaching files system. By using our export function of the viewer any physician can create teaching files easily and effectively. Now our teaching file system has 33 cases for clinical and physics contents. We expect that we can improve the safety and accuracy of charged particle therapy by using our teaching files system substantially.

Assessing and Managing Caregiver Stress: Development of a Teaching Tool for Medical Residents

ERIC Educational Resources Information Center

Famakinwa, Abisola; Fabiny, Anne

2008-01-01

Forty medical residents from major teaching hospitals in Boston, Massachusetts, participated in small group teaching sessions about caregiver stress. A teaching tool was developed that included a teaching handout, interactive cases, standard instruments for assessing caregiver stress, peer-reviewed articles about caregiving, and a list of…

Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

PubMed

Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

2016-03-01

Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

Healthcare's crown jewels. A looming 15% reduction in Medicare payments could tarnish the financial viability of teaching hospitals, studies say. Others, however, say they'll keep shining despite the scheduled cuts.

PubMed

Lovern, Ed

2002-05-27

Though saddled with higher costs than other hospitals, teaching hospitals reap plump margins on Medicare. But that could change this fall. A volley of studies say a looming 15% cut in indirect medical education payments and disproportionate-share payments could threaten the financial viability of healthcare's crown jewels unless Congress reverses current law.

[Academician Li Lianda talking about doctors doing scientific research].

PubMed

He, Ping; Li, Yi-kui

2015-09-01

At present, Chinese medical field faces with an important problem of how to correctly handle the relationship between medical and scientific research. Academician Li Lianda advocates doctors doing scientific research under the premise of putting the medical work first. He points out that there are many problems in the process of doctors doing scientific research at present such as paying more attention to scientific research than medical care, excessively promoting building scientific research hospital, only paying attention to training scientific talents, research direction be flashy without substance, the medical evaluation system should be improved and so on. Medical, scientific research and teaching are inseparable because improving medical standards depends on scientific research and personnel training. But not all doctors need to take into account of medical treatment, scientific research and teaching in the same degree while not all hospitals need to turn into three-in-one hospital, scientific research hospital or teaching hospital. It must be treated differently according to the actual situation.

77 FR 39700 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-05

..., and teaching hospitals and non-profit research institutes that are either owned by or formally... to determine the most appropriate and effective method of compliance with these requirements by... teaching hospital that is not owned by a college or university must keep a copy of its formal written...

Parental responses to involvement in rounds on a pediatric inpatient unit at a teaching hospital: a qualitative study.

PubMed

Latta, Linda C; Dick, Ronald; Parry, Carol; Tamura, Glen S

2008-03-01

In pediatric teaching hospitals, medical decisions are traditionally made by the attending and resident physicians during rounds that do not include parents. This structure limits the ability of the medical team to provide "family-centered care" and the attending physician to model communication skills. The authors thus set out to identify how parents responded to participation in interdisciplinary teaching rounds conducted in a large tertiary care children's teaching hospital. A qualitative descriptive study was conducted using data from semistructured interviews of parents who had participated in rounds on the inpatient medical unit of a large academic children's hospital. From December 2004 to April 2005, 18 parents were interviewed after their participation in rounds. Questions assessed their experiences, expectations, preferred communication styles, and suggestions for improvement. Transcripts of the interviews were analyzed using qualitative content analysis. Being able to communicate, understand the plan, and participate with the team in decision making about their child's care were the most frequently cited outcomes of importance to parents. All 18 participants described the overall experience as positive, and 17 of 18 described themselves as "comfortable" with inclusion in rounds. Use of lay terminology and inclusion of nurses in rounds were preferred. Including parents on ward rounds at a teaching hospital was viewed positively by parents. Specific themes of particular importance to parents were identified. Further study is needed to assess the impact of inclusion of parents on rounds on patient outcomes and the resident experience.

Use of ventricular assist devices in children across the United States: analysis of 7.5 million pediatric hospitalizations.

PubMed

Morales, David L S; Zafar, Farhan; Rossano, Joseph W; Salazar, Jorge D; Jefferies, John L; Graves, Daniel E; Heinle, Jeffrey S; Fraser, Charles D

2010-10-01

Recently, there has been a surge of interest by clinicians, industry, and the government in the development and use of ventricular assist devices (VAD) in children. Despite this rapidly expanding interest, the incidence of VAD use in children across the United States is unknown. The Healthcare Cost and Utilization Project (H-CUP) Kids' Inpatients Database (KID) was analyzed to characterize the current utilization of VADs in children nationwide. The most recent HCUP-KID (2006) was analyzed (n = 7.5 million). This database is a nationwide sampling of hospital discharges of patients less than 20 years old weighted to provide national estimates. In 2006, 187 children had a VAD implanted in the United States. Mean age was 13 ± 7 years. Forty patients (21%) were bridged to VAD by extracorporeal membrane oxygenation. Forty-nine patients (26%) were bridged to heart transplant. Fifty-six patients (30%) died in hospital. Eighty-six patients (46%) were discharged or transferred. Length of stay was 29 days (range, 0 to 285). Total cost was $174,743 (range, $4,230 to $1,911,588). Sixty-seven hospitals placed VADs; 66% of VADs (124) were implanted at large teaching hospitals (more than 500 beds), and 46% (85) were at high-volume hospitals (more than 5 VADs per year). High-volume, large teaching hospitals (10) had better survival (89% versus 61%; p < 0.001) and lower hospital cost ($236,000 ± $184,000 versus $300,000 ± $355,000; p = 0.002) compared with all other hospitals. On multivariate analysis, acute renal failure and extracorporeal membrane oxygenation were risk factors for mortality, whereas transplant and being at a high-volume large teaching hospital were protective factors from death. Preliminary data suggest that the growing use of VADs in children may be better served in regard to resource utilization and outcomes if centralized to high-volume large teaching hospitals. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2010-08-01

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

Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study

PubMed Central

Wan Ahmad, Wan Azman; Low, Ee Vien; Liau, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng-Bang; Mohd Ali, Rosli B.; Ismail, Omar; Ong, Tiong Kiam; Said, Mas Ayu; Dahlui, Maznah

2017-01-01

Introduction The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). Methods This cross-sectional study was conducted from the healthcare providers’ perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. Results The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients’ comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. Conclusions The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia. PMID:28873473

Feasibility of introducing rejection criteria for stool cultures in a teaching hospital in Portugal.

PubMed

Hänscheid, T; Cristino, J M; Salgado, M J

2002-02-01

The possible introduction of rejection criteria for stool cultures (

Drug-food interaction counseling programs in teaching hospitals.

PubMed

Wix, A R; Doering, P L; Hatton, R C

1992-04-01

The results of a survey to characterize drug-food interaction counseling programs in teaching hospitals and solicit opinions on these programs from pharmacists and dietitians are reported. A questionnaire was mailed to the pharmacy director and the director of dietary services at teaching hospitals nationwide. The questionnaire contained 33 questions relating to hospital characteristics, drug-food interaction counseling programs, and the standard calling for such programs issued by the Joint Commission on Accreditation of Healthcare Organizations. Of 792 questionnaires mailed, 425 were returned (response rate, 53.7). A majority of the pharmacists and dietitians (51.2%) did not consider their drug-food interaction counseling program to be formal; some had no program. The pharmacy department was involved more in program development than in the daily operation of such programs. The most frequent methods of identifying patients for counseling were using lists of patients' drugs and using physicians' orders. A mean of only five drugs were targeted per program. Slightly over half the respondents rated the Joint Commission standard less effective than other standards in its ability to improve patient care. A majority of teaching hospitals did not have formal drug-food interaction counseling programs. Pharmacists and dietitians did not view these programs as greatly beneficial and did not believe that the Joint Commission has clearly delineated the requirements for meeting its standard.

Performance of US teaching hospitals: a panel analysis of cost inefficiency.

PubMed

Rosko, Michael D

2004-02-01

This research summarizes an analysis of the impact of environment pressures on hospital inefficiency during the period 1990-1999. The panel design included 616 hospitals. Of these, 211 were academic medical centers and 415 were hospitals with smaller teaching programs. The primary sources of data were the American Hospital Association's Annual Survey of Hospitals and Medicare Cost Reports. Hospital inefficiency was estimated by a regression technique called stochastic frontier analysis. This technique estimates a "best practice cost frontier" for each hospital that is based on the hospital's outputs and input prices. The cost efficiency of each hospital was defined as the ratio of the stochastic frontier total costs to observed total costs. Average inefficiency declined from 14.35% in 1990 to 11.42% in 1998. It increased to 11.78% in 1999. Decreases in inefficiency were associated with the HMO penetration rate and time. Increases in inefficiency were associated with for-profit ownership status and Medicare share of admissions. The implementation of the provisions of the Balanced Budget Act of 1997 was followed by a small decrease in average hospital inefficiency. Analysis found that the SFA results were moderately sensitive to the specification of the teaching output variable. Thus, although the SFA technique can be useful for detecting differences in inefficiency between groups of hospitals (i.e., those with high versus those with low Medicare shares or for-profit versus not-for-profit hospitals), its relatively low precision indicates it should not be used for exact estimates of the magnitude of differences associated with inefficiency-effects variables.

Teaching the teacher program to assist nurse managers to educate nursing staff in Ecuadorian hospitals.

PubMed

Palmer, Sheri P; Heaston, Sondra

2009-03-01

Continuing education for hospital staff nurses is a concern worldwide. Current research shows that continuing education among nurses can positively affect patient outcomes (O'Brien, T., Freemantle, N., Oxman, A, et al., 2002. Interactive continuing education workshops or conferences can improve professional practice and patient outcomes. Journal of Evidence Based Nursing. 26 (5)). Seeing a need for improved patient outcomes among hospitals in Ecuador, we conducted a teaching the teacher program to assist nurse managers to carry-out continuing education in their hospital system. This teaching the teacher program was established through the collaboration between one College of Nursing in Utah, USA and a large healthcare system in Guayaquil, Ecuador. The collaboration has been ongoing for five years, 2003 to present. Initial projects included classes for the nursing staff including technical skills, life-saving techniques, and nursing process and assessment. Collaborators from the US and Ecuador believed that in order to maximize the improvement of nursing care in the hospital system it was necessary to turn attention on the nurse managers and not just the staff nurses. This would allow for meaningful ongoing learning beyond the one-time classroom setting. Continuing education is not common in Ecuadorian hospitals as it is in the United States. The purpose of this paper is to describe the project and provide initial evaluative data on the response to the curriculum; including evidence of managers using the teaching principles they were taught. The underlying aim of the project was to achieve a sustainable impact by teaching the leaders of each unit how to be more effective teachers. In May 2007, a two-day "teaching the teacher" workshop was developed with the needs of the managers in mind. The participants in the course included the chief nursing officer and leaders of various units of the hospital. In May 2008 a follow-up class was taught, along with an evaluation by a verbal and written survey with open ended questions and an observation of an actual class being taught by the participants.

A model of determining a fair market value for teaching residents: who profits?

PubMed

Cullen, Edward J; Lawless, Stephen T; Hertzog, James H; Penfil, Scott; Bradford, Kathleen K; Nadkarni, Vinay M; Corddry, David H; Costarino, Andrew T

2003-07-01

Centers for Medicare & Medicaid Services (CMS) Health Resources and Services Administration Children's Hospitals Graduate Medical Education (GME) Payment Program now supports freestanding children's teaching hospitals. To analyze the fair market value impact of GME payment on resident teaching efforts in our pediatric intensive care unit (PICU). Cost-accounting model, developed from a 1-year retrospective, descriptive, single-institution, longitudinal study, applied to physician teachers, residents, and CMS. Sixteen-bed PICU in a freestanding, university-affiliated children's teaching hospital. Pediatric critical care physicians, second-year residents. Cost of physician opportunity time; CMS investment return; the teaching physicians' investment return; residents' investment return; service balance between CMS and teaching service investment margins; economic balance points; fair market value. GME payments to our hospital increased 4.8-fold from 577 886 dollars to 2 772 606 dollars during a 1-year period. Critical care physicians' teaching opportunity cost rose from 250 097 dollars to 262 215 dollars to provide 1523 educational hours (6853 relative value units). Residents' net financial value for service provided to the PICU rose from 245 964 dollars to 317 299 dollars. There is an uneven return on investment in resident education for CMS, critical care physicians, and residents. Economic balance points are achievable for the present educational efforts of the CMS, critical care physicians, and residents if the present direct medical education payment increases from 29.38% to 36%. The current CMS Health Resources and Services Administration Children's Hospitals GME Payment Program produces uneven investment returns for CMS, critical care physicians, and residents. We propose a cost-accounting model, based on perceived production capability measured in relative value units and available GME funds, that would allow a clinical service to balance and obtain a fair market value for the resident education efforts of CMS, physician teachers, and residents.

Are medical students accepted by patients in teaching hospitals?

PubMed Central

Marwan, Yousef; Al-Saddique, Muhammad; Hassan, Adnan; Karim, Jumanah; Al-Saleh, Mervat

2012-01-01

Background Worldwide, patients are the cornerstone of bedside teaching of medical students. In this study, the authors aimed to assess patients’ acceptability toward medical students in teaching hospitals of the Faculty of Medicine of Kuwait University. Methods Ninehundred and ninety five patients were approached in 14 teaching hospitals; 932 patients agreed to participate (refusal rate is 6.3%). A self-administered questionnaire was used to collect data. Results In general, higher acceptance of students by patients was found when there is no direct contact between the patient and the student (e.g., reading patients’ files, presenting in outpatient clinic, observing doctors performing examination or procedures) compared to other situations (e.g., performing physical examination or procedures). Pediatrics patients showed higher acceptance of students compared to patients in other specialties, while Obstetrics/Gynecology patients showed the highest refusal of students. Gender of patients (especially females) and students appeared to affect the degree of acceptance of medical students by patients. Majority of the patients (436; 46.8%) believed that the presence of medical students in hospitals improves the quality of health care. Conclusion Patients are an important factor of bedside teaching. Clinical tutors must take advantage of patients who accept medical students. Clinical tutors and medical students should master essential communication skills to convince patients in accepting students, thus improving bedside teaching. Also, using simulation and standardization should be considered to address scenarios that most patients are unwilling to allow students to participate. PMID:22509091

A Census of Residents in Canadian Hospitals Approved for Training by the Royal College of Physicians and Surgeons of Canada, April 1965

PubMed Central

Clarke, G. Grant; Fish, D. G.; Giles, T. J.

1966-01-01

A census taken in April 1965 revealed that there were 3162 residents training in Canadian hospitals approved by the Royal College of Physicians and Surgeons of Canada. Thirty-one of the 151 approved hospitals had no residents in training, and another 43 hospitals each having 20 or more residents accounted for 85% of all residents training in Canada. Fifty-seven per cent of the residents in Canada were Canadian citizens, 19% were landed immigrants, and 24% were foreign trainees. Major teaching hospitals contained 65% of all residents; 70% of Canadian graduates and 60% of non-Canadian graduates were training in major teaching hospitals. Hospitals approved for full training in the specialty of the trainee contained 57% of all residents; 64% of Canadian graduates and 48% of foreign graduates were in such hospitals. PMID:5908720

Learning as Leaving Home: Fear, Empathy, and Hospitality in the Theology and Religion Classroom

ERIC Educational Resources Information Center

Fleming, Daniel; Lovat, Terence

2015-01-01

The article is a response to this journal's call for papers on metaphors for teaching, and also draws from a previous publication in which Kent Eilers developed a methodology for teaching global theologies. In this methodology, the ultimate goal was the development of "hermeneutical dispositions of empathy, hospitality, and receptivity toward…

Approaching Hospital-Bound/Home-Bound Special Education as an Opportunity for Innovation in Teaching

ERIC Educational Resources Information Center

Trentin, Guglielmo

2014-01-01

Paradoxically some "extreme" didactic needs, such as those of students who are unable to attend normal education regularly (e.g., hospitalized and/or homebound students), have shown themselves to be ideal for the development of a teaching style aimed at stimulating the active role of the student, at fostering a learning process based…

Quality Communication in Hospitality: Language Skills or Culture Transfer?

ERIC Educational Resources Information Center

Leung, Peggy; Lo, Terence

This paper focuses on English language teaching for the hospitality industry in Hong Kong, presenting a brief statement on the concept of transfer and its relevance to teaching English as a Foreign Language (EFL) for the world of work. The observable changes in the nature of language in the world of work in a service-oriented economy are…

Effect of Sex Education Programme on at-risk sexual behaviour of school-going adolescents in Ilorin, Nigeria.

PubMed

Esere, Mary Ogechi

2008-06-01

Adolescents display sexual behaviours and developmental characteristics that place them at risk for Sexually Transmitted Diseases (STDs). Because young people experiment sexually and because of the consequences of indiscriminate sexual activities on the youth, there is the need to mount sex education programmes that are geared towards enlightenment and appropriate education about sex and sexuality. To determine whether Sex Education Intervention Programme would reduce at-risk sexual behaviours of school-going adolescents. Pre-test, post-test control group quasi-experimental design. A randomly selected co-educational school in Ilorin Metropolis, Nigeria. 24 school-going adolescents aged 13-19 years. Sex Education Programme (treatment group) versus Control programme (placebo). Self-reported exposure to sexually transmitted diseases, multiple sex partners, anal sex, oral sex, non use of condom. When the treatment (intervention) group was compared with the control group in an intention to treat analysis, there were significant differences in at-risk sexual behaviours of the two groups. Those in the intervention group reported less at-risk sexual behaviours than their counterparts in the control group. The treatment group evaluated the intervention programme positively and their knowledge of sexual health improved. Lack of behavioural effect on the control group could be linked to differential quality of delivery of intervention. Compared with the control group, this specially designed intervention sex education programme reduced at-risk sexual behaviour in adolescents. Based on this finding, it was recommended that sex education be introduced into the curriculum of secondary school education in Nigeria.

Mapping knowledge management resources of maternal, newborn and child health (MNCH) among people living in rural and urban settings of Ilorin, Nigeria.

PubMed

Bolarinwa, Oladimeji Akeem; Ameen, Hafsat Abolore; Durowade, Kabir Adekunle; Akande, Tanimola Makanjuola

2014-01-01

Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level. The study showed that traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas. It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.

Electronic fetal monitoring: a Canadian survey.

PubMed Central

Davies, B L; Niday, P A; Nimrod, C A; Drake, E R; Sprague, A E; Trépanier, M J

1993-01-01

OBJECTIVES: To determine the current status of electronic fetal monitoring (EFM) in Canadian teaching and nonteaching hospitals, to review the medical and nursing standards of practice for EFM and to determine the availability of EFM educational programs. DESIGN: National survey in 1989. PARTICIPANTS: The directors of nursing at the 737 hospitals providing obstetric care were sent a questionnaire and asked to have it completed by the most appropriate staff member. The response rate was 80.5% (593/737); 44 hospitals did not have deliveries in 1988 and were excluded. The remaining hospitals varied in size from 8 to 1800 (mean 162.1) beds and had 1 to 7500 (mean 617.1) births in 1988; 18.8% were teaching hospitals. RESULTS: Of the 549 hospitals 419 (76.3%) reported having at least 1 monitor (range 1 to 30; mean 2.6); the mean number of monitors per hospital was higher in the teaching hospitals than in the nonteaching hospitals (6.2 v. 1.7). Manitoba had the lowest mean number of monitors per hospital (1.1) and Ontario the highest (3.7). In 71.8% of the hospitals with monitors almost all of the obstetric patients were monitored at some point during labour. However, 21.6% of the hospitals with monitors had no policy on EFM practice. The availability of EFM educational programs for physicians and nurses varied according to hospital size, type and region. CONCLUSIONS: Most Canadian hospitals providing obstetric services have electronic fetal monitors and use them frequently. Although substantial research has questioned the benefits of EFM, further definitive research is required. In the meantime, a national committee should be established to develop multidisciplinary guidelines for intrapartum fetal assessment. PMID:8485677

Pharmacy Information Systems in Teaching Hospitals: A Multi-dimensional Evaluation Study.

PubMed

Kazemi, Alireza; Rabiei, Reza; Moghaddasi, Hamid; Deimazar, Ghasem

2016-07-01

In hospitals, the pharmacy information system (PIS) is usually a sub-system of the hospital information system (HIS). The PIS supports the distribution and management of drugs, shows drug and medical device inventory, and facilitates preparing needed reports. In this study, pharmacy information systems implemented in general teaching hospitals affiliated to medical universities in Tehran (Iran) were evaluated using a multi-dimensional tool. This was an evaluation study conducted in 2015. To collect data, a checklist was developed by reviewing the relevant literature; this checklist included both general and specific criteria to evaluate pharmacy information systems. The checklist was then validated by medical informatics experts and pharmacists. The sample of the study included five PIS in general-teaching hospitals affiliated to three medical universities in Tehran (Iran). Data were collected using the checklist and through observing the systems. The findings were presented as tables. Five PIS were evaluated in the five general-teaching hospitals that had the highest bed numbers. The findings showed that the evaluated pharmacy information systems lacked some important general and specific criteria. Among the general evaluation criteria, it was found that only two of the PIS studied were capable of restricting repeated attempts made for unauthorized access to the systems. With respect to the specific evaluation criteria, no attention was paid to the patient safety aspect. The PIS studied were mainly designed to support financial tasks; little attention was paid to clinical and patient safety features.

Can teaching hospitals use serial formative OSCEs to improve student performance?

PubMed

Lien, Heng-Hui; Hsu, Sang-Feng; Chen, Shu-Chen; Yeh, Jiann-Horng

2016-10-14

We report on interns' clinical competence and experiences of an objective structured clinical examination (OSCE) training program over 3 years. We aimed to determine whether repeated formative OSCEs allow teaching hospitals to improve the effectiveness of clinical training and help interns to achieve high scores in the national summative OSCE. This study included 207 participants, among whom 82 were interns who had completed four mock OSCEs and a national OSCE at the clinical center of Cathay General Hospital (CGH). The other 125 participants were final-year medical students from Fu-Jen University who had completed the national OSCE between 2013 and 2015 at one of four teaching hospitals (including CGH). CGH interns were categorized into three groups according to the medical school attended and Fu-Jen University students were grouped according to their training hospitals. CGH held four mock OSCEs (30 stations), whereas each of the four training hospitals for Fu-Jen students each held one or two OSCEs (6-12 stations) annually. Differences in the mean OSCE scores among groups were analyzed. The medical school attended, pre-internship OSCE experience and the frequency of mock OSCEs held by training hospitals were independent factors in this study. The cumulative mean scores for five OSCEs among three groups of students trained at CGH tended to increase from the first OSCE (OSCE1) to the fifth (OSCE5). The mean score of the students who attended Fu-Jen Medical School was higher than that of students who graduated from foreign medical schools in all five OSCEs; however, the differences were significant only for OSCE2 (P = 0.022) and OSCE3 (P = 0.027). The mean national OSCE scores of FJU students showed no statistically significant differences among the four training hospitals for 2013; however, students training at CGH had significantly higher mean scores in the 2014 (P = 0.001) and 2015 (P = 0.005) OSCEs compared with students training at the other three hospitals. Serial administration of formative OSCEs by teaching hospitals enhances the performance of students on the sequential summative OSCE. Such programs provide multiple opportunities for students to practice their clinical skills, and for faculty to develop their teaching, assessment and consensus building skills.

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

PubMed

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

2010-03-09

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

CHILDREN HOSPITALIZED WITH LOWER EXTREMITY FRACTURES IN THE UNITED STATES IN 2006: A POPULATION-BASED APPROACH

PubMed Central

Gao, Yubo

2011-01-01

OBJECTIVE The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. METHODS Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under “Injury and Poisoning (800-999).” Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. RESULTS There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. CONCLUSIONS This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals. PMID:22096438

Children hospitalized with lower extremity fractures in the United States in 2006: a population-based approach.

PubMed

Gao, Yubo

2011-01-01

The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under "Injury and Poisoning (800-999)." Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals.

Knowledge, attitudes and practices regarding tuberculosis among senior secondary school students.

PubMed

Tanimowo, M O

1999-01-01

To evaluate knowledge, attitudes and practices regarding tuberculosis among Nigerian senior secondary school students. Questionnaire. Ilorin Grammar School, Ilorin, Kwara State, Nigeria. Seven hundred and ninety one senior secondary students. Questionnaire explained in English to whole class by author. Responses were streamlined and analysed based on responders, knowledge of, attitudes towards, and practices as regards tuberculosis. KNOWLEDGE: The response "Yes", "No", or "I don't know" was given to each of the following questions and their respective percentages are indicated: Have you ever heard of tuberculosis?: 81.4%, 13.9%, 4.7%. Have you ever been affected by it?: 8.3%, 86.3%, 5.3%. Can tuberculosis of the lung be contracted through drinking unclean water or eating unhygienic food?: 72.3%, 17.2%, 10.5%. Can it spread through air droplets?: 70.9%, 17.8%, 11.3%. Can it spread through overcrowding?: 71.6%, 18.1%, 10.4%. Is it caused by spirits, demons or evil doers?: 16.2%, 67.5%, 16.3%. Is it the only cause of long-standing cough?: 43.6%, 40.2%, 16.2%. Can it cause persistent fever?: 64.6%, 19.8%, 15.5%. Can it cause loss of weight?: 79.6%, 11.9%, 8.5%. Tuberculosis only affects the lungs?: 46.3%, 39.1%, 14.7%. Can it be cured at all?: 76.7%, 12.1%, 11.1%. Should the patient always be admitted to the hospital to receive treatment?: 69.7%, 9.7%, 20.6%. Can the disease be prevented?: 89.2%, 0.9%, 11.9%. Heaf or Mantoux test is dangerous?: 15.8%, 13.3%, 71.6%. Patients who are already on effective treatment (drugs) can still spread the disease?: 50.2%, 25.3%, 24.5%. Patients who have been cured can still spread the disease?: 33.5%, 49.6%, 16.9%. Should patients with tuberculosis be regarded as outcasts?: 40.1%, 38.9%, 21%. Can BCG vaccination prevent tuberculosis?: 57.6%, 18.6%, 23.8%. Can cigarette smoking predispose to tuberculosis of the lungs?: 66%, 15.8%, 18.1%. ATTITUDES: The responses on how tuberculosis can be cured are as follows: By making sacrifice to appease the angry spirits or demons 3%; by begging the evil doers 2.3%; by taking drugs prescribed by doctors 69.7%; by taking traditional medicines 4.8%; by a combination of all the above 20.1%. PRACTICES: On prevention of tuberculosis, 51 different methods are volunteered of which 41.2% are correct, 19.6% are controversial while 39.2% are definitely incorrect. A high level of ignorance, wrong knowledge, wrong attitudes and wrong practices is demonstrated among senior secondary students. Inclusion of health education in school syllabi is advocated.

Welcoming and Restoring, Dwelling and Sending: Creating a Space for Hospitality in Faculty Development

ERIC Educational Resources Information Center

Larson, Marion H.

2009-01-01

Parker Palmer's (1983) often-quoted definition of teaching--"To teach is to create a space in which obedience to truth is practiced"--can be applied productively to work in faculty development. Exploring this notion is enhanced by the theological literature in hospitality, which can be viewed through Amy Oden's (2001) discussion of four movements…

Knowledge Practice and Outcome of Quality Nursing Care among Nurses in University of Calabar Teaching Hospital (UCTH)

ERIC Educational Resources Information Center

Oyira, Emilia James; Ella, R. E.; Chukwudi, Usochukwu Easter; Paulina, Akpan Idiok

2016-01-01

Objectives: The main purpose of this study was to determine knowledge practice and outcome of quality nursing care among nurses in University of Calabar Teaching Hospital (UCTH). Three research questions and one hypothesis were formulated to guide this study. Literature related to the variables under study was reviewed according to the research…

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

ERIC Educational Resources Information Center

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

2016-01-01

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

Investigating the prevention of hospital-acquired infection through standardized teaching ward rounds in clinical nursing.

PubMed

Zhang, R

2015-04-22

This study aimed to explore the effect of standardized teaching ward rounds in clinical nursing on preventing hospital-acquired infection. The experimental group comprised 120 nursing students from our hospital selected between June 2010 and June 2012. The control group consisted of 120 nursing students selected from May 2008 to May 2010. Traditional teaching ward rounds for nursing education were carried out with the control group, while a standardized teaching ward round was carried out with the experimental group. The comprehensive application of nursing abilities and skills, the mastering of situational infection knowledge, and patient satisfaction were compared between the two groups. The applied knowledge of nursing procedures and the pass rate on comprehensive skill tests were significantly higher in the experimental group than in the control group (P < 0.05). The rate of mastery of sterilization and hygiene procedures was also higher in the experimental group than in the control group (P < 0.05). The patient satisfaction rate with infection control procedures in the experimental group time period was 98.09%, which was significantly higher than patient satisfaction in the control group time period (93.05%, P < 0.05). Standardized teaching ward rounds for nursing education expanded the knowledge of the nursing staff in controlling hospital-acquired infection and enhanced the ability of comprehensive application and awareness of infection control procedures.

Electronic implementation of national nursing standards--NANDA, NOC and NIC as an effective teaching tool.

PubMed

Allred, Sharon K; Smith, Kevin F; Flowers, Laura

2004-01-01

With the increased interest in evidence-based medicine, Internet access and the growing emphasis on national standards, there is an increased challenge for teaching institutions and nursing services to teach and implement standards. At the same time, electronic clinical documentation tools have started to become a common format for recording nursing notes. The major aim of this paper is to ascertain and assess the availability of clinical nursing tools based on the NANDA, NOC and NIC standards. Faculty at 20 large nursing schools and directors of nursing at 20 hospitals were interviewed regarding the use of nursing standards in clinical documentation packages, not only for teaching purposes but also for use in hospital-based systems to ensure patient safety. A survey tool was utilized that covered questions regarding what nursing standards are being taught in the nursing schools, what standards are encouraged by the hospitals, and teaching initiatives that include clinical documentation tools. Information was collected on how utilizing these standards in a clinical or hospital setting can improve the overall quality of care. Analysis included univariate and bivariate analysis. The consensus between both groups was that the NANDA, NOC and NIC national standards are the most widely taught and utilized. In addition, a training initiative was identified within a large university where a clinical documentation system based on these standards was developed utilizing handheld devices.

Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals.

PubMed

Shime, Nobuaki; Ono, Akira; Chihara, Eiichi; Tanaka, Yoshifumi

2005-01-01

We conducted a nationwide survey to investigate the current practice of the preoperative fasting period in Japanese anesthesia-teaching hospitals. Acceptance of the clinical practice guideline published by the American Society of Anesthesiologists (ASA) was also surveyed. A written type of questionnaire was mailed to 795 teaching hospitals. The response rate of the questionnaires was 57%. Most (>90%) of the respondents had been applying a longer fasting period than the ASA-recommended minimum period specifically in adults; the median duration of fasting was 12-13 h for solids and 6-9 h for liquids. Children or infants were allowed a more liberalized fasting period, frequently being permitted an oral intake of clear fluids up to 3 h before anesthesia. The incidence of pulmonary aspiration was 1/12,500 general anesthesia cases, and application of the ASA guideline appeared not to affect the incidence. Japanese anesthesiologists were still reluctant to depart from their traditional long fasting periods, as most of them could find little benefit in reducing the fasting periods. The long preoperative fasting period is still common practice in Japanese anesthesia-teaching hospitals. A national guideline for a preoperative fasting policy is worth exploring to change the current practice.

Eliminating Residents Increases the Cost of Care.

PubMed

DeMarco, Deborah M; Forster, Richard; Gakis, Thomas; Finberg, Robert W

2017-08-01

Academic health centers are facing a potential reduction in Medicare financing for graduate medical education (GME). Both the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform (Deficit Commission) have suggested cutting approximately half the funding that teaching hospitals receive for indirect medical education. Because of the effort that goes into teaching trainees, who are only transient employees, hospital executives often see teaching programs as a drain on resources. In light of the possibility of a Medicare cut to GME programs, we undertook an analysis to assess the financial risk of training programs to our institution and the possibility of saving money by reducing resident positions. The chief administrative officer, in collaboration with the hospital chief financial officer, performed a financial analysis to examine the possibility of decreasing costs by reducing residency programs at the University of Massachusetts Memorial Medical Center. Despite the real costs of our training programs, the analysis demonstrated that GME programs have a positive impact on hospital finances. Reducing or eliminating GME programs would have a negative impact on our hospital's bottom line.

A Survey of Managers' Access to Key Performance Indicators via HIS: The Case of Iranian Teaching Hospitals.

PubMed

Ahmadi, Maryam; Khorrami, Farid; Dehnad, Afsaneh; Golchin, Mohammad H; Azad, Mohsen; Rahimi, Shafei

2018-01-01

The challenges of using health information systems in developing countries are different from developed countries for various reasons such as infrastructure and data culture of organizations. The aim of this study is to assess managers' access to key performance indicators (KPI) via Hospital Information System (HIS) in teaching hospitals of Iran. All managers (Census method) of the four teaching hospitals affiliated to Hormozgan University of Medical Sciences (HUMS) were included in this study. KPIs which are linked to the strategic objectives of organizations were adopted from the strategic plan of HUMS. The questionnaire used in this study included three categories: Financial, Human Resources and clinical. One-sample t-test was used and the significant difference score was calculated for the acceptable level. We found that HIS cannot facilitate access to KPIs for managers in the main categories, but it was effective in two subcategories of income (p = 0.314) and salary (P = 0.289)). A study of barriers to the use of managers of HIS in hospitals is suggested.

The effect of transfers between health care facilities on costs and length of stay for pediatric burn patients.

PubMed

Myers, John; Smith, Michael; Woods, Charles; Espinosa, Claudia; Lehna, Carlee

2015-01-01

Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic impact on costs and LOS. As a result, unadjusted, pediatric hospitals are seen as being inefficient in treating pediatric burns. However, since pediatric hospitals see more severe cases, after adjustment, type of hospital did not influence costs and LOS. TBSA and transfer status were the predictors studied that independently affect costs and LOS.

A comparative study of the costliness of Manitoba hospitals.

PubMed

Shanahan, M; Loyd, M; Roos, N P; Brownell, M

1999-06-01

In light of ongoing discussions about health care policy, this study offered a method of calculating costs at Manitoba hospitals that compared relative costliness of inpatient care provided in each hospital. This methodology also allowed comparisons across types of hospitals-teaching, community, major rural, intermediate and small rural, as well as northern isolated facilities. Data used in this project include basic hospital information, both financial and statistical, for each of the Manitoba hospitals, hospital charge information by case from the State of Maryland, and hospital discharge abstract information for Manitoba. The data from Maryland were used to create relative cost weights (RCWs) for refined diagnostic related groups (RDRGs) and were subsequently adjusted for Manitoba length of stay. These case weights were then applied to cases in Manitoba hospitals, and several other adjustments were made for nontypical cases. This case mix system allows cost comparisons across hospitals. In general, hospital case mix costing demonstrated variability in hospital costliness, not only across types of hospitals but also within hospitals of the same type and size. Costs at the teaching hospitals were found to be considerably higher than the average, even after accounting for acuity and case mix.

Defining teaching hospitals' GME strategy in response to new financial and market challenges.

PubMed

Wray, J L; Sadowski, S M

1998-04-01

The authors present an overview of current graduate medical education (GME) issues, particularly the financial challenges to teaching hospitals resulting from the Balanced Budget and Tax Payer Relief Acts of 1997 and other recent market-driven factors. They describe in detail the nature of Medicare GME payments before and after the 1997 legislation, with specific examples, and explain the negative financial impact of the legislation and aspects of the legislation that are designed to alleviate that impact. Other factors influencing GME program size and composition are also discussed, including oversupplies or shortages of physicians, the concern that teaching hospitals are using public funds to train international medical graduates, changing training requirements, etc. The authors also describe a recent consulting assignment during which they assisted a major teaching hospital to develop a GME strategy that was responsive to the organization's mission and patients and that took into account future GME financing challenges. Detailed explanations are given of how the consultants analyzed the hospital's GME programs and finances, developed and ranked key institution-specific program criteria (strategic, organizational and operational, and financial), and, in consultation with all key stakeholders, formulated a GME strategy specific to the institution's needs. The authors conclude by cautioning that each institution's GME strategy will be different, but that it is important for institutions to develop such strategies to better face future challenges.

Clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland; a qualitative study.

PubMed

McSharry, Edel; Lathlean, Judith

2017-04-01

A preceptorship model of clinical teaching was introduced to support the new all-graduate nurse education programme in Ireland in 2002. Little is known about how this model impacts upon the pedagogical practices of the preceptor or student learning in clinical practice leading to question what constitutes effective teaching and learning in clinical practice at undergraduate level. This study aimed to explore the clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland and identify when best practice, based on current theoretical professional and educational principles occurred. A qualitative research study of a purposively selected sample of 13 students and 13 preceptors, working together in four clinical areas in one hospital in Ireland. Methods were semi-structured interviews, analysed thematically, complemented by documentary analysis relating to the teaching and assessment of the students. Ethical approval was gained from the hospital's Ethics Committee. Preceptor-student contact time within an empowering student-preceptor learning relationship was the foundation of effective teaching and learning and assessment. Dialoguing and talking through practice enhanced the students' knowledge and understanding, while the ability of the preceptor to ask higher order questions promoted the students' clinical reasoning and problem solving skills. Insufficient time to teach, and an over reliance on students' ability to participate in and contribute to practice with minimal guidance were found to negatively impact students' learning. Concepts such as cognitive apprenticeship, scaffolding and learning in communities of practice can be helpful in understanding the processes entailed in preceptorship. Preceptors need extensive educational preparation and support to ensure they have the pedagogical competencies necessary to provide the cognitive teaching techniques that foster professional performance and clinical reasoning. National competency based standards for preceptor preparation should be developed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized Veterans Health Administration and Medicare patients.

PubMed

Rosen, Amy K; Loveland, Susan A; Romano, Patrick S; Itani, Kamal M F; Silber, Jeffrey H; Even-Shoshan, Orit O; Halenar, Michael J; Teng, Yun; Zhu, Jingsan; Volpp, Kevin G

2009-07-01

Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.

The Teaching Nursing Home: Past Accomplishments and Future Directions.

ERIC Educational Resources Information Center

Lipsitz, Lewis A.

1996-01-01

Discusses the past, present, and future of the use of nursing homes as teaching sites. Suggests that teaching nursing homes must provide state-of-the-art care while avoiding the pitfalls that threaten academic hospitals; balance must be maintained between the benefits of teaching and the burdens placed on patients and staff. (JOW)

42 CFR 412.624 - Methodology for calculating the Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... defined in § 412.602. (4) Adjustments for teaching hospitals. For discharges on or after October 1, 2005... facilities that are teaching institutions or units of teaching institutions. This adjustment is made on a... location, and for teaching programs) as specified by CMS. The additional payment equals 80 percent of the...

42 CFR 415.206 - Services of residents in nonprovider settings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Services of Residents § 415.206 Services... equivalency residents in the calculation of a teaching hospital's resident count. The teaching physician rules on carrier payments in §§ 415.170 through 415.184 apply in these teaching settings. (b) Physician fee...

42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

Code of Federal Regulations, 2010 CFR

2010-10-01

... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in teaching...

A Course on Teaching for House Officers.

ERIC Educational Resources Information Center

Camp, Martha G.; And Others

1985-01-01

A Bowman Gray School of Medicine of Wake Forest University course on teaching is described that was developed specifically for hospital house officers so that they could become familiar with instructional principles and resources necessary to carry out their teaching responsibilities. (MLW)

Cataract surgery audit at an Australian urban teaching hospital.

PubMed

Kahawita, Shyalle K; Goggin, Michael

2015-08-01

To provide local data on visual acuity and surgical outcomes for cataract surgery performed in an Australian teaching hospital. Continuous audit over 7 years in a public teaching hospital. A total of 3740 eyes had cataract surgery performed at The Queen Elizabeth Hospital, South Australia, from May 2006 to September 2013. Visual acuity and complication rates were recorded for cataract surgery cases operated on between May 2006 and September 2013 on a digital database with data entry contemporaneous with final follow-up. Visual acuity and surgical complications. Of the patients, 91.4% achieved postoperative best-measured vision better than preoperative best-measured vision. The rate of posterior capsular tear was 2.59%, endophthalmitis was 0.11% and the overall complication rate was 11.7%. This audit is the first to document modern cataract surgery, overwhelmingly dominated by phacoemulsification in an Australian population and can be used to benchmark cataract surgery outcome in an urban Australian population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Management of a severe thoracoabdominal injury from motorized sawing machine in a temporary semi-urban university teaching hospital: a case report.

PubMed

Fente, B G; Nwagwu, C C; Ogulu, B N; Orukari, G I B; Okere, E O; Miss Ouserigha, O E

2012-01-01

Report of our experience and outcome of a case of severe thoracoabdominal injuries by motorized sawing machine (a rare cause) in a Semi-Urban temporary University Teaching Hospital. Literature review on the topic was done using Pubmed. Relevant journals and topics were also reviewed. Textbooks on relevant topics were also searched. A 25 year old male timber-cutter was traumatized by motorized sawing machine injuring the left half of the chest, upper abdomen, the left shoulder and left hand. It is an unusual presentation of penetrating thoracoabdominal injury. There was open pneumotharax, 3th-8th ribs fractures, diaphragmatic laceration, and eviscerations of abdominal contents without affecting other thoraco-abdominal organs. Urgent surgical intervention done was the only option. The challenges posed by severe motorized sawing machine thoraco-abdominal injuries in a Semi-Urban temporary University Teaching Hospital were successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.

Historical evidence for the origin of teaching hospital, medical school and the rise of academic medicine.

PubMed

Modanlou, H D

2011-04-01

Historical progression and the development of current teaching hospitals, medical schools and biomedical research originated from the people of many civilizations and cultures. Greeks, Indians, Syriacs, Persians and Jews, assembled first in Gondi-Shapur during the Sasanian empire in Persia, and later in Baghdad during the Golden Age of Islam, ushering the birth of current academic medicine.

Part II--IEPS Reports. The proper function of teaching hospitals within health systems.

PubMed

1998-01-01

The main points of the discussions from the international seminar organised by the World Health Organisation and the Institute for the Study of Health Policies (IEPS) were published in French by Flammarion Medecine-Sciences in the Collection entitled "The IEPS Reports" and in English by the WHO under the title "The Proper Function of Teaching Hospitals within Health Systems" (1995).

Characterization of the use of antiemetic agents in dogs with parvoviral enteritis treated at a veterinary teaching hospital: 77 cases (1997-2000).

PubMed

Mantione, Nina L; Otto, Cynthia M

2005-12-01

To characterize the use of antiemetic agents in dogs with canine parvovirus (CPV)-associated enteritis in a veterinary teaching hospital. Retrospective case series. 77 dogs with CPV-associated enteritis. Medical records of 560 dogs with confirmed CPV-associated enteritis that were admitted to a veterinary teaching hospital were reviewed. Exclusion criteria included vaccination against CPV infection within the preceding 2 weeks, hospitalization for < 24 hours or removal from the hospital against advice, or an incomplete record. Signalment, duration of hospitalization, and daily antiemetic administrations were assessed; WBC counts and clinical findings were used to classify dogs as having systemic inflammatory response syndrome (SIRS). 77 dogs were included in the study; 55 (71%) received antiemetics (53 received metoclopramide at least once). Seventy-one dogs survived, and 6 dogs died (all 6 received antiemetics). Compared with dogs that did not receive antiemetics, duration of hospitalization was significantly longer for antiemetic-treated dogs. Daily values of rectal temperature and heart and respiratory rates did not predict administration of antiemetics or duration of hospitalization; however, compared with survivors, SIRS developed more frequently among nonsurvivors. Assessment of emetic events recorded hourly for 17 dogs indicated that antiemetic treatment did not control emesis. Many dogs with CPV-associated enteritis had persistent vomiting despite antiemetic administration. The apparent difference in duration of hospitalization between antiemetic-treated dogs and other dogs may reflect a difference in disease severity between groups, although antiemetic-associated adverse events (e.g., signs of depression, hypotension, and immune modulation) may prolong hospitalization.

Field survey of dental manpower in Taiwan's hospitals.

PubMed

Cher, Tsang-Lie; Lai, Eddie Hsiang-Hua; Huang, Chiung-Shing; Lin, Chun-Pin

2012-06-01

In Taiwan, dental manpower in hospitals plays an important role in dental education other than clinical service. Questionnaires, as well as a field survey, were conducted to understand the situation of dental manpower in 2007 and 2008. During the period from 2007 to 2008, questionnaires about dental administration, clinical dental practice, dental education, dental manpower and dental facilities were mailed to the dental departments of 165 hospitals located around Taiwan; 134 completed the questionnaire and mailed it back. The field survey was also carried out by visiting hospitals, to collect and gather information at the local level. There were 102 hospitals within the 134 hospitals which accepted the field survey; the rate was 62.0%. In 2008, the number of dentists working in the hospitals was 1,421, which was approximately 13% of the number of total dentists in Taiwan (9672). Within the 1,421 dentists, 675 were attending staffs and 745 dentists were training residents. Within the 675 attending dentists, 510 (75.6%) had dental specialist certificates and 272 (40.3%) had teaching positions in dental schools. There were 382 dental interns (6(th) year undergraduate students) taking the training programs in hospitals, most of whom were trained in medical centers (342/382, 89.5%). Moreover, there were 888 dental assistants, 338 of whom were nurses and the other 550 were hospital self-trained personnel. Comparing the dental manpower of different types of hospitals in Taiwan, the medical center was the best, followed by the regional hospital and the district hospital was last. When comparing 2008 with 2002, the numbers of both dentists and auxiliary personnel in Taiwan's hospitals increased with years. Although there were still only 13% dentists working in the hospital, they were responsible for teaching young dentists and doing research in hospitals. In other words, the quality of clinical service, teaching, and research in hospitals would influence the development of young dentists. Copyright © 2012. Published by Elsevier B.V.

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

PubMed

Shortell, S M; Evashwick, C

1981-04-01

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

The evaluation of burnout and job satisfaction levels in residents of pediatrics.

PubMed

Anıl, Murat; Yurtseven, Ali; Yurtseven, İlkay; Ülgen, Mevlüt; Anıl, Ayşe Berna; Helvacı, Mehmet; Aksu, Nejat

2017-06-01

The aim of the study was to examine the level of job-related burnout and the level of job satisfaction among residents of pediatrics. A total of 102 residents of pediatrics who were trained in two Ministry of Health teaching and research hospitals and in two university hospitals in Izmir were included in the study. Demographic data (age, sex), lifestyle (living with parents or not, marital status, number of children) and professional characteristics (total time spent in profession, time spent in residency, number of night shifts per month, institution type: teaching hospital/university) were collected. Maslach Burnout Inventory (subscales: emotional exhaustion, desensitization, personal accomplishment) and Minnesota Satisfaction Questionnaire were used. High levels of emotional exhaustion and desensitization, and low levels of personal accomplishment and job satisfaction were found in residents of pediatrics. Low levels of emotional exhaustion in teaching and research hospitals and low levels of desensitization in university hospitals were determined (p<0.05). We found a positive correlation between age and job satisfaction levels and a negative correlation between age and emotional exhaustion levels (p<0.05). There were negative correlations between the length of time in education and desensitization and between the number of night shifts per month and desensitization (p<0.05). In residents of pediatrics, there is a high-level burnout and low-level of job satisfaction. Emotional exhaustion is more common in teaching and research hospitals and desensitization is more common in universities. Younger age, lower seniority, and the higher number of work-shift increases the burnout.

Opinions of clinical veterinarians at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections.

PubMed

Jacob, Megan E; Hoppin, Jane A; Steers, Nicola; Davis, Jennifer L; Davidson, Gigi; Hansen, Bernie; Lunn, Katharine F; Murphy, K Marcia; Papich, Mark G

2015-10-15

To determine opinions of faculty members with clinical appointments, clinical veterinarians, residents, and interns at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections. Cross-sectional survey. 71 veterinarians. An online questionnaire was sent to all veterinarians with clinical service responsibilities at the North Carolina State University veterinary teaching hospital (n = 167). The survey included 23 questions regarding demographic information, educational experiences, current prescribing practices, and personal opinions related to antimicrobial selection, antimicrobial use, restrictions on antimicrobial use, and antimicrobial resistance. Of the 167 veterinarians eligible to participate, 71 (43%) responded. When respondents were asked to rate their level of concern (very concerned = 1; not concerned = 5) about antimicrobial-resistant infections, most (41/70 [59%]) assigned a score of 1, with mean score for all respondents being 1.5. Most survey participants rated their immediate colleagues (mean score, 1.9) as more concerned than other veterinary medical professionals (mean score, 2.3) and their clients (mean score, 3.4). Fifty-nine of 67 (88%) respondents felt that antimicrobials were overprescribed at the hospital, and 32 of 69 (46%) respondents felt uncomfortable prescribing at least one class of antimicrobials (eg, carbapenems or glycopeptides) because of public health concerns. Findings indicated that veterinarians at this teaching hospital were concerned about antimicrobial resistance, thought antimicrobials were overprescribed, and supported restricting use of certain antimicrobial classes in companion animals. Findings may be useful in educating future veterinarians and altering prescribing habits and antimicrobial distribution systems in veterinary hospitals.

Exploring variability of teaching & supervision at clinical clerkship teaching sites

PubMed Central

Naeem, Naghma; Elzubeir, Margaret; Al-Houqani, Mohammad; Ahmed, Luai Awad

2018-01-01

Objective: To explore undergraduate medical students’ perception of variation in teaching and supervision at different clinical teaching sites. Methods: This descriptive cross-sectional study was conducted at the College of Medicine & Health Sciences, United Arab Emirates University, UAE during 2017. Four clinical teaching sites affiliated with CMHS were evaluated namely Shaikh Khalifa Medical City (SKMC), Ambulatory Care Clinics (AC), Tawam Hospital (TH) and Al-Ain Hospital (AH). An online questionnaire was administered to year five and six students. Results: The response rate was 84.4%. Overall perception of the students about their clinical clerkship experience was positive. SKMC was rated as the best teaching site with mean rating of 3.79±0.97-4.79±0.43. The highest rated item was clinical teacher’s promotion of critical thinking in students while the lowest rated item was the opportunity to take responsibility for patient care. Ambulatory Care site had a mean rating of 2.33±1.23-4.13±1.19. The highest rated item at this site was the clinical teacher encouraging students to ask questions and participate actively. At Tawam Hospital, the mean ratings ranged between 2.65±1.64-4.31±0.86 with highest rated item being ability of the students to see cases with positive clinical findings. At the Al-Ain Hospital, the mean rating was in the range of 2.79±1.45-3.81±1.11. The item rated highest here was the ability of students to see cases with positive clinical findings. The lowest rated item at all three sites was the availability of on-call rooms and lockers. Significant variability was seen across training sites in the clinical teacher’s ability to act as professional role models, the opportunity for students to apply their previous knowledge to patient care and to independently assess patients before discussion with teachers. Conclusion: This study tool highlights variation in clinical teaching and supervision at four clinical teaching sites. It provides specific, actionable information which can be utilized to deliver equitable learning experiences across clinical clerkships and teaching sites. It places emphasis on the fact that lack of physical facilities hampers clinical teaching and supervision, hence, on call rooms, lockers and separate rooms for independent student interaction with patients should be provided at all clinical teaching sites. PMID:29805410

Exploring variability of teaching & supervision at clinical clerkship teaching sites.

PubMed

Naeem, Naghma; Elzubeir, Margaret; Al-Houqani, Mohammad; Ahmed, Luai Awad

2018-01-01

To explore undergraduate medical students' perception of variation in teaching and supervision at different clinical teaching sites. This descriptive cross-sectional study was conducted at the College of Medicine & Health Sciences, United Arab Emirates University, UAE during 2017. Four clinical teaching sites affiliated with CMHS were evaluated namely Shaikh Khalifa Medical City (SKMC), Ambulatory Care Clinics (AC), Tawam Hospital (TH) and Al-Ain Hospital (AH). An online questionnaire was administered to year five and six students. The response rate was 84.4%. Overall perception of the students about their clinical clerkship experience was positive. SKMC was rated as the best teaching site with mean rating of 3.79±0.97-4.79±0.43. The highest rated item was clinical teacher's promotion of critical thinking in students while the lowest rated item was the opportunity to take responsibility for patient care. Ambulatory Care site had a mean rating of 2.33±1.23-4.13±1.19. The highest rated item at this site was the clinical teacher encouraging students to ask questions and participate actively. At Tawam Hospital, the mean ratings ranged between 2.65±1.64-4.31±0.86 with highest rated item being ability of the students to see cases with positive clinical findings. At the Al-Ain Hospital, the mean rating was in the range of 2.79±1.45-3.81±1.11. The item rated highest here was the ability of students to see cases with positive clinical findings. The lowest rated item at all three sites was the availability of on-call rooms and lockers. Significant variability was seen across training sites in the clinical teacher's ability to act as professional role models, the opportunity for students to apply their previous knowledge to patient care and to independently assess patients before discussion with teachers. This study tool highlights variation in clinical teaching and supervision at four clinical teaching sites. It provides specific, actionable information which can be utilized to deliver equitable learning experiences across clinical clerkships and teaching sites. It places emphasis on the fact that lack of physical facilities hampers clinical teaching and supervision, hence, on call rooms, lockers and separate rooms for independent student interaction with patients should be provided at all clinical teaching sites.

Mental Hospitals in India: Reforms for the future

PubMed Central

Daund, Muktesh; Sonavane, Sushma; Shrivastava, Amresh; Desousa, Avinash; Kumawat, Sanjay

2018-01-01

Mental hospitals are an integral part of mental health services in India. It is an interesting story how mental hospitals have responded to the challenges of contemporary period they were built in. It is beyond doubt that it is a progressive journey along with advances in mental health both in India and internationally. As in other countries, mental hospitals in India have responded to the social challenges, disparities, and poor resources of workforce and fiscal investment. Historically, there have been changes and three major reforms are needed, namely attempt to facilitate discharge and placing patients back into the family, introducing teaching and research in mental hospitals, and accountability to civil rights as per the requirements of the National Human Rights Commission. In this review, we explore the brief history of mental hospitals in India and examine the reforms in the clinical, administrative, and psychosocial areas of these hospitals and progress in teaching and research. We finally summarize and conclude the necessity and the relevance of mental hospitals in India akin to modern psychiatric practice. We believe that mental hospitals have an important and perhaps a central role in mental health services in India. Its modernization to address issues of long-term stay, burden on caregivers, stigma, research and teaching including undergraduate and postgraduate training, new curriculum, and training for nonpsychiatric professionals and primary care physicians are necessary components of the role of mental hospitals and responsibilities of both government and nongovernmental sectors. Last but not the least, it is obligatory for mental hospitals to ensure that evidence-based treatments are implemented and that the standard of care and respect of civil and human rights of the patients and families are provided while involving the people's participation in its functioning. PMID:29527055

[The effects of a new model of hospital management on undergraduate teaching of urology].

PubMed

Bogado S, Justo; Bogado C, Mariana; López C, Ilse; Rosselot J, Eduardo

2010-04-01

Since January 2005, a new model for hospital coordinated assistance was implanted in Chile, denominated Self Managed Hospitals in net, to improve resource use effectiveness and efficiency. This new design changed health care and teaching models. To analyze, understand and to reflect on how teachers and students of the Urology Unit of the Eastern Campus of the Faculty of Medicine in the University of Chile, perceive learning in this new hospital scenario. A qualitative methodology was used, including semi-structured interviews to chief teachers and focal groups of teachers and students. Also, a written structured questionnaire was answered by a group of 5th year students and interns. University teachers perceive that undergraduate learning is affected in the new hospital scenario. Students think that they have less opportunities to directly interact with patients, and therefore have fewer possibilities to take medical histories, perform physical examinations, and fewer occasions to discuss cases with their tutors. The new health system that runs hospitals under a network could jeopardize undergraduate teaching. This is the case for the Urology Service at Hospital and the corresponding Department of Specialties, where the dominant perception of teachers and a number of students is that their clinical learning is endangered by these innovations. To obtain the learning objectives of the undergraduate program in this subject, reorientation of their ambulatory practice and derivation skills must be rationally elaborated to improve students accomplishment.

Teaching hospital financial status and patient outcomes following ACGME duty hour reform.

PubMed

Navathe, Amol S; Silber, Jeffrey H; Small, Dylan S; Rosen, Amy K; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Zhu, Jingsan; Halenar, Michael J; Volpp, Kevin G

2013-04-01

To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 ("Post 1") or year 2 ("Post 2") versus the prereform period, were insignificant: Post 1 OR range 1.00-1.02 and Post 2 OR range 0.99-1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations. © Health Research and Educational Trust.

Perceptions regarding workplace hazards at a veterinary teaching hospital.

PubMed

Weaver, Dustin R; Newman, Lee S; Lezotte, Dennis C; Morley, Paul S

2010-07-01

To assess perceptions of personnel working at a veterinary teaching hospital regarding risks of occupational hazards and compare those perceptions with assessments made by occupational safety experts. Cross-sectional study. A representative sample of personnel (n = 90) working at the veterinary teaching hospital at Colorado State University and a panel of 3 occupational safety experts. Hospital personnel ranked perceptions of 14 physical, chemical, and biological workplace hazards and listed the injuries, illnesses, and near misses they had experienced. The expert panel provided consensus rankings of the same 14 hazards for 9 sections of the facility. Risk perceptions provided by the 2 sources were compared. Risk perceptions did not differ significantly between hospital personnel and the expert panel for most of the site-specific comparisons (94/126 [75%]). Personnel perceived greater risks for some physical hazards (loud noises, sharps injuries, and ionizing radiation) and some chemical or materials exposures (insecticides or pesticides and tissue digester emissions). In contrast, the expert panel perceived greater risks for physical hazards (bite or crush and restraining and moving animals), chemical exposures (anesthetic waste gas), and biological exposures (Toxoplasma gondii, antimicrobial-resistant bacteria, and allergens). Participants and safety experts had similar perceptions about occupational risks, but there were important differences where hospital personnel apparently overestimated or underappreciated the risks for workplace hazards. This type of study may be useful in guiding development of optimal workplace safety programs for veterinary hospitals.

Actual and Potential Effects of Medical Resident Coverage on Reimbursement for Inpatient Visits by Attending Physicians

PubMed Central

Shine, Daniel; Jessen, Laurie; Bajaj, Jasmeet; Pencak, Dorothy; Panush, Richard

2002-01-01

CONTEXT The impact of residents on hospital finance has been studied; there are no data describing the economic effect of residents on attending physicians. OBJECTIVE In a community teaching hospital, we compared allowable inpatient visit codes and payments (based on documentation in the daily progress notes) between a general medicine teaching unit and nonteaching general medicine units. DESIGN Retrospective chart review, matched cohort study. SETTING Six hundred fifty–bed community teaching hospital. PATIENTS Patients were discharged July 1998 through February 1999 from Saint Barnabas Medical Center. We randomly selected 200 patients in quartets. Each quartet consisted of a pair of patients cared for by residents and a pair cared for only by an attending physician. In each pair, 1 of the patients was under the care of an attending physician who usually admitted to the teaching service, and 1 was under the care of a usually nonteaching attending. Within each quartet, patients were matched for diagnosis-related group, length of stay, and discharge date. MAIN OUTCOME MEASURES We assigned the highest daily visit code justifiable by resident and attending chart documentation, determining relative value units (RVUs) and reimbursements allowed by each patient's insurance company. RESULTS Although more seriously ill, teaching-unit patients generated a mean 1.75 RVUs daily, compared with 1.84 among patients discharged from nonteaching units (P = .3). Median reimbursement, daily and per hospitalization, was similar on teaching and nonteaching units. Nonteaching attendings documented higher mean daily RVUs than teaching attendings (1.83 vs 1.76, P = .2). Median allowable reimbursements were $267 per case ($53 daily) among teaching attendings compared with $294 per case ($58 daily) among nonteaching attendings (Z = 1.54, P = .1). When only the resident note was considered, mean daily RVUs increased 39% and median allowable dollars per day 27% (Z = 4.21, P < .001). CONCLUSIONS Nonteaching attendings appear to document their visits more carefully from a billing perspective than do teaching attendings. Properly counter-documented, resident notes could substantially increase payments to attending physicians. PMID:12133156

Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness.

PubMed Central

Adams, E K; Houchens, R; Wright, G E; Robbins, J

1991-01-01

Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individual characteristics on hospital choice, using McFadden's conditional logit model. Some patient characteristics have not previously been accounted for in this type of analysis. In particular, the effect of a patient's complexity of illness (as measured by Disease Staging) on the choice of hospital is taken into account. The data consist of over 12,000 Medicare discharges in three overlapping rural market areas during 1986. The hospital choice set was aggregated into seven groups of urban and rural hospitals. Results indicate that rural Medicare beneficiaries tend to choose hospitals with a large scope of service and with teaching activity over those with a lower scope of service and no teaching activity, holding other factors constant. Distance is a deterrent to hospital choice, especially for older Medicare beneficiaries. The more complex cases tend to choose larger urban and rural hospitals over small rural hospitals more often than less complex cases do. PMID:1743970

The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada.

PubMed

Wang, Li; Grignon, Michel; Perry, Sheril; Chen, Xi-Kuan; Ytsma, Alison; Allin, Sara; Gapanenko, Katerina

2018-04-17

To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains. © Health Research and Educational Trust.

Interns' knowledge of clinical pharmacology and therapeutics after undergraduate and on-going internship training in Nigeria: a pilot study

PubMed Central

Oshikoya, Kazeem A; Senbanjo, Idowu O; Amole, Olufemi O

2009-01-01

Background A sound knowledge of pathophysiology of a disease and clinical pharmacology and therapeutics (CPT) of a drug is required for safe and rational prescribing. The aim of this study was therefore to assess how adequately the undergraduate CPT teaching had prepared interns in Nigeria for safe and rational prescribing and retrospectively, to know how they wanted the undergraduate curriculum to be modified so as to improve appropriate prescribing. The effect of internship training on the prescribing ability of the interns was also sought. Methods A total of 100 interns were randomly selected from the Lagos State University Teaching Hospital (LASUTH), Ikeja; Lagos University Teaching Hospital (LUTH), Idiaraba; General Hospital Lagos (GHL); the EKO Hospital, Ikeja; and Havana Specialist Hospital, Surulere. A structured questionnaire was the instrument of study. The questionnaire sought information about the demographics of the interns, their undergraduate CPT teaching, experience of adverse drug reactions (ADRs) and drug interactions since starting work, confidence in drug usage and, in retrospect; any perceived deficiencies in their undergraduate CPT teaching. Results The response rate was 81%. All the respondents graduated from universities in Nigeria. The ability of the interns to prescribe rationally (66, 81.4%) and safely (47, 58%) was provided by undergraduate CPT teaching. Forty two (51.8%) respondents had problems with prescription writing. The interns would likely prescribe antibiotics (71, 87.6%), nonsteroidal analgesics (66, 81.4%), diuretics (55, 67.9%), sedatives (52, 62.9%), and insulin and oral hypoglycaemics (43, 53%) with confidence and unsupervised. The higher the numbers of clinical rotations done, the more confident were the respondents to prescribe unsupervised (χ2 = 19.98, P < 0.001). Similarly, respondents who had rotated through the four major clinical rotations and at least a special posting (χ2 = 11.57, P < 0.001) or four major clinical rotations only (χ2 = 11.25, P < 0.001) were significantly more confident to prescribe drugs unsupervised. Conclusion Undergraduate CPT teaching in Nigeria appears to be deficient. Principles of rational prescribing, drug dose calculation in children and pharmacovigilance should be the focus of undergraduate CPT teaching and should be taught both theoretically and practically. Medical students and interns should be periodically assessed on prescribing knowledge and skills during their training as a means of minimizing prescribing errors. PMID:19638199

Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States.

PubMed

Zheng, Zhe; Zhang, Heng; Yuan, Xin; Rao, Chenfei; Zhao, Yan; Wang, Yun; Normand, Sharon-Lise; Krumholz, Harlan M; Hu, Shengshou

2017-06-01

Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals. Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P <0.001). This difference did not change significantly over time. In 2011 to 2013, there was no significant difference in in-hospital mortality among patients who underwent an isolated CABG surgery in large teaching and urban hospitals in China and the United States. The longer length of stay in China may represent an opportunity for improvement. © 2017 The Authors.

Correlation Between Soil Moisture and Dust Emissions: An Investigation for Global Climate Modeling

NASA Technical Reports Server (NTRS)

Fredrickson, Carley; Tan, Qian

2017-01-01

This work is using the newly available NASA SMAP soil moisture measurement data to evaluate its impact on the atmospheric dust emissions. Dust is an important component of atmospheric aerosols, which affects both climate and air quality. In this work, we focused on semi-desert regions, where dust emissions show seasonal variations due to soil moisture changes, i.e. in Sahel of Africa. We first identified three Aerosol Robotic Network (AERONET) sites in the Sahel (IER_Cinzana, Banizoumbou, and Zinder_Airport). We then utilized measurements of aerosol optical depth (AOD), fine mode fraction, size distribution, and single-scattering albedo and its wave-length dependence to select dust plumes from the available measurements We matched the latitude and longitude of the AERONET station to the corresponding SMAP data cell in the years 2015 and 2016, and calculated their correlation coefficient. Additionally, we looked at the correlation coefficient with a three-day and a five-day shift to check the impact of soil moisture on dust plumes with some time delay. Due to the arid nature of Banizoumbou and Zinder_Airport, no correlation was found to exist between local soil moisture and dust aerosol load. While IER_Cinzana had soil moisture levels above the satellite threshold of 0.02cm3/cm3, R-value approaching zero indicated no presence of a correlation. On the other hand, Ilorin demonstrated a significant negative correlation between aerosol optical depth and soil moisture. When isolating the analysis to Ilorin's dry season, a negative correlation of -0.593 was the largest dust-isolated R-value recorded, suggesting that soil moisture is driven the dust emission in this semi-desert region during transitional season.

The relationship of centralization, organizational culture and performance indexes in teaching hospitals affiliated to Tehran University of Medical Sciences.

PubMed

Nasirpour, Amir Ashkan; Gohari, Mahmoud Reza; Moradi, Saied

2010-01-01

One of the main problems in the efficiency and efficacy of an organization is its structural issue. Organizational culture is also considered as an effective factor in the performance of many organizations. The main goal of the present study was to determine the relationship of Centralization and organizational culture and performance indexes in Teaching Hospitals affiliated to Tehran University of Medical Sciences. This correlation study was performed in the year 2007. The population studied consisted of 4408 personnel from 13 hospitals among whom 441 subjects were selected and studied via a class sampling method. Data was compiled using a check list concerning the evaluation status of Centralization and another form concerning performance indexes as well as Robbin's organizational culture questionnaire. Data were obtained from the subjects by self answering and analyzed by using descriptive statistical indexes, T- test and Fisher's exact tests. Among the organizational culture indexes of the hospitals studied, control and organizational identity was better as compared to others (mean=3.32 and 3.30). Concerning the extent of Centralization in the hospitals studied, 53.85 % and 46.15 % were reported to have upper and lower organizational Centralization, respectively. Mean ratio of surgical operations to inpatients was 40%, the mean rate of admissions per active bed was 60.83, mean bed occupancy coefficient was 70.79%, average length of stay was 6.96 days, and mean net death rate was 1.41%. No significant correlation was seen between Centralization degree, organizational culture and performance indexes in teaching hospitals Tehran university of medical sciences. (with 95% confidence interval). Due to the fact that first grade Teaching hospitals use board certified members, expert personnel, and advanced equipments and because of the limitation of patients choice and, the extent of Centralization and many organizational culture components have no significant correlation with performance indexes of these hospitals. Further research regarding structure is suggested in the future.

Issues Regarding Graduate Medical Education. Hearing before the Subcommittee on Health of the Committee on Ways and Means. House of Representatives, One Hundred Fourth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Ways and Means.

The Subcommittee met in the first of a series of hearings on graduate medical education aimed at developing a new Medicare health professional education and teaching hospital payment policy. The hearing examined new policies for training future health professionals, future medical manpower needs, and the financing of teaching hospitals. Current…

Positioning academic medical centers and teaching hospitals to thrive in the next decade.

PubMed

Morris, D E

1985-06-01

Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification.

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

PubMed

Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten; Molden, Espen

2016-02-01

Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

[Pneumocystis pneumonia biological diagnosis at Fann Teaching Hospital in Dakar, Senegal].

PubMed

Dieng, Y; Dieng, T; Sow, D; Wlouhou, S; Sylla, K; Tine, R; Ndiaye, M; Ndiaye, J L; Faye, B; Faye, O; Gaye, O

2016-03-01

Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis. A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining. One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining. Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

42 CFR 415.164 - Payment to a fund.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.164 Payment to a fund. (a) General rules. Payment for certain voluntary services by physicians in teaching hospitals (as...

[Noise level in a care and teaching hospital institution].

PubMed

Mendoza-Sánchez, R S; Roque-Sánchez, R H; Moncada-González, B

1996-01-01

Noise in the environment is increasing over the years. Disturbances produced by noise are varied, some lead to serious health consequences. Noise level was registered in a teaching hospital. Levels in the wards were between 50 and 59 dB. In the Intensive Care Unit, main hallways and outpatients department levels were higher than 59 dB. Isolated peaks up to 90.0 dB (Pediatrics) were detected. The noise level recommended for a hospital is under 50.0 dB. We found that the principal source of noise came from the medical and nursing staff.

Work Satisfaction and Performance of Physicians in Pediatric Outpatient Clinics

PubMed Central

Nathanson, Constance A.; Becker, Marshall H.

1973-01-01

The sources and consequences of variations in work satisfaction are investigated in a study of approximately 100 physicians in six pediatric outpatient clinics, half of them associated with teaching hospitals and half with community hospitals. Measures of work satisfaction, role conflict, and performance are related to physicians' perceived internal and external reward values, controlling for clinic attributes and physicians' background characteristics, and differences between the two clinic types are documented. Implications of the study results for potential conflict between outpatient care and academic aims in teaching hospitals are discussed and avenues of possible further research are suggested. PMID:4705214

[Actual state and problems in neurology training at hospital].

PubMed

Fukutake, Toshio; Hashimoto, Yoichiro; Taniwaki, Takayuki; Toyoshima, Itaru; Amano, Takahiro; Aoki, Masashi; Yoshii, Fumihito; Inuzuka, Takashi; Kira, Jun-ichi

2014-01-01

To evaluate postgraduate neurological education, a questionnaire-based survey regarding junior and senior doctor-in-training and the Board Certification Examination in Neurology was carried out on the training supervisors of 690 insitutes, excluding 80 university hospitals. The institutes included 243 teaching hospitals, 326 semi-teaching hospitals and 121 education-associated institutes authorized by the Japanese Society of Neurology (JSN). The results were obtained from 388 institutes, and the response rate was 56.2%. The percentage of junior doctors-in-training that received training in neurology was 68.6% (the average of 2.1 months during 2 years). More than half of the institutes did not have any teaching programs for junior doctors-in-training who did not train in neurology. In senior doctors-in-training, the number of senior doctors-in-trainings per year per institute was 0.44 and was only able to experience limited types of disorders. Also, many institutes could not achieve training goals by the institutes themselves (56%). The problems were due to lack of teaching staffs and manpower, and there were many requests to the Society regarding training methods. As for the Board Certification Examination in Neurology by the Society, it was revealed that there were small number of candidates per year per institute, and over half of institutes could not sufficiently teach and support them. Most requests to the Society were regarding teaching seminars and hands-on courses, and some institutes asked small group meetings for arts and techniques of neurology to be held the Regional Society. In conclusion, there are problems that cannot be solved by individual institutes alone, and we need procedures for postgraduate training in neurology that is organized by the Regional and JSN working as the central organization.

Twenty-year trends in the utilization of Heller myotomy for achalasia in the United States.

PubMed

Haisley, Kelly R; Preston, Jennifer F; Dolan, James P; Diggs, Brian S; Hunter, John G

2017-08-01

Trends in the utilization of Heller myotomy for achalasia in the U.S. over time have not been previously described. Using the Nationwide Inpatient Sample (NIS) database, we analyzed patients undergoing Heller myotomy for achalasia over a 20-year period (1992-2011) to estimate rates of Heller myotomy, locations where the procedures were performed (rural, urban or teaching) and changes in technique (laparoscopic vs open) as well as outcomes of length of stay and in-hospital mortality. Over the last 20 years, the total number of Heller myotomies performed in the U.S. has increased (1576 cases in 1992 to 5046 cases in 2011, p = 0.001). These procedures are now being performed laparoscopically (0.9%-67.0%, p < 0.001) and at urban teaching hospitals (45.4%-77.1%, p < 0.001). In-hospital mortality has decreased (0.9%-0.3%, p = 0.006). Hospital length of stay has decreased from 7 days to 2 days (p < 0.001). These data show a trend of increasing utilization of laparoscopic Heller myotomy at teaching institutions with decreased in-hospital mortality and shorter LOS. Copyright © 2017. Published by Elsevier Inc.

The Relationship of Trust and Intent to Stay Among Registered Nurses at Jordanian Hospitals.

PubMed

Atiyeh, Huda Mohammad; AbuAlRub, Raeda Fawzi

2017-10-01

This study examined the relationship between the level of trust with immediate supervisor and the level of intent to stay at work among registered nurses (RNs) in Jordan and explored if there is a significant difference between RNs working in governmental- and university-affiliated teaching hospitals. Financial retention strategies are not feasible in low- and middle-income countries. This study investigated if the level of trust that RNs hold toward their immediate supervisors could affect their intent to stay at work, so as to be used as a nonfinancial strategy. A descriptive correlational design was used to examine this relationship among a convenience sample of 260 hospital nurses in Jordan. Descriptive and inferential statistics were used to analyze the data. When the level of trust increased, the level of intent to stay at work also increased. RNs working in governmental-affiliated teaching hospitals reported higher levels of trust and intent to stay at work than those working in university-affiliated teaching hospitals. The findings emphasized the positive effect of trust with immediate supervisor on the level of RNs' intent to stay. Building trust between RNs and their immediate supervisors could be an important retention strategy. © 2016 Wiley Periodicals, Inc.

Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities.

PubMed

Hoshiko, Sumi; Smith, Daniel; Fan, Cathyn; Jones, Carrie R; McNeel, Sandra V; Cohen, Ronald A

2014-05-01

Radiation exposure from medical sources now equals or exceeds that from natural background sources, largely attributable to a 20-fold increase in CT use since 1980. Increasing exposure to children and fetuses is of most concern due to their heightened susceptibility. More recently, CT use may be leveling or decreasing, but it is unclear whether this change is widespread or varies by type of institution. We sought to characterize trends in CT utilization in California hospitals and emergency departments among children and pregnant women, looking at different types of facilities, such as teaching, private, public and nonprofit institutions. We examined frequency of CT examinations by year from 229 facilities reporting CT usage in routinely collected California statewide data for 2005-2012. We modeled trends overall and by facility type. CT scans for pediatric and pregnant patient visits in the emergency department increased initially, then started to decline after 2008. Among hospital admissions, rates declined or leveled after 2005. In the emergency department, CT rates varied between types of facilities, with teaching hospitals reducing use sooner and more sharply than other types of facilities. CT utilization in California among children and pregnant women has begun to level or decline. Still, population exposure remains at historically high levels, warranting consideration of potential public health implications. Further examination of reasons for trends among hospital types, particularly how teaching hospitals have reduced rates of CT utilization, may help identify strategies for CT reduction without compromising patient care.

Financial Performance of Academic Health Center Hospitals, 1994-2000.

ERIC Educational Resources Information Center

Dobson, Allen; Koenig, Lane; Sen, Namrata; Ho, Silver; Gilani, Jawaria

This study examined how competitive market dynamics between 1994 and 2000 have affected the financial stability of Academic Health Center (AHC) hospitals and their ability to support their academic and social missions. It looked at the financial challenges facing AHC hospitals through a survey involving 1,138 teaching hospitals. Findings…

The impact of nonclinical factors on repeat cesarean section.

PubMed

Stafford, R S

1991-01-02

Nonclinical factors, including the setting in which health care takes place, influence clinical decisions. This research measures the independent effects of organizational and socioeconomic factors on repeat cesarean section use in California. Of 45,425 births to women with previous cesarean sections in 1986, vaginal birth after cesarean section occurred in 10.9%. Sizable nonclinical variations were noted. By hospital ownership, rates ranged from 4.9% (for-profit hospitals) to 29.2% (University of California). Variations also existed by hospital teaching level (nonteaching hospitals, 7.0%, vs formalized teaching hospitals, 23.3%); payment source (private insurance, 8.1%, vs indigent services, 25.2%); and obstetric volume (low-volume hospitals, 5.4%, vs high-volume hospitals, 16.6%). Multiple logistic regression demonstrated that these variables had independent effects after accounting for their overlapping influences and the effects of patient characteristics. The observed variations demonstrate the prominence of nonclinical factors in decision making and question the clinical appropriateness of current practice patterns.

Equipment and Energy Usage in a Large Teaching Hospital in Norway.

PubMed

Rohde, Tarald; Martinez, Robert

2015-01-01

This article presents a study of how equipment is used in a Norwegian University hospital and suggests ways to reduce hospital energy consumption. Analysis of energy data from Norway's newest teaching hospital showed that electricity consumption was up to 50% of the whole-building energy consumption. Much of this is due to the increasing energy intensity of hospital-specific equipment. Measured power and reported usage patterns for equipment in the studied departments show daytime energy intensity of equipment at about 28.5 kBTU/ft2 per year (90 kWh/m2 per year), compared to building code standard value of only 14.9 kBTU/ft2 (47 kWh/m2 per year) for hospitals. This article intends to fill gaps in our understanding of how users and their equipment affect the energy balance in hospitals and suggests ways in which designers and equipment suppliers can help optimize energy performance while maintaining quality in the delivery of health services.

Technical Efficiency of Hospitals in Tehran, Iran.

PubMed

Kakeman, Edris; Rahimi Forushani, Abbas; Dargahi, Hossein

2016-04-01

Nowadays, restriction on access and optimum use of resources is the main challenge of development in all organizations. Therefore, the aim of this study was to determine the technical efficiency and its factors, influencing hospitals of Tehran. This research was a descriptive-analytical and retrospective study conducted in 2014-2015. Fifty two hospitals with public, private, and social security ownership type were selected for this study. The required data was collected by a researcher-made check list in 3 sections of background data, inputs and outputs. The data was analyzed by DEAP 1.0.2, and STATA-13 technique. Seventeen (31/48) of hospitals had the efficiency score of 1 as the highest technical efficiency. The highest average score of efficiency was related to social security hospitals as 84.32, and then the public and private hospitals with the average of 84.29 and 79.64 respectively. Tobit regression results showed that the size, type of practice, and ownership of hospitals were effective on the degree of their technical efficiency. However, there was no significant correlation between teaching / non-teaching hospitals with technical efficiency. Establishment of competition system among hospitals, constitution of medium size hospitals and allocation of budget to hospitals based on national accreditation system are recommended.

[Brief history of the First Hospital of Harbin City (1913-2013)].

PubMed

Ji, Y; Li, Z P

2017-03-28

In 1913, after the Russian Prostitutes Sanatorium of Harbin Eastern Railway was received by the board of directors, they established the "Harbin City Board Hospital" and funded its expansion. In March 1926, the provisional Committee of the Harbin autonomous renamed the "City Board of First Hospital" to "The Public Hospital" . In November 1926, "The Public Hospital" was renamed as "Harbin Special Municipal Hospital" by the Harbin City Council and further funds were invested in its construction. In 1931, the Japanese invaded Northeast China, and controlled the "City Hospital" . In 1946, when Harbin was liberated, after the Communist's take-over of the Hospital, it developed sustainedly since then. From 1946-1949, The First Hospital of Harbin City dispatched manpower, material resources, and financial resources to support the people's Liberation Army, establishedthe medical service team, received and treated the wounded. From the 1930s, the Hospital was involved in the treatment of cholera, plague, scarlet fever, typhus and other infectious diseases, and participated in the medical rescue in Wenchuan of Sichuan and Xinjiang Aletai area. From 1928, the Hospital took over from Binjiang Hospital as the Teaching Hospital of Harbin Medical School, and later became the Harbin Medical University Teaching Hospital. It made contribution to the training of medical students.

Patient-perceived hospital service quality: an empirical assessment.

PubMed

Pai, Yogesh P; Chary, Satyanarayana T; Pai, Rashmi Yogesh

2018-02-12

Purpose The purpose of this paper is to appraise Pai and Chary's (2016) conceptual framework for measuring patient-perceived hospital service quality (HSQ). Design/methodology/approach A structured questionnaire was used to obtain data from teaching, public and corporate hospital patients. Several tests were conducted to assess the instrument's reliability and validity. Pai and Chary's (2016) nine dimensions for measuring HSQ were examined in this paper. Findings The tests confirm that Pai and Chary's (2016) conceptual framework is reliable and valid. The study also establishes that the nine dimensions measure HSQ. Practical implications The framework empowers managers to assess service quality in any hospital settings, corporate, public and teaching, using an approach that is superior to the existing HSQ scales. Originality/value This paper helps researchers and practitioners to assess HSQ from patient perspectives in any hospital setting.

Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran.

PubMed

Doshmangir, Leila; Rashidian, Arash; Jafari, Mehdi; Ravaghi, Hamid; Takian, Amirhossein

2016-04-21

In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called "hospital autonomy" policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals' performance, hoping to reduce government's costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals' organization, feasibility of policy implementation, actors and stakeholders' support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result.

An assessment of the effects of casemix funding on hospital utilisation: a Northern Territory perspective.

PubMed

Xiao, J; Lee, A; Vemuri, S R; Beaver, C

2000-01-01

This article is concerned with the methodological issues of assessing the effects of casemix funding on hospital utilisation. Time-series analysis and intervention analysis are proposed to ascertain the effects. It was found there had been a decline in average length of stay and number of bed-days, an increase in weighted separations for teaching and non-teaching hospitals, and no apparent increase of costliness in terms of a comprehensive casemix index. No evidence of decline in quality of care can be established in terms of readmission rates. The long-term effects of casemix funding, and specific issues in terms of the funding model used, patients and cost shifting between hospital services and community health services, remain to be studied.

[Evolution of clinical teaching at the medical college of Lisboa (I)].

PubMed

da Costa, J C

1990-01-01

Clinical teaching at Lisbon's Faculty of Medicine is analyzed in its two phases: 1. A period of stability and continuity of the institution (from 1911 to 1947) characterized by good rules in the selection of teachers: an impressive group of personalities (F. Gentil, Pulido Valente, Reynaldo dos Santos, Egas Moniz, A. Flores, Sobral Cid, Lopo de Carvalho, Gama Pinto, etc). At the some period a true University Hospital (of Santa Marta) provided clinical investigation (cerebral angiography and leucotomy, aortography and arteriography of the limbs, angiopneumography, endarterectomy) and the creation of new specialties (neurosurgery, vascular surgery, pneumology). 2. A period of instability due to a deleterious political intervention (from 1947 to the present day) responsible for the destruction of the structure and concept of a new teaching hospital (Hospital de Santa Maria). As a result of the socio-political situation conflicting law and vicious rules lead to an excess of non-selected teachers and an alarming increase of students, patients and medical doctors. A change from the present situation and a new concept of clinical teaching must be imagined.

[Evolution of clinical teaching at the Medical School of Lisbon (2)].

PubMed

da Costa, J C

1990-01-01

Clinical teaching at Lisbon's Faculty of Medicine is analyzed in its two phases: 1. A period of stability and continuity of the institution (from 1911 to 1947) characterized by good rules in the selection of teachers: an impressive group of personalities (F. Gentil, Pulido Valente, Reynaldo dos Santos, Egas Moniz, A. Flores, Sobral Cid, Lopo de Carvalho, Gama Pinto, etc). At the same period a true University Hospital (of Santa Marta) provided clinical investigation (cerebral angiography and leucotomy, aortography and arteriography of the limbs, angiopneumography, endarterectomy) and the creation of new specialities (neurosurgery, vascular surgery, pneumology) (Act. Méd. Port. 1990; 2: 109-114). 2. A period of instability due to a deleterious political intervention (from 1947 to the present day) responsible for the destruction of the structure and concept of a new teaching hospital (Hospital de Santa Maria). As a result of the socio-political situation conflicting laws and vicious rules lead to an excess of non-selected teachers and an alarming increase of students, patients and medical doctors A change from the present situation and a new concept of clinical teaching must be imagined.

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

PubMed

Younis, Mustafa Z

2006-01-01

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

In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals.

PubMed

Quintard, Hervé; Severac, Mathilde; Martin, Claude; Ichai, Carole

2015-08-01

The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Part I--IEPS (Institute for the Study of Health Policies) reports. The proper function of teaching hospitals within health systems.

PubMed

1997-01-01

The main points of the discussions from the international seminar organised by the World Health Organisation and the Institute for the Study of Health Policies (IEPS) were published in French by Flammarion Medecine-Sciences in the Collection entitled "The IEPS Reports" and in English by the WHO under the title "The Proper Function of Teaching Hospitals within Health Systems" (1995).

Who will pay for medical education in our teaching hospitals?

PubMed

Relman, A S

1984-10-05

Although most medical educators believe that education, research, and patient care are inseparable and essential to their academic mission, the educational component of this triad has never been given adequate, earmarked support. To fund educational programs, medical centers first relied on research grants and later on third-party payments intended for patient care. However, research money has long since ceased to be available for other purposes and recent federal cost containment measures have started to reduce payments for patient care. Teaching hospitals are threatened with loss of support not only for education, but for their capital improvements and care of the poor. Many institutions are now hoping to generate new income through business deals with for-profit health care corporations, but this effort probably will also fail and may compromise professional traditions. Teaching hospitals serve the public interest and will have to depend, at least in part, on public subsidy of their unavoidable extra costs.

Mentor Tutoring: An Efficient Method for Teaching Laparoscopic Colorectal Surgical Skills in a General Hospital.

PubMed

Ichikawa, Nobuki; Homma, Shigenori; Yoshida, Tadashi; Ohno, Yosuke; Kawamura, Hideki; Wakizaka, Kazuki; Nakanishi, Kazuaki; Kazui, Keizo; Iijima, Hiroaki; Shomura, Hiroki; Funakoshi, Tohru; Nakano, Shiro; Taketomi, Akinobu

2017-12-01

We retrospectively assessed the efficacy of our mentor tutoring system for teaching laparoscopic colorectal surgical skills in a general hospital. A series of 55 laparoscopic colectomies performed by 1 trainee were evaluated. Next, the learning curves for high anterior resection performed by the trainee (n=20) were compared with those of a self-trained surgeon (n=19). Cumulative sum analysis and multivariate regression analyses showed that 38 completed cases were needed to reduce the operative time. In high anterior resection, the mean operative times were significantly shorter after the seventh average for the tutored surgeon compared with that for the self-trained surgeon. In cumulative sum charting, the curve reached a plateau by the seventh case for the tutored surgeon, but continued to increase for the self-trained surgeon. Mentor tutoring effectively teaches laparoscopic colorectal surgical skills in a general hospital setting.

Curriculum at the Scholl College. Toward mainstream medical education.

PubMed

Becker, J H

1992-06-01

The Dr. William M. Scholl College of Podiatric Medicine in Chicago recently affiliated with a teaching hospital, the Illinois Masonic Medical Center, and used this alliance as a catalyst to effect a change in the clinical curriculum. The affiliation set up a joint venture to operate two clinics, one on Scholl College's traditional campus and one at the teaching hospital. At the hospital site, Scholl College students rotate through clinical externships in areas such as internal medicine, emergency medicine, and podiatric elective; podiatric and general medical residents assist in the tutelage of the students. At the Scholl College campus, beginning clinical students learn basic skills in a teaching clinic, then refine and further their skills in a comprehensive clinic under the guidance of faculty members. The faculty and administration at Scholl College have embraced the concept of mainstream medical education, and are striving to prepare podiatric physicians to practice 21st century medicine.

42 CFR 415.208 - Services of moonlighting residents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Services of Residents § 415.208 Services of... payment is made for services of a “teaching physician” associated with moonlighting services, and the time spent furnishing these services is not included in the teaching hospital's full-time equivalency count...

[Current situation of the education in gynaecology-obstetrics in France].

PubMed

Mesdag, V; Bot-Robin, V; Deruelle, P; Rubod, C

2016-03-01

To get an overview of the education offer for obstetrics trainees in France and to assess their satisfaction and requests regarding these classes and their access. Two questionnaires were sent over the country between September 2013 and July 2014. The first one was intended to the person in charge of teaching in each university hospital. We asked about the organization of teaching classes and access to simulation workshops. The second one was intended to the local representative of interns of the French association of gynaecology and obstetrics trainees (AGOF). We searched for overall satisfaction and requests concerning these learning classes. Over 28 university hospitals, 19 teachers (67.9 %) and 25 students (89.3 %) responded. Various ways and means of teaching are used throughout the country. Use of simulation workshop has spread in many university hospitals but their types and numbers are still very different among the organizations. Students are globally satisfied by the type, volume and content of their teaching classes. Simulation workshops are really appreciated by trainees and they wish more of them were organized. There is a great disparity in the ways of teaching in France. Gathering resources between the different centres may allow trainees to access to the same theoretical education and simulation workshops all over the country. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Clinical nurse preceptors' perception of e-portfolio use for undergraduate students.

PubMed

Chang, Chi-Ping; Lee, Ting-Ting; Mills, Mary Etta

Nursing schools and hospitals form partnerships to foster nursing education. Clinical nurse preceptors (CNPs) have a profound influence on nursing students' Last Mile practicum. Assisting preceptors to prepare students as future staff nurses has become a critical issue. E-portfolios utilize digital access and hyperlinks to integrate student knowledge, skills, and achievements with teaching assessment, process and evaluation. Based on the school-hospital partnership, preceptors require a teaching application to facilitate student learning. This descriptive qualitative study explored preceptors' perceptions regarding the use of e-portfolios. Data were collected from November 2012 to March 2013. One-on-one in-depth interviews with preceptors from different hospitals in Taiwan were examined using content analysis. Four key themes were revealed: utilizing students' learning experiences to design the CNP's teaching plan; a group-based discussion platform as a communication channel is needed; posting teaching content to facilitate student learning process; and, motivation usage factors in ease of use, sustaining use and win (student) - win (preceptor) outcomes. The use of e-portfolios allows preceptors to prepare for the learning needs of students. By considering preceptors' preferences, the design of e-portfolios may become more user friendly and useful for preceptors to expedite their teaching process and enhance student learning experiences. Copyright © 2016 Elsevier Inc. All rights reserved.

An Audit of Nursing Documentation at Three Public Hospitals in Jamaica.

PubMed

Lindo, Jascinth; Stennett, Rosain; Stephenson-Wilson, Kayon; Barrett, Kerry Ann; Bunnaman, Donna; Anderson-Johnson, Pauline; Waugh-Brown, Veronica; Wint, Yvonne

2016-09-01

Nursing documentation provides an important indicator of the quality of care provided for hospitalized patients. This study assessed the quality of nursing documentation on medical wards at three hospitals in Jamaica. This cross-sectional study audited a multilevel stratified sample of 245 patient records from three type B hospitals. An audit instrument which assessed nursing documentation of client history, biological data, client assessment, nursing standards, discharge planning, and teaching facilitated data collection. Descriptive statistics were conducted using IBM SPSS, Version 19 (IBM Inc., Armonk, NY, USA). Records from three hospitals (Hospital 1, n = 119, 48.6%; Hospital 2, n = 56, 22.9%; Hospital 3, n = 70, 28.6%) were audited. Documented evidence of the patient's chief complaint (81.6%), history of present illness (78.8%), past health (79.2%), and family health (11.0%) were noted; however, less than a third of the dockets audited recorded adequate assessment data (e.g., occupation or living accommodations of patients). The audit noted 90% of records had a physical assessment completed within 24 hr of admission and entries timed, dated, and signed by a nurse. Less than 5% of dockets had evidence of patient teaching, and 13.5% had documented evidence of discharge planning conducted within 72 hr of admission. This study highlights the weakness in nursing documentation and the need for increased training and continued monitoring of nursing documentation at the hospitals studied. Additional research regarding the factors that affect nursing documentation practice could prove useful. The study provides valuable information for the development of strategic risk management programs geared at improving the quality of care delivered to clients and presents an opportunity for nurse leaders to implement structured interventions geared at improving nursing documentation in Jamaica. In light of Jamaica's epidemiologic transition of chronic diseases, gaps in nurses' documentation of client assessment, patient teaching, and discharge planning should be addressed with urgency. Patient teaching and discharge planning enable the clients to participate more effectively in their health maintenance process. © 2016 Sigma Theta Tau International.

Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis.

PubMed

Medin, Emma; Anthun, Kjartan S; Häkkinen, Unto; Kittelsen, Sverre A C; Linna, Miika; Magnussen, Jon; Olsen, Kim; Rehnberg, Clas

2011-12-01

This paper estimates cost efficiency scores using the bootstrap bias-corrected procedure, including variables for teaching and research, for the performance of university hospitals in the Nordic countries. Previous research has shown that hospital provision of research and education interferes with patient care routines and inflates the costs of health care services, turning university hospitals into outliers in comparative productivity and efficiency analyses. The organisation of patient care, medical education and clinical research as well as available data at the university hospital level are highly similar in the Nordic countries, creating a data set of comparable decision-making units suitable for a cross-country cost efficiency analysis. The results demonstrate significant differences in university hospital cost efficiency when variables for teaching and research are entered into the analysis, both between and within the Nordic countries. The results of a second-stage analysis show that the most important explanatory variables are geographical location of the hospital and the share of discharges with a high case weight. However, a substantial amount of the variation in cost efficiency at the university hospital level remains unexplained.

Views of Family Medicine Trainees of a Teaching Hospital in Riyadh regarding their Hospital Rotations: A Qualitative Study.

PubMed

Alquaiz, Aljohara M; Abdulghani, Hamza M; Karim, Syed Irfan; Qureshi, Riaz

2013-01-01

To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine (FM) training program. This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees' views. The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts. Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn't reflect the views of trainees regarding its relevance to their day to day practice.

Teaching Hospital Financial Status and Patient Outcomes Following ACGME Duty Hour Reform

PubMed Central

Navathe, Amol S; Silber, Jeffrey H; Small, Dylan S; Rosen, Amy K; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Zhu, Jingsan; Halenar, Michael J; Volpp, Kevin G

2013-01-01

Objective To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. Data Sources/Study Setting Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. Study Design Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). Principal Findings All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 (“Post 1”) or year 2 (“Post 2”) versus the prereform period, were insignificant: Post 1 OR range 1.00–1.02 and Post 2 OR range 0.99–1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). Conclusions The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations. PMID:22862427

Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan

PubMed Central

Mirghani, Hyder O.; Elnour, Mohammed A.; Taha, Akasha M.; Elbadawi, Abdulateef S.

2016-01-01

Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05). Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications. PMID:27186156

Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan.

PubMed

Mirghani, Hyder O; Elnour, Mohammed A; Taha, Akasha M; Elbadawi, Abdulateef S

2016-01-01

Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05). Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.

Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study.

PubMed

Houchens, Nathan; Harrod, Molly; Moody, Stephanie; Fowler, Karen; Saint, Sanjay

2017-07-01

Clinician educators face numerous obstacles to their joint mission of facilitating high-quality learning while also delivering patient-centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds. An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015. Inpatient general medicine wards in 11 US hospitals, including university-affiliated hospitals and Veterans Affairs medical centers. Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners. In-depth, semi-structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds. Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient-centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels. This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds. © 2017 Society of Hospital Medicine

Academic season does not influence cardiac surgical outcomes at US Academic Medical Centers.

PubMed

Lapar, Damien J; Bhamidipati, Castigliano M; Mery, Carlos M; Stukenborg, George J; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav

2011-06-01

Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide. From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes. Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers. Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Financial Loss for Inpatient Care of Medicaid-Insured Children.

PubMed

Colvin, Jeffrey D; Hall, Matt; Berry, Jay G; Gottlieb, Laura M; Bettenhausen, Jessica L; Shah, Samir S; Fieldston, Evan S; Conway, Patrick H; Chung, Paul J

2016-11-01

Medicaid payments tend to be less than the cost of care. Federal Disproportionate Share Hospital (DSH) payments help hospitals recover such uncompensated costs of Medicaid-insured and uninsured patients. The Patient Protection and Affordable Care Act reduces DSH payments in anticipation of fewer uninsured patients and therefore decreased uncompensated care. However, unlike adults, few hospitalized children are uninsured, while many have Medicaid coverage. Therefore, DSH payment reductions may expose extensive Medicaid financial losses for hospitals serving large absolute numbers of children. To identify types of hospitals with the highest Medicaid losses from pediatric inpatient care and to estimate the proportion of losses recovered through DSH payments. This retrospective cross-sectional analysis evaluated Medicaid-insured hospital discharges of patients 20 years and younger from 23 states in the 2009 Kids' Inpatient Database. The dates of the analysis were March to September 2015. Hospitals were categorized as freestanding children's hospitals (FSCHs), children's hospitals within general hospitals, non-children's hospital teaching hospitals, and non-children's hospital nonteaching hospitals. Financial records of FSCHs in the data set were used to estimate the proportion of Medicaid losses recovered through DSH payments. Hospital financial losses from inpatient care of Medicaid-insured children (defined as the reimbursement minus the cost of care) were compared across hospital types. For our subsample of FSCHs, Medicaid-insured inpatient financial losses were calculated with and without each hospital's DSH payment. The 2009 Kids' Inpatient Database study population included 1485 hospitals and 843 725 Medicaid-insured discharges. Freestanding children's hospitals had a higher median number of Medicaid-insured discharges (4082; interquartile range [IQR], 3524-5213) vs non-children's hospital teaching hospitals (674; IQR, 258-1414) and non-children's hospital nonteaching hospitals (161; IQR, 41-420). Freestanding children's hospitals had the largest median Medicaid losses from pediatric inpatient care (-$9 722 367; IQR, -$16 248 369 to -$2 137 902). Smaller losses were experienced by non-children's hospital teaching hospitals (-$204 100; IQR, -$1 014 100 to $14 700]) and non-children's hospital nonteaching hospitals (-$28 310; IQR, -$152 370 to $9040]). Disproportionate Share Hospital payments to FSCHs reduced their Medicaid losses by almost half. Estimated financial losses from pediatric inpatients covered by Medicaid were much larger for FSCHs than for other hospital types. For children's hospitals, small anticipated increases in insured children are unlikely to offset the reductions in DSH payments.

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

PubMed

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

2013-01-01

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

Hospital pharmacy workforce in Brazil.

PubMed

Santos, Thiago R; Penm, Jonathan; Baldoni, André O; Ayres, Lorena Rocha; Moles, Rebekah; Sanches, Cristina

2018-01-04

This study aims to describe the distribution of the hospital pharmacy workforce in Brazil. Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19. The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals. This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.

Assessment of infection control practices in teaching hospitals of Quetta.

PubMed

Anwar, Muhammad; Majeed, Abdul; Saleem, Rana Muhammad; Manzoor, Farkhanda; Sharif, Saima

2016-08-01

To identify the gaps in infection control and prevention practices in teaching hospitals. This cross-sectional study was conducted at Bolan Medical Complex and Sandeman Medical College Hospital, Quetta, from August 2012 to January 2013.The study comprised members (n=7) of infection control committee who were interviewed through a self-developed, closed-ended questionnaire and their perception regarding infection control and prevention was recorded. Data was analysed using SPSS 16. Only 3(42.9%) of the committee members believed that the administrative factors for causing hospital-acquired infections were nurse-patient ratio. On the patient care side, 1(14.3%) participants at one of the hospitals attributed infections to antibiotic use, 5(71.4%) to invasive medical device and 1(14.3%) to other factors. Poor perception held by the members of infection control committee was the basic cause of bad outcome. Capacity-building of all the stakeholders is required.

Teaching Hospital and Other Issues Related to Graduate Medical Education. Hearing before the Subcommittee on Health of the Committee on Ways and Means. House of Representatives, One Hundred Fourth Congress, Second Session (June 11, 1196).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Ways and Means.

This document reports testimony presented on Medicare financing of graduate medical education, as proposed by the Balanced Budget Act of 1995. Witnesses included: (1) Timothy M. Golddfarb, Director, Healthcare Systems (Oregon), who noted the importance of graduate medical education funding to teaching hospitals; (2) Leo P. Brideau of Strong…

[An analysis of the questionnaire survey about the first year residency training in internal medicine in Peking Union Medical College Hospital].

PubMed

Zhang, Yun; Wang, Wei; Zeng, Xuejun; Huang, Xiaoming; Li, Hang; Zhang, Fengchun; Shen, Ti

2015-09-01

To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital. PGY-1 medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency. Forty-nine residents who completed their first year residency training participated in the survey with a 100% response rate. Before training, only a few had bedside (n = 18) and on-call experiences (n = 10). At the end of the one-year-training, all the residents (100%) considered themselves being improved to certain degrees, especially in clinical practice capability, and passed all the examinations. However, 53.1% and 8.2% of all the residents agreed that they need to improve their abilities in teaching (n = 26) and doctor-patient communication (n = 4), respectively. All residents hoped to get further improved by taking part in various forms of teaching activities, including experience summary/sharing and basic skills training. During the first year, 95.9% of them participated in all teaching activities in medicine actively. The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians. It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.

Practicing Hospitality in the Classroom

ERIC Educational Resources Information Center

Burwell, Rebecca; Huyser, Mackenzi

2013-01-01

This article explores pedagogical approaches to teaching students how to practice hospitality toward the other. Using case examples from the college classroom, the authors discuss the roots of Christian hospitality and educational theory on transformative learning to explore how students experience engaging with others after they have…

Teaching hospital performance: towards a community of shared values?

PubMed

Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

2014-01-01

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Physicians' Perceptions of Clinical Teaching: A Qualitative Analysis in the Context of Change

ERIC Educational Resources Information Center

Knight, Lynn V.; Bligh, John

2006-01-01

Background: Change is ubiquitous. Current trends in both educational and clinical settings bring new challenges to clinicians and have the potential to threaten the quality of clinical teaching. Objective: To investigate hospital specialists' perceptions of clinical teaching in the context of change. Design: Qualitative study using in-depth…

A Model for Analyzing Precepting in the Clinical Setting.

ERIC Educational Resources Information Center

Edelstein, Ronald A.

Teaching strategies used by precepters at a hospital-based family medicine center were investigated with seven preceptors who had previous teaching experiences and were board certified (six in family medicine). A third-year senior resident presented and discussed two patient cases to the preceptors in separate one-to-one teaching sessions, and the…

42 CFR 411.355 - General exceptions to the referral prohibition related to both ownership/investment and...

Code of Federal Regulations, 2013 CFR

2013-10-01

... medical center means an affiliated medical school, faculty practice plan, hospital, teaching facility... whose primary purpose is supporting the teaching mission of the academic medical center.) The components... § 411.355(e)(3)); and (D) Provides either substantial academic services or substantial clinical teaching...

42 CFR 411.355 - General exceptions to the referral prohibition related to both ownership/investment and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... medical center means an affiliated medical school, faculty practice plan, hospital, teaching facility... whose primary purpose is supporting the teaching mission of the academic medical center.) The components... § 411.355(e)(3)); and (D) Provides either substantial academic services or substantial clinical teaching...

42 CFR 411.355 - General exceptions to the referral prohibition related to both ownership/investment and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... medical center means an affiliated medical school, faculty practice plan, hospital, teaching facility... whose primary purpose is supporting the teaching mission of the academic medical center.) The components... § 411.355(e)(3)); and (D) Provides either substantial academic services or substantial clinical teaching...

42 CFR 411.355 - General exceptions to the referral prohibition related to both ownership/investment and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... medical center means an affiliated medical school, faculty practice plan, hospital, teaching facility... whose primary purpose is supporting the teaching mission of the academic medical center.) The components... § 411.355(e)(3)); and (D) Provides either substantial academic services or substantial clinical teaching...

42 CFR 411.355 - General exceptions to the referral prohibition related to both ownership/investment and...

Code of Federal Regulations, 2012 CFR

2012-10-01

... medical center means an affiliated medical school, faculty practice plan, hospital, teaching facility... whose primary purpose is supporting the teaching mission of the academic medical center.) The components... § 411.355(e)(3)); and (D) Provides either substantial academic services or substantial clinical teaching...

"Hospes": The Wabash Center as a Site of Transformative Hospitality

ERIC Educational Resources Information Center

Jones, Carolyn M.

2007-01-01

The Wabash Center for Teaching and Learning in Theology and Religion is a place of hospitality and its staff the epitome of the "good host." This essay explores the meaning of hospitality, including its problematic dimensions, drawing on a number of voices and texts: Jacques Derrida's "Of Hospitality"; Henri M. Nouwen's "Reaching Out: The Three…

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

PubMed Central

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

1995-01-01

OBJECTIVE. To determine if implementation of a PPS for Medicare hospital outpatient department (HOPD) services will have distributional consequences across hospital types and regions, this analysis assesses variation in service mix and the provision of high-technology services in the HOPD. DATA. HCFA's 1990 claims file for a 5 percent random sample of Medicare beneficiaries using the HOPD was merged, by hospital provider number, with various HCFA hospital characteristic files. STUDY DESIGN. Hospital characteristics examined are urban/rural location, teaching status, disproportionate-share status, and bed size. Two analyses of HOPD services are presented: mix of services provided and the provision of high-technology services. The mix of services is measured by the percentage of services in each of 14 type-of-service categories (e.g., medical visits, advanced imaging services, diagnostic testing services). Technology provision is measured by the percentage of hospitals providing selected high-technology services. FINDINGS/CONCLUSIONS. The findings suggest that the role hospital types play in providing HOPD services warrants consideration in establishing a PPS. HOPDs in major teaching hospitals and hospitals serving a disproportionate share of the poor play an important role in providing routine visits. HOPDs in both major and minor teaching hospitals are important providers of high-technology services. Other findings have implications for the structure of an HOPD PPS as well. First, over half of the services provided in the HOPD are laboratory tests and HOPDs may have limited control over these services since they are often for patients referred from local physician offices. Second, service mix and technology provision vary markedly among regions, suggesting the need for a transition to prospective payment. Third, the organization of service supply in a region may affect service provision in the HOPD suggesting that an HOPD PPS needs to be coordinated with payment policies in competing sites of care (e.g., ambulatory surgical centers). PMID:7721585

[Intensive care anaesthesia practice in the prison environment. Can a prisoner benefit from ambulatory anaesthesia].

PubMed

Manaouil, C; Montpellier, D; Sannier, O; Defouilloy, C; Radji, M; Jardé, O; Dupont, H

2010-01-01

Ambulatory anaesthesia is an anesthesia allowing the return of the patient home the same day. Even if the ambulatory hospitalization can, in theory, be applied to a prisoner as to every patient, caution is essential in such approach. Every anaesthetist reanimator doctor practicing in public hospitals may give care to patient prisoners while he is far from dominating all features of the prison world and while he must put down his therapeutic indications. The ambulatory anaesthesia in prison environment does not guarantee full security for the patient. Procedures could be set up between hospital complexes, caretakers practicing within penal middle (Unit of Consultation and Ambulatory Care [UCAC]) the prison service and hospital, the prefecture, to identify possible ambulatory interventions for a patient prisoner and to set up all guarantees of patient follow-up care in his return in prison environment. The development of interregional secure hospital units (ISHU) within teaching hospitals, allows an easier realization of interventions to the prisoners, but exists only in seven teaching hospitals in France. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Preschool and school programme in humanizing children's hospital stay.

PubMed

Kornhauser, P

1980-01-01

Introducing the article, the author emphasizes the importance of preschool and school instruction of the hospitalized children. Although this education and instruction programme differs in many particularities from that in normal schools, it should adhere to the same principles regarding the content and organization of the educational process and promote collaboration between the teaching staff in regular schools and teachers in hospitals. "Play therapy' is only one of the aspects of this activity and it is our task as pediatricians to provide a satisfactory number of full-time preschool and school teachers on the ward. Good planning in this field is of utmost importance. Suitable facilities for playing and learning are necessary, as well as toys, books and other possibilities for handcraft skills. Appropriate staff rooms should be provided for the hospital teaching staff. Today, the idea of hospital education and instruction programme is accepted and teachers and preschool teachers already work in some pediatric hospitals. Our task is, however, that kindergarten and school find their place in each children's hospital. This should also be enacted by law.

Medical Education, 1922-1924. Bulletin, 1925, No. 31

ERIC Educational Resources Information Center

Colwell, N. P.

1925-01-01

This bulletin documents: (1) a quarter century's progress in medical education, including inadequate governmental control over medical education, action by a voluntary agency, legal power v. publicity, greatly enlarged teaching plants, hospitals as related to medical education, hospital internships, and the hospital as an important educational…

Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.

PubMed

Barnett, Michael L; Olenski, Andrew R; Jena, Anupam B

2017-05-01

In the United States, hospitals receive accreditation through unannounced on-site inspections (ie, surveys) by The Joint Commission (TJC), which are high-pressure periods to demonstrate compliance with best practices. No research has addressed whether the potential changes in behavior and heightened vigilance during a TJC survey are associated with changes in patient outcomes. To assess whether heightened vigilance during survey weeks is associated with improved patient outcomes compared with nonsurvey weeks, particularly in major teaching hospitals. Quasi-randomized analysis of Medicare admissions at 1984 surveyed hospitals from calendar year 2008 through 2012 in the period from 3 weeks before to 3 weeks after surveys. Outcomes between surveys and surrounding weeks were compared, adjusting for beneficiaries' sociodemographic and clinical characteristics, with subanalyses for major teaching hospitals. Data analysis was conducted from January 1 to September 1, 2016. Hospitalization during a TJC survey week vs nonsurvey weeks. The primary outcome was 30-day mortality. Secondary outcomes were rates of Clostridium difficile infections, in-hospital cardiac arrest mortality, and Patient Safety Indicators (PSI) 90 and PSI 4 measure events. The study sample included 244 787 and 1 462 339 admissions during survey and nonsurvey weeks with similar patient characteristics, reason for admission, and in-hospital procedures across both groups. There were 811 598 (55.5%) women in the nonsurvey weeks (mean [SD] age, 72.84 [14.5] years) and 135 857 (55.5%) in the survey weeks (age, 72.76 [14.5] years). Overall, there was a significant reversible decrease in 30-day mortality for admissions during survey (7.03%) vs nonsurvey weeks (7.21%) (adjusted difference, -0.12%; 95% CI, -0.22% to -0.01%). This observed decrease was larger than 99.5% of mortality changes among 1000 random permutations of hospital survey date combinations, suggesting that observed mortality changes were not attributable to chance alone. Observed mortality reductions were largest in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks (adjusted difference, -0.38%; 95% CI, -0.74% to -0.03%), a 5.9% relative decrease. We observed no significant differences in admission volume, length of stay, or secondary outcomes. Patients admitted to hospitals during TJC survey weeks have significantly lower mortality than during nonsurvey weeks, particularly in major teaching hospitals. These results suggest that changes in practice occurring during periods of surveyor observation may meaningfully affect patient mortality.

Morbidity, mortality, and health care costs for patients undergoing spine surgery following the ACGME resident duty-hour reform: Clinical article.

PubMed

Babu, Ranjith; Thomas, Steven; Hazzard, Matthew A; Lokhnygina, Yuliya V; Friedman, Allan H; Gottfried, Oren N; Isaacs, Robert E; Boakye, Maxwell; Patil, Chirag G; Bagley, Carlos A; Haglund, Michael M; Lad, Shivanand P

2014-10-01

The Accreditation Council for Graduate Medical Education (ACGME) implemented resident duty-hour restrictions on July 1, 2003, in concern for patient and resident safety. Whereas studies have shown that duty-hour restrictions have increased resident quality of life, there have been mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay (LOS), and charges in patients who underwent spine surgery. The Nationwide Inpatient Sample was used to evaluate the effect of duty-hour restrictions on complications, mortality, LOS, and charges by comparing the prereform (2000-2002) and postreform (2005-2008) periods. Outcomes were compared between nonteaching and teaching hospitals using a difference-in-differences (DID) method. Results A total of 693,058 patients were included in the study. The overall complication rate was 8.6%, with patients in the postreform era having a significantly higher rate than those in the pre-duty-hour restriction era (8.7% vs. 8.4%, p < 0.0001). Examination of hospital teaching status revealed complication rates to decrease in nonteaching hospitals (8.2% vs. 7.6%, p < 0.0001) while increasing in teaching institutions (8.6% vs. 9.6%, p < 0.0001) in the duty-hour reform era. The DID analysis to compare the magnitude in change between teaching and nonteaching institutions revealed that teaching institutions to had a significantly greater increase in complications during the postreform era (p = 0.0002). The overall mortality rate was 0.37%, with no significant difference between the pre- and post-duty-hour eras (0.39% vs. 0.36%, p = 0.12). However, the mortality rate significantly decreased in nonteaching hospitals in the postreform era (0.30% vs. 0.23%, p = 0.0008), while remaining the same in teaching institutions (0.46% vs. 0.46%, p = 0.75). The DID analysis to compare the changes in mortality between groups revealed that the difference between the effects approached significance (p = 0.069). The mean LOS for all patients was 4.2 days, with hospital stay decreasing in nonteaching hospitals (3.7 vs. 3.5 days, p < 0.0001) while significantly increasing in teaching institutions (4.7 vs. 4.8 days, p < 0.0001). The DID analysis did not demonstrate the magnitude of change for each group to differ significantly (p = 0.26). Total patient charges were seen to rise significantly in the post-duty-hour reform era, increasing from $40,000 in the prereform era to $69,000 in the postreform era. The DID analysis did not reveal a significant difference between the changes in charges between teaching and nonteaching hospitals (p = 0.55). The implementation of duty-hour restrictions was associated with an increased risk of postoperative complications for patients undergoing spine surgery. Therefore, contrary to its intended purpose, duty-hour reform may have resulted in worse patient outcomes. Additional studies are needed to evaluate strategies to mitigate these effects and assist in the development of future health care policy.

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

PubMed

Yin, Yu-Chun

2013-06-01

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

Computer literacy enhancement in the Teaching Hospital Olomouc. Part I: project management techniques. Short communication.

PubMed

Sedlár, Drahomír; Potomková, Jarmila; Rehorová, Jarmila; Seckár, Pavel; Sukopová, Vera

2003-11-01

Information explosion and globalization make great demands on keeping pace with the new trends in the healthcare sector. The contemporary level of computer and information literacy among most health care professionals in the Teaching Hospital Olomouc (Czech Republic) is not satisfactory for efficient exploitation of modern information technology in diagnostics, therapy and nursing. The present contribution describes the application of two basic problem solving techniques (brainstorming, SWOT analysis) to develop a project aimed at information literacy enhancement.

Academic health center teaching hospitals in transition: a perspective from the field.

PubMed

Cyphert, S T; Colloton, J W; Levey, S

1997-01-01

A study of 11 Academic Health Center Teaching Hospitals (ATHs) in 11 states found that cost reduction programs, internal reorganizations, reengineering, benchmarking, and broadened entrepreneurial activity were prominent among the strategic initiatives reported in dealing with an increasingly turbulent environment. Although none of the ATHs had experienced negative net margins, we conclude that today's competitive healthcare system requires ATHs be reimbursed separately for their educational and other societally related costs to assist them in competing on a level playing fields.

Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.

PubMed

Mäkinen, M; Aune, S; Niemi-Murola, L; Herlitz, J; Varpula, T; Nurmi, J; Axelsson, A B; Thorén, A-B; Castrén, M

2007-02-01

Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme. Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered. All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (P<0.001), activating the AED without delay (P<0.01), setting the lower defibrillation electrode correctly (P<0.001) and using the correct resuscitation technique (P<0.05). The group-working skills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses. Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.

Salmonella enterica serovar Oranienburg outbreak in a veterinary medical teaching hospital with evidence of nosocomial and on-farm transmission.

PubMed

Cummings, Kevin J; Rodriguez-Rivera, Lorraine D; Mitchell, Katharyn J; Hoelzer, Karin; Wiedmann, Martin; McDonough, Patrick L; Altier, Craig; Warnick, Lorin D; Perkins, Gillian A

2014-07-01

Nosocomial salmonellosis continues to pose an important threat to veterinary medical teaching hospitals. The objectives of this study were to describe an outbreak of salmonellosis caused by Salmonella enterica serovar Oranienburg within our hospital and to highlight its unique features, which can be used to help mitigate or prevent nosocomial outbreaks in the future. We retrospectively analyzed data from patients that were fecal culture-positive for Salmonella Oranienburg between January 1, 2006, and June 1, 2011, including historical, clinical, and pulsed-field gel electrophoresis (PFGE) data. Salmonella Oranienburg was identified in 20 horses, five alpacas, and three cows during this time frame, with dates of admission spanning the period from August, 2006, through January, 2008. We consider most of these patients to have become infected through either nosocomial or on-farm transmission, as evidenced by molecular subtyping results and supportive epidemiologic data. Interpretation of PFGE results in this outbreak was challenging because of the identification of several closely related Salmonella Oranienburg subtypes. Furthermore, a high percentage of cases were fecal culture-positive for Salmonella Oranienburg within 24 h of admission. These patients initially appeared to represent new introductions of Salmonella into the hospital, but closer inspection of their medical records revealed epidemiologic links to the hospital following the index case. Cessation of this outbreak was observed following efforts to further heighten biosecurity efforts, with no known cases or positive environmental samples after January, 2008. This study demonstrates that a Salmonella-positive culture result within 24 h of admission does not exclude the hospital as the source of infection, and it underscores the important role played by veterinary medical teaching hospitals as nodes of Salmonella infection that can promote transmission outside of the hospital setting.

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

PubMed

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

2017-12-01

Quality anesthetic care is lacking in low- and middle-income countries (LMICs). Global health leaders call for perioperative capacity reports in limited-resource settings to guide improved health care initiatives. We describe a teaching hospital's resources and the national workforce and education in this LMIC capacity report. A prospective observational study was conducted at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, during 4 weeks in August 2016. Teaching hospital data were generated from observations of hospital facilities and patient care, review of archival records, and interviews with KATH personnel. National data were obtained from interviews with KATH personnel, correspondence with Ghana's anesthesia society, and review of public records. The practice of anesthesia at KATH incorporated preanesthesia clinics, intraoperative management, and critical care. However, there were not enough physicians to consistently supervise care, especially in postanesthesia care units (PACUs) and the critical care unit (CCU). Clean water and electricity were usually reliable in all 16 operating rooms (ORs) and throughout the hospital. Equipment and drugs were inventoried in detail. While much basic infrastructure, equipment, and medications were present in ORs, patient safety was hindered by hospital-wide oxygen supply failures and shortage of vital signs monitors and working ventilators in PACUs and the CCU. In 2015, there were 10,319 anesthetics administered, with obstetric and gynecologic, general, and orthopedic procedures comprising 62% of surgeries. From 2011 to 2015, all-cause perioperative mortality rate in ORs and PACUs was 0.65% or 1 death per 154 anesthetics, with 99% of deaths occurring in PACUs. Workforce and education data at KATH revealed 10 anesthesia attending physicians, 61 nurse anesthetists (NAs), and 7 anesthesia resident physicians in training. At the national level, 70 anesthesia attending physicians and 565 NAs cared for Ghana's population of 27 million. Providers were heavily concentrated in urban areas, and NAs frequently practiced independently. Two teaching hospitals provided accredited postgraduate training modeled after European curricula to 22 anesthesia resident physicians. While important limitations to capacity exist in Ghana, the overall situation is good compared to other LMICs. Many of the challenges encountered resulted from insufficient PACU and CCU provisions and few providers. Inadequate outcomes reporting made analysis and resolution of problem areas difficult. While many shortcomings stemmed from limited funding, strengthening physician commitment to overseeing care, ensuring oxygen supplies are uninterrupted, keeping ventilators in working order, and making vital signs monitors ubiquitously available are feasible ways to increase patient safety with the tools currently in place.

Hospitality Services. Curriculum Guide.

ERIC Educational Resources Information Center

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

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

Teaching Independent Eating to a Developmentally Handicapped Child Showing Chronic Food Refusal and Disruption at Mealtimes.

ERIC Educational Resources Information Center

MacArthur, Judy; And Others

1986-01-01

A successful intervention to establish independent eating behaviors in a developmentally handicapped, autistic-like three-year-old involved teaching appropriate behavior in a hospital setting (where he was being treated for dehydration and malnutrition) and then teaching his mother to implement the strategies at home. Skills were maintained at…

42 CFR 412.624 - Methodology for calculating the Federal prospective payment rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Adjustments for teaching hospitals. For discharges on or after October 1, 2005, CMS adjusts the Federal prospective payment on a facility basis by a factor as specified by CMS for facilities that are teaching institutions or units of teaching institutions. This adjustment is made on a claim basis as an interim payment...

Estimating the Effects of Teaching on the Costs of Inpatient Care: The Case of Radiology Treatments.

ERIC Educational Resources Information Center

Massell, Adele P.; Hosek, James R.

The report investigates production and the cost effects of teaching within hospital departments. Models of primary production show that the cost effects of teaching are determined by the salaries paid to students (including residents, interns, medical students, and technical trainees) and physicians, by the levels of student inputs used in…

How I teach evidence-based epidural information in a hospital and keep my job.

PubMed

Tumblin, Ann

2007-01-01

A childbirth educator reveals her dilemma in teaching evidence-based practice in today's high-tech birth climate. She focuses on strategies to use when sharing epidural information with expectant parents.

Special Issue of Teaching Ideas.

ERIC Educational Resources Information Center

Health Education (Washington D.C.), 1986

1986-01-01

This special issue contains teaching strategies and suggestions for health-related activities at all educational levels. A few of the topics addressed by the 21 articles are heart disease, testicular cancer, hospital stress, family life, and sexual responsibility. (MT)

Confirmatory Factor Analysis of the System for Evaluation of Teaching Qualities (SETQ) in Graduate Medical Training.

PubMed

Boerebach, Benjamin C M; Lombarts, Kiki M J M H; Arah, Onyebuchi A

2016-03-01

The System for Evaluation of Teaching Qualities (SETQ) was developed as a formative system for the continuous evaluation and development of physicians' teaching performance in graduate medical training. It has been seven years since the introduction and initial exploratory psychometric analysis of the SETQ questionnaires. This study investigates the validity and reliability of the SETQ questionnaires across hospitals and medical specialties using confirmatory factor analyses (CFAs), reliability analysis, and generalizability analysis. The SETQ questionnaires were tested in a sample of 3,025 physicians and 2,848 trainees in 46 hospitals. The CFA revealed acceptable fit of the data to the previously identified five-factor model. The high internal consistency estimates suggest satisfactory reliability of the subscales. These results provide robust evidence for the validity and reliability of the SETQ questionnaires for evaluating physicians' teaching performance. © The Author(s) 2014.

EBP partners: doctoral students and practicing clinicians bridging the theory-practice gap.

PubMed

Peck, Sydney; Lester, Jennifer; Hinshaw, Ginger; Stiles, Anne; Dingman, Sharon K

2009-01-01

The theory-practice gap is one component of the barriers to implementing evidence-based practice. Texas Woman's University College of Nursing and Presbyterian Hospital of Denton joined forces to bridge this gap, allowing doctoral students to provide educational offerings to practicing nurses. Through a Graduate Assistance in Areas of National Need grant, doctoral students completed supervised teaching practicums at the hospital, assisting the hospital to implement evidence-based practice with the ultimate goal of applying for Magnet status. The hospital benefited from the addition of research expertise and mentoring for the staff members. The students benefited from the opportunities to teach and to share knowledge with these clinical experts. This program has been successful in meeting the needs of both parties. Recommendations are given for other institutions interested in establishing similar relationships.

Development of a method for classification of hospitals based on results of the diagnosis-related groups and the principle of case-mix index.

PubMed

Shelf, Louay

2016-08-18

This research used DRGs and CMI to adjust medical waste production through the calculation of DRGs and CMI scores. These scores were used to assess the performances of teaching hospitals in Damascus. The linear correlations between these scores and the annual amount of waste and DRGs values were studied. The differences between the daily waste generations before and after the adjustment process were determined. Accordingly, the highest values of DRGs and CMI Scores were for the pediatric and Al Assad hospitals respectively. Among the teaching hospitals in Damascus, Al Assad has achieved the highest performance. Based on the results, the accuracy and homogeneity of medical waste generation rates were improved, which in turn leads to continuous improvement in the management of medical wastes.

Detection of CTX-M-15 Among Uropathogenic Escherichia coli Isolated from Five Major Hospitals in Tripoli, Libya.

PubMed

Zorgani, Abdulaziz; Almagatef, Asma; Sufya, Najib; Bashein, Abdulla; Tubbal, Abdullatif

2017-07-01

Multidrug resistance (MDR) and emergence of extended-spectrum β-lactamases (ESBLs) among uropathogenic Escherichia coli have been reported worldwide, but there was no information on the detection of bla CTX-M-15 in major teaching hospitals in Libya. The aim of the study was to investigate the occurrence of CTX-M-15 β-lactamases producers isolated from five teaching hospitals in Tripoli, Libya. A total of 346 urine samples were collected from hospitalized patients in five teaching hospitals with a diagnosis of urinary tract infection (UTI). Phenotypic confirmation of ESBLs was confirmed by E-test strip; all ESBL-producing E. coli isolates were screened for the bla CTX-M-15 gene. The distribution of ESBL-producing E. coli varied among the five hospitals. The highest proportion was identified in Tripoli Medical Centre (67.6%). There were extremely high proportions of isolates resistant to ceftriaxone, cefepime, and ceftazidime (93.0-100.0%) among ESBL producers compared to non-ESBL producers (2.2-4.7%). MDR was detected in 22.2% of isolates. The majority of isolates (85.9%) in which bla CTX-M-15 was identified were ESBL producers. There was a correlation ( p < 0.001) between expression of CTX-M-15 and resistance to ceftazidime. The isolation of MDR ESBL-producing uropathogens expressing the CTX-M-15 gene will limit the choices clinicians have to treat their patients with UTIs. Continued surveillance and implementation of efficient infection control measures are required.

Patient education process in teaching hospitals of Tehran University of Medical Sciences

PubMed Central

Seyedin, Hesam; Goharinezhad, Salime; Vatankhah, Soodabeh; Azmal, Mohammad

2015-01-01

Background: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. Methods: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. Results: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628). Conclusion: Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals. PMID:26478878

Bedside teaching and the acquisition of practical skills in mid-sixteenth-century Padua.

PubMed

Stolberg, Michael

2014-10-01

Very little is known to this point about the practical skills which sixteenth-century physicians needed and applied at the bedside and even less about how these skills were taught to students. Drawing on student notebooks and on printed collections of consilia by Padua professors, this paper outlines the different settings in which case-centered and, more specifically, bedside teaching was imparted in mid-sixteenth-century Padua. It describes the range of diagnostic and therapeutic skills that students acquired thanks to this hands-on training at the patient's bedside, from uroscopy and feeling the pulse to the manual exploration of the patient's abdomen, which, historians have wrongly believed, physicians performed very rarely or not at all, and surgical skills. Taking a closer look, more specifically, at the role of teaching in the Hospital of San Francesco in Padua, the paper provides evidence that not only Giovanna Battista da Monte but also at least one other mid-sixteenth-century professor, Antonio Fracanzani, made systematic use of the teaching opportunities which the hospital offered. Ultimately, the paper will argue that clinical teaching in the hospital did not differ fundamentally from forms of bedside teaching in the patients' homes, however. Both became increasingly popular in Padua and elsewhere at the time, reflecting a growing appreciation for the practical and sensory skills which future physicians needed in addition to theoretical learning if they hoped to be successful in the highly contested early modern medical marketplace. © The Author 2013. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Understanding resident ratings of teaching in the workplace: a multi-centre study.

PubMed

Fluit, Cornelia R M G; Feskens, Remco; Bolhuis, Sanneke; Grol, Richard; Wensing, Michel; Laan, Roland

2015-08-01

Providing clinical teachers with feedback about their teaching skills is a powerful tool to improve teaching. Evaluations are mostly based on questionnaires completed by residents. We investigated to what extent characteristics of residents, clinical teachers, and the clinical environment influenced these evaluations, and the relation between residents' scores and their teachers' self-scores. The evaluation and feedback for effective clinical teaching questionnaire (EFFECT) was used to (self)assess clinical teachers from 12 disciplines (15 departments, four hospitals). Items were scored on a five-point Likert scale. Main outcome measures were residents' mean overall scores (MOSs), specific scale scores (MSSs), and clinical teachers' self-evaluation scores. Multilevel regression analysis was used to identify predictors. Residents' scores and self-evaluations were compared. Residents filled in 1,013 questionnaires, evaluating 230 clinical teachers. We received 160 self-evaluations. 'Planning Teaching' and 'Personal Support' (4.52, SD .61 and 4.53, SD .59) were rated highest, 'Feedback Content' (CanMEDS related) (4.12, SD .71) was rated lowest. Teachers in affiliated hospitals showed highest MOS and MSS. Medical specialty did not influence MOS. Female clinical teachers were rated higher for most MSS, achieving statistical significance. Residents in year 1-2 were most positive about their teachers. Residents' gender did not affect the mean scores, except for role modeling. At group level, self-evaluations and residents' ratings correlated highly (Kendall's τ 0.859). Resident evaluations of clinical teachers are influenced by teacher's gender, year of residency training, type of hospital, and to a lesser extent teachers' gender. Clinical teachers and residents agree on strong and weak points of clinical teaching.

Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran.

PubMed

Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

2015-11-01

Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates' competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman's teaching hospitals located in southeastern Iran. This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman's teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. In all five dimensions of quality, gaps were observed between students' perceptions and expectations as follows: Assurance (mean = -1.18), Responsiveness (-1.56), Empathy (-1.4), Reliability (-1.27), and Tangibles (-1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). The clinical services provided by teaching hospitals in the study did not meet the students' expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do.

Socioeconomic factors affecting patients’ utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia

PubMed Central

Alsubaie, Abdulaziz M.; Almohaimede, Khaled A.; Aljadoa, Abdulrahman F.; Jarallah, Osamah J.; Althnayan, Yasser I.; Alturki, Yousef A.

2016-01-01

Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services. PMID:26929723

Case study: the Stanford University School of Medicine and its teaching hospitals.

PubMed

Pizzo, Philip A

2008-09-01

There is wide variation in the governance and organization of academic health centers (AHCs), often prompted by or associated with changes in leadership. Changes at AHCs are influenced by institutional priorities, economic factors, competing needs, and the personality and performance of leaders. No organizational model has uniform applicability, and it is important for each AHC to learn what works or does not on the basis of its experiences. This case study of the Stanford University School of Medicine and its teaching hospitals--which constitute Stanford's AHC, the Stanford University Medical Center--reflects responses to the consequences of a failed merger of the teaching hospitals and related clinical enterprises with those of the University of California-San Francisco School of Medicine that required a new definition of institutional priorities and directions. These were shaped by a strategic plan that helped define goals and objectives in education, research, patient care, and the necessary financial and administrative underpinnings needed. A governance model was created that made the medical school and its two major affiliated teaching hospitals partners; this arrangement requires collaboration and coordination that is highly dependent on the shared objectives of the institutional leaders involved. The case study provides the background factors and issues that led to these changes, how they were envisioned and implemented, the current status and challenges, and some lessons learned. Although the current model is working, future changes may be needed to respond to internal and external forces and changes in leadership.

Medical student teaching in the private sector - An overlooked opportunity?

PubMed

Galletly, Cherrie A; Turnbull, Carol; Goldney, Robert

2016-04-01

One in four psychiatric beds in Australia are located in the private sector, and more than half of Australian psychiatrists undertake private work. However, nearly all medical student teaching in psychiatry takes place in public hospitals. This paper explores the learning opportunities in the private sector. We report the South Australian experience; medical students have been taught in Ramsay Health Care (SA) Mental Health facilities for more than 23 years. Our experience demonstrates that clinical teaching in private hospitals is sustainable and well accepted by students, patients and clinicians. The private sector has the capacity to make a much greater contribution to medical student training in psychiatry. © The Royal Australian and New Zealand College of Psychiatrists 2016.

The learner's perspective in GP teaching practices with multi-level learners: a qualitative study.

PubMed

Thomson, Jennifer S; Anderson, Katrina; Haesler, Emily; Barnard, Amanda; Glasgow, Nicholas

2014-03-19

Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner. A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators. 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners' perspective.Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed "GP consultant teacher"). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning. Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.

The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study

PubMed Central

2014-01-01

Background Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner. Methods A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators. Results 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used. A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners’ perspective. Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed “GP consultant teacher”). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning. Conclusions Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers. PMID:24645670

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

PubMed

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

1995-03-01

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

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

PubMed

Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh

2014-03-30

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

Involving patients in medical education: ethical issues experienced by Syrian patients.

PubMed

Bashour, H; Sayed-Hassan, R; Koudsi, A

2012-11-01

Patients' involvement and their willingness to cooperate in clinical teaching is a vital element of medical education. Clinical teaching at the Faculty of Medicine of Damascus University relies heavily on inpatients at teaching hospitals but also on patients brought to teaching rooms. The purpose of this study was to identify patients' experiences and their attitudes toward the involvement of medical students in clinical consultations within teaching rooms conducted mainly for students' benefit. In-depth interviews were carried out by a sociologist using an interview guide with 14 patients whose clinical cases were presented to a large group of students in the teaching room at Damascus University teaching hospitals. Data analysis involved content analysis. Main themes were identified with negative ethical aspects, such as the lack of patient's involvement in decision making and approving to be part of clinical teaching. Risk and benefits were experienced by patients and identified in their experiences. Some felt that they were treated inhumanely and with a lack of dignity. Patients nevertheless felt a responsibility to be part of the teaching process. They expressed their positive attitudes towards involvement in the teaching process to serve medical students as well as the greater community. Findings provide perspectives and insights into the current clinical teaching at Damascus University Faculty of Medicine. The findings highlight the need in our institution to carry out medical education involving patients in a more ethical manner. Medical students and their teachers need more training in the ethical involvement of patients in students' learning process, as well as the need to better regulate patients' involvement in education.

A study on job satisfaction among clinical and non-clinical hospital staff in a teaching hospital in Lagos, Nigeria.

PubMed

Coker, O O; Coker, A O; Onuoha, B

2011-12-01

Previous studies had demonstrated that continuous and effective productivity of hospital staff are linked to job satisfaction and only those who are satisfied with their job can be maximally effective and productive. This cross-sectional descriptive survey was designed to determine the levels of job satisfaction among various groups of health care professionals working in a teaching hospital in Lagos, Nigeria. Two hundred clinical and non-clinical hospital staff were invited to take part in the study. They completed a sociodemographic questionnaire and the Job Descriptive Index (JDI). The results indicated that majority clinical and non-clinical staff were satisfied with their jobs as regards the parameters of the JDI compared with those not satisfied with their jobs. The government and health policy makers should continue to pay attention to boost job morale and satisfaction of medical health workers to continue to make them to be satisfied with their job.

Assessing Change in the Teaching Practice of Faculty in a Faculty Development Program for Primary Care Physicians: Toward a Mixed Method Evaluation Approach.

ERIC Educational Resources Information Center

Pinheiro, Sandro O.; Rohrer, Jonathan D.; Heimann, C. F. Larry

This paper describes a mixed method evaluation study that was developed to assess faculty teaching behavior change in a faculty development fellowship program for community-based hospital faculty. Principles of adult learning were taught to faculty participants over the fellowship period. These included instruction in teaching methods, group…

Changes in Admissions, Length of Stay, and Discharge Diagnoses at a Major University-Affiliated Teaching Hospital: Implications for Medical Education.

ERIC Educational Resources Information Center

Rosevear, G. Craig; Gary, Nancy E.

1989-01-01

A study of changes in hospital care suggests that for medical students and residents to be exposed to the same case mix of clinical disorders seen in the hospital in 1980, they must have experience in the ambulatory setting. (Author/MSE)

A Cost Analysis Study of the Radiography Program at Middlesex Hospital Using Shock's Analysis Model.

ERIC Educational Resources Information Center

Spence, Weymouth

Federal and state governments want to decrease payments for medical education, and other payers are trying to restrict payouts to direct and necessary patient care services. Teaching hospitals are increasing tuition and fees, reducing education budgets and, in many instances, closing education programs. Hospital administrators are examining the…

42 CFR 409.26 - Transfer agreement hospital services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... hospital services. (a) Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15) as posthospital SNF care, if the intern or resident...

42 CFR 409.26 - Transfer agreement hospital services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... hospital services. (a) Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15) as posthospital SNF care, if the intern or resident...

42 CFR 409.26 - Transfer agreement hospital services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... hospital services. (a) Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15) as posthospital SNF care, if the intern or resident...

42 CFR 409.26 - Transfer agreement hospital services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... hospital services. (a) Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15) as posthospital SNF care, if the intern or resident...

42 CFR 409.26 - Transfer agreement hospital services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... hospital services. (a) Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15) as posthospital SNF care, if the intern or resident...

Blended E-learning in a Web-based virtual hospital: a useful tool for undergraduate education in urology.

PubMed

Horstmann, M; Renninger, M; Hennenlotter, J; Horstmann, C C; Stenzl, A

2009-08-01

E-learning is a teaching tool used successfully in many medical subspecialties. Experience with its use in urology, however, is scarce. We present our teaching experience with the INMEDEA simulator to teach urological care to medical students. The INMEDEA simulator is an interactive e-learning system built around a virtual hospital which includes a department of urology. It allows students to solve virtual patient cases online. In this study, students were asked to prepare two urological cases prior to discussion of the cases in small groups. This blended teaching approach was evaluated by students through anonymous questionnaires. Of 70 4th year medical students 76% judged this teaching method as good or very good. Eighty-seven percent felt that it offered a good way to understand urological diseases better and 72% felt that learning with this method was fun. Nevertheless, 30 out of 70 free text statements revealed that further improvements of the program, including an easier and more comfortable navigation and a faster supply of information are necessary. Virtual patient cases offer a practicable solution for teaching based on problem solving in urology with a high acceptance rate by students.

Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals.

PubMed

Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

2014-01-01

The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a "high" score on at least 2 of the three dimensions of MBI. In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout.

Confirmation of Expectations and Satisfaction with Hospital Information Systems: A Nursing Perspective.

PubMed

Ayatollahi, Haleh; Langarizadeh, Mostafa; Chenani, Habib

2016-10-01

This study aimed to compare nurses' satisfaction with, and expectations of, hospital information systems in two teaching hospitals. This was a survey study, which was completed in 2014. The potential participants were 267 nurses who worked in two teaching hospitals and used the same hospital information system. Data were collected using two questionnaires. Both questionnaires were examined in terms of content validity and reliability. The results showed that, for a majority of nurses, their expectations of the system were not met in either hospital. Moreover, there was a significant association between the nurses' expectations and the perceived usefulness of the systems ( p < 0.001), between the nurses' expectations and their satisfaction with the systems ( p < 0.001), and between the perceived usefulness and nurses' satisfaction with the systems ( p < 0.001). The results suggested that, apart from the technical issues of implementing clinical information systems, non-technical factors should be taken into account. Among them, the nature of clinical tasks and the organizational culture require more attention to allow a successful system to be designed and implemented.

The diffusion of Magnet hospital recognition.

PubMed

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

2011-01-01

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

Bibliography. Citations Obtained through the National Library of Medicine's MEDLARS Program.

ERIC Educational Resources Information Center

Journal of Medical Education, 1980

1980-01-01

Approximately 250 citations on medical education are presented. Topics include professional continuing education, student evaluation, graduate medical education, medical schools, specialization, teaching hospitals, teaching methods and materials, educational history, medical students, faculty, computers, curriculum, accreditation, and medical…

Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

PubMed

Nwankwo, Okechukwu Emmanuel

2008-04-01

Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004.

[Public health education integrated in hospital. An internship proposal, "Medical information and pharmacology"].

PubMed

Boulay, F; Chevallier, T; Staccini, P; Chichmanian, R M

1997-06-01

According to a recent circular reforming french medical studies, we propose a teaching of medical information and pharmacology in situ within hospital instructions. Students could acquire an investigation methodology on the medicine economy. It will cover in four sessions the succeeding stages of medical information processing and be subject to an assessment: case studies and appreciation on student's, instruction record. By combining public health teaching with clinical practice, our project promotes its development in contact with other learnings and activities such as clinical research.

Relationship between organizational structure and creativity in teaching hospitals.

PubMed

Rezaee, Rita; Marhamati, Saadat; Nabeiei, Parisa; Marhamati, Raheleh

2014-07-01

Organization structure and manpower constitute two basic components of anorganization and both are necessary for stablishing an organization. The aim of this survey was to investigate the type of the organization structure (mechanic and organic) from viewpoint of senior and junior managers in Shiraz teaching hospitals and creativity in each of these two structures. In this cross-sectional and descriptive-analytic study, organization structure and organizational creation questionnaires were filled out by hospital managers. According to the statistical consultation and due to limited target population, the entire study population was considered as sample. Thus, the sample size in this study was 84 (12 hospitals and every hospital, n = 7). For data analysis, SPSS 14 was used and Spearman correlation coefficient and t-test were used. RESULTS showed that there is a negative association between centralization and complexity with organizational creation and its dimensions. Also there was a negative association between formalization and 4 organizational creation dimensions: reception change, accepting ambiguity, abet new view and less control outside (p=0.001). The results of this study showed that the creation in hospitals with organic structure is more than that in hospitals with mechanic structure.

Relationship between organizational structure and creativity in teaching hospitals

PubMed Central

REZAEE, RITA; MARHAMATI, SAADAT; NABEIEI, PARISA; MARHAMATI, RAHELEH

2014-01-01

Introduction: Organization structure and manpower constitute two basic components of anorganization and both are necessary for stablishing an organization. The aim of this survey was to investigate the type of the organization structure (mechanic and organic) from viewpoint of senior and junior managers in Shiraz teaching hospitals and creativity in each of these two structures. Methods: In this cross-sectional and descriptive-analytic study, organization structure and organizational creation questionnaires were filled out by hospital managers. According to the statistical consultation and due to limited target population, the entire study population was considered as sample. Thus, the sample size in this study was 84 (12 hospitals and every hospital, n = 7). For data analysis, SPSS 14 was used and Spearman correlation coefficient and t-test were used. Results: Results showed that there is a negative association between centralization and complexity with organizational creation and its dimensions. Also there was a negative association between formalization and 4 organizational creation dimensions: reception change, accepting ambiguity, abet new view and less control outside (p=0.001). Conclusion: The results of this study showed that the creation in hospitals with organic structure is more than that in hospitals with mechanic structure. PMID:25512934

[Hospital and organizational dynamics of the National Institutes of Health. Relationship with high-specialty hospitals].

PubMed

Gabilondo Navarro, Fernando

2011-01-01

In order to primarily encourage medical care, teaching and research activities in high specialty regional hospitals (HSRH), a number of strategies are explored to increase the number of patients cared for, improve the quality and timeliness of care and successfully integrate the function of these hospitals within the care and patient flow model expected by the Federal Government. These strategies include the use of information technology systems as platforms for telemedicine, including tele-imaging, tele-education and telepathology, thus fostering the quality and timeliness of medical care and narrow the relationship between these HSRH with the National Health Institutes. Other strategies such as extra-mural surgery, specific theme workshops, resident rotations, the use of simulators and "Science Weeks" are also explored so as to promote teaching and research. Finally, the reference and counter-reference system and the introduction of pension programs are evaluated as possible strategies supporting resource management.

Computer-assisted instruction: a library service for the community teaching hospital.

PubMed

McCorkel, J; Cook, V

1986-04-01

This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital.

Assessment of common interventions and perceived barriers to pressure ulcer prevention in southwest Nigeria.

PubMed

Ilesanmi, Rose Ekama; Olabisi, Prisca

2014-01-01

We examined the interventions used by nurses to prevent pressure ulcers in 3 hospitals in south west Nigeria and perceived barriers to effective nursing pressure ulcer prevention interventions. One hundred ninety-three nurses were purposively selected from neurological, orthopedic, intensive care, and accident and emergency units of participating hospitals. Study sites were 3 teaching hospitals in south west Nigeria (Lagos State University Teaching Hospital, Lagos; University College Hospital, Ibadan; and Obafemi Awolowo Teaching Hospital Ile-Ife). Data were collected via a structured questionnaire designed for this study. It included 3 sections: demographic information, practices used for pressure ulcer prevention, and perceived barriers to prevention. Sections of the questionnaire that queried interventions and perceived barriers to pressure ulcer prevention were evaluated for face and content validity. Reliability was evaluated via internal consistency; the split half reliability was 0.82. Similar practices regarding pressure ulcer prevention were found across the 3 hospitals. The most commonly used intervention was patient repositioning every 2 hours; the least used intervention was completion of a validated pressure ulcer risk scale. Nurses described using interventions that have not proved effective for pressure ulcer prevention such as massaging bony prominences and application of talcum powder. Nurses identified 2 principal factors that act as barriers to successful prevention of pressure ulcers: inadequate manpower and inadequate supply of linens on the wards. Nurses use a combination of evidence-based interventions, along with interventions that have not proved effective for pressure ulcer prevention. We recommend development of national standards for pressure ulcer prevention in Nigeria that are based on current best evidence and consistent with current international guidelines.

Effect of the learning climate of residency programs on faculty's teaching performance as evaluated by residents.

PubMed

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

2014-01-01

To understand teaching performance of individual faculty, the climate in which residents' learning takes place, the learning climate, may be important. There is emerging evidence that specific climates do predict specific outcomes. Until now, the effect of learning climate on the performance of the individual faculty who actually do the teaching was unknown. THIS STUDY: (i) tested the hypothesis that a positive learning climate was associated with better teaching performance of individual faculty as evaluated by residents, and (ii) explored which dimensions of learning climate were associated with faculty's teaching performance. We conducted two cross-sectional questionnaire surveys amongst residents from 45 residency training programs and multiple specialties in 17 hospitals in the Netherlands. Residents evaluated the teaching performance of individual faculty using the robust System for Evaluating Teaching Qualities (SETQ) and evaluated the learning climate of residency programs using the Dutch Residency Educational Climate Test (D-RECT). The validated D-RECT questionnaire consisted of 11 subscales of learning climate. Main outcome measure was faculty's overall teaching (SETQ) score. We used multivariable adjusted linear mixed models to estimate the separate associations of overall learning climate and each of its subscales with faculty's teaching performance. In total 451 residents completed 3569 SETQ evaluations of 502 faculty. Residents also evaluated the learning climate of 45 residency programs in 17 hospitals in the Netherlands. Overall learning climate was positively associated with faculty's teaching performance (regression coefficient 0.54, 95% confidence interval: 0.37 to 0.71; P<0.001). Three out of 11 learning climate subscales were substantially associated with better teaching performance: 'coaching and assessment', 'work is adapted to residents' competence', and 'formal education'. Individual faculty's teaching performance evaluations are positively affected by better learning climate of residency programs.

An assessment of the competence and experience of dentists with the management of medical emergencies in a Nigerian teaching hospital.

PubMed

Adewole, Richard Ayodeji; Sote, Elizabeth Obalowu; Oke, David Adewale; Agbelusi, Adewumi Gbemisola

2009-01-01

Previous reports show that medical emergency events have ocurred in Teaching Hospital Dental centres, with attendant mortality and morbidity. (1) To study the pattern of medical emergencies encountered by clinical dental staff of Lagos University Teaching Hospital (2) To evaluate their training, perception of their training and competence as undergraduates and postgraduates to manage such events. All the clinical staff viz: Dental surgeons of different cadres--consultants, registrars, house surgeons and dental nurses of Lagos University Teaching Hospital. A structured questionnaire requesting to know demographic data, respondents attendance of life support training viz: Basic life support (BLS), advanced trauma life support (ATLS), intensive care support (ICS). A self rating in the competence of management of medical emergencies and previous personal encounter with medical emergencies with success/failure in the management with/or without medical colleage assistance were sought. In addition adequacy of their dental clinic/centres for drugs, equipments and their perceived readiness to deal with emergencies were enquired. Among the dental surgeons, 20 (26.6%) were consultants, 40 (53.3%) were registrars and 35 (46.6%) were house-officers. Thirty five (43.7%) had previous knowledge of basic life support (BLS) training, while 45 (56.2%) denied such knowledge. The figures for other trainings such as advanced trauma life Support (ATLS) was 8 (10%) and intensive care support (ICS) 2 (2.5% 73.3% of the respondents felt inadequate in the management of cardiovascular emergencies, while only 15.4% felt adequately prepared. Similar ratings for respiratory emergencies are 63.1% inadequacy, 16.9% adequacy, and only 3.3% felt very adequate. The availability of oxygen extension tubing and ambu bag was nil in all departments. Emergency drugs were claimed to be present by 28.5% oral surgery respondents and, 34.7% Child Dental Health respondents. Most of the respondents felt their clinics are not adequately prepared to deal with medical emergencies. The study showed that syncope is the commonest medical emergency event in dental surgery practice in our teaching hospital, others are bleeding, seizure disorders and asthmatic attacks. The constitution of hospital emergency team (consisting of cardiologists, anaesthetists) as done in advanced countries is advocated and dentists should ensure that the departmental staff are adequately trained to provide basic life support.

[A Survey of the Perception of Nurses Toward the Practice Environment at a Regional Teaching Hospital in Central Taiwan].

PubMed

Hung, Jui-Tai; Lin, Ching-Wen; Wen, Wei-Chun; Lin, Esther Ching-Lan

2015-08-01

The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.

Detection of CTX-M-15 Among Uropathogenic Escherichia coli Isolated from Five Major Hospitals in Tripoli, Libya

PubMed Central

Zorgani, Abdulaziz; Almagatef, Asma; Sufya, Najib; Bashein, Abdulla; Tubbal, Abdullatif

2017-01-01

Objectives Multidrug resistance (MDR) and emergence of extended-spectrum β-lactamases (ESBLs) among uropathogenic Escherichia coli have been reported worldwide, but there was no information on the detection of blaCTX-M-15 in major teaching hospitals in Libya. The aim of the study was to investigate the occurrence of CTX-M-15 β-lactamases producers isolated from five teaching hospitals in Tripoli, Libya. Methods A total of 346 urine samples were collected from hospitalized patients in five teaching hospitals with a diagnosis of urinary tract infection (UTI). Phenotypic confirmation of ESBLs was confirmed by E-test strip; all ESBL-producing E. coli isolates were screened for the blaCTX-M-15 gene. Results The distribution of ESBL-producing E. coli varied among the five hospitals. The highest proportion was identified in Tripoli Medical Centre (67.6%). There were extremely high proportions of isolates resistant to ceftriaxone, cefepime, and ceftazidime (93.0–100.0%) among ESBL producers compared to non-ESBL producers (2.2–4.7%). MDR was detected in 22.2% of isolates. The majority of isolates (85.9%) in which blaCTX-M-15 was identified were ESBL producers. There was a correlation (p < 0.001) between expression of CTX-M-15 and resistance to ceftazidime. Conclusions The isolation of MDR ESBL-producing uropathogens expressing the CTX-M-15 gene will limit the choices clinicians have to treat their patients with UTIs. Continued surveillance and implementation of efficient infection control measures are required. PMID:28804585

Associations between attending physician workload, teaching effectiveness, and patient safety.

PubMed

Wingo, Majken T; Halvorsen, Andrew J; Beckman, Thomas J; Johnson, Matthew G; Reed, Darcy A

2016-03-01

Prior studies suggest that high workload among attending physicians may be associated with reduced teaching effectiveness and poor patient outcomes, but these relationships have not been investigated using objective measures of workload and safety. To examine associations between attending workload, teaching effectiveness, and patient safety, hypothesizing that higher workload would be associated with lower teaching effectiveness and negative patient outcomes. We conducted a retrospective study of 69,386 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians who supervised inpatient teaching services from July 2, 2005 to July 1, 2011. Attending workload measures included hospital service census, patient length of stay, daily admissions, daily discharges, and concurrent outpatient duties. Teaching effectiveness was measured using residents' evaluations of attendings. Patient outcomes considered were applicable patient safety indicators (PSIs), intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls, and patient deaths. Mixed linear models and generalized linear regression models were used for statistical analysis. Workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores (both β = -0.026, P < 0.0001). The number of daily admissions was associated with higher teaching scores (β = 0.021, P = 0.001) and increased PSIs (odds ratio = 1.81, P = 0.0001). Several measures of attending physician workload were associated with slightly lower teaching effectiveness, and patient safety may be compromised when teams are managing new admissions. Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings. © 2016 Society of Hospital Medicine.

Bibliography: Citations Obtained Through the National Library of Medicine's MEDLARS Program

ERIC Educational Resources Information Center

Journal of Medical Education, 1978

1978-01-01

Approximately 130 references obtained through MEDLARS are cited, dealing with such topics as accreditation, computers, continuing education, curriculum, educational measurement, faculty, foreign graduates, forensic medicine, graduate education, history, minority groups, medical schools, specialism, students, teaching hospitals, teaching methods,…

Resource utilization in lung cancer diagnostic procedures: Current use and budget consequences.

PubMed

Brinkhof, Sander; Groen, Harry J M; Siesling, Sabine S; IJzerman, Maarten J

2017-01-01

The main objective of this study is to determine the current use of lung cancer diagnostic procedures in two large hospitals in the Netherlands, to explore deviations in guideline adherence between the hospitals, and to estimate the budget impact of the diagnostic work-up as well as the over- and underutilization. A state transition model for the diagnostic pathway for lung cancer patients was developed using existing clinical practice guidelines (CPG) combined with a systematic literature. In addition to the CPGs depicting current practice, diagnostic utilization was gathered in two large hospitals representing an academic tertiary care hospital and a large regional teaching hospital for patients, who were selected from the Netherlands cancer registry. The total population consisted of 376 patients with lung cancer. Not in all cases the guideline was followed, for instance in the usage of MR brain with stage III lung cancer patients (n = 70). The state-transition model predicts an average budget impact for the diagnostic pathway per patient estimated of € 2496 in the academic tertiary care hospital and € 2191 in the large regional teaching hospital. The adherence to the CPG's differed between hospitals, which questions the adherence to CPG's in general. Adherence to CPG's could lead to less costs in the diagnostic pathway for lung cancer patients.

Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

PubMed

Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O

2014-06-01

The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program.

PubMed

Rajaram, Ravi; Chung, Jeanette W; Kinnier, Christine V; Barnard, Cynthia; Mohanty, Sanjay; Pavey, Emily S; McHugh, Megan C; Bilimoria, Karl Y

2015-07-28

In fiscal year (FY) 2015, the Centers for Medicare & Medicaid Services (CMS) instituted the Hospital-Acquired Condition (HAC) Reduction Program, which reduces payments to the lowest-performing hospitals. However, it is uncertain whether this program accurately measures quality and fairly penalizes hospitals. To examine the characteristics of hospitals penalized by the HAC Reduction Program and to evaluate the association of a summary score of hospital characteristics related to quality with penalization in the HAC program. Data for hospitals participating in the FY2015 HAC Reduction Program were obtained from CMS' Hospital Compare and merged with the 2014 American Hospital Association Annual Survey and FY2015 Medicare Impact File. Logistic regression models were developed to examine the association between hospital characteristics and HAC program penalization. An 8-point hospital quality summary score was created using hospital characteristics related to volume, accreditations, and offering of advanced care services. The relationship between the hospital quality summary score and HAC program penalization was examined. Publicly reported process-of-care and outcome measures were examined from 4 clinical areas (surgery, acute myocardial infarction, heart failure, pneumonia), and their association with the hospital quality summary score was evaluated. Penalization in the HAC Reduction Program. Hospital characteristics associated with penalization. Of the 3284 hospitals participating in the HAC program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); they were major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs nonteaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile 4 vs quartile 1: 32.8% vs 12.1%; OR, 1.98; 95% CI, 1.44-2.71); or they were safety-net hospitals vs non-safety-net hospitals (28.3% vs 19.9%; OR, 1.36; 95% CI, 1.11-1.68). Hospitals with higher hospital quality summary scores had significantly better performance on 9 of 10 publicly reported process and outcomes measures compared with hospitals that had lower quality scores (all P ≤ .01 for trend). However, hospitals with the highest quality score of 8 were penalized significantly more frequently than hospitals with the lowest quality score of 0 (67.3% [37/55] vs 12.6% [53/422]; P < .001 for trend). Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

PubMed

Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001). It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

Practice Patterns in Hepatitis B Virus Screening Before Cancer Chemotherapy in a Major US Hospital Network.

PubMed

Kwak, Ye Eun; Stein, Stacy M; Lim, Joseph K

2018-01-01

Cancer patients receiving chemotherapy face an increased risk of reactivation of chronic hepatitis B virus infection. To determine the HBV screening rate in patients receiving cancer chemotherapy in various clinical settings. We identified 11,959 adult cancer patients (age ≥ 18 years) receiving parenteral chemotherapy between 2012 and 2015 within a major US hospital network, including a large university hospital, community teaching hospitals, and community oncology clinics. Two thousand and forty-five patients (17.1%) were screened for either HBV surface antigen (HBsAg) or HBV core antibody (HBcAb) before chemotherapy, and 1850 patients (15.5%) had both HBsAg and HBcAb tested before chemotherapy. 8.4% were exposed to HBV, and 0.9% had chronic HBV infection (both HBsAg/HBcAb positive). Patients with hematologic tumor were more often screened than with solid tumor (55.6 vs. 8.3%, p < 0.001). Patients receiving chemotherapy with higher HBV reactivation risk had higher yet suboptimal HBV screening rate (41.1% B-depleting agents, 21.5% anthracycline, 14.9% steroid, 64.7% anti-TNF alpha and 18.6% other chemotherapy, p < 0.001). Patients with age ≥ 50 years (old 16.2% vs. young 23.9%, p < 0.001) and Asian ethnicity (Asian 13.6 vs. Caucasian 16.6%, p < 0.001) were screened less for HBV despite higher prevalence of HBV exposure (old 9.3% vs. young 4.3%, p < 0.001 and Asian 27.8% vs. Caucasian 6.4%, p < 0.001). Patients receiving chemotherapy in community oncology clinics were less screened versus community teaching hospitals or university hospital (12.7 vs. 19.1 vs. 19.7%, p < 0.001), despite similar prevalence of HBV infection. On multivariate analysis, receiving chemotherapy at a community oncology clinic [odds ratio (OR) 0.57, 95% confidence interval (CI) 0.45-0.72, p < 0.001] was independently associated with less HBV screening compared to receiving chemotherapy at a university or community teaching hospital. HBV screening among patients undergoing cancer chemotherapy was suboptimal and less commonly performed in community oncology clinics compared to teaching hospitals.

Hospital Variation in Survival Trends for In‐hospital Cardiac Arrest

PubMed Central

Girotra, Saket; Cram, Peter; Spertus, John A.; Nallamothu, Brahmajee K.; Li, Yan; Jones, Philip G.; Chan, Paul S.

2014-01-01

Background During the past decade, survival after in‐hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals. Methods and Results We identified 93 342 adults with an in‐hospital cardiac arrest at 231 hospitals in the Get With The Guidelines®‐Resuscitation registry during 2000–2010. Using hierarchical regression models, we evaluated hospital‐level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (P<0.001 for all) and an increase in prevalence of sepsis, respiratory insufficiency, renal insufficiency, intensive care unit location, and mechanical ventilation before arrest (P<0.001 for all). After adjustment for temporal trends in baseline characteristics, hospital rates of in‐hospital cardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, P<0.001). Improvement in survival varied markedly and ranged from 3% in the bottom hospital quartile to 11% in the top hospital quartile. Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03). Conclusion Although in‐hospital cardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival. PMID:24922627

Pulmonary resections performed at hospitals with thoracic surgery residency programs have superior outcomes.

PubMed

Bhamidipati, Castigliano M; Stukenborg, George J; Ailawadi, Gorav; Lau, Christine L; Kozower, Benjamin D; Jones, David R

2013-01-01

Pulmonary resections are performed at thoracic residency (TR), general surgery residency (GSR), no surgery residency, and no residency hospitals. We hypothesize that morbidity and mortality for these procedures are different between hospitals and that operations performed at TR teaching hospitals have superior results. Records of adults who underwent pneumonectomy, lobar, segmentectomy, and nonanatomic wedge resections (N = 498,099) were evaluated in an all-payer inpatient database between 2003 and 2009. Hospital teaching status was determined by linkage to Association of American Medical College's Graduate Medical Education Tracking System. Multiple hierarchical regression models examined the in-hospital mortality, occurrence of any complication, and failure to rescue. The mean annual pulmonary resection volume among hospitals was TR (16%), GSR (17%), no surgery residency (28%), and no residency (39%). Unadjusted mortality for all procedures was lowest at TR hospitals (P < .001). Likewise, any complication was least likely to occur at TR hospitals (P < .001). After case-mix adjustment, the risk of any complication after segmentectomy or nonanatomic wedge resection was lower at TR hospitals than in GSR hospitals (P < .001). Among pneumonectomy recipients, TR hospitals reduced the adjusted odds ratio of failure to rescue by more than 25% compared with no surgery residency (P < .001). Likewise, in patients who underwent pneumonectomy, TR centers were associated with reducing the odds ratio of death by more than 30% compared with GSR hospitals (P < .001). In comparison with other hospitals, including GSR hospitals, TR hospitals have lower morbidity and mortality. These results support using hospitals with a TR as an independent prognostic indicator of outcomes in pulmonary resections. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Prevalence and clinical characteristics of headaches among undergraduate students in three tertiary institutions in Ilorin, Nigeria.

PubMed

Sanya, E O; Desalu, O O; Aderibigbe, S A; Kolo, P M; Mustapha, A F; Adeyanju, O A

2017-11-01

Headache is a common chronic neurologic disorder with huge economic and psychosocial impact. In comparison with other neurological disorders, there is limited data on primary headache, especially from sub-Saharan Africa. This study was done to fill in the gap and provide recent information on headache among Nigerian undergraduate students. Quota sampling was used to select students from three tertiary educational institutions within Ilorin, the capital of Kwara state. Two-stage self-administered questionnaires developed from the guideline of the International Society of Headache were used to harvest information. A total of 1500 students participated in the study. The mean age of the students was 20.9 ± 3.1 years, with male:female ratio of 1.6:1. A total of 356 students have frequent headache within previous 1 year, given the headache frequency of 23.7%. Fifty-three students (3.5%) had headaches on almost daily basis, 84 (5.6%) had ≥4 attacks/week, 145 (9.7%) had ≤2-3 attacks/month, and 123 (8.2%) had 1-3 attacks every 3 months. Close to 75% indicated that it limits their daily activity frequently. One hundred and eighty-seven (12.5%) students fulfilled the criteria for tension-type headache, 36 (2.4%) for migraine headache, and 133 (8.9%) had nonclassified headaches. The most frequent headache-associated symptoms are photophia - 100 students (6.7%), phonophobia - 159 students (10.6%), while 62 students (4.1%) had nausea and vomiting. None of the students had seen a physician for proper headache diagnosis. Majority (90.2%) used none prescription over-the-counter analgesia (acetaminophen) for symptomatic treatment of their aches. Headache is a common complaint among Nigerian undergraduate students and it limits the daily activity of majority of the sufferers. Students need proper education regarding treatment to alleviate their suffering and forestall complication, especially those associated with analgesic overuse.

Variations of B0 and B1 with the solar quiet Sq-current system and comparison with IRI-2012 model at Ilorin

NASA Astrophysics Data System (ADS)

Bello, S. A.; Abdullah, M.; Hamid, N. S. A.; Yoshikawa, A.; Olawepo, A. O.

2017-07-01

The ionospheric thickness (B0) and shape (B1) are bottomside profile parameters introduced by the International Reference Ionosphere (IRI) model. We have validated these parameters with the latest version of the IRI-2012 model and compared them with the solar quiet of geomagnetic H-component (SqH). The B0, B1 and SqH are calculated from the measurements obtained from digisonde DPS-4 sounder and the Magnetic Data Acquisition System (MAGDAS) magnetometer, respectively at Ilorin (geo latitude 8.50°N, geo longitude 4.68°E, and Magnetic dip 4.1°S) an equatorial station in the African sector. The study was for the year 2010, a year of low solar activity (with 27-day averaged solar index, F10.7 = 80 sfu). The results show that B0 for the entire months was higher during the daytime than during the night time. On the other hand, the magnitude of B1during the daytime period is lower than nighttime values and exhibit oscillatory pattern. By comparing the experimental observations of the profile parameters with the IRI-2012 model prediction, we found that B0 was fairly represented by the IRI model options during the nighttime period while discrepancies exist between the model estimates and the experimental values during the morning till midday. A close agreement exists between the observed B1 values and IRI model options. We observed a positive and significant correlation coefficient between B0 and SqH indicating a plausible relationship between these parameters while a weak and negative correlation coefficient between B1 and SqH was observed. We concluded that the difference in the relationship of SqH and the profile parameters B0 and B1 observed can be attributed to their sensitivity to the electric field which is responsible for the E × B drift which in turn modulate the height of the F2.

Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress.

PubMed

Yarmohammadian, Mohammad H; Ebrahimipour, Hossein; Doosty, Farzaneh

2014-01-01

In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.

Retrospective observational study of interventions to improve acceptance of long-acting reversible contraception following abortion at Lusaka Teaching Hospital, Zambia.

PubMed

Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Pádua, Karla S; Faundes, Anibal

2018-04-01

To evaluate long-acting reversible contraceptive (LARC) uptake immediately after abortion at Lusaka University Teaching Hospital, Zambia in the period following an intervention to increase the acceptance of LARC. The present retrospective, observational study reviewed the clinical records of all patients admitted to the Lusaka University Teaching Hospital for an incomplete abortion or for a legal induced abortion between January 1 and December 31, 2016. The primary outcome measure was the proportion of adult women (aged 20-44 years) and adolescents (aged 10-19 years) who were already using an available contraceptive method at the time of hospital discharge. Contraceptive use was compared with historical data from the same institution before the intervention to increase LARC acceptance was performed. Data from 3858 patients (587 adolescents and 3271 adults) were included. LARC use was recorded among 108 (18.4%) and 409 (12.5%) adolescents and adults, respectively. This compared with rates from 2011 of less than 1% and less than 4%, respectively. The rate of LARC use at discharge following incomplete or induced abortion had increased when compared with historical control data from before the intervention program was performed; however, there remains room for improvement. © 2017 International Federation of Gynecology and Obstetrics.

Cancer in Indonesia, present and future.

PubMed

Tjindarbumi, Didid; Mangunkusumo, Rukmini

2002-03-01

Cancer control has been in effect in Indonesia since the early 1920s. It was the Dutch Colonial Government who started with the Institution for Cancer Control, which was closed by the Japanese Occupation Administration between 1942 and 1945. After the independence of the Republic of Indonesia, a Cancer Control Foundation was established in 1962. At present, clinical and non-clinical departments in government teaching hospitals (there are 13 teaching hospitals) usually handle all cancer problems. In 1993, Dharmais Cancer Center in Jakarta was established and has become the top referral cancer hospital for Indonesia. Until now, there have been no nationwide accurate data on cancer registration, owing to a lack of funds and manpower. Cancer data collection is usually provided as a relative frequency study from several departments of the teaching hospitals. It is currently estimated that there will be at least 170-190 new cancer cases annually for each 100 000 people. The most frequent and primary cancers are cervix, breast, lymph node, skin and nasopharynx. Since Indonesia is now in a transition phase and has many problems concerning the economy and health care, we suggested a well-planned cancer control program. It includes the primary, secondary and tertiary prevention of cancer in cities, where inhabitants can afford to subsidize a certain proportion of the budgets for the implementation of this program.

Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran

PubMed Central

Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

2015-01-01

Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094

[Preoperative structured patient education].

PubMed

Lamarche, D

1993-04-01

This article describes the factors that motivated the nursing staff of the cardiac surgery unit at the Royal Victoria Hospital in Montreal, to revise their preoperative teaching program. The motivating factors described are the length of the preoperative waiting period; the level of preoperative anxiety; the decreased length of hospital stay; the dissatisfaction of the nursing staff with current patient teaching practices; and the lack of available resources. The reorganization of the teaching program was based upon the previously described factors combined with a review of the literature that demonstrated the impact of preoperative anxiety, emotional support and psycho-educational interventions upon the client's recovery. The goals of the new teaching program are to provide the client and the family with cognitive and sensory information about the client's impending hospitalization, chronic illness and necessary lifestyle modifications. The program consists of a system of telephone calls during the preoperative waiting period; a videotape viewing; a tour of the cardiac surgery unit; informal discussion groups; and the availability of nursing consultation to decrease preoperative anxiety. The end result of these interventions is more time for client support and integration of necessary information by the client and family. This kind of program has the potential to provide satisfaction at many levels by identifying client's at risk; increasing client knowledge; increasing support; decreasing anxiety during the preoperative waiting period; and decreasing the length of hospital stay. The nursing staff gained a heightened sense of accomplishment because the program was developed according to the nursing department's philosophy, which includes primary nursing.(ABSTRACT TRUNCATED AT 250 WORDS)

Development and implementation of a comprehensive strategic plan for medical education at an academic medical center.

PubMed

Schwartzstein, Richard M; Huang, Grace C; Coughlin, Christine M

2008-06-01

Despite their vital contributions to the training of future physicians, many academic teaching hospitals have grown operationally and financially distinct from affiliated medical schools because of divergent missions, contributing to the erosion of clinical training. Some institutions have responded by building hybrid organizations; others by creating large health care networks with variable relationships with the affiliated medical school. In this case, the authors wished to establish the future educational mission of their medical center as a core element of the institution by creating data-driven recommendations for reorganization, programs, and financing. They conducted a self-study of all constituents, the results of which confirmed the importance of education at their institution but also revealed the insufficiency of incentives for teaching. They underwent an external review by a committee of prominent educators, and they involved administrators at the hospital and the medical school. Together, these inputs composed an informed assessment of medical education at their teaching hospital, from which they developed and actualized an institution-wide strategic plan for education. Over the course of three years, they centralized the administrative structure for education, implemented programs that cross departments and reinforce the UME-GME continuum, and created transparency in the financing of medical education. The plan was purposefully aligned with the clinical and research strategic plans by supporting patient safety in programs and the professional development of faculty. The application of a rigorous strategic planning process to medical education at an academic teaching hospital can focus the mission, invigorate faculty, and lead to innovative programs.

Double-blind randomized controlled trial comparing misoprostol and oxytocin for management of the third stage of labor in a Nigerian hospital.

PubMed

Musa, Abdulkarim O; Ijaiya, Munir'deen A; Saidu, Rakiya; Aboyeji, Abiodun P; Jimoh, Abiodun A; Adesina, Kikelomo T; Abdul, Ishaq F

2015-06-01

To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL). A double-blind randomized control trial was undertaken at a center in Ilorin, Nigeria, between January and June 2013. Every other eligible patient (in the first stage of labor at term, to have a spontaneous vaginal delivery, and no/low risk of postpartum hemorrhage [PPH]) were randomly assigned with computer-generated random numbers to receive oral misoprostol (600μg) plus placebo injection or oral placebo plus oxytocin injection (1mL of 10IU) in the third stage of labor. The primary outcome was amount of blood loss during delivery. Mean postpartum blood loss was 325.85±164.72mL in the 100 patients given misoprostol and 303.95±163.33mL in the 100 patients given oxytocin (P=0.391). PPH (≥500mL blood loss) was recorded in 15 (15.0%) patients given misoprostol and 14 (14.0%) given oxytocin (P=0.841). Shivering, pyrexia, and diarrhea were all significantly more common in the misoprostol group (P<0.01 for all). The efficacy of oral misoprostol was similar to that of intramuscular oxytocin. Adverse effects associated with misoprostol were transient and self-limiting. Thus, oral misoprostol is efficacious and a good alternative to oxytocin for AMTSL. Pan African Clinical Trials Registry:PACTR201407000825227. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

What motivates senior clinicians to teach medical students?

PubMed Central

Dahlstrom, Jane; Dorai-Raj, Anna; McGill, Darryl; Owen, Cathy; Tymms, Kathleen; Watson, D Ashley R

2005-01-01

Background This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. Methods The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia). Their motivations to teach medical students were assessed applying Q methodology. Results Of the 75 participants, 18 (24%) were female and 57 (76%) were male. The age distribution was as follows: 30–40 years = 16 participants (21.3%), 41–55 years = 46 participants (61.3%) and >55 years = 13 participants (17.3%). Most participants (n = 48, 64%) were staff specialists and 27 (36%) were visiting medical officers. Half of the participants were internists (n = 39, 52%), 12 (16%) were surgeons, and 24 (32%) were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41–55 year age group. The participating clinicians were moderately homogenous in their responses. Factor analysis produced 4 factors: one summarising positive motivations for teaching and three capturing impediments for teaching. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time. Conclusion This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce. PMID:16022738

A Practicum for Oral Cancer Teaching.

ERIC Educational Resources Information Center

Barr, Charles E.; Goldberg, Marshal D.

1983-01-01

A hospital-based method for teaching general practice dental residents, involving patients for whom the residents are responsible, is described. Residents present prepared cases of dental patients according to a predetermined protocol: a talk, complete documentation of clinical history and laboratory findings, and discussion of therapy and…

The Environment for General Clinical Education.

ERIC Educational Resources Information Center

Morgan, William L. Jr.

1986-01-01

The impact of the present changing environment on medical education is considered. Four major components of medical education are influenced by environmental change: the setting (hospital inpatient floors), the patients, the teachers, and way teaching is conducted. Educational goals are defined and recommendations for improving teaching are…

[A contribution to the needs assessment of faculty development measures in medical schools].

PubMed

Raupach, Tobias; Spering, Christopher; Bäumler, Christine; Burckhardt, Gerhard; Trümper, Lorenz; Pukrop, Tobias

2009-11-15

In addition to patient care and research activity, physicians working in medical school hospitals serve as teachers in undergraduate medical education. However, teaching qualifications of German university hospital physicians have not been studied in great detail. In January 2009, medical students as well as physicians involved in medical teaching at Göttingen Medical School, Germany, were invited to complete an online survey addressing their views on clinical teachers' educational skills. In addition, physicians' motivation to engage in pedagogical training was assessed. During a 12-day period, 359 students and 126 physicians involved in undergraduate medical education completed the survey. The latter did not feel well prepared for their teaching activities. At the same time, they expressed the willingness to improve their teaching skills. Students felt that, across all instructional methods, teachers would benefit from teacher training programs. In order to improve undergraduate education for future physicians, politicians and local representatives alike must set the scene for the implementation of faculty development measures in German medical schools.

Implementation of laparoscopic hysterectomy for endometrial cancer over the past decade.

PubMed

Wollinga, Tim; Ezendam, Nicole P M; Eggink, Florine A; Smink, Marieke; van Hamont, Dennis; Pijlman, Brenda; Boss, Erik; Robbe, Elisabeth J; Ngo, Huy; Boll, Dorry; Mom, Constantijne H; van der Aa, Maaike A; Kruitwagen, Roy F L P; Nijman, Hans W; Pijnenborg, Johanna M A

2018-01-01

Laparoscopic hysterectomy (LH) for the treatment of early-stage endometrial carcinoma/cancer (EC) has demonstrated to be safe in several randomized controlled trials. Yet, data on implementation of LH in clinical practice are limited. In the present study, implementation of LH for EC was evaluated in a large oncology network in the Netherlands. Retrospectively, a total of 556 EC patients with FIGO stage I-II were registered in the selected years. The proportion of LH gradually increased from 11% in 2006 to 85% in 2015. LH was more often performed in patients with low-grade EC and was not related to the studied patient characteristics. The introduction of TLH was frequently preceded by LAVH. Patients treated in teaching hospitals were more likely to undergo a LH compared to patients in non-teaching hospitals. The conversion rate was 7.7%, and the overall complication rates between LH and AH were comparable, but less postoperative complications in LH. Implementation of laparoscopic hysterectomy for early-stage EC increased from 11 to 85% in 10 years. Implementation of TLH was often preceded by LAVH and was faster in teaching hospitals.

Technical efficiency of teaching hospitals in Iran: the use of Stochastic Frontier Analysis, 1999–2011

PubMed Central

Goudarzi, Reza; Pourreza, Abolghasem; Shokoohi, Mostafa; Askari, Roohollah; Mahdavi, Mahdi; Moghri, Javad

2014-01-01

Background: Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011. Methods: The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable. Results: The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production (P< 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant. Conclusion: Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals. PMID:25114947

Understanding Costs of Care in the Operating Room.

PubMed

Childers, Christopher P; Maggard-Gibbons, Melinda

2018-04-18

Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory, $3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased. The mean cost of OR time is $36 to $37 per minute, using financial data from California's short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.

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

PubMed

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

2015-01-01

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

A Decomposition of Hospital Profitability

PubMed Central

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

2015-01-01

Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO hospitals, significant financial differences remain depending on their respective hospital characteristics. Those differences are tempered or exacerbated by location, size, teaching status, system affiliation, and critical access designation. With the exception of cost-based reimbursement for critical access hospitals, emerging payment systems are placing additional financial pressures on hospitals. The financial pressures being applied treat hospitals as a monolithic category and, given the delicate and often negative ROE for many hospitals, the long-term stability of the healthcare facility infrastructure may be negatively impacted. PMID:28462258

Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists.

PubMed

Sadoughi, Farahnaz; Erfannia, Leila; Sancholi, Mahboobe; Salmani, Fatemeh; Sarsarshahi, Aida

Teleradiology is considered as one of the important forms of telemedicine. Positive views of the users and providers of these services play an important role in its successful implementations. The aim of this study was to investigate the views of radiologists used in the radiology departments of teaching hospitals in the Zahedan University of Medical Sciences through teleradiology, as well as evaluate the executive possibility of teleradiology in these hospitals by the views of chief executive officer and comparison between these two views. The current cross-sectional research was performed in 2014 at Zahedan teaching hospitals. The views of 13 chief executive officers on the possibility of the execution of teleradiology and 26 radiologists on the teleradiology process were evaluated by means of two valid and reliable questionnaires. The results of the research revealed that most of the radiologists had knowledge of and positive opinions about teleradiology. Conversely, the view by chief executive officers was that implementation of these processes was not possible in the studied hospitals. Dealing with some issues including data security, controlling or restricting access to clinical information of patients during the process of teleradiology, the possibility of legal protection for the participating radiologists, constitution of executive teams in the organization along with the financial supports, and, subsequently, invitation of the supports from the chief executive officers as the main sponsors of teleradiology implementation in the teaching hospitals are all guidelines for improvement of the successful implementation of teleradiology.

Outbreak of Salmonella infantis infection in a large animal veterinary teaching hospital.

PubMed

Tillotson, K; Savage, C J; Salman, M D; Gentry-Weeks, C R; Rice, D; Fedorka-Cray, P J; Hendrickson, D A; Jones, R L; Nelson, W; Traub-Dargatz, J L

1997-12-15

During the past 11 years, there have been numerous reports of outbreaks of salmonellosis involving horses in veterinary teaching hospitals. Some of these outbreaks have been associated with Salmonella serotypes not commonly associated with infection of horses. Salmonella infantis is among the more common Salmonella serotypes isolated from human beings, and is an important pathogen in the broiler chicken industry. However, it was not commonly isolated from horses or cattle on a national basis between 1993 and 1995. In this report, we describe an outbreak of S infantis infection among large animals, primarily horses, in a veterinary teaching hospital and the control measures that were implemented. Factors that appeared to be key in control of this outbreak in this hospital included providing biosecurity training sessions for hospital personnel, adopting a standard operating procedure manual for biosecurity procedures, installing additional handwashing sinks throughout the facility, painting the interior of the facility with a nontoxic readily cleanable paint, replacing the dirt flooring in 4 stalls with concrete flooring, and removing noncleanable surfaces such as rubber stall mats, wooden hay storage bins, and open grain bins. Our experience with this outbreak suggests that although it is virtually impossible to eliminate Salmonella organisms from the environment, minimizing contamination is possible. Prevention of nosocomial infection must be approached in a multifaceted manner and care must be taken to search out covert sources of contamination, especially if standard intervention procedures do not prevent spread of the disease.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

PubMed

Nicholson, Alison M; Tennant, Ingrid A; Martin, Allie C; Ehikhametalor, Kelvin; Reynolds, Glendee; Thoms-Rodriguez, Camille-Ann; Nagassar, Rajeev; Hoilett, Tena-Kim; Allen, Roxanne; Redwood, Tahira; Crandon, Ivor

2016-10-31

Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Job satisfaction of nurses in Jimma University Specialized Teaching Hospital, Ethiopia.

PubMed

Negussie, Nebiat

2016-03-01

In Ethiopia nurses have played a very important role in providing timely and quality health service in healthcare organizations. However, there is a limited literature in the area of nurses' job satisfaction in Ethiopian public hospitals. The objective of this research is to measure job satisfaction of nurses in Jimma University Specialized Teaching Hospital and to determine the influencing factors. A cross-sectional survey was conducted from January 2012 to June 2012 in Jimma University Specialized Teaching Hospital. All full-time nurses with nonsupervisory management position and more than 1 year of work experience were invited to participate in the study. Minnesota Satisfaction Questionnaire was used to collect the data. A total of 175 copies of the questionnaires were returned out of 186 copies distributed to the respondents. The results indicated that nurses were not satisfied by their job (mean=2.21, SD=0.52). Remuneration (r=0.71, P<0.01) and job advancement (r=0.69, P<0.01) were statically significant and strongly correlated with nurses' job satisfaction. Job security was associated with highest satisfaction (r=0.41, P<0.05) CONCLUSION AND RECOMMENDATIONS: Remuneration and job advancement were the most important factors for nurses' job satisfaction. Hospital administrators as well as health policy makers need to address the two major identified sources of nurses' job dissatisfaction in the study (i.e. remuneration and narrow opportunity of job advancement) and take appropriate measures to overcome their consequences.

Towards tailored teaching: using participatory action research to enhance the learning experience of Longitudinal Integrated Clerkship students in a South African rural district hospital.

PubMed

von Pressentin, Klaus B; Waggie, Firdouza; Conradie, Hoffie

2016-03-08

The introduction of Stellenbosch University's Longitudinal Integrated Clerkship (LIC) model as part of the undergraduate medical curriculum offers a unique and exciting training model to develop generalist doctors for the changing South African health landscape. At one of these LIC sites, the need for an improvement of the local learning experience became evident. This paper explores how to identify and implement a tailored teaching and learning intervention to improve workplace-based learning for LIC students. A participatory action research approach was used in a co-operative inquiry group (ten participants), consisting of the students, clinician educators and researchers, who met over a period of 5 months. Through a cyclical process of action and reflection this group identified a teaching intervention. The results demonstrate the gaps and challenges identified when implementing a LIC model of medical education. A structured learning programme for the final 6 weeks of the students' placement at the district hospital was designed by the co-operative inquiry group as an agreed intervention. The post-intervention group reflection highlighted a need to create a structured programme in the spirit of local collaboration and learning across disciplines. The results also enhance our understanding of both students and clinician educators' perceptions of this new model of workplace-based training. This paper provides practical strategies to enhance teaching and learning in a new educational context. These strategies illuminate three paradigm shifts: (1) from the traditional medical education approach towards a transformative learning approach advocated for the 21(st) century health professional; (2) from the teaching hospital context to the district hospital context; and (3) from block-based teaching towards a longitudinal integrated learning model. A programme based on balancing structured and tailored learning activities is recommended in order to address the local learning needs of students in the LIC model. We recommend that action learning sets should be developed at these LIC sites, where the relevant aspects of work-place based learning are negotiated.

Patients transferred to academic medical centers and other hospitals: characteristics, resource use, and outcomes.

PubMed

Wyatt, S M; Moy, E; Levin, R J; Lawton, K B; Witter, D M; Valente, E; Lala, R; Griner, P F

1997-10-01

As purchasers of health care increasingly rely on hospital resource use and outcomes profiles to guide quality improvement efforts and contract decisions, a better understanding of the contribution of the most severely ill patients to aggregate resource use and outcomes is needed to develop measures that make fair comparisons between hospitals. In this article, the authors examine the distribution, resource utilization, and outcomes of transferred patients ("transfers"), a group known to be highly complex. The study examines the contributions to resource use and outcomes of these patients at academic medical centers (AMCs) and non-teaching hospitals. The authors go beyond previous work by comparing AMCs with non-teaching hospitals, and by using a nationally representative sample for the year 1992. The detailed findings demonstrated that AMCs provided a disproportionate share of care to transfers in 1992, and that transfers to AMCs are more complex and require more specialized care than do transfers to non-teaching hospitals. The study also determined that, during the time studied, AMCs received a disproportionate share of Medicaid and indigentcare transfers. Finally, the findings demonstrated that transfers increased in absolute numbers and as a percentage of total patient volumes for all hospitals from 1988 to 1994. The rate of increase was greatest for AMCs. The authors explain why they believe that their findings are applicable today, although they caution that study of more recent data should be made. The authors comment that purchasers of health care may find the study useful in better understanding benchmarking tools used to evaluate hospitals. This study may also help those involved in health policy to more fully understand the magnitude of the contribution to transfer patient care provided by AMCs. Finally, health policymakers and planners may find this work useful as they prepare for increasing numbers of transfers in the future, particularly at AMCs.

An Analysis of Deaths Due to Tuberculosis at the Lagos University Teaching Hospital

PubMed Central

Bandele, E.O.; Olude, I.O.

1985-01-01

An analysis was made of deaths from tuberculosis in the Lagos University Teaching Hospital from 1976 to 1980. Of the 320 patients assessed, 240 were determined to have died from tuberculosis. Tuberculous meningitis was the main cause of death. Forty-two percent of the deaths occurred in the age group of 0 to 10 years old, and 47.5 percent of the patients died within one week of diagnosis. Potentially avoidable factors contributing to death include late reporting by patients to medical personnel, lack of bacillus of Calmette and Guerin (BCG) vaccine, irregular taking of medications by patients, and late referral of patients to specialized hospitals. There is a need for improved education of patients and medical personnel about the management of tuberculosis in Lagos. PMID:4046063

Knowledge and power necessary to reconstruct nursing after management changes at a teaching hospital.

PubMed

Bernardino, Elizabeth; Felli, Vanda Elisa Andres

2008-01-01

This study was carried out at a teaching hospital in Southern Brazil, which adopted a management model that provoked the dismantling of the nursing service and the disbandment of nursing professionals. Its general goal was to promote changes that would be implemented in the re-organization of nursing work. It is a case study with a historical-dialectic approach, whose data were collected in March and April 2005 through the focal group technique. The study subjects were eight nurses, two technicians and two nursing auxiliaries. Data were analyzed through thematic content analysis. Results evidenced that the greatest challenges nursing faced at this hospital were: to construct a new identity, carry out teamwork while maintaining its professional identity, acquire visibility in the institution, change care and expand management.

Management map for tomorrow.

PubMed

Castella, Francisco

2005-02-01

The way forward for hospital services and facilities management is examined by Francisco Castella, Doctor of Engineering and a member of the International Federation of Hospital Engineering Council. In this article, which is based on a paper presented at the 18th IFHE Congress, he draws on his experience as facility manager and director of general services in the Teaching Hospital of Badalona, Spain, and on knowledge gained through attending IFHE Congresses - representing the Spanish Hospital Engineering Association.

Determinants of Hospital Casemix Complexity

PubMed Central

Becker, Edmund R.; Steinwald, Bruce

1981-01-01

Using the Commission on Professional and Hospital Activities' Resource Need Index as a measure of casemix complexity, this paper examines the relative contributions of teaching commitment and other hospital characteristics, hospital service and insurer distributions, and area characteristics to variations in casemix complexity. The empirical estimates indicate that all three types of independent variables have a substantial influence. These results are discussed in light of recent casemix research as well as current policy implications. PMID:6799430

Unit Cost of Medical Services at Different Hospitals in India

PubMed Central

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes. PMID:23936088

Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis.

PubMed

Odetola, Folafoluwa O; Gebremariam, Achamyeleh; Freed, Gary L

2007-03-01

Our goal was to describe patient and hospital characteristics associated with in-hospital mortality, length of stay, and charges for critically ill children with severe sepsis. Our study consisted of a retrospective study of children 0 to 19 years of age hospitalized with severe sepsis using the 2003 Kids' Inpatient Database. We generated national estimates of rates of hospitalization and then compared in-hospital mortality, length of stay, and total charges according to patient and hospital characteristics using multivariable regression methods. Severity of illness was measured by using all-patient refined diagnosis-related group severity of illness classification into minor, moderate, major, and extreme severity. There were an estimated 21,448 hospitalizations for severe pediatric sepsis nationally in 2003. The in-hospital mortality rate was 4.2%. Comorbid illness was present in 34% of hospitalized children. Most (70%) of the extremely ill children were admitted to children's hospitals. Length of stay was longer among patients with higher illness severity and nonsurvivors compared with survivors (13.5 vs 8.5 days). Hospitalizations at urban or children's hospitals were also associated with longer length of stay than nonchildren's or rural hospitals, respectively. Higher charges were associated with higher illness severity, and nonsurvivors had 2.5-fold higher total charges than survivors. Also, higher charges were observed among hospitalizations in urban or children's hospitals. In multivariable regression analysis, multiple comorbid illnesses, multiple organ dysfunction, and greater severity of illness were associated with higher odds of mortality and longer length of stay. Higher hospital charges and longer length of stay were observed among transfer hospitalizations and among hospitalizations to children's hospitals and nonchildren's teaching hospitals compared with hospitals, which had neither children's nor teaching status. Mortality from severe pediatric sepsis is associated with patient illness severity, comorbid illness, and multiple organ dysfunction. Many characteristics are associated with resource consumption, including type of hospital, source of admission, and illness severity.

Cross-sectional study of variables associated with length of stay and ICU need in open Roux-En-Y gastric bypass surgery for morbid obese patients: an exploratory analysis based on the Public Health System administrative database (Datasus) in Brazil.

PubMed

Asano, Elio Fernando; Rasera, Irineu; Shiraga, Elisabete Cristina

2012-12-01

This is an exploratory analysis of potential variables associated with open Roux-en-Y gastric bypass (RYGB) surgery hospitalization resource use pattern. Cross-sectional study based on an administrative database (DATASUS) records. Inclusion criteria were adult patients undergoing RYGB between Jan/2008 and Jun/2011. Dependent variables were length of stay (LoS) and ICU need. Independent variables were: gender, age, region, hospital volume, surgery at certified center of excellence (CoE) by the Surgical Review Corporation (SRC), teaching hospital, and year of hospitalization. Univariate and multivariate analysis (logistic regression for ICU need and linear regression for length of stay) were performed. Data from 13,069 surgeries were analyzed. In crude analysis, hospital volume was the most impactful variable associated with log-transformed LoS (1.312 ± 0.302 high volume vs. 1.670 ± 0.581 low volume, p < 0.001), whereas for ICU need it was certified CoE (odds ratio (OR), 0.016; 95% confidence interval (CI), 0.010-0.026). After adjustment by logistic regression, certified CoE remained as the strongest predictor of ICU need (OR, 0.011; 95% CI, 0.007-0.018), followed by hospital volume (OR, 3.096; 95% CI, 2.861-3.350). Age group, male gender, and teaching hospital were also significantly associated (p < 0.001). For log-transformed LoS, final model includes hospital volume (coefficient, -0.223; 95% CI, -0.250 to -0.196) and teaching hospital (coefficient, 0.375; 95% CI, 0.351-0.398). Region of Brazil was not associated with any of the outcomes. High-volume hospital was the strongest predictor for shorter LoS, whereas SRC certification was the strongest predictor of lower ICU need. Public health policies targeting an increase of efficiency and patient access to the procedure should take into account these results.

The financial status of Catholic hospitals: 1982-1983.

PubMed

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

1986-01-01

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

[Anaesthesia education at german university hospitals: the teachers' perspective -- results of a nationwide survey].

PubMed

Goldmann, K; Steinfeldt, T; Wulf, H

2006-04-01

The principle purpose of this study was to collect data on the conditions and practice of anaesthesia education as well as the teaching qualification of consultants at German university hospitals. Based upon the collected data, areas of weakness and strength as well as measures required to improve anaesthesia training are described. A questionnaire containing 26 items was mailed to 607 consultants employed at 41 German university hospitals in June 2003. A total of 255 questionnaires was analysed (response rate: 43 %). Genuine training activities account for 14 % of the working hours of the participating consultants. On average, at the institutions of participating consultants, novices work for a duration of 1 month together with a consultant anaesthetist before they give anaesthetics without direct and constant supervision. When asked to describe the predominant method of training at their institution 71 % indicated "case-oriented teaching"; however, 53 % chose "see one, do one, teach one" and 49 % "learning by doing" as method of training as well (multiple choice). According to 63 % of respondents, departmental educational activities usually happen after their regular working hours. "Daily workload" (96 %), "time pressure" (96 %), "lack of time" (96 %) and "lack of personnel" (90 %) were indicated as the main obstacles of teaching. According to 80 % of respondents, a dedicated financial budget for education does not exist; instead, financial resources of third parties (industry) (58 %), of the state (for research und undergraduate education) (60 %) and of patients service (66 %) are used to ensure training of anaesthesia residents. Due to a lack of a dedicated financial budget for resident training and an increasing economic pressure, "lack of time" and "lack of personnel" are the main factors leading to the situation at German university hospitals that consultants can only spend 14 % of their working hours for teaching purposes despite of sufficient qualification and motivation. As a consequence, novice anaesthetists are faced with the situation to be working without direct and constant supervision after 1 month of training.

Effects of a Short Video-Based Resident-as-Teacher Training Toolkit on Resident Teaching.

PubMed

Ricciotti, Hope A; Freret, Taylor S; Aluko, Ashley; McKeon, Bri Anne; Haviland, Miriam J; Newman, Lori R

2017-10-01

To pilot a short video-based resident-as-teacher training toolkit and assess its effect on resident teaching skills in clinical settings. A video-based resident-as-teacher training toolkit was previously developed by educational experts at Beth Israel Deaconess Medical Center, Harvard Medical School. Residents were recruited from two academic hospitals, watched two videos from the toolkit ("Clinical Teaching Skills" and "Effective Clinical Supervision"), and completed an accompanying self-study guide. A novel assessment instrument for evaluating the effect of the toolkit on teaching was created through a modified Delphi process. Before and after the intervention, residents were observed leading a clinical teaching encounter and scored using the 15-item assessment instrument. The primary outcome of interest was the change in number of skills exhibited, which was assessed using the Wilcoxon signed-rank test. Twenty-eight residents from two academic hospitals were enrolled, and 20 (71%) completed all phases of the study. More than one third of residents who volunteered to participate reported no prior formal teacher training. After completing two training modules, residents demonstrated a significant increase in the median number of teaching skills exhibited in a clinical teaching encounter, from 7.5 (interquartile range 6.5-9.5) to 10.0 (interquartile range 9.0-11.5; P<.001). Of the 15 teaching skills assessed, there were significant improvements in asking for the learner's perspective (P=.01), providing feedback (P=.005), and encouraging questions (P=.046). Using a resident-as-teacher video-based toolkit was associated with improvements in teaching skills in residents from multiple specialties.

Evaluation of the educational environment of postgraduate surgical teaching.

PubMed

Khan, Junaid Sarfraz

2008-01-01

Medical Education is becoming increasingly community-oriented, student-centred, self-learning and self & peer-assessing process especially in the undergraduate years. This is happening because of increasing patient awareness of their rights in our new healthcare world of increased consultant responsibility; and implementation in the U.K. health institutions of the 'European Working Time Directive' and 'Modernization of Medical Careers'. The study was conducted to determine the change if any in the education environment of postgraduate surgical teaching in a leading teaching hospital in London when a teacher-centred, old-fashioned postgraduate teaching approach was replaced with a student-centred, self-assessment, portfolio-based approach. Postgraduate Hospital Educational Environment Measure (PHEEM). Twenty postgraduate trainees filled in the questionnaire before and after the change in their learning/teaching pattern. The response rate was 100%. No statistically significant difference in the overall score for the two teaching environments (p = 0.8024, 95% CI = -5.549273 to 4.349273) was found, because the loss of on-call rooms, trainee's mess and catering services statistically significantly deteriorated the social support subscale of the PHEEM scale (p < 0.0001, 95% CI = 6.66752 to 13.03248) to counteract any statistically significant improvement in the teaching role perception subscale of the instrument (p = 0.001, 95% CI= -12.443896 to -4.856104). There was no statistically significant difference in the role autonomy perception subscale in the two methods (p = 0.3663, 95% CI = -5.870437 to 2.270437). A student-centred approach to postgraduate teaching is better than a teacher-centred approach. However, further studies will be needed to evaluate both postgraduate teaching and training environment.

Resident Physicians' Perspectives on Effective Outpatient Teaching: A Qualitative Study

ERIC Educational Resources Information Center

Kisiel, John B.; Bundrick, John B.; Beckman, Thomas J.

2010-01-01

Learning theories, which suggest that experienced faculty use collaborative teaching styles, are reflected in qualitative studies of learners in hospital settings. However, little research has used resident focus groups to explore characteristics of successful teachers in outpatient clinics. Therefore, focus group discussions with first through…

The Effects of a Dyslexia-Centred Teaching Programme.

ERIC Educational Resources Information Center

Hornsby, Beve; Miles, T. R.

1980-01-01

Results are presented for 107 dyslexic children who received instruction through a "dyslexia-centered" (structured, sequential, cumulative, and thorough) program at a hospital clinic, a unit attached to a university department, or a private center. This teaching program proved very successful at all three settings. (Author/SJL)

Recreation Leadership. Third Edition.

ERIC Educational Resources Information Center

Vannier, Maryhelen

This text is intended for use in college recreation courses. It presents leadership techniques and teaching methods for conducting successful recreation programs in community centers, schools, churches, industry, hospitals, prisons, and on playgrounds. Over 1,000 program ideas and ways to teach are suggested that cover a wide range of activities…

Program planning for the community teaching hospital medical library.

PubMed Central

McCorkel, J; Cook, V

1985-01-01

To respond to the increasing demand for information from medical educators and clinicians and to persuade administrators to purchase the newly available microcomputer library systems, medical librarians in community teaching hospitals may find it useful to engage in intermediate term (for example, five-year) program planning. To increase the probability that the plan which emerges will be implemented, the planning process should fit the organizational nexus. Planning involves needs assessment, prioritized program elements, a written plan, and facilities planning (if applicable), which lead to program implementation. Components of a model program plan are presented. PMID:4027443

Identification of Specific Effects of Title VI Restrictions on Selected Hospitals and Implications for Health Manpower. Executive Summary.

ERIC Educational Resources Information Center

Cohodes, Donald R.; And Others

The effects of Title VI provisions of the Health Professions Educational Assistance Act of 1976 on patient care services in hospitals were investigated. The law restricts the supply of foreign medical grduates in the United States. Interviews were conducted with representatives of the administrative, medical, and teaching staffs of 24 hospitals to…

Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals

PubMed Central

Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

2014-01-01

Introduction The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. Methods This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a “high“ score on at least 2 of the three dimensions of MBI. Results In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. Conclusion There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout. PMID:25422682

Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures.

PubMed

den Hartog, Yvon M; Mathijssen, Nina M C; Vehmeijer, Stephan B W

2013-10-01

Rapid recovery protocols after total hip arthroplasty (THA) have been introduced worldwide in the last few years and they have reduced the length of hospital stay. We show the results of the introduction of a rapid recovery protocol for primary THA for unselected patients in our large teaching hospital. In a retrospective cohort study, we included all 1,180 patients who underwent a primary THA between July 1, 2008 and June 30, 2012. These patients were divided into 3 groups: patients operated before, during, and after the introduction of the rapid recovery protocol. There were no exclusion criteria. All complications, re-admissions, and reoperations were registered and analyzed. The mean length of hospital stay decreased from 4.6 to 2.9 nights after the introduction of the rapid recovery protocol. There were no statistically significant differences in the rate of complications, re-admissions, or reoperations between the 3 groups. In a large teaching hospital, the length of hospital stay decreased after introduction of our protocol for rapid recovery after THA in unselected patients, without any increase in complications, re-admissions, or reoperation rate.

Variation in vaginal breech delivery rates by hospital type.

PubMed

Gregory, K D; Korst, L M; Krychman, M; Cane, P; Platt, L D

2001-03-01

To relate vaginal breech delivery rates to the following hospital types: public, health maintenance organization, private teaching, or private nonteaching. In a retrospective study using administrative discharge data from Los Angeles County, California, we calculated the vaginal breech delivery rates of singleton breech deliveries during calendar years 1988 and 1991. Ten thousand four hundred breech deliveries were identified, 8988 (86.4%) term and 1412 (13.6%) preterm. Twelve percent (1252 of 10,400) were vaginal deliveries (10.1% term and 24.5% preterm). Term vaginal breech deliveries varied by hospital type and were more frequent in public hospitals (28.4%, 95% confidence interval [CI] 26.1%, 30.7%) and less frequent in private nonteaching hospitals (5.4%, 95% CI 4.8%, 5.9%). Term vaginal deliveries were 2.4 to 11.3 times more likely among black women and 1.3 to 6.3 times more likely for Hispanic women across all hospital types, compared with white women in private nonteaching hospitals. There was no difference in the proportion of preterm vaginal breech deliveries by hospital type (mean 24.5%). However, with the exception of public hospitals, the proportion of vaginal breech deliveries for both term and preterm deliveries varied significantly by ethnicity. The use of vaginal breech delivery varied by hospital type and patient ethnicity. Within private teaching and nonteaching hospitals, vaginal breech delivery was more likely for black women than for women of other ethnic groups. Further study is needed to understand the hospital policies or organizational factors, as well as the patient-related sociocultural and clinical factors, that contribute to those differences.

A comparison of systemwide and hospital-specific performance measurement tools.

PubMed

Yap, Clarence; Siu, Emily; Baker, G Ross; Brown, Adalsteinn D

2005-01-01

Balanced scorecards are being implemented at the system and organizational levels to help managers link their organizational strategies with performance data to better manage their healthcare systems. Prior to this study, hospitals in Ontario, Canada, received two editions of the system-level scorecard (SLS)--a framework, based on the original balanced scorecard, that includes four quadrants: system integration and management innovation (learning and growth), clinical utilization and outcomes (internal processes), patient satisfaction (customer), and financial performance and condition (financial). This study examines the uptake of the SLS framework and indicators into institution-specific scorecards for 22 acute care institutions and 2 non-acute-care institutions. This study found that larger (teaching and community) hospitals were significantly more likely to use the SLS framework to report performance data than did small hospitals (p < 0.0049 and 0.0507) and that teaching hospitals used the framework significantly more than community hospitals did (p < 0.0529). The majority of hospitals in this study used at least one indicator from the SLS in their own scorecards. However, all hospitals in the study incorporated indicators that required data collection and analysis beyond the SLS framework. The study findings suggest that SLS may assist hospitals in developing institution-specific scorecards for hospital management and that the balanced scorecard model can be modified to meet the needs of a variety of hospitals. Based on the insight from this study and other activities that explore top priorities for hospital management, the issues related to efficiency and human resources should be further examined using SLSs.

Increasing access to legal termination of pregnancy and postabortion contraception at the University Teaching Hospital, Lusaka, Zambia.

PubMed

Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Faúndes, Anibal

2014-07-01

The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

No Variation in Patient Care Outcomes After Implementation of Resident Shift Work Duty Hour Limitations and a Hospitalist Model System.

PubMed

Hollier, John M; Wilson, Stephen D

This study examines whether implementing a resident shift work schedule (RSWS) alone or combined with a hospitalist-led model system (HMS/RSWS) affects patient care outcomes or costs at a pediatric tertiary care teaching hospital. A retrospective sample compared pre- and postintervention groups for the most common primary discharge diagnoses, including asthma and cellulitis (RSWS intervention) and inflammatory bowel disease and diabetic ketoacidosis (HMS/RSWS intervention). Outcome variables included length of stay, number of subspecialty consultations, and hospitalization charges. For the RSWS intervention, the preintervention (n = 107) and postintervention (n = 92) groups showed no difference in any of the outcome variables. For the HMS/RSWS intervention, the preintervention (n = 98) and postintervention (n = 69) groups did not differ in demographics or length of stay. However, subspecialty consultations increased significantly during postintervention from 0.83 to 1.52 consults/hospitalization ( P < .01) without significantly increasing hospitalization charges. Neither the RSWS nor HMS/RSWS intervention affected patient care outcomes at a pediatric tertiary care teaching hospital.

Special report: controlling aggression in hospitals--what security officers must know to avoid physical attacks.

PubMed

1992-03-01

Threats to the safety of security officers by persons they encounter in confrontational or potentially confrontational situations are an ever-present danger. This potential for physical violence can take place in the lobby, cafeteria, halls, elevators, or the parking lot of any corporate entity, not just hospitals. In hospitals, however, this danger is compounded by psychiatric patients and other hospital patients under stress. Hospital security personnel are often called to defuse potentially violent patient situations. Further compounding this risk of violence are increases in cutbacks in hospital personnel. Therefore, programs that teach hospital staff members how to control aggression will become increasingly important. Among the organizations have made a reputation for training security professionals and others in preventing and dealing with violence are R.E.B. Security Training, Inc., Avon, CT, and Wickersty & Associates, Inc., Bladensburg, MD. R.E.B. offers a two-day course in nonverbal communication that is taken by police officers and security directors. According to Ronald W. Ouellette, president, the course has also been attended by nurses, doctors, ambulance drivers, and psychologists. Wickersty & Associates has been conducting "Controlling Aggression" workshops in health care facilities for the past 12 years. According to Dr. Allan Wickersty, more and more hospitals are hiring consultants to teach staff members how to deal with aggressive behavior. But hospital violence remains an underreported problem. "One thing I have noticed is that the type of hospital experiencing violence is changing.(ABSTRACT TRUNCATED AT 250 WORDS)

Workload Impact of Medical Subspecialties in the Teaching Hospital

ERIC Educational Resources Information Center

Van Peenen, Hubert J.

1973-01-01

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

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

PubMed Central

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

2010-01-01

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

The impact of public hospital closure on medical and residency education: implications and recommendations.

PubMed

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

2008-12-01

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

The development and validation of the Clinical Teaching Behavior Inventory (CTBI-23): Nurse preceptors' and new graduate nurses' perceptions of precepting.

PubMed

Lee-Hsieh, Jane; O'Brien, Anthony; Liu, Chieh-Yu; Cheng, Su-Fen; Lee, Yea-Wen; Kao, Yu-Hsiu

2016-03-01

Few studies have examined the perceptions of clinical teaching behaviors among both nurse preceptors and preceptees. To develop a Clinical Teaching Behavior Inventory (CTBI) for nurse preceptors' self-evaluation, and for new graduate nurse preceptee evaluation of preceptor clinical teaching behaviors and to test the validity and reliability of the CTBI. This study used mixed research techniques in five phases. Phase I: based on a literature review, the researchers developed an instrument to measure clinical teaching behaviors. Phase II: 17 focus group interviews were conducted with 63 preceptors and 24 new graduate nurses from five hospitals across Taiwan. Clinical teaching behavior themes were extracted from the focus group data and integrated into the domains and items of the CTBI. Phase III: two rounds of an expert Delphi study were conducted to determine the content validity of the instrument. Phase IV: a total of 290 nurse preceptors and 260 new graduate nurses were recruited voluntarily in the same five hospitals in Taiwan. Of these, 521 completed questionnaires to test the construct validity of CTBI by using confirmatory factory analysis. Phase V: the internal consistency and reliability of the instrument were tested. CTBI consists of 23 items in six domains: (1) 'Committing to Teaching'; (2) 'Building a Learning Atmosphere'; (3) 'Using Appropriate Teaching Strategies'; (4) 'Guiding Inter-professional Communication'; (5) 'Providing Feedback and Evaluation'; and (6) 'Showing Concern and Support'. The confirmatory factor analysis yielded a good fit and reliable scores for the CTBI-23 model. The CTBI-23 is a valid and reliable instrument for identifying the clinical teaching behaviors of a preceptor as perceived by preceptors and new graduate preceptees. The CTBI-23 depicts clinical teaching behaviors of nurse preceptors in Taiwan. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria.

PubMed

Adebayo, Philip Babatunde; Asaolu, Stephen Olabode; Akinboro, Adeolu Oladayo; Akintunde, Adeseye Abiodun; Olakulehin, Olawale Adebayo; Ayodele, Olugbenga Edward

2016-01-01

This study aimed to evaluate how patients feel about the introduction of medical students into a former general hospital transformed to a teaching hospital in southwestern Nigeria and to also assess the extent to which they are willing to involve medical students in the management of their conditions. In a descriptive cross-sectional study, a sample of 251 randomly selected patients were interviewed using a pretested questionnaire that assessed patients' demography, patients' acceptance of and reaction to the involvement of medical students in their clinical care including the specific procedures the patients would allow medical students to perform. Two hundred and fifty-one patients with mean age ± standard deviation of 37.33 ± 19.01 (age range = 16-120 years; M:F = 1:1.26) were recruited between January 01 and March 31, 2013. Most patients (86.5%) preferred to be treated in a teaching hospital and were comfortable with medical students as observers (83.7%) and serving as the doctors' assistant (83.3%) during common diagnostic procedures. Men were more willing to have invasive procedures such as insertion of urinary catheter (56.6% vs. 43.4%, P = 0.001). Acceptability of medical students (such as willingness of patients to have students read their medical notes) was significantly higher in nonsurgical specialties than in surgical specialties (77.5% vs. 22.5%, P< 0.001). Factors associated with a positive disposition include age> 40 years, male gender, and higher level of education as well as consultation in nonsurgical specialties (P = 0.001). Medical students are well received into this new teaching hospital setting. However, there is a need for more education of younger, less educated female patients of surgical subspecialties so that they can understand their importance as irreplaceable partners in the training of medical students.

Supervisory needs of research doctoral students in a university teaching hospital setting.

PubMed

Caldwell, Patrina Hy; Oldmeadow, Wendy; Jones, Cheryl A

2012-10-01

Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Fit for purpose? Evaluation of CPD courses for nurses in an Irish university teaching hospital.

PubMed

Ryder, Mary; Browne, Freda; Galvin, Cáit; Leonard, Orla; O'Reilly, Jody

2018-04-26

acute tertiary hospitals require knowledgeable, skilled registered nurses to care for patients in specialist areas. It is also a professional responsibility that nurses maintain skills and competence. This article reports on stage 1 of an action research study to evaluate the delivery of continuing professional development (CPD) courses for registered nurses in an acute hospital in Ireland. an audit and qualitative self-reporting questionnaire was used to obtain data. The questionnaire focused on the areas of teaching learning and outcomes. Overall, five CPD courses, each of 26 weeks' duration, were evaluated. teaching delivery was all didactic and was delivered primarily by clinical staff with expert knowledge and skills, but the teaching approaches varied. The curriculum content was identified as excessive and at a high level for an introductory course, with a large volume of classroom-based theoretical delivery. Participant learning was reported as excellent in the clinical areas; however, this was counterbalanced by heavy workloads and staffing shortages. Participant motivation was also found to influence learning. From an outcome perspective the development of new knowledge and skills was reported in participants who had undertaken the courses, and participants reported that the CPD courses assisted in recruitment and retention. although many positive aspects of the CPD courses were identified, it is clear that some changes were required with particular reference to theoretical delivery and curriculum content.

Students' Educational Activities During Clerkship.

ERIC Educational Resources Information Center

O'Sullivan, Patricia S.; And Others

1997-01-01

Logs completed by 201 medical students in third-year clerkships at nine community-based hospitals indicated students received 6.5 hours of teaching with an instructor daily, spending 4.9 more hours in clerkship-related learning. Most teaching was by full-time faculty and residents. In half their educational activities, students participated with…

Nursing department orientation: are we missing the mark?

PubMed

Kennedy, Julie Marie; Nichols, Amy A; Halamek, Louis P; Arafeh, Julie M R

2012-01-01

Hospitals routinely provide orientation for the new nurses they hire. The evolution of nursing practice is not reflected in the current teaching methods of nursing orientation. The authors examine the past 60 years of nursing department orientation and assert the need to move toward more effective and innovative teaching strategies.

Stimulating Divergent Thinking in Junior High Career Education.

ERIC Educational Resources Information Center

Ranke, Charlotte; Champoux, Ellen M.

1981-01-01

Describes a middle school career-oriented teaching unit with emphasis on teaching for divergent thinking. The unit provides hands-on opportunities for eighth-grade students to explore careers using the knowledge and skills developed in their home economics class. The careers are restaurant management, hospitality service, and interior design. (CT)

A Class Education

ERIC Educational Resources Information Center

Jacobson, Linda

2005-01-01

In this article, the author discusses a partnership between Baylor University and the Waco public schools that embeds every teacher-candidate--from the freshman year on--into the K-12 system. To test whether professional-development schools, modeled after teaching hospitals, can be scaled up so that all of a college's teaching candidates--not just…

Dynamics of the Relationship between Teaching, Research, and Health Care.

ERIC Educational Resources Information Center

Kramer, Mebius F.

1991-01-01

Some problems in the changing pattern of relationships between bedside teaching, clinical research, and provision of medical services in academic hospitals are examined, including patient types, sophistication of medical intervention, and specialization. Four elements of government policy that might favor desirable development in these areas are…

The Effectiveness of Hypermedia Instructional Modules for Radiology Residents.

ERIC Educational Resources Information Center

Shaw, Steven G.; And Others

1995-01-01

Details the development and field testing of hypermedia training materials for teaching radiology residents at the Montreal General Hospital (Canada). Compares results of randomly teaching 24 residents with either hypermedia or traditional classroom methods. Results indicate that residents who learned with hypermedia generally performed as well as…

The effect of educational interventions with siblings of hospitalized children.

PubMed

Gursky, Barbara

2007-10-01

Research has demonstrated that siblings of chronically ill children can experience significant emotional and behavior changes; however, few studies have looked at the specific impact of pediatric hospitalization on the nonhospitalized child. Studies also indicate that children who receive age-appropriate information are better equipped to handle the stress and anxiety often associated with hospitalization.This study explored whether siblings of hospitalized children who received educational interventions had lower anxiety levels compared to siblings who did not receive interventions. A pretest-posttest experimental design was used with 50 subjects, ages 6-17 years, recruited from a children's hospital within a university medical center. Subjects were matched according to age, sex, and race, with 25 siblings each in the experimental and control groups. Siblings assigned to the experimental group received interventions from a standardized educational intervention protocol developed by the researcher. Interventions focused on teaching the sibling about hospitalization, illness or injury, and treatment for the patient, based on cognitive stages of development. All interventions were conducted by child life specialists on staff at the hospital with extensive training and experience in preparation and procedural teaching. Results shows that siblings who received educational interventions had significantly lower anxiety levels after interventions, compared to siblings who did not receive interventions. These findings have significant impact on children's health care and supporting family needs when a child is hospitalized.

Utilization of Parenteral Morphine by Application of ATC/DDD Methodology: Retrospective Study in the Referral Teaching Hospital.

PubMed

Dragojevic-Simic, Viktorija; Rancic, Nemanja; Stamenkovic, Dusica; Simic, Radoje

2017-01-01

Few studies analyzed the pattern of opioid analgesic utilization in hospital settings. The aim of this study was to determine the consumption pattern of parenteral morphine in patients hospitalized in the Serbian referral teaching hospital and to correlate it with utilization at the national and international level. In retrospective study, the required data were extracted from medical records of surgical patients who received parenteral morphine in the 5-year period, from 2011 to 2015. We used the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (DDD) international system for consumption evaluation. While the number of performed surgical procedures in our hospital steadily increased from 2011 to 2015, the number of inpatient bed-days decreased from 2012. However, the consumption of parenteral morphine varied and was not more than 0.867 DDD/100 bed-days in the observed period. Based on the available data, parenteral morphine consumption in our hospital was lower compared with international data. The low level of morphine use in the hospital was in accordance with national data, and compared with other countries, morphine consumption applied for medical indications in Serbia was low. Adequate legal provision to ensure the availability of opioids, better education and training of medical personnel, as well as multidisciplinary approach should enable more rational and individual pain management in the future, not only within the hospitals.

Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

PubMed

Durand, Wesley M; Johnson, Joseph R; Li, Neill Y; Yang, JaeWon; Eltorai, Adam E M; DePasse, J Mason; Daniels, Alan H

2018-04-01

Interhospital competition has been shown to influence the adoption of surgical techniques and approaches, clinical patient outcomes, and health care resource use for select surgical procedures. However, little is known regarding these dynamics as they relate to spine surgery. This investigation sought to examine the relationship between interhospital competitive intensity and perioperative outcomes following lumbar spinal fusion. This study used the Nationwide Inpatient Sample dataset, years 2003, 2006, and 2009. Patients were included based on the presence of the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes corresponding to lumbar spinal fusion, as well as on the presence of data on the Herfindahl-Hirschman Index (HHI). The outcome measures are perioperative complications, defined using an ICD-9-CM coding algorithm. The HHI, a validated measure of competition within a market, was used to assess hospital market competitiveness. The HHI was calculated based on the hospital cachement area. Multiple regression was performed to adjust for confounding variables including patient age, gender, primary payer, severity of illness score, primary versus revision fusion, anterior versus posterior approach, national region, hospital bed size, location or teaching status, ownership, and year. Perioperative clinical outcomes were assessed based on ICD-9-CM codes with modifications. In total, 417,520 weighted patients (87,999 unweighted records) were analyzed. The mean cachement area HHI was 0.31 (range 0.099-0.724). The average patient age was 55.4 years (standard error=0.194), and the majority of patients were female (55.8%, n=232,727). The majority of procedures were primary spinal fusions (92.7%, n=386,998) and fusions with a posterior-only technique (81.5%, n=340,271). Most procedures occurred in the South (42.5%, n=177,509) or the Midwest (27.0%, n=112,758) regions. In the multiple regression analysis, increased hospital competitive intensity was associated with an increased total complication rate (odds ratio [OR] 1.52, p<.0001), device-related complications (OR 1.46, p=.0294), genitourinary complications (OR 2.15, p=.0091), infection (OR 3.48, p<.0001), neurologic complications (OR 1.69, p=.0422), total charges (+29%, p=.0034), and inpatient hospital length of stay (LOS) (+16%, p=.0012). The likelihood of complications at state-owned hospitals (OR 2.81, p=.0001) was more highly associated with HHI than at private, non-profit hospitals (OR 1.39, p=.0050). The occurrence of complications at urban teaching hospitals (OR 2.14, p<.0001) was generally more associated with HHI than at urban non-teaching hospitals (OR 1.19, p=.2457). Increased interhospital competitive intensity is associated with increased odds of complications, increased total charges, and prolonged LOS following lumbar spine fusion. These differences are generally highest among state-owned and urban teaching hospitals. Differences in outcome related to hospital competition may be due to suboptimal resource allocation. Identifying differences in perioperative outcomes associated with hospital market competition is important in the contemporary environment of health care reimbursement reform and hospital consolidation. Perioperative outcome disparities between highly competitive and minimally competitive areas should be monitored and further studied. Copyright © 2017 Elsevier Inc. All rights reserved.

[A paradigm change in German academic medicine. Merger and privatization as exemplified with the university hospitals in Marburg and Giessen].

PubMed

Maisch, Bernhard

2005-03-01

1. The intended fusion of the university hospitals Marburg and Giessen in the state of Hessia is "a marriage under pressure with uncalculated risk" (Spiegel 2005). In the present political and financial situation it hardly appears to be avoidable. From the point of the view of the faculty of medicine in Marburg it is difficult to understand, that the profits of this well guided university hospital with a positive yearly budget should go to the neighboring university hospital which still had a fair amount of deficit spending in the last years.2. Both medical faculties suffer from a very low budget from the state of Hessia for research and teaching. Giessen much more than Marburg, have a substantial need for investments in buildings and infrastructure. Both institutions have a similar need for investments in costly medical apparatuses. This is a problem, which many university hospitals face nowadays.3. The intended privatisation of one or both university hospitals will need sound answers to several fundamental questions and problems:a) A privatisation potentially endangers the freedom of research and teaching garanteed by the German constitution. A private company will undoubtedly influence by active or missing additional support the direction of research in the respective academic institution. An example is the priorisation of clinical in contrast to basic research.b) With the privatisation practical absurdities in the separation of research and teaching on one side and hospital care on the other will become obvious with respect to the status of the academic employees, the obligatory taxation (16%) when a transfer of labor from one institution to the other is taken into account. The use of rooms for seminars, lectures and bedside with a double function for both teaching, research and hospital care has to be clarified with a convincing solution in everyday practice.c) The potential additional acquisition of patients, which has been advocated by the Hessian state government, may be unrealistic, when the 4th biggest university hospital in Germany will be created by the merger. University hospitals recrute the patients for high end medicine beyond their region because of the specialized academic competence and advanced technical possibilities. Additional recruitment of patients for routine hospital can hardly be expected.d) A private management will have to consider primarily the "shareholder value", even when investing in infrastructure and buildings, as it can be expected for one partner. On the longterm this will not be possible without a substantial reduction of employees in both institutions. There are, however, also substantial efforts of some private hospital chains in clinical research, e. g. by Helios in Berlin and Rhön Gmbh at the Leipzig Heart Center.e) There is a yet underestimated but very substantial risk because of the taxation for the private owner when academic staff is transferred from the university to hospital care in their dual function as academic teachers and doctors. This risk also applies for the university if the transfer should come from hospital to the university. These costs would add to the financial burden, which has to be carried in addition to the DRGs.

Transforming Children's Health Spaces into Learning Places

ERIC Educational Resources Information Center

Nisselle, Amy; Green, Julie; Scrimshaw, Chantel

2011-01-01

Purpose: Chronic health conditions can cause children extended school absences, creating significant barriers for continued education. Out-of-school learning environments, such as hospitals, provide opportunities to maintain children's learning identities during school absences. This paper seeks to present an example of hospital-based teaching and…

Laparoscopic assisted vaginal hysterectomy, setting up a service at a peripheral teaching hospital.

PubMed

Tsaltas, J; Kovacs, G; Dennis, J; Pratt, A

1996-01-01

The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit.

Diffusion of breast conserving surgery in medical communities.

PubMed

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

2005-01-01

Excluding skin cancers, breast cancer is the most common form of cancer in women. Due to an increased focus on early detection, many more cases of breast cancer are now diagnosed at an early stage, which makes the use of breast conserving surgery (BCS) an efficacious and often more desirable treatment choice than mastectomy. An analysis of the variation in the use of BCS in the United States was performed using data from the years 1988 and 1994, and stratifying hospitals on the basis of teaching status. In both 1988 and 1994, BCS was highest in academic teaching hospitals and lowest in community hospitals. This finding is interpreted within the framework of classical diffusion theory. Social and cultural norms in local medical communities have a strong effect on the degree to which innovations diffuse rapidly or not. This analysis is useful in the understanding of geographic and hospital-based variations in treatment for early stage breast cancer and other illnesses that have long and strongly held traditions of treatment.

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

Infection burden for hip and knee arthroplasty in the United States.

PubMed

Kurtz, Steven M; Lau, Edmund; Schmier, Jordana; Ong, Kevin L; Zhao, Ke; Parvizi, Javad

2008-10-01

We quantified the current and historical incidence of periprosthetic infection associated with hip and knee arthroplasty in the United States using the Nationwide Inpatient Sample, as well as corresponding hospitalization charges and length of stay. The rate of infected knee arthroplasties was 0.92%, significantly greater than that of infected hip arthroplasties with 0.88%. Length of stay was significantly longer for infected hip (9.7 days) and knee (7.6 days) arthroplasties compared to uninfected procedures (hip, 4.3 days; knee, 3.9 days) (P < .0001). Hospitalization charges were also significantly greater for infected joint arthroplasties than for uninfected arthroplasties (hips, 1.76 times; knees, 1.52 times) (P < .0001). Urban-non-teaching hospitals experienced the highest burden of infection with 1.18% for hips and 1.26% for knees compared to rural (0.61% for hips and 0.69% for knees) and urban-teaching hospitals (0.73% for hips and 0.77% for knees). We found an increasing number of joint arthroplasties being diagnosed with periprosthetic infection.

Peer Observation of Rounds Leads to Collegial Discussion of Teaching.

PubMed

Pierce, J Rush; Rendón, Patrick; Rao, Deepti

2018-01-01

Faculty in the Division of Hospital Medicine provide most of the clinical teaching for learners at our institution. The majority of these faculty are Assistant Professors with limited formal instruction in clinical teaching. Previous Divisional strategies to improve clinical teaching ability included discussion of effective teaching behaviors, developing written expectations for teaching faculty, and instituting seminars on effective clinical teaching. Heretofore, the Division had not utilized a direct observation exercise. We developed a direct observation exercise to encourage discussion of teaching techniques and contemplation of change. Using a social learning model, we developed a peer-to-peer observation followed by a nonevaluative discussion. We created a tool for describing teaching behaviors in 5 domains that were similar to or different from the usual behavior of the observing peer: learner presentations, team leadership, bedside teaching, professionalism, and other. After the observation, the observing and observed faculty met to discuss observed teaching behaviors. Both faculty members discussed and then recorded any teaching behaviors that they planned to adopt or change. We implemented this intervention in a 22-member Academic Division of Hospital Medicine at a tertiary care medical center in the United States. A high proportion were junior faculty and graduates of our residency program. We reviewed records of 28 of 31 observations that were completed during the initial 9-month period of implementation and later surveyed faculty. The exercise resulted in planned changes in teaching behaviors that included instituting new methods to improve teaching team leadership, triaging of patients seen on rounds, faculty behaviors during oral presentations, giving real-time feedback, use of technology and humor, demonstrating physical examination findings, and modeling professional behaviors. Faculty later reported adoption of new teaching behaviors that were important to them. This exercise was easily implemented, resulted in planned changes by both observed and observing peers, and resulted in widespread adoption of some specific teaching behaviors. The most commonly planned change dealt with team leadership or organizational issues. When given the freedom to choose, junior faculty were more likely to observe senior faculty.

Breastfeeding Counseling, Barriers and Facilitators of Lactation in the Military Community

DTIC Science & Technology

1998-05-01

play in health promotion and disease prevention. The advanced practice registered nurse employs complex strategies, interventions, and teaching to... teaching of breastfeeding, and regard by peers as experts in the content area. A pilot study was conducted at a mid-sized military hospital to assess the...admissions for infection in infants. Pediatrics, 65, 1,121-1,124. Freed, G. (1993). Breast-feeding: Time to teach what we preach. Journal of the American

Use of OsiriX in developing a digital radiology teaching library.

PubMed

Shamshuddin, S; Matthews, H R

2014-10-01

Widespread adoption of digital imaging in clinical practice and for the image-based examinations of the Royal College of Radiologists has created a desire to provide a digital radiology teaching library in many hospital departments around the UK. This article describes our experience of using OsiriX software in developing digital radiology teaching libraries. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Variability in Treatment for Patients with Cervical Spine Fracture and Dislocation: An Analysis of 107,152 Patients.

PubMed

Wang, Jing; Eltorai, Adam E M; DePasse, J Mason; Durand, Wesley; Reid, Daniel; Daniels, Alan H

2018-06-01

Cervical spine injuries are a common cause of morbidity and mortality; however, the optimal treatment of many of these injuries is debated, and previous studies have shown substantial variation in treatment. We sought to examined treatment variation in arthrodesis and halo/tong placement in cervical spine injury patients over a 12-year period. Data from the Healthcare Cost and Utilization Project National Inpatient Sample, from 2000 to 2011, were used for this study. Patients were identified with a cervical vertebral facture or dislocation based on the International Classification of Diseases, 9th Revision codes. Using χ 2 analysis, spinal arthrodesis rates and halo/tong placement rates were compared between hospitals based on teaching status for patients with and without spinal cord injury (SCI). The records of 107,152 patients with cervical fractures were examined. From 2000 to 2011, the overall arthrodesis rates fell from 25.2% to 20.6% (P < 0.001), and halo/tong placement rates fell from 13.2% to 3.6% (P < 0.001). In patients with cervical fracture without SCI, arthrodesis rates fell from 17.6% to 13.9% (P < 0.001), in cervical fracture patients with SCI, arthrodesis rates rose from 50.0% to 58.9% (P < 0.001), and in cervical dislocation patients, arthrodesis rates rose from 47.6% to 57.5% (P < 0.001). During the 12-year period, teaching hospitals had higher arthrodesis rates compared with nonteaching hospitals for patients with cervical fractures with SCI (57.3% vs. 53.4%, P = 0.001) and higher halo/tong placement rates for patients with cervical dislocations (2.7% vs. 1.7%, P = 0.004). Individual hospital variation showed a 3.5-fold variation in arthrodesis rates in 2000 to 2002, which fell to 3.0-fold by 2009 to 2011. Arthrodesis rates for cervical fracture patients significantly decreased, and arthrodesis rates for cervical dislocation and SCI patients increased from 2000 to 2011, with variability in treatment based on hospital teaching status. Rates of halo/tong placement rapidly decreased for cervical spine trauma at both teaching and nonteaching hospitals. Individual hospital treatment variation also decreased over the study period. Further clinical studies examining the optimal treatment for spine trauma may lead to continued decreases in treatment variability. Copyright © 2018 Elsevier Inc. All rights reserved.

Developing a Virtual Teach-To-Goal™ Inhaler Technique Learning Module: A Mixed Methods Approach.

PubMed

Wu, Meng; Woodrick, Nicole M; Arora, Vineet M; Farnan, Jeanne M; Press, Valerie G

Most hospitalized patients with asthma or chronic obstructive pulmonary disease misuse respiratory inhalers. An in-person educational strategy, teach-to-goal (TTG), improves inpatients' inhaler technique. To develop an effective, portable education intervention that remains accessible to hospitalized patients postdischarge for reinforcement of proper inhaler technique. A mixed methods approach at an urban academic hospital was used to iteratively develop, modify, and test a virtual teach-to-goal ™ (V-TTG ™ ) educational intervention using patient end-user feedback. A survey examined access and willingness to use technology for self-management education. Focus groups evaluated patients' feedback on access, functionality, and quality of V-TTG ™ . Forty-eight participants completed the survey, with most reporting having Internet access; 77% used the Internet at home and 82% used the Internet at least once every few weeks. More than 80% reported that they were somewhat or very likely to use V-TTG ™ to gain skills to improve their health. Most participants reported smartphone access (73%); half owned laptop computers (52%). Participants with asthma versus chronic obstructive pulmonary disease were more likely to own a smartphone, have a data plan, and have daily Internet use (P < .05). Nine focus groups (n = 25) identified themes for each domain: access-platform and delivery, Internet access, and technological literacy; functionality-usefulness, content, and teaching strategy; and quality-clarity, ease of use, length, and likability. V-TTG ™ is a promising educational tool for improving patients' inhaler technique, iteratively developed and refined with patient input. Patients in our urban, academic hospital overwhelmingly reported access to platforms and willingness to use V-TTG ™ for health education. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The financial experience of hospitals with HMO contracts: evidence from Florida.

PubMed

Young, Gary J; Burgess, James F; Desai, Kamal R; Valley, Danielle

2002-01-01

In this paper, we report results from the first study to systematically examine trends in the financial experience of hospitals with health maintenance organization (HMO) contracts. The longitudinal analysis (1990 through 1997) focused on hospitals in Florida. Hospital operating margins for HMO contracts grew tighter toward the end of the study period when the median margin was less than 1%. Teaching hospitals had operating margins that on average were below that of their nonteaching counterparts. The continued growth of HMOs and other managed care entities may have important implications for the future financial viability of U.S. hospitals.

Assessment of Service Quality in Teaching Hospitals of Yazd University of Medical Sciences: Using Multi-criteria Decision Making Techniques.

PubMed

Shafii, Milad; Rafiei, Sima; Abooee, Fatemeh; Bahrami, Mohammad Amin; Nouhi, Mojtaba; Lotfi, Farhad; Khanjankhani, Khatere

2016-08-01

Hospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). A literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards. Six dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851). Findings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients' security and plan effectively for its promotion.

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

PubMed

Kuo, Yu-Chun; Cheng, Shou-Hsia

2017-06-01

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

Compensation of chief executive officers at nonprofit US hospitals.

PubMed

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

2014-01-01

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

Project CHOICE: #62. A Career Unit for Grades 5 and 6. Hospitals. (Health Occupations Career Cluster).

ERIC Educational Resources Information Center

Kern County Superintendent of Schools, Bakersfield, CA.

This teaching unit, Hospitals, is one in a series of curriculum guides developed by Project CHOICE (Children Have Options in Career Education) to provide the classroom teacher with a source of career-related activities linking 5th and 6th grade elementary classroom experiences with the world of work. These eight lessons on hospitals cover the…

Awareness of Patients' Rights among Inpatients of a Tertiary Care Teaching Hospital- A Cross-sectional Study.

PubMed

Agrawal, Upasana; D'Souza, Brayal C; Seetharam, Arun Mavaji

2017-09-01

The rights of a patient are a set of rules of conduct which govern the interaction between the patients' and healthcare professionals. Every patient has a right to be informed about their rights and also the responsibility of the healthcare provider. To assess awareness among inpatient about patients' rights at an academic accredited hospital. A questionnaire based cross-sectional study was carried out among 350 patients admitted to the wards of a Tertiary Care Teaching Hospital. A 21-point questionnaire was developed based on standards of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and patients' charter of rights and validated. This charter of rights is also displayed in the hospital for patient's awareness. Frequencies and percentages were depicted. Chi-square test was used for statistical analysis. Positive awareness among the patients ranged from 28% to 97.4%. Females were more aware of their rights than males for 11 out of the 21 patient rights items. Younger adults were more aware than any other age group participants. Participants who were admitted to wards of higher categories (deluxe rooms) had high degree of awareness about patients' rights and education. Patients from urban areas and higher educational status were more aware than patients coming from rural areas. The study concludes that effective measures should be taken to improve the overall awareness not only among patients but also among different stakeholders in the healthcare delivery system. Readability of the patients' rights charter with good readability score, developing and distributing patient education materials in simple language about the rights and responsibilities to the patient and their family/relatives during their stay in the hospital or at the time of registration.Continuing nursing and medical education in medical teaching institutions and hospitals should focus on patients' rights and its importance, its need for awareness and its consequences should be taught to students and hospital staff. Patient Right Committee in the hospital should be established for supervision monitoring and observance of patients' rights.

The Role Of The Family Physician In Hospital

PubMed Central

Shea, P. E.; Johnston, M. A.; Premi, J. N.; Tweedie, T.

1980-01-01

Five family doctors at St. Joseph's Hospital in Hamilton, Ontario, completed a comprehensive survey of 88 active, associate and senior members of the Department of Family Medicine, detailing their activities in hospital, their attitudes toward the hospital, their actual and desired roles and their Department of Family Medicine. The study illustrates the changing role in hospital from procedure-orientation to patient advocate, and the resulting problems. These problems were mainly lack of communication skills and feeling impotent in dealing with the hospital power structure. Implications for family medicine training programs, continuing medical education programs and teaching and community hospitals are discussed in a series of four papers. PMID:21297840

A case-crossover study of sleep, fatigue, and other transient exposures at workplace and the risk of non-fatal occupational injuries among the employees of an Italian academic hospital.

PubMed

Valent, Francesca; Mariuz, Marika; Liva, Giulia; Bellomo, Fabrizio; De Corti, Daniela; Degan, Stefania; Ferrazzano, Alberto; Brusaferro, Silvio

2016-11-18

Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital. A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures. Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers' safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6):1001-1009. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran.

PubMed

Nashibi, Roohangiz; Mohammadi, Mohammad Javad; Alavi, Seyed Mohammad; Yousefi, Farid; Salmanzadeh, Shokrolah; Ahmadi, Fatemeh; Varnaseri, Mehran; Ramazani, Asghar; Moogahi, Sasan

2018-02-01

The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2], [3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16.

Does patient satisfaction affect patient loyalty?

PubMed

Kessler, Daniel P; Mylod, Deirdre

2011-01-01

This paper aims to investigate how patient satisfaction affects propensity to return, i.e. loyalty. Data from 678 hospitals were matched using three sources. Patient satisfaction data were obtained from Press Ganey Associates, a leading survey firm; process-based quality measures and hospital characteristics (such as ownership and teaching status) and geographic areas were obtained from the Centers for Medicare and Medicaid Services. The frequency with which end-of-life patients return to seek treatment at the same hospital was obtained from the Dartmouth Atlas. The study uses regression analysis to estimate satisfaction's effects on patient loyalty, while holding process-based quality measures and hospital and market characteristics constant. There is a statistically significant link between satisfaction and loyalty. Although satisfaction's effect overall is relatively small, contentment with certain hospitalization experience may be important. The link between satisfaction and loyalty is weaker for high-satisfaction hospitals, consistent with other studies in the marketing literature. RESEARCH LIMITATION/IMPLICATIONS: The US hospitals analyzed are not a random sample; the results are most applicable to large, non-profit teaching hospitals in competitive markets. Satisfaction ratings have business implications for healthcare providers and may be useful as a management tool for private and public purchasers. The paper is the first to show that patient satisfaction affects actual hospital choices in a large sample. Because patient satisfaction ratings are also correlated with other quality measures, the findings suggest a pathway through which individuals naturally gravitate toward higher-quality care.

Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization.

PubMed

Horwitz, Leora I; Wang, Yongfei; Altaf, Faseeha K; Wang, Changqin; Lin, Zhenqiu; Liu, Shuling; Grady, Jacqueline; Bernheim, Susannah M; Desai, Nihar R; Venkatesh, Arjun K; Herrin, Jeph

2018-04-01

Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. Cross-sectional analysis. Nonfederal United States acute care hospitals. Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0). We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0-1.5 versus 21.7% of hospitals with ratios >2.0. Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform disproportionately poorly versus nonteaching or public hospitals. However, it enables identification of more outliers and a more granular assessment of the association of hospital factors and outcomes.

Hospital variation in survival trends for in-hospital cardiac arrest.

PubMed

Girotra, Saket; Cram, Peter; Spertus, John A; Nallamothu, Brahmajee K; Li, Yan; Jones, Philip G; Chan, Paul S

2014-06-10

During the past decade, survival after in-hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals. We identified 93 342 adults with an in-hospital cardiac arrest at 231 hospitals in the Get With The Guidelines(®)-Resuscitation registry during 2000-2010. Using hierarchical regression models, we evaluated hospital-level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (P<0.001 for all) and an increase in prevalence of sepsis, respiratory insufficiency, renal insufficiency, intensive care unit location, and mechanical ventilation before arrest (P<0.001 for all). After adjustment for temporal trends in baseline characteristics, hospital rates of in-hospital cardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, P<0.001). Improvement in survival varied markedly and ranged from 3% in the bottom hospital quartile to 11% in the top hospital quartile. Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03). Although in-hospital cardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Use of social media across US hospitals: descriptive analysis of adoption and utilization.

PubMed

Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin; Merchant, Raina M

2014-11-27

Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization

PubMed Central

Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin

2014-01-01

Background Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. Objective The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. Methods We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Results Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Conclusions Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services. PMID:25431831

Preserving Catholic identity in mergers--an ethical and Canon Law perspective.

PubMed

Vowell, T H

1992-03-01

A merger or joint venture between a Catholic healthcare facility and a non-Catholic healthcare facility that provides procedures the Catholic Church believes to violate moral principles raises a number of issues to be considered by diocesan bishops. The 1983 Code of Canon Law provides bishops with guidelines to help establish the Catholicity of a Catholic hospital that has affiliated with a non-Catholic hospital. The diocesan bishop exercises his authority through a threefold ministry of teaching, sanctifying, and governing. These ministries stand as a reminder of his decision-making authority in matters that affect the spiritual state and growth of those entrusted to his care. Catholic identity, as it is presented in the Code of Canon Law, can be determined through the presence of a relationship between an institution and ecclesiastical authorities, the legal establishment of the entity, and a degree of control that the Church exercises over the institution. When evaluating a possible merger of joint venture between a Catholic hospital and a non-Catholic hospital that is performing procedures not in accord with Catholic Church teaching, the diocesan bishop must consider what limits must be observed. The good effects of the affiliation must be intended and direct, and the harmful effects must be perceived as unintended and indirect. The difficulties in determining and protecting the identity of Catholic hospitals in possible mergers or joint ventures should not prevent facilities from considering alternative forms of corporate structures. The Code of Canon Law and the Church's ethical teachings provide guidelines to ensure these possibilities.

National evaluation of policies on individual financial conflicts of interest in Canadian academic health science centers.

PubMed

Lexchin, Joel; Sekeres, Melanie; Gold, Jennifer; Ferris, Lorraine E; Kalkar, Sunila R; Wu, Wei; Van Laethem, Marleen; Chan, An-Wen; Moher, David; Maskalyk, M James; Taback, Nathan; Rochon, Paula A

2008-11-01

Conflicts of interest (COI) in research are an important emerging topic of investigation and are frequently cited as a serious threat to the integrity of human participant research. To study financial conflicts of interest (FCOI) policies for individual investigators working in Canadian academic health centers. Survey instrument containing 61 items related to FCOI. All Canadian academic health science centers (universities with faculties of medicine, faculties of medicine and teaching hospitals) were requested to provide their three primary FCOI policies. Number of all centers and teaching hospitals with policies addressing each of the 61 items related to FCOI. Only one item was addressed by all 74 centers. Thirteen items were present in fewer than 25% of centers. Fewer than one-quarter of hospitals required researchers to disclose FCOI to research participants. The role of research ethics boards (REBs) in hospitals was marginal. Asking centers to identify only three policies may not have inclusively identified all FCOI policies in use. Additionally, policies at other levels might apply. For instance, all institutions receiving federal grant money must comply with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Canadian centers within the same level (for instance, teaching hospitals) differ significantly in the areas that their policies address and these policies differ widely in their coverage. Presently, no single policy in any Canadian center informs researchers about the broad range of individual FCOI issues. Canadian investigators need to understand the environment surrounding FCOI, be able to access and follow the relevant policies and be confident that they can avoid entering into a FCOI.

The performance implications of pharmacy information system at the university teaching hospitals of Shiraz, Iran: Cluster approach

PubMed Central

Bayati, Saeede; Bastani, Peivand; Sagheb, Zahra Mahmoodzade; Jamalabadi, Sara; Samadbeik, Mahnaz

2017-01-01

Pharmacy information system (PIS) is becoming vital in assisting pharmacists to do their responsibilities. The aim of this study was to identify the current PIS implications in teaching hospitals affiliated with Shiraz University of Medical Science. This cross-sectional study was conducted in teaching hospitals affiliated with Shiraz University of Medical Science over the year 2016. Data were collected by observing the PIS as well as interviewing its users based on the researcher-made checklist. The checklist was prepared based on reviewing the Persian and English literature and its content validity was approved by the experts. To determine the reliability of the checklist, inter-rater reliability was used. Data were analyzed using SPSS16, and hospitals were clustered using SK-means method. In this study, the least conformity to the standards was shown in smart clinical features (4.54%), pharmaceutical companies' relationship (32.6%), and optimization of drug therapy (34.6%). In contrast, the highest conformity to the standards was shown in reporting capabilities (77.3%) and entry information and input (70.4%). Medication stock checking and optimization of drug therapy were effective features that have made a distinction between hospitals and lead to 95% variance between clusters. Based on the results, the current PIS design pays less attention to clinical features. Besides, clinical information for pharmacists and outside organization relationship were not provided by the current system. Thus, emphasis should be placed on the implementation of corrective actions to eliminate the current system's deficiencies. PMID:29184843

Improved quality of care for patients infected or colonised with ESBL-producing Enterobacteriaceae in a French teaching hospital: impact of an interventional prospective study and development of specific tools.

PubMed

Mondain, Véronique; Lieutier, Florence; Pulcini, Céline; Degand, Nicolas; Landraud, Luce; Ruimy, Raymond; Fosse, Thierry; Roger, Pierre Marie

2018-05-01

The increasing incidence of ESBL-producing Enterobacteriaceae (ESBL-E) in France prompted the publication of national recommendations in 2010. Based on these, we developed a toolkit and a warning system to optimise management of ESBL-E infected or colonised patients in both community and hospital settings. The impact of this initiative on quality of care was assessed in a teaching hospital. The ESBL toolkit was developed in 2011 during multidisciplinary meetings involving a regional network of hospital, private clinic and laboratory staff in Southeastern France. It includes antibiotic treatment protocols, a check list, mail templates and a patient information sheet focusing on infection control. Upon identification of ESBL-E, the warning system involves alerting the attending physician and the infectious disease (ID) advisor, with immediate, advice-based implementation of the toolkit. The procedure and toolkit were tested in our teaching hospital. Patient management was compared before and after implementation of the toolkit over two 3-month periods (July-October 2010 and 2012). Implementation of the ESBL-E warning system and ESBL-E toolkit was tested for 87 patients in 2010 and 92 patients in 2012, resulting in improved patient management: expert advice sought and followed (16 vs 97%), information provided to the patient's general practitioner (18 vs 63%) and coding of the condition in the patient's medical file (17 vs 59%), respectively. Our multidisciplinary strategy improved quality of care for in-patients infected or colonised with ESBL-E, increasing compliance with national recommendations.

Laparoscopic Assisted Vaginal Hysterectomy, Setting Up a Service at a Peripheral Teaching Hospital

PubMed Central

Kovacs, Gab; Dennis, Jenny; Pratt, Amanda

1996-01-01

The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit. PMID:18493427

Rewarding Teaching Faculty with a Reimbursement Plan

PubMed Central

Rouan, Gregory W; Wones, Robert G; Tsevat, Joel; Galla, John H; Dorfmeister, John W; Luke, Robert G

1999-01-01

OBJECTIVE To develop a system for measuring the teaching effort of medical school faculty and to implement a payment system that is based on it. DESIGN An interventional study with outcomes measured before and after the intervention. SETTING A department of internal medicine with a university hospital and an affiliated Veterans Administration hospital. INTERVENTION We assigned a value in teaching units to each teaching activity in proportion to the time expended by the faculty and the intensity of their effort. We then calculated total teaching units for each faculty member in the Division of General Internal Medicine and for combined faculty effort in each subspecialty division in the Department of Medicine. After determining the dollar value for a teaching unit, we distributed discretionary teaching dollars to each faculty member in the Division of General Internal Medicine and to each subspecialty division according to total teaching units. MEASUREMENTS AND MAIN RESULTS The distribution of discretionary teaching dollars was determined. In the year after the intervention, there was a substantial redistribution of discretionary teaching dollars among divisions. Compared with an increase in total discretionary dollars of 11.4%, the change in allocation for individual divisions ranged from an increase of 78.2% to a decrease of −28.5%. Further changes in the second year after the intervention were modest. The distribution of teaching units among divisions was similar to the distribution of questions across subspecialties on the American College of Physicians In-Training Examination (r = .67) and the American Board of Internal Medicine Certifying Examination (r = .88). CONCLUSIONS It is possible to measure the value of teaching effort by medical school faculty and to distribute discretionary teaching funds among divisions according to the value of teaching effort. When this intervention was used at our institution, there were substantial changes in the amounts received by some divisions. We believe that the new distribution more closely approximates the desired distribution because it reflects the desired emphasis on knowledge as measured by two of the most experienced professional groups in internal medicine. We also believe that our method is flexible and adaptable to the needs of most clinical teaching PMID:10354251

The experience of implementing the board of trustees’ policy in teaching hospitals in Iran: an example of health system decentralization

PubMed Central

Doshmangir, Leila; Rashidian, Arash; Ravaghi, Hamid; Takian, Amirhossein; Jafari, Mehdi

2015-01-01

Background: In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods: We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results: Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion: The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization policies in the past and their outcomes were overlooked, while the context was not prepared appropriately and key stakeholders, particularly the government, did not support the decentralization of Iran’s health system. PMID:25844379

The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada.

PubMed

Doumouras, Aristithes G; Saleh, Fady; Anvari, Sama; Gmora, Scott; Anvari, Mehran; Hong, Dennis

2017-11-01

Previous data demonstrate that patients who receive bariatric surgery at a Center of Excellence are different than those who receive care at non-accredited centers. Canada provides a unique opportunity to naturally exclude confounders such as insurance status, hospital ownership, and lack of access on comparisons between hospitals and surgeons in bariatric surgery outcomes. The objective of this study was to determine the effect of hospital accreditation and other health system factors on all-cause morbidity after bariatric surgery in Canada. This was a population-based study of all patients aged ≥18 who received a bariatric procedure in Canada (excluding Quebec) from April 2008 until March 2015. The main outcomes for this study were all-cause morbidity and costs during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24 h or required reoperation. Risk-adjusted hierarchical regression models were used to determine predictors of morbidity and cost. Overall, 18,398 patients were identified and the all-cause morbidity rate was 10.1%. Surgeon volume and teaching hospitals were both found to significantly decrease the odds of all-cause morbidity. Specifically, for each increase in 25 bariatric cases per year, the odds of all-cause morbidity was 0.94 times lower (95% CI 0.87-1.00, p = 0.03). Teaching hospitals conferred a 0.75 lower odds of all-cause morbidity (95% CI 0.58-0.95, p < 0.001). Importantly, formal accreditation was not associated with a decrease in all-cause morbidity within a universal healthcare system. No health system factors were associated with significant cost differences. This national cohort study found that surgeon volume and teaching hospitals predicted lower all-cause morbidity after surgery while hospital accreditation was not a significant factor.

Work-related health complaints in surgical residents and the influence of social support and job-related autonomy.

PubMed

Boerjan, Martine; Bluyssen, Simone J M; Bleichrodt, Robert P; van Weel-Baumgarten, Evelyn M; van Goor, Harry

2010-08-01

The aim of this cross-sectional study was to investigate the influence of job-related autonomy and social support provided by consultants and colleagues on the stress-related health complaints of surgical residents in the Netherlands. All (n = 400) Dutch residents in training in general surgery were sent validated self-report questionnaires. Odds ratios were calculated predicting health and exposure to long-term stress for gender, number of working hours, type of hospital, level of social support, job-related autonomy and training phase. The interactions between job-related autonomy and level of social support provided by consultants and colleagues, and all variables, were analysed. A total of 254 of 400 (64%) residents returned questionnaires that were eligible for analysis. Residents experienced more health complaints than the average member of the Dutch working population (4.0 versus 2.5; p = 0.000). Male and senior residents were significantly 'healthier' than female and junior residents, respectively. Social support by consultants was a strong predictor of health and social support by colleagues showed a significant interaction with gender. Women and residents in university hospitals experienced less social support by consultants than men and residents in general teaching hospitals. Residents working in university hospitals experienced lower levels of job-related autonomy and less support from colleagues in comparison with those working in general teaching hospitals. A working week of > 60 hours adversely affected health and job-related autonomy. Social support provided by consultants and colleagues, and job control, are important factors that interact with the work-associated, stress-related health of residents in training in general surgery. Residents report a greater number of health complaints than the average member of the working population, especially female and junior residents. General teaching hospitals seem to provide better support at work than university hospitals.

Development of postgraduate research supervisors within a teaching hospital setting.

PubMed

Scott, K M; Caldwell, P H Y; Oldmeadow, W; Dale, R C; Jones, C A

2015-08-01

The recent trend to embed medical research at point of care has created a need for postgraduate research supervisors in hospitals who are practising clinicians and lab-based researchers. We explored the training needs of supervisors to inform the design and evaluation of a hospital-based development programme. We found that if hospital-based supervisors are to improve their practice, the programme needs to be on-site to ensure access and relevance to local issues. © 2015 Royal Australasian College of Physicians.

A new type of rural nurse residency.

PubMed

Molinari, Deana L; Monserud, Maria; Hudzinski, Dionetta

2008-01-01

The Rural Nurse Internship program is a distance education-based nurse residency designed to meet the needs of rural hospitals across the country. Nurses learn to perform the generalist role by practicing crisis assessment and management in six subnursing specialties. The collaborative yearlong residency provides preceptors, mentors, monthly seminars, and just-in-time information to novice nurses in their own hospitals using instructional technologies. Expert rural nurses teach novice employees using a standardized curriculum. Hospitals individualize the program to meet employee and hospital needs.

[Causes of iron-deficiency anaemia in the internal medecine department of the national teaching hospital of Ouagadougou].

PubMed

Nacoulma, Eric William Camille; Sakande, Jean; Ouermi, Alain; Tieno, Hervé; Drabo, Youssoufou Joseph

2008-01-01

This retrospective study in the internal medicine department of the national teaching hospital of Ouagadougou was conducted to identify the main causes of iron-deficiency anaemia. Among the 65 subjects meeting the inclusion and exclusion criteria, mean haemoglobin was 7.5 g/dl, with mean serum ferritin 8.9 microg/l among women and 15.5 microg/l among men. The most common cause was chronic blood loss, and hookworm was a major cause in 19.6% of cases. These results suggest the need for preventive measures against iron deficiency and for reinforcement of the fight against diseases producing fecal blood loss.

[Nursing personnel downsizing in a teaching hospital].

PubMed

Fakih, Flávio Trevisan; Carmagnani, Maria Isabel Sampaio; Cunha, Isabel Cristina Kowal Olm

2006-01-01

The objective of this study was to adjust the downsizing of nursing personnel in a teaching hospital to the resolution of Federal Nursing Council no. 293/2004. The classification of patients in levels of complexity care was done and the required time for the nurse care also was verified. The present number of employees was compared to the measured one. The outcomes showed the levels of patients'care complexity is on intermediate care (42%), and the required time to the nurse care was greater on intensive care patients (42%). The present staff has a deficit of 205 nurses and an exceding of 284 professionals of techinical college level.

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

PubMed

Siddiqui, Tahir Saeed; Rehman, Anis ur; Ahmed, Basharat

2006-01-01

Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.

Teaching Pediatric Nursing Concepts to Non-Pediatric Nurses Using an Advance Organizer

ERIC Educational Resources Information Center

Bell, Julie Ann

2013-01-01

Non-pediatric nurses in rural areas often care for children in adult units, emergency departments, and procedural areas. A half-day program about pediatric nursing using constructivist teaching strategies including an advance organizer, case studies, and simulation was offered at a community hospital in Western North Carolina. Nurses reported a…

Postpartum Patient Teaching Success: Implications from Nursing and Patient Perspectives

ERIC Educational Resources Information Center

Day, Dawn

2014-01-01

A recent examination of postpartum patient satisfaction scores in an inner-city hospital revealed decreased satisfaction of discharge teaching practices. Guided by Knowles' model of andragogy and Donabedian's model of structure-process-outcome, the purpose of this study was to gain an understanding of how the structure and process of discharge…

Connecting College Learners with Rural Entrepreneurship Opportunities: The Rural Entrepreneurship Teaching Unit

ERIC Educational Resources Information Center

Frazier, Barbara J.; Niehm, Linda S.; Stoel, Leslie

2012-01-01

The Rural Entrepreneurship Teaching Unit (RETU) is designed to acquaint university retailing and hospitality majors with rural entrepreneurship opportunities. The unit is an outcome of a federal grant focused on the contribution of the local retail sector to rural community resilience. The RETU integrates knowledge regarding rural development,…

Hospital waste management status in Iran: a case study in the teaching hospitals of Iran University of Medical Sciences.

PubMed

Farzadkia, Mahdi; Moradi, Arash; Mohammadi, Mojtaba Shah; Jorfi, Sahand

2009-06-01

Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed(-1) day(-1), which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended.

Why hospitals adopt patient engagement functionalities at different speeds? A moderated trend analysis.

PubMed

Asagbra, O Elijah; Burke, Darrell; Liang, Huigang

2018-03-01

To investigate acute care hospitals' adoption speed of patient engagement health information technology (HIT) functionalities from 2008 to 2013 and how this speed is contingent on environmental factors and hospital characteristics. Data on non-government acute care hospitals located in the United States was obtained from merging three databases: the American Hospital Association's (AHA) annual survey information technology supplement, AHA annual survey, and the Area Health Resource File (AHRF). The variables obtained from these datasets were the amount of annually adopted patient engagement HIT functionalities and environmental and organizational characteristics. Environmental factors included were uncertainty, munificence, and complexity. Hospital characteristics included size, system membership, ownership, and teaching status. A regression analysis of 4176 hospital-year observations revealed a positive trend in the adoption of HIT functionalities for patient engagement (β= 1.109, p < 0.05). Moreover, the study showed that large, system-affiliated, not-for-profit, teaching hospitals adopt patient engagement HIT functionalities at a faster speed than their counterparts. Environmental munificence and uncertainty were also associated with an accelerating speed of adoption. Environmental complexity however did not show a significant impact on the speed of adoption. From 2008 to 2013, there was a significant acceleration in the speed of adopting patient engagement HIT functionalities. Further efforts should be made to ensure proper adoption and consistent use by patients in order to reap the benefits of these IT investments. Hospitals adopted at least one HIT functionality for patient engagement per year. The adoption speed varied across hospitals, depending on both environmental and organizational factors. Copyright © 2017 Elsevier B.V. All rights reserved.

[Hospitals' evolution through the ages].

PubMed

de Micheli, Alfredo

2005-01-01

The predecessor institutions of modern hospitals--Byzantine nosocómeion, European hospitale and Islamic maristan--were dissimilar both in their patients and their aims. The first charitable organizations in West Europe (Rome) and in the East (Cesarea in Cappadocia) were rather hospices. After the collapse of the Western Roman Empire (476 A.D.), some monastic centers were prepared to provide medical assistance to religious and secular patients. Since the XI and XII Centuries in all of Christian Europe the charitable institutions, designated as hospitale, multiplied. Among the Italian ones, the Roman Santo Spirito (Holy Ghost) Hospital, built in the 1201-1204 period, reached a preeminet position. This one soon became the most important of the entire Christendom (archihospital), with a lot of affiliated hospitals in Europe and later in America. The first American hospital, Saint Nicholas Hospital, opened on December 29, 1503 in Santo Domingo, obtained in 1541 its affiliation to the Santo Spirito archihospital. Regarding continental America, the first health centers were established in Mexico: the Immaculate Conception Hospital and the Saint Lazarus Hospital, both established by Hernán Cortés. For its part, clinical teaching was systematized at the Saint Francis Hospital in Padua and by there moved to Leyden. In Mexico, the chair of medical clinics or practical medicine was established in 1806 at the Saint Andrew Hospital. During the XX century, Dr. Ignacio Chávez was the driving force behind the creation of the modern Mexican Health Institutes. These ones are dedicated to the treatment of poor patients, as well as to medical teaching and research.

Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.

PubMed

Glover, McKinley; Khalilzadeh, Omid; Choy, Garry; Prabhakar, Anand M; Pandharipande, Pari V; Gazelle, G Scott

2015-10-01

An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality. The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates. This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate. The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type. Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p < 0.01). The average rating for hospitals with low readmission rates (4.15 ± 0.31) was higher than that for hospitals with higher readmission rates (4.05 ± 0.41, p < 0.01). Major teaching hospitals were 14.3 times more likely to be in the high readmission rate group. A one-star increase in Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p <  0.01), when controlling for hospital characteristics and Facebook-related variables. Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.

42 CFR 433.68 - Permissible health care-related taxes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... any deducted amounts for bad debts, charity care, and payer discounts. (iv) The tax is imposed on... all revenues (including Medicare and Medicaid) but excludes teaching hospitals would have to meet this... the State; (2) Providers that do not charge for services within the class; (3) Rural hospitals...

Effects of Assertive Training on Hospitalized Adolescents and Young Adults.

ERIC Educational Resources Information Center

Fiedler, Phyllis E.; And Others

1979-01-01

This study focuses on reducing the hostility of hospitalized adolescent and young adult psychiatric patients through assertive training techniques designed to teach appropriate responses to interpersonal conflict. It was predicted that, after treatment, the assertive group would show greater assertiveness, less hostility, and a more positive…

The Longitudinal Study of Computer Simulation in Learning Statistics for Hospitality College Students

ERIC Educational Resources Information Center

Huang, Ching-Hsu

2014-01-01

The class quasi-experiment was conducted to determine whether using computer simulation teaching strategy enhanced student understanding of statistics concepts for students enrolled in an introductory course. One hundred and ninety-three sophomores in hospitality management department were invited as participants in this two-year longitudinal…

Differences in Routine Laboratory Ordering Between a Teaching Service and a Hospitalist Service at a Single Academic Medical Center.

PubMed

Ellenbogen, Michael I; Ma, Madeleine; Christensen, Nicholas P; Lee, Jungwha; O'Leary, Kevin J

2017-01-01

Studies have shown that the overutilization of laboratory tests ("labs") for hospitalized patients is common and can cause adverse health outcomes. Our objective was to compare the ordering tendencies for routine complete blood counts (CBC) and chemistry panels by internal medicine residents and hospitalists. This observational study included a survey of medicine residents and hospitalists and a retrospective analysis of labs ordering data. The retrospective data analysis comprised patients admitted to either the teaching service or nonteaching hospitalist service at a single hospital during 2014. The survey asked residents and hospitalists about their practices and preferences on labs ordering. The frequency and timing of one-time and daily CBC and basic chemistry panel ordering for teaching service and hospitalist patients were obtained from our data warehouse. The average number of CBCs per patient per day and chemistry panels per patient per day was calculated for both services and multivariate regression was performed to control for patient characteristics. Forty-four of 120 (37%) residents and 41 of 53 (77%) hospitalists responded to the survey. Forty-four (100%) residents reported ordering a daily CBC and chemistry panel rather than one-time labs at patient admission compared with 22 (54%) hospitalists ( P < 0.001). For CBCs, teaching service patients averaged 1.72/day and hospitalist service patients averaged 1.43/day ( P < 0.001). For basic chemistry panels, teaching service patients averaged 1.96/day and hospitalist service patients averaged 1.78/day ( P < 0.001). Results were similar in multivariate regression models adjusting for patient characteristics. Residents' self-reported and actual use of CBCs and chemistry panels is significantly higher than that of hospitalists in the same hospital. Our results reveal an opportunity for greater supervision and improved instruction of cost-conscious ordering practices.

1. AERIAL VIEW, LOOKING WEST OF 'THE BIRMINGHAM MEDICAL CENTER,' ...

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

1. AERIAL VIEW, LOOKING WEST OF 'THE BIRMINGHAM MEDICAL CENTER,' WITH HILLMAN HOSPITAL, THE FIVE-STORY BUILDING (CENTER RIGHT AT 20TH STREET AND SIXTH AVENUE SOUTH), JEFFERSON TOWER (CENTER LEFT AT 20TH STREET AND SEVENTH AVENUE SOUTH, AND THE MANY HOSPITALS AND TEACHING FACILITIES OF THE UNIVERSITY OF ALABAMA AT BIRMINGHAM MEDICAL CENTER. - Hillman Hospital, 600 Block Westside Twentieth Street South, Birmingham, Jefferson County, AL

Bed Capacity Planning Using Stochastic Simulation Approach in Cardiac-surgery Department of Teaching Hospitals, Tehran, Iran

PubMed Central

TORABIPOUR, Amin; ZERAATI, Hojjat; ARAB, Mohammad; RASHIDIAN, Arash; AKBARI SARI, Ali; SARZAIEM, Mahmuod Reza

2016-01-01

Background: To determine the hospital required beds using stochastic simulation approach in cardiac surgery departments. Methods: This study was performed from Mar 2011 to Jul 2012 in three phases: First, collection data from 649 patients in cardiac surgery departments of two large teaching hospitals (in Tehran, Iran). Second, statistical analysis and formulate a multivariate linier regression model to determine factors that affect patient's length of stay. Third, develop a stochastic simulation system (from admission to discharge) based on key parameters to estimate required bed capacity. Results: Current cardiac surgery department with 33 beds can only admit patients in 90.7% of days. (4535 d) and will be required to over the 33 beds only in 9.3% of days (efficient cut off point). According to simulation method, studied cardiac surgery department will requires 41–52 beds for admission of all patients in the 12 next years. Finally, one-day reduction of length of stay lead to decrease need for two hospital beds annually. Conclusion: Variation of length of stay and its affecting factors can affect required beds. Statistic and stochastic simulation model are applied and useful methods to estimate and manage hospital beds based on key hospital parameters. PMID:27957466

Resource utilization in primary repair of cleft lip.

PubMed

Owusu, James A; Liu, Meixia; Sidman, James D; Scott, Andrew R

2013-03-01

To determine national variations in resource utilization for primary repair of cleft lip, identify patient and institutional factors associated with high resource use, and estimate the current incidence of cleft lip in the United States. Retrospective analysis of a national, pediatric database (2009 Kids' Inpatient Database [KID]). Patients aged 1 year and younger were selected using international classification of disease codes for cleft lip and procedure codes for cleft lip repair. A number of demographic variables were analyzed, and hospital charges were considered as a measure of resource utilization. There were 1318 patients identified. The national incidence was 0.09%, with a male to female ratio of 1.8:1. Regional incidence varied from 0.07% (Northeast) to 0.10% (West). The mean age at surgery was 4.2 months. The average length of stay was 1.4 days. The national average hospital charge was $20,147, ranging from $14,635 (South) to $23,663 (West). Teaching hospitals charge an average of $9764 higher than nonteaching hospitals. The strongest predictor of charge was length of stay, increasing charge by $8102 for every additional hospital day (P < .01). Regional variations exist in resource utilization for primary cleft lip repair. Resource use is higher in the West and among teaching hospitals.

[Qualitative fungal composition of services at risk of nosocomial infections at Aristide Le Dantec Hospital (Dakar)].

PubMed

Diongue, K; Badiane, A S; Seck, M C; Ndiaye, M; Diallo, M A; Diallo, S; Sy, O; Ndiaye, J L; Faye, B; Ndir, O; Ndiaye, D

2015-03-01

In hospitals, the quality control of the air is a key element. Indeed airborne fungi constitute a real danger for patients hospitalized in wards at risk of nosocomial infections especially when they are immunocompromised. The objective was to determine the qualitative fungal flora composition of wards at risk of nosocomial infections at Le Dantec teaching hospital. Between April and May 2013, 73 samples were collected from 45 compartments within seven services at risk of nosocomial infection at Aristide Le Dantec teaching Hospital (Dakar). Samples were made once by sedimentation method and the percentage of positive cultures was 100%. The most represented species were Cladosporium spp. (91.1%), Aspergillus spp. (86.6%), Penicillium spp. 71.1% and Candida spp. (57.7%). Candida albicans and Aspergillus fumigatus were isolated respectively at 15.5% and 11.1%. Wards have been classified according to the number of species isolated; 11 species in pediatric oncology, 10 species in pediatric surgery/neonatal and intensive care, nine species for oncology, eight species in general surgery and dermatology, and four species in internal medicine. This study shows that fungi causing nosocomial infections are present in hospital and their monitoring should be included in the program of Nosocomial Infections Prevention Committees (CLIN). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Coexistence of SHV-4- and TEM-24-Producing Enterobacter aerogenes Strains before a Large Outbreak of TEM-24-Producing Strains in a French Hospital

PubMed Central

Mammeri, H.; Laurans, G.; Eveillard, M.; Castelain, S.; Eb, F.

2001-01-01

In 1996, a monitoring program was initiated at the teaching hospital of Amiens, France, and carried out for 3 years. All extended-spectrum β-lactamase (ESBL)-producing Enterobacter aerogenes isolates recovered from clinical specimens were collected for investigation of their epidemiological relatedness by pulsed-field gel electrophoresis and enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) and determination of the type of ESBL harbored by isoelectric focusing and DNA sequencing. Molecular typing revealed the endemic coexistence, during the first 2 years, of two clones expressing, respectively, SHV-4 and TEM-24 ESBLs, while an outbreak of the TEM-24-producing strain raged in the hospital during the third year, causing the infection or colonization of 165 patients. Furthermore, this strain was identified as the prevalent clone responsible for outbreaks in many French hospitals since 1996. This study shows that TEM-24-producing E. aerogenes is an epidemic clone that is well established in the hospital's ecology and able to spread throughout wards. The management of the outbreak at the teaching hospital of Amiens, which included the reinforcement of infection control measures, failed to obtain complete eradication of the clone, which has become an endemic pathogen. PMID:11376055

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital.

PubMed

Timmers, T K; Kortekaas, E; Beyer, Bpc; Huizinga, E; V Hezik van, S M; Twagirayezu, E; Bemelman, M

2016-09-01

Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. During 2010-2012, medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility. Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education. The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.

Professionalism of physicians at a major teaching hospital during the Fukushima nuclear disaster.

PubMed

Narita, M; Tokuda, Y; Barnett, P

2016-07-01

It poses a serious problem if physicians leave a hospital without having a replacement or without permission. A huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. This disaster overwhelmed a major teaching hospital in the local area and many hospital employees, including some resident physicians, left the premises. Since the threat of severe radiation exposure poses a potentially greater lifetime risk to younger individuals, letting the young resident physicians leave the hospital was not only allowed, it was actually recommended by many attending physicians and hospital administrators. The hospital administrator was required to make the difficult decision of whether to make all efforts to provide the highest level of medical care, including keeping all of the physicians on the premises, or to evacuate the resident physicians in order to preserve their health and their potential future contributions to healthcare. Consideration and compassion needed to be provided to all people, regardless of the reason they wanted to leave. From an ethical perspective, the roles of performance under these complex circumstances should be understood and embraced by us as individuals, professionals, supervisors and society as a whole. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Infective endocarditis: Clinical features and prognosis between 2004 and 2014 in a non-teaching hospital].

PubMed

Capilla, E; Poyet, R; Tortat, A-V; Marchi, J; Brocq, F-X; Pons, F; Kerebel, S; Jego, C; Mayet, A; Cellarier, G R

2017-04-01

Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a severe disease. The aim of the study was to describe clinical features and prognosis of patients with IE in a non-teaching hospital and compare them with current data and a similar study conducted 10 years earlier in the same center. We performed a single institution retrospective study including all patients with Duke-Li definite IE between 2004 and 2014. Ninety-four patients were included. Results are consistent with current French and international data, including in-hospital death rate of 16%. In accordance with literature, we report on an increase in Staphylococcus and health care-associated IE and endocarditis on pacemaker leads, but without significant difference compared to our previous study. In univariate analyses, renal failure, age over 77 years and Staphylococcus aureus IE were associated with in-hospital mortality. In multivariate analyses, predictors of in-hospital death were renal failure and lack of surgery. There was a non-significant trend of excess mortality in Staphylococcus endocarditis and in patients with heart failure. IE remains a severe disease and S. aureus is more often involved. IE seems to be safely managed in a peripheral hospital provided that there is a partnership with a reference hospital. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Establishment of the world's first telerobotic remote surgical service: for provision of advanced laparoscopic surgery in a rural community.

PubMed

Anvari, Mehran; McKinley, Craig; Stein, Harvey

2005-03-01

To establish a telerobotic surgical service between a teaching hospital and a rural hospital for provision of telerobotic surgery and assistance to aid rural surgeons in providing a variety of advanced laparoscopic surgery to their community patients. The above service was established between St. Joseph's Hospital in Hamilton and North Bay General Hospital 400 km north of Hamilton on February 28, 2003. The service uses an IP-VPN (15 Mbps of bandwidth) commercially available network to connect the robotic console in Hamilton with 3 arms of the Zeus-TS surgical system in North Bay. To date, 21 telerobotic laparoscopic surgeries have taken place between North Bay and Hamilton, including 13 fundoplications, 3 sigmoid resections, 2 right hemicolectomies, 1 anterior resection, and 2 inguinal hernia repairs. The 2 surgeons were able to operate together using the same surgical footprint and interchange roles seamlessly when desired. There have been no serious intraoperative complications and no cases have had to be converted to open surgeries. The mean hospital stays were equivalent to mean laparoscopic LOS in the tertiary institution. Telerobotic remote surgery is now in routine use, providing high-quality laparoscopic surgical services to patients in a rural community and providing a superior degree of collaboration between surgeons in teaching hospitals and rural hospitals. Further refinement of the robotic and telecommunication technology should ensure its wider application in the near future.

Establishment of the World's First Telerobotic Remote Surgical Service

PubMed Central

Anvari, Mehran; McKinley, Craig; Stein, Harvey

2005-01-01

Objective: To establish a telerobotic surgical service between a teaching hospital and a rural hospital for provision of telerobotic surgery and assistance to aid rural surgeons in providing a variety of advanced laparoscopic surgery to their community patients. Summary Background Data: The above service was established between St. Joseph's Hospital in Hamilton and North Bay General Hospital 400 km north of Hamilton on February 28, 2003. The service uses an IP-VPN (15 Mbps of bandwidth) commercially available network to connect the robotic console in Hamilton with 3 arms of the Zeus-TS surgical system in North Bay. Results: To date, 21 telerobotic laparoscopic surgeries have taken place between North Bay and Hamilton, including 13 fundoplications, 3 sigmoid resections, 2 right hemicolectomies, 1 anterior resection, and 2 inguinal hernia repairs. The 2 surgeons were able to operate together using the same surgical footprint and interchange roles seamlessly when desired. There have been no serious intraoperative complications and no cases have had to be converted to open surgeries. The mean hospital stays were equivalent to mean laparoscopic LOS in the tertiary institution. Conclusions: Telerobotic remote surgery is now in routine use, providing high-quality laparoscopic surgical services to patients in a rural community and providing a superior degree of collaboration between surgeons in teaching hospitals and rural hospitals. Further refinement of the robotic and telecommunication technology should ensure its wider application in the near future. PMID:15729068

Simulation-Based Dysphagia Training: Teaching Interprofessional Clinical Reasoning in a Hospital Environment.

PubMed

Miles, Anna; Friary, Philippa; Jackson, Bianca; Sekula, Julia; Braakhuis, Andrea

2016-06-01

This study evaluated hospital readiness and interprofessional clinical reasoning in speech-language pathology and dietetics students following a simulation-based teaching package. Thirty-one students participated in two half-day simulation workshops. The training included orientation to the hospital setting, part-task skill learning and immersive simulated cases. Students completed workshop evaluation forms. They filled in a 10-question survey regarding confidence, knowledge and preparedness for working in a hospital environment before and immediately after the workshops. Students completed written 15-min clinical vignettes at 1 month prior to training, immediately prior to training and immediately after training. A marking rubric was devised to evaluate the responses to the clinical vignettes within a framework of interprofessional education. The simulation workshops were well received by all students. There was a significant increase in students' self-ratings of confidence, preparedness and knowledge following the study day (p < .001). There was a significant increase in student overall scores in clinical vignettes after training with the greatest increase in clinical reasoning (p < .001). Interprofessional simulation-based training has benefits in developing hospital readiness and clinical reasoning in allied health students.

Indirect medical education and disproportionate share adjustments to Medicare inpatient payment rates.

PubMed

Nguyen, Nguyen Xuan; Sheingold, Steven H

2011-11-04

The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare's prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations. These adjustments were originally established based on the statistical relationships between IME and DSH and hospital costs. Due to a variety of policy considerations, the legislated levels of these adjustments may have deviated over time from these "empirically justified levels," or simply, "empirical levels." In this paper, we estimate the empirical levels of IME and DSH using 2006 hospital data and 2009 Medicare final payment rules. Our analyses suggest that the empirical level for IME would be much smaller than under current law-about one-third to one-half. Our analyses also support the DSH adjustment prescribed by the Affordable Care Act of 2010 (ACA)--about one-quarter of the pre-ACA level. For IME, the estimates imply an increase in costs of 1.88% for each 10% increase in teaching intensity. For DSH, the estimates imply that costs would rise by 0.52% for each 10% increase in the low-income patient share for large urban hospitals. Public Domain.

PACS industry in Korea

NASA Astrophysics Data System (ADS)

Kim, Hee-Joung

2002-05-01

PACS industry in Korea has been rapidly growing, since government had supported collaborative PACS project between industry and university hospital. In the beginning, PACS industry had focused on developing peripheral PACS solutions, while the Korea PACS society was being formed. A few companies had started developing and installing domestic large-scale full-PACS system for teaching hospitals. Several years later, many hospitals have installed full-PACS system with national policy of reimbursement for PACS exams in November 1999. Both experiences of full-PACS installation and national policy generated tremendous intellectual and technological expertise about PACS at all levels, clinical, hospital management, education, and industrial sectors. There are now more than 20 domestic PACS companies. They have enough experiences which are capable of installing a truly full-PACS system for large-scale teaching hospitals. As an example, a domestic company had installed more than 40 full-PACS systems within 2-3 years. Enough experiences of full-PACS installation in Korea lead PACS industry to start exporting their full-PACS solutions. However, further understanding and timely implementation of continuously evolving international standard and integrated healthcare enterprise concepts may be necessary for international leading of PACS technologies for the future.

Patient attitudes towards medical students at Damascus University teaching hospitals.

PubMed

Sayed-Hassan, Rima M; Bashour, Hyam N; Koudsi, Abir Y

2012-03-22

The cooperation of patients and their consent to involve medical students in their care is vital to clinical education, but large numbers of students and lack of experience as well as loss of privacy may evoke negative attitudes of patients, which may sometimes adversely affect the clinical teaching environment. This study aimed to explore the attitudes of patients towards medical students at Damascus University hospitals, and to explore the determinants of those attitudes thus discussing possible implications applicable to clinical teaching. This cross-sectional study was conducted at three teaching hospitals affiliated to the Faculty of Medicine at Damascus University. Four hundred patients were interviewed between March and April 2011 by a trained sociologist using a structured questionnaire. Of the patients interviewed, 67.8% approved the presence of medical students during the medical consultation and 58.2% of them felt comfortable with the presence of students, especially among patients with better socio-economic characteristics. 81.5% of the patients agreed to be examined by students in the presence of the supervisor, while 40.2% gave agreement even in the absence of the supervisor. Privacy was the most important factor in the patients' reticence towards examination by the students, whilst the relative safety and comfort if a supervisor was available determined patients' agreement. The study concluded overall positive attitudes to the medical students' involvement in medical education. However, it is essential that students and clinical supervisors understand and adhere to professional and ethical conduct when involving patients in medical education.

Factors associated with hospital arrival time after the onset of stroke symptoms: A cross-sectional study at two teaching hospitals in Harare, Zimbabwe.

PubMed

Seremwe, Farayi; Kaseke, Farayi; Chikwanha, Theodora M; Chikwasha, Vasco

2017-06-01

Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. A descriptive cross sectional study was conducted at two teaching hospitals in Zimbabwe. Participants included patients admitted with stroke and their relatives. A self-administered questionnaire was used to collect information on history of stroke occurrence and time taken to present to hospital. Data was analysed for means, frequencies, percentages and Odds ratios. Less than half (33%) of the participants were able to recognize symptoms of stroke. Not having money to pay for hospital bills was a predictor of late hospital presentation (OR =6.64; 95% CI, (2.05-21.53); p=0.002). The other factors, though not statistically significant included not perceiving stroke as a serious illness (OR = 2.43; 95% CI (0.78-5.51); p=0.083) and unavailability of transport (OR=2.33; 95% CI (0.71-7.56); p=0.161). Predictors for early presentation included receiving knowledge about stroke from the community (OR=0.46; 95% CI (0.15-1.39); p=0.170); seeking help at the hospital (OR=0.50; 95% CI (0.18-1.37); p=0.177) and having a stroke while at the workplace (OR =0.46; 95% CI (0.08-2.72); p=0.389). Regarding stroke as an emergency that does not require prerequisite payment for services at hospitals and improved community awareness on stroke may improve time taken to present to hospital after the onset of stroke symptoms.

Does outsourcing affect hospital profitability?

PubMed

Danvers, Kreag; Nikolov, Pavel

2010-01-01

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

Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan, Iran.

PubMed

Ataei, B; Zahraei, S M; Pezeshki, Z; Babak, A; Nokhodian, Z; Mobasherizadeh, S; Hoseini, S G

2013-09-01

Hand hygiene is the mainstay of nosocomial infection prevention. This study was a baseline survey to assess hand hygiene compliance of healthcare workers by direct observation in three major hospitals of Isfahan, Iran. The use of different hand hygiene products was also evaluated. In 3078 potential opportunities hand hygiene products were available on 2653 occasions (86.2%). Overall compliance was 6.4% (teaching hospital: 7.4%; public hospital: 6.2%; private hospital: 1.4%). Nurses (8.4%) had the highest rates of compliance. Poor hand hygiene compliance in Isfahan hospitals necessitates urgent interventions to improve both hospital infrastructure and staff knowledge. © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Knowledge, attitude and practice of aspects of laboratory safety in Pathology Laboratories at the University of Port Harcourt Teaching Hospital, Nigeria.

PubMed

Ejilemele, A A; Ojule, A C

2005-12-01

To assess current knowledge, attitudes and practice of aspects of laboratory safety in pathology laboratories at the University of Port Harcourt Teaching Hospital in view of perceived inadequacies in safety practices in clinical laboratories in developing countries. Sixty (60) self- administered questionnaires were distributed to all cadres of staff in four (4) different laboratories (Chemical Pathology, Haematology, Blood bank and Medical Microbiology) at the Hospital. Gross deficiencies were found in the knowledge, attitudes and practice of laboratory safety by laboratory staff in areas of use of personal protective equipment, specimen collection and processing, centrifuge--related hazards, infective hazards waste disposal and provision and use of First Aid Kits. Issues pertaining to laboratory safety are not yet given adequate attention by both employers and employees in developing countries in this ear of resurgence of diseases such as HIV/AIDS and Hepatitis Band C, is emphasized.

Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

PubMed

Antioch, K; Walsh, M

2000-01-01

This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

Fellows as Teachers: Raising the Educational Bar.

PubMed

Miloslavsky, Eli M; Boyer, Debra; Winn, Ariel S; Stafford, Diane E J; McSparron, Jakob I

2016-04-01

Fellows are expected to educate trainees, peers, and patients, during and long after fellowship. However, there has been relatively little emphasis on the acquisition of teaching skills in fellowship programs. Challenges to teaching by fellows during subspecialty training include demanding clinical duties, their limited knowledge base in the field, brief contact time with learners during consultative roles, and, for new fellows, personal unfamiliarity with the learners and hospital culture. Fellows' teaching skills can be improved by formal curricula addressing teaching, and by direct observation and feedback of teaching akin to what is provided for learning clinical care. Further expansion of fellow-as-teacher programs will allow in-depth training for fellows seeking careers as medical educators. Even without such dedicated programs, emphasis on honing teaching skills during fellowship will telegraph the importance of teaching and help evolve divisional culture. Such efforts can have a positive impact on patients and learners, and enhance the teaching skills of future faculty.

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

PubMed Central

Thalakada, Rosanne; Legal, Michael; Lau, Tim T Y; Luey, Tiffany; Batterink, Josh; Ensom, Mary H H

2012-01-01

Background: Recent guidelines recommend a vancomycin trough (predose) level between 15 and 20 mg/L in the treatment of invasive gram-positive infections, but most initial dosing nomograms are designed to achieve lower targets (5–15 mg/L). Clinicians need guidance about appropriate initial dosing to achieve the higher target. Objective: To develop and validate a high-target vancomycin dosing nomogram to achieve trough levels of 15–20 mg/L. Methods: A retrospective study was conducted at 2 teaching hospitals, St Paul’s Hospital and Vancouver General Hospital in Vancouver, British Columbia. Patients who were treated with vancomycin between January 2008 and June 2010 and who had achieved a trough level of 14.5–20.5 mg/L were identified. Demographic and clinical data were collected. Multiple linear regression was used to develop a vancomycin dosing nomogram for each hospital site. An integrated nomogram was constructed by merging the data from the 2 hospitals. A unique set of patients at each institution was used for validating their respective nomograms and a pooled group of patients for validating the integrated nomogram. Predictive success was evaluated, and a nomogram was deemed significantly different from another nomogram if p < 0.05 via “χ2 testing. Results: Data from 78 patients at one hospital and 91 patients at the other were used in developing the respective institutional nomograms. For each hospital’s data set, both age and initial serum creatinine were significantly associated with the predicted dosing interval (p < 0.001). Validation in a total of 105 test patients showed that the integrated nomogram had a predictive success rate of 56%. Conclusions: A novel vancomycin dosing nomogram was developed and validated at 2 Canadian teaching hospitals. This integrated nomogram is a tool that clinicians can use in selecting appropriate initial vancomycin regimens on the basis of age and serum creatinine, to achieve high-target levels of 15–20 mg/L. The nomogram should not replace clinical judgment for patients with unstable and/or reduced renal function. PMID:22783028