Fourth-generation spinal instrumentation: experience with adolescent idiopathic scoliosis at a tertiary care hospital in Pakistan

PubMed Central

Fazal, Akil; Lakdawala, Riaz H

2012-01-01

Objective To evaluate the radiological and functional outcome of surgical treatment of adolescent idiopathic scoliosis using fourth-generation posterior spinal instrumentation at The Aga Khan University, Karachi, Pakistan. Design Case series. Place and duration of study The Aga Khan University Hospital after a minimum of 2 years postoperatively. Patients and methods A total of 20 patients with adolescent idiopathic scoliosis were recruited into the study and evaluated for radiological and functional outcome. The study period was from 2000 to 2005. Radiological outcome was assessed using Cobb angle measurement pre and postoperatively, hence assessing percentage correction. The lower instrumented vertebra was taken as the neutral vertebra and the level was recorded. Functional outcome was determined using the Scoliosis Research Society patient administered questionnaire. All patients were called to the clinic and asked to fill in the form. Those patients who were out of the city were mailed the forms and requested via telephone to complete and return. Results Of the 20 patients operated on, twelve were female and eight were male. The average age at operation was 12.7 years. The mean Cobb angle was 69° preoperatively and 20° postoperatively, representing a percentage correction of 71%. The average duration of follow-up was 3.6 years. There was one major complication involving neurological injury post-op and two minor complications involving wound infection. The average Scoliosis Research Society score (on a scale of 1–5, with 5 being best) for pain was 4.5, self-image was 4.2, functional status was 4.1, mental status was 3.8, and satisfaction was 4.4. There was no relationship between the percentage correction of scoliosis and the functional outcome. Those patients with a high preoperative Cobb angle tended to have a better outcome for functional and mental status postoperatively. There was no relation between the lower instrumented vertebra and functional outcome. Conclusion In the correct indications, fourth-generation posterior instrumentation and fusion is a reliable and satisfactory technique to treat adolescent idiopathic scoliosis. PMID:22393301

Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya

PubMed Central

2014-01-01

Background The health sector is faced with constant changes as new approaches to tackle illnesses are unveiled through research. Information, communication and technology have greatly transformed healthcare practice the world over. Nursing is continually exposed to a variety of changes. Variables including age, educational level, years worked in nursing, computer knowledge and experience have been found to influence the attitudes of nurses towards computerisation. The purpose of the study was to determine the attitudes of nurses towards the use of computers and the factors that influence these attitudes. Methods This cross sectional descriptive study was conducted among staff nurses working at one public hospital (Kenyatta National Hospital, (KNH) and one private hospital (Aga Khan University Hospital (AKUH). A convenience sample of 200 nurses filled the questionnaires. Data was collected using the modified Nurses’ Attitudes Towards Computerisation (NATC) questionnaire. Results Nurses had a favorable attitude towards computerisation. Non-users had a significantly higher attitude score compared to the users (p = 0.0274). Statistically significant associations were observed with age (p = 0.039), level of education (p = 0.025), duration of exposure to computers (p = 0.025) and attitudes towards computerisation. Conclusion Generally, nurses have positive attitudes towards computerisation. This information is important for the planning and implementation of computerisation in the hospital as suggested in other studies. PMID:24774008

Perinatal outcomes in pregnancy with asthma.

PubMed

Syed, Rashid Zaheer; Zubairi, Ali Bin Sarwar; Zafar, Muhammad Ahsan; Qureshi, Rahat

2008-09-01

To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort. A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths. The mean age of asthmatics and nonasthmatics were 28.0 +/- 4.9 years and 27.7 +/- 3.6 years respectively. The average parity among asthmatic women was 2.97 while that in controls was 2.57 (p < 0.137). Neonates born to asthmatic mothers had shorter mean gestational age with increased risk of premature birth and lower Apgar scores. Asthmatic mothers had a greater risk of abortions and low birth weight babies. They also had higher rates of UTIs and hospital admissions. Asthmatic pregnancies are more likely to result in abortion, premature delivery and low birth weight babies. The asthmatic pregnancies were also linked with higher rates of maternal UTI. Thcrefore a more vigilant monitoring is required in asthmatic pregnancies.

Introduction and development of NCP using ICNP in Pakistan.

PubMed

Rukanuddin, R J

2005-12-01

Traditionally, nursing care has been described as performing nursing tasks and often focused on nurses carrying out doctors' orders. In many countries of the world, including Pakistan, nurses do not document care in a standardized manner. Because of this limitation many health administrators, policy makers, and consumers make inadequate assumptions about nursing work, often regarding nurses as any other 'health care technician' who can be easily replaced by more economical health care workers. To overcome this problem, standardized documentation is being introduced into the Aga Khan University School of Nursing and hospital, Aga Khan Health Services, Public Health School in Karachi, and government colleges of nursing, using the International Classification for Nursing Practice (ICNP). The purpose of this paper is to highlight the process of introducing and developing standardized nursing care plans (NCP) using ICNP in Pakistan. The process for introducing ICNP consists of four components, including administrative planning, development, teaching and training, and testing. Subsets of the ICNP for (i) maternity: antenatal, postnatal and natal care; and (ii) cardiology were developed using standardized NCPs. The subsets were developed by nurse experts and introduced at the testing sites. The testing will be conducted as a pilot project. Findings from the pilot will be used to continue and expand standardized nursing documentation using the ICNP across Pakistan. Through this project, nurses, midwives and lady health visitors (midwives, vaccinator and health educators) will test standardization of documentation and begin to evaluate efficiency and effectiveness of clinical practice.

The use of teleglaucoma at the University of Alberta.

PubMed

Kassam, Faazil; Amin, Samreen; Sogbesan, Enitan; Damji, Karim F

2012-10-01

The aim of the teleglaucoma service at the University of Alberta is to improve access for people in northern Alberta who have early-stage glaucoma or who are at risk for glaucoma. Two types of teleglaucoma service are offered: remote and in-house. A standardized approach is used to capture patient information (structured histories, examinations and fundus photographs) which is then sent to a tertiary care centre for grading and recommendations. Only one grader reads and makes management recommendations for each case. Reports are sent electronically. A total of 195 cases have been graded through the remote service since 2008. A total of 62 cases have been graded through the in-house service since 2011. The average reporting time for consultations in the in-house service was 7 days, and it was also 7 days for the remote service. We believe that the use of teleglaucoma can improve the way that patients are diagnosed and managed, both in industrialized and developing countries. Teleglaucoma is currently being used as a screening tool at the Aga Khan University Hospital in Nairobi with mobile units equipped with a fundus camera and a visual field machine.

Effect of different plant spacing on the production of cauliflower (Brassica oleraceae var. Botrytis) under the agro-climatic conditions of D.I. Khan.

PubMed

Mujeeb-ur-Rahman; Iqbal, Muhammad; Jilani, Muhammad Saleem; Waseem, Kashif

2007-12-15

A research project to evaluate the effect of different plant spacing on the production of cauliflower was conducted at Horticulture Research Area, Faculty of Agriculture, Gomal University, Dera Ismail Khan, NWFP, Pakistan. Six different plant spacing viz., 30, 35, 40, 45, 50 and 55 cm were used. The results revealed significant variations in all the parameters and amongst various plant spacing, 45 cm spacing showed the best response for all the parameters. Maximum plant height (49.33 cm), curd diameter (19.13 cm), maximum curd weight (1.23 kg plant(-1)) and yield (30.77 t ha(-1)) were recorded in the plots where the plants were spaced 45 cm apart.

Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan).

PubMed

Bhutta, Zulfiqar A; Khan, Iqtidar; Salat, Suhail; Raza, Farukh; Ara, Husan

2004-11-13

Clinical care of infants with a very low birth weight (less than 1500 g) in developing countries can be labour intensive and is often associated with a prolonged stay in hospital. The Aga Khan University Medical Center in Karachi, Pakistan, established a neonatal intensive care unit in 1987. By 1993-4, very low birthweight infants remained in hospital for 18-21 days. A stepdown unit was established in September 1994, with mothers providing all basic nursing care for their infants before being discharged under supervision. We analysed neonatal outcomes for the time periods before and after the stepdown unit was created (1987-94 and 1995-2001). We compared these two time periods for survival after birth until discharge, morbidity patterns during hospitalisation, length of stay in hospital, and readmission rates to hospital in the four weeks after discharge. Of 509 consecutive, very low birthweight infants, 494 (97%) preterm and 140 (28%) weighing < 1000 g at birth), 391 (76%) survived to discharge from the hospital. The length of hospitalisation fell significantly from 1987-90, when it was 34 (SD 18) days, to 16 (SD 14) days in 1999-2001 (P < 0.001). Readmission rates to hospital did not rise, nor did adverse outcomes at 12 months of age. Our results indicate that it is possible to involve mothers in the active care of their very low birthweight infants before discharge. This may translate into earlier discharge from hospital to home settings without any increase in short term complications and readmissions.

Flip or Flop: Are Math Teachers Using Khan Academy as Envisioned by Sal Khan?

ERIC Educational Resources Information Center

Cargile, Lori A.; Harkness, Shelly Sheats

2014-01-01

Khan Academy (KA) is a free web-based intelligent tutor, which has been featured in countless media outlets for its potential to change mathematics instruction. The founder and executive director, Salman Khan, recommends that KA be used to personalize instruction, freeing up class time for engaging high yield activities like student discourse and…

Toward a One-World Schoolhouse: Interview with Sal Khan

ERIC Educational Resources Information Center

Pinkus, Ari

2015-01-01

Ten years ago, Salman Khan, with three degrees from MIT and an MBA from Harvard, agreed to help tutor his cousin Nadia, who was struggling in math. Using Yahoo's Doodle notepad, Khan offered Nadia a sequence of mini lessons designed to scaffold her learning. Over time, other friends and relatives heard about Khan's success and asked for similar…

Scaling Value: Transnationalism and the Aga Khan's English as a "Second Language" Policy

ERIC Educational Resources Information Center

Bolander, Brook

2018-01-01

Against the backdrop of growing sociolinguistic interest in transnationalism, this paper uses the notion of "scale" as an "ideological project" (Irvine in "Scale. Discourse and dimensions of social life," University of California Press, California, 2016: 214) to study situated discursive performances of…

75 FR 74769 - Designation of Three Individuals Pursuant to Executive Order 13224

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

..., Pakistan (individual) [SDGT] 2. KHAN, Mohammad Naushad Alam (a.k.a. KHAN, Muhammad Nowshad Alam; a.k.a. KHAN, Naushad Aalam; a.k.a. KHAN, Rahat Hasan); DOB Aug 1971; alt. DOB Dec 1970; Holder of a Pakistan... Abdul; a.k.a. RAUF, Hafiz Abdul), Dola Khurd, Lahore, Pakistan; 4 Lake Road, Room No. 7, Choburji...

76 FR 69318 - In the Matter of the Designation of Mali Khan also known as Madi Khan as a Specially Designated...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... DEPARTMENT OF STATE [Public Notice 7681] In the Matter of the Designation of Mali Khan also known... Khan, committed, or poses a significant risk of committing, acts of terrorism that threaten the security of U.S. nationals or the national security, foreign policy, or economy of the United States...

Commentary: The Khan Academy and the Day-Night Flipped Classroom

ERIC Educational Resources Information Center

Parslow, Graham R.

2012-01-01

Teaching by night and reflecting on a subject by day is the way that Salman Khan sees education evolving in the age of online lectures. Khan believes he is onto something in what he styles the "flipped classroom." In Khan's view, there is no need for students to be divided into grades by age. Instead, they should learn at their own pace, moving on…

2014 Summer Series - Salman Khan - Khan Academy: Education Re-imagined

NASA Image and Video Library

2014-06-26

In 2004, Khan began tutoring his young cousin in math. By 2006, word got around and Khan was tutoring 15 family friends and cousins as a hobby. He also began posting videos of his hand-scribbled tutorials on YouTube. In 2009, when the practice problems and instructional videos were reaching tens of thousands of students per month, he quit his day job to commit himself fully to the not-for-profit Khan Academy. It's now the most-used library of educational lessons on the web, with over 10 million unique students per month, over 300 million lessons delivered, and over a billion exercises completed.

K-12 Online Lesson Alignment to the Principles of Universal Design for Learning: The Khan Academy

ERIC Educational Resources Information Center

Smith, Sean J.; Harvey, Evelyn E.

2014-01-01

The field of K-12 education is being transformed, with an influx of students, including those with identified disabilities, engaging in blended and fully online learning. While online learning shows promise for students with disabilities through flexible content and personalised instruction, concerns regarding accessibility and appropriateness of…

Commentary on: "Randomized, controlled, double-blind, cross-over trial assessing treatment preference for pazopanib versus sunitinib in patients with metastatic renal cell carcinoma: PISCES study." Escudier B, Porta C, Bono P, Powles T, Eisen T, Sternberg CN, Gschwend JE, De Giorgi U, Parikh O, Hawkins R, Sevin E, Négrier S, Khan S, Diaz J, Redhu S, Mehmud F, Cella D. Bernard Escudier, Institut Gustave Roussy, Villejuif; Emmanuel Sevin, Centre François Baclesse, Caen; Sylvie Négrier, Leon Berard Cancer Center, Lyon, France; Camillo Porta, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Matteo, Pavia; Cora N Sternberg, San Camillo Forlanini Hospital, Rome; Ugo De Giorgi, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy; Petri Bono, Helsinki University Central Hospital, Helsinki, Finland; Thomas Powles, Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London; Tim Eisen, Cambridge University Health Partners, Cambridge; Omi Parikh, Royal Preston Hospital, Lancashire; Robert Hawkins, Christie Cancer Research UK, Manchester; Sadya Khan, Jose Diaz, and Faisal Mehmud, GlaxoSmithKline, Uxbridge, United Kingdom; Jürgen E Gschwend, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany; Suman Redhu, GlaxoSmithKline, Collegeville, PA; David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL.: J Clin Oncol. 2014 May 10;32(14):1412-1418; doi: 10.1200/JCO.2013.50.8267. [Epub 2014 Mar 31].

PubMed

Trump, Donald

2016-05-01

Patient-reported outcomes may help inform treatment choice in advanced/metastatic renal cell carcinoma (RCC), particularly between approved targeted therapies with similar efficacy. This double-blind crossover study evaluated patient preference for pazopanib or sunitinib and the influence of health-related quality of life (HRQoL) and safety factors on their stated preference. Patients with metastatic renal cell carcinoma were randomly assigned to pazopanib 800mg per day for 10 weeks, a 2-week washout, and then sunitinib 50mg per day (4 weeks on, 2 weeks off, 4weeks on) for 10 weeks, or the reverse sequence. The primary end point, patient preference for a specific treatment, was assessed by questionnaire at the end of the two treatment periods. Other end points and analyses included reasons for preference, physician preference, safety, and HRQoL. Of 169 randomly assigned patients, 114 met the following prespecified modified intent-to-treat criteria for the primary analysis: exposure to both treatments, no disease progression before cross over, and completion of the preference questionnaire. Significantly more patients preferred pazopanib (70%) over sunitinib (22%); 8% expressed no preference (P<.001). All preplanned sensitivity analyses, including the intent-to-treat population, statistically favored pazopanib. Less fatigue and better overall quality of life were the main reasons for preferring pazopanib, with less diarrhea being the most cited reason for preferring sunitinib. Physicians also preferred pazopanib (61%) over sunitinib (22%); 17% expressed no preference. Adverse events were consistent with each drug׳s known profile. Pazopanib was superior to sunitinib in HRQoL measures evaluating fatigue, hand/foot soreness, and mouth/throat soreness. This innovative crossover trial demonstrated a significant patient preference for pazopanib over sunitinib, with HRQoL and safety as key influencing factors. Copyright © 2016 Elsevier Inc. All rights reserved.

Increasing transcultural awareness: the McMaster-Aga Khan-CIDA Project workshop model.

PubMed

Smith, S E

1997-01-01

McMaster-Aga Khan-CIDA Project personnel at McMaster University School of Nursing over a period of four years designed and conducted eight one-day introductory workshops for nurses, faculty, staff, host families, and others involved with Pakistani nurses and Lady Health Visitors studying in Canada. The workshops (entitled Increasing Intercultural Awareness) assisted the Canadian and international participants to improve their awareness and knowledge of transcultural communication in preparation for working and socializing together. Using a participatory and active-learning approach, the workshop method introduced participants to transcultural communication; emphasized appreciation of cultural values, similarities and differences; and provided country-specific information on Pakistan. This article outlines the workshop design and rationale and describes specific examples of the transcultural nursing principles, practices, and teaching activities included in the one-day event.

The association of transequatorial loops in the solar corona with coronal mass ejection onset

NASA Astrophysics Data System (ADS)

Glover, A.; Harra, L. K.; Matthews, S. A.; Foley, C. A.

2003-03-01

It has been shown that transequatorial loops can disappear in association with the onset of a coronal mass ejection (CME) (Khan & Hudson \\cite{khan}). We extend this result by considering a larger sample of transequatorial loop systems (TLS) to investigate their associated flaring and CME activity. We find 10 of a total 18 TLS considered here to be associated with flaring and CME onset originating from a connected active region. A total 33 cases of flaring and associated CME onset are observed from these 10 systems during their lifetime. We observe the influence of this activity on the TLS in each case. In contrast to the Khan & Hudson result, we find evidence that transequatorial loop eruption leading to soft X-ray brightening equivalent in temperature to a B-class flare is equally as common as dimming in the corona. Consequently we conclude that the scenario observed by Khan & Hudson is not universal and that other types of CME-TLS association occur. It was found that for transequatorial loops that were associated with CMEs the asymmetry in longitude was larger than for those that were not associated to a CME by 10o. In addition, the extent in latitude (as a measure of the loop length) was nearly twice as large for those TLS associated with CMEs than those that were not. The asymmetry in latitude was actually on average larger for those TLS not associated with CMEs, than for those that were. This suggests that differential rotation is not a major contributor to the production of CMEs from transequatorial loops. Instead it is more likely for a CME to be produced if the loop is long, and if there is a large asymmetry in longitude. The implications of these results for CME onset prediction are discussed.

Improving Practices in Early Childhood Classrooms in Pakistan: Issues and Challenges from the Field

ERIC Educational Resources Information Center

Juma, Audrey

2004-01-01

This article focuses on an early childhood programme that has been initiated by the Institute for Educational Development at the Aga Khan University in Karachi, Pakistan. The programme is a Certificate in Education and involves training teachers so as to enable them to understand early childhood education and development, and to become effective…

Peripherally Inserted Central Venous Catheters in Pediatric Hematology/Oncology Patients in Tertiary Care Setting: A Developing Country Experience.

PubMed

Fadoo, Zehra; Nisar, Muhammad I; Iftikhar, Raza; Ali, Sajida; Mushtaq, Naureen; Sayani, Raza

2015-10-01

Peripherally inserted central venous catheters (PICC) have been successfully used to provide central access for chemotherapy and frequent transfusions. The purpose of this study was to assess the feasibility of PICCs and determine PICC-related complications in pediatric hematology/oncology patients in a resource-poor setting. All pediatric patients (age below 16 y) with hematologic and malignant disorders who underwent PICC line insertion at Aga Khan University Hospital from January 2008 to June 2010 were enrolled in the study. Demographic features, primary diagnosis, catheter days, complications, and reasons for removal of device were recorded. Total of 36 PICC lines were inserted in 32 pediatric patients. Complication rate of 5.29/1000 catheter days was recorded. Our study showed comparable complication profile such as infection rate, occlusion, breakage, and dislodgement. The median catheter life was found to be 69 days. We conclude that PICC lines are feasible in a resource-poor setting and recommend its use for chemotherapy administration and prolonged venous access.

Impact of delay in admission on the outcome of critically ill patients presenting to the emergency department of a tertiary care hospital from low income country.

PubMed

Khan, Badar Afzal; Shakeel, Nishi; Siddiqui, Emad Uddin; Kazi, Ghazala; Khan, Irum Qamar; Khursheed, Munawer; Feroze, Asher; Ejaz, Kiran; Khan, Sumaiya Tauseeq; Adel, Hatem

2016-05-01

To assess the impact of admission delay on the outcome of critical patients. The retrospective chart review was done at Aga Khan University Hospital, Karachi, and comprised adult patients visiting the Emergency Department during 2010. Outcome measures assessed were total hospital length of stay, total cost of the visit and in-hospital mortality. Patients admitted within 6 hours of presentation at Emergency Department were defined as non-delayed. Data was analysed using SPSS 19. Of the 49,532 patients reporting at the Emergency Department during the study period, 17,968 (36.3%) were admitted. Of them 2356(13%) were admitted to special or intensive care units, 1595(67.7%) of this sub-group stayed in the Emergency Department for >6 hours before being shifted to intensive care. The study focussed on 325(0.65%) of the total patients; 164(50.5%) in the non-delayed group and 161(49.5%) in the delayed group. The admitting diagnosis of myocardial infarction (p=0.00) and acute coronary syndrome (p=0.01) was significantly more common in the non-delayed group compared to other diagnoses like cerebrovascular attacks (p=0.03) which was significantly more common in the delayed group. There was no significant difference in the hospital length of stay between the two groups (p>0.05). The Emergency Department cost was significantly increased in the delayed group (p<0.05), but there was no difference in the overall hospital cost between the groups (p>0.05). There was no significant difference in the delayed and non-delayed groups, but long Emergency Department stays are distressing for both physicians and patients.

Can Khan Move the Bell Curve to the Right?

ERIC Educational Resources Information Center

Kronholz, June

2012-01-01

This article features Khan Academy which offers an online math program and short video lectures embedded in the "module", or math concept, that fit students' goals. By now, more than 1 million people have watched the online video in which Salman Khan--a charming MIT math whiz, Harvard Business School graduate, and former Boston hedge-fund…

78 FR 48539 - Designation of Bahawal Khan, Also Known as Salahuddin Ayubi, Also Known as Bahwal Khan, as a...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... DEPARTMENT OF STATE [Public Notice 8415] Designation of Bahawal Khan, Also Known as Salahuddin... committing, acts of terrorism that threaten the security of U.S. nationals or the national security, foreign policy, or economy of the United States. Consistent with the determination in section 10 of Executive...

Perception and knowledge about dietary intake in patients with liver cirrhosis and its relationship with the level of education.

PubMed

Khan, Rustam; Ahmed, Ashfaq; Ismail, Faisal Wasim; Abid, Shahab; Awan, Safia; Shah, Hasnain; Hamid, Saeed; Jafri, Wasim

2012-07-01

To determine patients perception and knowledge regarding diet in cirrhosis and its relationship with the level of patients education. Cross-sectional observational study. This study was conducted at Gastroenterology Outpatient Clinics at the Aga Khan University Hospital, Karachi, the Aga Khan Health Services, Malir, Karachi and Hamdard University, Karachi, from January to December 2010. Consecutive adult patients with compensated cirrhosis were enrolled. Demographic data, level of education, type and reason of food restriction as well as the source of dietary information was asked. Baseline laboratory test were performed, and nutritional status was assessed by BMI normogram. Ninety patients, 58% male were enrolled. Mean age of the patient was 49 ± 11 years. Overall 73% of the patients were restricting fat, meat, fish and eggs in their diet; 53% were in uneducated group and 47% were in educated group (CI, 0.24-1.62, p-0.34). Twenty two patients (62.8%) in uneducated and 21 in educated group (68%) were restricting diet on the advice of their doctors, whereas 13 in uneducated group (37%) and 11 in educated group (32%) believed these dietary components to be harmful for the liver. Thirty two of uneducated patient (71.1%) and 28 of educated patients (62.2%) believed that vegetables, fruits and sugarcane had a beneficial effect on the liver. Main source of dietary information to the patients was the doctor. On sub-group analysis those who restricted diet irrespective of their educational level, had more patients with BMI less than 18.5 kg/m2, (CI 0.01-0.94, p-0.001), haemoglobin less than 12 g/dl (CI 0- 0.03, p-0.001) and serum albumin less than 3 g/dl (CI 0.1- 03, p-0.001). Both educated and uneducated classes of the patients have improper knowledge and perception of diet in cirrhosis. Patients with cirrhosis who restricted diet, had relatively low BMI, haemoglobin and albumin as compared to those who did not restrict. Main source of dietary information to cirrhotic patients were health care personnels.

Validation of the Arabic Version of the Group Personality Projective Test among university students in Bahrain.

PubMed

Al-Musawi, Nu'man M

2003-04-01

Using confirmatory factor analytic techniques on data generated from 200 students enrolled at the University of Bahrain, we obtained some construct validity and reliability data for the Arabic Version of the 1961 Group Personality Projective Test by Cassel and Khan. In contrast to the 5-factor model proposed for the Group Personality Projective Test, a 6-factor solution appeared justified for the Arabic Version of this test, suggesting some variance between the cultural groups in the United States and in Bahrain.

Pandemic influenza A(H1N1)pdm09: An unrecognized cause of mortality in children in Pakistan

PubMed Central

ALI, SYED ASAD; AZIZ, FATIMA; AKHTAR, NIDA; QURESHI, SHAHIDA; EDWARDS, KATHRYN; ZAIDI, ANITA

2016-01-01

The role of influenza virus as a cause of child mortality in South Asia is under-recognized. We aimed to determine the incidence and case fatality rate of influenza A(H1N1)pdm09 infections in hospitalized children in Karachi, Pakistan. Children less than 5 y old admitted with respiratory illnesses to the Aga Khan University Hospital, Karachi, from 17 August 2009 to 16 September 2011, were tested for influenza A(H1N1)pdm09 using a real-time reverse transcriptase polymerase chain reaction. Out of 2650 children less than 5 y old admitted with a respiratory illness during the study period, 812 (31%) were enrolled. Influenza A(H1N1)pdm09 virus was detected in 27 (3.3%) children. There were 4 deaths in children who tested positive for influenza A(H1N1)pdm09 (case fatality rate of 15%). Children with influenza A(H1N1)pdm09 were 5 times more likely to be admitted or transferred to the intensive care unit, 5.5 times more likely to be intubated, and 12.9 times more likely to die as compared to children testing negative for influenza A(H1N1)pdm09. PMID:23826795

Can Khan Move the Bell Curve to the Right?

ERIC Educational Resources Information Center

Kronholz, June

2012-01-01

More than 1 million people have watched the online video in which Salman Khan--a charming MIT math whiz, Harvard Business School graduate, and former Boston hedge-fund analyst--explains how he began tutoring his cousins in math by posting short lessons for them on YouTube. Other people began watching the lessons and sending Khan adulatory notes.…

Khan Academy as Supplemental Instruction: A Controlled Study of a Computer-Based Mathematics Intervention

ERIC Educational Resources Information Center

Kelly, Daniel P.; Rutherford, Teomara

2017-01-01

Khan Academy is a large and popular open educational resource (OER) with little empirical study into its impact on student achievement in mathematics when used in schools. In this study, we examined the use of Khan Academy as a mathematics intervention among seventh grade students over a 4-week period versus a control group. We also compared…

Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study.

PubMed

Muthaura, Patricia N; Khamis, Tashmin; Ahmed, Mushtaq; Hussain, Syeda Ra'ana

2015-10-21

Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital.

PubMed

Baig, Ayaz; Siddiqui, Imran; Jabbar, Abdul; Azam, Syed Iqbal; Sabir, Salman; Alam, Shahryar; Ghani, Farooq

2007-01-01

To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels.

Indispensable Nation: U.S. Security Guarantees and Nuclear Proliferation

DTIC Science & Technology

2017-06-01

to achieve this capability. This is encapsulated in Pakistani Prime Minister Zulfikar Ali Bhutto’s famous declaration, “We will make an atomic bomb ...the Bomb " argues that states that receive sensitive nuclear assistance, in the form of aid in weapons design, enrichment facility construction, or...3 Feroz Khan, Eating Grass: The Making of the Pakistani Bomb . (Stanford: Stanford University Press, 2012), 87. 4 Matthew Kroenig, “Importing

Analysis of homicidal deaths in district DI Khan: an autopsy study.

PubMed

Humayun, Muhammad; Khan, Dilawar; Fasee-uz-Zaman; Khan, Jahanzeb; Khan, Omair; Parveen, Zahida; Humayun, Wajid

2009-01-01

One of the oldest crimes in human civilization is homicide which started from murder of Abel by the hands of Cane. With the passage of time manner of homicide have been changing. Study of pattern of homicide in any civil society is the first step towards development of intervention to reduce the impact of homicidal crimes. This study was conducted at the department of forensic medicine and toxicology Gomal Medical College DI Khan to know the pattern of the homicides, taking it as the first step in the prevention of crime. The present study was conducted over two years 2007-08. The data collected includes all reported unnatural deaths from the urban and rural areas of district on which autopsies were conducted in the district headquarter teaching hospital DI Khan and department of Forensic Medicine and Toxicology, Gomal Medical College DL Khan. Homicidal deaths constituted 259/341 (76%) of all autopsies. Out of these homicides 59.07% were caused by the firearm. The most common firearm weapons were high velocity rifled weapons (AK-47, rifles and pistols). A total of 304 injuries were found in various body regions giving an average of about two injuries per victim/person. The head, neck and face sustained the highest numbers of injuries 100, (32.90%) followed by chest 91 (29.93%) and abdomen 47 (15.4%); the extremities, buttock and genitalia together sustained 65 (21.38 %) injuries. A part from firearm injuries unfortunately in our this study the second highest cause of homicidal deaths was bomb blasts injuries either due to suicide bombers or remote control bombs. The numbers of deaths due to blast injuries were 82 for the year 2007/08 out of total homicidal deaths and percentage was 32.66%. The vast majority of homicidal deaths in this area are caused by firearms like other big cities of the province like Peshawar, which bring up issues related to possession of firearms and change in cultural attitude towards the use of firearm, if a decrease in firearm related homicides is desired.

Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study.

PubMed

Syed, Ahsan A; Almas, Aysha; Naeem, Quratulain; Malik, Umer F; Muhammad, Tariq

2017-02-01

In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient's autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown. To determine the barriers and perceptions in discussion of code status by physicians. Questionnaire-based cross-sectional study. This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included. A total of 77 (57.4%) physicians responded. Family-related barriers were found to be the most common barriers. They include family denial (74.0%), level of education of family (66.2%), and conflict between individual family members (66.2%). Regarding personal barriers, lack of knowledge regarding prognosis (44.1%), personal discomfort in discussing death (29.8%), and fear of legal consequences (28.5%) were the top most barriers. In hospital-related barriers, time constraint (57.1%), lack of hospital administration support (48.0%), and suboptimal nursing care after do not resuscitate (48.0%) were the most frequent. There were significant differences among opinions of trainees when compared to those of attending physicians. Family-related barriers are the most frequent roadblocks in the end-of-life care discussions for physicians in Pakistan. Strengthening communication skills of physicians and family education are the potential strategies to improve end-of-life care. Large multi-center studies are needed to better understand the barriers of code status discussion in developing countries.

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study

PubMed Central

2009-01-01

Background Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. Methods At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. Results During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002–04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01). Conclusion We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project. PMID:19480683

Tetralogy of Fallot with absent pulmonary valve syndrome; appropriate surgical strategies.

PubMed

Shahid, Fatima; Siddiqui, Maria Tariq; Amanullah, Muhammad Muneer

2015-05-01

To evaluate patients presenting with Tetralogy of Fallot with absent pulmonary valve syndrome to a tertiary care hospital and their surgical management. The retrospective study was conducted at Congenital Cardiac Services, Aga Khan University Hospital, Karachi, Pakistan, and comprised data of Tetralogy of Fallot patients between April 2007 and June 2012. Data was analysed together with follow-up echocardiography. Variables assessed included demographics, imaging, operative technique, complications, post-operative recovery and follow-up echocardiography. SPSS 17 was used for statistical analysis. Of the 204 patients, 6 (3%) had undergone surgical correction for Tetralogy of Fallot with absent pulmonary valve syndrome. All 6(100%) patients underwent complete repair. Median age for surgery was 8.5 years (range: 0.5-29 years). Of the different surgical strategies used, Contegra and Bioprosthetic valve placement had satisfactory outcome with minimal gradient at Right Ventricular Outflow Tract, good ventricular function and mild valvular regurgitation. One (16.6%) patient with Trans Annular Patch developed post-operative Right Ventricle Outflow Tract gradient of 80mmHg with moderate pulmonary regurgitation. One (16.6%) patient with monocusp valve developed free pulmonary regurgitation at 6 months. The other 4(66.6%) patients are currently free from any complications or re-intervention. Early surgery is preferred in symptomatic patients. The repair depends upon achieving integrity of pulmonary circulation which is best achieved by using right ventricle to pulmonary artery conduit or inserting a pulmonary valve.

Crimean-Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: case report and virological investigation.

PubMed

Hasan, Zahra; Mahmood, Faisal; Jamil, Bushra; Atkinson, Barry; Mohammed, Murtaza; Samreen, Azra; Altaf, Lamia; Moatter, Tariq; Hewson, Roger

2013-03-01

Crimean-Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43-year-old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real-time reverse transcription polymerase chain reaction (RT-PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post-onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. Copyright © 2012 Wiley Periodicals, Inc.

Professionalism in medical students at a private medical college in Karachi, Pakistan.

PubMed

Sobani, Zain-ul-abedeen; Mohyuddin, Muhammad Masaud; Farooq, Fahd; Qaiser, Kanza Noor; Gani, Faiz; Bham, Nida Shahab; Raheem, Ahmed; Mehraj, Vikram; Saeed, Syed Abdul; Sharif, Hasanat; Sheerani, Mughis; Zuberi, Rukhsana Wamiq; Beg, Mohamamd Asim

2013-07-01

To determine levels of professionalism in undergraduate medical students at a private medical college and assess how changes emerge during their training. The study was conducted at Aga Khan University, a tertiary care teaching hospital, during November and December 2011. Freshmen, Year 3 and Year 5 students were requested to fill out a questionnaire. It was designed to assess the participants' levels of professionalism and how they perceived the professional environment around them by incorporating previously described scales. The questionnaire was re-validated on a random sample of practising clinicians at the same hospital. SPSS 17 was used for statistical analysis. The study sample comprised 204 participants. The mean score for level of individual professionalism was 7.72+/-3.43. Only 13 (6.4%) students had a score one standard deviation above the faculty mean. About 24 (11.8%) were one standard deviation and 35 (17.2%) were 2 standard deviations below the faculty mean. The remaining 130 (63.7%) were >2 standard deviations below the faculty mean. Considering the level of education, the mean score for level of professionalism was 8.00+/-3.39 for freshmen, 6.85+/-3.41 for year 3 students, and 8.40+/-3.34 for year 5 students. The currently employed teaching practices inculcating the values of professionalism in medical students are serving as a buffer to maintain the pre-training levels of professionalism from declining.

Evaluation of the Parasight Platform for Malaria Diagnosis

PubMed Central

Eshel, Yochay; Houri-Yafin, Arnon; Benkuzari, Hagai; Lezmy, Natalie; Soni, Mamta; Charles, Malini; Swaminathan, Jayanthi; Solomon, Hilda; Sampathkumar, Pavithra; Premji, Zul; Mbithi, Caroline; Nneka, Zaitun; Onsongo, Simon; Maina, Daniel; Levy-Schreier, Sarah; Cohen, Caitlin Lee; Gluck, Dan; Pollak, Joseph Joel

2016-01-01

ABSTRACT The World Health Organization estimates that nearly 500 million malaria tests are performed annually. While microscopy and rapid diagnostic tests (RDTs) are the main diagnostic approaches, no single method is inexpensive, rapid, and highly accurate. Two recent studies from our group have demonstrated a prototype computer vision platform that meets those needs. Here we present the results from two clinical studies on the commercially available version of this technology, the Sight Diagnostics Parasight platform, which provides malaria diagnosis, species identification, and parasite quantification. We conducted a multisite trial in Chennai, India (Apollo Hospital [n = 205]), and Nairobi, Kenya (Aga Khan University Hospital [n = 263]), in which we compared the device to microscopy, RDTs, and PCR. For identification of malaria, the device performed similarly well in both contexts (sensitivity of 99% and specificity of 100% at the Indian site and sensitivity of 99.3% and specificity of 98.9% at the Kenyan site, compared to PCR). For species identification, the device correctly identified 100% of samples with Plasmodium vivax and 100% of samples with Plasmodium falciparum in India and 100% of samples with P. vivax and 96.1% of samples with P. falciparum in Kenya, compared to PCR. Lastly, comparisons of the device parasite counts with those of trained microscopists produced average Pearson correlation coefficients of 0.84 at the Indian site and 0.85 at the Kenyan site. PMID:27974542

Genghis Khan: Leadership for the Airland Battle

DTIC Science & Technology

1988-04-01

COLLEGE AIR UNIVERSITY MAXWELL AFB, AL 36112-5542 t , , _ I _ * LIAUIVmzKz // /9) REPOR SOCUMUNTATION PAGEON it. WPM UIQPM fP",, A101-, W ., Ia itT zN... succesful completion, The advsor Lt Cot Rodger L, Tunnel, Army Instructor Group, Air Command an~d Staff College, provided invaluable advice in all...Command and Staff College at Maxwell Air Force Base, Alabama, where he resides with Beata and their two children, Melissa and Justin. ,Aooession Fror

Erratum: Erratum to: "New Data on the Age and Nature of the Khan-Bogd Alkaline Granites, Mongolia"

NASA Astrophysics Data System (ADS)

Gerdes, A.; Kogarko, L. N.; Vladykin, N. V.

2018-01-01

The list of authors and their affiliations should read as follows: A. Gerdes a , Academician L. N. Kogarko b,*, and N. V. Vladykin c a Institute of Earth Sciences, Goethe University, Frankfurt, Germany b Vernadsky Institute of Geochemistry and Analytical Chemistry, Russian Academy of Sciences, Moscow, 119991 Russia c Vinogradov Institute of Geochemistry, Siberian Branch, Russian Academy of Sciences, Irkutsk, 664033 Russia * e-mail: kogarko@geochi.ru

Selective lymphadenectomy in endometrial cancer: Retrospective analysis of morbidity and survival data at a tertiary care centre

PubMed Central

Chishti, Uzma; Aziz, Aliya B.; Akhtar, Munazza; Sheikh, Sana

2015-01-01

Objective: To compare perioperative morbidity and survival data between patients with early-stage endometrial cancer who did or did not undergo selective lymphadenectomy. Methods: Retrospective analysis of 180 patients with early-stage endometrial carcinoma treated between 1999 and 2008 was performed in Aga Khan University Hospital, Karachi, Pakistan. Results: Data from 180 patients were analysed. The selective lymphadenectomy group contained 108 women (60%) and the no lymphadenectomy group contained 72 women (40%). The median number of lymph nodes removed was 9. The mean age and extent of disease, as assessed by staging, tumour size, myometrial invasion, and lymphovascular invasion were comparable between groups. Upstaging of the disease to stage 3 and 4 occurred in 11% of patients in the lymphadenectomy group. There were no significant differences in the medical or surgical complications between groups. At a median follow-up of 26 months, both groups had comparable survival (lymphadenectomy versus no lymphadenectomy: 34 versus 32 months). Similar survival was noted for patients who underwent the removal of more or less than 5 pelvic lymph nodes. Conclusion: Selective lymphadenectomy offers the advantage of improved surgical staging but no therapeutic benefit in terms of overall survival. PMID:26430436

SU-E-J-81: Adaptive Radiotherapy for IMRT Head & Neck Patient in AKUH

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yousuf, A; Qureshi, B; Qadir, A

2015-06-15

Purpose: In this study we proposed Adaptive radiotherapy for IMRT patients which will brought an additional dimension to the management of patients with H&N cancer in Aga Khan University Hospital. Methods: In this study 5 Head and Neck (H&N) patients plan where selected, who’s Re-CT were done during the course of their treatment, they were simulated with IMRT technique to learn the consequence of anatomical changes that may occur during the treatment, as they are more dramatic changes can occur as compare to conventional treatment. All the organ at risk were drawn according RTOG guidelines and doses were checked asmore » per NCCN guidelines. Results: The reduction in size of Planning target volume (PTV) is more than 20% in all the cases which leads to 3 to 5 % overdose to normal tissues and Organ at Risk. Conclusion: Through this study we would like to emphasis the importance of Adaptive Radiotherapy practice in all IMRT (H&N) patients, although prospective studies are required with larger sample sizes to address the safety and the clinical effect of such approaches on patient outcome, also one need to develop protocols before implementation of this technique in practice.« less

Surgical management of inflammatory bowel disease: A low prevalence, developing country perspective.

PubMed

Nasim, Sana; Chawla, Tabish; Murtaza, Ghulam

2016-03-01

To determine the outcomes of surgical management of inflammatory bowel disease. The retrospective case series was conducted at Aga Khan University Hospital, Karachi, and comprised medical record of adult patients operated between January 1986 and December 2010 for inflammatory bowel disease. Outcomes consisted of complications till last follow-up and 30-day mortality (disease or procedure related). Functional status of patients with ileal pouch was determined via telephone. SPSS 16 was used to analyse data. Of the 36 patients whose records were reviewed, 21(58%) were males, and body mass index was less than 23 in 34(91%). A total of 27(75%) patients underwent elective surgery for their condition. Ileal pouch was formed in 9(25%). Overall mortality was 14(38.8%). Overall incidence of complications was 26(72%), with wound infection being the most common early morbidity in 11(30.5%). Late morbidity included pouchitisin 4/9 (44.9%) and strictures 2/36 (5.5%).On telephonic follow-up, 6 of the remaining 7patients (85%) with ileal pouch were satisfied with the functional results of the procedure. The retrospective case series represents results from a developing country with low prevalence of inflammatory bowel disease and hence limited experience.

Patient Attitudes towards Physician Nonverbal Behaviors during Consultancy: Result from a Developing Country

PubMed Central

Khan, Fahad Hanif; Hanif, Raheela; Tabassum, Rumina

2014-01-01

Background. Nonverbal behaviors have a significant impact on patients during consultations. This study was undertaken to find out the attitudes and preferences of the patients regarding nonverbal communication during consultations with physicians, in a tertiary care hospital. Methods. A questionnaire based cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, Pakistan, during the months of January to March 2012. All patients (>18 years of age) coming for consultancy in the family medicine clinics were approached; out of 133, 120 agreed to participate. The subjects were asked questions regarding physician's comforting touch and eye contact and their responses were noted. The data were analyzed using SPSS and chi-square test was used to identify corelations. Results. Overall, 120 patients were enrolled. About 58.3% were men and 41.7% were women with a mean age of 34.9 ± 10.9 years. 95.8% were Muslims and 57.6% had more than 12 years of education. Among females 74% wanted supportive touch from doctors, used to comfort the patient (45%) or to show respect (27.5%) or as healing (30%). 86.1% of the respondents believe that establishing eye contact with the patient shows that the doctor is attentive towards his/her patient. The eye contact should be brief but regular (54.1%) and prolonged staring (36.7%) makes them uncomfortable. Conclusion. Nonverbal communication helps to strengthen the doctor-patient relation as patients do appreciate positive touch and eye contact from their physicians. PMID:24977140

Frequency of colistin and fosfomycin resistance in carbapenem-resistant Enterobacteriaceae from a tertiary care hospital in Karachi.

PubMed

Qamar, Salima; Shaheen, Najma; Shakoor, Sadia; Farooqi, Joveria; Jabeen, Kauser; Hasan, Rumina

2017-01-01

Management of infections with carbapenem-resistant Enterobacteriaceae (CRE) is challenging. In recent times, agents such as colistin and fosfomycin have been used in combination with other antibiotics to treat such infections. In this study, we aim to seek frequency of colistin and fosfomycin resistance in CRE from Pakistan. This study was conducted at clinical laboratories, Aga Khan University Hospital. In total, 251 CRE were included in the study. Colistin minimum inhibitory concentrations (MICs) were performed using broth microdilution (BMD) method and VITEK ® 2 system, whereas fosfomycin susceptibility was performed using Kirby-Bauer method. MIC 50 and MIC 90 were calculated for colistin and agreement between VITEK and BMD was also calculated. Out of 251 strains colistin MIC of ≥4 µg/mL was seen in 40 (15.9%). Of these strains 20 (50%) were Klebsiella pneumoniae . Colistin MIC 50 and MIC 90 were found to be 0.5 and 16 µg/mL, respectively. BMD and VITEK 2 showed 100% categorical agreement. Essential agreement was 88.5% with kappa score 0.733 indicating strong agreement between VITEK and BMD. 31 out of 251 (12.3%) CREs were resistant to fosfomycin. Study shows frequency of colistin and fosfomycin resistance to be 15.9% and 12.3%, respectively. In countries where rate of CREs is high, emerging resistance against these last resort antibiotics is alarming as it leaves clinicians with almost no options to manage such multidrug resistant and extensively drug resistant infections.

Quality of Life in Individuals Surgically Treated for Congenital Hydrocephalus During Infancy: A Single-Institution Experience.

PubMed

Khan, Saad Akhtar; Khan, Muhammad Faheem; Bakhshi, Saqib Kamran; Irfan, Omar; Khan, Hamza Abdur Rahim; Abbas, Asad; Awan, Safia; Bari, Muhammad Ehsan

2017-05-01

Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country. This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at <1 year old and underwent surgery for primary CH. The Hydrocephalus Outcome Questionnaire was used to assess outcomes with respect to QOL. Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, 28 patients had died after surgery. Shunt infection (P = 0.012) and delayed milestones (P = 0.003) were found to be statistically significant factors affecting mortality in the patients who died. The mean overall health score was 0.67 ± 0.30. Age <6 months at the time of first surgery was a poor predictor of overall health on the Hydrocephalus Outcome Questionnaire (P = 0.039). In our analysis, we assessed the QOL associated with CH. We hope that these results will provide insight for future prospective work with the ultimate goal of improving long-term QOL in children with CH. Copyright © 2017 Elsevier Inc. All rights reserved.

One hundred injured patients a day: multicenter emergency room surveillance of trauma in Pakistan.

PubMed

Hyder, A A; He, S; Zafar, W; Mir, M U; Razzak, J A

2017-07-01

Injuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system. Cross-sectional study conducted using active surveillance approach. This study included EDs of seven tertiary care hospitals in Pakistan. The data were collected between November 2010 and March 2011. All patients presenting with injuries to the participating EDs were enrolled. The study was approved by the Institutional Review Boards of the Johns Hopkins School of Public Health, Aga Khan University, and all participating sites. The study recorded 68,390 patients; 93.8% were from the public hospitals. There were seven male for every three female patients, and 50% were 20-39 years of age. About 69.3% were unintentional injuries. Among injuries with a known mechanism (19,102), 51.1% were road traffic injuries (RTIs) and 17.5% were falls. Female, patients aged 60 years or older, patients transferred by ambulance, patients who had RTIs, and patients with intentional injuries were more likely to be hospitalized. The study is the first to use standardized methods for regular collection of multiple ED data in Pakistan. It explored the pattern of injuries and the feasibility to develop and implement facility-based systems for injury and acute illness in countries like Pakistan. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

RSV associated hospitalizations in children in Karachi, Pakistan: Implications for vaccine prevention strategies.

PubMed

Ali, Asad; Yousafzai, Mohammad Tahir; Waris, Rabbia; Jafri, Fatima; Aziz, Fatima; Abbasi, Imran Naeem; Zaidi, Anita

2017-07-01

Major progress is being made in vaccines against Respiratory Syncytial Virus (RSV), with multiple vaccine candidates currently in the clinical phase of development. Making an investment case for public sector financing of RSV vaccine will require estimation of burden, cost-effectiveness, and impact. The aim of this study is to determine the proportion, age distribution and clinical spectrum of RSV associated hospitalizations in children in Karachi, Pakistan. A three years prospective study was conducted at the Aga Khan University Hospital in Karachi, a city of 20 million in south Pakistan, from August 2009 to June 2012. Children less than five years old admitted with acute respiratory infections (ARI) were enrolled. Throat swabs were collected and tested for RSV using real-time PCR. Multivariable log binomial regression analysis was performed to identify the associated factors of RSV infection. Out of 1150 children enrolled, RSV was detected among 223 (19%). Highest rate of RSV detection was in young infants less than 3 months of age (48/168, 29%), which accounted for 22% of all RSV detected. Most common diagnosis in RSV positive infants (<12 months of age) was bronchiolitis followed by pneumonia, while in older children between the ages of one and 5 years of age, pneumonia and asthma were the most common diagnosis. Although identified year-round, RSV was most prevalent from August to October with peak in September, coinciding with the rainy season. This study identified RSV to be independently associated with younger age (P = 0.036), rainy season (P < 0.001), post-tussive emesis (P = 0.008), intubation (P = 0.003), and discharge diagnosis of bronchiolitis (P = 0.004). Vaccines against RSV that target this age group are likely to yield remarkable benefit. © 2017 Wiley Periodicals, Inc.

Male hypogonadism at a tertiary care hospital in Karachi, Pakistan.

PubMed

Ram, Nanik; Asghar, Ali; Hashmi, Fauzan; Islam, Najmul

2012-01-01

Male hypogonadism is defined as 'inadequate gonadal function, manifested by deficiency in gametogenesis and/or secretion of gonadal hormones'. Signs and symptoms of hypogonadism depend primarily on the age of onset. It can be classified according to the site primarily involved: the gonads, the hypothalamus, or the pituitary gland. The objective this study was to determine the presentation and aetiology of male hypogonadism seen in a tertiary care hospital. This cross-sectional study was conducted at Endocrine Clinics, Aga Khan University Hospital Karachi. Data of male patients with hypogonadism who attended clinics during January 2009 to August 2011 were reviewed. All male patients with clinical and biochemical evidence of hypogonadism were included in the study. Patients with Diabetes Mellitus, Metabolic Syndrome, Andropause, AIDS, Chronic Renal Failure, and Cirrhosis were excluded. Mean +/- SD were computed for quantitative variables. Frequency and percentages were computed for qualitative variables. Aetiology of male hypogonadism was categorised as primary and secondary hypogonadism. A total of 85 patients with male hypogonadism attended the endocrine clinic. Mean age of patients was 25 +/- 10 years. Clinical presentations were small genitalia (65%), absent secondary sexual characteristics (53%), not attained puberty (47%), infertility (53%), erectile dysfunction (41%) and loss of libido (29%). Seventy-three (86%) patients had hypogonadotrophic hypogonadism (secondary hypogonadism) and 12 (14%) patients had hypergonadotrophic hypogonadism (primary hypogonadism). Among the patients with hypogonadotrophic hypogonadism 38 had idiopathic hypogonadotrophic hypogonadsim, 7 had pituitary adenoma, 6 had empty sella syndrome, 3 had Kallman's syndrome, and 1 patient had haemosiderosis due to thalassaemia major; 18 patients did not undergo brain imaging. Small genitalia, absent secondary sexual characteristics and infertility were the main presenting features of hypogonad men. Majority of patients had hypogonadotrophic hypogonadsim.

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

PubMed Central

Shamim, Muhammad Shahzad; Ali, Syed Faizan; Enam, Syed Ather

2011-01-01

Background: Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. Methods: A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Results: Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001). Conclusion: We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity. PMID:22145085

Inter-facility transfer of surgical emergencies in a developing country: effects on management and surgical outcomes.

PubMed

Khan, Salma; Zafar, Hasnain; Zafar, Syed Nabeel; Haroon, Naveed

2014-02-01

Outcomes of surgical emergencies are associated with promptness of the appropriate surgical intervention. However, delayed presentation of surgical patients is common in most developing countries. Delays commonly occur due to transfer of patients between facilities. The aim of the present study was to assess the effect of delays in treatment caused by inter-facility transfers of patients presenting with surgical emergencies as measured by objective and subjective parameters. We prospectively collected data on all patients presenting with an acute surgical emergency at Aga Khan University Hospital (AKUH). Information regarding demographics, social class, reason and number of transfers, and distance traveled were collected. Patients were categorized into two groups, those transferred to AKUH from another facility (transferred) and direct arrivals (non-transfers). Differences between presenting physiological parameters, vital statistics, and management were tested between the two groups by the chi square and t tests. Ninety-nine patients were included, 49 (49.5 %) patients having been transferred from another facility. The most common reason for transfer was "lack of satisfactory surgical care." There were significant differences in presenting pulse, oxygen saturation, respiratory rate, fluid for resuscitation, glasgow coma scale, and revised trauma score (all p values <0.001) between transferred and non-transferred patients. In 56 patients there was a further delay in admission, and the most common reason was bed availability, followed by financial constraints. Three patients were shifted out of the hospital due to lack of ventilator, and 14 patients left against medical advice due to financial limitations. One patient died. Inter-facility transfer of patients with surgical emergencies is common. These patients arrive with deranged physiology which requires complex and prolonged hospital care. Patients who cannot afford treatment are most vulnerable to transfers and delays.

Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: a cross-sectional study from Karachi, Pakistan.

PubMed

Zuberi, Saman I; Syed, Ehsan U; Bhatti, Junaid A

2011-02-15

To assess the associations of depression with glycemic control and compliance to self-care activities in adult patients with Type 2 Diabetes Mellitus This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS ≥ 8) with poor glycemic control (Hemoglobin A1c level ≥ 7%) and compliance to self-care activities were assessed by logistic regression analyses. A total of 286 patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7% of them, the duration of diabetes was more than 3 years. Depressed patients were more likely to be female (adjusted odds ratio [OR] = 1.88; 95% confidence interval [95%CI] = 1.07-3.31), had a family history of diabetes (OR = 2.64; 95%CI = 1.26-5.55), and poor glycemic control (OR = 5.57; 95%CI = 2.88-10.76) compared with non-depressed patients. Depression was also associated with low compliance to self-care activities such as taking dose as advised (OR = 0.32; 95%CI = 0.14-0.73), dietary restrictions (OR = 0.45; 95%CI = 0.26-0.79) and foot care (OR = 0.38; 95%CI = 0.18-0.83). Adult patients with Type 2 Diabetes who have depression were more likely to have poor glycemic control and lower compliance to self-care activities, and they might need particular attention during follow-up visits.

Death certificate completion skills of hospital physicians in a developing country.

PubMed

Haque, Ahmed Suleman; Shamim, Kanza; Siddiqui, Najm Hasan; Irfan, Muhammad; Khan, Javaid Ahmed

2013-06-06

Death certificates (DC) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. Incomplete and inaccurate DC data, on the other hand, can significantly impair the precision of a national health information database. In this study we evaluated the accuracy of death certificates at a tertiary care teaching hospital in a Karachi, Pakistan. A retrospective study conducted at Aga Khan University Hospital, Karachi, Pakistan for a period of six months. Medical records and death certificates of all patients who died under adult medical service were studied. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. Accuracy of this information was validated using their medical records. Errors in the death certificates were classified into six categories, from 0 to 5 according to increasing severity; a grade 0 was assigned if no errors were identified, and 5, if an incorrect cause of death was attributed or placed in an improper sequence. 223 deaths occurred during the study period. 9 certificates were not accessible and 12 patients had incomplete medical records. 202 certificates were finally analyzed. Most frequent errors pertaining to patients' demographics (92%) and cause/s of death (87%) were identified. 156 (77%) certificates had 3 or more errors and 124 (62%) certificates had a combination of errors that significantly changed the death certificate interpretation. Only 1% certificates were error free. A very high rate of errors was identified in death certificates completed at our academic institution. There is a pressing need for appropriate intervention/s to resolve this important issue.

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan.

PubMed

Shamim, Muhammad Shahzad; Ali, Syed Faizan; Enam, Syed Ather

2011-01-01

Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001). We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.

The financial burden of cancer: estimates from patients undergoing cancer care in a tertiary care hospital.

PubMed

Zaidi, Adnan A; Ansari, Tayyaba Z; Khan, Aziz

2012-10-15

The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancer care for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH) Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancer care was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%). The financial burden of cancer was perceived as significant by 28 (42%) patients and unmanageable by 18 (27%) patients. This perceived level of burden was associated significantly with average monthly income (p = <0.001). Our study indicates that the financial burden of cancer care is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.

Increasing Student Engagement in Math: The Use of Khan Academy in Chilean Classrooms

ERIC Educational Resources Information Center

Light, Daniel; Pierson, Elizabeth

2014-01-01

Khan Academy, an online platform offering educational videos and exercises in different content areas, has awakened intense interest among foundations, multilateral organizations, policy makers, and educators about how this tool can help meet the educational challenges facing countries around the world. With support from Intel, Education…

The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire.

PubMed

Safavi-Abbasi, Sam; Brasiliense, Leonardo B C; Workman, Ryan K; Talley, Melanie C; Feiz-Erfan, Iman; Theodore, Nicholas; Spetzler, Robert F; Preul, Mark C

2007-01-01

In 25 years, the Mongolian army of Genghis Khan conquered more of the known world than the Roman Empire accomplished in 400 years of conquest. The recent revised view is that Genghis Khan and his descendants brought about "pax Mongolica" by securing trade routes across Eurasia. After the initial shock of destruction by an unknown barbaric tribe, almost every country conquered by the Mongols was transformed by a rise in cultural communication, expanded trade, and advances in civilization. Medicine, including techniques related to surgery and neurological surgery, became one of the many areas of life and culture that the Mongolian Empire influenced.

76 FR 42159 - Lifting of Sanctions on Person Associated With the A.Q. Khan Nuclear Procurement Network

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-18

... DEPARTMENT OF STATE [Public Notice: 7525] Lifting of Sanctions on Person Associated With the A.Q. Khan Nuclear Procurement Network AGENCY: Bureau of International Security and Nonproliferation, Department of State. ACTION: Notice. SUMMARY: A determination has been made to lift the measures imposed on...

Shaping Influences on the Leadership of Genghis Khan, George Washington, and Nelson Mandela: Applications for Educators

ERIC Educational Resources Information Center

Bongila, Jean-Pierre

2011-01-01

Using a prosopographical methodology this study examines common leadership influences that might have existed among Genghis Khan, George Washington, and Nelson Mandela. Shoup (2005) suggests that the following seven influences have contributed to nurturing the leadership of 12 renowned individuals: involved parents, happy childhood, formal,…

75 FR 19668 - Culturally Significant Objects Imported for Exhibition Determinations: “From Xanadu to Dadu: The...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-15

... DEPARTMENT OF STATE [Public Notice 6955] Culturally Significant Objects Imported for Exhibition Determinations: ``From Xanadu to Dadu: The World of Khubilai Khan'' SUMMARY: Notice is hereby given of the... objects to be included in the exhibition ``From Xanadu to Dadu: The World of Khubilai Khan,'' imported...

A Case Study for Teaching Quantitative Biochemical Buffer Problems Using Group Work and "Khan Style" Videos

ERIC Educational Resources Information Center

Barreto, Jose; Reilly, John; Brown, David; Frost. Laura; Coticone, Sulekha Rao; Dubetz, Terry Ann; Beharry, Zanna; Davis-McGibony, C. Michele; Ramoutar, Ria; Rudd, Gillian

2014-01-01

New technological developments have minimized training, hardware expense, and distribution problems for the production and use of instructional videos, and any science instructor can now make instructional videos for their classes. We created short "Khan style" videos for the topic of buffers in biochemistry and assigned them as…

"Kubla Khan" and Its Narratives of Possible Worlds

ERIC Educational Resources Information Center

Nayar, Pramod K.

2013-01-01

This essay argues that Coleridge's "Kubla Khan" is a poem about narrative and specifically focuses on the narrative construction of possible worlds, or even utopian worlds. It notes two pairs of narratives. In pair one the utopian narrative of the monarch's decree which seeks to build a space of pure pleasure is in opposition to the…

Parents' Attitude toward Daughters' Education in Tribal Area of Dera Ghazi Khan (Pakistan)

ERIC Educational Resources Information Center

Buzdar, Muhammad Ayub; Ali, Akhtar

2011-01-01

The paper aimed to investigate the parents' attitudes toward their daughters' education in tribal areas of district Dera Ghazi Khan (Pakistan). To achieve the objectives four research questions were established. Focus of the questions was to examine the significance of girls' education for tribal parents. Existing and expected role of tribal…

Just in Time to Flip Your Classroom

ERIC Educational Resources Information Center

Lasry, Nathaniel; Dugdale, Michael; Charles, Elizabeth

2014-01-01

With advocates like Sal Khan and Bill Gates, flipped classrooms are attracting an increasing amount of media and research attention. We had heard Khan's TED talk and were aware of the concept of inverted pedagogies in general. Yet it really hit home when we accidentally flipped our classroom. Our objective was to better prepare our students…

Microbial contamination of the drinking water distribution system and its impact on human health in Khan Yunis Governorate, Gaza Strip: seven years of monitoring (2000-2006).

PubMed

Abu Amr, S S; Yassin, M M

2008-11-01

To assess total and faecal coliform contamination in water wells and distribution networks over the past 7 years, and their association with human health in Khan Yunis Governorate, Gaza Strip. Historical data and interview questionnaire. Data were obtained from the Palestinian Ministry of Health on total and faecal coliform contamination in water wells and distribution networks, and on the incidence of water-related diseases in Khan Yunis Governorate. An interview questionnaire was conducted with 210 residents of Khan Yunis Governorate. Total and faecal coliform contamination exceeded the World Health Organization's limit for water wells and networks. However, the contamination percentages were higher in networks than in wells. Diarrhoeal diseases were strongly correlated with faecal coliform contamination in water networks (r=0.98). This is consistent with the finding that diarrhoeal diseases were the most common self-reported diseases among the interviewees. Such diseases were more prevalent among subjects who drank municipal water than subjects who drank desalinated or home-filtered water (odds ratio=2.03). Intermittent water supply, insufficient chlorination and sewage flooding seem to be associated with self-reported diseases. Residents in the Gaza Strip have a good level of knowledge about drinking water contamination, and this is reflected in good practice. Water quality has deteriorated in the Gaza Strip, and this may contribute to the prevalence of water-related diseases. Self-reported diseases among interviewees in Khan Yunis Governorate were associated with source of drinking water, intermittent water supply, insufficient chlorination, sewage flooding and age of water networks.

The relationship between emotional intelligence and task-switching in temporal lobe epilepsy.

PubMed

Gul, Amara; Hussain, Imtiaz

2016-01-01

To examine the role of emotional intelligence (EI) in task-switching performance of patients with temporal lobe epilepsy (TLE). An experimental research design conducted at Sheikh Zayed Hospital, Rahim Yar Khan, Mayo and Services Hospital, Lahore, Pakistan from March 2013 to October 2014. Twenty-five patients with TLE and 25 healthy individuals from local community participated in the study. Participants completed measures of intelligence, EI, depression, anxiety, stress, and task-switching experiment. Patients and controls showed an average intelligence quotient, and normal levels of depression, anxiety, and stress. In contrast to controls, patients showed lower EI and impaired task-switching abilities. This result can be seen in the context of disintegrated white matter and cerebral connectivity in patients with TLE. Emotional intelligence was found to be a significant predictor of task-switching performance. Emotional intelligence is a potential marker of higher order cognitive functioning in patients with TLE.

Bomb Blast and Its Consequences: Successful Intensive Care Management of Massive Pulmonary Embolsim.

PubMed

Shamim, Faisal; Rizwan, Muhammad; Aziz, Adil

2016-06-01

A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit. Based on history, echocardiography findings and patient parameters, a clinical diagnosis of massive pulmonary embolism was made and immediate thrombolytic therapy with alteplase was started. The immediate improvement in hemodynamic status was evident following 2 hours of alteplase infusion. This case also highlights the aggressiveness of resuscitation, decision making in initiating thrombolytic therapy on clinical grounds, importance of deep venous thrombosis prophylaxis, and exhaustion of health resources due to blast related mass destruction.

An Analysis of Blood Utilization for Stem Cell Transplant Patients in a Tertiary Care Hospital.

PubMed

Ali, Natasha

2017-05-30

Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Aga Khan University Hospital. A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from June 2014∼June 2015. All consecutive patients, admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger. During the study period, n=25 patients underwent haematopoietic stem cell transplant. There were n=19 males and n=6 females. One patient was less than 15 years of age while rests were adults. Median age±SD was 26.5±14.5 years (12∼54 years). The underlying diagnosis included Aplastic anemia (n=8), Thalassemia major (n=3), Multiple Myeloma (n=4), Acute leukemia (n=5), Hodgkin's lymphoma (n=4), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204 while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gms/dl. The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international benchmark.

Outcome of infants with unrepaired heart disease admitted to the pediatric intensive care unit: single-center developing country perspective.

PubMed

Mohsin, Shazia Samad; Haque, Anwarul; Shaikh, Abdul Sattar; Bano, Surraiya; Hasan, Babar Sultan

2014-01-01

Congenital heart disease (CHD) has an incidence of ∼0.8-1%. Outcome of previously diagnosed CHD patients awaiting surgery (either correction or palliation) in a developing country setting is unknown. We strive to determine the outcome of patients with CHD awaiting surgery who present to pediatric intensive care unit (PICU) setting with an acute illness. Retrospective cross-sectional chart review. Pediatric intensive care unit of The Aga Khan University Hospital, Karachi, Pakistan. Medical records of infants (1-12 months) with CHD awaiting surgery presenting to the PICU with an acute illness between January 2009 and June 2012 were included. Newly diagnosed CHD patients, those not requiring PICU admission, and those transferred to another hospital were excluded. A total of 34 infants met the inclusion criteria. Median age at presentation was 5 months. Seventy-four percent of the infants had CHD lesion characterized by increased pulmonary blood flow (shunt lesions). Though none of the patients met the strict criteria for sepsis or pneumonia, 74% were admitted with a diagnosis of pneumonia or sepsis. Only 15% of patient had congestive heart failure as an admitting diagnosis. Oxygen therapy was given to 94% of these patients. Fifty-nine percent of these patients expired during the admission, 95% of those expired had multiorgan dysfunction. Patients with CHD awaiting surgery and who admitted to the PICU with acute illness are at high risk for mortality. Stringent criteria to diagnose pneumonia or sepsis should be used in these patients. © 2013 Wiley Periodicals, Inc.

Role of serum angiotensin converting enzyme in sarcoidosis.

PubMed

Khan, A H; Ghani, F; Khan, A; Khan, M A; Khurshid, M

1998-05-01

This study was conducted to determine the role of Serum Angiotensin Converting Enzyme (SACE) as a marker in the differential diagnosis of pulmonary diseases and prognosis of sarcoidosis. A retrospective analysis of 113 medical records of patients at The Aga Khan University Hospital, with laboratory investigation for SACE was performed. Among 113 patients, 51 cases were found to have sarcoidosis, 44 of them had SACE levels greater than 52 IU/L (mean ACE 104.44). SACE levels were also found elevated in other clinical conditions like tuberculosis (mean 58.64 IU/L), but the enzyme level were less (p 0.04) than those found in sarcoidosis (mean (92.97 IU/L). SACE activity was found to be considerably lower in other chronic lung diseases such as, fibrosing alveolitis (mean 43.98 IU/L), interstitial lung disease (mean 42.11 IU/L) and chronic obstructive lung disease (mean 40.85 IU/L). Twenty patients of sarcoidosis, who received steroid treatment subsequently showed a decline in the SACE levels. SACE is a useful marker in differential diagnosis as 37.2% cases of sarcoidosis compared to only 9.09% of tuberculosis had SACE levels greater than 100 IU/L. In addition, our data also suggest that serum ACE is useful for the diagnosis as well as monitoring prognosis in sarcoidosis.

Comparison of fracture and deformation in the rotary endodontic instruments: Protaper versus K-3 system.

PubMed

Nagi, Sana Ehsen; Khan, Farhan Raza; Rahman, Munawar

2016-03-01

This experimental study was done on extracted human teeth to compare the fracture and deformation of the two rotary endodontic files system namely K-3 and Protapers. It was conducted at the dental clinics of the Aga Khan University Hospital, Karachi, A log of file deformation or fracture during root canal preparation was kept. The location of fracture was noted along with the identity of the canal in which fracture took place. The fracture in the two rotary systems was compared. SPSS 20 was used for data analysis. Of the 172(80.4%) teeth possessing more than 15 degrees of curvature, fracture occurred in 7(4.1%) cases and deformation in 10(5.8%). Of the 42(19.6%) teeth possessing less than 15 degrees of curvature, fracture occurred in none of them while deformation was seen in 1(2.4%). There was no difference in K-3 and Protaper files with respect to file deformation and fracture. Most of the fractures occurred in mesiobuccal canals of maxillary molars, n=3(21.4%). The likelihood of file fracture increased 5.65-fold when the same file was used more than 3 times. Irrespective of the rotary system, apical third of the root canal space was the most common site for file fracture.

Case Series of Naegleria fowleri Primary Ameobic Meningoencephalitis from Karachi, Pakistan.

PubMed

Ghanchi, Najia K; Jamil, Bushra; Khan, Erum; Ansar, Zeeshan; Samreen, Azra; Zafar, Afia; Hasan, Zahra

2017-11-01

Naegleria fowleri causes primary amoebic meningoencephalitis (PAM) which is almost always fatal. Naegleria fowleri is waterborne, and its infections are usually associated with aquatic activities but it can also be transmitted via the domestic water supply. An increasing number of N. fowleri cases have been reported from Pakistan. Improved methods for diagnosis are required. We report the utility of polymerase chain reaction (PCR) for the diagnosis of N. fowleri in patients suspected of PAM. One hundred and sixteen cases suspected of having PAM were examined. Cerebrospinal fluid (CSF) specimens were tested at the Aga Khan University Hospital, Karachi. Nineteen CSF specimens were positive for N. fowleri using PCR. Naegleria fowleri positive patients had a median age of 28 years and were 84% male and 16% female. Overall, CSF wet preparation microscopy was performed in 85 (73%) cases and identified that seven specimens were positive for motile trophozoites. The CSF wet preparation results were available for 15 of the 19 N. fowleri PCR positive CSF samples; seven (40%) wet preparations were positive. Our data highlight the threat of N. fowleri infection as a cause of PAM. It also emphasizes the utility of the PCR-based diagnosis of the amoeba for early diagnosis and management of the disease.

Subacute sclerosing panencephalitis: clinical and demographic characteristics.

PubMed

Rafique, Arshad; Amjad, Nida; Chand, Prem; Zaidi, Syed Sohail Zahoor; Rana, Muhammad Suleman; Ahmed, Khalid; Ibrahim, Shahnaz

2014-08-01

To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE). Case series. The Aga Khan University Hospital, Karachi, from January 2000 to June 2012. A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. RESULTS were expressed as percentages. Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of measles was present in 17 patients (39.5%). All children had seizures at presentation and 65% had cognitive impairment. Most patients required poly therapy for control of seizures. Sodium valproate was the most commonly used anti-epileptic agent; Isoprinosine was tried in 22 (51%) patients. CSF for antimeasles antibodies was positive in approximately 86% of the 40 (93%) children. EEG showed burst suppression pattern in 36 (83.7%) cases. Forty-two patients (97.6%) were discharged home in a vegetative state. SSPE is progressive neurodegenerative disorder. It can be prevented by timely immunization against measles. Measles antibody in the CSF is diagnostic for SSPE and is helpful in early diagnosis. Most patients experience a gradual but progressive decline in motor and cognitive functions.

Investigating the Use of the Khan Academy and Mathematics Software with a Flipped Classroom Approach in Mathematics Teaching

ERIC Educational Resources Information Center

Zengin, Yilmaz

2017-01-01

The purpose of this study was to determine the effect of the flipped classroom approach designed by using Khan Academy and free open source software on students' academic achievement and to examine students' views about this approach. The research was evaluated in the light of both qualitative and quantitative data. Twenty-eight students studying…

KSC-04PD-1105

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- During filming at KSC, writer- director from India Ashutosh Gowariker, his wife Sunita, and actor Shahrukh Khan pose for a photo with the Vehicle Assembly Building in the background. The film crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. Khan is one of the lead actors in the film; the other is Gayatri Joshi. Sunita Gowariker is executive producer.

Mixing mechanisms in siliciclastic-carbonate successions of Khan Formation (Permian), Central Iran

NASA Astrophysics Data System (ADS)

Shadan, Mahdi; Hosseini-Barzi, Mahboubeh

2010-05-01

Mixing mechanisms in siliciclastic-carbonate successions of Khan Formation (Permian), Central Iran M. Shadan & M. Hosseini-Barzi Geology Department, Faculty of Earth Science, Shahid Beheshti University, Tehran, Iran shadangeo@gmail.com Mixing mechanisms in siliciclastic-carbonate successions of Khan Formation (Permian) have been studied in two sections (Chahroof with 197 m thick in north and Cheshmeh Bakhshi with 204 m thick in south) along basement Kalmard fault in Posht-e-Badam block, Central Iran. Siliciclastic units are characterized by well sorted, fine to medium grain quartzarenites with laterite interbeds, deposited in shoreline zone (foreshore, upper and lower shoreface) influencing wave and longshore currents. Longshore sands which have been transported along the coast made the sand bars in the shoreface. Further along the coast, returning of these currents as rip currents produced erosive channel inlets and caused to carry fine grain into the deeper regions of the basin. Based on this sedimentary model we introduced longshore currents as a probable agent for mixing, by transporting some volumes of sands into the adjacent carbonate environments. Vertically, clastic units of Khan Formation underlined by carbonate units of a tidal flat and high-energy inner ramp system. Repeating of this pattern produced 3 cycles in each section. Cyclic evolution, in studied sections, is accompanied with discrepancy in erosion and sedimentation. These factors caused to disperse local sub-aerial exposures in successions which are recognizable by laterite and conglomerate interbeds. These horizons of sub-aerial exposures are more often in Chahroof section than in Cheshmeh Bakhshi section and indicate more fluctuations of relative sea level probably due to more local tectonic activity in the northern part of the Kalmard fault than in the southern part of it. Also, thicker siliciclastic units in Chahroof section show higher rate of sediment supply and/or more accommodation space there. Moreover, the late Paleozoic glacial conditions in Gondwana lands supported the large volume of clastic supply into the basin by intense weathering and erosion of vast exposed regions in Posht-e-Badam block. Also, tectonic activity along Kalmard basement fault mainly controlled local sea level changes and lithology of outcrops in the hinterlands. Therefore, interplay of these factors during lowstand of relative sea level, with lower accommodation space and higher gradient led to high rate of sediment input and distribution of siliciclastics in the base of each cycles. In contrast, relative sea level rises have been corresponded to the more accommodation space and reducing of siliciclastic entrance into the sedimentary basin that made a suitable condition for carbonate production. Therefore, during relative sea level rise, verities of carbonate-producing organisms tend to more rates of biogenic carbonate products and eventually formation of carbonate units upon the preexistence silisiclastics. Therefore, mixing of siliciclastics with carbonate deposits in Khan Formation have mainly been controlled temporally by sea level fluctuations due to local and/or eustatic sea level changes and spatially by variations in local tectonic activities and lateral facies mixing by longshore currents.

Effective and Efficient Training and Advising in Pakistan

DTIC Science & Technology

2010-06-01

the TTP’s violent tactics nevertheless see the TTP as a beneficial alternative to a government whose reach is too limited. 25 NEFA , “Interview...with Haji Muslim Khan: Chief Spokesman for the Tehrik e Taliban, Swat Valley,” NEFA Foundation, http://www1.nefafoundation.org/multimedia-intvu.html...2009. NEFA . “Interview with Haji Muslim Khan: Chief Spokesman for the Tehrik e Taliban, Swat Valley.” NEFA Foundation, http://www1.nefafoundation.org

KSC-04pd1105

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- During filming at KSC, writer-director from India Ashutosh Gowariker, his wife Sunita, and actor Shahrukh Khan pose for a photo with the Vehicle Assembly Building in the background. The film crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. Khan is one of the lead actors in the film; the other is Gayatri Joshi. Sunita Gowariker is executive producer.

Treatment of Memory Impairment and Sensorimotor Deficits in an Animal Model for the Gulf War Veterans Illnesses

DTIC Science & Technology

2010-09-01

B.E. and Khan, W.A., (2001b). Locomotor and sensorimotor performance deficit in rats following exposure to pyridostigmine bromide , DEET, and...Induction of urinary excretion of 3-nitrotyrosine, a m arker of oxidative stress foll owing administration of pyridostigmine bromide , N,N-diethyl-m...Abdel-Rahman, A.A., Bull man, S. L., and Khan, W .A., (2004). Co-exposure to pyridostig mine bromide , DEET and/or perm ethrin causes

JPRS Report, Near East & South Asia: Pakistan

DTIC Science & Technology

1993-06-15

Muslims’ and, this needed to counter negative reactions. Movements with a fact will prove to be a great advantage for Tahrik- strong popular base, when...have done it. As it is, they claim that the much WAPDA [Water and Power Development Authority], needed SP gun will be in service with the strike corps...Isahq Khan self Mr Ghulam Ishaq Khan greeted the verdict of the perpetuation means more than the peace and happiness Supreme Court by reciting a

First report of ophthalmomyaisis externa in Pakistan.

PubMed

Ali, Azam; Feroze, Agha Hassan; Ferrar, Paul; Abbas, Asad; Beg, Mohammad Asim

2006-02-01

Two individuals presented to the Aga Khan University Opthalmology service with foreign-body sensation, pain and redness in one of their eyes. Slit-lamp biomicroscopy revealed tiny larvae crawling around the conjunctival sac. They were mechanically removed under topical anaesthesia and preserved for light microscopy and photography. Comprehensive liaison was established with the Australian Centre for International Agriculture Research for identification of these larvae. Their morphology characterized them as members of fruit-fly, Oestridae family. At least one of them was positively identified as first instar larva of Oestrus ovis. This report describes the first instance of such infections in Southern Pakistan, as concluded after a Medline search.

Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan.

PubMed

Awais, Muhammad; Nadeem, Naila; Husen, Yousuf; Rehman, Abdul; Beg, Madiha; Khattak, Yasir Jamil

2014-12-01

To compare Greulich-Pyle (GP) and Girdany-Golden (GG) methods for estimation of Skeletal Age (SA) in children referred to a tertiary care hospital in Karachi, Pakistan. Cross-sectional study. Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan, from July 2010 to June 2012. Children up to the age of 18 years, who had undergone X-ray for the evaluation of trauma were included. Each X-ray was interpreted using both methods by two consultant paediatric radiologists having at least 10 years experience, who were blinded to the actual Chronologic Age (CA) of children. A total of 283 children were included. No significant difference was noted in mean SA estimated by GP method and mean CA for female children (p=0.695). However, a significant difference was noted between mean CA and mean SA by GG method for females (p=0.011). For males, there was a significant difference between mean CA and mean SA estimated by both GP and GG methods. A stronger correlation was found between CA and SA estimated by GP method (r=0.943 for girls, r=0.915 for boys) as compared to GG method (r=0.909 for girls, r=0.865 for boys) respectively. Bland- Altman analysis also revealed that the two methods cannot be used interchangeably. Excellent correlation was seen between the two readers for both GP and GG methods. There was no additional benefit of using GP and GG methods simultaneously over using GP method alone. Moreover, although GP was reliable in estimating SA in girls, it was unable to accurately assess SA in boys. Therefore, it would be ideal to develop indigenous standards of bone age estimation based on a representative sample of healthy native children.

Pediatric critical incidents reported over 15 years at a tertiary care teaching hospital of a developing country.

PubMed

Abbasi, Shemila; Khan, Fauzia Anis; Khan, Sobia

2018-01-01

The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University hospital was done. This was retrospective form review. The Department has a structured CI form in use since 1998 which is intermittently evaluated and modified if needed. A total of 451 pediatric CIs were included. Thirty-four percent of the incidents were reported in infants. Ninety-six percent of the reported incidents took place during elective surgery and 4% during emergency surgery. Equipment-related events (n = 114), respiratory events (n = 112), and drug events (n = 110) were equally distributed (25.6%, 25.3%, and 24.7%). Human factors accounted for 74% of reports followed by, equipment failure (10%) and patient factors (8%). Only 5% of the incidents were system errors. Failure to check (equipment/drugs/doses) was the most common cause for human factors. Poor outcome was seen in 7% of cases. Medication and equipment are the clinical areas that need to be looked at more closely. We also recommend quality improvement projects in both these areas as well as training of residents and staff in managing airway-related problems in pediatric patients.

Value of Routine Preoperative Tests for Coagulation Before Elective Cranial Surgery. Results of an Institutional Audit and a Nationwide Survey of Neurosurgical Centers in Pakistan.

PubMed

Akhunzada, Naveed Zaman; Tariq, Muhammad Bilal; Khan, Saad Akhtar; Sattar, Sidra; Tariq, Wajeeha; Shamim, Muhammad Shahzad; Dogar, Samie Asghar

2018-05-03

Routine preoperative blood testing has become a dogma. The general practice is to order preoperative workup as a knee-jerk response rather than individualize it for each patient. The fact that the bleeding brain tends to swell, which coupled with limited options for proximal control, packing, and overall hemostasis, leads to an overemphasis on the preoperative coagulation profile. This is a retrospective review of the medical records of patients admitted at Aga Khan University Hospital from January 2010 to December 2015 for an elective craniotomy. The hospital registry was used to identify files for review. Data were collected on a predefined proforma. A nationwide survey was performed, and 30 neurosurgery centers were contacted across Pakistan to confirm the practice of preoperative workup. The survey revealed that all centers had a similar practice of preoperative workup. This included complete blood count, serum electrolytes, and coagulation profile, including prothrombin time, activated partial thromboplastin time (aPTT), and international normalized ratio (INR). A total of 1800 files were reviewed. Nine (0.5%) patients were found to have deranged clotting profile without any predictive history of clotting derangement; 56% were male and 44% were female. Median age was 32 years with an interquartile range of 27 years. Median aPTT was (40.8 with 20.8 IQR). Median INR was (1.59 with 0.48 IQR). Median blood loss was (400 with 50 IQR). No significant association between coagulation profile (aPTT, INR) and blood loss was found (P = 0.85, r = -0.07). We conclude that patients without a history of coagulopathy and normal physical examination do not require routine coagulation screening before elective craniotomy. Copyright © 2018 Elsevier Inc. All rights reserved.

Radiofrequency ablation of hepatocellular carcinomas: A new spectrum of anesthetic experience at a tertiary care hospital in Pakistan

PubMed Central

Shamim, Faisal; Asghar, Ali; Tauheed, Saman; Yahya, Muhammad

2017-01-01

Background: Radiofrequency ablation (RFA) is a minimally invasive technique of tumor destruction for patients with hepatic cancer who are not candidates for conventional therapy. The therapy required general anesthesia (GA) or sedation to ensure patient safety and comfort. The study is aimed to report and evaluate factors that influenced the periprocedural anesthetic management, drugs used, and complications during and immediately after RFA procedure for hepatocellular carcinoma. Methods: For this retrospective study, we included 46 patients who underwent percutaneous RFA under GA or conscious sedation from January 2010 to June 2013 in Aga Khan University Hospital, Pakistan. The patients' characteristics, hepatic illness severity (Child-Pugh classification), anesthetic techniques, drugs, and complications of procedure were collected on a predesigned approved form. The data were assessed and summarized using descriptive statistics. Results: The majority of patients were female (57%) and mostly classified as American Society of Anesthesiologist III (65.2%). The preoperative hepatic illness severity in most patients was Child-Pugh Class A (76.10%). Thirty-eight patients (69.09%) had only single lesion and majority number of lesions were <3 cm (65.45). GA was the main anesthetic technique (87%) with laryngeal mask airway as an airway adjunct predominantly (70%). The mainly used anesthetic agents for hypnosis and analgesia were propofol and fentanyl, respectively. Pain was the only significant complaint in postoperative period but only in nine (19%) patients and mild in nature. Conclusions: Percutaneous RFA is a safe treatment of hepatocellular cancer. The procedure required good anesthetic support in the form of sedation-analgesia or complete GA that ensures maximum patient comfort and technical success of the procedure. PMID:28217048

Molecular Genealogy of a Mongol Queen's Family and Her Possible Kinship with Genghis Khan.

PubMed

Lkhagvasuren, Gavaachimed; Shin, Heejin; Lee, Si Eun; Tumen, Dashtseveg; Kim, Jae-Hyun; Kim, Kyung-Yong; Kim, Kijeong; Park, Ae Ja; Lee, Ho Woon; Kim, Mi Jin; Choi, Jaesung; Choi, Jee-Hye; Min, Na Young; Lee, Kwang-Ho

2016-01-01

Members of the Mongol imperial family (designated the Golden family) are buried in a secret necropolis; therefore, none of their burial grounds have been found. In 2004, we first discovered 5 graves belonging to the Golden family in Tavan Tolgoi, Eastern Mongolia. To define the genealogy of the 5 bodies and the kinship among them, SNP and/or STR profiles of mitochondria, autosomes, and Y chromosomes were analyzed. Four of the 5 bodies were determined to carry the mitochondrial DNA haplogroup D4, while the fifth carried haplogroup CZ, indicating that this individual had no kinship with the others. Meanwhile, Y-SNP and Y-STR profiles indicate that the males examined belonged to the R1b-M343 haplogroup. Thus, their East Asian D4 or CZ matrilineal and West Eurasian R1b-M343 patrilineal origins reveal genealogical admixture between Caucasoid and Mongoloid ethnic groups, despite a Mongoloid physical appearance. In addition, Y chromosomal and autosomal STR profiles revealed that the four D4-carrying bodies bore the relationship of either mother and three sons or four full siblings with almost the same probability. Moreover, the geographical distribution of R1b-M343-carrying modern-day individuals demonstrates that descendants of Tavan Tolgoi bodies today live mainly in Western Eurasia, with a high frequency in the territories of the past Mongol khanates. Here, we propose that Genghis Khan and his family carried Y-haplogroup R1b-M343, which is prevalent in West Eurasia, rather than the Y-haplogroup C3c-M48, which is prevalent in Asia and which is widely accepted to be present in the family members of Genghis Khan. Additionally, Tavan Tolgoi bodies may have been the product of marriages between the lineage of Genghis Khan's Borjigin clan and the lineage of either the Ongud or Hongirad clans, indicating that these individuals were members of Genghis Khan's immediate family or his close relatives.

Role of Airpower for Counterinsurgency in Afghanistan and FATA (Federally Administered Tribal Areas)

DTIC Science & Technology

2009-06-01

pakistan_separating_the_facts_from_the_myths/6329/. 183 Syed Saleem Shehzad, “Taliban Win a Fight – and Settle Scores,” Asia Times, August 14, 2008...Nadeem Malik, “Islamabad Tonight: Imran Khan with Nadeem Malik,” April 1, 2009, press conference at Pakistan Tehreek-e-Insaf web site; available...from http://www.insaf.pk/Media/Videos/tabid/62/articleType/ArticleView/articleId/2084/Islamabad-Tonight- Imran -Khan-with-Nadeem-Malik-April-1-2009.aspx

Analysis of pattern of mortality in Medicine and Allied Departments at a tertiary care hospital in Islamabad: A losing battle against sepsis.

PubMed

Azim, Saad; Zahoor, Sidra; Janjua, Jamal; Majeed, Azer; Hussain, Syed Waqar

2017-01-01

To identify the pattern of mortality in medical wards of a tertiary care hospital. This retrospective study was conducted at the Khan Research Laboratories Hospital, Islamabad, Pakistan, and comprised medical records of people who died during hospital stay between December 2013 and November 2014.SPSS 11 was used for data analysis. Of the 3,228 admissions, 105(3.25%) patients expired. Of them, 41(39.04%) were men with a mean age of 55±13.48 years (range: 17-88 years) and 64±11.76 (60.9%) were women with a mean age of 61±15.5 years (range: 23-91 years). The mean length of time between admission and death was 6.58±3.7 days (range: 1-33 days). The causes of death were categorised as infectious in 37(35.23%) patients, cancer-related in 20(19.045%), pulmonary in 19(18.09%), cardiovascular in 18(17.14%), gastrointestinal and neurological in 13(12.38%) each, nephrology in 10(9.52%), autoimmune disorders in 6(5.71%) and miscellaneous in 9(8.57%). Complications of sepsis were the most common cause of death in 38(36.19%) cases. Sepsis, primarily from pneumonia, was the major cause of mortality.

Assessment of psychosocial impact of dental aesthetics.

PubMed

Khan, Munizeh; Fida, Mubassar

2008-09-01

To assess the psychosocial impact of dental aesthetics using the 'Psychosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ) and self-rated Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Cross-sectional study. Dental Section, the Aga Khan University Hospital, Karachi, from August to September 2006. Adults with no prior orthodontic treatment were asked to complete a modified version of the 'Psychosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ). A total of four variables including 'Dental Self-confidence', 'Social impact', 'Psychological impact' and 'Perceived orthodontic treatment need' were assessed by a series of statements, whereas dental aesthetics were assessed by the respondents using the IOTN Aesthetic Component (self-rated IOTN-AC). Kruskal-Walli's test was applied to determine significance. The respondents were 120 adults (70 females and 50 males; mean age 25.8 years), all four of the above-mentioned variables measuring psychosocial impact showed positive and significant correlations with the perceived severity of malocclusion as depicted by the Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN), with p-value of less than 0.01 for all variables. The results indicate the strong psychosocial impact of altered dental aesthetics on the emotional state of an individual. The association between self-rated IOTN-AC grading with psychosocial well-being stands established, indicating that the perceived aesthetics of malocclusion may be as significant a factor in determining treatment need as the degree of malocclusion.

Lip line preference for variant face types.

PubMed

Anwar, Nabila; Fida, Mubassar

2012-06-01

To determine the effect of altered lip line on attractiveness and to find preferred lip line for vertical face types in both genders. Cross-sectional analytical study. The Aga Khan University Hospital, Karachi, from May to July 2009. Photographs of two selected subjects were altered to produce three face types for the same individual with the aim of keeping the frame of the smile constant. Lip line was then altered for both the subjects as: both dentitions visible, upper incisors visible, upper incisors and 2 mm gum and 4 mm gum visible. The pictures were rated by different professionals for attractiveness. Descriptive statistics for the raters and multiple factor ANOVA was used to find the most attractive lip line. The total number of raters was 100 with the mean age of 30.3 ± 8 years. The alterations in the smile parameters produced statistically significant difference in the attractiveness of faces, whereas the perception difference was found to be insignificant amongst raters of different professions. Preferred lip line was the one showing only the upper incisors in dolico and mesofacial male and female genders whereas 2 mm gum show was preferred in brachyfacial subjects. The variability in lip line showed significant difference in the perceived attractiveness. Preferred lip lines as the one showing only the upper incisors in dolico and mesofacial male and female genders whereas 2 mm gum show was preferred in brachyfacial subjects.

Risk factors associated with development of ventilator associated pneumonia.

PubMed

Noor, Ahmed; Hussain, Syed Fayyaz

2005-02-01

To assess the risk factors associated with development of ventilator associated pneumonia (VAP). A case control study. Intensive Care Unit (ICU) at the Aga Khan University Hospital, Karachi, between January 1999 and June 2000. All patients with assisted mechanical ventilation were assessed for the development of VAP. Risk factors associated with development of VAP were determined. Adult patients who developed pneumonia, 48 hours after ventilation, were called cases while those who did not develop pneumonia were called controls. Seventy (28%) out of 250 mechanically ventilated patients developed VAP (rate of VAP was 26 cases per 1000 ventilator days). Shock during first 48 hours of ventilation (odds ratio (OR), 5.95; 95% confidence interval (CI), 2.83-12.52), transport out of ICU during mechanical ventilation (OR, 6.0; 95% CI, 2.92-12.37), re-intubation (OR, 4.23; 95% CI, 2.53-9.85), prior episode of aspiration of gastric content (OR, 3.07; 95% CI, 1.35-7.01), and use of antibiotics prior to intubation (OR,2.55; 95% CI, 1.20-5.41) were found to be independently associated with a higher risk of developing VAP. Gram negative organisms and Staphylococcus aureus were responsible for over 90% of cases. Patients with VAP had higher crude mortality rate (57.1%) compared with controls (32.2%). Ventilator associated pneumonia is associated with a high mortality. This study has identified risk factors associated with VAP.

Nutritional status in patients with hepatitis C.

PubMed

Ismail, Faisal Wasim; Khan, Rustam A; Kamani, Lubna; Wadalawala, Ashfaq A; Shah, Hasnain Ali; Hamid, Saeed S; Jafri, Wasim

2012-03-01

To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease. Descriptive study. Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011. Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) tool was used to assess nutritional status. A total of 400 patients were enrolled. Most of the patients in the HC group were class 'A' (best nutritional status). In contrast, the majority (64%) in the DC group were in the class 'C' (worst status). The compensated cirrhosis (CC) group showed that 90% of patients were malnourished, while 98% of all patients were malnourished in the DC group, predominantly class 'C'. Most importantly, 14% of patients with chronic hepatitis C (CHC) also scored a 'B' on the SGA; which when compared to HC was statistically significant (p=0.005). As the groups progressed in their disease from CHC to DC, the transition in nutritional status from 'A' to 'C' between groups was statistically significant. Malnutrition occurs early in the course of HCV, and progresses relentlessly throughout the spectrum of HCVdisease.

The accuracy of ultrasound in the diagnosis of congenital abnormalities.

PubMed

Munim, Shama; Nadeem, Salva; Khuwaja, Nadya Ali

2006-01-01

To determine the accuracy of ultrasound in the diagnosis of congenital abnormalities at the Aga Khan University Hospital, Karachi. The data of congenital abnormalities was obtained from the obstetrical database and medical records of all cases complicated by congenital abnormalities, delivering from January 2001 to December 2003 and was reviewed. Antenatal ultrasounds had been performed by operators with different level of experience. In addition this data was retrieved from the termination and Congenital anomaly register. A structured data collection form was used to collect information of different variables of interest. Congenital abnormalities, complicated 2.8% (n=170), of all deliveries, including all cases of termination of pregnancy, stillbirth and live births. Out of the total, 11.6% occurred in women above the age of 35 years. Consanguinity was found in 18.2% cases. Prenatal diagnosis was made in just under half of the cases (48.8%). Central nervous system and renal abnormalities were commonly diagnosed. However, facial defects, heart defects or skeletal defects were more commonly missed. Antenatal ultrasound successfully diagnosed foetal abnormalities in 48.8% of cases, and more than 90% Central Nervous system defects and renal abnormalities. In contrast about a quarter of Cardiac defects and none of the facial defects were detected. Based on these findings we recommend that the Sonologist should incorporate four chamber view of the heart and also look at the face carefully.

Operative management of patients with non-spinal metastatic bone disease. Does it actually improve quality of life?

PubMed

Umer, Masood; Mohib, Yasir; Umer, Hafiz

2014-12-01

To determine the survival rate and functional outcome of skeletal stabilisation in patients with metastatic bone disease. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with non-spinal metastatic bone disease managed surgically from January 2002 to December 2010. All patients had been managed by experienced orthopaedic, oncology and multidisciplinary teams. Patients managed by non-oncologic orthopaedic surgeons were excluded. The prognostic influence of clinical, pathological and treatment variables on Musculoskeletal Tumour Society score, range of motion, local complications and death rate were measured. SPSS 19 was used for statistical analysis. Of the 49 patients whose records were included in the study, 21(42.9%) males and 28(57.1%) females with an overall median age of 59 years. Most common primary tumour site was breast in 15(3.8%) followed by lungs in 11(22.4%), Open reduction and internal fixation was the mpst commonly used procedure in 18(36.7%) patients. Mean duration of follow-up was 30.20±29.2 SD months (range: 10-48 months). The median patient survival was 23 months. 23% patients have superficial surgical site infection. Mean Musculoskeletal Tumour Society score was 23.73±14.3 SD. The results confirm the principle that surgery for metastatic disease is done primarily to improve quality of life and ambulation status, and to alleviate pain.

Clinical outcomes of pneumocystis pneumonia from a tertiary care centre in Pakistan.

PubMed

Sarwar Zubairi, Ali Bin; Shahzad, Hira; Zafar, Afia

2016-11-01

To assess the predisposing immunocompromised states, administration of pneumocystis jirovecii pneumonia prophylaxis, the disease course and outcomes of patients with pneumocystis jirovecii pneumonia. The retrospective study was conducted at the Aga Khan University Hospital in Karachi. The medical records of patients diagnosed with pneumocystis jirovecii pneumonia from January 1995 to October 2015 were retrieved. Baseline characteristics, clinical course, treatment, and mortality rates were noted. SPSS 19 was used for data analysis. Of the 37 patients, 24(64.9%) were men and 13(35.1%) were women. The overall mean presenting age was 47.08±16.21 years (range: 19-83 years). Ten (27%) patients were positive for human immunodeficiency virus; 12(32.4%) had an underlying autoimmune disease; 3(8.1%) were transplant recipients; 10(27%) had an underlying malignancy, and 19(51.3%) were on long-term corticosteroid therapy. Only 2(5.4%) patients had received pneumocystis jirovecii pneumonia prophylaxis with trimethoprim-sulfamethoxazole. Moreover, 8(21.6%) patients required intensive care unit admission with a mean stay of 2.03±4.91 days (range: 1-22 days).The overall mortality rate was 7(18.9%). Pneumonia due to pneumocystis jirovecii was found to be a life-threatening disease in the immunocompromised population. The high mortality burden and resource intensive management of the disease emphasizes the need for PCP prophylaxis in immunosuppressed individuals.

Does Spinal Analgesia have Advantage over General Anesthesia for Achieving Success in In-Vitro Fertilization?

PubMed Central

Aghaamoo, Shahrzad; Azmoodeh, Azra; Yousefshahi, Fardin; Berjis, Katayon; Ahmady, Farahnazsadat; Qods, Kamran; Mirmohammadkhani, Majid

2014-01-01

Objective Because of high psychological burden and considerable costs of in-vitro fertilization, it is greatly important to identify all factors that may influence its results. In this study, general anesthesia and spinal analgesia used for oocyte retrieval were compared in terms of success in treating infertility among couples who had undergone in-vitro fertilization at an infertility center in Tehran, Iran. Methods This cohort study that was based on analysis of patient records at Mirza Kochak Khan Hospital, Tehran University of Medical Sciences, in 2008-2009. In this study, the status of chemical pregnancy among those who experienced general anesthesia or spinal anesthesia for in-vitro fertilization for the first time were compared, and the possible effects of clinical and laboratory factors using logistic regression models were considered. Results Considering the number of transferred embryos, underlying cause of infertility and fetus grade, it was found that practicing spinal anesthesia is significantly related to increased chance of chemical pregnancy (adjusted Odds Ratio=2.07; 95% CI: 1.02,4.20; p=0.043). Conclusion According to analysis of recorded data in an infertility treatment center in Iran, it is recommended to use spinal anesthesia instead of general anesthesia for oocyte retrieval to achieve successful in-vitro fertilization outcome. This can be studied and investigated further via a proper multicentric study in the country. PMID:24715934

Does Spinal Analgesia have Advantage over General Anesthesia for Achieving Success in In-Vitro Fertilization?

PubMed

Aghaamoo, Shahrzad; Azmoodeh, Azra; Yousefshahi, Fardin; Berjis, Katayon; Ahmady, Farahnazsadat; Qods, Kamran; Mirmohammadkhani, Majid

2014-03-01

Because of high psychological burden and considerable costs of in-vitro fertilization, it is greatly important to identify all factors that may influence its results. In this study, general anesthesia and spinal analgesia used for oocyte retrieval were compared in terms of success in treating infertility among couples who had undergone in-vitro fertilization at an infertility center in Tehran, Iran. This cohort study that was based on analysis of patient records at Mirza Kochak Khan Hospital, Tehran University of Medical Sciences, in 2008-2009. In this study, the status of chemical pregnancy among those who experienced general anesthesia or spinal anesthesia for in-vitro fertilization for the first time were compared, and the possible effects of clinical and laboratory factors using logistic regression models were considered. Considering the number of transferred embryos, underlying cause of infertility and fetus grade, it was found that practicing spinal anesthesia is significantly related to increased chance of chemical pregnancy (adjusted Odds Ratio=2.07; 95% CI: 1.02,4.20; p=0.043). According to analysis of recorded data in an infertility treatment center in Iran, it is recommended to use spinal anesthesia instead of general anesthesia for oocyte retrieval to achieve successful in-vitro fertilization outcome. This can be studied and investigated further via a proper multicentric study in the country.

Strategic Implications of Turkey’s Potential Admission to the European Union on the War Against Islamic Terrorism

DTIC Science & Technology

2005-02-22

invasions by other nations, Mustafa Kemal Ataturk led a movement which created the Republic of Turkey. His vision was for a stable, modern...Khan and M. Hakan Yavuz note, “…in the mid-1990s, a Muslim-oriented political movement emerged as the most dynamic and popular force in Turkey.”65 The...to Khan and Yavuz , “there are perceptions that foreign policy-making in the current Bush administration is increasingly dominated by hard-liners with

Government Investment and Follow-on Private Sector Investment in Pakistan, 1972-1995

DTIC Science & Technology

1997-06-01

private sector investment has long been suggested. Until recently, an appropriate model to test for the relationship in developing countries has been absent. In 1984, Blejer and Khan developed and estimated a model for 24 developing countries between 1971 and 1979. They found that higher rates of investment took place when the private sector took a large role in capital formation. This paper estimates a similar model for one developing country, Pakistan, for the period 1972 to 1995. Our results are broadly similar to those obtained by Blejer and Khan

Surgical wisdom and Genghis Khan's Pax Mongolica.

PubMed

Köstenbauer, Jakob

2017-03-01

The unrivalled conquests of Genghis Khan (CE c.1162-1227) led to the establishment of the Greater Mongolian Empire. By 1279, the Mongol dynasty controlled a vast Empire which, for the first time in history, unified Europe and China via the famous Silk Road. The ensuing century of peace and stability is referred to by historians as the Pax Mongolica, which facilitated Europe's renaissance and remarkably contributed to the rise of modern medicine and surgery. Secondary sources from published literature, primary sources from manuscripts and illustrations courtesy of universities, museum libraries and archives. There is ample evidence detailing the Mongol Empire's power during the thirteenth century and the Silk Road's role as a vehicle of commercial, cultural and scientific exchange. Advances in medical knowledge and surgical skills were made in all parts of the Empire and exchanged from China to Constantinople and back. Prominent medical figures traversed these centres, and no doubt contributed to the spread of surgical science, including Rashid al-Din and Mansur Ibn Ilyas. Their works, it is argued, enriched the practice of surgery and may have indirectly ushered-in the rise of modern surgery in the early medical schools at Salerno, Bologna, Pavia, Oxford, Montpellier and Constantinople to name but a few. The blossoming and diversification of medical and surgical knowledge was an integral part of the great cultural exchange facilitated by the Pax Mongolica. This enhanced surgical practice in China, Persia and Arabia, while coinciding with the renaissance of surgical teaching in Europe. © 2017 Royal Australasian College of Surgeons.

An efficient and secure dynamic ID-based authentication scheme for telecare medical information systems.

PubMed

Chen, Hung-Ming; Lo, Jung-Wen; Yeh, Chang-Kuo

2012-12-01

The rapidly increased availability of always-on broadband telecommunication environments and lower-cost vital signs monitoring devices bring the advantages of telemedicine directly into the patient's home. Hence, the control of access to remote medical servers' resources has become a crucial challenge. A secure authentication scheme between the medical server and remote users is therefore needed to safeguard data integrity, confidentiality and to ensure availability. Recently, many authentication schemes that use low-cost mobile devices have been proposed to meet these requirements. In contrast to previous schemes, Khan et al. proposed a dynamic ID-based remote user authentication scheme that reduces computational complexity and includes features such as a provision for the revocation of lost or stolen smart cards and a time expiry check for the authentication process. However, Khan et al.'s scheme has some security drawbacks. To remedy theses, this study proposes an enhanced authentication scheme that overcomes the weaknesses inherent in Khan et al.'s scheme and demonstrated this scheme is more secure and robust for use in a telecare medical information system.

PREFACE: 5th International Conference on Mechatronics (ICOM'13)

NASA Astrophysics Data System (ADS)

Akramin Shafie, Amir; Raisuddin Khan, Md

2013-12-01

The Fifth International Conference on Mechatronics (ICOM2013), took place in Kuala Lumpur Malaysia from 2-4 July 2013. The biannual conference which started in 2001 is regularly organized by Faculty of Engineering, International Islamic University Malaysia (IIUM) with the aims to serve as a platform for exchange of ideas on advances of in mechatronics and their applications as well as to foster research and worldwide collaboration. The theme for the 2013 conference was 'Mechatronics: Sustainable Development through Innovative Solutions'. The ICOM 2013 Conference consisted of Keynote Speeches (5) and oral contributions (150). The topics of the conference were: Mechatronic systems and Applications Intelligent Systems Control and Instrumentation Signal and Image Processing Machine Vision Robotics and Automation Manufacturing Mechatronics Green Mechatronics Mechatronic Education Smart Materials and Structures Active Vibration Control Computer and Information Technology MEMS and NEMS Biomechatronics and Rehabilitation Engineering Autonomous Systems Energy and Sustainability Transportation System It is our great pleasure to present this volume of IOP Conference Series: Materials Science and Engineering (MSE) to the scientific community to promote further research in these areas. We believe that this volume will be both an excellent source of scientific material in the fast evolving fields that were covered by ICOM 2013. We thank the authors for their enthusiastic and high-grade contributions. We would also like to express our gratitude to the Organizing Committee, the Institutions and Sponsors and everyone who contributed to this conference through their supports and invaluable efforts. Editors Amir A Shafie aashafie@iium.edu.my Raisuddin Khan raisuddin@iium.edu.my Mahbubur Rashid mahbub@iium.edu.my Department of Mechatronics, International Islamic University Malaysia (IIUM), Kuala Lumpur Malaysia Organizing Committee Md Raisuddin Khan Md Mozasser Rahman Shahrul Naim Sidek Muhammad Mahbubur Rashid Amir Akramin Shafie Nahrul Khair Alang Md Rasyid Rini Akmeliati Roslizar Mat Ali Hazlina Md Yusof Asan Gani Abdul Muthalif Wahju Sediono Salmiah Ahmad Iskandar Al-Thani Mahmood Yasir Mohd Mustafah Moinul Bhuiyan Zulkifli Zainal Abidin Nadzril Sulaiman Momoh J Salami Conference logos

Use of liquid nitrogen and albendazole in successfully treating cutaneous larva migrans.

PubMed

Kapadia, Naseema; Borhany, Tasneem; Farooqui, Maria

2013-05-01

To determine the efficacy of combination treatment of Albendazole along with liquid nitrogen in cutaneous larva migrans. Quasi-experimental study. Abbasi Shaheed Hospital and The Aga Khan Hospital, Karachi, from December 2008 to December 2010. Eighteen cases of cutaneous larva migrans were collected and divided into two groups. Group-A was administered oral Albendazole 400 mg once per day along with topical steroid and oral cetrizine 10 mg once at night for 7 days. Group-B also received oral Albendazole 400 mg once per day along with cetrizine 10 mg once at night but they also received single application of liquid nitrogen to freeze the larva. It was found that in Group-A only 2 out of 9 (22%) showed improvement whereas 78% had to be given liquid nitrogen cryotherapy 3 - 7 days after Albendazole to prevent migration of larva. In Group-B, the improvement was 100% and all 9 patients were successfully treated. Use of liquid nitrogen along with oral anti-helminths is very effective in treating cutaneous larva migrans than Albendazole alone.

Diabetic ketoacidosis characteristics and differences In type 1 versus type 2 diabetes patients.

PubMed

Rashid, Muhammad Owais; Sheikh, Aisha; Salam, Abdus; Farooq, Saad; Kiran, Zareen; Islam, Najmul

2017-01-01

Diabetes is undoubtedly one of the most challenging health problems of the 21st century. It is well known that diabetes once develop can lead to several complications. Diabetic ketoacidosis (DKA) is one of the life-threatening complications of diabetes. This study was designed to determine the frequency of DKA in diabetes patients and find out the clinical and biochemical determinants of DKA. This descriptive study was conducted at Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 2010 to February 2016. All known or newly diagnosed diabetic patients of >16 years of age irrespective of gender and type of diabetes were included. Information regarding patient's demographics, presenting symptoms, precipitating causes of DKA, biochemical profiles and outcome at the time of discharge was collected. Majority (54.7%) had moderate and 12.4% had severe DKA at presentation. Previous history of DKA was found higher in type 1 diabetes patients (T1DM) (14%) as compare to (4%) type 2 diabetes patients (T2DM) (p<0.05). DKA severity was observed more (12%) in newly diagnosed (T1DM) (p<0.05). Comorbidities were found more (81%) in (T2DM) (p<0.05) Mortality was also observed higher in Type 2 diabetes patients (p<0.05). Majority of the diabetics had moderate to severe DKA at presentation. Mortality and morbidity related with DKA was found considerably higher among patients with T2DM while infection, myocardial infarction and stroke found as triggering factors in these patients.

Factors associated with postoperative pain in endodontic therapy.

PubMed

Sadaf, Durre; Ahmad, Muhammad Zubair

2014-12-01

To assess postoperative pain in endodontic therapy and its association with clinical factors such as gender, age, tooth type, pulpal diagnosis, and preoperative pain, length of obturation and sealer extrusion. Cross-Sectional study. Dental section of the Aga khan university hospital, Karachi, Pakistan from January to December 2009. One hundred and forty patients (140) requiring endodontic therapy for molar and premolar teeth were included in this study. Local Anesthesia (2% Lidocain with 1:80,000 Epinephrine) was administered. The tooth was isolated with rubber dam. Access cavity was prepared with the help of round carbide No. 2 bur. Canal preparation was completed using crown-down technique. Access was sealed with sterile dry cotton pallet and restored temporarily with double layer of Glass ionomer cement and Cavit. After one week patients were recalled and access was re-opened, obturation was done using cold lateral condensation technique. Ca(OH)(2) based sealer was used. Postoperative radiographs were taken. Patients were recalled after 24 hours and postobturation pain was recorded using Visual analogue scale (VAS).Data was obtained on a structured Performa. χ(2) test was used for statistical analysis. Pain was present in 42.9% of patients. Females more frequently experienced pain (65%) than males (35%). Preoperative pain was found to be significantly associated with postoperative pain (p value < 0.001). Obturation length was not found to be significantly associated with postoperative pain (p value 1.0). Sealer extrusion was not found to be significantly associated with postoperative (P value 0.547).

Contegra valved conduit in the paediatric population: an exciting prospect for right ventricle to pulmonary artery reconstruction; experience and outcomes at Aga Khan University.

PubMed

Siddiqui, Maria Tariq; Hasan, Asif; Mohsin, Shazia; Hamid, Mohammad; Amanullah, Muhammad Muneer

2012-10-01

The focus of this study is to share the experience and outcomes of Contegra graft implantation in the paediatric and adult population in Pakistan. Between May 2007 and July 2011, 16 patients, underwent implantation of a Contegra valved conduit. All operations were performed through a median sternotomy with cardiopulmonary bypass. Indications included: Pulmonary atresia with ventricular septal defect (n = 11), Tetralogy of Fallot with absent Pulmonary Valve (PV) syndrome (n = 2), double outlet right ventricle, transposition of great arteries and pulmonary stenosis (n = 1), isolated aortic valve disease (n = 1) and a pseudo-aneurysm with infective endocarditis (n = 1).Conduit sizes varied between 16-22 mm. The three in hospital deaths were unrelated to the Contegra valved conduit. One patient was lost to follow up. Of the 12 survivors, 10 are currently free from re-operation or complications related to the conduit while one needed distal pulmonary artery dilatation owing to critical stenosis and another had severe Valvular regurgitation. Echocardiographic evaluation of the Contegra valved conduit demonstrated no haemodynamically significant valve regurgitation in 10 patients. In this small review of 16 operations using the Contegra valved conduit for Right Venticular Outflow Tract (RVOT) reconstruction in the paediatric population, we observed good post operative results concerning conduit function. The Contegra conduit provides an excellent substitute to the homograft with satisfactory early and mid-term results though long-term results are awaited in Pakistan.

A descriptive study to find possible correlation between MRI findings of pituitary gland and serum prolactin level.

PubMed

Azeemuddin, Muhammad; Naqi, Rohana; Wasay, Mohammad

2013-06-01

To explore equation, if any, between findings of magnetic resonance imaging of pituitary gland and serum prolactin level. The retrospective, descriptive study was conducted at the Department of Radiology, Aga Khan University Hospital, Karachi, and related to patients' records from April 19, 2006 to April 23, 2009. Seventy patients underwent magnetic resonance imaging of brain for pituitary gland. Inclusion criteria were all patients referred with relevant clinical symptoms or deranged serum prolactin level. Patients who were claustrophobic or had a pacemaker, aneurysm clip, metallic foreign body in the orbit or with no laboratory investigation were excluded from the study. SPSS 19 was used for statistical analysis. Of the 70 patients, normal imaging was noted in 29 (41.4%) patients. Out of these, 18 (62.06%) patients had normal and 11 (37.93%) had raised serum prolactin levels. Microadenoma was found in 23 (32.8%) patients. Out of these, 10 (42.47%) had normal and 13 (56.52%) had raised prolactin levels. Macroadenoma was found in 16 (22.8 %). Out of these, 8 (50%) had normal and 8 (50%) had raised prolactin levels. Pituitary cyst was located in 2 (2.8 %) patients. Out of these, 1 (50%) had normal and 1 (50%) had raised serum prolactin levels. Magnetic resonance imaging of pituitary gland was not associated with serum prolactin levels in patients with clinical suspicion of pituitary abnormality. Therefore, regular monitoring of serum prolactin is suggested.

Patient expectations from an emergency medical service.

PubMed

Qidwai, Waris; Ali, Syed Sohail; Baqir, Muhammad; Ayub, Semi

2005-01-01

Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool. The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met. A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the patients expected a waiting time and a consultation time of less than 30 minutes and 20 minutes, respectively. The majority of respondents expected and agreed to be examined by a trainee but there were reluctant to be examined by the students. There was an expectation that the consultant will examine patients and not advice the attending team over the phone. The majority of the patients expected intravenous fluid therapy. There was a desire to have patient attendant present during the consultation process. The majority of the patients expected to pay less than three thousand rupees for the visit. An expectation exists for investigations and hospitalization. Involvement of patients in decisions concerning their treatment and written feedback on their visit was expected. We have documented the need and value of patient expectation survey at the Emergency Medical Services department. The use of such a tool is recommended in order to improve the satisfaction levels of patients visiting such facilities.

Lymphoma cases referred to the radiation oncology service of a tertiary referral university hospital in Karachi, Pakistan: a retrospective study.

PubMed

Abbasi, Ahmed Nadeem; Zahid, Sumaiya; Karsan, Farrok; Ali, Nasir; Bhurgri, Yasmin

2010-01-01

Radiation therapy is an important component of curative therapy for Lymphoma [Hodgkin's disease (HD) and non Hodgkin's Lymphoma (NHL)]. The current study was conducted to give us an overview of lymphoma patients presenting to a tertiary care hospital for complementary adjuvant RT. Data of lymphoma patients who underwent radiotherapy during February 2006 till August 2009 at the department of radiation oncology, Aga Khan University, Hospital, Karachi was retrieved from the medical records and analyzed using SPSS (version 16.0). A total of 1,678 cancer patients were registered, 75 (0.45%) were lymphoma patients (25.3% HD; 74.7% NHL). HD and NHL were both seen predominantly in males, with a male:female ratio of 2 and 3 respectively. Nodal HD comprised 94.7% and nodal NHL comprised 41.1%. Extranodal NHL (EN-NHL) comprised 53.6% whereas 5.4% cases had both nodal and EN-NHL; 6.7% of EN-NHL were primary CNS lymphomas. Stages of presentation for HD were IIA (52.6%), 1A (21.1%), IIB (10.5%) and IB, IIIB and IVA collectively 15.9%. The ages of HD patients ranged from 11 to 54 years (median 23.5 years 13.2 SD). Response to therapy for HD was 52.6% complete remission, 36.8% partial response, and 5.3% each with stable and progressive disease. Almost all patients (94.7%) received radical treatment with radiation doses (between 1950 cG to 5404 cGy) with a median of 40 Grays.Stages at presentation for NHL were II (23.2%), IV (21.4%) and IE (17.9%); I, IIE, and III were found to be 12.5 %. NHL patients ranged from 15 to 88 years. It was more commonly observed amongst the elderly with 25% patients diagnosed in the fifth decade of life; 50% patients aged at or above 50 years, 41.1% belonged to the 25-49 years age group and 8.9% below 25 years of age. Majority of the cases were diffuse NHL (82.1%), follicular NHL (7.1%), Primary CNS unclassified type (8.9%), and unclassified other than CNS variety (1.8%). Response to chemotherapy for NHL was 51.8% complete remission, 25.9% progressive disease, 20.4% partial response. Forty (71.4%) patients with NHL received radical treatment with radiation doses between 2340 cG to 6600 cGy; 28.6% received palliative RT. Radiation therapy though important for curative lymphoma therapy, is relatively underutilized in our population, despite encouraging outcomes.

Development and pilot implementation of a locally developed Trauma Registry: lessons learnt in a low-income country.

PubMed

Mehmood, Amber; Razzak, Junaid Abdul; Kabir, Sarah; Mackenzie, Ellen J; Hyder, Adnan A

2013-03-21

Trauma registries (TRs) play an integral role in the assessment of trauma care quality. TRs are still uncommon in developing countries owing to awareness and cost. We present a case study of development and pilot implementation of "Karachi Trauma Registry" (KITR), using existing medical records at a tertiary-care hospital of Karachi, Pakistan to present results of initial data and describe its process of implementation. KITR is a locally developed, customized, electronic trauma registry based on open source software designed by local software developers in Karachi. Data for KITR was collected from November 2010 to January 2011. All patients presenting to the Emergency Department (ED) of the Aga Khan University Hospital (AKUH) with a diagnosis of injury as defined in ICD-9 CM were included. There was no direct contact with patients or health care providers for data collection. Basic demographics, injury details, event detail, injury severity and outcome were recorded. Data was entered in the KITR and reports were generated. Complete data of 542 patients were entered and analysed. The mean age of patients was 27 years, and 72.5% were males. About 87% of patients had sustained blunt injury. Falls and motor vehicle crashes were the most common mechanisms of injury. Head and face, followed by the extremities, were the most frequently injured anatomical regions. The mean Injury Severity Score (ISS) was 4.99 and there were 8 deaths. The most common missing variables in the medical records were ethnicity, ED notification prior to transfer, and pre-hospital IV fluids. Average time to review each chart was 14.5 minutes and entry into the electronic registry required 15 minutes. Using existing medical records, we were able to enter data on most variables including mechanism of injuries, burden of severe injuries and quality indicators such as length of stay in ED, injury to arrival delay, as well as generate injury severity and survival probability but missed information such as ethnicity, ED notification. To make the data collection process more effective, we propose provider based data collection or making a standardized data collection tool a part of medical records.

The effect of two fixation methods (TAF and DESS) on morphometric parameters of Aphelenchoides ritzemabosi.

PubMed

Chałańska, Aneta; Bogumił, Aleksandra; Malewski, Tadeusz; Kowalewska, Katarzyna

2016-02-19

Identification of nematode species by using conventional methods requires fixation of the isolated material and a suitable preparation for further analyses. Tentative identification using microscopic methods should also be performed prior to initiating molecular studies. In the literature, various methods are described for the preparation of nematodes from the genus Aphelenchoides for identification and microscopic studies. The most commonly used fixatives are formalin (Timm 1969; Szczygieł & Cid del Prado Vera 1981, Crozzoli et al. 2008, Khan et al. 2008), FAA (Wasilewska 1969; Vovlas et al. 2005, Khan et al. 2007) and TAF (Hooper 1958, Chizhov et al. 2006, Jagdale & Grewal 2006).

Intussusception among children less than 2years of age: Findings from pre-vaccine introduction surveillance in Pakistan.

PubMed

Yousafzai, Mohammad Tahir; Thobani, Rozina; Qazi, Saqib Hamid; Saddal, Nasir; Yen, Catherine; Aliabadi, Negar; Ali, Syed Asad

2017-07-11

Rotavirus vaccination introduction in routine immunization is under consideration in Pakistan. Data on the baseline epidemiology of intussusception will inform surveillance strategies for intussusception after rotavirus vaccine introduction in Pakistan. We describe the epidemiology of intussusception-associated hospitalizations among children <2years of age in Karachi, Pakistan. We conducted a retrospective chart review for July 01, 2012 through June 30, 2015 at the National Institute of Child Health (NICH) and Aga Khan University Hospital (AKUH) Karachi. At AKUH, the International Classification of Disease, ninth revision, code 560.0 for intussusception was used to retrieve intussusception case records. At NICH, daily Operation Theater, Emergency Room, and surgical daycare log sheets and surgical ward census sheets were used to identify cases. Records of children who fulfilled eligibility criteria and the Brighton Collaboration level one case definition of intussusception were selected for data analysis. We used structured case report forms to extract data for the descriptive analysis. We identified 158 cases of confirmed intussusception; 30 cases (19%) were from AKUH. More than half (53%) of the cases occurred in children aged 6-12months, followed by 35% among those aged <6months. Two-thirds (106/158) of the cases were male. The most common presenting complaints were vomiting and bloody stool. At NICH, almost all (93%) were managed surgically, while at AKUH, ∼57% of the cases were managed with enemas. Three deaths occurred, all from NICH. Cases occurred without any seasonality. At NICH, 4% (128/3618) of surgical admissions among children aged <2years were attributed to intussusception, while that for AKUH was 2% (30/1702). In this chart review, intussusception predominantly affected children 0-6months of age and occurred more commonly in males. This information on the baseline epidemiology of intussusception will inform post-vaccine introduction adverse event monitoring related to intussusception in Pakistan. Copyright © 2017 Elsevier Ltd. All rights reserved.

Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma.

PubMed

Faruque, Ahmad Vaqas; Qazi, Saqib Hamid; Khan, Muhammad Arif Mateen; Akhtar, Wassem; Majeed, Amina

2013-03-01

To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive. The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis. Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p>0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up. Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed sonography is positive.

Cryptanalysis and Improvement of an Image Encryption Scheme Using Fourier Series

NASA Astrophysics Data System (ADS)

Ahmad, Musheer; Doja, M. N.; Beg, M. M. Sufyan

2017-12-01

This paper proposes cryptanalysis of an image encryption scheme reported in (Khan, J Vib Control 21(16):3450-3455, 2015). The encryption scheme synthesized nonlinear substitution-box using Fourier series to accomplish encryption of color images. Security investigation unveils that the scheme has inherent flaws which can be exploited by an attacker to reveal the plain-image information. We show that the encryption scheme is breakable under chosen-plaintext attack without owning secret key. The simulation analyses bring to notice that Khan's scheme is insecure for encryption of images during secure communication. Besides, an improved image encryption scheme is proposed which is backed up by better statistical results and performance.

Comparison of two regimens of RhG-CSF in neutropenic neonatal septicemia: a randomized clinical trial.

PubMed

Nayeri, Fatemeh; Soheili, Habib; Kaveh, Mahbod; Oloomi Yazdi, Zohre; Shariat, Mamak; Dalili, Hosein

2011-01-01

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals (Tehran, Iran). The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10 μg/kg/s.c. to neonates in group A and as 10 μg/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups (P>0.05). The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups (P>0.05). The results of this study showed that administration of a single dose of RhG-CSF (10 μg/kg) was effective in treating neonatal septicemic neutropenia.

Homeostatic Model Assessment for Insulin Resistance (HOMA-IR): A Better Marker for Evaluating Insulin Resistance Than Fasting Insulin in Women with Polycystic Ovarian Syndrome.

PubMed

Majid, Hafsa; Masood, Qamar; Khan, Aysha Habib

2017-03-01

To assess the utility of HOMA-IR in assessing insulin resistance in patients with polycystic ovary syndrome (PCOS) and compare it with fasting insulin for assessing insulin resistance (IR). Observational study. Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2009 to September 2012. Medical chart review of all women diagnosed with PCOS was performed. Of the 400 PCOS women reviewed, 91 met the inclusion criteria. Insulin resistance was assessed by calculating HOMA-IR using the formula (fasting glucose x fasting insulin)/405, taking normal value <2 in adults and hyperinsulinemia based on fasting insulin levels ≥12 µIU/ml. A total of 91 premenopausal women diagnosed with PCOS were included. Mean age was 30 ±5.5 years. Mean HOMA-IR of women was 3.1 ±1.7, respectively with IR in 69% (n=63) women, while hyperinsulinemia was present in 60% (n=55) women (fasting Insulin 18.5 ±5.8 µIU/ml). Hyperandrogenism was present in 53.8% (n=49), whereas 38.5% (n=35) women had primary infertility or subfertility, while 65.9% (n=60) had menstrual irregularities; and higher frequencies were observed in women with IR. Eight subjects with IR and endocrine abnormalities were missed by fasting insulin. Insulin resistance is common in PCOS and it is likely a pathogenic factor for development of PCOS. HOMAIR model performed better than hyperinsulinemia alone for diagnosing IR.

Healthcare-associated infections among pediatric oncology patients in Pakistan: risk factors and outcome.

PubMed

Siddiqui, Naveed-ur-Rehman; Wali, Rabia; Haque, Anwar-ul; Fadoo, Zehra

2012-05-14

Pediatric oncology patients are at increased risk of contracting healthcare-associated infections (HAIs), which are responsible for increased morbidity and mortality rates as well as treatment costs.  This study aimed to identify the frequency of HAIs among pediatric oncology patients and their outcome. Pediatric oncology patients admitted between January 2009 and June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi, Pakistan, who developed HAIs, were analyzed. A total of 90 HAIs were identified in 32 patients in 70 admissions. The HAI rate among pediatric oncology patients was 3.1/100 admission episodes. Bloodstream infections (63 episodes, 90.0%) were the most common, followed by urinary tract infection (two episodes, 2.9%). Gram-positive infections were seen in 54 (60%) patients, followed by Gram-negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase negative staphylococci was the most common Gram-positive and Escherichia coli and Pseudomonas aeruginosa were most common Gram-negative infections. Mortality rate among pediatric oncology patients who developed HAIs was 12.5% (4/32). Total parental nutrition use and length of stay longer than 30 days were the identified risk factors associated with increased mortality among pediatric oncology patients who developed HAIs. We report an HAI rate among pediatric oncology patients of 3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan. Further studies should be done, especially in the developing world, to identify the risk factors associated with increased mortality among pediatric oncology patients so that adequate measures can be taken to reduce the mortality among these patients.

Do clinical manifestations of Systemic Lupus Erythematosus in Pakistan correlate with rest of Asia?

PubMed

Rabbani, Malik Anas; Siddiqui, Bilal Karim; Tahir, Muhammad Hammad; Ahmad, Bushra; Shamim, A; Majid, Shahid; Ali, Syed Sohail; Shah, Syed Mansoor Ahmed; Ahmad, Aasim

2006-05-01

Systemic Lupus Erythematosus (SLE) is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data. Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races. This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations.

The genome of a Mongolian individual reveals the genetic imprints of Mongolians on modern human populations.

PubMed

Bai, Haihua; Guo, Xiaosen; Zhang, Dong; Narisu, Narisu; Bu, Junjie; Jirimutu, Jirimutu; Liang, Fan; Zhao, Xiang; Xing, Yanping; Wang, Dingzhu; Li, Tongda; Zhang, Yanru; Guan, Baozhu; Yang, Xukui; Yang, Zili; Shuangshan, Shuangshan; Su, Zhe; Wu, Huiguang; Li, Wenjing; Chen, Ming; Zhu, Shilin; Bayinnamula, Bayinnamula; Chang, Yuqi; Gao, Ying; Lan, Tianming; Suyalatu, Suyalatu; Huang, Hui; Su, Yan; Chen, Yujie; Li, Wenqi; Yang, Xu; Feng, Qiang; Wang, Jian; Yang, Huanming; Wang, Jun; Wu, Qizhu; Yin, Ye; Zhou, Huanmin

2014-11-05

Mongolians have played a significant role in modern human evolution, especially after the rise of Genghis Khan (1162[?]-1227). Although the social cultural impacts of Genghis Khan and the Mongolian population have been well documented, explorations of their genome structure and genetic imprints on other human populations have been lacking. We here present the genome of a Mongolian male individual. The genome was de novo assembled using a total of 130.8-fold genomic data produced from massively parallel whole-genome sequencing. We identified high-confidence variation sets, including 3.7 million single nucleotide polymorphisms (SNPs) and 756,234 short insertions and deletions. Functional SNP analysis predicted that the individual has a pathogenic risk for carnitine deficiency. We located the patrilineal inheritance of the Mongolian genome to the lineage D3a through Y haplogroup analysis and inferred that the individual has a common patrilineal ancestor with Tibeto-Burman populations and is likely to be the progeny of the earliest settlers in East Asia. We finally investigated the genetic imprints of Mongolians on other human populations using different approaches. We found varying degrees of gene flows between Mongolians and populations living in Europe, South/Central Asia, and the Indian subcontinent. The analyses demonstrate that the genetic impacts of Mongolians likely resulted from the expansion of the Mongolian Empire in the 13th century. The genome will be of great help in further explorations of modern human evolution and genetic causes of diseases/traits specific to Mongolians. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya.

PubMed

Omondi, Stephen; Weru, John; Shaikh, Asim Jamal; Yonga, Gerald

2017-01-25

An advance directive (AD) is a written or verbal document that legally stipulates a person's health care preference while they are competent to make decisions for themselves and is used to guide decisions on life-sustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya. The study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study. In total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient's caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient's functional impairment were the factors with statistically significant association with completion of AD. The proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient's functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients.

Just in Time to Flip Your Classroom

NASA Astrophysics Data System (ADS)

Lasry, Nathaniel; Dugdale, Michael; Charles, Elizabeth

2014-01-01

With advocates like Sal Khan and Bill Gates, flipped classrooms are attracting an increasing amount of media and research attention.2 We had heard Khan's TED talk and were aware of the concept of inverted pedagogies in general. Yet it really hit home when we accidentally flipped our classroom. Our objective was to better prepare our students for class. We set out to effectively move some of our course content outside of class and decided to tweak the Just-in-Time Teaching approach (JiTT).3 To our surprise, this tweak—which we like to call the flip-JiTT—ended up completely flipping our classroom. What follows is narrative of our experience and a procedure that any teacher can use to extend JiTT to a flipped classroom.

[Emergency eye care in French university hospitals].

PubMed

Bourges, J-L

2018-03-01

The patient's request for urgent care in ophthalmology (PRUCO) at health care centers is constantly growing. In France, university hospitals are managing 75% of these cases. We sought to quantify PRUCO referred to French university hospital emergency units as well as to approach the structure and the territorial distribution of emergency eye care provided by French university hospitals. We conducted a quick cross-sectional survey sent to the 32 metropolitan and overseas French university hospitals. It inquired for each hospital whether emergency eye care units were available, whether ophthalmologists were on duty or on call overnight and how many PRUCO were managed in 2016. The 32 university hospitals completed the survey. A total of 398650 PRUCO were managed in French university hospitals in 2016. The emergency unit was exclusively dedicated to eye care for 70% of the hospitals, with 47% (15/32) of them employing an ophthalmologist on duty overnight. Every hospital but one had at least one ophthalmologist on call. The city of Paris set aside, university hospitals took care of an annual mean of 9000 PRUCO (min=500; max=32,250). The 32 French university hospitals are actively responding to patient's requests for urgent care in ophthalmology with very heterogeneous patient volumes and organizational systems. Half of them employ ophthalmologists on duty. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital].

PubMed

Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes

2018-05-01

Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, p<0.01). Nurses of both hospitals had sufficient opportunity to reconcile work and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective workload and stress factors reported by physicians at the University Hospital were significantly higher than those by doctors at the municipal hospital. © Georg Thieme Verlag KG Stuttgart · New York.

Feminist pedagogy: a framework for nursing education?

PubMed

Hezekiah, J

1993-02-01

This article describes the feminist pedagogical strategies used in a nursing course in the post-RN Bachelor of Science in Nursing (BScN) program, Aga Khan University, Karachi, Pakistan. A variety of concepts that have direct relevance for nurses were discussed within small groups. These settings provided the venue for an examination of the issues that nurses, as primarily female, face in a patriarchal Muslim society and an androcentric health care system. Emphasis is on the process used in terms of feminist pedagogical practices and its relationship to feminist theory and critical pedagogy. The five process goals suggested by Schniedewind (1983) formed the basis for an exploration of this relationship through an analysis of the content and practices used in the course. It is demonstrated that the teaching practices advocated by feminist pedagogy hold much promise for nursing education to empower nurses and to make an impact on the health care system.

Content Validity of a Tool Measuring Medication Errors.

PubMed

Tabassum, Nishat; Allana, Saleema; Saeed, Tanveer; Dias, Jacqueline Maria

2015-08-01

The objective of this study was to determine content and face validity of a tool measuring medication errors among nursing students in baccalaureate nursing education. Data was collected from the Aga Khan University School of Nursing and Midwifery (AKUSoNaM), Karachi, from March to August 2014. The tool was developed utilizing literature and the expertise of the team members, expert in different areas. The developed tool was then sent to five experts from all over Karachi for ensuring the content validity of the tool, which was measured on relevance and clarity of the questions. The Scale Content Validity Index (S-CVI) for clarity and relevance of the questions was found to be 0.94 and 0.98, respectively. The tool measuring medication errors has an excellent content validity. This tool should be used for future studies on medication errors, with different study populations such as medical students, doctors, and nurses.

Ependymal tumors with oligodendroglioma like clear cells: Experience from a tertiary care hospital in Pakistan

PubMed Central

Hashmi, Fauzan Alam; Khan, Muhammad Faheem; Khan, Saad Akhtar; Waqas, Muhammad; Bari, Muhammad Ehsan; Ahmed, Arsalan

2015-01-01

Background: Ependymal tumors with oligodendroglioma like clear cells have never been reported from Pakistan. We aimed to see the features and outcomes of this rare entity. Methods: It was retrospective cohort conducted at the Department of Neurosurgery, Aga Khan University from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. Analysis was done on SPSS 20. Results: Eleven cases of ependymal tumors with clear cells were found, which equated to 1.5% of the total tumor burden in 11 years. The median age was 49 years. Most common presenting symptom was headache 54.5%. Out of 11 patients, 9 patients had a supratentorial tumor. Magnetic resonance imaging showed hypointense signals on T1 and hyperintense signals on T2-weighted images in all cases. Contrast enhancement was found in 9 patients (77.8%), necrosis and hemorrhage was found in 4 (36%) and 3 (27%) patients, respectively. Immunohistochemistry showed glial fibrillary acidic protein and epithelial membrane antigen positivity in all cases. Ki-67 showed high proliferative index in 6 patients. According to the World Health Organization grading of ependymal tumors, 2 patients had Grade II tumors, and 9 patients had Grade III tumors with clear cells. Gross total resection was achieved in 6 (54.5%) and subtotal resection in 5 patients (45.4%). Recurrence was observed in 9 patients. Six patients died of the disease. Median progression-free survival and overall survival was 8 months and 10 months, respectively. Conclusion: Ependymal tumors with clear cells presented more commonly in Grade III lesions and were more aggressive in behavior with poorer outcome compared to similar studies. PMID:26664928

Remission of Grave's disease after oral anti-thyroid drug treatment.

PubMed

Ishtiaq, Osama; Waseem, Sabiha; Haque, M Naeemul; Islam, Najmul; Jabbar, Abdul

2009-11-01

To evaluate remission rate of anti-thyroid drug treatment in patients with Grave's disease, and to study the factors associated with remission. A cross sectional study. The Endocrine Department of the Aga Khan University Hospital, Karachi from 1999 to 2000. Seventy four patients of Grave's disease were recruited who were prescribed medical treatment. Grave's disease was diagnosed in the presence of clinical and biochemical hyperthyroidism along with anti-microsomal (AMA) and anti-thyroglobulin antibodies (ATA) and thyroid scan. These patients were prescribed oral anti-thyroid drugs using titration regime and followed at 3, 6, 12 and 18 months. Patients were categorized into two groups: "remission group" and "treatment failure group" and results were compared using a chi-square test, t-test and logistic regression model with significance at p < 0.05. A majority of the patients were females (62.6%, n=46). During the follow-up period of 18 months, 41.9% patients went into remission. Univariate analysis showed that the initial free T4 level was significantly different (p < 0.05) in patients in remission and treatment failure groups. Multivariate analysis showed only initial free T4 level was a significant predictor of outcome. Positive AMA patients (n=27) had higher treatment failure (odds ratio: 2.55: 95%, CI 0.69 - 9:31), although the difference was not statistically significant (p = 0.13). Remission rates with oral anti-thyroid agents is markedly high. Patients should be offered alternate treatment options to those who do not enter remission during a period of 12-18 months of treatment, those who develop relapse, and those who have aggressive disease on initial presentation.

Computed Tomography-Guided Biopsy for Potts Disease: An Institutional Experience from an Endemic Developing Country

PubMed Central

Waqas, Muhammad; Qadeer, Mohsin; Faiz, Faizuddin; Alvi, Mohammad Ali

2015-01-01

Study Design A retrospective chart review. Purpose In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available. Overview of Literature CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little. Methods This study was conducted at the Neurosurgery section of Aga Khan University Hospital Karachi. All the patients with suspected Potts disease who underwent CT-guided biopsy during the 7 year period from 2007 to 2013 were included in this study. Details of the procedure, histopathology and microbiology were recorded. Results One hundred and seventy-eight patients were treated for suspected Potts disease during the study period. CT-guided biopsies of the spinal lesions were performed in 91 patients (51.12%). Of the 91 procedures, 22 (24.2%) were inconclusive because of inadequate sample (10), normal tissue (6) or reactive tissue (6). Sixty-nine biopsies were positive (75.8%). Granulomatous inflammation was seen in 58 patients (84.05%), positive acid-fast bacillus (AFB) smear in 4 (5.7%) and positive AFB culture in 12 patients (17.3%). All 91 cases in which CT-guided biopsy was performed responded positively to antituberculosis therapy (ATT). Conclusions 75.8% of the specimens yielded positive diagnoses. Granulomatous inflammation on histopathology was the commonest diagnostic feature. In this series, the rates of positive AFB smear and culture were low compared to previous literature. PMID:26097654

Central nervous system lesions: correlation of intraoperative and final diagnoses, six year experience at a referral centre in a developing country, Pakistan.

PubMed

Ud Din, Nasir; Memon, Aisha; Idress, Romana; Ahmad, Zubair; Hasan, Sheema

2011-01-01

Intraoperative consultation of CNS lesions provides accurate diagnosis to neurosurgeons. Some lesions, however, may cause diagnostic difficulty. In this study accuracy of intraoperative consultations of CNS lesions and discrepancies in diagnosis and deferrals were analysed. All CNS cases from May 1, 2004 to September 20, 2010 in which intraoperative frozen section had been performed, and which were reported in the Section of Histopathology, Aga Khan University Hospital, Karachi Pakistan were retrieved. The diagnoses given on FS were compared with the final diagnosis given on permanent sections (and additional material if received), as indicated in the frozen section and final pathology report. During the study period, 171 CNS cases were received for intraoperative consultation. In all cases, cryostat sections (FS) plus cytology smears were prepared. The ages of the patients ranged from 03 to 77 years. 106 were males and 65 were females. Out of these 171 cases, 160 cases (94.1 %) were concordant, 10 cases (5.8 %) were discrepant, and one case was deferred until permanent sections. The diagnostic accuracy of frozen section was 88.9%. The sensitivity and specificity were 94.8% and 87.5% respectively. The positive predictive value was 98.6% and negative predictive value was 63.6%. All our cases in which intraoperative consultation was requested were sent for primary diagnosis. Adequacy per se was not a criterion for sending cases for intraoperative consultation. Our results show a reasonably high percentage of accuracy in the intraoperative diagnosis of CNS lesions. However, there are limitations and some lesions pose a diagnostic challenge. There is a need to improve our own diagnostic skills and establish better communication with neurosurgeons.

Tramadol-Paracetamol Combination for Postoperative Pain Relief in Elective Single-level Microdisectomy Surgery.

PubMed

Dogar, Samie A; Khan, Fauzia A

2017-04-01

The tramadol and paracetamol combination is used frequently for postoperative pain management. The literature on the use of this combination for vertebral surgery is limited. Our objective was to compare a combination of paracetamol 1 g and a lower dose of tramadol (1 mg/kg: group 1T) with a combination of paracetamol 1 g and a higher dose of tramadol (1.5 mg/kg: group 1.5T) for postoperative pain after microdisectomy surgery. Our main outcome measure was Visual Analogue Scale pain scores for 4 hours postoperatively. This prospective randomized triple-blind clinical trial was conducted at Aga Khan University Hospital, Karachi. Ninety-four patients aged between 18 and 50 years scheduled for elective single-level microdisectomy were allocated randomly into 1 of 2 groups. Twenty minutes before the end of the surgery, patients received the study drugs. There was no significant demographic difference between groups. None of the patients experienced severe pain (VAS>6). There was no significant difference in the mean pain score between groups. The mean score at 4 hours was 2.17 (1.38) in group 1.5T and 1.74 (1.37) in group 1T. The difference was not statistically significant (P=0.14). In group 1.5T, 13 patients reported having nausea and vomiting compared with 2 patients in group 1T. This was a statistically significant difference (P=0.004). The sedation score was similar between groups. The combination of low-dose tramadol (1 mg/kg) and paracetamol has comparable analgesia and a decreased incidence of nausea and vomiting compared with the higher dose of tramadol (1.5 mg/kg) and paracetamol combination.

Primary hyperoxaluria in populations of Pakistan origin: results from a literature review and two major registries.

PubMed

Talati, Jamsheer Jehangir; Hulton, Sally-Anne; Garrelfs, Sander F; Aziz, Wajahat; Rao, Shoaib; Memon, Amanullah; Nazir, Zafar; Biyabani, Raziuddin; Qazi, Saqib; Azam, Iqbal; Khan, Aysha Habib; Ahmed, Jamil; Jafri, Lena; Zeeshan, Mohammad

2018-04-01

Primary hyperoxalurias (PH) are devastating, autosomal recessive diseases causing renal stones. Undifferentiated hyperoxaluria is seen in up to 43% of Pakistani paediatric stone patients. High rates of consanguinity in Pakistan suggest significant local prevalence. There is no detailed information regarding number of cases, clinical features, and genetics in Pakistan-origin (P-o) patients. We reviewed available information on P-o PH patients recorded in the literature as well as from two major PH registries (the Rare Kidney Stone Consortium PH Registry (RKSCPHR) and the OxalEurope PH Registry (OxER); and the Aga Khan University Hospital in Pakistan. After excluding overlaps, we noted 217 P-o PH subjects (42 in OxER and 4 in RKSCPHR). Presentations were protean. Details of mutations were available for 94 patients of 201 who had genetic analyses. Unique mutations were noted. Mutation [c.508G>A (p. Gly170Arg)] (present in up to 25% in the West) was reported in only one case. In one series, only 30% had mutations on exons 1,4,7 of AGXT. Of 42 P-o patients in OxER, 52.4% were PH1, 45.2% PH2, and 2.4% PH3. Of concern is that diagnosis was made after renal transplant rejection (four cases) and on bone-marrow aspiration (in five). Lack of consideration of PH as a diagnosis, late diagnosis, and loss of transplanted kidneys mandates that PH be searched for diligently. Mutation analysis will need to extend to all exons and include PH 1,2,3. There is a need to spread awareness and identify patients through a scoring or screening system that alerts physicians to consider a diagnosis of PH.

Rapid detection of in vitro antituberculous drug resistance among smear-positive respiratory samples using microcolony detection-based direct drug susceptibility testing method.

PubMed

Iftikhar, Irim; Irfan, Seema; Farooqi, Joveria; Azizullah, Zahida; Hasan, Rumina

2017-01-01

With the rise in multidrug-resistant tuberculosis, there is a search for newer techniques that will rapidly detect drug-resistant Mycobacterium tuberculosis. Although molecular techniques can detect resistance, culture is still considered gold standard, especially in resource-limited settings where quick, cheap, and easy techniques are needed. The aim of the study was to evaluate microcolony method thin layer agar (TLA) for quick detection of resistance against the first- and second-line antituberculous drugs in clinical isolates. This was a cross-sectional study performed at Aga Khan University Hospital. A total of 87 Z-N stain smear-positive pulmonary samples were received and indirect drug susceptibility test (ID-DST) was performed using Lowenstein-Jensen and mycobacteria growth indicator tube. Direct DST was performed using TLA on 7H10 agar. TLA was observed twice weekly under microscope for 4 weeks. Sensitivity, specificity, and accuracy were calculated for TLA using indirect susceptibility method as the gold standard. Level of agreement was calculated using Kappa score. TLA showed sensitivity of 89% and 95.2% for isoniazid and rifampicin, while for ethionamide, ofloxacin, and injectable aminoglycosides, it was 96.6%, 92.1%, and 100%, respectively. Specificity for the first-line drugs was >95% while second-line drugs ranged from 70% to 100%. Mean time to positivity was 10.2 days by TLA as compared to 43.1 days by ID-DST. TLA is a quick and reliable method in identifying resistance, especially in resource-limited settings. However, additional liquid culture can be set up as backup, especially in patients on therapy to avoid false negative results.

High Burden of Subclinical Lead Toxicity after Phase Out of Lead from Petroleum in Pakistan.

PubMed

Majid, Hafsa; Khan, Aysha Habib; Khan, Nadeem Ullah; Siddiqui, Imran; Ghani, Farooq; Jafri, Lena

2017-12-01

To evaluate the frequency of subclinical lead toxicity. Cross-sectional study. Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014. Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity. Amongst the total number of subjects tested (n=524), 26.5% (n=139) were children (<16 years) while rest were adults. Overall median BLLs was 6.4 ug/dl (20.9-3.1). The median BLL was 4 ug/dl (6.7-2.6) in children and 8.3 ug/dl (27.9-3.4) in adults, respectively. The BLL increased with age; higher levels were observed in age range 21-30 years of subjects [median lead level 16.9 ug/dl (36.1-4)] and lower level [4.2 ug/dl (6.8-2.6)] in children with <10 years of age. Only 16% (n=22) children had desirable lead levels while most had either subclinical (76%, n=106) or toxic lead levels (8%, n=11). In adults, (55%, n=212) subjects had desired lead levels, and 40% (n=154) and 4.99% (n=19) had subclinical and toxic lead levels. Presence of subclinical lead poisoning even after phasing out of lead petroleum in Pakistanis is alarming, especially in children. A national population-based study to determine the lead status and targeted intervention to identify potential sources is need of the time.

Genetic diversity of Plasmodium vivax clinical isolates from southern Pakistan using pvcsp and pvmsp1 genetic markers

PubMed Central

2013-01-01

Background Plasmodium vivax is the prevalent malarial species accounting for 70% of malaria burden in Pakistan; however, there is no baseline data on the circulating genotypes. Studies have shown that polymorphic loci of gene encoding antigens pvcsp and pvmsp1 can be used reliably for conducting molecular epidemiological studies. Therefore, this study aimed to bridge the existing knowledge gap on population structure on P. vivax from Pakistan using these two polymorphic genes. Methods During the period January 2008 to May 2009, a total of 250 blood samples were collected from patients tested slide positive for P. vivax, at the Aga Khan University Hospital, Karachi, or its collection units located in Baluchistan and Sindh Province. Nested PCR/RFLP was performed, using pvcsp and pvmsp1 markers to detect the extent of genetic diversity in clinical isolates of P. vivax from southern Pakistan. Results A total of 227/250 (91%) isolates were included in the analysis while the remainder were excluded due to negative PCR outcome for P.vivax. Pvcsp analysis showed that both VK 210 (85.5%, 194/227) and VK 247 type (14.5%, 33/227) were found to be circulating in P. vivax isolates from southern Pakistan. A total of sixteen and eighty-seven genotypes of pvcsp and pvmsp-1 were detected respectively. Conclusion This is the first report from southern Pakistan on characterization of P. vivax isolates confirming that extensively diverse pvcsp and pvmsp1 variants are present within this region. Results from this study provide valuable data on genetic diversity of P. vivax that will be helpful for further epidemiological studies. PMID:23311628

Genetics Home Reference: ankylosing spondylitis

MedlinePlus

... SUSCEPTIBILITY TO, 1 Sources for This Page Brown MA. Breakthroughs in genetic studies of ankylosing spondylitis. Rheumatology ( ... 10.1002/art.23177. Citation on PubMed Khan MA. HLA-B27 and its pathogenic role. J Clin ...

Close-packed structure dynamics with finite-range interaction: computational mechanics with individual layer interaction.

PubMed

Rodriguez-Horta, Edwin; Estevez-Rams, Ernesto; Lora-Serrano, Raimundo; Neder, Reinhard

2017-09-01

This is the second contribution in a series of papers dealing with dynamical models in equilibrium theories of polytypism. A Hamiltonian introduced by Ahmad & Khan [Phys. Status Solidi B (2000), 218, 425-430] avoids the unphysical assignment of interaction terms to fictitious entities given by spins in the Hägg coding of the stacking arrangement. In this paper an analysis of polytype generation and disorder in close-packed structures is made for such a Hamiltonian. Results are compared with a previous analysis using the Ising model. Computational mechanics is the framework under which the analysis is performed. The competing effects of disorder and structure, as given by entropy density and excess entropy, respectively, are discussed. It is argued that the Ahmad & Khan model is simpler and predicts a larger set of polytypes than previous treatments.

Merging a Pair of Supermassive Black Holes

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2016-10-01

When galaxies merge, the supermassive black holes (SMBHs) at the galaxies centers are thought to coalesce, forming a new, larger black hole. But can this merger process take place on timescales short enough that we could actually observe it? Results from a new simulation suggests that it can!When Galaxies CollideThese stills demonstrate the time evolution of the galaxy merger after the beginning of the authors simulation (starting from z=3.6). The red and blue dots mark the positions of the SMBHs. [Adapted from Khan et al. 2016]At present, its not well understood how the merger of two SMBHs proceeds from the merger of their host galaxies. Whats more, there are concerns about whether the SMBHs can coalesce on reasonable timescales; in many simulations and models, the inspiral of these behemoths stalls out when they are about a parsec apart, in whats known as the final parsec problem.Why are these mergers poorly understood? Modeling them from the initial interactions of the host galaxies all the way down to the final coalescence of their SMBHs in a burst of gravitational waves is notoriously complicated, due to the enormous range of scales and different processes that must be accounted for.But in a recent study, a team of scientists led by Fazeel Khan (Institute of Space Technology in Pakistan) has presented a simulation that successfully manages to track the entire merger making it the first multi-scale simulation to model the complete evolution of an SMBH binary that forms within a cosmological galaxy merger.Stages of aSimulationKhan and collaborators tackled the challenges of this simulation by using a multi-tiered approach.Beginning with the output of a cosmological hydrodynamical simulation, the authors select a merger of two typical massive galaxies at z=3.6 and use this as the starting point for their simulation. They increase the resolution and add in two supermassive black holes, one at the center of each galaxy.They then continue to evolve the galaxies hydrodynamically, simulating the final stages of the galaxy merger.When the separation of the two SMBHs is small enough, the authors extract a spherical region of 5 kpc from around the pair and evolve this as an N-body simulation.Finally, the separation of the SMBHs becomes so small (0.01 pc) that gravitational-wave emission is the dominant loss of energy driving the inspiral. The authors add post-Newtonian terms into the N-body simulation to account for this.Time evolution of the separation between the SMBHs, beginning with the hydrodynamical simulation (blue), then transitioning to the direct N-body calculation (red), and ending with the introduction of post-Newtonian terms (green) to account for gravitational-wave emission. [Adapted from Khan et al. 2016]Successful CoalescenceKhan and collaborators complex approach allows them to simulate the entire process of the merger and SMBH coalescence, resulting in several key determinations.First, they demonstrate that the SMBHs can coalesce on timescales of only tens of Myr, which is roughly two orders of magnitude smaller than what was typically estimated before. They find that gas dissipation before the merger is instrumental in creating the conditions that allow for this rapid orbital decay.The authors also demonstrate that the gravitational potential of the galaxy merger remnant is triaxial throughout the merger. Khan and collaborators simulations confirm that this non-spherical potential solves the final parsec problem by sending stars on plunging orbits around the SMBHs. These more distant stars cause the SMBHs to lose angular momentum through dynamical friction and continue their inspiral, even when the stars immediately surrounding the SMBHs have been depleted.This simulation isan important step toward a better understanding of SMBH mergers. Its outcomes are especially promising for future gravitational-wave campaigns, as the short SMBH coalescence timescales indicate that these mergers could indeed be observable!CitationFazeel Mahmood Khan et al 2016 ApJ 828 73. doi:10.3847/0004-637X/828/2/73

[Issues related to national university medical schools: focusing on the low wages of university hospital physicians].

PubMed

Takamuku, Masatoshi

2015-01-01

University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.

Urolithiasis analysis in a multiethnic population at a tertiary hospital in Nairobi, Kenya.

PubMed

Wathigo, Francis K; Hayombe, Alfred; Maina, Daniel

2017-04-20

Urolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used. This was a retrospective study which utilized patients' clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confirmed urolithiasis formed the study. This study aimed to describe the clinical characteristics of patients, modalities of treatment as well as the chemical composition of renal stones from patients diagnosed and managed for urolithiasis during a duration spanning 17 months. Wet chemistry was utilized for analyzing the chemical composition of the urinary calculi. Data on age, sex, symptoms, radiological investigations done, location of the calculi, chemical composition of calculi and therapeutic procedures instituted were extracted and analyzed. Ages ranged from 3 to 87 years with a median of 42; males were the majority (79%) and the commonest presenting symptoms were flank pain (91%) and dysuria (19%). The majority of the stones were located in the ureters (46%) and at the pelvi-ureteric junction (25%). A statistically significant difference in frequency of lodgment at the pelvi-ureteric site between males and females was noted. However, the number of female patients in this study was small and studies with larger numbers of female participants are required to confirm this observation. All stones contained calcium and oxalate, often as the only constituents (72%). In the remainder of the stones, other constituents such bicarbonate, ammonium, phosphorous, magnesium, uric acid and cystine occurred in varying combinations with calcium oxalate. Laser lithotripsy was the most performed therapeutic procedure (77.6%). Males formed the majority of patient with urolithiasis. Overall, most of the calculi were located in the ureters except in women where the pelviureteric location was commoner. Stones containing calcium oxalate only were predominant across the age groups and in both sexes. Lithotripsy was the commonest mode of management.

Residency hospital type and career paths in Japan: an analysis of physician registration cohorts.

PubMed

Koike, Soichi; Kodama, Tomoko; Matsumoto, Shinya; Ide, Hiroo; Yasunaga, Hideo; Imamura, Tomoaki

2010-01-01

In 2004, a new postgraduate medical training system was introduced in Japan and a shift of new graduates from university hospitals to other postgraduate education hospitals happened. The aim of this study is to analyse the past trends on postgraduate medical education choices and subsequent career options to discuss possible outcomes of the current shift and policy implications. Data from the national physician survey from 1976 to 2006 were analysed. The proportion change of physicians started their career in university hospitals was calculated. The career paths for physicians by different residency type were presented. More than 90% of physicians experienced university hospital work at least once in their 20-year careers. In their first 10 years of their career, physicians who started their residency in a university hospital tended to spend more years working in university hospitals, and those who started in other post-graduate training hospitals tended to spend less in university hospitals. Then, these groups presented quite similar patterns in their career choices. University hospitals need to strengthen their function as continuing education and career development centres and to adopt a less paternalistic approach, as fewer residents start their career in university hospitals.

Genetics Home Reference: microcephalic osteodysplastic primordial dwarfism type II

MedlinePlus

... Sources for This Page Bober MB, Khan N, Kaplan J, Lewis K, Feinstein JA, Scott CI Jr, ... Sutton syndrome All New & Updated Pages Reviewed : February 2018 Published : June 19, 2018 The resources on this ...

University hospitals as drivers of career success: an empirical study of the duration of promotion and promotion success of hospital physicians

PubMed Central

2014-01-01

Background German hospitals have a well-defined career structure for clinicians. In this hierarchical career system university hospital are stepping stones for career advancement. This longitudinal study investigates the impact of working in university hospitals on the career success of junior physicians and senior physicians. Methods Consideration of the career trajectories of 324 hospital physicians. Discrete-time event history analysis is used to study the influence of working in university hospitals on the chance of promotion from junior physician to senior physician and senior physician to chief physician. A comparison of medians provides information about the impact of working in university hospitals on the duration of promotion to senior and chief physician positions. Results Working in university hospitals has a negative impact for advancement to a senior physician position in terms of promotion duration (p = 0.005) and also in terms of promotion success, where a short time span of just 1–2 years in university hospitals has a negative effect (OR = 0.38, p < 0.01), while working there for a medium or long term has no significant effect. However, working in universities has a positive effect on the duration of promotion to a chief physician position (p = 0.079), and working in university hospitals for 3–4 years increases the chance of promotion to a chief physician position (OR = 4.02, p < 0.05), while working there > =7 years decreases this chance (OR = 0.27, p < 0.05). In addition, physicians have a higher chance of promotion to a chief physician position through career mobility when they come to the position from a university hospital. Conclusion Working at university hospitals has a career-enhancing effect for a senior physician with ambitions to become a chief physician. For junior physicians on the trajectory to a senior physician position, however, university hospitals are not drivers of career success. PMID:24755299

University hospitals as drivers of career success: an empirical study of the duration of promotion and promotion success of hospital physicians.

PubMed

Degen, Christiane; Kuntz, Ludwig

2014-04-23

German hospitals have a well-defined career structure for clinicians. In this hierarchical career system university hospital are stepping stones for career advancement. This longitudinal study investigates the impact of working in university hospitals on the career success of junior physicians and senior physicians. Consideration of the career trajectories of 324 hospital physicians. Discrete-time event history analysis is used to study the influence of working in university hospitals on the chance of promotion from junior physician to senior physician and senior physician to chief physician. A comparison of medians provides information about the impact of working in university hospitals on the duration of promotion to senior and chief physician positions. Working in university hospitals has a negative impact for advancement to a senior physician position in terms of promotion duration (p = 0.005) and also in terms of promotion success, where a short time span of just 1-2 years in university hospitals has a negative effect (OR = 0.38, p < 0.01), while working there for a medium or long term has no significant effect. However, working in universities has a positive effect on the duration of promotion to a chief physician position (p = 0.079), and working in university hospitals for 3-4 years increases the chance of promotion to a chief physician position (OR = 4.02, p < 0.05), while working there > =7 years decreases this chance (OR = 0.27, p < 0.05). In addition, physicians have a higher chance of promotion to a chief physician position through career mobility when they come to the position from a university hospital. Working at university hospitals has a career-enhancing effect for a senior physician with ambitions to become a chief physician. For junior physicians on the trajectory to a senior physician position, however, university hospitals are not drivers of career success.

[Physician shortage in Japan: the new postgraduate medical education program and physicians as a human medical resource].

PubMed

Nomura, Kyoko

2011-01-01

Japan now faces a serious physician shortage. After introducing the new postgraduate medical education (PGME) system and doctor-to-facility matching system, residents shifted their teaching hospitals from university hospitals to non-university hospitals. Because university hospitals had played a central role in allocating physicians to communities, the decrease in the number of physicians at university hospitals has driven this physician shortage. Japanese policymakers blame the new PGME for exacerbating this physician shortage and have tentatively agreed to reform the PGME to encourage residents to return to university hospitals. However, the PGME system should not be reformed only for political reasons; such a change requires a scientific basis. First, after the introduction of the new PGME, residents showed an improved clinical competence; therefore, it has accomplished its ultimate goal. Second, the residents' satisfaction level in terms of the residency system and clinical skills training was significantly higher at non-university hospitals than at university hospitals. This implies that training conditions at university hospitals are not as good as at non-university hospitals, which explains the decrease in the number of physicians at university hospitals. Third, in 2009, the Japanese government increased the maximum medical school enrollment to mitigate the physician shortage. However, a simple increase does not solve the problem of physician shortage unless it also addresses the problem of physician maldistribution. Fourth, the number of females entering medicine is increasing, and women constituted 30% of newly certified physicians in 2010. In this era of physician shortage, female physicians are highly recommended as a human medical resource.

Pluvials, droughts, the Mongol Empire, and modern Mongolia

NASA Astrophysics Data System (ADS)

Pederson, Neil; Hessl, Amy E.; Baatarbileg, Nachin; Anchukaitis, Kevin J.; Di Cosmo, Nicola

2014-03-01

Although many studies have associated the demise of complex societies with deteriorating climate, few have investigated the connection between an ameliorating environment, surplus resources, energy, and the rise of empires. The 13th-century Mongol Empire was the largest contiguous land empire in world history. Although drought has been proposed as one factor that spurred these conquests, no high-resolution moisture data are available during the rapid development of the Mongol Empire. Here we present a 1,112-y tree-ring reconstruction of warm-season water balance derived from Siberian pine (Pinus sibirica) trees in central Mongolia. Our reconstruction accounts for 56% of the variability in the regional water balance and is significantly correlated with steppe productivity across central Mongolia. In combination with a gridded temperature reconstruction, our results indicate that the regional climate during the conquests of Chinggis Khan's (Genghis Khan's) 13th-century Mongol Empire was warm and persistently wet. This period, characterized by 15 consecutive years of above-average moisture in central Mongolia and coinciding with the rise of Chinggis Khan, is unprecedented over the last 1,112 y. We propose that these climate conditions promoted high grassland productivity and favored the formation of Mongol political and military power. Tree-ring and meteorological data also suggest that the early 21st-century drought in central Mongolia was the hottest drought in the last 1,112 y, consistent with projections of warming over Inner Asia. Future warming may overwhelm increases in precipitation leading to similar heat droughts, with potentially severe consequences for modern Mongolia.

Pluvials, droughts, the Mongol Empire, and modern Mongolia.

PubMed

Pederson, Neil; Hessl, Amy E; Baatarbileg, Nachin; Anchukaitis, Kevin J; Di Cosmo, Nicola

2014-03-25

Although many studies have associated the demise of complex societies with deteriorating climate, few have investigated the connection between an ameliorating environment, surplus resources, energy, and the rise of empires. The 13th-century Mongol Empire was the largest contiguous land empire in world history. Although drought has been proposed as one factor that spurred these conquests, no high-resolution moisture data are available during the rapid development of the Mongol Empire. Here we present a 1,112-y tree-ring reconstruction of warm-season water balance derived from Siberian pine (Pinus sibirica) trees in central Mongolia. Our reconstruction accounts for 56% of the variability in the regional water balance and is significantly correlated with steppe productivity across central Mongolia. In combination with a gridded temperature reconstruction, our results indicate that the regional climate during the conquests of Chinggis Khan's (Genghis Khan's) 13th-century Mongol Empire was warm and persistently wet. This period, characterized by 15 consecutive years of above-average moisture in central Mongolia and coinciding with the rise of Chinggis Khan, is unprecedented over the last 1,112 y. We propose that these climate conditions promoted high grassland productivity and favored the formation of Mongol political and military power. Tree-ring and meteorological data also suggest that the early 21st-century drought in central Mongolia was the hottest drought in the last 1,112 y, consistent with projections of warming over Inner Asia. Future warming may overwhelm increases in precipitation leading to similar heat droughts, with potentially severe consequences for modern Mongolia.

Patterns And Determinants Of Breast Feeding Among Mother Infant Pairs In Dera Ghazi Khan, Pakistan.

PubMed

Khan, Moazzam Ali; Qureshi, Zubia; Khan, Kauser Aftab; Gill, Fouzia Nadeem

2016-01-01

Proper breastfeeding practices are effective ways for reducing childhood morbidity and mortality. The objective of the present study was to determine the patterns and explore the determinants associated with breast feeding practices among the nursing women in Dera Ghazi Khan. A cross sectional study was conducted on randomly selected lactating mother infant pairs in Dera Ghazi Khan. Structured questionnaire was used for data collection. Analysis was done by using SPSS, chi square test was applied to see the association between breast feeding practices and its determinants such as knowledge of breast feeding practices. Majority 372 (93%) of mothers mentioned that they had ever breastfed the youngest child. About 292 (73%) mothers gave colostrum to the child, and 48 (12%) exclusively breastfed. Weaning babies before four month of age was practiced by 84 (21%) of the mothers, 120 (55%) mothers started weaning at 4-6 months of child age, while 72 (18%) started to give additional food after baby turned six months old. Out of total 276 (69%) mothers reported that they had knowledge regarding breast feeding. Significant association was found between knowledge of breastfeeding and initiation and Exclusive Breast Feeding (EBF) practices (p-values <0.05). Income, family type, mode of delivery and assistance for child were significantly associated with initiation of breastfeeding within one hour after birth (p-value <0.001). Breast feeding practices in the studied area were not up to the mark. There is a strong need to improve the breastfeeding practices by Behavior Change Communication.

Effect of a Computerized Provider Order Entry (CPOE) System on Medication Orders at a Community Hospital and University Hospital

PubMed Central

Wess, Mark L.; Embi, Peter J.; Besier, James L.; Lowry, Chad H.; Anderson, Paul F.; Besier, James C.; Thelen, Geriann; Hegner, Catherine

2007-01-01

Computerized Provider Order Entry (CPOE) has been demonstrated to improve the medication ordering process, but most published studies have been performed at academic hospitals. Little is known about the effects of CPOE at community hospitals. With a pre-post study design, we assessed the effects of a CPOE system on the medication ordering process at both a community and university hospital. The time from provider ordering to pharmacist verification decreased by two hours with CPOE at the community hospital (p<0.0001) and by one hour at the university hospital (p<0.0001). The rate of medication clarifications requiring signature was 2.80 percent pre-CPOE and 0.40 percent with CPOE (p<0.0001) at the community hospital. The university hospital was 2.76 percent pre-CPOE and 0.46 percent with CPOE (p<0.0001). CPOE improved medication order processing at both community and university hospitals. These findings add to the limited literature on CPOE in community hospitals. PMID:18693946

State University of New York Stony Brook University Hospital: Selected Expenditure Controls. Report 92-S-66.

ERIC Educational Resources Information Center

New York State Office of the Comptroller, Albany. Div. of Management Audit.

An audit was done of selected expenditure controls at the State University of New York (SUNY) at Stony Brook University Hospital particularly payroll costs and procurement practices. The Hospital reported an operating loss of $24 million in 1992. The audit reviewed Hospital management and staff and applicable policies and procedures as well as…

Assessing advertising content in a hospital advertising campaign: An application of Puto and Wells (1984) measure of informational and transformational advertising content.

PubMed

Menon, Mohan K; Goodnight, Janelle M; Wayne, Robin J

2006-01-01

The following is a report of a study designed to measure advertising content based on the cognitive and affective elements of informational (i.e., information processing) and transformational (i.e., experiential) content using the measure of advertising informational and transformational content developed by Puto and Wells (1984). A university hospital advertising campaign designed to be high in transformational content did not appear to affect perceived quality of local university hospitals relative to private hospitals or increase the likelihood of choosing a university hospital in the future. Further, experiences with university hospitals that seemed to be in direct contrast to the content of the advertisements based on subject perceptions affected how university hospital advertisements were perceived in terms of content. Conclusions and implications for hospital advertising campaigns are discussed.

Financial Analysis of National University Hospitals in Korea.

PubMed

Lee, Munjae

2015-10-01

This paper provides information for decision making of the managers and the staff of national university hospitals. In order to conduct a financial analysis of national university hospitals, this study uses reports on the final accounts of 10 university hospitals from 2008 to 2011. The results of comparing 2008 and 2011 showed that there was a general decrease in total assets, an increase in liabilities, and a decrease in total medical revenues, with a continuous deficit in many hospitals. Moreover, as national university hospitals have low debt dependence, their management conditions generally seem satisfactory. However, some individual hospitals suffer severe financial difficulties and thus depend on short-term debts, which generally aggravate the profit and loss structure. Various indicators show that the financial state and business performance of national university hospitals have been deteriorating. These research findings will be used as important basic data for managers who make direct decisions in this uncertain business environment or by researchers who analyze the medical industry to enable informed decision-making and optimized execution. Furthermore, this study is expected to contribute to raising government awareness of the need to foster and support the national university hospital industry.

Financial Analysis of National University Hospitals in Korea

PubMed Central

Lee, Munjae

2015-01-01

Objectives This paper provides information for decision making of the managers and the staff of national university hospitals. Methods In order to conduct a financial analysis of national university hospitals, this study uses reports on the final accounts of 10 university hospitals from 2008 to 2011. Results The results of comparing 2008 and 2011 showed that there was a general decrease in total assets, an increase in liabilities, and a decrease in total medical revenues, with a continuous deficit in many hospitals. Moreover, as national university hospitals have low debt dependence, their management conditions generally seem satisfactory. However, some individual hospitals suffer severe financial difficulties and thus depend on short-term debts, which generally aggravate the profit and loss structure. Various indicators show that the financial state and business performance of national university hospitals have been deteriorating. Conclusion These research findings will be used as important basic data for managers who make direct decisions in this uncertain business environment or by researchers who analyze the medical industry to enable informed decision-making and optimized execution. Furthermore, this study is expected to contribute to raising government awareness of the need to foster and support the national university hospital industry. PMID:26730356

75 FR 14258 - Unblocking of Specially Designated Nationals Pursuant to Executive Order 13224

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-24

..., Pakistan; c/o Alam General Store Shop 17, Awami Market, Peshawar, Pakistan; c/o Zahir Shah s/o Murad Khan Ander Sher, Peshawar, Pakistan (individual) [SDGT] The removal of the individual's name from the list of...

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Singer Chaka Khan performs during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Summary of breakout session f: facility and equipment decontamination strategies.

PubMed

Norwood, Laurie P; Suvarna, Kalavati

2011-01-01

CONFERENCE PROCEEDING Proceedings of the PDA/FDA Adventitious Viruses in Biologics: Detection and Mitigation Strategies Workshop in Bethesda, MD, USA; December 1-3, 2010 Guest Editors: Arifa Khan (Bethesda, MD), Patricia Hughes (Bethesda, MD) and Michael Wiebe (San Francisco, CA).

Child health and education in Kenyan schools programmes.

PubMed

Fleming, J

1991-03-01

Jane Fleming describes the health education in schools programme launched by the Aga Khan Health Services in Kisumu, Kenya. The project has brought major improvements in child health and mortality rates as well as better health awareness to the community as a whole.

Near East/South Asia Report

DTIC Science & Technology

1985-04-23

jails in which security inmates are incarcerated serve as a hotbed for training men for hostile lenity against Israel. The sources maintain that...Mirpur Khas, Mansehra, Sailkot, Rahim -yar-Khan Naushki Loralai, Kharan, SIM, Khuzdar, Chha-chairo, Omar Kot and Mithi. [Text] [Lahore THE PAKISTAN

Smart information system for gachon university gil hospital.

PubMed

Park, Dong Kyun; Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-03-01

In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

Smart Information System for Gachon University Gil Hospital

PubMed Central

Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-01-01

Objectives In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. Methods This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. Results The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Conclusions Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future. PMID:22509476

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.

Prevalence of hepatitis B and C in healthy adult males of paramilitary personnel in Punjab.

PubMed

Hafeez-ud-din; Siddiqui, Tahir Saeed; Lahrasab, Waseem; Sharif, Muhammad Ashraf

2012-01-01

Global prevalence of Hepatitis B varies from high (> 8%) in Africa, Asia and Western Pacific to low (< 2%) in Western Europe, North America and Australia. An estimated 180 million people worldwide including 4 million people in USA are infected with HCV. This cross-sectional observational study was carried out at Department of Pathology, Pakistan Rangers (Punjab) Central Hospital, Lahore from March to June 2010 to determine prevalence of HBV and HCV infection among serving asymptomatic healthy adult males of paramilitary force. The healthy adult males from province Punjab serving in Pakistan Rangers Punjab without previous history of known positivity for HBV or HCV infection were included in the study. Demographic data including the district of origin were noted. HBsAg and anti-HCV antibodies were tested by rapid immuno-chromatographic method while positive tests were reconfirmed by enzyme immuno-assay (EIA). Out of total 15,793 adults screened for Hepatitis B & C viral infections, 14,027 adults belonged to the province of Punjab. There were 396 (2.82%) adults who were found positive for HBsAg and 511 (3.64%) positive for anti-HCV on screening. Retesting of the positive tests by EIA showed 396 (2.82%) positive for HBsAg, and 440 (3.13%) for anti-HCV respectively. Specificity of immune chromatographic method for HBsAg and anti-HCV calculated taking EIA as gold standard was 100% for HBsAg and 99.5% for anti-HCV while positive predictive value of the immuno-chromatographic methods was 100% for HBsAg and 86.1% for anti-HCV. Highest of prevalence of HBsAg was seen in Rahimyar Khan (7.58%) while high prevalence of anti-HCV was seen in Chiniot (8.9%), Faisalabad (7.2%), Vehari (7.03%), Muzaffargarh (5.95%) and Sheikhupura (5.83%). Overall prevalence of HBsAg and anti-HCV is on the decline. The isolated pockets of very high prevalence of HCV infection in the districts of Chiniot, Faisalabad, Vehari, Sheikhupura, Rahimyar Khan, Muzaffargarh, and Okara pose a community health problem with a dire need to adopt strict preventive measures in the medical and social practices with effective public awareness campaigns.

Identifying a parsimonious model for predicting academic achievement in undergraduate medical education: A confirmatory factor analysis

PubMed Central

Ali, Syeda Kauser; Baig, Lubna Ansari; Violato, Claudio; Zahid, Onaiza

2017-01-01

Objectives: This study was conducted to adduce evidence of validity for admissions tests and processes and for identifying a parsimonious model that predicts students’ academic achievement in Medical College. Methods: Psychometric study done on admission data and assessment scores for five years of medical studies at Aga Khan University Medical College, Pakistan using confirmatory factor analysis (CFA) and structured equation modeling (SEM). Sample included 276 medical students admitted in 2003, 2004 and 2005. Results: The SEM supported the existence of covariance between verbal reasoning, science and clinical knowledge for predicting achievement in medical school employing Maximum Likelihood (ML) estimations (n=112). Fit indices: χ2 (21) = 59.70, p =<.0001; CFI=.873; RMSEA = 0.129; SRMR = 0.093. Conclusions: This study shows that in addition to biology and chemistry which have been traditionally used as major criteria for admission to medical colleges in Pakistan; mathematics has proven to be a better predictor for higher achievements in medical college. PMID:29067063

RADIOLOGY EDUCATION: A PILOT STUDY TO ASSESS KNOWLEDGE OF MEDICAL STUDENTS REGARDING IMAGING IN TRAUMA.

PubMed

Siddiqui, Saad; Saeed, Muhammad Anwar; Shah, Noreen; Nadeem, Naila

2015-01-01

Trauma remains one of the most frequent presentations in emergency departments. Imaging has established role in setting of acute trauma with ability to identify potentially fatal conditions. Adequate knowledge of health professionals regarding trauma imaging is vital for improved healthcare. In this work we try to assess knowledge of medical students regarding imaging in trauma as well as identify most effective way of imparting radiology education. This cross-sectional pilot study was conducted at Aga Khan University Medical College & Khyber Girls Medical College, to assess knowledge of medical students regarding imaging protocols practiced in initial management of trauma patients. Only 40 & 20% respectively were able to identify radiographs included in trauma series. Very few had knowledge of correct indication for Focused abdominal sonography in trauma. Clinical radiology rotation was reported as best way of learning radiology. Change in curricula & restructuring of clinical radiology rotation structure is needed to improve knowledge regarding Trauma imaging.

Identifying a parsimonious model for predicting academic achievement in undergraduate medical education: A confirmatory factor analysis.

PubMed

Ali, Syeda Kauser; Baig, Lubna Ansari; Violato, Claudio; Zahid, Onaiza

2017-01-01

This study was conducted to adduce evidence of validity for admissions tests and processes and for identifying a parsimonious model that predicts students' academic achievement in Medical College. Psychometric study done on admission data and assessment scores for five years of medical studies at Aga Khan University Medical College, Pakistan using confirmatory factor analysis (CFA) and structured equation modeling (SEM). Sample included 276 medical students admitted in 2003, 2004 and 2005. The SEM supported the existence of covariance between verbal reasoning, science and clinical knowledge for predicting achievement in medical school employing Maximum Likelihood (ML) estimations (n=112). Fit indices: χ 2 (21) = 59.70, p =<.0001; CFI=.873; RMSEA = 0.129; SRMR = 0.093. This study shows that in addition to biology and chemistry which have been traditionally used as major criteria for admission to medical colleges in Pakistan; mathematics has proven to be a better predictor for higher achievements in medical college.

Flipping Preservice Elementary Teachers' Mathematics Anxieties

ERIC Educational Resources Information Center

Dove, Anthony; Dove, Emily

2017-01-01

In preparing future elementary educators in mathematics, helping them overcome their anxieties of mathematics and teaching mathematics is paramount. This study examined how different instructional practices (in-class lecture, flipped learning with teacher-created videos, flipped classroom with Khan Academy videos) compared in improving students'…

Scientists Urge DHS to Improve Bioterrorism Risk Assessment

DTIC Science & Technology

2008-01-01

ability of outcomes. These are not mere theoretical sug- gestions , but rather substantive tools and methods drawn from extensive research and experience...declassified for NRC publica - tion. 7. Rotz LD, Khan AS, Lillibridge SR, Ostroff SM, Hughes JM. Public health assessment of potential biological

Mini-Craniotomy Under Local Anesthesia for Chronic Subdural Hematoma: An Effective Choice for Elderly Patients and for Patients in a Resource-Strained Environment.

PubMed

Mahmood, Shaikh Danish; Waqas, Muhammad; Baig, Mirza Zain; Darbar, Aneela

2017-10-01

Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA). This was a retrospective medical chart review conducted in the section of Neurosurgery at the Aga Khan Hospital in Karachi, Pakistan. The study duration was 1 year. We included patients aged 55 years or older undergoing surgery for CSDH. Clinical characteristics, hospital stay, and recurrence rates were compared between 2 groups, local versus general anesthesia. Thirty-five patients underwent mini-craniotomy for CSDH in the study period. Sixteen patients underwent mini-craniotomy under LA versus 19 patients for GA. Median age for the LA group was 67 years compared with 70 years in the GA group. Four patients from the LA group experienced postoperative complications versus 7 from the GA group. Only one patient in the LA group required an ICU bed in the postoperative period. There was no recurrence in LA group. The overall recurrence was 2.86%. Mini-craniotomy for CSDH under LA is an equally effective procedure compared with mini-craniotomy under GA. In addition, it minimizes the risks of GA in the elderly population and obviates the need of a postoperative ICU bed. It also reduces operative time and hospital stay as compared with GA. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of Mode of Curriculum on Knowledge and Attitudes of Medical Students towards Health Research

PubMed Central

Haseeb, Abdul; Ansari, M. Ahmed; Raheem, Ahmed; Khan, Aleena; Arshad, Mohammad Hussham; Motiani, Vanita; Akhtar, Muhammad Shahzeb

2016-01-01

Introduction Equipping students with skills in medical research should be an integral part of medical education systems. This study is designed to gauge the difference in knowledge and attitudes towards health research between two sets of undergraduate medical students; those enrolled in the new Problem Based Learning (PBL) education system versus those of the conventional Lecture Based Learning (LBL) curricula. Materials and Methods From the 4th and 5th years of medical university students, 90 participants were recruited from the Aga Khan University (PBL group) and Dow University of Health Sciences (LBL group) and were presented with structured and pre-validated questionnaire. Responses obtained for knowledge and attitudes of each group were recorded on a scale and graduated in percentages to be compared statistically for differences to identify the effectiveness of each curriculum. Results The score on the knowledge scale for the PBL group was found to be 44.77% against the 31.55% of the LBL students (p-value<0.001). Furthermore, the mean attitude score of AKU students was 72.22% as opposed to the 56.11% of the DUHS participants (p-value<0.001). Conclusion The PBL group achieved significantly higher scores in all aspects than the LBL group, showing healthier attitudes towards health science research along with better knowledge. Hence, the apparent positive influence of PBL curricula on attitudes towards research may be helpful in improving research output of medical students in Pakistan. PMID:27190837

Howard University Hospital finds partner in helping children succeed.

PubMed

Botvin, Judith D

2005-01-01

Howard University Hospital, Washington, D.C., becomes the site for the launch of a national ad campaign by the nonprofit youth education organization, Communities in Schools. The hospital and university share the organization's mission of supporting young people in the community.

77 FR 41477 - Designation of 2 Individuals and 2 Entities Pursuant to Executive Order 13224 of September 23...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-13

..., Quetta, Balochistan Province, Pakistan; Nasrullah Khan Chowk, Pashtunabad Area, Balochistan Province, Pakistan; Chaman, Balochistan Province, Pakistan; Abdul Satar Food Shop, Eno Mina 0093, Kandahar... Qilla Abdullah, Pakistan; alt. POB Mirmadaw Village, Gereshk District, Helmand Province, Afghanistan...

75 FR 24948 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-06

... Holdings plc. G Better Place, Inc. G Better Place, Inc. 20100480 G James C. Davis. G Erickson Group, LLC. G Erickson Retirement Communities, LLC. 20100481 G Mr. Shahid Khan. G Georgia Frontiere Revocable Trust u/d/t...

Pakistan’s Gwadar Port - Prospects of Economic Revival

DTIC Science & Technology

2005-06-01

Ahmed , who stood by me all the time during the academic rigors involved in the completion of this thesis. They sacrificed their opportunities to... Ashraf Khan, “Pakistan Fishing Village undergoes Transformation into global mega-port,” Agence France Presse, (September 14, 2003). 107 Kux Dennis

PDA Cell Substrate Task Force: Emerging Technologies for Virus Detection Technical Document--A Progress Report.

PubMed

King, Kathryn; Wiebe, Michael

2011-01-01

CONFERENCE PROCEEDING Proceedings of the PDA/FDA Adventitious Viruses in Biologics: Detection and Mitigation Strategies Workshop in Bethesda, MD, USA; December 1-3, 2010 Guest Editors: Arifa Khan (Bethesda, MD), Patricia Hughes (Bethesda, MD) and Michael Wiebe (San Francisco, CA).

The Common Vision. Reviews: Books.

ERIC Educational Resources Information Center

Chattin-McNichols, John

1998-01-01

Reviews Marshak's book describing the work of educators Maria Montessori, Rudolf Steiner, Aurobindo Ghose, and Inayat Khan. Maintains that the book gives clear, concise information on each educator and presents a common vision for children and their education; also maintains that it gives theoretical and practical information and discusses…

Use of Prescription Assistance Programs After the Affordable Health Care Act.

PubMed

Khan, Ghazala; Karabon, Patrick; Lerchenfeldt, Sarah

2018-03-01

Insurance coverage in the United States seems to be in a state of unrest. The 2010 passage of the Patient Protection and Affordable Health Care Act (ACA) extended health insurance coverage to roughly 32 million people. An increase in the number of people with health insurance benefits raised the question of whether prescription assistance programs (PAPs) would still be used after ACA implementation. To evaluate the use of PAPs following the implementation of the ACA insurance mandate. Health insurance was not required by the ACA until January 2014, so we retrospectively examined the use of drug company-sponsored PAPs before and after the ACA implementation. Since each PAP had its own qualifying criteria, any person who used a PAP through the assistance of NeedyMeds and its PAPTracker between the years of 2011 and 2016 were included for analysis. Data were pulled by NeedyMeds from the PAPTracker software, which produces completed PAP applications from drug manufacturer forms for PAPs. The number of PAP orders, number of unique patient orders, and annual patient prescription savings were assessed. Between 2011 and 2013, there was an average of 4.2 annual PAP orders per patient; however, annual PAP orders decreased to 3.1 per patient between 2014 and 2016 (P < 0.001). PAP orders declined by an average of 3.0% per month between 2014 and 2016 (P < 0.001), and average prescription savings per order increased from $870.40 before the ACA to $1,086.40 after ACA implementation (P = 0.0024). Patients saved an average of over $3,000 on prescriptions annually with the use of PAPs after the ACA mandate. Although health care reform is inevitable, our study showed that PAPs remain important to help cover prescription drug costs for eligible patients, even with invariable changes to health insurance, including a health insurance requirement. While the ACA may have been an important step forward in extending health insurance coverage to millions, PAPs are still used to help U.S. patients obtain their medications at no cost or very low cost. These programs will most likely remain relevant until other approaches are taken to help alleviate the effects of increasing drug prices in the United States. No outside funding supported this research. The authors have no relevant financial or nonfinancial relationships to disclose. Study concept and design were contributed by Khan, Lerchenfeldt, and Karabon. Khan collected the data, and all authors participated in data analysis. The manuscript was primarily written by Lerchenfeldt, along with Khan and Karabon, and revised by Lerchenfeldt, along with Karabon and Khan.

Attitudes towards child restrains and seat belts usage in the learned population of Karachi, Pakistan.

PubMed

Siddiqui, Emaduddin; Ejaz, Kiran; Waheed, Shahan; Kazi, Ghazala Irfan; Khursheed, Munawar

2014-01-01

Motor vehicles crashes (MVCs) are the leading cause of injury related morbidity and mortality in developed countries. Recent evidence proves that properly used child seat belts can dramatically reduce the risk of severe and life-threatening injury from MVCs. There are rarities of thought and inspiration regarding the use of child seat belts in our society and region, therefore we lack of data regarding factors and paucity of usage of child seat belts in motor vehicles. This study aimed to assess the knowledge and attitudes of child seat belt usage among the educated population in Karachi, Pakistan. Altogether 304 employees were investigated. They were employees of Aga Khan University who were using their cars and having children younger than 10 years old. A cross sectional observational study was designed, and a 36-item questionnaire in English was used to collect data on participants' demographic details, designation, educational level, economic status, validity of driving license, number of children and cars, availability of adult seat belts and child seat belts along with their functionality, awareness, knowledge and attitude toward its use, and reason of not using these devices. SPSS version 20 for Windows was used to analyze the data and the Chi-square test was used. Totally 290 participants were recruited with a response rate of 72% (212). Of 212 participants, 126 (59%) were male. 154 (72.6%) participants had valid driver licenses, and 154 (72.6%) had adult seat belts in their vehicles. Only 32 (15%) reported regular use of adult seat belts. Although 168 (79.2%) participants had some knowledge about child restrains (CRs), only 65 (22%) had CRs in their cars. Eighty-two (38.7%) participants got the knowledge about CRs and seat belts from media. Mothers were more concerned about the use of CRs than fathers. Only 14 (6.6%) parents were found to use both adult and child seat belts all the time. Of the 157 parents who did not us use CRs, 42 considered unnecessary, 35 lacked relevant knowledge. But 15 parents used CR against their children's wills. The pattern of CR usage among the employees at Aga Khan University, Karachi is dictated by the unavailability of CR, followed by ignorance, inconvenience, and non-acceptance by their children. The important issue of CR has consistently been ignored over the years and it has never gained enough popularity in Pakistan.

Accuracy and Coverage of Diagnosis and Procedural Coding of Severely Injured Patients in the Finnish Hospital Discharge Register: Comparison to Patient Files and the Helsinki Trauma Registry.

PubMed

Heinänen, M; Brinck, T; Handolin, L; Mattila, V M; Söderlund, T

2017-09-01

The Finnish Hospital Discharge Register data are frequently used for research purposes. The Finnish Hospital Discharge Register has shown excellent validity in single injuries or disease groups, but no studies have assessed patients with multiple trauma diagnoses. We aimed to evaluate the accuracy and coverage of the Finnish Hospital Discharge Register but at the same time validate the data of the trauma registry of the Helsinki University Hospital's Trauma Unit. We assessed the accuracy and coverage of the Finnish Hospital Discharge Register data by comparing them to the original patient files and trauma registry files from the trauma registry of the Helsinki University Hospital's Trauma Unit. We identified a baseline cohort of patients with severe thorax injury from the trauma registry of the Helsinki University Hospital's Trauma Unit of 2013 (sample of 107 patients). We hypothesized that the Finnish Hospital Discharge Register would lack valuable information about these patients. Using patient files, we identified 965 trauma diagnoses in these 107 patients. From the Finnish Hospital Discharge Register, we identified 632 (65.5%) diagnoses and from the trauma registry of the Helsinki University Hospital's Trauma Unit, 924 (95.8%) diagnoses. A total of 170 (17.6%) trauma diagnoses were missing from the Finnish Hospital Discharge Register data and 41 (4.2%) from the trauma registry of the Helsinki University Hospital's Trauma Unit data. The coverage and accuracy of diagnoses in the Finnish Hospital Discharge Register were 65.5% (95% confidence interval: 62.5%-68.5%) and 73.8% (95% confidence interval: 70.4%-77.2%), respectively, and for the trauma registry of the Helsinki University Hospital's Trauma Unit, 95.8% (95% confidence interval: 94.5%-97.0%) and 97.6% (95% confidence interval: 96.7%-98.6%), respectively. According to patient records, these patients were subjects in 249 operations. We identified 40 (16.1%) missing operation codes from the Finnish Hospital Discharge Register and 19 (7.6%) from the trauma registry of the Helsinki University Hospital's Trauma Unit. The validity of the Finnish Hospital Discharge Register data is unsatisfactory in terms of the accuracy and coverage of diagnoses in patients with multiple trauma diagnoses. Procedural codes provide greater accuracy. We found the coverage and accuracy of the trauma registry of the Helsinki University Hospital's Trauma Unit to be excellent. Therefore, a special trauma registry, such as the trauma registry of the Helsinki University Hospital's Trauma Unit, provides much more accurate data and should be the preferred registry when extracting data for research or for administrative use, such as resource prioritizing.

A substantial number of scientific publications originate from non-university hospitals.

PubMed

Fedder, Jens; Nielsen, Gunnar Lauge; Petersen, Lars J; Rasmussen, Claus; Lauszus, Finn F; Frost, Lars; Hornung, Nete; Lederballe, Ole; Andersen, Jens Peter

2011-11-01

As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities. We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus. In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Publications were cited more often if the first or last author was from a university hospital and even more so if they were affiliated to foreign institutions. Cardiology, gynaecology and obstetrics, and environmental medicine were the three specialities with the largest number of regional hospital publications. A substantial number of scientific publications originate from non-university hospitals. Almost two thirds of the publications were original research published in international journals. Variations between specialities may reflect local conditions. not relevant. not relevant.

Colliding impulsive gravitational waves

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nutku, Y.; Halil, M.

1977-11-28

We formulate the problem of colliding plane gravitational waves with two polarizations as the harmonic mappings of Riemannian manifolds and construct an exact solution of the vacuum Einstein field equations describing the interaction of colliding impulsive gravitational waves which in the limit of collinear polarization reduces to the solution of Khan and Penrose.

DU Fragment Carcinogenicity: Extrapolation of Findings in Rodents to Man

DTIC Science & Technology

2004-03-01

changes in intrahepatic cholangiocarcinoma induced by thorotrast. Radiat. Res. 152: S 118-S 124. Khan, J., R. Simon, M. Bittner, Y. Chen, S. B. Leighton, T... cholangiocarcinomas demonstrated with a sensitive polymerase chain reaction technique. Cancer Res. 51: 3497-3502. MacDonald, J. S. and H. H. Scribner (1999

Flipping the Foreign Language Classroom and Critical Pedagogies: A (New) Old Trend

ERIC Educational Resources Information Center

Correa, Maite

2015-01-01

Since the foundation of the Khan Academy (2006), a great deal of attention has been generated to the term "flipped classrooms" (also known as "reverse" or "backwards" classrooms), which is a (new) pedagogical movement that reverses the traditional paradigm of class lecture and homework. This approach subordinates…

Collaborations among Diverse Support Areas for Hybrid Success

ERIC Educational Resources Information Center

Haggar, Faye; Kelley, Bruce; Chen, Weichao

2017-01-01

Successful implementation of hybrid courses typically demands collaboration among diverse support areas on campus. This article examines these collaborations through the lens of Badrul Khan's theory of managing blended learning support. Also discussed is the central role that faculty developers can play in connecting these support areas to ensure…

KSC-04PD-1104

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- Sashikant Dhawan is costume director with the film crew from India who spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. Ashutosh Gowariker is the writer-director. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Home

Science.gov Websites

Military Commissions History USCMCR History USCMCR Judges Legal System Comparison FAQs CASES Military General Public About Us Cases Calendar CCTV Sites Legal Community Cases Legal Resources Travel Victims and Transcripts | Press Releases | Calendar Quick Links Cases Cases Active Cases Majid Shoukat Khan Ahmed Mohammed

Non-Governmental Organisations. Their Role in Development. Courier No. 37.

ERIC Educational Resources Information Center

ASPBAE Courier, 1986

1986-01-01

This issue of the "Courier" contains several articles on the role of nongovernmental organizations (NGOs) working for social justice and development for people in Third World countries. The following articles appear: "Sharing One Earth" (Nighat Said Khan, Kamla Bhasin); "Beware of the Gongo--Regulating NGOs in India: New…

Water resources and related geology of Dera Ismail Khan district, West Pakistan, with reference to the availability of ground water for development

USGS Publications Warehouse

Hood, J.W.; Khan, Lutfe Ali; Jawaid, Khalid

1970-01-01

Dera Ismail (D.I.) Khan District contains an area of 3,450 square miles between the right bank of the Indus River and the Sulaiman Range in westcentral West Pakistan. Agriculture is the principal source of income in the District, but only a small part of the arable land is fully utilized. The region is semiarid and has an average annual rainfall of about 9 inches and a potential evapotranspirational rate of eight to nine times the annual rainfall. Thus, rainfall alone is not adequate for high-intensity cropping. Irrigation is practiced near the Indus River; the Paharpur Canal is used, as well as the traditional inundation method. Elsewhere in the District, adequate water is supplied to local areas by karezes, perennial streams from the mountains, and some recently installed tubewells (see 'Glossary'). Further development of ground-water supplies would permit a more effective utilization of most of the presently tilled land and would allow additional land to be farmed. D.I. Khan District is primarily an alluvial plain that slopes from the mountain ranges in the northern and western parts of the District toward the Indus River. Rocks in the bordering mountains are of Paleozoic to early or middle Pleistocene age. The unconsolidated rocks of the plain, of middle (?) Pleistocene to Holocene (Recent) age, consist of piedmont deposits derived from the hills to the north and west and of alluvium laid down by the Indus River. These deposits interfinger in a transitional zone about 8 to 12 miles west of the river. Lithologic and structural features indicate that the unconsolidated rocks possibly may be divided into broad units. The investigations in D.I. Khan District have revealed two main areas of potential ground-water development based on considerations of both permeability and chemical quality of the ground water: 1. A belt about 10 miles wide parallels the Indus River from the Khisor Range southward to the area immediately south of D.I. Khan town. In this belt, the material penetrated by test holes and tubewells consists predominantly of sand, which in tubewells can yield from 2 to 3 cfs (cubic feet per second) of water with only moderate drawdown. Also in this belt, ground water of good chemical quality extends to depths of 1,000 feet or more. 2. The area from the mouth of the Gumal River gorge to the vicinity of Kot Azam contains sand and gravel strata that may yield from 1 to 3 cfs of water, which contains 500 to 1,500 ppm (parts per million) of total dissolved solids. Other marginal parts of the District also contain water of good chemical quality, but developmental prospects are somewhat poorer because of greater depths to water, lower permeabilities, or greater depths to aquifers, all of which would require greater costs in the tubewell installations. The stratification or zoning of water of different chemical qualities to some extent governs the local availability of useful water. Generally, the ground water of poorest quality is found in the shallow zone, and quality improves with depth. The central part of the District, in a belt reaching from the vicinity of Tank southward to the Indus River near Dera Ghfizi Khan District, contains highly mineralized water and few aquifers. The mineralization of water in this belt is due primarily to large concentrations of sodium and sulfate and thus differs from the main part of the Punjab region where highly mineralized waters are generally chloride waters. Radical changes in water quality, both horizontally and vertically, are common in the District. Changes in chemical quality of water from large-capacity wells near areas of highly mineralized water are taking place, and further changes may be expected as withdrawals continue and increase in magnitude. Under present conditions, surface-water supplies are fully utilized, and ground water is the largest supply available for development-other than that from the Indus River.

SU-C-BRB-02: Symmetric and Asymmetric MLC Based Lung Shielding and Dose Optimization During Translating Bed TBI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmed, S; Kakakhel, MB; Ahmed, SBS

2015-06-15

Purpose: The primary aim was to introduce a dose optimization method for translating bed total body irradiation technique that ensures lung shielding dynamically. Symmetric and asymmetric dynamic MLC apertures were employed for this purpose. Methods: The MLC aperture sizes were defined based on the radiological depth values along the divergent ray lines passing through the individual CT slices. Based on these RD values, asymmetrically shaped MLC apertures were defined every 9 mm of the phantom in superior-inferior direction. Individual MLC files were created with MATLAB™ and were imported into Eclipse™ treatment planning system for dose calculations. Lungs can be shieldedmore » to an optimum level by reducing the MLC aperture width over the lungs. The process was repeated with symmetrically shaped apertures. Results: Dose-volume histogram (DVH) analysis shows that the asymmetric MLC based technique provides better dose coverage to the body and optimum shielding of the lungs compared to symmetrically shaped beam apertures. Midline dose homogeneity is within ±3% with asymmetric MLC apertures whereas it remains within ±4.5% with symmetric ones (except head region where it drops down to −7%). The substantial over and under dosage of ±5% at tissue interfaces has been reduced to ±2% with asymmetric MLC technique. Lungs dose can be reduced to any desired limit. In this experiment lungs dose was reduced to 80% of the prescribed dose, as was desired. Conclusion: The novel asymmetric MLC based technique assures optimum shielding of OARs (e.g. lungs) and better 3-D dose homogeneity and body-dose coverage in comparison with the symmetric MLC aperture optimization. The authors acknowledge the financial and infrastructural support provided by Pakistan Institute of Engineering & Applied Sciences (PIEAS), Islamabad and Aga Khan University Hospital (AKUH), Karachi during the course of this research project. Authors have no conflict of interest with any national / international body for the presented work.« less

A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma

PubMed Central

2012-01-01

Background Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins. Methods After obtaining clearance from the in-house ethical review committee, a prospective study was conducted at Aga Khan University Hospital, Karachi, from August 15, 2009 to March 14, 2010. A sample of 56 consenting patients with biopsy-proven OSCC were included in the study, giving us 280 tumor margins. Margins were analyzed using toluidine blue staining and frozen section histopathology. A receiver operator curve (ROC) was then applied to compare assessment of margin status by toluidine blue and frozen section. Results Of the 280 examined margins 11 stained positive with toluidine blue, three were positive on frozen section biopsy, and three were positive on final histopathology. Toluidine blue staining had sensitivity and specificity of 100% and 97%, respectively. The diagnostic accuracy of toluidine blue was found to be 97.1% with a positive predictive value (PPV) of 27.2% and a negative predictive value (NPV) of 100%. Conclusions Toluidine blue can be used as an effective screening modality for the assessment of intraoperative margins in resource limited environments and reducing the number of frozen section biopsies performed. Further by providing real-time clinical information within minutes it can reduce indirect costs such as operating room time. It may also be used as an ad hoc for frozen section biopsies where frozen section facilities are available. PMID:22500814

Spectrum of Celiac disease in Paediatric population: Experience of Tertiary Care Center from Pakistan.

PubMed

Aziz, Danish Abdul; Kahlid, Misha; Memon, Fozia; Sadiq, Kamran

2017-01-01

To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD). This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and non-diarrheal celiac disease (Atypical celiac) and their clinical features and relevant laboratory investigations were documented. Total 66 patients were selected with celiac disease according to inclusion criteria, 39 (59.09%) patients were labeled as CCD and 27 (40.91%) patients were labeled as NDCD. Marsh grading 3a and above were more marked in CCD as compared to NDCD. Mean titer for Tissue transglutaminase antibodies (TTG) were higher in CCD group in comparison to NDCD group. In CCD, the most common clinical presentations were abdominal distension whereas in NDCD, the most remarkable features were recurrent abdominal pain (62.9%). Frequency of failure to thrive is significantly high in CCD (82.05%) but patients merely with short stature were more common in NDCD (33.3%). Refractory anemia was present in 66.6% patients in NDCD group and 41.1% patients in CCD group. 74.3% patients in CCD group were vitamin D deficient whereas 85% patient had vitamin D deficiency in NDCD group (p= 0.03). NDCD is not uncommon in our population. Recurrent abdominal pain, failure to thrive or patients only with short stature and refractory anemia are prominent features in NCDC group whereas abdominal distension, failure to thrive and recurrent abdominal pain were noticeable features in CCD. High grade histopathology and raised antibodies titer is hallmark of CCD. Vitamin D deficiency is almost equally present in both groups.

Neonatal Hyperbilirubinemia in infants with G6PD c.563C > TVariant

PubMed Central

2012-01-01

Background There is a strong correlation between glucose-6-phosphate dehydrogenase (G6PD) deficiency and neonatal hyperbilirubinemia with a rare but potential threat of devastating acute bilirubin encephalopathy. G6PD deficiency was observed in 4–14% of hospitalized icteric neonates in Pakistan. G6PD c.563C > T is the most frequently reported variant in this population. The present study was aimed at evaluating the time to onset of hyperbilirubinemia and the postnatal bilirubin trajectory in infants having G6PD c.563C > T. Methods This was a case–control study conducted at The Aga Khan University, Pakistan during the year 2008. We studied 216 icteric male neonates who were re-admitted for phototherapy during the study period. No selection was exercised. Medical records showed that 32 were G6PD deficient while 184 were G6PD normal. Each infant was studied for birth weight, gestational age, age at the time of presentation, presence of cephalhematoma, sepsis and neurological signs, peak bilirubin level, age at peak bilirubin level, days of hospitalization, whether phototherapy or exchange blood transfusion was initiated, and the outcome. During hospital stay, each baby was tested for complete blood count, reticulocyte count, ABO and Rh blood type, direct antiglobulin test and quantitative G6PD estimation [by kinetic determination of G6PDH]. G6PDgenotype was analyzed in 32 deficient infants through PCR-RFLP analysis and gene sequencing. Results G6PD variants c.563C > T and c.131 C > G were observed in 21 (65%) and three (9%) of the 32 G6PD deficient infants, respectively. DNA of eight (25%) newborns remained uncharacterized. In contrast to G6PD normal neonates, infants with c.563C > T variant had significantly lower enzyme activity (mean ± 1SD; 0.3 ± 0.2 U/gHb vs. 14.0 ± 4.5 U/gHb, p < 0.001) experienced higher peak levels of total serum bilirubin (mean ± 1SD; 16.8 ± 5.4 mg/dl vs. 13.8 ± 4.6 mg/dl, p = 0.008) which peaked earlier after birth (mean ± 1SD 2.9 ± 1.6 vs. 4.3 ± 2.3 days, p = 0.007). No statistically significant difference was observed in mean weight, age at presentation, hemoglobin, reticulocyte count, TSH level, hospital stay or in the frequency of initiation of phototherapy or blood exchange between the two groups. Conclusions We concluded that infants with G6PD c.563C > T variant developed jaundice earlier than infants with normal G6PD enzyme levels. Compared to G6PD normal infants, G6PD c.563C > T carrying infants had significantly low G6PD activity. PMID:22906047

Environmental Issues in Further and Higher Education. Conference Proceedings (Bristol, England, United Kingdom).

ERIC Educational Resources Information Center

Khan, Shirley Ali; And Others

1993-01-01

A conference was held to improve the environmental awareness of colleges in such areas as energy conservation, waste management, transportation policy, and use of grounds. This document contains the presentations of speakers who attended the conference. Chapter 1, "Greening Further and Higher Education" (Shirley Ali Khan), discusses the…

Issues in the Convergence of Control with Communication and Computation

DTIC Science & Technology

2004-10-04

Library/Upload/116/Cal1.doc. [42] M. H. Shwehdi and A. Z. Khan, “A power line data communication interface using spread spectrum technology in home ... automation ,” IEEE Transactions on Power Delivery, vol. 11, pp. 1232–1237, July 1996. ISSN: 0885-8977. [43] R. G. Olsen, “Technical considerations for

Teaching with Technology: Using Websites and Videos to Increase Understanding of Bacterial Transformation

ERIC Educational Resources Information Center

McCormack, Stephanie; Ross, Donna L.

2010-01-01

Technology can be a powerful tool to increase motivation, engagement, and achievement (Park, Khan, and Petrina 2009). In this article, the authors describe their collaborative approach to integrating technology with a lab on bacterial transformation. Students view websites and create videos to increase their conceptual understanding. Although the…

75 FR 60068 - Global Free Flow of Information on the Internet

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-29

...\\ Id. \\8\\ Khan, et. al., Mobile Advertising: An In-Depth Look at the Future of Mobile Advertising, J.P... shaped the questions described below. The Task Force now seeks detailed comments from all stakeholders on...., Access Controlled: The Shaping of Power, Rights, and Rule in Cyberspace (MIT Press 2010), at 6. Many...

The Influence of Islam in the Military; Comparative Study of Malaysia, Indonesia and Pakistan

DTIC Science & Technology

2004-03-01

3(1) of the Federal constitution since independence.90 However, it never practiced ‘shariah’ law because the first Prime Minister, Tunku Abdul ......the military to be professional and modern. Musharraf also brought in his men to head the military with Lt Gen Muhammad Aziz Khan and Lt Gen

KSC-04pd1104

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- Sashikant Dhawan is costume director with the film crew from India who spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. Ashutosh Gowariker is the writer-director. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Implementing Comprehensive Teacher Training in Business Doctoral Programs

ERIC Educational Resources Information Center

Brightman, Harvey J.; Nargundkar, Satish

2013-01-01

The advent of digital course offerings, the use of social media, the integration of the Khan Academy into curricula, the use of smart phones and tablets, and massive online courses place greater emphasis than ever on effective teaching. While business schools fund faculty development in teaching, too few doctoral programs offer systematic teacher…

Further Thoughts on "How Task Features Impact Evidence from Assessments Embedded in Simulations and Games"

ERIC Educational Resources Information Center

Oliveri, María Elena; Khan, Saad

2014-01-01

María Oliveri, and Saad Khan write that the article: "How Task Features Impact Evidence from Assessments Embedded in Simulations and Games" provided helpful illustrations regarding the implementation of evidence-centered assessment design (Mislevy & Haertel, 2006; Mislevy, Steinberg, & Almond, 1999) with games and simulations.…

Mobile Panoramic Video Applications for Learning

ERIC Educational Resources Information Center

Multisilta, Jari

2014-01-01

The use of videos on the internet has grown significantly in the last few years. For example, Khan Academy has a large collection of educational videos, especially on STEM subjects, available for free on the internet. Professional panoramic video cameras are expensive and usually not easy to carry because of the large size of the equipment.…

Making Our Judgments Right: Ethics of Corporal Punishment in Indian Schools

ERIC Educational Resources Information Center

Tiwari, Ashwini

2015-01-01

The case "Ayub Khan v. Municipal Corporation of Delhi Schools" is one of the landmark cases for promoting a conversation on ethics of corporal punishment in Indian society. Based on literature synthesis and the critical examination of the Court case using ethical frameworks (Stefkovich, 2006; Stefkovich & Shapiro, 2010) this paper…

Try Sci Fi for Reading That's Out of This World!

ERIC Educational Resources Information Center

Bell, Robert; Zjawin, Dorothy

1983-01-01

Teachers can capitalize on children's interest in recent science fiction movies by using books based on the films in their classrooms. Books taken from "E. T.,""Star Wars,""The Empire Strikes Back," and "The Wrath of Khan" are summarized, and learning activities to be used in conjunction with the books are suggested. (PP)

Isolation of Escherichia coli Strains with AcrAB–TolC Efflux Pump-Associated Intermediate Interpretation or Resistance to Fluoroquinolone, Chloramphenicol and Aminopenicillin from Dogs Admitted to a University Veterinary Hospital

PubMed Central

SATO, Toyotaka; YOKOTA, Shin-ichi; ICHIHASHI, Risa; MIYAUCHI, Tomoka; OKUBO, Torahiko; USUI, Masaru; FUJII, Nobuhiro; TAMURA, Yutaka

2014-01-01

ABSTRACT Understanding the prevalence of antimicrobial-resistance and the relationship between emergence of resistant bacteria and clinical treatment can facilitate design of effective treatment strategies. We here examined antimicrobial susceptibilities of Escherichia coli isolated from dogs admitted to a university hospital (University hospital) and companion animal clinics (Community clinics) in the same city and investigated underlying multidrug-resistance mechanisms. The prevalence of E. coli with intermediate and resistant interpretations to ampicillin (AMP), enrofloxacin (ENR) and chloramphenicol (CHL) was higher in the University hospital than in the Community clinics cases. Use of antimicrobials, including fluoroquinolone, was also significantly higher in the University hospital than in the Community clinics cases. Upon isolation using ENR-supplemented agar plates, all ENR-resistant isolates had 3–4 nucleotide mutations that accompanied by amino acid substitutions in the quinolone-resistance-determining regions of gyrA, parC and parE, and 94.7% of all isolates derived from the University hospital showed AMP and/or CHL resistance and possessed blaTEM and/or catA1. The average mRNA expression levels of acrA, acrB and tolC and the prevalence of organic solvent tolerance, in isolates derived from ENR-supplemented agar plates were significantly higher in the University hospital than in the Community clinics isolates. Thus, E. coli derived from the University hospital cases more often showed concomitant decreased susceptibilities to aminopenicillins, fluoroquinolones and CHL than did those derived from the Community clinics; this was related to an active AcrAB–TolC efflux pump, in addition to acquisition of specific resistance genes and genetic mutations. PMID:24646457

[Postgraduate training program in neurology at the regional hospitals in Hokkaido area].

PubMed

Matsumoto, Akihisa

2007-11-01

In the new post graduate training system, the 55% of interns in the Hokkaido area choosed the post graduate training at the general hospitals and 45% of them choosed the medical universities (Hokkaido university, Asahikawa medical university, Sapporo medical university). Furthermore, 23% of interns in Hokkaido area choosed the general hospitals and medical universities in Sapporo city. As to the post graduate training system in neurology, 5 hospitals included the neurology for at least 1 month to 3 months. On the other hand, in one general hospital in Sapporo city, the clinical training of neurology was not included in the post graduate training system. During 2 years of the new post graduate training system, only 25% of the interns could rotate the neurological department. Since the neurology training course is necessary for the post graduate training system, it is suggested to need to support the opportunity to rotate the neurology for the interns.

O Brincar como uma Acao Mediadora no Trabalho Desenvolvido com Criancas Hospitalizadas (Play as a Mediating Activity in Work Developed with Hospitalized Children).

ERIC Educational Resources Information Center

Goulart, Aurea Maria Paes Leme; de Moraes, Silvia Pereira Gonzaga

2000-01-01

Describes experiences with hospitalized children through the extension project "Writing and Reading at the University Hospital", State University of Maringa Hospital (Brazil). States the initial project proposal provided educational assistance to the children separated from school due to being in the hospital. Used play and games as an…

Looking at eye dominance from a different angle: is sighting strength related to hand preference?

PubMed

Carey, David P; Hutchinson, Claire V

2013-10-01

Sighting dominance (the behavioural preference for one eye over the other under monocular viewing conditions) has traditionally been thought of as a robust individual trait. However, Khan and Crawford (2001) have shown that, under certain viewing conditions, eye preference reverses as a function of horizontal gaze angle. Remarkably, the reversal of sighting from one eye to the other depends on which hand is used to reach out and grasp the target. Their procedure provides an ideal way to measure the strength of monocular preference for sighting, which may be related to other indicators of hemispheric specialisation for speech, language and motor function. Therefore, we hypothesised that individuals with consistent side preferences (e.g., right hand, right eye) should have more robust sighting dominance than those with crossed lateral preferences. To test this idea, we compared strength of eye dominance in individuals who are consistently right or left sided for hand and foot preference with those who are not. We also modified their procedure in order to minimise a potential image size confound, suggested by Banks et al. (2004) as an explanation of Khan and Crawford's results. We found that the sighting dominance switch occurred at similar eccentricities when we controlled for effects of hand occlusion and target size differences. We also found that sighting dominance thresholds change predictably with the hand used. However, we found no evidence for relationships between strength of hand preference as assessed by questionnaire or by pegboard performance and strength of sighting dominance. Similarly, participants with consistent hand and foot preferences did not show stronger eye preference as assessed using the Khan and Crawford procedure. These data are discussed in terms of indirect relationships between sighting dominance, hand preference and cerebral specialisation for language and motor control. Copyright © 2013 Elsevier Ltd. All rights reserved.

Molecular Genealogy of a Mongol Queen’s Family and Her Possible Kinship with Genghis Khan

PubMed Central

Lkhagvasuren, Gavaachimed; Shin, Heejin; Lee, Si Eun; Tumen, Dashtseveg; Kim, Jae-Hyun; Kim, Kyung-Yong; Kim, Kijeong; Park, Ae Ja; Lee, Ho Woon; Kim, Mi Jin; Choi, Jaesung; Choi, Jee-Hye; Min, Na Young

2016-01-01

Members of the Mongol imperial family (designated the Golden family) are buried in a secret necropolis; therefore, none of their burial grounds have been found. In 2004, we first discovered 5 graves belonging to the Golden family in Tavan Tolgoi, Eastern Mongolia. To define the genealogy of the 5 bodies and the kinship among them, SNP and/or STR profiles of mitochondria, autosomes, and Y chromosomes were analyzed. Four of the 5 bodies were determined to carry the mitochondrial DNA haplogroup D4, while the fifth carried haplogroup CZ, indicating that this individual had no kinship with the others. Meanwhile, Y-SNP and Y-STR profiles indicate that the males examined belonged to the R1b-M343 haplogroup. Thus, their East Asian D4 or CZ matrilineal and West Eurasian R1b-M343 patrilineal origins reveal genealogical admixture between Caucasoid and Mongoloid ethnic groups, despite a Mongoloid physical appearance. In addition, Y chromosomal and autosomal STR profiles revealed that the four D4-carrying bodies bore the relationship of either mother and three sons or four full siblings with almost the same probability. Moreover, the geographical distribution of R1b-M343-carrying modern-day individuals demonstrates that descendants of Tavan Tolgoi bodies today live mainly in Western Eurasia, with a high frequency in the territories of the past Mongol khanates. Here, we propose that Genghis Khan and his family carried Y-haplogroup R1b-M343, which is prevalent in West Eurasia, rather than the Y-haplogroup C3c-M48, which is prevalent in Asia and which is widely accepted to be present in the family members of Genghis Khan. Additionally, Tavan Tolgoi bodies may have been the product of marriages between the lineage of Genghis Khan’s Borjigin clan and the lineage of either the Ongud or Hongirad clans, indicating that these individuals were members of Genghis Khan’s immediate family or his close relatives. PMID:27627454

Which Implant Is Best After Failed Treatment for Pathologic Femur Fractures?

DTIC Science & Technology

2012-01-01

performed at the Karolinska University Hospital, Stockholm, Sweden. J. A. Forsberg (&) Regenerative Medicine, Naval Medical Research Center, Silver...Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden 123 Clin Orthop Relat Res DOI 10.1007/s11999-012-2558-2...NAME(S) AND ADDRESS(ES) Karolinska Institute, Karolinska University Hospital,Section of Orthopaedics and Sports Medicine, Department,of Molecular

A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel.

PubMed

Muhsen, Khitam; Rubenstein, Uri; Kassem, Eias; Goren, Sophy; Schachter, Yaakov; Kremer, Adi; Shulman, Lester M; Ephros, Moshe; Cohen, Dani

2015-01-01

Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008-2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011-2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0-23 months (60-61%) than in toddlers aged 24-59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.

Making collaboration work.

PubMed

Sims, Alison

2016-10-07

The Children's Hospitals Network (CHN) was formed in 2012 following a review of national specialist services. Oxford University Hospitals NHS Foundation Trust (OUH) and the University Hospital Southampton NHS Foundation Trust (UHS) collaborated in its formation, with the CHN hosting clinical and operational networks across more than 20 district general hospitals in the Thames Valley and Wessex regions.

[Efforts of gender equality at Kinki University School of Medicine].

PubMed

Miyamoto, Katsuichi

2013-01-01

In recent years, medical doctors are in short supply in many university hospitals. Retirement of female doctor after delivery is one of the reasons. Although they want to return to work after giving birth, they quit unavoidable because the working conditions do not match. Then, Kinki university hospital established the "provisions for special work arrangements". This work arrangement is the wage less, but the working hours is less than the regular. This work arrangement increased returner to the university hospital after delivery.

[Evaluation of the management of soft tissue sarcomas in Franche-Comté since the establishment of a multidisciplinary meeting at University Hospital. About 47 cases].

PubMed

Haddad, J; Kalbacher, E; Piccard, M; Aubry, S; Chaigneau, L; Pauchot, J

2017-02-01

A multidisciplinary meeting (RCP) dedicated to the treatment of sarcoma was established in Franche-Comte in 2010. The goals of the study are: (a) To evaluate the treatment of sarcomas by confrontation with the existing literature; (b) To evaluate the influence of the multidisciplinary meeting on the management of sarcomas by hospitals at the regional level. This is a retrospective single center study from 2010 to 2015 on patients with sarcoma and peripheral soft tissue drawn from a Netsarc database (National Network of sarcomas) and communicating cancer record. A database Cleanweb especially dedicated is created. Forty-seven patients were included: ten sarcomas at the upper member 26 to the lower limbs, 11 on the trunk. Forty patients were operated on: ten out of the university hospital, 28 at the university hospital and two in a coordinating center. Ninety percent of patients treated at the university hospital were in accordance with the recommandations. None of the patients operated out of the university hospital benefited from medical care in accordance to the recommendations. There is an increase in the number of files sent by the hospitals out of the university hospital discussed in multidisciplinary meeting, before treatment. The creation of a dedicated multidisciplinary meeting sarcoma improves the medical management of these tumors and decreases inappropriate medical managements thanks to a better education of the regional physicians. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Psychiatric Morbidity, Perceived Stress and Ways of Coping Among Parents of Children With Intellectual Disability in Lahore, Pakistan

PubMed Central

Ashraf, Sania; Imran, Nazish; Hussain, Sadia; Azeem, Muhammad W

2018-01-01

Background This study assessed anxiety and depression levels among parents of children with intellectual disability (ID) and analyzed their coping strategies. Methods One hundred parents of children with ID were recruited through child psychiatry outpatient services in a tertiary care setting in Lahore, Pakistan. A structured questionnaire including sociodemographic details, the Agha Khan University Anxiety Depression Scale, the Family Stress and Coping Questionnaire, Brief COPE questionnaire, and Support questionnaire were used for data collection. Results The mean age of parents was 35 years, and the majority of parents (86%) in the study were females. Seventy percent of the parents had significant levels of anxiety and depression. Parents mostly used emotion-based coping to deal with their anxiety and depression; self-distraction, behavioral disengagement, and venting were the main coping strategies used. Conclusions The study showed family stressors, various coping strategies, and support sources in depressed parents who are taking care of their intellectually disabled children. Based on these results, effective culturally sensitive intervention programs can be designed to educate parents and help them effectively cope with stress. PMID:29666778

Psychiatric Morbidity, Perceived Stress and Ways of Coping Among Parents of Children With Intellectual Disability in Lahore, Pakistan.

PubMed

Sheikh, Muhammad H; Ashraf, Sania; Imran, Nazish; Hussain, Sadia; Azeem, Muhammad W

2018-02-16

Background This study assessed anxiety and depression levels among parents of children with intellectual disability (ID) and analyzed their coping strategies. Methods One hundred parents of children with ID were recruited through child psychiatry outpatient services in a tertiary care setting in Lahore, Pakistan. A structured questionnaire including sociodemographic details, the Agha Khan University Anxiety Depression Scale, the Family Stress and Coping Questionnaire, Brief COPE questionnaire, and Support questionnaire were used for data collection. Results The mean age of parents was 35 years, and the majority of parents (86%) in the study were females. Seventy percent of the parents had significant levels of anxiety and depression. Parents mostly used emotion-based coping to deal with their anxiety and depression; self-distraction, behavioral disengagement, and venting were the main coping strategies used. Conclusions The study showed family stressors, various coping strategies, and support sources in depressed parents who are taking care of their intellectually disabled children. Based on these results, effective culturally sensitive intervention programs can be designed to educate parents and help them effectively cope with stress.

Death and Rebirth in "Star Trek II: The Wrath of Khan."

ERIC Educational Resources Information Center

Roth, Lane

"Star Trek II" is a treatment of the penultimate stages of the monomyth in which the hero descends into the underworld and is reborn. This psychological sense of rebirth is evoked in modern audiences by the film. In particular, the doppelganger (psychic double) motif, so often associated in film, literature, and myth with the…

Driver Performance and Behavior in Adverse Weather Conditions: An Investigation Using the SHRP2 Naturalistic Driving Study Data—Phase 2

DOT National Transportation Integrated Search

2018-02-01

Ahmed (orcid.org/0000-0002-1921-0724); Ghasemzadeh (orcid.org/0000-0003-1232-251X); Hammit (orcid.org/0000-0002-8859-9075); Khan (orcid.org/0000-0001-5996-091X); Das (orcid.org/0000-0003-4674-5334); Ali (orcid.org/0000-0001-7643-7143); Eldeeb (orcid....

A Question of Evidence, or a Leap of Faith?

ERIC Educational Resources Information Center

Howard, Jennifer

2008-01-01

Did he or didn't he? The question is vexing Coleridge scholars. Did the author of "Christabel," "Kubla Khan," and "The Rime of the Ancient Mariner" compose a blank-verse translation of Goethe's "Faust" that was published anonymously in London in 1821? Two prominent Romanticists, Frederick Burwick and James C. McKusick, both Americans, believe they…

First report of ratoon stunt of sugarcane caused by Leifsonia xyl. subsp. xyli in Pakistan

USDA-ARS?s Scientific Manuscript database

During a survey of the sugarcane crop in the area of Faisalabad, Sargodha and the Dera Ghazi Khan Division of the Punjab province of Pakistan from 2007 to 2010, symptoms consistent with ratoon stunting, including stunted growth and reddening of the vascular bundles at the nodal regions were observed...

A Bold New Math Class

ERIC Educational Resources Information Center

Khan, Salman; Slavitt, Elizabeth

2013-01-01

Summit San Jose is part of the Summit Public Schools network, a group of charter schools in California's Bay Area. In 2011, when Summit San Jose first opened its new high school with a cohort of 9th graders, the teachers decided to pilot Khan Academy. At the time, they had piloted their math resources and platform with five classrooms in Los…

Improving Early-Grade Literacy in East Africa: Experimental Evidence from Kenya and Uganda

ERIC Educational Resources Information Center

Lucas, Adrienne M.; McEwan, Patrick J.; Ngware, Moses; Oketch, Moses

2014-01-01

Primary school enrollments have increased rapidly in sub-Saharan Africa, spurring concerns about low levels of learning. We analyze field experiments in Kenya and Uganda that assessed whether the Reading to Learn intervention, implemented by the Aga Khan Foundation in both countries, improved early-grade literacy as measured by common assessments.…

Learner Behaviour in a MOOC Practice-Oriented Course: In Empirical Study Integrating TAM and TPB

ERIC Educational Resources Information Center

Yang, Hsi-Hsun; Su, Chung-Ho

2017-01-01

Few practice-oriented courses are currently integrated into online learning platforms, such as OpenCourseWare, Khan Academy, and Massive Open Online Courses (MOOCs). It is worthwhile to explore how learners respond to information technology and new teaching methods when practice-oriented course are placed online. Therefore, this study probes…

Evaluating the Relevance of Educational Videos Using BKT and Big Data

ERIC Educational Resources Information Center

MacHardy, Zachary; Pardos, Zachary A.

2015-01-01

Along with the advent of MOOCs and other online learning platforms such as Khan Academy, the role of online education has continued to grow in relation to that of traditional on-campus instruction. Rather than tackle the problem of evaluating large educational units such as entire online courses, this paper approaches a smaller problem: exploring…

Envisioning an Alternative to the Neoliberalization of Education in the Global South: The Aga Khan's Philosophies of Education

ERIC Educational Resources Information Center

Khoja-Moolji, Shenila S.

2017-01-01

Studies in education over the past decade highlight the hijacking of educational agendas by neoliberal rationalities and logics. I illustrate these processes in relation to transnational campaigns for girls' education, where the purpose of "education" is reduced to producing wage-based labor and an accumulation of skills that enhance…

The Common Vision: Parenting and Educating for Wholeness.

ERIC Educational Resources Information Center

Marshak, David

2003-01-01

Presents a spiritually based view of needs and potentials of children and youth, from birth through age 21, based on works of Rudolf Steiner, Sri Aurobindo Ghose, and Hazrat Inayat Khan. Focuses on their common vision of the true nature of human beings, the course of human growth, and the desired functions of child rearing and education.…

KSC-04PD-1098

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The writer and director is Ashutosh Gowariker and lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04PD-1097

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The writer and director is Ashutosh Gowariker and lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Willingness of Medical Students for Hepatitis B & C Screening

ERIC Educational Resources Information Center

Ahmad, Iftikhar; Mahsud, Muhammad Amin Jan; Hussain, Javed; Khan, Muhammad Hussain; Khan, Habibullah; Noman, Nargis; Rabi, Fazle, Din, Siraj ud

2010-01-01

Background: Health care workers including medical students are vulnerable to hepatitis B & C virus infections. The objective of this study was to determine the level of willingness for screening among medical students. Methodology: This cross-sectional survey was carried out at Gomal Medical College, Dera Ismail Khan from 1st April 2010 to 15…

The Math of Khan

ERIC Educational Resources Information Center

Schaffhauser, Dian

2013-01-01

It's like a dream come true for educators: free resources available wherever a web browser can operate and with nary an iota of advertising. What's not to like? What is it about this organization, whose mission is "to provide a free, world-class education for anyone anywhere," that has provoked such vitriol? Part of it is that when its videos have…

[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.

Hospitality Major Vocational High School Students' Expectations on University Education

ERIC Educational Resources Information Center

Chung, Ya-Ting; Yang, Cheng-Cheng

2013-01-01

Hospitality is not a new industry in Asia, but high quality hospitality industry has become more and more important in the trend of questing service-based economy and the increasing number of tourists in Asia. Thus there are more universities opened hospitality degree programs in Asia, Taiwan is no exception. In this context, why high school…

Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme

ERIC Educational Resources Information Center

Pongpirul, Krit

2011-01-01

In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

What affects local community hospitals' survival in turbulent times?

PubMed

Chiang, Hung-Che; Wang, Shiow-Ing

2015-06-01

Hospital closures became a prevalent phenomenon in Taiwan after the implementation of a national health insurance program. A wide range of causes contributes to the viability of hospitals, but little is known about the situation under universal coverage health systems. The purpose of present study is to recognize the factors that may contribute to hospital survival under the universal coverage health system. This is a retrospective case-control study. Local community hospitals that contracted with the Bureau of National Health Insurance in 1998 and remained open during the period 1998-2011 are the designated cases. Controls are local community hospitals that closed during the same period. Using longitudinal representative health claim data, 209 local community hospitals that closed during 1998-2011 were compared with 165 that remained open. Variables related to institutional characteristics, degree of competition, characteristics of patients and financial performance were analyzed by logistic regression models. Hospitals' survival was positively related to specialty hospital, the number of respiratory care beds, the physician to population ratio, the number of clinics in the same region, a highly competitive market and the occupancy rate of elderly patients in the hospital. Teaching hospitals, investor-owned hospitals, the provision of obstetrics services or home care, and the number of medical centers or other local community hospitals may jeopardize the chance of survival. Factors-enhanced local hospitals to survive under the universal coverage health system have been identified. Hospital managers could manipulate these findings and adapt strategies for subsistence. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

[Diagnosing gender identity].

PubMed

Kaltiala-Heino, Riittakerttu; Mattila, Aino; Kärnä, Teemu; Joutsenneimi, Kaisla

2015-01-01

Transsexualism and other variations of gender identity are based on a stable sense of identity. The aetiology of this phenomenon is not fully known. Suffering caused by gender dysphoria is alleviated with sex reassignment. The psychiatric assessment of both adolescents and adults has been centralized in Finland to two university hospitals, the Helsinki University Hospital and Tampere University Hospital. In both hospitals, multidisciplinary teams aim at differential diagnosis by using well-known psychiatric and psychological instruments. Wishes for sex reassignment that are caused by a mental health disorder are excluded. Assessment in adolescence is challenging because the identity in youth is still forming.

Impact of Terrorism on Managerial Efficiency of Heads of Secondary Schools in Khyber Pakhtunkhwa, Pakistan

ERIC Educational Resources Information Center

Khattak, Usman Ghani; Iqba, Javed

2015-01-01

Terrorism has adversely affected the educational environment in Khyber Pakhtoon Khwa Province. This study was conducted to know the impact of Terrorism on managerial efficiency of heads of secondary schools in Khyber Pakhtoon Khwa that included Malakand, Mangawara, Dir, Hangu , Bannu and D I Khan which are the highly affected areas of terrorism.…

Impact of Visual Aids in Enhancing the Learning Process Case Research: District Dera Ghazi Khan

ERIC Educational Resources Information Center

Shabiralyani, Ghulam; Hasan, Khuram Shahzad; Hamad, Naqvi; Iqbal, Nadeem

2015-01-01

This research explores teachers' opinions on the use of visual aids (e.g., pictures, animation videos, projectors and films) as a motivational tool in enhancing students' attention in reading literary texts. To accomplish the aim of the research, a closed ended questionnaire was used to collect the required data. The targeted population for this…

KSC-04pd1098

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker and lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04pd1097

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker and lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04PD-1100

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The writer and director is Ashutosh Gowariker, standing at left. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Expanding the Qawm: Culturally Savvy Counterinsurgency and Nation-Building in Afghanistan

DTIC Science & Technology

2010-03-31

logical step in that it contravenes the proclivity to impose a single, nationwide template upon an inherently local issue. As anthropologist Kevin ...of Islam without the need to communicate in a hierarchical line with leadership .” 42...middle of a competition between tribal, or qawm leadership institutions, such as jirgas and khans; religious functionaries, to include shuras and

Letters

NASA Astrophysics Data System (ADS)

2008-07-01

Confused or incorrect? J Khan Reply to the above letter from the authors of 'Aerodynamics experiments with an observable airflow: a fog-wind-tunnel' B Priemer A misleading explanation H Fricker Reply to the above letter from the authors of 'Demonstrate Lenz's law with an aluminium ring' Lyna, C T Chee, C L Sai, G N Khang and T A Ling The heart of the problem B Marshall

Khan Academy Videos in Chinese: A Case Study in OER Revision

ERIC Educational Resources Information Center

Rao, Allen; Hilton, John, III; Harper, Sarah

2017-01-01

Over the past decade, great progress has been made in improving the quality and availability of Open Educational Resources (OER). OER proponents often discuss the ability for users to revise and remix OER to make them more suitable for local contexts; however, much OER goes unmodified. This note from the field examines the efforts of NetEase…

Education in Dede Korkut's Stories: Qualification of Bravery in Boghach Khan and Uruz

ERIC Educational Resources Information Center

Firat, Hatice

2014-01-01

Dede Korkut's stories, one of the most important works in Turkish literature, are distinguished with their feature of reflecting the Oghuz culture. In this respect, it is possible to obtain information about children and their education in the light of the works. In the study, it is intended to reveal the education of the characters called Boghach…

Two new species of Paurodontella Husain and Khan, 1968 (Nematoda: Sphaerulariidae) associated with wheat and a diagnostic compendium to the genus

USDA-ARS?s Scientific Manuscript database

An identification key to 10 valid species of Paurodontella is given. A compendium of the most important diagnostic characters with illustrations of each species is included as a practical alternative and supplement to the key. The diagnosis of Paurodontella is emended and a list of all valid specie...

The Influence of Parents Educational Level on Secondary School Students Academic Achievements in District Rajanpur

ERIC Educational Resources Information Center

Khan, Rana Muhammad Asad; Iqbal, Nadeem; Tasneem, Saima

2015-01-01

This study was conducted to focus the influence and impact of parents educational level on students academic achievement at secondary level of education. The study utilizes the students results of the 9th class in secondary school certificate examination taken by the Board of Intermediate & Secondary Education Dera Ghazi Khan. Oral interview,…

Fluoride enrichment in groundwater of semi-arid urban area: Khan Younis City, southern Gaza Strip (Palestine)

NASA Astrophysics Data System (ADS)

Abu Jabal, Mohamed Shaban; Abustan, Ismail; Rozaimy, Mohd Remy; Al-Najar, Hussam

2014-12-01

The aim of this study is to determine fluoride enhancement in the groundwater of semi-arid urban area of Khan Younis City, southern Gaza Strip. Physicochemical data for a total of 200 groundwater samples were analyzed. The fluoride concentrations were varied from 0.3 to 6.45 mg/L with average value of 2.87 mg/L. Correlations between fluorides with other measured ions were relatively observed, negative correlation with calcium and the positive correlation with pH, bicarbonate and sodium increase the dissolution/solubility of fluoride bearing minerals, leading to fluoride leaching into the groundwater. Fluoride enrichment in the groundwater of the area is due to water hydrochemistry, mineral-water interaction (mainly calcite and fluorite), fluorite resulted from fluorapatite dissolution. The saturation indexes evaluation indicated that 42% of the samples are over saturated with respect to calcite and 35.5% under saturated with respect to fluorite, while 40.5% approached equilibrium with respect to both calcite and fluorite. At fluoride concentrations of less than 2.2 mg/L fluorite saturation indexes show under-saturation condition for fluorite and at higher fluoride concentrations show near saturation condition.

Radio advertising increases hospital call center volume by 48%.

PubMed

2006-01-01

Since the fall of 2005, call volume at University of Southern California University Hospital of Los Angeles' call center has increased by nearly 50%. How? The hospital embarked on a long-term radio campaign to promote its presence as a premier academic medical center and to increase patient volume.

Aggressive television ad campaign for Cooper University Hospital features hometown celebrity.

PubMed

2006-01-01

Cooper University Hospital in Camden, NJ, features an extensive ambulatory care network that includes practice sites across eight counties of Southern New Jersey. Recently, the hospital worked with Willing Strategic Advertising to produce an award-winning television advertising campaign endorsed by New Jersey-born TV personality, Kelly Ripa.

Tertiary-care facility's seniors association attracts its highest number of referrals through word-of-mouth. University Hospital, Denver, CO.

PubMed

Lewicki, G

1999-01-01

University Hospital, Denver, has started its University Seniors Assn. to promote health and wellness to people 50 and older. Within four months the organization had 500 members. Now the association is 3,500 members strong.

Adverse Events in Affiliated Hospitals of Mazandaran University of Medical Sciences

PubMed Central

Saravi, Benyamin Mohseni; Siamian, Hasan; Nezhad, Ayyob Barzegar; Asghari, Zoleleykha; Kabirzadeh, Azar

2014-01-01

Due to the complexity of the hospital environment, its structure faces with multiple hazards. The risks whether by providing the care and whether by hospital environment endanger patients, relatives and care providers. Therefore, a more accurate reporting and analysis of the report by focusing on access to preventative methods is essential. In this study, hospitals' adverse event that has sent by affiliated hospitals of Mazandaran University of Medical Sciences to deputy for treatment has studied. PMID:24944536

The O3-Vet project: integration of a standard nomenclature of clinical terms in a veterinary electronic medical record for veterinary hospitals.

PubMed

Zaninelli, M; Campagnoli, A; Reyes, M; Rojas, V

2012-11-01

In order to improve the hospital information system of the Chilean University Hospital, the Veterinary Medicine School of Universidad de Chile made a research cooperation with Università San Raffaele Roma to develop and test a new release of the O3-Vet software application. O3-Vet was selected by the Chilean University mainly for two reasons: (1) it uses human medicine standardized technologies such as "Health Level 7" (HL7) and "Integrating the Healthcare Enterprise" (IHE), which allow a good level of data sharing and hospital management; (2) it is open source, which means it can be adapted to specific hospital needs. In the new release, a subset of diagnostic terms was added from the "Systematized Nomenclature of Medicine Clinical Terms" (SNOMED CT), selected by the "American Animal Hospital Association" (AAHA) to standardize the filing of clinical data and its retrieval. Results from a limited survey of veterinarians of the University (n=9) show that the new release improved the management of the Chilean University Hospital and the ability to retrieve useful clinical data. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

California's county hospitals and the University of California graduate medical education system. Current issues and future directions.

PubMed

Jameson, W J; Pierce, K; Martin, D K

1998-05-01

California's county hospitals train 45% of the state's graduate medical residents, including 33% of residents in the University of California system. This paper describes the interrelationships of California's county hospitals and the University of California (UC) graduate medical education (GME) programs, highlighting key challenges facing both systems. The mission of California's county health care systems is to serve all who need health care services regardless of ability to pay. Locating UC GME programs in county hospitals helps serve the public missions of both institutions. Such partnerships enhance the GME experience of UC residents, provide key primary care training opportunities, and ensure continued health care access for indigent and uninsured populations. Only through affiliation with university training programs have county hospitals been able to run the cost-effective, quality programs that constitute an acceptable safety net for the poor. Financial stress, however, has led county hospitals and UC's GME programs to advocate for reform in both GME financing and indigent care funding. County hospitals must participate in constructing strategies for GME reform to assure that GME funding mechanisms provide for equitable compensation of county hospitals' essential role. Joint advocacy will also be essential in achieving significant indigent care policy reform.

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…

Historical development of the renal histopathology services in Malaysia.

PubMed

Looi, Lai-Meng; Cheah, Phaik-Leng

2009-06-01

Western-style medicine was introduced to Malaya by the Portuguese, Dutch and British between the 1500s and 1800s. Although the earliest pathology laboratories were developed within hospitals towards the end of the 19th Century, histopathology emerged much later than the biochemistry and bacteriology services. The University Departments of Pathology were the pioneers of the renal histopathology diagnostic services. The Department of Pathology, University of Malaya (UM) received its first renal biopsy on 19 May 1968. Hospital Universiti Kebangsaan Malaysia (HUKM) and Hospital Universiti Sains Malaysia (HUSM) started their services in 1979 and 1987 respectively. It is notable that the early services in these University centres caterred for both the university hospitals and the Ministry of Health (MOH) until the mid-1990s when MOH began to develop its own services, pivoted on renal pathologists trained through Fellowship programmes. Currently, key centres in the MOH are Kuala Lumpur Hospital, Sultanah Aminah Hospital Johor Bahru and Malacca Hospital. With the inclusion of renal biopsy interpretation in the Master of Pathology programmes, basic renal histopathology services became widely available throughout the country from 2000. This subsequently filtered out to the private sector as more histopathologists embraced private practice. There is now active continuing professional development in renal histopathology through clinicopathological dicussions, seminars and workshops. Renal research on amyloid nephropathy, minimal change disease, IgA nephropathy, fibrillary glomerulonephritis, lupus nephritis and microwave technology have provided an insight into the patterns of renal pathology and changing criteria for biopsy. More recently, there has been increasing involvement of renal teams in clinical trials, particularly for lupus nephritis and renal transplant modulation.

Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare

PubMed Central

Choi, Jinwook; Seo, Jeong-Wook; Chung, Chun Kee; Kim, Kyung-Hwan; Kim, Ju Han; Kim, Jong Hyo; Chie, Eui Kyu; Cho, Hyun-Jai; Goo, Jin Mo; Lee, Hyuk-Joon; Wee, Won Ryang; Nam, Sang Mo; Lim, Mi-Sun; Kim, Young-Ah; Yang, Seung Hoon; Jo, Eun Mi; Hwang, Min-A; Kim, Wan Suk; Lee, Eun Hye; Choi, Su Hi

2010-01-01

Objectives Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. Methods The hospital information system in Seoul National University Hospital consists of component applications: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. Results Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. Conclusions Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system. PMID:21818449

Hospitable Gestures in the University Lecture: Analysing Derrida's Pedagogy

ERIC Educational Resources Information Center

Ruitenberg, Claudia

2014-01-01

Based on archival research, this article analyses the pedagogical gestures in Derrida's (largely unpublished) lectures on hospitality (1995/96), with particular attention to the enactment of hospitality in these gestures. The motivation for this analysis is twofold. First, since the large-group university lecture has been widely critiqued as…

Drug selection in French university hospitals: analysis of formularies for nine competitive pharmacological classes.

PubMed

Gallini, Adeline; Juillard-Condat, Blandine; Saux, Marie-Claude; Taboulet, Florence

2011-11-01

To give a panorama of the selectivity and agreement of French university hospitals' drug formularies (HDF) for nine competitive classes. All university hospitals were asked to send their HDF and selection criteria as of January 2009 for nine competitive pharmacological classes (proton pump inhibitors, serotonin antagonists, low molecular weight heparins, erythropoietins, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, statins, α-adrenoreceptor antagonists and selective serotonin re-uptake inhibitors). Selectivity of HDF was estimated by the percentage of drug entities selected by the hospital within the pharmacological class. Agreement between hospitals was assessed with modified kappa coefficients for multi-raters. Twenty-one out of the 29 hospitals agreed to participate. These hospitals selected between 34% and 63% of the drug entities available for the nine classes, which represented 18 to 35 agents. Regarding the nature of chosen drug entities, the overall level of agreement was 'fair' and varied with pharmacological classes. Selection criteria were sent by only 12 hospitals. The technical component was the most important element in all hospitals. The weight of the economic component varied between 20% and 40% in the tender's grade. Large variations were seen in the number and nature of drugs selected by university hospitals which can be attributable to two successive decision-making processes (evaluation by the Drug and Therapeutics Committee followed by the purchasing process). © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

Impact of structural and economic factors on hospitalization costs, inpatient mortality, and treatment type of traumatic hip fractures in Switzerland.

PubMed

Mehra, Tarun; Moos, Rudolf M; Seifert, Burkhardt; Bopp, Matthias; Senn, Oliver; Simmen, Hans-Peter; Neuhaus, Valentin; Ciritsis, Bernhard

2017-12-01

The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively. The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland. The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed. We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals respectively). The proportion of privately insured varied between 16.0% in university hospitals and 38.9% in specialized hospitals. Private insurance had an OR of 1.419 (95% CI 1.306-1.542) in predicting treatment of a hip fracture with primary hip replacement. The seeming importance of insurance type on hip fracture treatment and the large inequity in the distribution of privately insured between provider types would be worth a closer look by the regulatory authorities. Better outcomes, i.e., lower mortality rates for hip fracture treatment in hospitals with a higher structural care level advocate centralization of care.

Going all digital in a university hospital: a unified large-scale PACS for multiple departments and hospitals

NASA Astrophysics Data System (ADS)

Vogl, Raimund

2001-08-01

In 1997, a large PACS was first introduced at Innsbruck University Hospital in the context of a new traumatology centre. In the subsequent years, this initial PACS setting covering only one department was expanded to most of the hospital campus, with currently some 250 viewing stations attached. Constantly connecting new modalities and viewing stations created the demand for several redesigns from the original PACS configuration to cope with the increasing data load. We give an account of these changes necessary to develop a multi hospital PACS and the considerations that lead us there. Issues of personnel for running a large scale PACS are discussed and we give an outlook to the new information systems currently under development for archiving and communication of general medical imaging data and for simple telemedicine networking between several large university hospitals.

Diametral tensile strength of two dental composites when immersed in ethanol, distilled water and artificial saliva.

PubMed

Rehman, Abdur; Amin, Faiza; Abbas, Muhammad

2014-11-01

To examine the effect of distilled water, artificial saliva and ethanol on the tensile strength of direct tooth-coloured restorative material. The study was conducted at Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences (DUHS), Karachi, from April 2011 to September 2012. The testing was performed at the Pakistan Council of Scientific and Industrial Research (PCSIR) laboratories. Two composite resins Filtek Z250 and Spectrum TPH were tested. Specimens (13 mm x 3 mm x 2 mm) of each material were prepared in the stainless steel mould according to the manufacturers' instructions and distributed into 3 equal groups: one immersed in distilled water, the other in artificial saliva, and the last one in ethanol for 24 hours. Tensile strength was determined after 24 hours in universal Instron Testing Machine. There were 72 specimens in all; 36 (50%) each for Filtek Z250 and Spectrum TPH. The three sub-groups in each case had 12 (33.3%) specimens. For the Filtek Z250, there was no statistically significant difference between immersion in distilled water and artificial saliva, but the ethanol group presented lower tensile strength (p<0.05). For the Spectrum TPH, samples immersed in ethanol and artificial saliva presented lower tensile strength compared to distilled water (p<0.05). The tested composite resins were affected by the immersion media and adversely affected the mechanical properties of composite resins.

Enhancement by Enlargement: The Proliferation Security Initiative

DTIC Science & Technology

2008-01-01

Minister Mahathir Mohammad. In any event, Malaysia’s expressions of common interest with the United States in cooperative efforts to combat terrorism...instances 10 The sharp change in the current Malaysian government’s stance toward cooperation with the United States from that of the preceding, Mahathir ...preceding prime minister, Mahathir , Malaysia was implicated in the proliferation network of Pakistan’s A. Q. Khan. As part of that network

Performance Assessment of High and Low Income Families through "Online RAW Achievement Battery Test" of Primary Grade Students

ERIC Educational Resources Information Center

Ahmed, Tamim; Hanif, Maria

2016-01-01

This study is intended to investigate student's achievement capability among two families i.e. Low and High income families and designed for primary level learners. A Reading, Arithmetic and Writing (RAW) Achievement test that was developed as a part of another research study (Tamim Ahmed Khan, 2015) was adopted for this study. Both English medium…

Dynamic Multi-Axial Loading Response and Constitutive/Damage Modeling of Titanium and Titanium Alloys

DTIC Science & Technology

2006-06-24

crystals and assume same yield stress in tension and compression. Some anisotropic models have been proposed and used in the literature for HCP poly...2006), etc. These criteria dealt with the modeling of cubic crystals and assume same yield stress in tension an compression. Some anisotropic...Constitutive/Damage Modeling of Titanium and Titanium Alloys Principal Investigator: Akhtar S. Khan

Engineered Joint Lubrication for OA Prevention and Treatment

DTIC Science & Technology

2015-09-01

Williams, C. G., Khan, M., Manson, P. & Elisseeff, J .H. In vivo chondrogenesis of mesenchymal stem cells in photopolymerized hydrogel. Plast...protecting cells from free-radical damage20–22. Coating surfaces with HA may also physically protect the surfaces from cytokines and degrading enzymes...modification provides a biomimetic mechanism to concentrate HA on the surface. Numerous endogenous enzymes and reactive oxygen species can degrade HA

KSC-04pd1100

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker, standing at left. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04pd1099

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- Part of the crew from India filming at KSC, Director of Photography Mahesh Aney directs a camera setup. Writer and director of the film Ashutosh Gowariker is behind him. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Sub-Scale Analysis of New Large Aircraft Pool Fire-Suppression

DTIC Science & Technology

2016-01-01

discrete ordinates radiation and single step Khan and Greeves soot model provided radiation and soot interaction. Agent spray dynamics were...Notable differences observed showed a modeled increase in the mockup surface heat-up rate as well as a modeled decreased rate of soot production...488 K SUPPRESSION STARTED  Large deviation between sensors due to sensor alignment challenges and asymmetric fuel surface ignition  Unremarkable

Unconventional Warfare and Counterinsurgency in Pakistan: A Brief History

DTIC Science & Technology

2012-11-01

inter-connected. Punjabi Pakistani militants with sophisticated asymmetric warfare training and experience fighting Indian forces in Kashmir...factions. These Punjabi Pakistani militants would prove to be some of the most dangerous opponents of the government after 2006. From 2003 to 2006, the...68 Khan. “Untangling the Punjabi Taliban Network”. CTC Sentinel, March 2010; Franco, “Tehrik-e-Taliban Pakistan.” 69 Iqbal

The Common Vision: Parenting and Educating for Wholeness. Counterpoints: Studies in the Postmodern Theory of Education, Volume 48.

ERIC Educational Resources Information Center

Marshak, David

This book describes the needs and potentials of children and youth from birth to age 21, based on a holistic understanding of what human beings are and can become. The description is based on the insights of three early twentieth-century spiritual teachers--Rudolf Steiner, Aurobindo Ghose, and Inayat Khan--whose works, the book claims, articulate…

KSC-04PD-1109

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- KSC videographer Dave Stanley, at right, films the crew from India who are setting up their equipment. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The writer and director is Ashutosh Gowariker (seen to the right of center). The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04PD-1107

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- Mahesh Aney, who is director of photography on a film crew from India, sets up a camera at the stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The writer and director is Ashutosh Gowariker. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04PD-1099

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- Part of the crew from India filming at KSC, Director of Photography Mahesh Aney directs a camera setup. Writer and director of the film Ashutosh Gowariker is behind him. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04PD-1103

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- During filming at KSC, Shirish R. Patel (left, with KSCs International Space Station Payload Processing) joins the writer-director Ashutosh Gowariker and actor Rahul Vohra for a photo. The film crew from India spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Is there a disparity in the hospital care received under a universal health insurance program in Taiwan?

PubMed

Hsiao, Yu-Yu; Cheng, Shou-Hsia

2013-07-01

To analyze the disparity in hospital care among people of various socio-economic status (SES) under a universal health insurance scheme. A survey questionnaire was mailed to discharged patients in October 2010. This study included 183 large-scale hospitals in Taiwan. A total of 3015 patients/caregivers completed the questionnaires, which yielded a response rate of 58%. Three variables were included. The two access-to-care variables were admission route and accreditation level of the hospital in which the patient stayed. A structured questionnaire, the patient-reported hospital quality (PRHQ), was included to characterize patient's experience of hospital stay. Patients with lower education were less likely to be admitted to a hospital according to a planned schedule, or to choose an Medical Center Hospital. However, SES was not associated with the PRHQ scores. Furthermore, patients with unplanned admission were associated with lower PRHQ scores than those with planned admission to the hospital. Under the universal health insurance system in Taiwan, lower education is associated with unplanned admission to a hospital, which might result in poorer perceived quality of care. Reducing unplanned admission is a challenge for health authorities in the future.

Do acute myocardial infarction and stroke mortality vary by distance to hospitals in Switzerland? Results from the Swiss National Cohort Study.

PubMed

Berlin, Claudia; Panczak, Radoslaw; Hasler, Rebecca; Zwahlen, Marcel

2016-11-01

Switzerland has mountains and valleys complicating the access to a hospital and critical care in case of emergencies. Treatment success for acute myocardial infarction (AMI) or stroke depends on timely treatment. We examined the relationship between distance to different hospital types and mortality from AMI or stroke in the Swiss National Cohort (SNC) Study. The SNC is a longitudinal mortality study of the census 2000 population of Switzerland. For 4.5 million Swiss residents not living in a nursing home and older than 30 years in the year 2000, we calculated driving time and straight-line distance from their home to the nearest acute, acute with emergency room, central and university hospital (in total 173 hospitals). On the basis of quintiles, we used multivariable Cox proportional hazard models to estimate HRs of AMI and stroke mortality for driving time distance groups compared to the closest distance group. Over 8 years, 19 301 AMI and 21 931 stroke deaths occurred. Mean driving time to the nearest acute hospital was 6.5 min (29.7 min to a university hospital). For AMI mortality, driving time to a university hospital showed the strongest association among the four types of hospitals with a hazard ratio (HR) of 1.19 (95% CI 1.10 to 1.30) and 1.10 (95% CI 1.01 to 1.20) for men and women aged 65+ years when comparing the highest quintile with the lowest quintile of driving time. For stroke mortality, the association with university hospital driving time was less pronounced than for AMI mortality and did not show a clear incremental pattern with increasing driving time. There was no association with driving time to the nearest hospital. The increasing AMI mortality with increasing driving time to the nearest university hospital but not to any nearest hospital reflects a complex interplay of many factors along the care pathway. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[The state of pediatric anesthesia in Japan: an analysis of the Japanese society of anesthesiologists survey of critical incidents in the operating room].

PubMed

Irita, Kazuo; Tsuzaki, Koichi; Sawa, Tomohiro; Sanuki, Michiyoshi; Nakatsuka, Hideki; Makita, Koshi; Morita, Kiyoshi

2007-01-01

The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room and other reports have shown that pediatric patients undergoing anesthesia are at an increased risk. Purpose was to examine the state of pediatric anesthesia in Japan. This might clarify the role of children's hospitals for pediatric anesthesia, and the relationship between critical incidents and volume of pediatric anesthetic procedures. The JSA has conducted annual surveys of critical incidents in the operating room by sending to and collecting confidential questionnaires from all JSA Certified Training Hospitals. From 1999 to 2003, 342,840 pediatric (0-5 yr) anesthetic procedures were registered. During this period, only 15 cardiac arrests and 3 deaths within 7 postoperative days totally attributable to anesthetic management were reported. Therefore, we analyzed cardiac arrests and deaths due to all etiologies. The hospitals were classified as children's hospitals, university hospitals, and other hospitals, and the incidence of cardiac arrest, the recovery rate from cardiac arrest without any sequelae, and the mortality rate were compared according to types of the hospitals. The relationship between death due to intraoperative critical incidents and the volume of pediatric anesthetic procedures was examined using data from the 2003 survey, the recovery rate of which was 85.7%. In 2003, 739 JSA Certified Training Hospitals responded to the survey: 7 children's hospitals, 109 university hospitals, and 623 other hospitals. Among these hospitals, 707 and 270 hospitals conducted pediatric and newborn (<1 mo) anesthesia, respectively. In 2003, 4,630 newborn, 17,890 infant (<1 yr), and 60,524 child (1-5 yr) anesthetic procedures were registered. Odds ratios were determined to compare the risks among the hospital groups, and the 95% confidential interval (CI) was shown. The Chi square test was used to compare the background of patients with cardiac arrest. P values less than 0.05 were considered significant. In 2003, 95.7% and 36.5% of JSA Certified Training Hospitals which responded to the survey had conducted pediatric and newborn anesthesia, respectively. Children's hospitals, university hospitals, and other hospitals were responsible for 10.7%, 31.0%, and 58.3% of pediatric anesthetic procedures, respectively. Seven children's hospitals (100.0%), 54 university hospitals (50.5%), and 54 other hospitals (9.1%) conducted more than 201 annual pediatric anesthetic procedures, respectively, and these 115 hospitals conducted 62.5% of all pediatric anesthetic procedures in Japan. There was no significant difference between the overall mortality rate in hospitals with an annual pediatric anesthetic volume of less than 200 and that in hospitals with an annual pediatric anesthetic volume of more than 201 (5.46 versus 7.12/10,000 anesthetic procedures). However, the overall mortality rate was 4.87 times higher (95% confidential interval: 1.53-15.66) in hospitals with an annual pediatric anesthetic volume of more than 101 (7.91/10,000 anesthetic procedures) than in those with an annual pediatric anesthetic volume of less than 100 (1.62/10,000 anesthetic procedures). The situation was quite different when we focused on newborn anesthetic procedures : the overall mortality was 2.63 times higher (95% confidential interval : 1.19-5.84) in hospitals with an annual newborn anesthetic volume of less than 12 (126.6/ 10,000 anesthetic procedures) than those with an annual newborn anesthetic volume of more than 13 (48.5/10,000 anesthetic procedures). Between 1999 and 2003, the incidences of cardiac arrest in children's hospitals, university hospitals, and other hospitals were 9.54 (1.89 times higher than the other hospitals; CI 1.31-2.67), 10.30, and 5.11/10,000 anesthetic procedures, respectively. Among the children who developed cardiac arrest, the ratio of poor preoperative conditions with an American Society of Anesthesiologists physical status classification of more than 3 was significantly lower in the children's hospitals (68.9%) than the university hospitals (84.3%) and the other hospitals (84.0%). The recovery rate from cardiac arrest was 51.1% (2.49 times higher than the university hospitals; CI 1.23-5.06, and 3.05 times higher than the other hospitals ; CI 1.45-6.43), 29.6%, and 25.5%, respectively. The mortality rate was 9.54 (1.77 times higher than the other hospitals; CI 1.25-2.52), 8.87, and 5.38/10,000 anesthetic procedures in children's hospitals, university hospitals and other hospitals, respectively. Almost all JSA Certified Training Hospitals conducted pediatric anesthesia, although only 15.6% of them had an annual pediatric anesthetic volume of more than 200. It was suggested that general pediatric anesthesia was conduced safely in JSA Certified Training Hospitals, even if they had a low annual pediatric anesthetic volume. The exception was newborn anesthetic procedures : the mortality was high in hospitals with an annual newborn anesthetic volume of less than 12. Analysis of critical incidents in the operating room failed to show the superiority of children's hospitals in comparison with the university hospitals and other hospitals. Collecting and analyzing data including the patients without critical incidents are required for further analysis.

University Hospital Struck Deaf and Silent by Lightning: Lessons to Learn.

PubMed

Dami, Fabrice; Carron, Pierre-Nicolas; Yersin, Bertrand; Hugli, Olivier

2015-08-01

We describe how an electromagnetic wave after a lightning strike affected a university hospital, including the communication shutdown that followed, the way it was handled, and the lessons learned from this incident.

[Success factors in the German healthcare market. Hospitals between cluster formation and privatisation].

PubMed

Schmidt, C; Möller, J; Hardt, F; Gabbert, T; Bauer, M

2007-12-01

The German hospital market is in a state of transition due to the introduction of diagnosis-related groups (DRGs) and a constant change of the reimbursement, demographic, economical and technical framework. To date mainly public hospitals were bought by private hospital chains, but this trend has currently reached university hospitals. During recent months a consolidation within the market of private hospitals took place, while new market players such as foreign hospital chains, US universities and private equity firms emerged on the scene. The target of the privatisation process, however, turns more and more to larger hospitals. Central key values remain the cluster formation and centralisation of key competences such as food supply, purchasing and pharmacy. Within a network of clinics the representation of different care components (basic, regular and maximum care provider) and care levels (low, normal, intermediate and intensive care) remain important elements of efficient hospital management. Today, successful hospital operation is based on the successful competition for patients and even more for qualified staff. In this aspect, university hospitals could play a decisive role, because of their combination of maximum acute care provision and educational mandate. No such network has yet been formed due to the different interests of the owners, however, given the new market situation this alternative concept could become more attractive.

KAMEDO report No. 93-the power failure at Karolinska University Hospital, Huddinge, 07 April 2007.

PubMed

Angantyr, Lars-Göran; Häggström, Eskil; Kulling, Per

2009-01-01

A sudden and extensive power failure occurred at Karolinska University Hospital in Huddinge on Easter Saturday, 07 April 2007. The power failure lasted one hour and 22 minutes, but it took a longer time for activities to return to normal. It put many patients at great risk, particularly in the intensive care unit and other departments with critically ill patients. This report details the conditions and response at Karolinska University Hospital during the power failure and provides lessons learned for future events.

Activity-based costing and its application in a Turkish university hospital.

PubMed

Yereli, Ayşe Necef

2009-03-01

Resource management in hospitals is of increasing importance in today's global economy. Traditional accounting systems have become inadequate for managing hospital resources and accurately determining service costs. Conversely, the activity-based costing approach to hospital accounting is an effective cost management model that determines costs and evaluates financial performance across departments. Obtaining costs that are more accurate can enable hospitals to analyze and interpret costing decisions and make more accurate budgeting decisions. Traditional and activity-based costing approaches were compared using a cost analysis of gall bladder surgeries in the general surgery department of one university hospital in Manisa, Turkey. Copyright (c) AORN, Inc, 2009.

Polycystic kidney disease at Howard University Hospital.

PubMed

Hosten, A O; Cummings, Y

1977-08-01

Adult polycystic kidney disease treatment at Howard University Hospital is summarized. The cases are taken from autopsies performed between January 1955 and November 1975 and from the Hospital's dialysis population. Polycystic kidney disease was identified in six adults and four infants. Only two dialysis patients were clinically thought to have the disease. A review of the major clinical features of the disease is presented.

Annual Trauma Anesthesia and Critical Care Symposium (4th) Held in Baltimore, Maryland on May 2 - 5, 1991

DTIC Science & Technology

1991-07-01

Chairman for the Clinic of Anaesthesiology University Hospital Mainz, Germany Vice-President, European Academy of Anaesthesiology Medical Director...Consultant Anesthetist Department of Anaesthesiology Frenchay Hospital President, Association of Anaesthetists of Great Britain and Ireland President...of the Institute for Anaesthesiology University Hospital-Nijmegen Member of the National Health Council (Gezondheidsraad) Vice-President, National

Screening, testing, and reporting for drug and alcohol use on labor and delivery: a survey of Maryland birthing hospitals.

PubMed

Miller, Catherine; Lanham, Amy; Welsh, Christopher; Ramanadhan, Shaalini; Terplan, Mishka

2014-01-01

Recent amendments to the Child Abuse Prevention and Treatment Act tie the receipt of federal block grants to mandatory reporting of substance-exposed newborns. To determine rates of screening, testing, and reporting of drug and alcohol use at the time of delivery, we administered a telephone survey of nursing managers and perinatal social workers at Maryland birthing hospitals. Of the 34 hospitals, 31 responded (response rate 91%). Although 97% of hospitals reported universal screening, only 6% used a validated instrument. Testing was reported by 94% with 45% reporting universal maternal testing and 7% universal newborn testing. Only 32% reported obtaining maternal consent prior to testing. There is significant heterogeneity in screening and testing for substance use in birthing hospitals. Given federal reporting mandates, state-level practices need to be standardized.

Determinants of childhood mortality in slums of Karachi, Pakistan.

PubMed

D'souza, R M; Bryant, J H

1999-01-01

Pakistan has an infant mortality rate (IMR) of 90.5/1000 live births, and the country's child mortality level of 117.5 is worse than in other South Asian countries. Rapid population growth combined with rural-to-urban migration has led to the creation of urban slums in which morbidity levels are usually higher than in rural populations. A study was conducted in January 1993 in 6 slums of Karachi where the Aga Khan University has operated primary health care programs since 1985. Researchers recorded the deaths of 347 children under age 5 years old due to diarrhea and acute respiratory infections (ARI) during 1989-93. 235 mothers of these children were interviewed. The following are discussed as risk factors for under-5 child mortality: the use of traditional healers, poor nutritional status, incomplete or no immunization, the quick change of healers, inappropriate child care arrangements, mother's literacy, who decides about outside treatment, short birth interval, bottle feeding, and nuclear family structure. Maternal autonomy, appropriate health-seeking behavior, and child-rearing processes identified in the study point to the need for intervention strategies which go beyond the usual primary health care initiatives and involve communities in developing social support systems for mothers.

Mandibular third molar angulation in extraction and non extraction orthodontic cases.

PubMed

Ahmed, Imtiaz; Gul-e-Erum; Kumar, Naresh

2011-01-01

The purpose of this study is to determine the angulation of mandibular third molar in orthodontic cases which are planned for extraction and non extraction. This is a cross-sectional descriptive study in which pre-treatment panoramic radiographs of 49 patients, age range 11-26 years were taken from the OPD of Department of Orthodontics, Dr. Ishrat- ul -Ebad Khan Institute of Oral and Health Sciences (DIKIOHS), Dow University of Health Sciences. The angles between the long axis of the second and third molars were measured. Descriptive statistics were applied. Mann-Whitney U-test was used for intergroup comparison extraction and non extraction cases. This study consists of 49 patients with mean age of 17.94 years. Over all result concluded that mandibular third molar angulations were from 8-94 degrees in extraction cases and 10-73 degrees in non extraction cases. However, the pre-treatment 3rd molar angulation differences in extraction and non extraction cases were statistically insignificant with p-value >0.05. This study evaluates third molar angulations in pre-treatment cases, the differences in angulation were like other morphological differences but changes in angulation after treatment may or may not be related to extractions.

Standardizing Quality Assessment of Fused Remotely Sensed Images

NASA Astrophysics Data System (ADS)

Pohl, C.; Moellmann, J.; Fries, K.

2017-09-01

The multitude of available operational remote sensing satellites led to the development of many image fusion techniques to provide high spatial, spectral and temporal resolution images. The comparison of different techniques is necessary to obtain an optimized image for the different applications of remote sensing. There are two approaches in assessing image quality: 1. Quantitatively by visual interpretation and 2. Quantitatively using image quality indices. However an objective comparison is difficult due to the fact that a visual assessment is always subject and a quantitative assessment is done by different criteria. Depending on the criteria and indices the result varies. Therefore it is necessary to standardize both processes (qualitative and quantitative assessment) in order to allow an objective image fusion quality evaluation. Various studies have been conducted at the University of Osnabrueck (UOS) to establish a standardized process to objectively compare fused image quality. First established image fusion quality assessment protocols, i.e. Quality with No Reference (QNR) and Khan's protocol, were compared on varies fusion experiments. Second the process of visual quality assessment was structured and standardized with the aim to provide an evaluation protocol. This manuscript reports on the results of the comparison and provides recommendations for future research.

The first competency-based higher education programme for midwives in the South Asian region--Pakistan.

PubMed

Jan, Rafat; Lakhani, Arusa; Kaufman, Karyn; Karimi, Sadia

2016-02-01

Midwives in Pakistan and the South Asian region who complete a diploma program face many challenges for career growth and development. The absence of higher education in professional midwifery in the region has contributed to general non-acceptance and invisibility of midwifery. In response to the interest, Aga Khan University (AKU) developed bachelors program in midwifery based on the Global Standards for Midwifery Education developed by the International Confederation of Midwives (ICM) with the vision to equip midwives to provide full-scope practice, develop confidence to practice midwifery independently, become clinical leaders and contribute to the future of midwifery. The final curriculum had a balance of theory and clinical practice in order to develop a high level of clinical competence that would meet the ICM standards and guidelines. The two year bachelors program is currently in progress. The first cohort of 21 midwives graduated in 2014 and a second cohort was enrolled in 2015. There is a planning for a future graduate program in midwifery to prepare individuals for leadership roles in practice, teaching, maternal-child health provision and policy making through a master's degree in midwifery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi.

PubMed

Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

2014-01-01

Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

The impact of varicella vaccination on varicella-related hospitalization rates: global data review

PubMed Central

Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

2016-01-01

Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%–99.2% reduction in hospitalization rates in children younger than four years, 6–14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1–4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1–4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1–4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1–4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7%–73.8% decrease (general population), coverage of 60%–95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. PMID:26965075

The impact of varicella vaccination on varicella-related hospitalization rates: global data review.

PubMed

Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

2016-09-01

to describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. we identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4% -99.2% reduction in hospitalization rates in children younger than four years after 6-14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1-4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1-4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1-4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1-4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7% -73.8% decrease (general population), coverage of 60%-95%. The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Review of thromboembolic prophylaxis in patients attending Cork University Hospital.

PubMed

Byrne, Stephen; Weaver, Daniel Timothy

2013-06-01

Although preventable, venous thromboembolism remains a common cause of hospital acquired morbidity and mortality. Guidelines, such as the one produced by the American College of Chest Physicians (ACCP), are aimed at reducing hospital associated venous thromboemboli. Unfortunately the majority of studies have revealed inadequate adherence to these guidelines. The objective of this study was to evaluate the use of venous thromboembolism prophylaxis at Cork University Hospital. Cork University Hospital, Wilton, Cork, Ireland. Data from the patient's chart, drug kardex and laboratory results were recorded during April 2010. A Caprini score, a venous thromboembolism risk factor assessment tool, was subsequently calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data collected, Caprini score and prophylactic regime according to the ACCP 8th edition guidelines. Primary outcome was to analyse adherence to VTE prophylaxis guidelines. A total of 394 patients met the inclusion criteria and were reviewed, of which, 60% (n = 236) were medical and 37% (n = 146) were surgical patients. In total 63% of patients received some form of venous thromboembolism prophylaxis. Furthermore, 54% of medical and 76% of surgical patients received prophylaxis. However only 37% of the patients studied received appropriate thromboprophylaxis according to the ACCP 8th edition guidelines (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). Additionally 51% of surgical and 27% of medical patients received appropriate prophylaxis. Data collected from Cork University Hospital revealed poor adherence to international venous thromboembolism prophylaxis guidelines. As stated in the ACCP 8th edition guidelines, every hospital should develop a formal strategy for venous thromboembolism prevention (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). In order to improve adherence to guidelines, Cork University Hospital should develop, implement and re-evaluate a specific protocol for venous thromboembolism prophylaxis.

Using Click Chemistry to Identify Potential Drug Targets in Plasmodium

DTIC Science & Technology

2016-06-01

test, * p < 0.05. These and other results are reported in a manuscript currently have undergone initial review at Molecular Microbiology . The referees...sporozoites requires cGMP-dependent protein kinase and calcium dependent protein kinase 4 (manuscript in review at Molecular Microbiology ) References...manuscript in review at Molecular Microbiology ) (3) Invited Articles: None (4) Abstracts: Bhanot, P., Govindasamy, K., Khan, R. , Ojo, K.K., Van

Connecting to the Khans: Shaping National Identity of the Next Generation through Education in Kazakhstan and the Beliefs of the Next Generation

ERIC Educational Resources Information Center

Stein, Matthew

2011-01-01

When the Soviet Union collapsed in 1991, Kazakhs did not make up the majority of the population in their own titular state. Since then, Kazakhs have become the majority ethnic group and the government revised the education system to reflect this demographic change. Education is an important tool for shaping national identity in a multiethnic…

KSC-04pd1103

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- During filming at KSC, Shirish R. Patel (left, with KSC’s International Space Station Payload Processing) joins the writer-director Ashutosh Gowariker and actor Rahul Vohra for a photo. The film crew from India spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

KSC-04pd1107

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- Mahesh Aney, who is director of photography on a film crew from India, sets up a camera at the stands near the NASA News Center. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

CTC Sentinel. Volume 7, Issue 7

DTIC Science & Technology

2014-07-01

provide other support activities to organizations operating outside of Europe.3 The largely laissez - faire attitude of Swiss authorities (an approach, it...Counterterrorism Strategy By J.N.C. Hill 18 Contrasting the Leadership of Mullah Fazlullah and Khan Said Sajna in Pakistan By Daud Khattak 20...the IMU’s leadership since 2009.5 The existing literature, however, fails to explore the role played by the IMU in recent high- profile attacks in

One-to-One Mobile Devices in Rural School Districts: A Mixed Methods Study Investigating the Impact of Khan Academy on Mathematics Achievement and Teacher Pedagogy

ERIC Educational Resources Information Center

Dickinson, Brady D.

2016-01-01

Providing students with necessary intervention in the instruction of mathematics can be accomplished through the use of digital resources. Schools reaching a one-to-one (one device for every student) status have the ability to implement a digital intervention on a broad scale. For the purpose of this study, mixed methods research afforded an…

KSC-04pd1109

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- KSC videographer Dave Stanley, at right, films the crew from India who are setting up their equipment. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker (seen to the right of center). The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

The A. Q. Khan Network: Causes and Implications

DTIC Science & Technology

2005-12-01

relations battle to win popular esteem (and discredit the opposing laboratory) and a competition over responsibilities and resources between the two...technology was, we bought it with money,” she said.194 Bhutto is savvy and self -serving politician, whose statements should be taken with a grain...Pakistan, which then converted it and transferred it Libya.226 B.S.A. Tahir told Malaysian investigators that uranium hexafluoride was shipped

AN ADDITIVE EFFECT OF A MIXTURE OF AMMONIUM PERCHLORATE AND SODIUM CHLORATE ON PITUTARY-THYROID AXIS IN MALE F-344 RATS

EPA Science Inventory

An Additive Effect of a Mixture of Ammonium Perchlorate
and Sodium Chlorate on Pitutary-Thyroid Axis in Male F-344 Rats

Moazzam A. Khan 1,2,, 3Suzanne E. Fenton. 2Adam E. Swank, ZGeremy W. Knapp, 2Susan D.
Hester, and 2Douglas C. Wolf. 1NRC, 2Environmental Carcinog...

KSC-04PD-1106

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. Behind the camera at right is Director of Photography Mahesh Aney. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. The writer and director is Ashutosh Gowariker. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Implementation of Venous Thromboembolism Prophylaxis Guidelines in Clinical Practice: A Retrospective Study in Two Croatian Hospitals.

PubMed

Marušić, Srećko; Knežević, Aleksandar; Bačić Vrca, Vesna; Marinović, Ivana; Bačić, Julija; Obreli Neto, Paulo Roque; Amidžić Klarić, Daniela; Diklić, Dijaneta

2017-12-01

The aim of this study was to evaluate the implementation of the 9th edition of the American College of Chest Physicians (ACCP9) guidelines for prevention of venous thromboembolism in nonsurgical patients in clinical practice in one university and one general Croatian hospital. A retrospective study was conducted at Zadar General Hospital from Zadar and Dubrava University Hospital from Zagreb. Medical charts of all patients admitted to Medical Departments in two periods, before and after implementation of the ACCP9 guidelines, were analyzed. The ACCP9 guidelines were made available to all physicians through the hospital electronic information system immediately after the publication. The Hospital Drug Committees promoted implementation of the guidelines during their periodical clinical visits. Overall, 850 patients were included in the study in two periods. There was no statistically significant difference in the number of high-risk patients receiving thromboprophylaxis after the guidelines implementation in either hospital. In both periods, a signifi-cantly higher number of high-risk patients received thromboprophylaxis in Dubrava University Hos-pital in comparison with Zadar General Hospital (31.7% vs. 3.8% and 40.3% vs. 7.3%, respectively; p<0.001). This study revealed insufficient implementation of evidence-based thromboprophylaxis guidelines in clinical practice in two Croatian hospitals.

Pesticides in shallow groundwater of Bahawalnagar, Muzafargarh, D.G. Khan and Rajan Pur districts of Punjab, Pakistan.

PubMed

Tariq, Muhammad Ilyas; Afzal, Shahzad; Hussain, Ishtiaq

2004-06-01

In Pakistan there is little data on environmental contamination of rural water sources by pesticides. This study evaluated pesticide contamination of groundwater in four intensive cotton growing districts. Water samples were collected from 37 rural open wells in the areas of Bahwalnagar, Muzafargarh, D.G. Khan and Rajan Pur districts of Punjab and analysed for eight pesticides which are mostly used. Information on types of pesticide used and distance to nearest pesticide mixing area and application areas was obtained for each site. From the eight pesticides analysed, six pesticides were detected in the water samples. Only cypermethrin and cabosulfan were not detected. The percentage of detection of bifenthrin, lambda-cyhalothrin, carbofuran, endosulfan, methyl parathion and monocrotophos was, respectively 13.5%, 5.4%, 59.4%, 8%, 5.4% and 35.1% in July; 16.2%, 13.55%, 43.2%, 8%, N.D. (not detected) and 24.3% in October. Maximum contamination levels (MCLs) established by the U.S. Environmental Protection Agency for drinking water were not exceeded. The study has shown the need for monitoring pesticide contamination in rural water resources, and the development of drinking water quality standards for specific pesticides in Pakistan. The conclusions and recommendations will be disseminated to senior decision makers in central and local governments, extension agents and farmers.

Bloodstream and central line isolates from hematopoietic stem cell transplant recipients: data from a developing country.

PubMed

Ali, N; Adil, S N; Shaikh, M U

2014-02-01

Bloodstream infections (BSIs) and central line infections remain among the major causes of morbidity and mortality in transplant recipients because of prolonged neutropenia and mucosal damage. The objective of this study was to determine the frequency and outcome of bacterial and fungal isolates from patients undergoing allogeneic hematopoietic stem cell transplant. This study was conducted at the Aga Khan University and Hospital's bone marrow transplant unit. All patients who underwent an allogeneic stem cell transplant with matched sibling/parent donor were included. The study period ranged from April 2004 to December 2012. Transplantation was performed according to institutional protocols. All patients were admitted in single rooms with positive pressure and high-efficiency particulate air filters. Ciprofloxacin, fluconazole, and valaciclovir were used for standard prophylaxis, which was started at the time of conditioning. All blood cultures were obtained at clinical suspicion of systemic infection, mainly documented as fever (temperature of >38.5°C). BSIs and line infections were defined as isolation of bacterial or fungal pathogen from at least one blood/central line culture. In total, 101 of 108 patients developed febrile neutropenia. In the 101 patients, 245 documented febrile episodes occurred. There were 40 culture-positive episodes and 205 culture-negative episodes. Of these 40 culture-positive episodes, 22 patients had bloodstream isolates and 18 had central line isolates. The median ± standard deviation time of febrile neutropenia was day 7 ± 2 days (range: day -3 to day +13). The most common bloodstream isolate was Escherichia coli (n = 9) followed by Staphylococcus epidermidis (n = 5). One patient developed Fusarium infection. In central line infections, S. epidermidis was the most common organism (n = 8). In 2 patients with central venous catheters, Candida albicans was the isolate. Transplant-related mortality from sepsis occurred in 9.2%. E.coli was mainly responsible for BSI, while gram-positive organisms dominated catheter-related febrile episodes. Transplant-related mortality due to sepsis was 9%. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Continuation of metformin reduces early pregnancy loss in obese Pakistani women with polycystic ovarian syndrome.

PubMed

Nawaz, Fauzia Haq; Rizvi, Javed

2010-01-01

Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility worldwide. In addition to a poor conception rate, pregnancy loss rates are significantly higher (30-50%) during the first trimester in women with PCOS. Insulin resistance (IR) in this syndrome is not only implicated toward early pregnancy loss (EPL) but also pathognomic for various obstetrical complications during pregnancy. We evaluated the role of Metformin in the reduction of EPL in women with PCOS who conceived spontaneously or after induction ovulation with or without Metformin. The primary objective was to evaluate the effectiveness of Metformin in the reduction of EPL in women with PCOS. Secondary outcomes like gestational diabetes, pregnancy-induced hypertension and intrauterine growth restriction were also analyzed at the end of the study. This case-control study was conducted from March 2005 to March 2008 in the infertility and antenatal clinics of the Department of Obstetrics and Gynecology of Aga Khan University Hospital, Karachi, Pakistan. A total of 197 infertile women with PCOS were included. 'Cases' were women with PCOS who conceived while taking Metformin and it whom it was continued throughout pregnancy. 'Controls' were women in whom Metformin was either stopped in first trimester after confirmation of pregnancy (by serum betaHCG or by ultrasound) or they conceived spontaneously without the use of Metformin. All 197 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed till the final outcome of pregnancy was achieved. Both groups were compared for risk of EPL. It was found that continuation of Metformin during pregnancy reduces EPL, i.e. 8.8 vs. 29.4% in cases and controls, respectively (p < 0.001). In the subset of women with a prior history of miscarriage, the pregnancy loss rate was 12.5% in the Metformin versus 49.4% in control group (p = 0.002). Metformin continuation during pregnancy significantly reduces EPL in women with PCOS. IR may play a significant role in EPL. Copyright 2009 S. Karger AG, Basel.

Perceptions about the cause of schizophrenia and the subsequent help seeking behavior in a Pakistani population - results of a cross-sectional survey.

PubMed

Zafar, Syed Nabeel; Syed, Reema; Tehseen, Sarah; Gowani, Saqib A; Waqar, Sana; Zubair, Amina; Yousaf, Wajeeha; Zubairi, Akbar J; Naqvi, Haider

2008-07-17

There is a cultural variability around the perception of what causes the syndrome of schizophrenia. Generally patients with schizophrenia are considered dangerous. They are isolated and treatment is delayed. Studies have shown favorable prognosis with good family and social support, early diagnosis and management. Duration of untreated psychosis is a bad prognostic indicator. We aimed to determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behavior. This cross-sectional study was carried out on a sample of 404 people at the out patient departments of Aga Khan University Hospital Karachi. Data was collected via a self-administered questionnaire. Questions were related to a vignette of a young man displaying schizophrenic behavior. Data was analyzed on SPSS v 14. The mean age of the participants was 31.4 years (range = 18-72) and 77% of them were males. The majorities were graduates (61.9%) and employed (50%). Only 30% of the participants attributed 'mental illness' as the main cause of psychotic symptoms while a large number thought of 'God's will' (32.3%), 'superstitious ideas' (33.1%), 'loneliness' (24.8%) and 'unemployment' (19.3%) as the main cause. Mental illness as the single most important cause was reported by only 22%. As far as management is concerned, only 40% reported psychiatric consultation to be the single most important management step. Other responses included spiritual healing (19.5%) and Sociachanges (10.6) while 14.8% of respondents said that they would do nothing. Gender, age, family system and education level were significantly associated with the beliefs about the cause of schizophrenia (p < 0.05). While these variables plus 'religious inclination' and 'beliefs about cause' were significantly associated with the help seeking behavior of the participants. Despite majority of the study population being well educated, only a few recognized schizophrenia as a mental illness and many held superstitious beliefs. A vast majority of Pakistanis have non-biomedical beliefs about the cause of schizophrenia. Their help seeking behavior in this regard is inappropriate and detrimental to the health of schizophrenic patients. Areas for future research have been identified.

Risk of maternal alloimmunization in Southern Pakistan - a study in a cohort of 1000 pregnant women.

PubMed

Karim, Farheen; Moiz, Bushra; Kamran, Nausheen

2015-02-01

Haemolytic disease of the fetus and the newborn [HDFN] is caused by incompatibility of maternal and fetal erythrocytes. Red blood cell alloimmunization is a well-known cause of HDFN. Due to heterogeneity of populations, the spectrum of alloimmunization varies around the world. This study aimed to determine the frequency of alloimmunization in pregnant women and to determine the risk of HDFN in our population. This was a descriptive study conducted at Aga Khan University Hospital Karachi. Blood type and red cell antibody screening was determined on every pregnant woman at her first antenatal visit. Red cell antibody identification was performed on positive screening results. A total of 1000 pregnant females including 633 (63.3%) multigravida were studied. Blood type B was predominant (n = 374 or 37.4%) and D negative was observed in 136 women (13.6%). No red cell antibody was detected in 982 females (98.2%). 20 red cell antibodies were detected in 18 women (1.8%). The incidence of non-anti-D was 16/1000 [1.6%] in all pregnant females. The non-anti-D alloantibodies included anti-M (n = 3; 15%), anti-Lewis(a) (n = 3; 15%), anti C ( n = 1; 5%), anti-E (n = 1; 5%), anti-e (n = 1; 5%), anti-Lewis(b) (n = 1; 5%) and nonspecific antibodies (n = 6; 30%). The incidence of anti-D was 4/136 or 2.9% in D negative blood type. After excluding prior sensitization due to blood transfusions, risk remained was 2.2%. Antibodies of clinical significance were identified in 9 (0.9%) females. In our cohort, frequency of red cell alloimmunization during pregnancy was 1. 8% out of which 0.9% were clinically significant antibodies posing a risk for HDFN. Despite prenatal and post natal prophylaxis, risk of sensitization with D antigen in D negative women was high at 2.2%. We recommend that all pregnant women should be screened for irregular antibodies irrespective of the rhesus type. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of age on outcome after colorectal cancer surgery in the elderly - a developing country perspective.

PubMed

Khan, Muhammad Rizwan; Bari, Hassaan; Zafar, Syed Nabeel; Raza, Syed Ahsan

2011-08-17

Colorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population and surgery is often the only definitive management option. The suitability of surgical candidates based on age alone has traditionally been a source of controversy. Surgical resection may be considered detrimental in the elderly solely on the basis of advanced age. Based on recent evidence suggesting that age alone is not a predictor of outcomes, Western societies are increasingly performing definitive procedures on the elderly. Such evidence is not available from our region. We aimed to determine whether age has an independent effect on complications after surgery for colorectal cancer in our population. A retrospective review of all patients who underwent surgery for pathologically confirmed colorectal cancer at Aga Khan University Hospital, Karachi between January 1999 and December 2008 was conducted. Using a cut-off of 70 years, patients were divided into two groups. Patient demographics, tumor characteristics and postoperative complications and 30-day mortality were compared. Multivariate logistic regression analysis was performed with clinically relevant variables to determine whether age had an independent and significant association with the outcome. A total of 271 files were reviewed, of which 56 belonged to elderly patients (≥ 70 years). The gender ratio was equal in both groups. Elderly patients had a significantly higher comorbidity status, Charlson score and American society of anesthesiologists (ASA) class (all p < 0.001). Upon multivariate analysis, factors associated with more complications were ASA status (95% CI = 1.30-6.25), preoperative perforation (95% CI = 1.94-48.0) and rectal tumors (95% CI = 1.21-5.34). Old age was significantly associated with systemic complications upon univariate analysis (p = 0.05), however, this association vanished upon multivariate analysis (p = 0.36). Older patients have more co-morbid conditions and higher ASA scores, but increasing age itself is not independently associated with complications after surgery for CRC. Therefore patient selection should focus on the clinical status and ASA class of the patient rather than age.

Hemoptysis, a developing world perspective.

PubMed

Ashraf, Omer

2006-01-13

Hemoptysis is a significant clinical presentation in respiratory medicine. Often a life threatening emergency, it mandates prompt assessment and intervention. Various investigations and management protocols are proposed globally, to advocate a standardized approach towards patients presenting with hemoptysis. It is the etiology, however, that has been known to influence clinical outcome and prognosis. With marked contrast in geographical patterns of pulmonary pathologies, etiological agents for hemoptysis vary over the world. Studies in West, usually demonstrate neoplastic and non-granulomatous causes to be the leading agents for hemoptysis. The diagnostic accuracy of various investigations and efficacy of management alternatives has been established there. Developing nations differ in their burden of diseases of lung. Lack of health resources and initiative often prevent quality research in critical areas. This is a retrospective observational study with a cross-sectional design in which charts of all patients admitted with the presentation of haemoptysis in the past ten years will be reviewed, at Aga Khan University Hospital, Karachi, Pakistan. A series of variables, based on previous literature on haemoptysis related to the objectives of present study, will be determined in the study. Demographics, co-morbids and etiology will be determined. Findings of various investigation modalities and their accuracy in localizing the bleeding site will be determined. Efficacy of different management strategies will also be observed. Also observed will be any complications and follow-up. Pakistan is a third world nation of over 150 million, established as highly endemic for pulmonary tuberculosis. To date no study has been generated to look into hemoptysis patterns, in this nation. Lack of evidence based medicine poses a major hindrance towards confident decision-making in the approach towards a patient presenting with hemoptysis in this country. This study is devised to obtain the first insight in this direction, from this part of the world. The etiologies, accuracy of various investigations and efficacy of treatment options will be investigated. The results and conclusions will prove to be of value not just for health administrators in this country, but many other regions that share similarities in patterns of pulmonary pathologies.

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)

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

PubMed

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

2012-12-01

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

Building new university hospital--what citizens know and policy makers should be aware of.

PubMed

Oresković, S; Letica, S; Mastilica, M; Babić-Bosanac, S; Civljak, M; Bozicević, I; Borovecki, A

2002-12-01

Survey of citizens' attitudes in the process of strategic decision making is one of the most important methods for determining health care priorities. We describe the results of a survey carried out in December 2001, with an aim to collect and analyze the attitudes of the citizens and health care professionals toward the possibilities and strategies of construction of the University Hospital in Blato, Zagreb. The first referendum on the construction of the new hospital was conducted among Zagreb citizens in 1982, when they agreed that the new University Hospital was much needed. Zagreb citizens confirmed once again their attitudes toward and opinions on the need to continue the construction of new hospital in the city outskirts. By 1992, when the construction of the hospital was halted due to insufficient financial means, Zagreb citizens had already invested over 150 epsilon million in the project. It is interesting that today, 89.4% of the citizens and 74.5% of physicians agree that the new hospital building should be completed. Also, 66.7% of the citizens and 88% of physicians think that this hospital should be a University hospital that could offer the most complex treatments and medical education. To finish the construction of the new hospital further 200 epsilon million needs to be invested. Survey showed that 71% of citizens and 82.2% of physicians think that funds should be raised from some form of credit or budget rather than by special local tax, additional tax or voluntary tax. This project will significantly determine the future of hospital and health care system in Croatia due to its capacities in terms of space, technology, and staff. Before the decision to continue with the new hospital construction be made, the expected future needs, demands, and supply of the health care services in hospital sector in Zagreb and Croatia should be provided using SWOT analysis for each of existing the facilities.

Information technology governance domains in hospitals: a case study in Iran.

PubMed

Shahi, Mehraban; Sadoughi, Farahnaz; Ahmadi, Maryam

2014-11-30

IT governance is a set of organizational structures ensuring decision-making rights and responsibilities with regard to the organization's IT assets. This qualitative study was carried out to identify the IT governance domains in teaching hospitals affiliated to Iran University of Medical Sciences. There were 10 heads of IT departments and 10 hospital directors. Semi structured interviews used for data collection. To analyze the data content analysis was applied. All the interviewees (100%) believed that decisions upon hospital software needs could be made in a decentralized fashion by the IT department of the university. Most of the interviewees (90%) believed that there were policies for logistics and maintenance of networks, purchase and maintenance, standards and general policies in the direction of the policies of the ministry of health and medical education. About 80% of the interviewees believed that the current emphasis of the hospital's IT unit and the hospital management for outsourcing of services were in the format of specialized contracts and under supervision of the university Statistic and IT department. A hospital strategic committee is an official organizational group consisting of hospital executives, heads of IT and multiple functional areas and business units in a hospital. In this committee, "the head of hospital" acts as the director of IT activities and ensures that IT strategies are alignment with the hospital business strategies.

Time trends in pediatric hospitalizations for hepatitis A in Greece (1999-2013): Assessment of the impact of universal infant immunization in 2008.

PubMed

Papaevangelou, V; Alexopoulou, Z; Hadjichristodoulou, C; Kourlamba, G; Katsioulis, A; Theodoridou, K; Spoulou, V; Theodoridou, M

2016-07-02

Hepatitis A vaccine was introduced in the Greek National Immunization Program in 2008. To estimate possible impact of the universal vaccination implementation, time trends of hospitalizations for hepatitis A at the Infectious Diseases Unit of a Tertiary Pediatric Hospital in Athens during 1999-2013 were analyzed. Hepatitis A hospitalizations were recorded from the discharge database and were expressed as frequencies and rate of annual departmental hospitalizations. Time series analysis (ARIMA) was used to explore trends and the impact of the vaccination. Moreover, changes in patient age, population group distribution and the duration of hospitalization were also examined. Hepatitis A hospitalizations rate significantly decreased between pre-vaccination (1999-2008) and post-vaccination (2009-2013) era from 50.5 to 20.8/1000 hospitalizations (p = 0.005). A 3-year periodicity and a trend of reduction on hepatitis A hospitalizations rates across years were noted. Roma children had significant higher rates of hepatitis A hospitalization, followed by immigrant children. Importantly, possibly due to preceding vaccine availability with considerable uptake in private market and unvaccinated group/pockets of children (Roma), overall vaccination effect was less apparent when compared to data from other countries that implemented universal vaccination. No significant change in patient age, population group distribution, or duration of hospitalization was observed. High risk groups such as Roma children should be targeted for vaccination to reduce future outbreaks.

[Measures taken by a university hospital for the prevention and control of the 2009 H1N1 influenza].

PubMed

Hayashi, Jun; Murata, Masayuki; Furusyo, Norihiro; Hoshina, Takayuki; Shimono, Nobuyuki

2010-09-01

After extensive discussion with the Fukuoka City government of measures for the prevention and control of the 2009 H1N1 influenza pandemic, Kyushu University Hospital organized the infection control teams of 39 hospitals in the Fukuoka City area in preparation for a possible outbreak. A facility was set up at Kyushu University Hospital for the screening of outpatients with fever, and those with influenza and an underlying disease or severe symptoms were admitted to the hospital. 37 (22%) of the 171 outpatients with fever were infected with the new strain of influenza, confirmed by rapid influenza antigen test and PCR: Of these 37 patients, 17 (45.9%) were negative by influenza antigen test. Other 37 patients (5 adults, 32 children) were admitted, all of whom were successfully treated with neuraminidase inhibitors and discharged with no aftereffects.

A Comparison Of The Universal TOR Guideline To The Absence Of Prehospital ROSC And Duration Of Resuscitation In Predicting Futility From Out-of-Hospital Cardiac Arrest

PubMed Central

Drennan, Ian R.; Case, Erin; Verbeek, P. Richard; Reynolds, Joshua C.; Goldberger, Zachary D.; Jasti, Jamie; Charleston, Mark; Herren, Heather; Idris, Ahamed H.; Leslie, Paul R.; Austin, Michael A.; Xiong, Yan; Schmicker, Robert H.; Morrison, Laurie J.

2017-01-01

Introduction The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some emergency medical service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination. Objective To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline. Design Retrospective, observational cohort study Participants Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers Setting ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011. Outcomes Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC. Results 36,543 treated OHCAs occurred of which 9,467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5%–3.4%) compared to 0.7% (95% CI 0.4%–0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR. Conclusion Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival. PMID:27923115

The Value of Survival Gains in Pancreatic Cancer from Novel Treatment Regimens.

PubMed

MacEwan, Joanna P; Yin, Wes; Kaura, Satyin; Khan, Zeba M

2017-02-01

Metastatic pancreatic cancer (mPC) is associated with low survival, with less than 10% of patients surviving 5 years. Recent therapies improve survival outcomes where few alternative therapies exist, but few economic analyses measure the value of survival gains attributable to new therapies. To estimate the value of survival gains in advanced or mPC attributable to the introduction of novel treatment regimens. Multivariate Cox proportional hazards models were used to estimate real-world survival gains associated with the introduction of gemcitabine (GEM) for patients diagnosed with stage IV or unstaged mPC in the Surveillance, Epidemiology, and End Results Program cancer registries. Then, evidence from clinical trials was used to evaluate the survival gains associated with nab-paclitaxel + gemcitabine (nP +GEM) and FOLFIRINOX (FFX) relative to GEM. The survival estimates and clinical trial evidence were used to calibrate an economic model and assess the cumulative value of survival gains in mPC to patients. Costs of treatment were calculated based on published cost-effectiveness studies. We estimated that the introduction of GEM in 1996 was associated with a hazard ratio of 0.920 (P < 0.05) and an increase in median survival from 3.1 to 4.5 months. Results suggested that the value of survival gains attributable to GEM equaled about $71,000 per patient, while the value attributable to nP + GEM was an additional $56,700. Estimates for the value of survival gains per patient, net of total incremental lifetime treatment costs (drugs, adverse events, and other costs), were $50,294 for GEM and an additional $31,900 for nP + GEM. Clinical trials and cost-effectiveness studies reported an overall survival gain from FFX that was larger than, but statistically similar to, nP + GEM and had greater risk of adverse events and total incremental costs. We estimated that the total value of survival gains to mPC patients, net of total costs, associated with GEM was up to $47.6 billion, and the additional values attributable to nP+GEM and FFX were up to $39.0 billion and $26.3 billion, respectively. Historically, mPC patients have faced high disease burden and had few treatment options. Treatments introduced since 1996 have led to improved survival, with varying costs associated with treatment and adverse events. Accounting for total incremental costs, the majority of the value of survival gains from GEM and nP+GEM was retained by mPC patients, highlighting the value of innovation in settings where survival is low and few alternative therapies exist. Support for this research was provided by Celgene. Precision Health Economics was compensated by Celgene for work on this study. MacEwan is an employee of, and Yin is a consultant to, Precision Health Economics. Kaura and Khan are employees of Celgene. Study concept and design were contributed primarily by Yin and MacEwan, along with Kaura and Khan. MacEwan collected the data, and data interpretation was performed primarily by MacEwan and Yin, along with Kaura and Khan. The manuscript was written and revised by MacEwan, Yin, Kaura, and Khan.

Two Programs for Primary Care Practitioners: Family Medicine Training in an Affiliated University Hospital Program and Primary Care Graduate Training in an Urban Private Medical Center

ERIC Educational Resources Information Center

Farley, Eugene S.; Piemme, Thomas E.

1975-01-01

Eugene Farley describes the University of Rochester and Highland Hospital Family Medicine Program for teaching of primary care internists, primary care pediatricians, and family doctors. Thomas Piemme presents the George Washington University School of Medicine alternative, a 2-year program in an ambulatory setting leading to broad eligibility in…

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A simulation model of hospital management based on cost accounting analysis according to disease.

PubMed

Tanaka, Koji; Sato, Junzo; Guo, Jinqiu; Takada, Akira; Yoshihara, Hiroyuki

2004-12-01

Since a little before 2000, hospital cost accounting has been increasingly performed at Japanese national university hospitals. At Kumamoto University Hospital, for instance, departmental costs have been analyzed since 2000. And, since 2003, the cost balance has been obtained according to certain diseases for the preparation of Diagnosis-Related Groups and Prospective Payment System. On the basis of these experiences, we have constructed a simulation model of hospital management. This program has worked correctly at repeated trials and with satisfactory speed. Although there has been room for improvement of detailed accounts and cost accounting engine, the basic model has proved satisfactory. We have constructed a hospital management model based on the financial data of an existing hospital. We will later improve this program from the viewpoint of construction and using more various data of hospital management. A prospective outlook may be obtained for the practical application of this hospital management model.

They use humor, off-beat images. These ads keep the consumers' minds OUT of the hospital.

PubMed

Botvin, Judith D

2003-01-01

Limited budgets make it more important for a healthcare campaign to stand out. NeathawkDubuque, Richmond, Va., showcases television commercials for Washington Hospital Center and Georgetown University Hospital, both in Washington, D.C.; and print ads for the University of Virginia Health System, Charlottesville, Va. Additionally, Coil Counts Ford and Cheney, Chicago, provide a distinctive campaign for Advocate Illinois Masonic Medical Center, Chicago.

[How do hospital clinical laboratories and laboratory testing companies cooperate and build reciprocal relations?].

PubMed

Kawano, Seiji

2014-12-01

As the 2nd Joint Symposium of the Japanese Society of Laboratory Medicine and the Japanese Association of Laboratory Pathologists, the symposium on clinical test out-sourcing and branch laboratories was held at the 60th General Meeting of the Japanese Society of Laboratory Medicine on November 2nd, 2013 in Kobe. For the symposium, we conducted a questionnaire survey on the usage of clinical test out-sourcing and the introduction of branch laboratories to clinical laboratories of Japanese university hospitals, both private and public, between July 25th and August 20th, 2013. Seventy-two hospitals responded to the questionnaire survey, consisting of 41 public medical school hospitals and 31 private ones. According to the survey, the selection of each clinical test for out-sourcing was mainly determined by the capacities of hospital clinical laboratories and their equipment, as well as the profitability of each test. The main concerns of clinical laboratory members of university hospitals involved the continuity of measurement principles, traceability, and standardization of reference values for each test. They strongly requested the interchangeability and computerization of test data between laboratory testing companies. A branch laboratory was introduced to six hospitals, all of which were private medical college hospitals, out of 72 university hospitals, and eight of the other hospitals were open to its introduction. The merits and demerits of introducing a branch laboratory were also discussed. (Review).

Afghanistan: Politics, Elections, and Government Performance

DTIC Science & Technology

2014-11-04

which 10 seats are elected by Kuchi nomads ) and a selected 102 seat upper house (Meshrano Jirga, House of Elders). The upper house is selected as...Ghazni; 9 in Badakhshan, Konduz, and Faryab; 8 in Helmand; and 2 to 6 in the remaining provinces. Ten are reserved for Kuchis ( nomads ). Afghanistan...Islamic clergy. One of his vice presidential running mates was Ismail Khan, a faction leader discussed above. The ticket polled in the single digits

Anapidae (Arachnida: Araneae), a spider family newly recorded from Laos.

PubMed

Lin, Yucheng; Li, Shuqiang; Jäger, Peter

2013-01-23

The spider family Anapidae is reported from Laos for the first time. One new species is described: Pseudanapis namkhan n. sp. from Nam Khan Valley, Luang Prabang Province. Another species is recorded for the first time from Champasak Province, Laos and the following new synonymy is proposed: Sinanapis thaleri Ono 2009 = Sinanapis crassitarsus Wunderlich & Song 1995 n. syn. Morphological descriptions, diagnoses and comparative illustrations are provided for the two species.

Minority Undergraduate Research in Prostate Cancer: Bridging Opportunities for Postbaccalaureate Education

DTIC Science & Technology

2012-03-01

students  were  assigned  to  read  both  popular  and   scientific  literature  regarding  the   genetic ,  socio...Biochemistry, Soma Jobbagy, BS Biochemistry, and Erica Boetefuer, Biological Sciences Judging Rubrics for the ASBMB Undergraduate Poster Competition 2007...Bruce Boman, Biological Sciences Role of miRNAs in Regulating Colon Cancer Stem Cells 37) Carrie Barnum and Jennifer Sabatino, Genetics Zohra Ali-Khan

KSC-04pd1106

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment at the viewing stands near the NASA News Center. Behind the camera at right is Director of Photography Mahesh Aney. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Structural and Electrical-Optical Characterizations of Semiconductor-Atomic Superlattice

DTIC Science & Technology

2007-05-01

and Avalanche diodes certainly fall into this category. Resonant tunneling diodes like Esaki Tunnel diodes are NDC devices belong to a class where...Heterostructures, Eds. M. Dutta and M. Stroscio, (World Sci. 2003, Singapore), p221 177 Cooling by Inverse Nottingham Effect with Resonant Tunneling ...controlled emitter, V. Semet, V.T. Binh, J.Zhang, J.Yang, M.A. Khan, and R. Tsu, APL. 84,1937 (2004) 186 Stability Issues in Tunneling via Quantum

Pakistan’s Domestic Political Developments

DTIC Science & Technology

2005-09-19

Daily Times (Lahore), Aug. 29, 2005; Aamer Ahmed Khan, “Musharraf Under Fire After Local elections,” BBC News, Aug. 30, 2005; Husain Haqqani, “Hit... Ahmed serves as MMA president. Another long-standing Islamist party is the Jamiat Ulema-i-Islam faction led by Maulana Fazlur Rehman (JUI-F). The JUI...Harper Collins India, 2000), p. 135. 37 Pakistani Ambassador to the United States Ashraf Jehangir Qazi, “Transition in Pakistan” (letter), New York

Salvaging hope: Is increasing NAD(+) a key to treating mitochondrial myopathy?

PubMed

Lightowlers, Robert N; Chrzanowska-Lightowlers, Zofia M A

2014-06-01

Mitochondrial diseases can arise from mutations either in mitochondrial DNA or in nuclear DNA encoding mitochondrially destined proteins. Currently, there is no cure for these diseases although treatments to ameliorate a subset of the symptoms are being developed. In this issue of EMBO Molecular Medicine, Khan et al (2014) use a mouse model to test the efficacy of a simple dietary supplement of nicotinamide riboside to treat and prevent mitochondrial myopathies.

KSC-04PD-1108

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment inside the television studio at the NASA News Center. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. At center is Mahesh Aney, director of photography. The writer and director is Ashutosh Gowariker (seen to the right of Aney). The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Irksome and Unpopular Duties: Pakistan’s Frontier Corps, Local Security Forces and Counterinsurgency

DTIC Science & Technology

2012-05-01

the Karakorum mountain range in North West Frontier Province (now Khyber Pakhtunkhwa) to the Makran coast in Balochistan . I he Khan <>l Lalpura and...the corps along geographical lines, creating Frontier Corps-North West Frontier Province and Frontier Corps- Balochistan . Pakistan also created...major combat operations, including the Indo-Pakistani wars of 1948, 1965, and 1971. The Frontier Corps fought against separatists in Balochistan in the

Biomechanical Factors in the Etiology of Tibial Stress Fractures

DTIC Science & Technology

2006-08-01

stiffness in these runners. A “stiff” runner will spend less time in contact with the ground (Farley and Gonzalez, 1996 ) and will attenuate less shock...between the leg and the head (McMahon et al., 1987). This is in agreement with the findings of Farley and Gonzalez ( 1996 ) who suggested lower...Army Natick Research and Development Laboratories. Brukner, P., Bradshaw, C., Khan, K., White, S. and Crossley, K. ( 1996 ) Stress fractures: a

Sir Sayyid Ahmed Kahn's History of the Bijnor Rebellion, Translated with Notes and Introduction. South Asia Series, Occasional Paper No. 17.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Asian Studies Center.

The Bijnor Rebellion of 1857 was a revolt of the Muslim minority in the Bijnor district of India against the British East India Company and Hindu loyalists. Sir Sayyid Ahmad Khan was an Indian Muslim serving the British Company. His account of the events of 1857 is the only one produced by an Indian who both participated in and analyzed the…

Analysis of Time-of-Day Energy Demand and Supply in University and Hospital

NASA Astrophysics Data System (ADS)

Shimazaki, Yoichi

The aim of this study was to estimate the time-of-day energy demand in University of Yamanashi. Our University consisted of Kofu campus (Faculty of Education & Human Sciences and Faculty of Engineering) and Faculty of Medicine campus (Faculty of Medicine and University Hospital). The energy data of 4 facilities were classified into hot water, heating, cooling and electric power demands based on electric power consumptions, city gas and heavy oil from 1996 to 2005. For 10 years, primary energy increased 1.2 times in the whole of the university. The amount of electric power consumption was 63% in the fuel classification. The amount of electric power consumption of faculty reacted to the change in temperature greatly. In 2005, it was found that thermoelectric-ratios for 4 facilities, i.e. Education, Engineering, Medicine and Hospital were 2.3, 1.5, 2.0 and 2.7 respectively. These data are very useful for the energy saving and energy management of university.

Oncological outcomes of metastatic testicular cancers under centralized management through regional medical network.

PubMed

Inai, Hiromu; Kawai, Koji; Kojima, Takahiro; Joraku, Akira; Shimazui, Toru; Yamauchi, Atsushi; Miyagawa, Tomoaki; Endo, Tsuyoshi; Fukuhara, Yoshiharu; Miyazaki, Jun; Uchida, Katsunori; Nishiyama, Hiroyuki

2013-12-01

To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network. We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin. Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was >0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate- and poor-prognosis groups were 97, 93 and 84%, respectively. Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.

Consultation clinics for complementary and alternative medicine at Japanese university hospitals: An analysis at Tokushima University Hospital

PubMed Central

YANAGAWA, HIROAKI; TERAO, JUNJI; TAKEDA, EIJI; TAKAISHI, YOSHIHISA; KASHIWADA, YOSHIKI; KAWAZOE, KAZUYOSHI; FUSHITANI, SHUJI; TSUCHIYA, KOICHIRO; YAMAUCHI, AIKO; SATO, CHIHO; IRAHARA, MINORU

2010-01-01

Here, we report on a Consultation Clinic for Complementary and Alternative Medicine (CAM) which we established at Tokushima University Hospital in July of 2007 with the aim of providing person-to-person information on CAM, though not CAM therapy itself. In December of 2008, we received 55 applications for consultation, 37% concerning health foods, 37% Japanese herbal medicine (Kampo), and 26% various other topics. The consultants (nutritionists and pharmacists) communicated individually with 38 applicants; malignancies (26%) and cardiovascular disease (24%) were the main underlying concerns. To promote the quality of consultation, data was collected by means of focus group interviews concerning the perspective of the consultants. Safe and effective use of CAM requires a network of communication linking individuals, consultation teams, physicians, primary care institutions and university hospitals. To advance this goal, we plan to broaden the efforts described herein. Our findings indicate that the specific role of the consultation clinic in promoting the scientific use of CAM merits further study. PMID:22993564

[Are investment activity and backlog in investments risks for university medicine in Germany?].

PubMed

Amann, I; Heyder, R; Strehl, R

2009-08-01

University medicine in Germany requires significantly higher funding and investment because its tasks not only include health care but also research and teaching. However, over recent decades less and less funding compared to the development of the turnover has been available. This trend is due to decreasing public funding. The diminishing funding has caused a major backlog of investment at German university hospitals. The first part of the article summarizes the investments policies at university hospitals and other hospitals. The second part describes the investment needs in university medicine and exposes risk factors for research, education and health care due to the process of investment planning and realization. Goal-oriented solutions are shown to facilitate investments. The third part discusses several risks caused by insufficient investments in university medicine. There are special risks for research, teaching, and the capacity for innovation in university medicine besides economical and medical risks. Some policies and financial strategies to overcome the backlog in investments are presented. After a summary, the article concludes with some practical examples of further measures to ensure sustainable funding.

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

PubMed

Tengilimoglu, Dilaver; Kisa, Adnan

2005-01-01

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

Medical school hotline: A History of the University of Hawai'i Postgraduate Medical Education Program at Okinawa Chubu Hospital, 1966-2012.

PubMed

Maeshiro, Masao; Izutsu, Satoru; Connolly, Kathleen Kihmm

2014-06-01

The University of Hawai'i (UH) has been collaborating with Okinawa Prefectural Chubu Hospital for over 46 years. This collaboration started as a post-World War II effort to increase the physician workforce. At the initiation of the US Army and State Department, the University of Hawai'i was recruited, in cooperation with the government of the Ryukyus and USCAR, to initiate a US style postgraduate clinical training program. The Postgraduate Medical Training Program of University of Hawai'i at Okinawa Chubu Hospital introduced a style of training similar to that in the US by offering a rotating internship. The initial contract had UH establish and run the Postgraduate Medical Training Program of University of Hawaii at Okinawa Central Hospital. After Okinawa's reversion to Japan, under a new contract, UH physicians participated as consultants by providing lectures at "grand rounds" and guidance to faculty, staff, and students. To date, 895 physicians have completed the University of Hawai'i Postgraduate Medical Training Program with 74 currently training. Approximately 662 (74%) of the trainees have remained in Okinawa Prefecture to practice medicine. As a result, the program has enhanced the physician workforce for the islands of Okinawa and neighbor archipelagos of Miyako and Yaeyama Islands.

Outbreak of OXA-48-Producing Klebsiella pneumoniae Involving a Sequence Type 101 Clone in Batna University Hospital, Algeria

PubMed Central

Loucif, Lotfi; Kassah-Laouar, Ahmed; Saidi, Mahdia; Messala, Amina; Chelaghma, Widad

2016-01-01

Seven nonredundant ertapenem-resistant Klebsiella pneumoniae isolates were collected between May 2014 and 19 January 2015 in the nephrology and hematology units of Batna University Hospital in Algeria. All strains coproduced the blaOXA-48, blaCTX-M-15, blaSHV-1, and blaTEM-1D genes. Six of these isolates belonged to the pandemic clone sequence type 101 (ST101). The blaOXA-48 gene was located on a conjugative IncL/M-type plasmid. This is the first known outbreak of OXA-48-producing K. pneumoniae isolates involving an ST101 clone in Batna University Hospital. PMID:27645236

Time trends in pediatric hospitalizations for hepatitis A in Greece (1999–2013): Assessment of the impact of universal infant immunization in 2008

PubMed Central

Papaevangelou, V.; Alexopoulou, Z.; Hadjichristodoulou, C.; Kourlamba, G.; Katsioulis, A.; Theodoridou, K.; Spoulou, V.; Theodoridou, M.

2016-01-01

ABSTRACT Hepatitis A vaccine was introduced in the Greek National Immunization Program in 2008. To estimate possible impact of the universal vaccination implementation, time trends of hospitalizations for hepatitis A at the Infectious Diseases Unit of a Tertiary Pediatric Hospital in Athens during 1999–2013 were analyzed. Hepatitis A hospitalizations were recorded from the discharge database and were expressed as frequencies and rate of annual departmental hospitalizations. Time series analysis (ARIMA) was used to explore trends and the impact of the vaccination. Moreover, changes in patient age, population group distribution and the duration of hospitalization were also examined. Hepatitis A hospitalizations rate significantly decreased between pre-vaccination (1999–2008) and post-vaccination (2009–2013) era from 50.5 to 20.8/1000 hospitalizations (p = 0.005). A 3-year periodicity and a trend of reduction on hepatitis A hospitalizations rates across years were noted. Roma children had significant higher rates of hepatitis A hospitalization, followed by immigrant children. Importantly, possibly due to preceding vaccine availability with considerable uptake in private market and unvaccinated group/pockets of children (Roma), overall vaccination effect was less apparent when compared to data from other countries that implemented universal vaccination. No significant change in patient age, population group distribution, or duration of hospitalization was observed. High risk groups such as Roma children should be targeted for vaccination to reduce future outbreaks. PMID:27141813

Research-to-policy translation for prevention of disordered weight and shape control behaviors: A case example targeting dietary supplements sold for weight loss and muscle building.

PubMed

Austin, S Bryn; Yu, Kimberly; Tran, Alvin; Mayer, Beth

2017-04-01

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Western University (No. 10 Canadian Stationary Hospital and No. 14 Canadian General Hospital): a study of medical volunteerism in the First World War.

PubMed

Istl, Alexandra C; McAlister, Vivian C

2016-12-01

The Canadian government depended on chaotic civilian volunteerism to staff a huge medical commitment during the First World War. Offers from Canadian universities to raise, staff and equip hospitals for deployment, initially rejected, were incrementally accepted as casualties mounted. When its offer was accepted in 1916, Western University Hospital quickly adopted military decorum and equipped itself using Canadian Red Cross Commission guidelines. Staff of the No. 10 Canadian Stationary Hospital and the No. 14 Canadian General Hospital retained excellent morale throughout the war despite heavy medical demand, poor conditions, aerial bombardment and external medical politics. The overwhelming majority of volunteers were Canadian-born and educated. The story of the hospital's commanding officer, Edwin Seaborn, is examined to understand the background upon which the urge to volunteer in the First World War was based. Although many Western volunteers came from British stock, they promoted Canadian independence. A classical education and a broad range of interests outside of medicine, including biology, history and native Canadian culture, were features that Seaborn shared with other leaders in Canadian medicine, such as William Osler, who also volunteered quickly in the First World War.

Clinical efficacy of telemedicine in emergency radiotherapy for malignant spinal cord compression.

PubMed

Hashimoto, S; Shirato, H; Kaneko, K; Ooshio, W; Nishioka, T; Miyasaka, K

2001-09-01

The authors developed a Telecommunication-HElped Radiotherapy Planning and Information SysTem (THERAPIST), then estimated its clinical benefit in radiotherapy in district hospitals where consultation with the university hospital was required. The system consists of a personal computer with an image scanner and a digital camera, set up in district hospitals and directly connected via ISDN to an image server, and a treatment planning device set up in a university hospital. Image data and consultative reports are sent to the server. Radiation oncologists at the university hospital determine a treatment schedule and verify actual treatment fields. From 1998 to 1999, 12 patients with malignant spinal cord compression (MSCC) were treated by emergency radiotherapy with the help of this system. Image quality, transmission time, and cost benefit also were satisfactory for clinical use. The mean time between the onset of symptoms and the start of radiotherapy was reduced significantly from 7.1 days to 0.8 days (P < .05) by the introduction of the system. Five of 6 nonambulant patients became ambulant after the introduction of THERAPIST compared with 2 of 8 before the introduction of THERAPIST. The treatment outcome was significantly better after the introduction of the system (P < .05), and suggested to be beyond the international standard. The telecommunication-helped radiotherapy and information system was useful in emergency radiotherapy in district hospitals for patients with MSCC for whom consultation with experienced radiation oncologists at a university hospital was required.

Son preference in Pakistan: an analysis of intentions vs. behavior.

PubMed

De Tray, D

1984-01-01

The study assesses the extent to which the very strong expressed preference for sons in Pakistan influences couples' actual fertility behavior. Several fertility measures and estimation techniques were used to determine whether subsequent fertility behavior is influenced by the sex composition of previous births. Khan and Sirageldin's work on sex preference and desires for additional children in Pakistan were reviewed, followed by consideration of several methods of testing the relationship between sex of children and subsequent fertility and presentation of the results of several other tests of the hypothesis that sex composition of children affects actual fertility behavior. The Khan and Sirageldin (1977) results can be translated into a stopping rule which states that the higher the proportion of boys in a family, the less likely a couple is to go on to have another child. This finding, based on intentions, conflicts with the results based on actual behavior presented here. The Khan and Sirageldin results were extended by assessing the extent to which couples translated their very strong expressed preferences for sons into actual behavior. This extension was based on a sample of women, most of whom have completed fertility (all were aged 35 or older) and all of whom had at least 1 live birth. No overall relationship was found between the sex composition of children and subsequent fertility behavior. At least 2 explanations are possible for this inconsistency between intentions and behavior with each having a different implication for population policy and for the future of population growth in general. The first explanation is that in traditional societies such as Pakistan couples are unable to control their fertility adequately. The policy implications of this view suggest family planning and contraceptive distribution programs aimed at reducing the cost of achieving whatever desired family size couples want. Another explanation is that although parents indicate that they want more boys than girls, their actions do not reflect this preference because of the dominating influence of overall desires for numbers of children regardless of the sex of those children. In other words, couples may prefer boy to girl children, but they would still rather have many girl children than few or no children at all. This explanation is consistent with theoretical findings. The results suggest that with regard to actual behavior, Pakistani preferences for having children may dominate preferences for children of a certain type.

A survey of knowledge, attitude, and practices of private retail pharmacies staff in tuberculosis care: study from Dera Ismail Khan City, Pakistan.

PubMed

Mustafa, Tehmina; Shahzad, Yasir; Kiani, Ayyaz

2018-01-01

In order to engage pharmacies in tuberculosis (TB) care, a survey was conducted in the Dera Ismail (DI) Khan City of the Khyber Pakhtoon Khwa province, Pakistan. The objectives were to; 1) characterize the retail pharmacies; 2) determine knowledge of the staff on various aspects of pulmonary TB; 3) determine practices related to the sale of anti-TB drugs, and referrals of presumptive TB patient, and willingness to participate in the National Tuberculosis Control Programme's (NTP) Directly Observed Treatment Short-Course (DOTS) strategy. A cross-sectional survey was conducted by using a structured questionnaire to collect data from pharmacy staff at all the private retail pharmacies of the DI khan city. All the interviewed staff ( n  = 82) were males, only 38% had formal training as pharmacist (5%) or as a pharmacy assistant (33%). Pharmacies established for a longer period were better staffed and had high customer load. About 92% of the interviewed staff knew that persistent cough is a symptom for TB, 82% knew that TB is diagnosed by examination of sputum. Almost 66% of the pharmacy staff did not know multi-drug resistance TB as a consequence of improper treatment. Those with formal training and longer experience in retail pharmacy had better knowledge of various aspects of TB as compared to the staff with no formal pharmacy training and lesser experience ( p  < 0.01). Only 57% were aware of NTP while only 30% had heard of the DOTS strategy. All reported sale of first-line TB drugs as fixed dose combinations. The majority (80%) referred presumptive TB patients to chest physicians and no patient was referred to the NTP. Nearly 83% of the interviewed staff was willing to be involved in TB control efforts by getting training and referring patients to the DOTS facility. There was shortage of professionally qualified and female staff in private retail pharmacies. Knowledge of professionally qualified staff about TB seemed sufficient to identify presumptive TB patients; however, their knowledge about NTP and DOTS was poor, and referral practices to NTP and DOTS centers were suboptimal. Majority of staff was willing to be involved in TB control efforts.

Information Technology Governance Domains in Hospitals: A Case Study in Iran

PubMed Central

Shahi, Mehraban; Sadoughi, Farahnaz; Ahmadi, Maryam

2015-01-01

IT governance is a set of organizational structures ensuring decision-making rights and responsibilities with regard to the organization’s IT assets. This qualitative study was carried out to identify the IT governance domains in teaching hospitals affiliated to Iran University of Medical Sciences. There were 10 heads of IT departments and 10 hospital directors. Semi structured interviews used for data collection. To analyze the data content analysis was applied. All the interviewees (100%) believed that decisions upon hospital software needs could be made in a decentralized fashion by the IT department of the university. Most of the interviewees (90%) believed that there were policies for logistics and maintenance of networks, purchase and maintenance, standards and general policies in the direction of the policies of the ministry of health and medical education. About 80% of the interviewees believed that the current emphasis of the hospital’s IT unit and the hospital management for outsourcing of services were in the format of specialized contracts and under supervision of the university Statistic and IT department. A hospital strategic committee is an official organizational group consisting of hospital executives, heads of IT and multiple functional areas and business units in a hospital. In this committee, “the head of hospital” acts as the director of IT activities and ensures that IT strategies are alignment with the hospital business strategies. PMID:25948446

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)

Managing out of hours clinical photography at the University Hospitals Bristol.

PubMed

Brinkworth, Simon; Kenny, Alice; Knights, Christina

2018-04-01

In recent years, Medical Illustration at University Hospitals Bristol (UHBristol) NHS Foundation Trust has seen a steady increase in photography requests, including the need for out of hours photography provision. This paper details how Medical Illustration at UHBristol decided to manage an out of hours clinical photography service.

Brief Report: The Negev Hospital-University-Based (HUB) Autism Database

ERIC Educational Resources Information Center

Meiri, Gal; Dinstein, Ilan; Michaelowski, Analya; Flusser, Hagit; Ilan, Michal; Faroy, Michal; Bar-Sinai, Asif; Manelis, Liora; Stolowicz, Dana; Yosef, Lili Lea; Davidovitch, Nadav; Golan, Hava; Arbelle, Shosh; Menashe, Idan

2017-01-01

Elucidating the heterogeneous etiologies of autism will require investment in comprehensive longitudinal data acquisition from large community based cohorts. With this in mind, we have established a hospital-university-based (HUB) database of autism which incorporates prospective and retrospective data from a large and ethnically diverse…

Strategies for Effective Psychiatric Hospitalization of College and University Students

ERIC Educational Resources Information Center

Rockland-Miller, Harry; Eells, Gregory

2008-01-01

University and college counseling services face growing demands for services and self-reported increases in the level of presenting psychopathology, including need for psychiatric hospitalization. However, challenges in communication often occur between the systems of an inpatient psychiatric unit and an outpatient college and/or university…

Impacts of Campus Involvement on Hospitality Student Achievement and Satisfaction

ERIC Educational Resources Information Center

Yin, Dean; Lei, Simon A.

2007-01-01

Campus involvement affecting satisfaction and academic achievement (overall grade point average) of hospitality undergraduate students at a state university in the Midwest (University X) was investigated through a survey research. A four-part survey instrument was developed to facilitate this study. There were a number of academic, professional,…

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 Oregon Health and Science University-Oregon State Hospital Collaboration: Reflections on an Evolving Public-Academic Partnership.

PubMed

Chien, Joseph; Novosad, David; Mobbs, Karl E

2016-03-01

This column describes the conceptualization and implementation of an innovative collaboration between Oregon State Hospital and Oregon Health and Science University that was created to address understaffing and improve the quality of care. The hospital created a forensic evaluation rotation to address the growing population of forensic patients, which created a valuable recruiting tool for the hospital. One of the authors, a recent recruit, provides a first-person account of his experience working within the collaboration. The model could be emulated by other public-sector facilities facing similar challenges with psychiatrist recruitment and retention.

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.

The Search for Peace in Mindanao: Resolving a Wicked Problem

DTIC Science & Technology

2012-03-22

negotiating panel, still led by Mohagher Iqbal, but with new members such as Professor Abhoud Syed Linga and Datu Antonio Kinoc of B‘laan tribe...that the MILF received funds from charitable institutions operated by Mohammed Jamal Khalifa, Osama Bin Laden‘s brother-in-law.53 The MILF has...Crucible: A Reader (Quezon City: CenPeg Publications), 2008, p. 136. 19 7 Hermoso, p. 61. 8 Dato‘ Md Ismael bin Ahmad Khan, ―The International

KSC-04PD-1101

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- Sashikant Dhawan (left), costume director with a film crew from India, and Shirish R. Patel (right), with KSCs International Space Station Payload Processing, pose for a photo near the viewing stands at the NASA News Center. The crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain- drain. The writer and director is Ashutosh Gowariker. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

China Pakistan Economic Corridor (CPEC): Benefits For Pakistan And Comparison With Suez And Panama Canals

DTIC Science & Technology

2017-12-01

ECONOMIC CORRIDOR (CPEC): BENEFITS FOR PAKISTAN AND COMPARISON WITH SUEZ AND PANAMA CANALS by Hanif Ullah Khan December 2017 Thesis...DATE December 2017 3. REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE CHINA PAKISTAN ECONOMIC CORRIDOR (CPEC): BENEFITS FOR...The China Pakistan Economic Corridor (CPEC) is part of China’s “One Belt, One Road” initiative and joins two major economic corridors: The Silk Road

Army Pacific Pathways: Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance Value for Participating Units

DTIC Science & Technology

2016-11-01

Force and Number of Personnela Exercises 14 Aug. – Nov. 2014 2-2 Stryker Brigade Combat Team (BCT) ~820 personnel Keris Strike ( Malaysia ... Malaysia ) 15-3 June-July, Aug. – Nov. 2015 1-25 Stryker BCT ~420 personnel Khan Quest (Mongolia) Orient Shield (Japan) Hoguk (South Korea...Sept. 2016 2-2 Stryker BCT ~700 personnel Hanuman Guardian (Thailand) Salaknib (Philippines) Garuda Shield (Indonesia) Keris Strike ( Malaysia

KSC-04pd1108

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- A film crew from India sets up equipment inside the television studio at the NASA News Center. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. At center is Mahesh Aney, director of photography. The writer and director is Ashutosh Gowariker (seen to the right of Aney). The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Transnational Organized Crime and New Terrorism in Sri Lanka: A Nexus

DTIC Science & Technology

2017-12-01

Second Reader: Feroz Khan THIS PAGE INTENTIONALLY LEFT BLANK i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704–0188 Public reporting...ABSTRACT UU NSN 7540–01-280-5500 Standard Form 298 (Rev. 2–89) Prescribed by ANSI Std. 239–18 ii THIS PAGE INTENTIONALLY LEFT BLANK iii...significant differences from traditional (old) terrorism; this new form “promotes an uncompromising view of the world in accordance with religious beliefs

Salvaging hope: Is increasing NAD+ a key to treating mitochondrial myopathy?

PubMed Central

Lightowlers, Robert N; Chrzanowska-Lightowlers, Zofia MA

2014-01-01

Mitochondrial diseases can arise from mutations either in mitochondrial DNA or in nuclear DNA encoding mitochondrially destined proteins. Currently, there is no cure for these diseases although treatments to ameliorate a subset of the symptoms are being developed. In this issue of EMBO Molecular Medicine, Khan et al (2014) use a mouse model to test the efficacy of a simple dietary supplement of nicotinamide riboside to treat and prevent mitochondrial myopathies. PMID:24838280

Pakistan’s Madrassas -- Weapons of Mass Instruction?

DTIC Science & Technology

2007-03-01

61 (accessed 26 Jan 2007). 71 Abigail Cutler and Saleem Ali, “Madrassah reform is key to terror war,” Christian Science Monitor, 27 Jun 2005, http...106 —Parliamentarian Imran Khan Pakistan’s reforms thus far have yielded little change in the operation of madrassas in Pakistan, particularly those...Cutler, Abigail and Saleem Ali. “Madrassah reform is key to terror war,” Christian Science Monitor, 27 Jun 2005. http://www.csmonitor.com/2005/0627

Effect of Context on Internal and External Actor’s Perception on COIN

DTIC Science & Technology

2011-05-19

beautiful mountain ranges, tourism industry and expansive fruit orchards along the Swat River has been a cradle of civilization since the third century BC...execute, created a class system in Swat consisting of a few privileged rich landowners, Khans, and the majority of poor farmers and peasants. The Wali...key bridges and culverts that not only affected military convoys, but also the local farmers and traders whose goods could not be brought to the

Biomechanical Factors in Tibial Stress Fractures

DTIC Science & Technology

2005-08-01

runners. A "stiff’ runner will spend less time in contact with the ground (Farley and Gonzalez, 1996 ) and will attenuate less shock between the leg and the...head (McMahon et al., 1987). This is in agreement with the findings of Farley and Gonzalez ( 1996 ) who suggested lower extremity stiffness and knee...83/026). Natick, MA: U.S. Army Natick Research and Development Laboratories. Brukner, P., Bradshaw, C., Khan, K., White, S. and Crossley, K. ( 1996

Comparison between air pollution concentrations measured at the nearest monitoring station to the delivery hospital and those measured at stations nearest the residential postal code regions of pregnant women in Fukuoka.

PubMed

Michikawa, Takehiro; Morokuma, Seiichi; Nitta, Hiroshi; Kato, Kiyoko; Yamazaki, Shin

2017-06-13

Numerous earlier studies examining the association of air pollution with maternal and foetal health estimated maternal exposure to air pollutants based on the women's residential addresses. However, residential addresses, which are personally identifiable information, are not always obtainable. Since a majority of pregnant women reside near their delivery hospitals, the concentrations of air pollutants at the respective delivery hospitals may be surrogate markers of pollutant exposure at home. We compared air pollutant concentrations measured at the nearest monitoring station to Kyushu University Hospital with those measured at the closest monitoring stations to the respective residential postal code regions of pregnant women in Fukuoka. Aggregated postal code data for the home addresses of pregnant women who delivered at Kyushu University Hospital in 2014 was obtained from Kyushu University Hospital. For each of the study's 695 women who resided in Fukuoka Prefecture, we assigned pollutant concentrations measured at the nearest monitoring station to Kyushu University Hospital and pollutant concentrations measured at the nearest monitoring station to their respective residential postal code regions. Among the 695 women, 584 (84.0%) resided in the proximity of the nearest monitoring station to hospital or one of the four other stations (as the nearest stations to their respective residential postal code region) in Fukuoka city. Pearson's correlation for daily mean concentrations among the monitoring stations in Fukuoka city was strong for fine particulate matter (PM 2.5 ), suspended particulate matter (SPM), and photochemical oxidants (Ox) (coefficients ≥0.9), but moderate for coarse particulate matter (the result of subtracting the PM 2.5 from the SPM concentrations), nitrogen dioxide, and sulphur dioxide. Hospital-based and residence-based concentrations of PM 2.5 , SPM, and Ox were comparable. For PM 2.5 , SPM, and Ox, exposure estimation based on the delivery hospital is likely to approximate that based on the home of pregnant women.

Radiology Online Patient Education Materials Provided by Major University Hospitals: Do They Conform to NIH and AMA Guidelines?

PubMed

Prabhu, Arpan V; Donovan, Ashley L; Crihalmeanu, Tudor; Hansberry, David R; Agarwal, Nitin; Beriwal, Sushil; Kale, Hrishikesh; Heller, Matthew

The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making. Owing to health literacy variations in the general population, the American Medical Association and National Institutes of Health recommend patient education resources to be written between the third and seventh grade levels. Our purpose is to quantitatively assess the readability levels of online radiology educational materials, written for the public, in 20 major university hospitals. In September and October 2016, we identified 20 major university hospitals with radiology residency-affiliated hospital systems. On each hospital׳s website, we downloaded all radiology-related articles written for patient use. A total of 375 articles were analyzed for readability level using 9 quantitative readability scales that are well validated in the medical literature. The 375 articles from 20 hospital systems were collectively written at an 11.4 ± 3.0 grade level (range: 8.4-17.1). Only 11 (2.9%) articles were written at the recommended third to seventh grade levels. Overall, 126 (33.6%) were written above a full high-school reading level. University of Washington Medical Center׳s articles were the most readable with a reading level corresponding to 7.9 ± 0.9. The vast majority of websites at major academic hospitals with radiology residencies designed to provide patients with information about imaging were written above the nationally recommended health literacy guidelines to meet the needs of the average American. This may limit the benefit that patients can derive from these educational materials. Copyright © 2018 Elsevier Inc. All rights reserved.

Percutaneous coronary intervention in Thammasat University Hospital: the first three-year experience.

PubMed

Piyayotai, Dilok; Hutayanon, Pisit

2010-12-01

To study the results of percutaneous coronary intervention (PCI) and in-hospital outcomes in cardiac catheterization laboratory, Thammasat University Hospital since May, 2006 until April, 2009. This is the prospective, single-center study. The consecutive patients who underwent PCI in Thammasat University Hospital since May 2006 to April 2009 were recruited in the study. Clinical data, angiographic data, and in-hospital outcomes were analyzed and demonstrated. Six hundred and seventeen patients undergoing 755 PCI procedures were enrolled in the study. 62.70% were male and 37.30% were female. Mean age was 65.45 +/- 11.21 years (range 33-97 years) and 20.10% were more than 75 years old. The indications for PCI were non-ST segment-elevation acute coronary syndrome (NSTEACS) (41.72%), chronic stable angina (25.32%), acute ST segment elevation myocardial infarction (STEMI) (8.87%), staged PCI (15.76%). The other indications were heart failure, cardiomyopathy, post-cardiac arrest and etc. The procedure was single vessel PCI in 73.25% and multivessel PCI in 26.75% (double vessels PCI 24.64% and triple vessels PCI 2.11%). According to lesion locations, 45.21% were left anterior descending (LAD) artery lesions, 30.09% were right coronary artery (RCA) lesions, 23.28% were left circumflex (LCX) artery lesions, 1.19% were left main (LM) lesions and 0.24% were graft lesions. The overall angiographic success rate was 95.57%. During hospital stay the major adverse events developed as death in 0.93%, periprocedural myocardial infarction in 3.17%, emergency coronary artery bypass graft in 0.53%, and stroke in 0.26%. During the first three years of PCI experience in Thammasat University Hospital, the overall success rate was high with low in-hospital adverse outcomes.

Relationship of Employees’ Achievement Motivation and Quality of Working Life with Their Self-efficacy at Selected Hospitals with a Multi-group Analysis: Moderating Role of Organizational Ownership

PubMed Central

Mahmoudi, Ghahraman; Rostami, Fahimeh Hoseinian; Mahmoudjanloo, Shaharbanoo; Jahani, Mohammad Ali

2017-01-01

Introduction: Motivational deficiencies and the low quality of working life significantly reduce employees’ work performance and consequently their efficacy (effectiveness and proper performance in doing a task or specific tasks). Aim: The aim of this study was to determine the relationship between achievement motivation and quality of working life with self-efficacy among staff working in Mazandaran hospitals, by taking organizational ownership as a mediator variable. Materials and Methods: This study was an applied descriptive-correlation. Research population consisted of all staff working in selected hospitals of Mazandaran Province, Iran. 341 employees were selected with randomly-stratified sampling as the statistical sample. Three valid questionnaires were used for data collection. Data were analysis based on structured equations and path analysis with SPSS19 and AMOS. Results: In private hospitals, there was a significant relationship between the quality of working life and self-efficacy (p<0.001). In relationship between achievement motivation and self-efficacy, there was no significant differences between university hospitals and social security hospitals, but relationship between the quality of working life and self-efficacy was significant (p <0. 05). Considering achievement motivation and self-efficacy in private hospitals and university hospitals, a significant differences was observed (p<0. 05). Conclusion: The hospital ownership has a moderating in relationship of achievement motivation and quality of working life with self-efficacy. Staff’s empowerment courses for university hospitals and improvement in the overall space of job, increase in job security, reducing salary differences is suggested for private hospitals. PMID:29284991

Relationship of Employees' Achievement Motivation and Quality of Working Life with Their Self-efficacy at Selected Hospitals with a Multi-group Analysis: Moderating Role of Organizational Ownership.

PubMed

Mahmoudi, Ghahraman; Rostami, Fahimeh Hoseinian; Mahmoudjanloo, Shaharbanoo; Jahani, Mohammad Ali

2017-12-01

Motivational deficiencies and the low quality of working life significantly reduce employees' work performance and consequently their efficacy (effectiveness and proper performance in doing a task or specific tasks). The aim of this study was to determine the relationship between achievement motivation and quality of working life with self-efficacy among staff working in Mazandaran hospitals, by taking organizational ownership as a mediator variable. This study was an applied descriptive-correlation. Research population consisted of all staff working in selected hospitals of Mazandaran Province, Iran. 341 employees were selected with randomly-stratified sampling as the statistical sample. Three valid questionnaires were used for data collection. Data were analysis based on structured equations and path analysis with SPSS19 and AMOS. In private hospitals, there was a significant relationship between the quality of working life and self-efficacy (p<0.001). In relationship between achievement motivation and self-efficacy, there was no significant differences between university hospitals and social security hospitals, but relationship between the quality of working life and self-efficacy was significant (p <0. 05). Considering achievement motivation and self-efficacy in private hospitals and university hospitals, a significant differences was observed (p<0. 05). The hospital ownership has a moderating in relationship of achievement motivation and quality of working life with self-efficacy. Staff's empowerment courses for university hospitals and improvement in the overall space of job, increase in job security, reducing salary differences is suggested for private hospitals.

[110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

PubMed

Zlatkov, V

2014-01-01

The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients.

[Development of advanced educational programs, including research programs, for undergraduate students in National Universities: the facts in 2010].

PubMed

Kurosaki, Yuji; Tomioka, Yoshihisa; Santa, Tomofumi; Kitamura, Yoshihisa

2012-01-01

This article summarizes detailed facts obtained from the questionnaire conducted in 2010 at about 14 National Universities on the topic of "Research programs and advanced educational programs for undergraduate students". The contents of the questionnaire included: (1) Research programs based on the coalition of university and hospital and/or community pharmacy, other Graduate Schools, such as School of Medicine etc., and the University Hospital, (2) Educational systems for the achievement of research programs and their research outcomes, (3) Research programs based on pharmacist practices, (4) Ongoing advanced educational programs for undergraduate students, taking advantage of the coalition with Graduate School, School of Medicine (and Dentistry), and University Hospital. Some of the advanced educational programs outlined in this questionnaire will be carried out by our group in the coming years and the educational benefits together with associated problems shall as well be clarified. This approach will be informative for the development of the leader-oriented pharmacist programs for the college of Pharmacy.

Histopathological diagnosis of eyelid tumors in Chiang Mai University Hospital.

PubMed

Nithithanaphat, Chanut; Ausayakhun, Sakarin; Wiwatwongwana, Damrong; Mahanupab, Pongsak

2014-10-01

To report the histopathological diagnosis ofeyelid tumors and to study the prevalence of eyelid tumors in Chiang Mai University Hospital Chiang Mai, Thailand. A retrospective review of medical and pathological records ofpatients diagnosed as eyelid tumor that underwent histopathological biopsy between January 2007 and December 2013 in Chiang Mai University Hospital was done. Three hundred sixteen cases of eyelid tumors were reviewed. The mean age at diagnosis was 54.2 +/- 19.6 years (range 1 month-99 years), women were 59.5% (n = 188) and men 40.5% (n = 128). The tumor sites were left lower eyelid (27.5%), right upper eyelid (24.4%), right lower eyelid (21.2%), and left upper eyelid (18.7%). There were 204 (64.6%) benign tumors and 112 (35.4%) malignant tumors. Nevi were the most common in benign group (16.4%) and basal cell carcinoma was the most common eyelid malignancy (18.0%). The most common histopathological diagnosis for benign eyelid tumor was nevus, while the most common malignant eyelid tumor was basal cell carcinoma at Chiang Mai University Hospital.

[Description of current hypnosis practice in French university hospitals].

PubMed

Chabridon, G; Nekrouf, N; Bioy, A

2017-10-01

Hypnosis is very fashionable as an entertainment through TV shows searching for new sensational experiences. What about its practice in the medical world? The aim of this article is to answer to this question. Therefore, we contacted every French University Hospital of each region to find out if hypnosis was practiced for the care of pain (hypnoanalgesia), for chirurgical procedures (hypnosedation) and in adult psychiatry care units (hypnotherapy). For this last practice, we also questioned the type of indications. All 30 of the French University Hospitals had replied by November 2015. Hypnoanalgesia is practiced by all and two-thirds offer hypnosedation. Hypnotherapy is practiced by 40 % of the University Hospitals, 91,7 % for anxiety disorders, 66,7 % for psychotraumatic care and 25 % for mood disorders. Therefore, hypnosis seems to have found its place in the care of pain and as an anesthetic to replace standard procedures. However, the use of hypnotherapy in psychiatry is less frequent, indications for its use being variable and not very consensual. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Economic Burden of Mental Illnesses in Pakistan.

PubMed

Malik, Muhammad Ashar; Khan, Murad Moosa

2016-09-01

The economic consequences of mental illnesses are much more than health consequences. In Low and Middle Income Countries (LMIC) the economic impact of mental illnesses is rarely analyzed. This paper attempts to fill the gap in research on economics of mental health in LMIC. We provide economic burden of mental illness in Pakistan that can serve as an argument for reorienting health policy, resource allocation and priority settings. To estimate economic burden of mental illnesses in Pakistan. The study used prevalence based cost of illnesses approach using bottom-up costing methodology. We used Aga Khan University Hospital, Psychiatry department data set (N = 1882) on admission and ambulatory care for the year 2005-06. Healthcare cost data was obtained from finance department of the hospital. Productivity losses, caregiver and travel cost were estimated using socio-economic features of patients in the data set and data of national household survey. We used stratified random sampling and methods of ordinary least square multiple linear regressions to estimate cost on medicines for ambulatory care. All estimates of cost are based on 1000 bootstrap samples by ICD-10 disease classification. Prevalence data on mental illnesses from Pakistan and regional countries was used to estimate economic burden. The economic burden of mental illnesses in Pakistan was Pakistan Rupees (PKR) 250,483 million (USD 4264.27 million) in 2006. Medical care costs and productivity losses contributed 37% and 58.97% of the economic burden respectively. Tertiary care admissions costs were 70% of total medical care costs. The average length of stay (LOS) for admissions care was around 8 days. Daily average medical care cost of admitted patients was PKR 3273 (USD 55.72). For ambulatory care, on average a patient visited the clinic twice a year. The estimated average yearly cost for all mental illnesses was PKR 81,922 (USD 1394.65) and PKR 19,592 (USD 333.54) for admissions and ambulatory care respectively. In the sensitivity analysis productivity losses showed high variability (from USD 1022.17 million to USD 4007.01 million). Assuming a gate keeping role of primary healthcare (PHC) demonstrated a saving of USD 1577.19 million in total economic burden. This study set out to generate evidence using a low cost innovative approach relevant to many LMICs. In Pakistan, like many LMICs, patients access tertiary care directly, even for illness that can be efficiently managed at PHC level. In economic terms the non-medical consequences of mental illnesses are far greater than medical consequences. Based on these finding we recommend, firstly, that mental illnesses should be prioritized equally as other illnesses in health policy and secondly there needs to be integration of mental health in primary health care in Pakistan.

University Hospitals for Sale.

ERIC Educational Resources Information Center

Culliton, Barbara J.

1984-01-01

Although faculty opposition stopped the sale of Harvard's McLean Hospital to the Hospital Corporation of America (HCA), a partnership remains a possibility. Issues related to the proposed sale as well as those affecting hospital economics are considered. Proposed terms of the sale are included. (JN)

Rotavirus genotypes in Malaysia and Universal rotavirus vaccination

PubMed Central

Lee, Way Seah; Lim, Benjamin Tze Ying; Chai, Pei Fan; Kirkwood, Carl D.; Lee, Jimmy Kok Foo

2012-01-01

Group A rotavirus (RV-A) genotypes isolated in Malaysia was studied to estimate the effectiveness of a universal RV-A vaccination in Malaysia. A simple mathematical model was used, with input from a two-year, two-center, prospective study on hospitalization of RV-A gastroenteritis (RVGE) in young children, published data on RV-A hospitalizations and genotypes, mortality on childhood GE and published genotype-specific efficacy data on two RV-A vaccines. Assuming a 95% vaccine coverage, the overall projected effectiveness was 75.7 to 88.1% for Rotateq® and 78.7 to 90.6% for Rotarix® against RVGE-related hospitalizations. The projected annual reduction in RVGE-related deaths was 27 to 32 deaths (from 34 deaths) for Rotateq® and 28 to 32 deaths annually forRotarix®. A universal RV-A vaccine is efficacious in reducing RVGE-related hospitalizations and mortality in Malaysia. PMID:23022710

Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

PubMed

Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

2016-03-01

This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

Pediatric trauma at an adult trauma center.

PubMed

Siram, Suryanarayana; Oyetunji, Tolulope A; Khoury, Amal L; Walker, Sonya R; Bolorunduro, Oluwaseyi B; Chang, David C; Greene, Wendy R; Cornwell, Edward E; Frederick, Wayne A I

2010-08-01

Accidental traumatic injury is the number 1 cause of morbidity and mortality in the pediatric population. In this study, we aim to prove that certain pediatric patients can be treated with good outcomes at an adult level 1 trauma center. Retrospective analysis using the Howard University Hospital trauma registry identified 71 patients treated at Howard University Hospital between the ages of 1 and 17 years old. Specific variables were identified and collected for each patient. The majority of pediatric traumas treated at Howard University Hospital between June 2004 and May 2005 had high survival rates (93%). The patients who did not survive (7%) included 3 patients who were dead on arrival and 2 who died shortly after arrival to the hospital. Certain pediatric populations who present with minor and/or isolated injuries can be treated in an adult level 1 trauma center with similar outcomes to treatment in a pediatric level 1 trauma center.

A haemovigilance team provides both significant financial and quality benefits in a University Hospital.

PubMed

Decadt, Ine; Costermans, Els; Van de Poel, Maai; Kesteloot, Katrien; Devos, Timothy

2017-04-01

Haemovigilance is the process of surveillance of blood transfusion procedures including unexpected hazards and reactions during the transfusion pathway in both donors and recipients. The haemovigilance team aims to increase blood transfusion safety and to decrease both morbidity and mortality in donors and recipients. The team collects data about transfusion reactions and incidents, instructs the involved health workers and assures the tracing of blood components. The haemovigilance team at the University Hospitals Leuven has played a pioneering role in the development of haemovigilance in Belgium Although the literature about safety and quality improvements by haemovigilance systems is abundant, there are no published data available measuring their financial impact in a hospital. Therefore, we studied the costs and returns of the haemovigilance team at the University Hospitals Leuven. This study has a descriptive explorative design. Research of the current costs and returns of the haemovigilance team were based upon data from the Medical Administration of the hospital. Data were analyzed descriptively. The haemovigilance team of the University Hospitals Leuven is financially viable: the direct costs are covered by the annual financial support of the National Public Health Service. The indirect returns come from two important tasks of the haemovigilance team itself: correction of the electronic registration of administered blood component and improvement of the return of conform preserved blood components to the blood bank. Besides safety and quality improvement, which are obviously their main goals, the haemovigilance team also implies a financial benefit for the hospital. Copyright © 2016 Elsevier Ltd. All rights reserved.

AirBase - A database of 160,000 aerial photos of Greenland 1930-1980s

NASA Astrophysics Data System (ADS)

Korsgaard, Niels; Weng, Willy L.; Kjær, Kurt H.

2017-04-01

Beginning in the 1930s Danish survey agencies and US military organizations conducted large-scale aerial photograph surveys of Greenland for mapping purposes (1), eventuating in the recording of more than 160,000 photographs. Glaciological researchers have used this amazing resource of multi-decadal observations of the Greenlandic cryosphere for many decades (e.g. (2), (3), (4)). In recent years this information has been synthesized with modern remote sensing data resulting in a range of published research and data sets ((5), (6), (7), (8)). Today, the historical aerial photographs are stored at the SDFE (Agency for Data Supply and Effiency), the successor agency for the institutions doing the surveying and mapping of Greenland where the material is accessible to researchers and general public alike. The digitized flightline maps and databases necessary for the creation of this data for this work was made available by the SDFE, and it the past and present work with this database we present here. Based on digitized flight line maps, the database contains geocoded metadata such as recording dates, camera and film roll canister, connecting the database with the analog archive material. Past work concentrated on bulk digitization, while the focus of the current work is to improve positional accuracy, completeness, and refinements for web publication. (1) Nielsen, A., Olsen, J. & Weng, W. L. Grønlands opmåling og kortlægning. Landinspektøren 37 (1995). (2) Weidick A. Frontal variations at Upernaviks Isstrøm in the last 100 years. Medd. fra Dansk Geol. Forening. Vol. 14 (1958. (3) Bauer, A., Baussart, M., Carbonnell, M., Kasser, P. Perroud, P. & Renaud, A. Missions aériennes de reconnaissance au Groenland 1957-1958. Observations aériennes et terrestres, exploitation des photographies aériennes, détermination des vitesses des glaciers vêlant dans Disko Bugt et Umanak Fjord. Meddelelser om Grønland 173(3) (1968a. (4) Rignot, E. Box, J.E., Burgess, E. & Hanna, E. Mass balance of the Greenland ice sheet from 1958 to 2007. Geophys. Res. Lett. (2008. (5) Kjær, K.H., Khan, S.A., Korsgaard, N.J., Wahr, J., Bamber, J.L., Hurkmans, R., van den Broeke, M., Timm, L.H., Kjeldsen, K.K., Bjørk, A.A., Larsen, N.K., Jørgensen, L.T., Færch-Jensen, A. & Willerslev, E. Aerial Photographs Reveal Late-20th-Century Dynamic Ice Loss in Northwestern Greenland. Science 337 (2012). (6) Bjørk, A.A., Kjær, K.H., Korsgaard, N.J., Khan, S.A., Kjeldsen, K.K., Andresen, C.S., Box, J, Larsen, N.K. & Funder, S.V. An aerial view of 80 years of climate-related glacier fluctuations in southeast Greenland. Nat. Geosci. 5 (2012). (7) Kjeldsen, K.K., Korsgaard, N.J., Bjørk, A.A., Khan, S.A., Box, J.E., Funder, S., Larsen, N.K., Bamber, J.L., Colgan, W., van den Broeke, M., Siggaard-Andersen, M.-L., Nuth, C., Schomacker, A., Andresen, C.S., Willerslev, E. & Kjær, K.H. Spatial and temporal distribution of mass loss from the Greenland Ice Sheet since AD 1900. Nature 528 (2015). (8) Korsgaard, N.J., Nuth, C., Khan, S.A., Kjeldsen, K.K., Bjørk, A.A., Schomacker A. & Kjær, K.H. Digital elevation model and orthophotographs of Greenland based on aerial photographs from 1978-1987. Sci. Data 3:160032 (2016).

Renovating Charity Hospital or building a new hospital in post-Katrina New Orleans: economic rationale versus political will.

PubMed

Leleu, Hervé; Moises, James; Valdmanis, Vivian Grace

2013-02-01

Since September 2005, Charity Hospital of New Orleans has been closed due to Hurricane Katrina. A debate following the closing arose about whether this public hospital should be renovated or a new medical center affiliated with the Louisiana State University should be built. Using academic literature, government statistics, and popular press reports, we describe the economic implications that support the view that Charity Hospital should have been renovated. We also address why this policy was not pursued by demonstrating the influence politics and individual stakeholders (specifically, Louisiana State University) had on the eventual policy pursued. In this commentary we also note the political identity movement away from public-sector provision of services to private-sector interests.

The Hospital Microbiome Project: Meeting Report for the 1st Hospital Microbiome Project Workshop on sampling design and building science measurements, Chicago, USA, June 7th-8th 2012

PubMed Central

Smith, Daniel; Alverdy, John; An, Gary; Coleman, Maureen; Garcia-Houchins, Sylvia; Green, Jessica; Keegan, Kevin; Kelley, Scott T.; Kirkup, Benjamin C.; Kociolek, Larry; Levin, Hal; Landon, Emily; Olsiewski, Paula; Knight, Rob; Siegel, Jeffrey; Weber, Stephen; Gilbert, Jack

2013-01-01

This report details the outcome of the 1st Hospital Microbiome Project workshop held on June 7th-8th, 2012 at the University of Chicago, USA. The workshop was arranged to determine the most appropriate sampling strategy and approach to building science measurement to characterize the development of a microbial community within a new hospital pavilion being built at the University of Chicago Medical Center. The workshop made several recommendations and led to the development of a full proposal to the Alfred P. Sloan Foundation as well as to the creation of the Hospital Microbiome Consortium. PMID:23961316

[Analysis of HIV antibody positive cases in Peking University Hospital of Stomatology during 9 years].

PubMed

Ding, Jian-fen; Qiu, Juan; Shen, Shu-ming

2016-02-01

To investigate the prevalence and characteristics of HIV patients found in Peking University Hospital of Stomatology during 9 years, and provide management strategy for early diagnosis and control of HIV in Stomatology Hospital. A retrospective study of the HIV positive patients diagnosed by HIV antibody screening was carried out. The related information about these patients found in Peking University School of Stomatology during 2005-2013 was obtained from China Disease Control Information System. 68,562 patients accepted HIV antibody screening in Peking University Hospital of Stomatology during 2005-2013. Thirty one patients were found HIV antibody positive. The ratio of HIV antibody positive was about 0.045%, which was composed of 25 males and 6 females. 61.29% patients aged between 20-40 years, and their career was mainly commercial service with a education level of junior high school. The proportion of sexual route of transmission was about 74.91%, and 34.78% of them were male homosexuality. Most of the patients with HIV antibody positive were found in the out-patient clinic, especially in the department of oral mucosal diseases, accounting for 70.97%. HIV antibody positive rate in Peking University School of Stomatology was slightly lower than that in general hospitals. Medical staff should increase their awareness of AIDS prevention and control, for higher HIV risk departments, such as oral mucosal diseases and periodontal disease, efforts should be made to increase HIV screening, expand the scope of screening, and promote provider-initiated HIV testing and counseling.

[Information from the invoicing sector as support for decision-making: a case study at the University Hospital of the Federal University of Grande Dourados (UFGD)].

PubMed

Cintra, Renato Fabiano; Vieira, Saulo Fabiano Amâncio; Hall, Rosemar José; Fernandes, Cristiano Rodrigues

2013-10-01

The public sector is the main financing agent of hospital admissions and the information generated constitutes the input for the hospital information network of the Unified Health System (SUS). This paper seeks to design a report template to be used for decision-making in both public and university hospitals. The theoretical approach sought inspiration in discussions about the SUS, hospital institutions, hospital information systems and decision-making. The methodological procedures used are characterized as qualitative-descriptive methods and were conducted in a single case study and action research. The primary data analysis was carried out in two stages from January through December 2007 and from January through December 2008. Based on these periods, the findings were described and the elaboration of new reports was presented, with the importance and need for each being duly emphasized. Lastly, a structured report template was created for the case study that includes information discussed in the article. The conclusion reached is that the hospital information system can become a potential support tool, as the necessary adjustments are made and the report is structured to furnish the institution with an objective communication tool for decision-making.

Technical efficiency and resources allocation in university hospitals in Tehran, 2009-2012.

PubMed

Rezapour, Aziz; Ebadifard Azar, Farbod; Yousef Zadeh, Negar; Roumiani, YarAllah; Bagheri Faradonbeh, Saeed

2015-01-01

Assessment of hospitals' performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran. This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier 4,1 software. According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389. This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved.

Web-based training in German university eye hospitals - Education 2.0?

PubMed

Handzel, Daniel M; Hesse, L

2011-01-01

To analyse web-based training in ophthalmology offered by German university eye hospitals. In January 2010 the websites of all 36 German university hospitals were searched for information provided for visitors, students and doctors alike. We evaluated the offer in terms of quantity and quality. All websites could be accessed at the time of the study. 28 pages provided information for students and doctors, one page only for students, three exclusively for doctors. Four pages didn't offer any information for these target groups. The websites offered information on events like congresses or students curricular education, there were also material for download for these events or for other purposes. We found complex e-learning-platforms on 9 pages. These dealt with special ophthalmological topics in a didactic arrangement. In spite of the extensive possibilities offered by the technology of Web 2.0, many conceivable tools were only rarely made available. It was not always possible to determine if the information provided was up-to-date, very often the last actualization of the content was long ago. On one page the date for the last change was stated as 2004. Currently there are 9 functional e-learning-applications offered by German university eye hospitals. Two additional hospitals present links to a project of the German Ophthalmological Society. There was a considerable variation in quantity and quality. No website made use of crediting successful studying, e.g. with CME-points or OSCE-credits. All German university eye hospitals present themselves in the World Wide Web. However, the lack of modern, technical as well as didactical state-of-the-art learning applications is alarming as it leaves an essential medium of today's communication unused.

National Medical Care System May Impede Fostering of True Specialization of Radiation Oncologists: Study Based on Structure Survey in Japan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi

2012-01-01

Purpose: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. Methods and Materials: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient onmore » the basis of Japanese Blue Book guidelines (200 patients per RO). Results: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). Conclusions: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.« less

National medical care system may impede fostering of true specialization of radiation oncologists: study based on structure survey in Japan.

PubMed

Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi; Ikeda, Hiroshi; Sekiguchi, Kenji; Kamikonya, Norihiko; Koizumi, Masahiko; Tago, Masao; Ando, Yutaka; Tsukamoto, Nobuhiro; Terahara, Atsuro; Nakamura, Katsumasa; Mitsumori, Michihide; Nishimura, Tetsuo; Hareyama, Masato; Teshima, Teruki

2012-01-01

To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists. Copyright © 2012 Elsevier Inc. All rights reserved.

Can We Improve Workflows in the OR? A Comparison of Quality Perceptions and Preoperative Efficiency across Institutions in Spine Surgery.

PubMed

Wasterlain, Amy S; Tran, Andrew A; Tang, Chad; Campbell, David R; Braun, Hillary J; Scuderi, Yasmeen A; Scuderi, Gaetano J

2015-03-01

Cost containment and surgical inefficiencies are major concerns for hospitals in this era of declining resources. The primary aim of this investigation was to understand subjective perceptions of perioperative spine surgical quality across three practice settings and to identify potential factors contributing to these perceptions. Subsequently, we objectively evaluated factors that influence the duration of time in which the patient is in the operating room (OR) prior to the surgical incision and assessed the influence of fluoroscopy technician expertise on radiation dose and imaging efficiency. One hundred and eight medical device representatives with at least 1 year of OR experience were surveyed at a national conference. Three distinct healthcare facilities were identified: university, small volume, and large volume private hospitals. Respondents rated facilities on a five-point scale for staff quality; size and consistency of surgical teams; and overall likelihood of recommending the facility. Separately, 140 posterior lumbar procedures from two institutions were retrospectively reviewed. Two time periods were quantified for each surgical case: patient arrival in the OR to induction of anesthesia (T1) and induction to surgical incision (T2). T1 and T2 were compared between university and large private hospital settings using t tests and multivariate analysis. For 44 separate lumbar spine surgical procedures, practice setting, patient BMI, number of vertebral levels requiring imaging, number of localizing fluoroscopy images taken, total fluoroscopy time, total radiation dose, fluoroscopy machine, and whether the fluoroscopist could correctly state his or her role, which was to obtain a lateral lumbar localizing image, were recorded. T-tests were used to compare cases in which the fluoroscopist could and could not correctly state the task. Survey ratings for surgeons were not significantly different across university, large private, and small private hospitals. Fewer circulating nurses were rated as excellent or good in university versus private hospitals (p < 0.001). Small volume private hospital surgical teams were more likely to have worked together before than university teams (p < 0.05), and university teams were larger (p < 0.05). Respondents were more likely to recommend a university or large private hospital for complex instrumentation cases (p < 0.001). On objective measures, university patients were older, less obese, and had higher mean ASA scores (2.5 versus 2.2, p < 0.001). Compared to the university setting, private hospital cases had significantly shorter Time 1 (8 versus 37 min, p < 0.001) and Time 2 (23 versus 30 min, p < 0.001), even after adjusting for ASA score, BMI, and age. Cases in which the fluoroscopist knew the imaging purpose were associated with significantly fewer images (mean 1.8 versus 3.4 images, p < 0.0001) and shorter total exposure times (2.3 versus 4.0 sec, p < 0.001). Operations performed in the university setting were associated with significantly more images (2.7 versus 1.8 images, p < 0.001), longer total exposure times (3.2 versus 2.3 sec, p = 0.0027), and total radiation dose (27.8 versus 53.3 rad, p < 0.001) when compared with those performed in the private setting. The university practice setting was associated with significantly more images (2.7 versus 1.8 images, p < 0.001), longer total exposure times (3.2 versus 2.3 sec, p = 0.003), and total radiation dose (27.8 versus 53.3 rad, p < 0.001) when compared with non-university settings. Large private and university hospitals had higher surgeon ratings. The university setting was associated with larger and less consistent surgical teams and lower nurse ratings. Surgical staff awareness of the procedure and attention to preoperative tasks specific to the procedure reduced pre-operative time spent in the OR as well as fluoroscopy radiation. These data suggest that nurses and support staff make substantial contributions to overall quality of care, and that leadership and interpersonal coordination are especially important within large teams at teaching hospitals.

The art of improvisation: the working process of administrators at a Federal University Hospital.

PubMed

Littike, Denilda; Sodré, Francis

2015-10-01

The scope of this article is to analyze the working process of administrators at a Federal University Hospital (HUF). It includes research with a qualitative approach conducted through interviews with twelve administrators. The work process, the work tools and the human activity per se are understood to be under scrutiny. Work is acknowledged as a category that analyzes the management methods used by professional health workers. The HUFs are responsible for two social policies, namely education and health. The aim of the administrators' work is an organizational issue, and the administration tools used are bureaucratic and out-of-date for the current political context of hospital management. The most significant feature of this hospital administration is improvisation, which reduces the potential of the administrators in such a way that, instead of introducing innovative changes into their work process, they prefer to leave their jobs. Improvisation is caused by the production of sequential obstacles in management decision-making at this teaching hospital. In short, the transfer of administration at the HUF, from direct government administration by the University to the Brazilian Company of Hospital Services (EBSERH), was analyzed on the grounds that this would establish a "new" management model.

Training rotations at hospitals as a recruitment tool for Certified Registered Nurse Anesthetists.

PubMed

Wachtel, Ruth E; Dexter, Franklin

2012-08-01

Recruiting newly graduating Certified Registered Nurse Anesthetists (CRNAs) is expensive. Recruitment into rural areas is especially challenging. We analyzed the first jobs of all 95 graduates of the University of Iowa's CRNA training program, from the initial graduating class of 1997 through the class of 2009. We compared the location of the student's first job to where the student lived at the time of application to the program. Hospitals enhanced recruitment of CRNAs by having student rotations (P = .001). Most students who joined a practice offering an outside rotation were not from the county or contiguous counties of the hospital they joined (P < .001). In years that hospitals with rotations hired more than the median number of students, significantly more students had rotated through the hospital (P = .02). Offering a CRNA training program did not facilitate the university's retention of nurses already living in its county or contiguous counties (P = 0.58). Consequently, rural hospitals can view sponsoring rotations as a recruitment tool for graduating CRNAs. The university sponsoring the training program did not retain an advantage, however, in hiring its own graduates. Because this case study provided valuable insights, other programs should consider performing similar analyses.

Hazardous medical waste generation rates of different categories of health-care facilities.

PubMed

Komilis, Dimitrios; Fouki, Anastassia; Papadopoulos, Dimitrios

2012-07-01

Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed(-1)d(-1), using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed(-1)d(-1), for the public psychiatric hospitals, to up to 0.72 kg bed(-1)d(-1), for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed(-1)d(-1), for the psychiatric clinics, to up to 0.49 kg bed(-1)d(-1), for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Evaluation of the Oran university hospital information system].

PubMed

Chougrani, Saada; Ouhadj, Salah; Agag, Fouzia

2013-01-01

Oran university hospital has been operating since 2010. It is a public institution that must assess the resources required to achieve institutional goals integrated into the strategic objectives defined in the hospital development project. Implementation of this project could be supported, among other things, by a strong and efficient hospital information system. Three investigations were conducted: 1- evaluation of the hospital information system, 2- assessment of the quality of the hospital discharge summary reports, 3- assessment of the quality of medical records. The six components of the hospital information system (resources, indicators, sources, management, quality and dissemination and use of data) were clearly present but not satisfactory with a score ranging from 25 to 50% of the total score. The scores by component were as follows: 36% for resources, 37% for indicators, 42% for patient records, 19% for data management and 27% for the dissemination of information. The overall completeness of medical records was 85.2%. Completeness by group of variables gave the following results: 66% for medical information, 54% for the patient's stay and 38% for information relating to the patient's discharge. Hospital discharge summary reports were available in 59.8% of cases, but were blank in 4% of cases. The critical variable, the principal diagnosis was found in 51% of cases. The correct principal diagnosis rate was 33.3%. The deficiencies observed for content and data management raise real questions concerning data management at Oran university hospital as part of a real managerial approach.

Stretching the boundaries of medical education A case of medical college embracing humanities and social sciences in medical education.

PubMed

Ghias, Kulsoom; Khan, Kausar S; Ali, Rukhsana; Azfar, Shireen; Ahmed, Rashida

2016-01-01

Aga Khan University, a private medical college, had a vision of producing physicians who are not only scientifically competent, but also socially sensitive, the latter by exposure of medical students to a broad-based curriculum. The objective of this study was to identify the genesis of broad-based education and its integration into the undergraduate medical education program as the Humanities and Social Sciences (HASS) course. A qualitative methodology was used for this study. Sources of data included document review and in-depth key informant interviews. Nvivo software was utilized to extract themes. The study revealed the process of operationalization of the institutional vision to produce competent and culturally sensitive physicians. The delay in the establishment of the Faculty of Arts and Sciences, which was expected to take a lead role in the delivery of a broad-based education, led to the development of an innovative HASS course in the medical curriculum. The study also identified availability of faculty and resistance from students as challenges faced in the implementation and evolution of HASS. The description of the journey and viability of integration of HASS into the medical curriculum offers a model to medical colleges seeking ways to produce socially sensitive physicians.

Paediatric innovation in Pakistan: our experience and a call to action.

PubMed

Farooqi, Walid; Subhani, Faysal; Mian, Asad

2017-10-01

Standardisation in paediatric medicine may have the unintended effect of stifling innovation. Thinking outside the box becomes even more important in low-income to middle-income countries like Pakistan, where a large paediatric population requires healthcare. In addition, there is always a lack of funds, making an innovative, low-cost and high impact solution all the more necessary. While regulation and formal research is an integral part of the process, the local synthesis of a solution must start with a creative idea. To address the dearth of avenues promoting lateral thinking relevant to biomedicine and healthcare among students and faculty, the Critical Creative Innovative Thinking forum was formed at the Aga Khan University in Karachi, Pakistan, by a group consisting of students and faculty in 2014. The primary objective of the forum was to provide an arena conducive to lateral thinking and to equip biomedical professionals with the skill set to enable and promote creativity and innovation. This paper seeks to outline those efforts and discuss their potential impact on paediatric care for resource-limited settings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Flipped classroom instructional approach in undergraduate medical education

PubMed Central

Fatima, Syeda Sadia; Arain, Fazal Manzoor; Enam, Syed Ather

2017-01-01

Objective: In this study we implemented the “flipped classroom” model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi. Methods: Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class quizzes, work sheets and blog posts for each session. Student feedback was recorded via a likert scale survey. Results: Eighty four percent students gave positive responses towards utility of flipped classroom in terms of being highly interactive, thought provoking and activity lead learning. Seventy five percent of the class completed the pre-session preparation. Students reported that their queries and misconceptions were cleared in a much better way in the face-to-face session as compared to the traditional setting (4.09 ±1.04). Conclusion: Flipped classroom(FCR) teaching and learning pedagogy is an effective way of enhancing student engagement and active learning. Thus, this pedagogy can be used as an effective tool in medical schools. PMID:29492071

How we developed a bioethics theme in an undergraduate medical curriculum.

PubMed

Ghias, Kulsoom; Ali, Syeda Kauser; Khan, Kausar S; Khan, Robyna; Khan, Murad M; Farooqui, Arshi; Nayani, Parvez

2011-01-01

The 5-year undergraduate medical curriculum at Aga Khan University integrates basic sciences with clinical and community health sciences. Multimodal strategies of teaching and learning, with an emphasis on problem-based learning, are utilized to equip students with knowledge, skills, behaviours, attitudes and values necessary for a high-calibre medical graduate. Bioethics teaching was introduced in the medical curriculum in 1988 and has since undergone several changes. In 2009, a multidisciplinary voluntary group began review of undergraduate bioethics teaching and invested over 350 man-hours in curricular revision. This involved formulating terminal objectives, delineating specific objectives and identifying instructional methodologies and assessment strategies appropriate for the contents of each objective. Innovative strategies were specially devised to work within the time constraints of the existing medical curriculum and importantly, to increase student interest and engagement. The new bioethics curriculum is designed to be comprehensive and robust, and strives to develop graduates who, in addition to being technically skilled and competent, are well-versed in the history and philosophy of ethics and bioethics and are ethical in their thinking and practice, especially in the context of a developing country like Pakistan where health indicators are among the worst in the region, and clinical practices are not effectively regulated to ensure quality of care.

Flipped classroom instructional approach in undergraduate medical education.

PubMed

Fatima, Syeda Sadia; Arain, Fazal Manzoor; Enam, Syed Ather

2017-01-01

In this study we implemented the "flipped classroom" model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi. Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class quizzes, work sheets and blog posts for each session. Student feedback was recorded via a likert scale survey. Eighty four percent students gave positive responses towards utility of flipped classroom in terms of being highly interactive, thought provoking and activity lead learning. Seventy five percent of the class completed the pre-session preparation. Students reported that their queries and misconceptions were cleared in a much better way in the face-to-face session as compared to the traditional setting (4.09 ±1.04). Flipped classroom(FCR) teaching and learning pedagogy is an effective way of enhancing student engagement and active learning. Thus, this pedagogy can be used as an effective tool in medical schools.

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

PubMed Central

Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

2014-01-01

Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup. PMID:26464857

Stretching the boundaries of medical education A case of medical college embracing humanities and social sciences in medical education

PubMed Central

Ghias, Kulsoom; Khan, Kausar S; Ali, Rukhsana; Azfar, Shireen; Ahmed, Rashida

2016-01-01

Objective: Aga Khan University, a private medical college, had a vision of producing physicians who are not only scientifically competent, but also socially sensitive, the latter by exposure of medical students to a broad-based curriculum. The objective of this study was to identify the genesis of broad-based education and its integration into the undergraduate medical education program as the Humanities and Social Sciences (HASS) course. Methods: A qualitative methodology was used for this study. Sources of data included document review and in-depth key informant interviews. Nvivo software was utilized to extract themes. Results: The study revealed the process of operationalization of the institutional vision to produce competent and culturally sensitive physicians. The delay in the establishment of the Faculty of Arts and Sciences, which was expected to take a lead role in the delivery of a broad-based education, led to the development of an innovative HASS course in the medical curriculum. The study also identified availability of faculty and resistance from students as challenges faced in the implementation and evolution of HASS. Conclusions: The description of the journey and viability of integration of HASS into the medical curriculum offers a model to medical colleges seeking ways to produce socially sensitive physicians. PMID:27648038

[Screening for malnutrition among hospitalized patients in a Colombian University Hospital].

PubMed

Cruz, Viviana; Bernal, Laura; Buitrago, Giancarlo; Ruiz, Álvaro J

2017-04-01

On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design

PubMed Central

Hahnenkamp, Klaus; Buhre, Wolfgang F.F.A; de Korte-de Boer, Dianne; Hamaekers, Ankie E.W; Metelmann, Bibiana; Metelmann, Camila; Bortul, Marina; Palmisano, Silvia; Mellin-Olsen, Jannicke; Macas, Andrius; Andres, Janusz; Prokop-Dorner, Anna; Vymazal, Tomáš; Hinkelmann, Juergen; Rodde, Sibyll; Pfleiderer, Bettina

2017-01-01

Background All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe. Objectives The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts. Methods We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women’s academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on “personal construct theory” through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management. Results A discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service. Conclusions The main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals. PMID:28768613

Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

PubMed

Bynum, Debra L; Wilson, Lindsay A; Ong, Thuan; Callahan, Kathryn E; Dalton, Thomas; Ohuabunwa, Ugochi

2015-09-01

In order to determine how often internal medicine and family medicine residents performed specific actions related to the geriatric competencies established by the American Geriatrics Society (AGS) when caring for older hospitalized adults, a cross-sectional anonymous survey of residents at the University of North Carolina, University of Washington, Wake Forest University, Duke University, and Emory University was undertaken. Data on frequency of self-reported behaviors were analyzed, with comparisons made for different levels of training, institution, and program. A total of 375 residents responded for an overall response rate of 48%. Residents reported that they often do not demonstrate all of the AGS recommended core competencies when caring for older adults in the hospital setting. Residents report more frequently performing activities that are routinely integrated into hospital systems such as reviewing medication lists, working with an interdisciplinary team, evaluating for inappropriate bladder catheters, and evaluating for pressure ulcers. There were no consistent differences between institutions and only minor differences noted between Family Medicine and Internal Medicine residents. Operationalizing core competencies by integrating them into hospital systems' quality process indicators may prompt more consistent high-quality care and ensure systems support residents' competence. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Implementation of an advanced clinical and administrative hospital information system.

PubMed

Vegoda, P R; Dyro, J F

1986-01-01

Over the last six years since University Hospital opened, the University Hospital Information System (UHIS) has continued to evolve to what is today an advanced administrative and clinical information system. At University Hospital UHIS is the way of conducting business. A wide range of patient care applications are operational including Patient Registration, ADT for Inpatient/Outpatient/Emergency Room visits, Advanced Order Entry/Result Reporting, Medical Records, Lab Automated Data Acquisition/Quality Control, Pharmacy, Radiology, Dietary, Respiratory Therapy, ECG, EEG, Cardiology, Physical/Occupational Therapy and Nursing. These systems and numerous financial systems have been installed in a highly tuned, efficient computer system. All applications are real-time, on-line, and data base oriented. Each system is provided with multiple data security levels, forward file recovery, and dynamic transaction backout of in-flight tasks. Sensitive medical information is safeguarded by job function passwords, identification codes, need-to-know master screens and terminal keylocks. University Hospital has an IBM 3083 CPU with five 3380 disk drives, four dual density tape drives, and a 3705 network controller. The network of 300 terminals and 100 printers is connected to the computer center by an RF broadband cable. The software is configured around the IBM/MVS operating system using CICS as the telecommunication monitor, IMS as the data base management system and PCS/ADS as the application enabling tool. The most extensive clinical system added to UHIS is the Physiological Monitoring/Patient Data Management System with serves 92 critical care beds. In keeping with the Hospital's philosophy of integrated computing, the PMS/PDMS with its network of minicomputers was linked to the UHIS system. In a pilot program, remote access to UHIS through the IBM personal computer has been implemented in several physician offices in the local community, further extending the communications horizons of University Hospital's Information System. The implications of remote access to PDMS through the IBM PC emulating a Siemens Model 420 Patient Data Management Terminal are being examined.

Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.

PubMed

Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

2016-02-01

At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

["How can hospitals develop a beneficial relationship with laboratory testing companies?" - Chairmen's introductory remarks].

PubMed

Morita, Toshisuke; Kawano, Seiji

2014-12-01

The symposium was held with the Japanese Society of Laboratory Medicine and JACLaP to discuss the way to develop a beneficial relationship between hospitals and laboratory testing companies with co-chairing by Seiji Kawano, Kobe University and Toshisuke Morita, Toho University. Clinical testing is considered to be essential for medical diagnosis and treatment; however, it is difficult for a hospital to perform all clinical testing for various reasons, including cost-effectiveness. In this session, 4 guest speakers gave a talk from their viewpoints. Doctor Kawano talked about the results of a questionnaire filled out by 114 university hospitals on how to develop a beneficial relationship between hospitalsoand laboratory testing companies. Next, Mr. Shinji Ogawa, president and CEO of SRL, talked about favorable ways to utilize laboratory testing companies, sayingthat such companies, which have a variety of skills, are expected to offer new and advanced technologies to hospitals continuously, and abundant data which laboratory testing companies have should be used for the advancement of community medicine. Professor Koshiba, Hyogo Medical School, expressed his apprehension to develop a so-called branch lab. in university hospitals from his own experience, and concluded that a beneficial relationship with companies to perform tasks required by hospitals should be sought. The last speaker, Yuichi Setoyama, Mitsubishi Chemical Medience, talked about the new relationship between hospitals and laboratory testing companies, and emphasized that hospitals and such companies should know the strong and weak points of each other and build a mutually complementary system. After all presentations were over, a discussion with participants was held. Doctors of clinics said that the role of laboratory testing companies for large hospitals is different from that for small clinics, and such companies are indispensable for his everyday medical activities. Each medical institute has its own medical mission, and, therefore, what constitutes a beneficial relationship varies with each medical institute. The key to the success of building a win-win relationship with laboratory testing companies is held by each hospital. (Review).

The National Security Model: A Hybrid Approach for Determining the Legality of the Targeted Killing of U.S. Citizens

DTIC Science & Technology

2012-12-14

principles .33 Attorney General Holder asserted that the President is not required to get permission from any federal court before taking action against a...damages from the defendants because they claimed that the deaths al-Awlaki and Khan were foreseeable consequences of the actions and omissions of the...noted by the District Court, “the presence of a political question suffices to prevent the power of the federal judiciary from being invoked.”5

Epigenetic Programming of Breast Cancer and Nutrition Prevention

DTIC Science & Technology

2012-05-01

to control (Figure 2). Maternal dietary supplementation with Res reduced by ~60% DNMT1 occupancy on the BRCA-1 promoter, compared with TCDD exposed...2009;75:1227–30. [57] Jeuken A, Keser BJ, Khan E, Brouwer A, Koeman J, DenisonMS. Activation of the Ah receptor by extracts of dietary herbal ... supplements , vegetables, and fruits. J Agric Food Chem 2003;51:5478–87. [58] Amakura Y, Tsutsumi T, Sasaki K, Nakamura M, Yoshida T, Maitani T. Influence of

Army Pacific Pathways: Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance Value for Participating Units

DTIC Science & Technology

2016-11-01

Strike ( Malaysia ) Garuda Shield (Indonesia) Orient Shield (Japan) 15-1 Jan. – May 2015 2-25 Stryker BCT ~880 personnel Cobra Gold (Thailand) Foal...Keris Strike ( Malaysia ) 15-3 June-July, Aug. – Nov. 2015 1-25 Stryker BCT ~420 personnel Khan Quest (Mongolia) Orient Shield (Japan) Hoguk...Strike ( Malaysia ) Source: GAO analysis of U.S. Army Pacific data. | GAO-17-126 aIn addition to the brigades identified here, other units and personnel

Effects of Environment on Infection in Burn Patients

DTIC Science & Technology

1986-01-01

medical archives; NSA, nurses’ station, acute-care patients ; NSB, nurses’ station, intermediate-care patients ; OT", occupational therapy section; QAP...Reprinted from the Archives of Surgery January 1986, Volume 121 Copyright 1986, American Medical Association 00 ’d". CD Y" E LE C; I Effects of...Environment on Infection in Burn Patients LTC Khan Z. Shirani, MC, USA; Albert T. McManus, PhD; LTC George M. Vaughan, MC, USA; COL William F. McManus, MC

It’s Just Not Cricket - The Anglo-Afghan Wars and Their Relevance to Current Operations

DTIC Science & Technology

2010-03-30

Khan wished to seize the initiative and on 28 May began an artillery bombardment on the city of Thai , which stood on the British-Afghan border... Thai was under siege for six days and although the resident garrison repelled the Afghans, the situation was perilous for those that survived the...onslaught. Consequently, the British ordered a relief-in-place. Having dealt with Afghan resistance en route, Brigadier General Dyer arrived at Thai on 1

Command and Control Began with Subotai Bahadur, the Thirteenth Century Mongol General

DTIC Science & Technology

2010-04-01

embodied a lifetime of Mongol military experience and training when he planned and led the Hungarian Campaign. By the time of his death in 1248 at the...to function after Chinggis Khan’s death , became the home of the best officers, and each was trained in staff work and attended education and briefin...were forbidden by punishment of death , and soldiers served their entire lives in a single unit. 57 Juvaini noted: "When the line ’goes into battle

Characterization of Pulsed Vortex Generator Jets for Active Flow Control

DTIC Science & Technology

2001-06-01

approaches to calculating these quantities shown to not to play a significant role in the developing vortex, were assessed; most of which used Amtec ...obtained very close to Since this method was developed. Amtec Engineering’s CFD the wall, but not completely through the laminar sub-layer. The...Francisco, California, July 18-23 1999. 31 "’Khan, Z.U. & Jolmston, J.P., "On Vortex Generating Jets," " Amtec Engineering Inc., ©1988-2000 [http

KSC-04pd1102

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- During filming at KSC by a crew from India, KSC videographer Glen “Mic” Miracle (left) and Bobbie Faye Ferguson talk to actor Rahul Vohra (right). The film crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. Vohra is one of the actors in the film that stars Shahrukh Khan and Gayatri Joshi. The writer-director is Ashutosh Gowariker. Sunita Gowariker is executive producer. Ferguson is manager of Multimedia, for NASA Public Affairs.

KSC-04pd1101

NASA Image and Video Library

2004-05-05

KENNEDY SPACE CENTER, FLA. -- Sashikant Dhawan (left), costume director with a film crew from India, and Shirish R. Patel (right), with KSC’s International Space Station Payload Processing, pose for a photo near the viewing stands at the NASA News Center. The crew spent several days at KSC filming at various sites for the movie “Swades,” a story about India’s brain-drain. The writer and director is Ashutosh Gowariker. The lead actors are Shahrukh Khan and Gayatri Joshi. Sunita Gowariker is executive producer.

Krayola Khans: An Analysis of US Operational Commanders and Indigenous Warlords

DTIC Science & Technology

2006-05-09

state. History has shown that Afghanistan has rarely, if ever, been ruled from the capital. Traditionally, whoever ruled in Kabul did so with the aid...holds within his tribal network, one could then deduce his CV to be the bond he has with the tribe . Of the three CV’s listed above, the last could be...appearing to be attacking the tribe itself. In this particular case, the use of information operations will be one of the keys to success. The JFC

The Effects of Perceived Over Qualification on Job Satisfaction, Organizational Commitment, and Turnover: A Study of AFIT Graduates

DTIC Science & Technology

2003-03-25

Economics 3: 434-463 (October 1985). Bowlus, Audra J. “Matching Workers and Jobs: Cyclical Fluctuations in Match Quality,” Journal of Labor ...Education Review, 21: 263-275 (2002). Clark, Andrew E. “What really matters in a job? Hedonic measurement using quit data,” Labor Economics , 8: 223...242 (2001). Cohn, Elchanan and Shahina P. Khan. “The wage effect of overschooling revisited,” Labor Economics , 2: 67-76 (1995) Dooley, David

The Strategic Alternatives of the Gulf Cooperation Council (GCC): Disruption of Maritime Traffic in the Arabian Gulf as a Result of Iranian Threats to Close the Strait of Hormuz

DTIC Science & Technology

2012-03-01

71Saira Khan, Iran and Nuclear Weapons: Protracted Conflict and Proliferation. (London: Routledge, 2010), 73. 72 Hays, Peter, Brenda, Vallance , and...exports, are by sea; thus, closure of the 74 Heinberg, Richard , et al. The Middle East Unrest and...11 Reaction.” Journal of International Affairs, Vol. 59, No. 1 (Fall/Winter 2005):157–178. Hays, Peter L., Brenda J. Vallance , and Alan R. Tassel

Bone Marrow-derived Mesenchymal Stem Cells (MSCs) as a Selective Delivery Vehicle for a PSA-Activated Protoxin for Advanced Prostate Cancer

DTIC Science & Technology

2014-04-01

other groups are seeking to develop MSCs as vectors to deliver prostate - specific antigen (PSA)-activated prodrugs (Denmeade et al. 2003) and protoxins...Denmeade SR, Jakobsen CM, Janssen S, Khan SR, Garrett ES, Lilja H, Christensen SB & Isaacs JT 2003 Prostate - specific antigen -activated thapsigargin...cells derived from benign prostatic hyperplasia specimens possess stem cell like property. Prostate 67 1265–1276. (doi:10.1002/ pros .20599) Lin G, Yang R

KSC-04PD-1102

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. -- During filming at KSC by a crew from India, KSC videographer Glen Mic Miracle (left) and Bobbie Faye Ferguson talk to actor Rahul Vohra (right). The film crew spent several days at KSC filming at various sites for the movie Swades, a story about Indias brain-drain. Vohra is one of the actors in the film that stars Shahrukh Khan and Gayatri Joshi. The writer-director is Ashutosh Gowariker. Sunita Gowariker is executive producer. Ferguson is manager of Multimedia, for NASA Public Affairs.

Crisis in Baluchistan: A Historical Analysis of the Baluch Nationalist Movement in Pakistan

DTIC Science & Technology

2006-06-01

Nawab Akhbar Khan Bugti. Interview posted on www.balochvoice.com, 1 August 2003, accessed 30 April 2006. 2 “English Rendering of President’s...Cody, Edward. "Pakistanis Prowl Border Peaks but See Few Signs of Al Qaeda." The Washington Post, 4 Jan 2002. Accessed from http...65345&RQT=3 09&VName=PQD on 19 Apr 2006. Grare, Frederic. “Pakistan: The Resurgence of Baluch Nationalism.” Carnegie Papers 65 ( Jan 2006). Hah

Prevalence of Diabetes Mellitus in the Surgical Population of the University of Puerto Rico Affiliated Hospitals: A Study using the Surgery Database.

PubMed

Cruz, Norma I; Santiago, Elvis; Abdul-Hadi, Anwar

2016-09-01

To evaluate the prevalence of diabetes mellitus in the surgical population of the University of Puerto Rico (UPR)-affiliated hospitals. We examined all the surgical cases that were entered into the Surgical Database from April 1, 2014 through September 30, 2014. This database collects patient and procedural information from different surgical services of various UPR-affiliated hospitals (the University District Hospital, the University Pediatric Hospital, the UPR Carolina Hospital, the Dr. Isaac Gonzalez Oncologic Hospital, the PR Cardiovascular Center [thoracic service], the Pavia Hospital [colorectal service], and the Auxilio Mutuo Hospital [colorectal and oncological services]). The prevalence of diabetes mellitus (types 1 and 2 combined) was estimated, and the nondiabetic and diabetic groups were compared. The difference between groups was evaluated using a Chi2 test, Student's t-test, or ANOVA, whichever was appropriate, with a p-value of less than 0.05 being considered significant. Information from 2,603 surgical patients was available. The mean age of the group was 49 (±23) years. The gender distribution indicated that 56% were women and 44% were men. Diabetes was present in 21% of the surgical population, increasing to 40% in patients aged 65 and over. The surgical procedures most frequently required by diabetic patients were in the categories of general surgery (36%), colorectal surgery (22%), vascular surgery (16%) and oncologic surgery (14%). Complications (5%, diabetic group vs. 2%, nondiabetic group; p < 0.05) and postoperative mortality (2%, diabetic group vs. 0.2%, nondiabetic group; p < 0.05) were significantly higher in the diabetic group than in the nondiabetic group. Our surgical population has a high prevalence of diabetes, and these diabetic patients showed higher complication and mortality rates from surgery than did the non-diabetic patients. Surgeons must consider the specific needs of these diabetic patients in order to provide optimal care.

Screening and Brief Intervention for Alcohol Problems among College Students Treated in a University Hospital Emergency Department

ERIC Educational Resources Information Center

Helmkamp, James C.; Hungerford, Daniel W.; Williams, Janet M.; Manley, William G.; Furbee, Paul M.; Horn, Kimberly A.; Pollock, Daniel A.

2003-01-01

The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score [less…

Experiencing Work: Supporting the Undergraduate Hospitality, Tourism and Cruise Management Student on an Overseas Work Placement

ERIC Educational Resources Information Center

Gibson, Philip; Busby, Graham

2009-01-01

This paper reports on a funded research project into the experiences of tourism, hospitality and cruise management students on internship outside the UK as part of their British university degree between 2007 and 2009. The research reflected on the perceptions of students, course managers, placement officers and members of university placement…

Technical efficiency and resources allocation in university hospitals in Tehran, 2009-2012

PubMed Central

Rezapour, Aziz; Ebadifard Azar, Farbod; Yousef Zadeh, Negar; Roumiani, YarAllah; Bagheri Faradonbeh, Saeed

2015-01-01

Background: Assessment of hospitals’ performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran. Methods: This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier 4,1 software. Results: According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389. Conclusion: This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved. PMID:26793657

Organisation of diagnosis and treatment of idiopathic pulmonary fibrosis and other interstitial lung diseases in the Nordic countries

PubMed Central

Bendstrup, Elisabeth; Hyldgaard, Charlotte; Altraja, Alan; Sjåheim, Tone; Myllärniemi, Marjukka; Gudmundsson, Gunnar; Sköld, Magnus; Hilberg, Ole

2015-01-01

Introduction Differences in the organisation of idiopathic pulmonary fibrosis (IPF) and interstitial lung diseases (ILDs) in the Nordic countries are not well described. Diagnostic setups, treatment modalities and follow-up plans may vary due to national, cultural and epidemiological features. The aim of the present study was to describe the different organisation of diagnostics and treatment of IPF and ILD in the Nordic countries. Methods All university and regional hospitals with respiratory physicians were invited to respond to a questionnaire collecting data on the number of physicians, nurses, patients with ILD/IPF, the presence of and adherence to disease-specific national and international guidelines, diagnosis and treatment including ILD-specific palliation and rehabilitation programmes. Results Twenty-four university and 22 regional hospitals returned the questionnaire. ILD and IPF incidence varied between 1.4 and 20/100,000 and 0.4 and 10/100,000, respectively. Denmark and Estonia have official national plans for the organisation of ILD. The majority of patients are managed at the university hospitals. The regional hospitals each manage 46 (5–200) patients with ILD and 10 (0–20) patients with IPF. There are from one to four ILD centres in each country with a median of two ILD specialists employed. Specialised ILD nurses are present in nine hospitals. None of the Nordic countries have national guidelines made by health authorities. The respiratory societies in Sweden, Norway and Denmark have developed national guidelines. All hospitals except two use the ATS/ERS/JRS/ALAT IPF guidelines from 2011. The limited number of ILD specialists, ILD-specialised radiologists and pathologists and the low volume of ILD centres were perceived as bottlenecks for implementation of guidelines. Twenty of the 24 university hospitals have multidisciplinary conferences (MDCs). Pulmonologists and radiologists take part in all MDCs while pathologists only participate at 17 hospitals. Prescription of pirfenidone is performed by all university hospitals except in Estonia. Triple therapy with steroid, azathioprine and N-acetylcysteine is not used. No hospitals have specific palliation programmes for patients with ILD/IPF, but 36 hospitals have the possibility of referring patients for palliative care, mostly based on existing oncology palliative care teams; seven hospitals have rehabilitation programmes for ILD. Conclusion There are obvious differences between the organisations of ILD patients in the Nordic countries. We call for national plans that consider the challenge of cultural and geographical differences and suggest the establishment of national reference centres and satellite collaborative hospitals to enable development of common guidelines for diagnostics, therapy and palliation in this patient group. PMID:26557259

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

PubMed

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

2016-06-01

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

A Graduate Program in Institutional Pharmacy Management Leading to an MS in Hospital Pharmacy, MBA and Residency.

ERIC Educational Resources Information Center

Blair, Jan N.; Lipman, Arthur G.

1981-01-01

A combined program leading to the MS in Hospital Pharmacy, MBA, and Certificate of Residency in Hospital Pharmacy established at the University of Utah in 1978 is described. The program provides coursework in both hospital pharmacy and management plus practical experience in hospital pharmacy practice management. (Author/MLW)

[Proposal for graduate school education in the future: from the viewpoint of the Department of clinical Laboratory in a university hospital].

PubMed

Ishii, Junichi

2009-08-01

Fujita Health University Hospital, located in Toyoake, is a large teaching hospital with 1,505 beds. The Department of Clinical Laboratory in our hospital, in which 136 medical technologists work, is one of the largest clinical laboratories in Japan. Medical technologists in our hospital are required not only to perform accurate laboratory examinations, but also to contribute to the medical care team. In addition, they must educate students and trainee medical technologists. Furthermore, they conduct research to develop and evaluate new laboratory methods. Thus, we hope that education in graduate schools of medical technology (Master's course), along with promoting the specialty of laboratory techniques, will develop students' clinical skills to examine patients and research skills to conduct studies.

The experience of physicians in pharmacogenomic clinical decision support within eight German university hospitals.

PubMed

Hinderer, Marc; Boeker, Martin; Wagner, Sebastian A; Binder, Harald; Ückert, Frank; Newe, Stephanie; Hülsemann, Jan L; Neumaier, Michael; Schade-Brittinger, Carmen; Acker, Till; Prokosch, Hans-Ulrich; Sedlmayr, Brita

2017-06-01

The aim of this study was to assess the physicians' attitude, their knowledge and their experience in pharmacogenomic clinical decision support in German hospitals. We conducted an online survey to address physicians of 13 different medical specialties across eight German university hospitals. In total, 564 returned questionnaires were analyzed. The remaining knowledge gap, the uncertainty of test reimbursement and the physicians' lack of awareness of existing pharmacogenomic clinical decision support systems (CDSS) are the major barriers for implementing pharmacogenomic CDSS into German hospitals. Furthermore, pharmacogenomic CDSS are most effective in the form of real-time decision support for internists. Physicians in German hospitals require additional education of both genetics and pharmacogenomics. They need to be provided with access to relevant pharmacogenomic CDSS.

[Accidents with biological material at West Paraná University Hospital].

PubMed

Murofuse, Neide Tiemi; Marziale, Maria Helena Palucci; Gemelli, Lorena Moraes Goetem

2005-08-01

It is a descriptive and retrospective study with the purpose of investigating labor accidents with biological material involving workers and trainees occurred in 2003 and 2004 in a University Hospital of Parana. For data collection, the electronic form of the Net of Occupational Accidents Prevention - REPAT has been utilized. Out of the 586 hospital workers, there was a register of 20 (3,4%) injured workers in 2003 and 23 (3,8%) in 2004, representing an increase of 15% in the notifications from one year to the other.

LISA, the next generation: from a web-based application to a fat client.

PubMed

Pierlet, Noëlla; Aerts, Werner; Vanautgaerden, Mark; Van den Bosch, Bart; De Deurwaerder, André; Schils, Erik; Noppe, Thomas

2008-01-01

The LISA application, developed by the University Hospitals Leuven, permits referring physicians to consult the electronic medical records of their patients over the internet in a highly secure way. We decided to completely change the way we secured the application, discard the existing web application and build a completely new application, based on the in-house developed hospital information system, used in the University Hospitals Leuven. The result is a fat Java client, running on a Windows Terminal Server, secured by a commercial SSL-VPN solution.

Highlighting 2004 award-winning initiatives.

PubMed

2005-02-01

This issue takes a closer look at how five award-winning healthcare organizations are finding--and continually refining--innovative ways to provide high-quality healthcare. One of those organizations is Robert Wood Johnson University Hospital Hamilton, which recently was named the fourth healthcare winner of the annual Malcolm Baldrige National Quality Award. The Joint Commission on Accreditation of Healthcare Organizations recently selected two facilities in the hospital category--Stamford Hospital and Staten Island University Hospital--as recipients of the eighth annual Codman Award for their work in using outcomes measurement to promote quality care. The Reading Hospital and Medical Center received a Cheers Award from the Institute for Safe Medication Practices for its toolkit promoting patient safety. Sentara Healthcare System, top winner of the American Hospital Association's Quest for Quality Award, has been cited for its efforts to align its quality and safety goals with its organizational goals.

Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations.

PubMed

Johnson, Timothy V; Schoenberg, Evan D; Abbasi, Ammara; Ehrlich, Samantha S; Kleris, Renee; Owen-Smith, Ashli; Gunderson, Kristin; Master, Viraj A

2009-01-01

Recent research suggests that low education and illiteracy may drive misunderstanding of the American Urological Association Symptom Score, a key tool in the American Urological Association benign prostatic hyperplasia guidelines. It is unclear whether misunderstanding is confined to patients of low socioeconomic status. Therefore, we reevaluated the prevalence and impact of this misunderstanding in a county vs university hospital population. This prospective study involved 407 patients from a county hospital and a university hospital who completed the American Urological Association Symptom Score as self-administered and then as interviewer administered. Responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association Symptom Score. Multivariate logistic regression analyses were used to examine the association between patient characteristics and poor understanding of the American Urological Association Symptom Score. Of the patients 72% understood all 7 American Urological Association Symptom Score questions. Of the measured demographic variables only education level significantly affected this understanding. Compared to patients with more than 12 years of education county hospital patients with less than 9 years of education were 57.06 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 14.32-329.34) while university hospital patients with less than 9 years of education were 38.27 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 1.69-867.83). Of county hospital patients 31% and of university hospital patients 21% significantly misrepresented their symptom severity according to current guidelines. Patients with low education regardless of location are more likely to misunderstand the American Urological Association Symptom Score, misrepresent their symptoms and, therefore, receive inappropriate treatment.

Factors affecting the technical efficiency of general hospitals in Iran: data envelopment analysis.

PubMed

Kalhor, Rohollah; Amini, Saeed; Sokhanvar, Mobin; Lotfi, Farhad; Sharifi, Marziye; Kakemam, Edris

2016-03-01

Restrictions on resource accessibility and its optimal application is the main challenge in organizations nowadays. The aim of this research was to study the technical efficiency and its related factors in Tehran general hospitals. This descriptive analytical study was conducted retrospectively in 2014. Fifty-four hospitals with private, university, and social security ownerships from the total 110 general hospitals were randomly selected for inclusion into this study on the basis of the share of ownership. Data were collected using a checklist with three sections, including background variables, inputs, and outputs. Seventeen (31.48%) hospitals had an efficiency score of 1 (highest efficiency score). The highest average efficiency score was in social security hospitals (84.32). Private and university hospitals ranked next with an average of 84.29 and 79.64, respectively. Analytical results showed that there was a significant relationship between hospital ownership, hospital type in terms of duty and specialization, educational field of the chief executive officer, and technical efficiency. There was no significant relationship between education level of hospital manager and technical efficiency. Most of the studied hospitals were operating at low efficiency. Therefore, policymakers should plan to improve the hospital operations and promote hospitals to an optimal level of efficiency.

[Current status of tuberculosis education in universities and future tasks].

PubMed

2000-02-01

Symposium Topics and Presenters: 1. Education of tuberculosis in medial school: Kaoru SHIMOKATA (Department of Clinical Preventive Medicine, Nagoya University Daiko Medical Center) 2. From Medical University holding Tuberculous ward: Shosaku ABE (Third Department of Internal Medicine, Sapporo Medical University School of Medicine), et al. 3. Necessity and Significance of Sanatorium ward associated with University Hospital: Saburo SONE, et al. (Third Department of Internal Medicine, The University of Tokushima School of Medicine) 4. A proposal on education and training for tuberculosis in medical school from aspect of sanitariums: Takeshi OGURA (Toneyama National Hospital) 5. How to avoid infecting TB and to prevent contracting TB while medical and nursing practices: Keiichi NAGAO (Health Sciences, Center, Chiba University), et al. 6. Special speech: A review of the year since TB patient rooms were included in a common ward as a part of ministry of welfare's model project: Shuji KURANE (Fourth Department of Internal Medicine, Nippon Medical School) Tuberculosis began to rank first in mortality rate in Japan in the Meiji Era, and especially since it did not conform to the "national wealth and military strength" that was the national policy of the time due to the high mortality rates in the early decades of life, it was referred to as the "disease that was destroying the country" and the "pandemic disease." Even after entering the Showa Era, tuberculosis long occupied first place as the cause of death in Japan, and it raged unchecked for a period after World War II. However, the prognosis of tuberculosis as a whole improved considerably as a result of the development of antituberculosis agents, such as streptomycin, and the advent of rifampicin made it a curable disease. Its rank as a cause of death subsequently fell precipitously, and many of the TB wards that had been established in university hospitals were closed as the numbers of patients rapidly declined. At the present time, only 22 of the 80 university hospitals in the country have TB wards or TB beds, and 18 of the hospitals that had TB wards have closed them. Two of them closed them prior to 1964, 6 between 1965 and 1974, 4 between 1975 and 1984, 4 between 1985 and 1994, and 2 since 1995. Thus, it would be no exaggeration to say that there has been a steady decline in the TB wards of university hospitals. It is fairly easy to surmise that the result has been a decrease in the opportunities and time available for educating medical students about tuberculosis. Today, university hospitals not only accept medical students, but 80% of clinical residents as well, and they too have lost opportunities for education concerning tuberculosis. We would hope that the concern of Japanese physicians regarding tuberculosis has not diminished in proportion to the decrease in TB wards in our university hospitals. However, as is truly revealed by the expression "doctor's delay" in the diagnosis and treatment of tuberculosis, it is a fact that physicians no longer bear pulmonary tuberculosis in mind when diagnosing and treating patients with respiratory disease, and that as a result diagnosis is delayed, treatment is drawn out, and in the worst-case scenario, we see scattered instances of a tragic outcome. When we consider the recent conditions in society, as reported in recent newspapers, tuberculosis is not a disease that is on the decline at all in Japan today. However, as stated above, but if the concern of ordinary physicians has drifted away from tuberculosis, it is fair to say that it is not only a major problem medically, but socially as well. Consideration of the tuberculosis education in university medical schools seems to be opportune at this time. Professor Shimokata of Nagoya University, who is chairperson of the Japan Tuberculosis Education Committee, outlined the problems of tuberculosis education in his speech at this symposium. (ABSTRACT TRUNCATED)

Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

PubMed

Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

2016-10-01

The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods. Copyright © 2016 Elsevier Inc. All rights reserved.

The history of anatomy in Persia

PubMed Central

Shoja, Mohammadali M; Tubbs, R Shane

2007-01-01

The study of human anatomy can be found throughout the rich history of Persia. For thousands of years, morphological descriptions derived from this part of the world have contributed to and have helped form our current anatomical knowledge base. In this article we review the major influential Persian periods and the individuals who have contributed to the development of anatomy. We have divided the history of Persia into five eras: (1) the period of the Elamites, Medes, early Persians and Babylonians (10th millennium to 6th century BC); (2) following the establishment of the Persian Empire (6th century BC) to the 7th century AD; (3) after the Islamic conquest of Persia to the ascendency of Baghdad (7th to 13th century AD); (4) from the Mongol invasion of Persia to the foundations of modern anatomy (13th to 18th century AD); and (5) modern Persia/Iran (18th century AD to present). Evidence indicates that human dissection was commonplace in the first era, which led to a disciplined practice of surgery in the centuries leading to the foundation of the Persian Empire. By the emergence of Zoroastrianism in the Persian Empire, the microcosm theory was widely used to understand internal anatomy in relation to the external universe. The world's first cosmopolitan university and hospital were built in Gondishapur, south-western Persia, in the third century AD. Greek and Syriac knowledge influenced the second era. With the gradual ruin of Gondishapur and the foundation of Baghdad following the Islamic conquest of Persia (637–651 AD), a great movement took place, which led to the flourishing of the so-called Middle Age or Islamic Golden Age. Of the influential anatomists of this period, Mesue (777–857 AD), Tabbari (838–870 AD), Rhazes (865–925 AD), Joveini (?−983 AD), Ali ibn Abbas (930–994 AD), Avicenna (980–1037 AD) and Jorjani (1042–1137 AD) all hailed from Persia. There is evidence in the Persian literature as to the direct involvement of these scholars in human dissection. Syro-Indian, Byzantine, Greek, Chinese and Arabic knowledge all influenced the third era. In the fourth period, the first colour illustrated anatomical text (by Mansur, 14th century AD) was compiled. Chinese and Indian anatomical styles were embraced, though there was a strong religious siege of anatomy late in this era. By the 19th century, Persia had entered a new era of modernizing movements and academic contact with the West through the reforms of Mirza Tagi Khan Amir Kabir. Knowledge of anatomy for this region in the 20th century was greatly influenced by Europe and America. PMID:17428200

The history of anatomy in Persia.

PubMed

Shoja, Mohammadali M; Tubbs, R Shane

2007-04-01

The study of human anatomy can be found throughout the rich history of Persia. For thousands of years, morphological descriptions derived from this part of the world have contributed to and have helped form our current anatomical knowledge base. In this article we review the major influential Persian periods and the individuals who have contributed to the development of anatomy. We have divided the history of Persia into five eras: (1) the period of the Elamites, Medes, early Persians and Babylonians (10th millennium to 6th century BC); (2) following the establishment of the Persian Empire (6th century BC) to the 7th century AD; (3) after the Islamic conquest of Persia to the ascendency of Baghdad (7th to 13th century AD); (4) from the Mongol invasion of Persia to the foundations of modern anatomy (13th to 18th century AD); and (5) modern Persia/Iran (18th century AD to present). Evidence indicates that human dissection was commonplace in the first era, which led to a disciplined practice of surgery in the centuries leading to the foundation of the Persian Empire. By the emergence of Zoroastrianism in the Persian Empire, the microcosm theory was widely used to understand internal anatomy in relation to the external universe. The world's first cosmopolitan university and hospital were built in Gondishapur, south-western Persia, in the third century AD. Greek and Syriac knowledge influenced the second era. With the gradual ruin of Gondishapur and the foundation of Baghdad following the Islamic conquest of Persia (637-651 AD), a great movement took place, which led to the flourishing of the so-called Middle Age or Islamic Golden Age. Of the influential anatomists of this period, Mesue (777-857 AD), Tabbari (838-870 AD), Rhazes (865-925 AD), Joveini (?-983 AD), Ali ibn Abbas (930-994 AD), Avicenna (980-1037 AD) and Jorjani (1042-1137 AD) all hailed from Persia. There is evidence in the Persian literature as to the direct involvement of these scholars in human dissection. Syro-Indian, Byzantine, Greek, Chinese and Arabic knowledge all influenced the third era. In the fourth period, the first colour illustrated anatomical text (by Mansur, 14th century AD) was compiled. Chinese and Indian anatomical styles were embraced, though there was a strong religious siege of anatomy late in this era. By the 19th century, Persia had entered a new era of modernizing movements and academic contact with the West through the reforms of Mirza Tagi Khan Amir Kabir. Knowledge of anatomy for this region in the 20th century was greatly influenced by Europe and America.

A European late starter: lessons from the history of reform in Irish health care.

PubMed

Wren, Maev-Ann; Connolly, Sheelah

2017-12-26

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

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…

Health Information Security in Hospitals: the Application of Security Safeguards.

PubMed

Mehraeen, Esmaeil; Ayatollahi, Haleh; Ahmadi, Maryam

2016-02-01

A hospital information system has potentials to improve the accessibility of clinical information and the quality of health care. However, the use of this system has resulted in new challenges, such as concerns over health information security. This paper aims to assess the status of information security in terms of administrative, technical and physical safeguards in the university hospitals. This was a survey study in which the participants were information technology (IT) managers (n=36) who worked in the hospitals affiliated to the top ranked medical universities (university A and university B). Data were collected using a questionnaire. The content validity of the questionnaire was examined by the experts and the reliability of the questionnaire was determined using Cronbach's coefficient alpha (α=0.75). The results showed that the administrative safeguards were arranged at a medium level. In terms of the technical safeguards and the physical safeguards, the IT managers rated them at a strong level. According to the results, among three types of security safeguards, the administrative safeguards were assessed at the medium level. To improve it, developing security policies, implementing access control models and training users are recommended.

[Survey of pediatric sedation in Japan--results of questionnaire to universities of dentistry].

PubMed

Takeuchi, Lisa; Kuratani, Norifumi; Hoshijima, Hiroshi; Kikuchi, Hirosato

2010-12-01

Despite widespread use of sedation for stress management during dental treatment in adults, its prevalence of use for pediatric in patients Japan has not been clarified. We investigated here, the present situation of pediatric sedation by the questionnaire sent to the dental anesthesia departments of university hospitals in Japan. Postal survey was conducted of the dental anesthesia departments of university hospitals (29 institutions) throughout the country. Information was requested on hospital policy of indication and technique of pediatric sedation for dental treatment. The causes for avoiding pediatric sedation were also investigated. The response rate was 86.2% (25/29 institutions). Of these respondents, 16 institutions (64%, 16/25 institutions) employ sedation for pediatric dental treatment stress management. The cases performed were around 1-5 cases every month. However, the criteria for employment of pediatric sedation during dental treatment varied among institutes. They preferred to provide general endotracheal anesthesia for pediatric dental procedures, and tended to avoid sedation without airway security for children. The present survey suggests that pediatric sedation for stress management during dental treatment are employed in more than half of the dental university hospitals. However, there was little consensus regarding pediatric sedation during dental treatment among dental anesthesiologists in Japan.

Strategic planning in healthcare: the experience of the University of Wisconsin Hospital and Clinics.

PubMed

Sollenberger, Donna K

2006-01-01

In 1999, after 25 years of stable leadership from a single CEO, the University of Wisconsin Hospital and Clinics (UWHC) Authority Board named a new CEO. The 471-bed academic medical center had recently experienced significant change and challenges. In 1996, it had emerged as a public authority, a statutory designation by the state of Wisconsin that moved the hospital and clinics from the University of Wisconsin and the state of Wisconsin, and created it as a quasi-public entity with its own board. In 1999, when the new CEO was named, the hospital was experiencing a loss of revenue and market share, operating deficits, a 22 percent nurse vacancy rate, and patient satisfaction scores below the 40th percentile. The first task assigned to the new CEO by the board was the development of a new strategic plan that would reverse these trends and position UWHC as a premier academic hospital. The CEO began a strategic planning process that involved leaders, physicians, and staff from throughout the hospital and clinics, its affiliated medical school, and the physician practice plan. This article describes the collaborative, integrative, and communicative strategic planning process UWHC used; details the organization of the process; describes the results achieved by UWHC; and lists the lessons learned along the way.

A new model in teaching undergraduate research: A collaborative approach and learning cooperatives.

PubMed

O'Neal, Pamela V; McClellan, Lynx Carlton; Jarosinski, Judith M

2016-05-01

Forming new, innovative collaborative approaches and cooperative learning methods between universities and hospitals maximize learning for undergraduate nursing students in a research course and provide professional development for nurses on the unit. The purpose of this Collaborative Approach and Learning Cooperatives (CALC) Model is to foster working relations between faculty and hospital administrators, maximize small group learning of undergraduate nursing students, and promote onsite knowledge of evidence based care for unit nurses. A quality improvement study using the CALC Model was implemented in an undergraduate nursing research course at a southern university. Hospital administrators provided a list of clinical concerns based on national performance outcome measures. Undergraduate junior nursing student teams chose a clinical question, gathered evidence from the literature, synthesized results, demonstrated practice application, and developed practice recommendations. The student teams developed posters, which were evaluated by hospital administrators. The administrators selected several posters to display on hospital units for continuing education opportunity. This CALC Model is a systematic, calculated approach and an economically feasible plan to maximize personnel and financial resources to optimize collaboration and cooperative learning. Universities and hospital administrators, nurses, and students benefit from working together and learning from each other. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of Patient Costs in Internal Medicine and Anaesthesiology Intensive Care Units in a Tertiary University Hospital.

PubMed

Kara, İskender; Yıldırım, Fatma; Başak, Dilek Yumuş; Küçük, Hamit; Türkoğlu, Melda; Aygencel, Gülbin; Katı, İsmail; Karabıyık, Lale

2015-06-01

The allocation of the Gross Domestic Product (GDP) to health is limited, therefore it has made a need for professional management of health business. Hospital managers as well as employees are required to have sufficient knowledge about the hospital costs. Hospital facilities like intensive care units that require specialization and advanced technology have an important part in costs. For this purpose, cost analysis studies should be done in the general health business and special units separately. In this study we aimed to compare the costs of anaesthesiology and internal medicine intensive care units (ICU) roughly. After approval of this study by Gazi University Faculty of Medicine Ethics Committee, the costs of 855 patients that were hospitalized, examined and treated for at least 24 hours in internal medicine and anaesthesiology ICUs between January 2012-August 2013 (20 months period) were taken and analyzed from chief staff of the Department of Information Technology, Gazi University Hospital. At the end of the study, we observed clear differences between internal medicine and anaesthesiology ICUs arising from transactions and patient characteristics of units. We stated that these differences should be considered by Social Security Institution (SSI) for the reimbursement of the services. Further, we revealed that SSI payments do not meet the intensive care expenditure.

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.

Clinical innovations in Philippine thoracic surgery

PubMed Central

2016-01-01

Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases—first at the Quezon Institute (QI) and presently at the Lung Center of the Philippines although some university and private hospitals made occasional forays into the chest. Esophageal surgery began its early attempts during the post-World War II era at the Philippine General Hospital (PGH), a university hospital affiliated with the University of the Philippines. With the introduction of minimally invasive thoracic surgical approaches, Filipino thoracic surgeons have managed to keep up with their Asian counterparts although the problems of financial reimbursement typical of a developing country remain. The need for creative innovative approaches of a focused multidisciplinary team will advance the boundaries of thoracic surgery in the Philippines. PMID:27651936

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.

Genomic Characterization of the Genus Nairovirus (Family Bunyaviridae).

PubMed

Kuhn, Jens H; Wiley, Michael R; Rodriguez, Sergio E; Bào, Yīmíng; Prieto, Karla; Travassos da Rosa, Amelia P A; Guzman, Hilda; Savji, Nazir; Ladner, Jason T; Tesh, Robert B; Wada, Jiro; Jahrling, Peter B; Bente, Dennis A; Palacios, Gustavo

2016-06-10

Nairovirus, one of five bunyaviral genera, includes seven species. Genomic sequence information is limited for members of the Dera Ghazi Khan, Hughes, Qalyub, Sakhalin, and Thiafora nairovirus species. We used next-generation sequencing and historical virus-culture samples to determine 14 complete and nine coding-complete nairoviral genome sequences to further characterize these species. Previously unsequenced viruses include Abu Mina, Clo Mor, Great Saltee, Hughes, Raza, Sakhalin, Soldado, and Tillamook viruses. In addition, we present genomic sequence information on additional isolates of previously sequenced Avalon, Dugbe, Sapphire II, and Zirqa viruses. Finally, we identify Tunis virus, previously thought to be a phlebovirus, as an isolate of Abu Hammad virus. Phylogenetic analyses indicate the need for reassignment of Sapphire II virus to Dera Ghazi Khan nairovirus and reassignment of Hazara, Tofla, and Nairobi sheep disease viruses to novel species. We also propose new species for the Kasokero group (Kasokero, Leopards Hill, Yogue viruses), the Ketarah group (Gossas, Issyk-kul, Keterah/soft tick viruses) and the Burana group (Wēnzhōu tick virus, Huángpí tick virus 1, Tǎchéng tick virus 1). Our analyses emphasize the sister relationship of nairoviruses and arenaviruses, and indicate that several nairo-like viruses (Shāyáng spider virus 1, Xīnzhōu spider virus, Sānxiá water strider virus 1, South Bay virus, Wǔhàn millipede virus 2) require establishment of novel genera in a larger nairovirus-arenavirus supergroup.

DOE Office of Scientific and Technical Information (OSTI.GOV)

W. Lynn Watney; John H. Doveton

GEMINI (Geo-Engineering Modeling through Internet Informatics) is a public-domain web application focused on analysis and modeling of petroleum reservoirs and plays (http://www.kgs.ukans.edu/Gemini/index.html). GEMINI creates a virtual project by ''on-the-fly'' assembly and analysis of on-line data either from the Kansas Geological Survey or uploaded from the user. GEMINI's suite of geological and engineering web applications for reservoir analysis include: (1) petrofacies-based core and log modeling using an interactive relational rock catalog and log analysis modules; (2) a well profile module; (3) interactive cross sections to display ''marked'' wireline logs; (4) deterministic gridding and mapping of petrophysical data; (5) calculation and mappingmore » of layer volumetrics; (6) material balance calculations; (7) PVT calculator; (8) DST analyst, (9) automated hydrocarbon association navigator (KHAN) for database mining, and (10) tutorial and help functions. The Kansas Hydrocarbon Association Navigator (KHAN) utilizes petrophysical databases to estimate hydrocarbon pay or other constituent at a play- or field-scale. Databases analyzed and displayed include digital logs, core analysis and photos, DST, and production data. GEMINI accommodates distant collaborations using secure password protection and authorized access. Assembled data, analyses, charts, and maps can readily be moved to other applications. GEMINI's target audience includes small independents and consultants seeking to find, quantitatively characterize, and develop subtle and bypassed pays by leveraging the growing base of digital data resources. Participating companies involved in the testing and evaluation of GEMINI included Anadarko, BP, Conoco-Phillips, Lario, Mull, Murfin, and Pioneer Resources.« less

The effect of substrate, season, and agroecological zone on mycoflora and aflatoxin contamination of poultry feed from Khyber Pakhtunkhwa, Pakistan.

PubMed

Alam, Sahib; Shah, Hamid Ullah; Khan, Habibullah; Magan, Naresh

2012-10-01

To study the effects of and interactions among feed types, seasons, and agroecological zones on the total fungal viable count and aflatoxins B1 (AFB1), B2 (AFB2), G1 (AFG1), and G2 (AFG2) production in poultry feed, an experiment was conducted using three-factorial design. A total of 216 samples of poultry feed ingredients, viz. maize, wheat, rice, cotton seed meal (CSM), and finished products, that is, starter and finisher broilers' rations, were collected from Peshawar, Swat, and D. I. Khan districts of Khyber Pakhtunkhwa, Pakistan, during the winter, spring, summer, and autumn seasons of the year 2007/2008. Analysis of variance showed that there was a complex interaction among all these factors and that this influenced the total fungal viable count and relative concentrations of the aflatoxins produced. Minimum total culturable fungi (6.43 × 10³ CFUs/g) were counted in CSM from D. I. Khan region in winter season while maximum (26.68 × 10³ CFUs/g) in starter ration from Peshawar region in summer. Maximum concentrations of AFB1 (191.65 ng/g), AFB2 (86.85 ng/g), and AFG2 (89.90 ng/g) were examined during the summer season whereas the concentration of AFG1 was maximum (167.82 ng/g) in autumn in finisher ration from Peshawar region. Minimum aflatoxins were produced in the winter season across all the three agroecological zones.

Stroke Thrombolysis in a Centralized and a Decentralized System (Helsinki and Telemedical Project for Integrative Stroke Care Network).

PubMed

Hubert, Gordian J; Meretoja, Atte; Audebert, Heinrich J; Tatlisumak, Turgut; Zeman, Florian; Boy, Sandra; Haberl, Roman L; Kaste, Markku; Müller-Barna, Peter

2016-12-01

Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1.56 million inhabitants, 9096 km 2 ) and the decentralized TeleStroke Unit network in a predominantly rural area (Telemedical Project for Integrative Stroke Care [TEMPiS], South-East Bavaria, Germany, 1.94 million inhabitants, 14 992 km 2 ). All consecutive tPA treatments were prospectively registered. We compared tPA rates per total ischemic stroke admissions in the Helsinki and TEMPiS catchment areas. For delay comparisons, we excluded patients with basilar artery occlusions, in-hospital strokes, and those being treated after 270 minutes. From January 1, 2011, to December 31, 2013, 912 patients received tPA in Helsinki University Central Hospital and 1779 in TEMPiS hospitals. Area-based tPA rates were equal (13.0% of 7017 ischemic strokes in the Helsinki University Central Hospital area versus 13.3% of 14 637 ischemic strokes in the TEMPiS area; P=0.078). Median prehospital delays were longer (88; interquartile range, 60-135 versus 65; 48-101 minutes; P<0.001) but in-hospital delays were shorter (18; interquartile range, 13-30 versus 39; 26-56 minutes; P<0.001) in Helsinki University Central Hospital compared with TEMPiS with no difference in overall delays (117; interquartile range, 81-168 versus 115; 87-155 minutes; P=0.45). A decentralized telestroke thrombolysis service can achieve similar treatment rates and time delays for a rural population as a centralized system can achieve for an urban population. © 2016 American Heart Association, Inc.

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

ERIC Educational Resources Information Center

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

2015-01-01

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

Environmental auditing in hospitals: approach and implementation in an university hospital.

PubMed

Dettenkofer, M; Kümmerer, K; Schuster, A; Mühlich, M; Scherrer, M; Daschner, F D

1997-05-01

Medical audit in infection control today is accepted as an important element in the quality assurance of health care. In contrast, environmental auditing, which was approved in 1993 by the Council of the European Communities for industry ("Eco-Management and Audit Scheme-EMAS), has not so far been used as a tool to control and reduce environmental pollution caused by medical care in hospitals. The aim of this study was to investigate, whether environmental auditing in hospitals is useful. This process should also be cost effective. In this paper, methodological and organizational issues are described. Initially an environmental review of activities at the University Hospital, Freiburg and an eco-analysis of the input and output were performed. The first results of the study and a critical discussion will be presented in another paper.

Improving adverse drug reaction reporting in hospitals: results of the French Pharmacovigilance in Midi-Pyrénées region (PharmacoMIP) network 2-year pilot study.

PubMed

Gony, Mireille; Badie, Kattalin; Sommet, Agnès; Jacquot, Julien; Baudrin, Dominique; Gauthier, Pierre; Montastruc, Jean Louis; Bagheri, Haleh

2010-05-01

Spontaneous reporting of adverse drug reactions (ADRs) is fundamental to drug safety surveillance (pharmacovigilance); however, substantial under-reporting exists and is the main limitation of the system. Several factors could favour under-reporting. The aim of this pilot study was to assess the effect of regular visits of a Clinical Research Assistant (CRA) on the improvement of ADR reporting in non-university hospitals. We set up an ADR report collecting system that involved regular visits by a CRA to non-university hospitals, which was similar to a system that already existed in university hospitals in Toulouse, France. Two areas in our region were chosen: Haute Garonne and Gers. We compared firstly the reporting rate (number of reports/number of beds) of total ADRs (i.e. spontaneously reported ADRs plus solicited ADRs collected by the CRA) and secondly, the percentage of serious ADRs reported by non-university hospitals in these two areas, in 2005 (the year prior to CRA visits) and after the start of CRA visits (2006 until the end of December 2008). We also compared the reporting rate of total ADRs in Haute Garonne and Gers non-university hospitals with those reported during the same period with a control group (the Ariège area, which has a similar number of beds to Gers and that was not visited by the CRA). The characteristics of ADRs collected by the CRA were also described. A total of 687 reports were collected by the CRA: 40% were classified as serious, including two deaths. The number of ADRs and the reporting rate increased significantly between 2005 and 2008 in non-university hospitals of Haute-Garonne and Gers, but not in Ariège. In Gers, the reporting rate was 3% in 2005 and 25% in 2008. In Haute-Garonne, the reporting rate was 11% in 2005 and 40% in 2008. The difference between the number of spontaneous and solicited reports also increased. This study shows that regular visits by a CRA increases the number of ADRs collected by a Regional Pharmacovigilance Centre. Another interesting consequence was the rise in spontaneous reporting by healthcare professionals following the set-up of this system. Further assessment of this procedure is necessary for the long-term evaluation of its effectiveness.

The Heart and Mind Coming Together: A Case Study of the Implementation of a University-Children's Hospital Partnership

ERIC Educational Resources Information Center

O'Connor, C. Richele

2008-01-01

The purpose of this qualitative study was to investigate the perceptions of university students serving as volunteers in an oncology ward at a local children's hospital. The implementation of this project was guided by the body of literature regarding service learning. Data were collected from the five students using a structured interview and was…

Multidrug-resistant bacteria infection control: study of compliance with isolation precautions in a Paris university hospital.

PubMed

Vidal-Trecan, G M; Delamare, N; Tcherny-Lessenot, S; Lamory, J; Baudin, F; de Prittwitz, M; Salmon-Ceron, D

2001-02-01

Isolation practices in a university hospital were analyzed for 137 patients with multidrug-resistant bacteria. Isolation was ordered in writing by physicians for 40% and instituted by nurses for 60%; 74% were isolated. Compliance depended on physician ordering in writing (odds ratio, 36.3; 95% confidence interval, 4.8-274.9). Nurses complied best with hand washing.

Military Family Coping Project - Phase 2

DTIC Science & Technology

2014-09-01

ORGANIZATION: Baylor University, Waco , TX 76798 REPORT DATE: September 2014 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and...February 28). Baylor, Waco VA hospital studying veterans’ family stress. Waco , TX: Tribune Herald. Slayden, Stacey (Reporter). (2012, February 28...VA Hospital and Baylor University team up to study effects of deployment. Waco , TX: Fox 44 news. Ellor, J. W., Crow, J, Myers, D., Morissette, S

Incidence of rotavirus gastroenteritis hospitalizations and genotypes, before and five years after introducing universal immunization in Israel.

PubMed

Muhsen, Khitam; Kassem, Eias; Rubenstein, Uri; Goren, Sophy; Ephros, Moshe; Cohen, Dani; Shulman, Lester M

2016-11-21

Uncertainty exists about the sustainability of the reduction in rotavirus gastroenteritis (RVGE) following the introduction of rotavirus vaccines into national immunization programs, and on its potential impact on circulating genotypes. RotaTeq was introduced into the Israeli national immunization program in December 2010, and vaccination coverage is around 80%. To examine the change in incidence of RVGE hospitalization and rotavirus genotypes, during the five years after introduction of RotaTeq into the Israeli national immunization program. Data were obtained prospectively on hospitalization of children aged 0-59months due to acute gastroenteritis (N=7346) from three hospitals in northern Israel. Stool samples were tested for rotavirus by immunochromatography. Rotavirus was genotyped (N=506) by RT-PCR and/or sequencing. The average incidence of RVGE hospitalization declined by 61.0% (95% CI 49.0-73.4%), from 5.6 per 1000 (95% CI 5.0-6.2) in the pre-universal immunization period (2008-2010) to 2.2 per 1000 (95% CI 1.8-2.5) during the universal immunization period (2012-2015), but yearly fluctuations were still observed. The most common genotypes in the pre-universal immunization period were G1P[8] (35.3%) followed by G2P[4] (15.5%), G3P[8] (8.8%), G4P[8] (4.3%) and G9P[8] (4.3%), and 19.5% were mixed infections. The dominance of G1P[8] continued into the universal immunization period (48.6%), followed by G3P[8] (21.5%), G9P[8] (15.9%) and G12P[8] (4.7%), while mixed rotavirus infections were no longer detected. Universal immunization with RotaTeq in Israel was associated a sustained reduction in RVGE hospitalization. It is unclear whether changes in the circulating rotavirus genotypes are due to vaccine-induced selective pressure. Assessment of the long-term impact of rotavirus vaccination on the incidence of rotavirus gastroenteritis and continued strain surveillance is warranted. Copyright © 2016. Published by Elsevier Ltd.

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.

Medication literacy status of outpatients in ambulatory care settings in Changsha, China.

PubMed

Zheng, Feng; Ding, Siqing; Luo, Aijing; Zhong, Zhuqing; Duan, Yinglong; Shen, Zhiying

2017-02-01

Objective To assess medication literacy status and to examine risk factors of inadequate medication literacy of outpatients in ambulatory care settings. Methods Study participants were recruited randomly from outpatient departments in four tertiary hospitals (Xiangya Hospital of Central South University, Second Xiangya Hospital of Central South University, Third Xiangya Hospital of Central South University, People's Hospital of Hunan Province) in Changsha, Hunan, China, between October 2014 and January 2015. Medication literacy was assessed using the Medication Literacy Scale, Chinese version. Demographic and clinical data were collected using structured interviews. Multiple logistic regression analysis was used to estimate the independent effects of demographic and clinical factors on medication literacy. Results Of 465 participants, 425 (91.4%) produced valid responses for analysis. The mean medication literacy score was 8.31 (standard deviation = 3.47). Medication literacy was adequate in 131 participants (30.8%), marginally adequate in 248 (58.4%), and inadequate in 46 (10.8%). The risk of inadequate medication literacy was greater for older and unmarried patients but lower for more educated patients. Conclusion Many Chinese outpatients in ambulatory care have inadequate medication literacy. Greater age, low education, and unmarried status are important risk factors of inadequate medication literacy.

Learning Organization Profile of Educational Hospitals in Iran: Practice of Organizational Interlocking Systems.

PubMed

Mohebbifar, Rafat; Hashemi, Hassan Jahani; Rajaee, Roya; Najafi, Marziye; Etedal, Mahbobeh G H

2015-02-24

Organizational learning has been identified as necessary for different organizations to improve their performance in the changing and competitive environment. The main purpose of this research was to specify the learning organization profile of educational and health centers of Tehran and Qazvin Universities of Medical Sciences in Iran. The present research was conducted using a cross-sectional method in the academic year of 2013-2014. A staff of 530 from educational hospitals subordinated to Tehran and Qazvin universities of medical sciences participated in the research. The participants were selected using stratified random sampling. That is to say, a random sample of a proportionate size was selected from each hospital. The instrument for data collection was a Likert-scale questionnaire involving 50 items. The statistical techniques of ANOVA, t-test, Chi-square, correlation coefficients (Pearson and Spearman), and regression were utilized to analyze the data. All of them were performed using the Statistical Package for Social Sciences (SPSS) 16.0 for windows. the results indicated that 449 of participants (84.7%) had a B.S. degree and 78 of them (14.7%) had an M.S. or a Ph.D. degree. Among the fivefold dimensions of "Learning Organization" model (Learning, Organization, People, Knowledge, and Technology) in comparison of the two universities, the "people" dimension was the highest-rated dimension with the mean rating of 25.71±8.36 and the "learning" dimension was the lowest-rated dimension with the mean of 25.35±8.04. Comparison between the two universities yielded the result that educational hospitals in Tehran University of medical sciences with the rating of 126.56 had a more complete profile than that of educational hospitals in Qazvin university of medical sciences with the rating of 122.23. The hospitals of the two above-mentioned universities were, to a great extent, far from the characteristics of Learning Organization. In light of the massive mission of these centers to maintain and improve the community health and to train the skilled labor force, the centers should embark on updating the data and institutionalizing learning. Furthermore, to modify staff's behavior and performance and to achieve their goals, they should accentuate the importance of acquiring, creating, and transferring knowledge.

Learning Organization Profile of Educational Hospitals in Iran: Practice of Organizational Interlocking Systems

PubMed Central

Mohebbifar, Rafat; Hashemi, Hassan Jahani; Rajaee, Roya; Najafi, Marziye; Etedal, Mahbobeh GH

2015-01-01

Background: Organizational learning has been identified as necessary for different organizations to improve their performance in the changing and competitive environment. Purpose: The main purpose of this research was to specify the learning organization profile of educational and health centers of Tehran and Qazvin Universities of Medical Sciences in Iran. Methodology: The present research was conducted using a cross-sectional method in the academic year of 2013-2014. A staff of 530 from educational hospitals subordinated to Tehran and Qazvin universities of medical sciences participated in the research. The participants were selected using stratified random sampling. That is to say, a random sample of a proportionate size was selected from each hospital. The instrument for data collection was a Likert-scale questionnaire involving 50 items. The statistical techniques of ANOVA, t-test, Chi-square, correlation coefficients (Pearson and Spearman), and regression were utilized to analyze the data. All of them were performed using the Statistical Package for Social Sciences (SPSS) 16.0 for windows. Result: The results indicated that 449 of participants (84.7%) had a B.S. degree and 78 of them (14.7%) had an M.S. or a Ph.D. degree. Among the fivefold dimensions of “Learning Organization” model (Learning, Organization, People, Knowledge, and Technology) in comparison of the two universities, the “people” dimension was the highest-rated dimension with the mean rating of 25.71±8.36 and the “learning” dimension was the lowest-rated dimension with the mean of 25.35±8.04. Comparison between the two universities yielded the result that educational hospitals in Tehran University of medical sciences with the rating of 126.56 had a more complete profile than that of educational hospitals in Qazvin university of medical sciences with the rating of 122.23. Conclusion: The hospitals of the two above-mentioned universities were, to a great extent, far from the characteristics of Learning Organization. In light of the massive mission of these centers to maintain and improve the community health and to train the skilled labor force, the centers should embark on updating the data and institutionalizing learning. Furthermore, to modify staff’s behavior and performance and to achieve their goals, they should accentuate the importance of acquiring, creating, and transferring knowledge. PMID:26156903

A Hospital Local Area Communication Network—The First Year's Experience

PubMed Central

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

1982-01-01

A local area communications network has been implemented at the University of California, San Francisco Hospital to integrate major components of the hospital's information system. This microprocessor-based network technology was developed by The Applied Physics Laboratory of the Johns Hopkins University. The first year's experience has demonstrated the basic feasibility of this technology in simplifying the integration of diverse hardware and software systems. Four minicomputer-based UCSF systems now use the network to synchronize key patient identification and registration information among the systems. Clinical uses of the network will begin during the second year of the project.

A university-sponsored home health nursing program in Karachi, Pakistan.

PubMed

Smego, Raymond A; Khan, Mohammad Aslam; Khowaja, Khurshid; Rafique, Rozina; Datoo, Farida

2005-11-01

This article describes a university-sponsored home health nursing program in a large urban center in Pakistan and details the essential elements needed in implementing such a program in a developing country. Compared to in-hospital treatment, home healthcare reduced hospital stay from 12.8 days to 3.9 days, and resulted in a net savings of Pakistani rupees (PRs) 5,374,135 (USD 89,569). A cost-effective home treatment program in a resource-limited country can be successfully implemented by using the hospital pharmacy as the central point for the preparation and distribution of medications and specialty nursing services.

Stenotrophomonas maltophilia in a university hospital of traditional Chinese medicine: molecular epidemiology and antimicrobial resistance.

PubMed

Zhao, S; Yang, L; Liu, H; Gao, F

2017-07-01

Stenotrophomona maltophilia has emerged as an important opportunistic pathogen that is highly antibiotic resistant. Analysis of antibiotic susceptibilities, drug-resistant gene profiles and molecular typing of S. maltophilia was undertaken in a university hospital of traditional Chinese medicine in East China. Resistance to sulphamethoxazole (SXT) was found to be an indicator of multi-drug resistance. SXT resistance was mediated by sul and dfrA genes in integrons, especially class 1. Some evidence of clonal dissemination was found, indicating the occurrence of cross-transmission of antibiotic-resistant strains within the hospital. This underscores the need for effective control and prevention measures in hospitals. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Influence of superstition on the date of hospital discharge and medical cost in Japan: retrospective and descriptive study.

PubMed

Hira, K; Fukui, T; Endoh, A; Rahman, M; Maekawa, M

To determine the influence of superstition about Taian (a lucky day)-Butsumetsu (an unlucky day) on decision to leave hospital. To estimate the costs of the effect of this superstition. Retrospective and descriptive study. University hospital in Kyoto, Japan. Patients who were discharged alive from Kyoto University Hospital from 1 April 1992 to 31 March 1995. Mean number, age, and hospital stay of patients discharged on each day of six day cycle. The mean number, age, and hospital stay of discharged patients were highest on Taian and lowest on Butsumetsu (25.8 v 19.3 patients/day, P=0.0001; 43.9 v 41.4 years, P=0.0001; and 43.1 v 33.3 days, P=0.0001 respectively). The effect of this difference on the hospital's costs was estimated to be 7.4 million yen (¿31 000). The superstition influenced the decision to leave hospital, contributing to higher medical care costs in Japan. Although hospital stays need to be kept as short as possible to minimise costs, doctors should not ignore the possible psychological effects on patients' health caused by dismissing the superstition.

Youth motorcycle-related brain injury by state helmet law type: United States, 2005-2007.

PubMed

Weiss, Harold; Agimi, Yll; Steiner, Claudia

2010-12-01

Twenty-seven states have youth-specific helmet laws even though such laws have been shown to decrease helmet use and increase youth mortality compared with all-age (universal) laws. Our goal was to quantify the impact of age-specific helmet laws on youth under age 20 hospitalized with traumatic brain injury (TBI). Our cross-sectional ecological group analysis compared TBI proportions among US states with different helmet laws. We examined the following null hypothesis: If age-specific helmet laws are as effective as universal laws, there will be no difference in the proportion of hospitalized young motorcycle riders with TBI in the respective states. The data are derived from the 2005 to 2007 State Inpatient Databases of the Healthcare Cost and Utilization Project. We examined data for 17 states with universal laws, 6 states with laws for ages <21, and 12 states with laws for children younger than 18 (9287 motorcycle injury discharges). In states with a <21 law, serious TBI among youth was 38% higher than in universal-law states. Motorcycle riders aged 12 to 17 in 18 helmet-law states had a higher proportion of serious/severe TBI and higher average Abbreviated Injury Scores for head-region injuries than riders from universal-law states. States with youth-specific laws had an increased risk of TBI that required hospitalization, serious and severe TBI, TBI-related disability, and in-hospital death among the youth they are supposed to protect. The only method known to keep motorcycle-helmet use high among youth is to adopt or maintain universal helmet laws.

[History of the 4th Department of Internal Medicine of the First Faculty of Medicine at Charles University and the General University Hospital in Prague].

PubMed

Bartůněk, Petr

In 2015, the doctors and nurses of the 4th Department of Internal Medicine of the First Faculty of Medicine, Charles University and the General University Hospital in Prague celebrated the 70th anniversary of its founding. The article summarizes the clinics contribution to the field of internal medicine, and particularly to angiology, hepatogastroenterology and lipidology. It comments the clinics current activities and the possibilities of its further development. Attention is also paid to the tradition of high ethical and professional standards of medical care in accordance with the norms established by the clinic's founder, prof. MUDr. Bohumil Prusík.

Dietary Almonds Increase Serum HDL Cholesterol in Coronary Artery Disease Patients in a Randomized Controlled Trial.

PubMed

Jamshed, Humaira; Sultan, Fateh Ali Tipoo; Iqbal, Romaina; Gilani, Anwar Hassan

2015-10-01

More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol despite having well-managed LDL cholesterol. Almond supplementation has not been shown to elevate circulating HDL cholesterol concentrations in clinical trials, perhaps because the baseline HDL cholesterol of trial subjects was not low. This clinical trial was designed to test the effect of almond supplementation on low HDL cholesterol in CAD patients. A total of 150 CAD patients (50 per group), with serum LDL cholesterol ≤100 mg/dL and HDL cholesterol ≤40 mg/dL in men and ≤50 mg/dL in women, were recruited from the Aga Khan University Hospital. After recording vital signs and completing a dietary and physical activity questionnaire, patients were randomly assigned to 1 of the following 3 groups: the no-intervention group (NI), the Pakistani almonds group (PA), and the American almonds group (AA). The respective almond varieties (10 g/d) were given to patients with instructions to soak them overnight, remove the skin, and eat them before breakfast. Blood samples for lipid profiling, body weight, and blood pressure were collected, and assessment of dietary patterns was done at baseline, week 6, and week 12. Almonds significantly increased HDL cholesterol. At weeks 6 and 12, HDL cholesterol was 12-14% and 14-16% higher, respectively, in the PA and AA than their respective baselines. In line with previous reports, serum concentrations of total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol; total-to-HDL and LDL-to-HDL cholesterol ratios, and the atherogenic index were reduced in both the PA and AA at weeks 6 and 12 compared with baseline (P < 0.05). Effects on serum lipids did not differ between the 2 almond groups. Dietary patterns, body weight, and blood pressure did not change in any of the 3 groups during the trial. A low dose of almonds (10 g/d) consumed before breakfast can increase HDL cholesterol, in addition to improving other markers of abnormal lipid metabolism in CAD patients with low initial HDL cholesterol. This trial was registered at the Australian New Zealand Clinical Trial Registry as ACTRN12614000036617. © 2015 American Society for Nutrition.

Perceptions about the cause of schizophrenia and the subsequent help seeking behavior in a Pakistani population – results of a cross-sectional survey

PubMed Central

Zafar, Syed Nabeel; Syed, Reema; Tehseen, Sarah; Gowani, Saqib A; Waqar, Sana; Zubair, Amina; Yousaf, Wajeeha; Zubairi, Akbar J; Naqvi, Haider

2008-01-01

Background There is a cultural variability around the perception of what causes the syndrome of schizophrenia. Generally patients with schizophrenia are considered dangerous. They are isolated and treatment is delayed. Studies have shown favorable prognosis with good family and social support, early diagnosis and management. Duration of untreated psychosis is a bad prognostic indicator. We aimed to determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behavior. Methods This cross-sectional study was carried out on a sample of 404 people at the out patient departments of Aga Khan University Hospital Karachi. Data was collected via a self-administered questionnaire. Questions were related to a vignette of a young man displaying schizophrenic behavior. Data was analyzed on SPSS v 14. Results The mean age of the participants was 31.4 years (range = 18–72) and 77% of them were males. The majorities were graduates (61.9%) and employed (50%). Only 30% of the participants attributed 'mental illness' as the main cause of psychotic symptoms while a large number thought of 'God's will' (32.3%), 'superstitious ideas' (33.1%), 'loneliness' (24.8%) and 'unemployment' (19.3%) as the main cause. Mental illness as the single most important cause was reported by only 22%. As far as management is concerned, only 40% reported psychiatric consultation to be the single most important management step. Other responses included spiritual healing (19.5%) and Sociachanges (10.6) while 14.8% of respondents said that they would do nothing. Gender, age, family system and education level were significantly associated with the beliefs about the cause of schizophrenia (p < 0.05). While these variables plus 'religious inclination' and 'beliefs about cause' were significantly associated with the help seeking behavior of the participants. Conclusion Despite majority of the study population being well educated, only a few recognized schizophrenia as a mental illness and many held superstitious beliefs. A vast majority of Pakistanis have non-biomedical beliefs about the cause of schizophrenia. Their help seeking behavior in this regard is inappropriate and detrimental to the health of schizophrenic patients. Areas for future research have been identified. PMID:18637176

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal

PubMed Central

Hinkelmann, Jürgen; Volkert, Thomas; Rodde, Sibyll; Hahnenkamp, Klaus

2016-01-01

Background University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. Objective In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. Methods Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production (“industry 4.0”) because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts’ scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention. Results We expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones). Conclusions All measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be presented at conferences and published in journals. PMID:28003176

The Howard University Hospital Experience with Routineized HIV Screening: A Progress Report*

PubMed Central

Scott, Victor F.; Sitapati, Amy; Martin, Sayyida; Summers, Pamela; Washington, Michael; Daniels, Fernando; Mouton, Charles; Bonney, George; Apprey, Victor; Webster, Virginia; Smith, Avemaria; Mountvarner, Geoffrey; Daftary, Monica; Maxwell, Celia J.

2009-01-01

Background: Howard University Hospital (HUH) is the first hospital in the nation to have instituted a hospital-wide routine rapid HIV screening campaign as recommended by the CDC for healthcare settings. Methods: HUH developed a protocol and implemented a hospital-wide routine HIV screening in October 2006. Rapid oral fluid-based HIV testing was conducted throughout the hospital using the OraSure OraQuick Advance Rapid HIV-1/2 Antibody Test. Patients with a preliminarily reactive test result were either referred for confirmatory testing or offered a Western Blot confirmatory test on-site and referred for follow-up care. This is a report on the progress of this program for the first eight months. Results: Of the 9,817 patients offered HIV testing, 5,642 consented. The mean age of the screened population was 40.7 years. Ninety percent of the patients screened were black and 55% were female. A preliminarily reactive test result was identified in 139 patients for a seroprevalence rate of 2.46%. Of these patients, 136, or 98% were black; 63% were male and 37% were female. HIV prevalence in the overall sample, among blacks, and among both black males and females peaked in the 40–54 year old age group. Challenges were experienced initially in securing confirmatory tests. Conclusions: Hospital-wide routine HIV screening is both possible and productive. The routine HIV screening campaign instituted at Howard University Hospital has identified a significant number of previously unidentified HIV positive persons. Success in assuring confirmatory testing and transition to care improved as time progressed. PMID:19768195

The Howard University Hospital experience with routineized HIV screening: a progress report.

PubMed

Scott, Victor F; Sitapati, Amy; Martin, Sayyida; Summers, Pamela; Washington, Michael; Daniels, Fernando; Mouton, Charles; Bonney, George; Apprey, Victor; Webster, Virginia; Smith, Avemaria; Mountvarner, Geoffrey; Daftary, Monica; Maxwell, Celia J

2009-01-01

Howard University Hospital (HUH) is the first hospital in the nation to have instituted a hospital-wide routine rapid HIV screening campaign as recommended by the CDC for healthcare settings. HUH developed a protocol and implemented a hospital-wide routine HIV screening in October 2006. Rapid oral fluid-based HIV testing was conducted throughout the hospital using the OraSure OraQuick Advance Rapid HIV-1/2 Antibody Test. Patients with a preliminarily reactive test result were either referred for confirmatory testing or offered a Western Blot confirmatory test on-site and referred for follow-up care. This is a report on the progress of this program for the first eight months. Of the 9,817 patients offered HIV testing, 5,642 consented. The mean age of the screened population was 40.7 years. Ninety percent of the patients screened were black and 55% were female. A preliminarily reactive test result was identified in 139 patients for a seroprevalence rate of 2.46%. Of these patients, 136, or 98% were black; 63% were male and 37% were female. HIV prevalence in the overall sample, among blacks, and among both black males and females peaked in the 40-54 year old age group. Challenges were experienced initially in securing confirmatory tests. Hospital-wide routine HIV screening is both possible and productive. The routine HIV screening campaign instituted at Howard University Hospital has identified a significant number of previously unidentified HIV positive persons. Success in assuring confirmatory testing and transition to care improved as time progressed.

Patients' satisfaction with inpatient services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2011-2013

PubMed Central

Makarem, Jalil; Larijani, Bagher; Joodaki, Kobra; Ghaderi, Sahar; Nayeri, Fatemeh; Mohammadpoor, Masoud

2016-01-01

Implementation of patient feedback is considered as a critical part of effective and efficient management in developed countries. The main objectives of this study were to assess patient satisfaction with the services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, identify areas of patient dissatisfaction, and find ways to improve patient satisfaction with hospital services. This cross-sectional study was conducted in 3 phases. After 2 initial preparation phases, the valid instrument was applied through telephone interviews with 21476 participants from 26 hospitals during August, 2011 to February, 2013.Using the Satisfaction Survey tool, information of patient's demographic characteristics were collected and patient satisfaction with 15 areas of hospital services and the intent to return the same hospitals were assessed. The mean score of overall satisfaction with hospital services was 16.86 ± 2.72 out of 20. It was found that 58% of participants were highly satisfied with the services provided. Comparison of mean scores showed physician and medical services (17.75 ± 4.02), laboratory and radiology services (17.67 ± 3.66), and privacy and religious issues (17.55 ± 4.32) had the highest satisfaction. The patients were the most dissatisfied with the food services (15.50 ± 5.54). It was also found that 83.7% of the participants intended to return to the same hospital in case of need, which supported the measured satisfaction level. Patient satisfaction in hospitals affiliated to Tehran University of Medical Sciences was high. It seems that the present study, with its large sample size, has sufficient reliability to express the patient satisfaction status. Moreover, appropriate measures should be taken in some areas (food, cost, and etc.) to increase patient satisfaction. PMID:27471589

Organizing integrated care in a university hospital: application of a conceptual framework.

PubMed

Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

2014-04-01

As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

[The carrier model of neurology in Hungary: a proposal for the solution until 2020].

PubMed

Bereczki, Dániel; Csiba, László; Komoly, Sámuel; Vécsei, László; Ajtay, András

2011-11-30

Based on our previous survey on the capacities of neurological services and on the predictable changes in the neurologist workforce in Hungary, we present a proposal for the organization of the structure of neurological services in the future. We discuss the diagnostic groups treated by neurologists, the neurological services and their progressive organization. Using the current capacities as baseline, we propose patient groups to be treated by neurologists in the future, and the levels of services. Based on the tendencies seen in the last years we suggest to consider to allocate acute stroke services exclusively to stroke units in neurological departments, and we identify a few other diagnostic groups where neurology should have a larger share in patient care. We define three levels for inpatient care: university departments, regional/county hospitals, city hospitals. Instead of minimum criteria we assign outpatient and inpatient standards that are functional from the economic point of view as well. University departments cover all areas of neurological services, have a function in graduate and postgraduate training, and on a regional basis they participate in professional quality assurance activities at the county and city hospital levels, and would have a more independent role in residency training. As far as patient care is concerned, the task of the regional/county hospitals would be similar to that of university departments - without the exclusively university functions. A general neurological service would be offered at the city hospital level - the representation of all subspecialties of neurology is not required. Neurorehabilitation would be organized at special units of neurological wards at the city hospital level, at independent neurorehabilitation wards in regional/county hospitals, and also as an outpatient service offered at the patients' home. The most significant organizational change would affect the outpatient neurological services. In addition to the special outpatient units associated with university departments and regional/county hospitals, the general neurological outpatient services would be organized as private practices, similarly to the current system of general practitioners, where the individual practices contract independently with the health insurance fund. Their task would be a general neurological service offered 30 hours per week, and also basic, screening neurophysiological and neurosonological examinations, with proper equipment and trained assistance. A transformation in residency training and a change in financing is needed for this plan to fulfill.

For what illnesses is a disease management program most effective?

PubMed

Jutkowitz, Eric; Nyman, John A; Michaud, Tzeyu L; Abraham, Jean M; Dowd, Bryan

2015-02-01

We examined the impact of a disease management (DM) program offered at the University of Minnesota for those with various chronic diseases. Differences-in-differences regression equations were estimated to determine the effect of DM participation by chronic condition on expenditures, absenteeism, hospitalizations, and avoidable hospitalizations. Disease management reduced health care expenditures for individuals with asthma, cardiovascular disease, congestive heart failure, depression, musculoskeletal problems, low back pain, and migraines. Disease management reduced hospitalizations for those same conditions except for congestive heart failure and reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain. Disease management did not have any effect for individuals with diabetes, arthritis, or osteoporosis, nor did DM have any effect on absenteeism. Employers should focus on those conditions that generate savings when purchasing DM programs. This study suggests that the University of Minnesota's DM program reduces hospitalizations for individuals with asthma, cardiovascular disease, depression, musculoskeletal problems, low back pain, and migraines. The program also reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain.

The p202 Gene as a Tumor Suppressor in Prostate Cancer Cells

DTIC Science & Technology

2005-06-01

Inst 29. Shibata MA, Ward JM, Devor DE , Liu ML, Green JE. 39. Bagatell R, Khan 0, Paine-Murrieta G, et al. Destabi- 2000;92:1918-25. Progression of...search for treatment options [7, 71]. Therefore, in this study, we will use the autochthonous TRAMP (transgenic adenocarcinoma of murine prostate... adenocarcinoma at 16 weeks of age. Mature 10-and 16-week-old EZC-TRAMP mice (n=5 per group) will be i.v. injected with CMV-BikDD/SN, ATTP-BikDD/SN, ARR2PB

Replicating Viral Particles and other Shape-controlled, Functional Particles for Targeted Delivery Applications Using Nano-molding Techniques

DTIC Science & Technology

2007-10-23

of the protein mimic can them be tested. 16 References: 1. Vialle, S.; Sepulcri, P.; Dubayle, J .; Talaga, P., The teichoic acid (C...1960, 47, (4), 454-466. 3. M. Reth, G. J . Hdmmerling and K. Rajewsky, Analysis of the repertoire of anti-NP antibodies in C57BL/6 mice by cell...negotiate appropriate terms. 5. Kato, M. K. McDonald, S. Khan, I. Ross, S. Vukovic , K. Chen, D. Munster, K. MacDonald and D. Hart. Expression of