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Sample records for pacientes del hospital

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

    PubMed

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

    2013-01-01

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

  2. RELACIÓN MÉDICO PACIENTE: DERECHOS DEL ADULTO MAYOR

    PubMed Central

    Barrantes-Monge, Melba; Rodríguez, Eduardo; Lama, Alexis

    2009-01-01

    Existen prejuicios en relación con la vejez, incluso entre los profesionales que se dedican a la gerontología. Uno común y peligroso es considerar que los viejos son todos enfermos o discapacitados. La relación médico-paciente es la piedra angular de la práctica y ética médicas. Para alcanzar el respeto por los adultos mayores es necesaria una medicina prudente, basada en una práctica en la cual la reflexión ética y clínica pueda contribuir. Esto último es posible si se hacen valer los derechos del adulto mayor, en particular como paciente para la toma de decisiones. PMID:20379380

  3. Seguridad del paciente en Radioterapia Intraoperatoria: Impacto de los elementos controlados por el Radiofisico

    NASA Astrophysics Data System (ADS)

    Tarjuelo, Juan Lopez

    tambien se uso para estudiar la estabilidad de las camaras de ionizacion mencionadas. Se realizo la dosimetria in vivo en 45 pacientes con MOSFET reforzados mobile TN-502RDM-H, pelicula radiocromica Gafchromic MD-55-2, y se elaboro un modelo teorico para explicar los datos. Por ultimo, al precisarse el uso en RIO de la simulacion virtual y del calculo de la dosis absorbida en el paciente virtual, se ha ilustrado este apartado con la aceptacion y el estado de referencia inicial del planificador de tratamientos modulados con calculo de Monte Carlo Elekta Monaco. Para ello se utilizaron la camara de ionizacion TW31016-0104 y la matriz seven29 de PTW-Freiburg, pelicula radiocromica Gafchromic EBT-2, y diferentes maniquies. Resultados: El FMEA identifico 57 modos de fallo y efectos potenciales. No se experimentaron sucesos relativos a una administracion inadecuada de la dosis absorbida. Se identificaron las revisiones dobles y por un par como claves para reducir los riesgos asociados al equipo de profesionales involucrado en la RIO. Se identificaron tambien oportunidades de mejora con el uso de la automatizacion y el enclavamiento. En cuanto al SPC, los indices de capacidad del proceso abarcaron de 1,6 a 9,3 para un nivel de especificaciones del +/-2%. Las intervenciones simuladas alcanzaron del 2% al 34% de las sesiones de medida. Las camaras de ionizacion Farmer derivaron en direcciones opuestas en un periodo de 6 anos; aunque ello no se aprecio en los informes de calibracion del laboratorio acreditado. No derivo la camara PPC-40. En la dosimetria in vivo, las medidas de los MOSFET no se desviaron significativamente de las medidas con pelicula. Los valores centrales de las dosis absorbidas quedaron entre la dosis absorbida prescrita y la maxima, con lo que indicaron un tratamiento correcto del lecho tumoral. Las anchuras de los intervalos de confianza de las dosis absorbidas esperadas segun el modelo teorico al nivel del 95% abarcaron del 8,6% al 14,7%. Las verificaciones de

  4. Tratamiento Quirúrgico de los Meningiomas del Foramen Óptico, Técnicay Resultados de una Serie de 18 Pacientes

    PubMed Central

    Goldschmidt, Ezequiel; Ajler, Pablo; Campero, Álvaro; Landriel, Federico; Sposito, Maximiliano; Carrizo, Antonio

    2014-01-01

    Introducción: los meningiomas del foramen óptico producen un rápido deterioro de la función visual aún cuando su tamaño es pequeño, por eso su diagnóstico y manejo difiere del resto de los meningiomas clinoideos. El propósito de este estudio es presentar la técnica y los resultados de nuestro manejo quirúrgico de meningiomas foraminales (MF). Pacientes y Métodos: se llevó a cabo una revisión de las historias clínicas de 47 pacientes con meningiomas primarios intraorbitarios. Se realizaron 52 cirugías en los pacientes con MF. Se empleó una craneotomía fronto-orbitaria, seguida de una descompresión extradural del canal óptico, resección del componente intraorbitario y exploración intradural del nervio óptico. Resultados: de los 12 pacientes con MF que presentaban la visión conservada, la agudeza visual fue preservada en 7 casos, mejoró en 2, y empeoró en 3. En 18 pacientes, el principal síntoma fue exoftalmos y en 35 pacientes ceguera unilateral. Ocurrieron 6 recurrencias, 2 a 10 años después de la resección quirúrgica. Cinco de ellos fueron reoperados. Se indicó radioterapia después de la recurrencia en 3 pacientes. Conclusión: el manejo de los MF continúa siendo controvertido y frecuentemente se propone un tratamiento conservador. Basados en nuestros hallazgos de frecuente extensión intracraneal, proponemos realizar una resección total o subtotal del tumor, preservando el nervio óptico en pacientes con visión prequirúrgica conservada. PMID:25165616

  5. [Registry of myocardial infarction in a tertiary hospital of the Instituto Mexicano del Seguro Social].

    PubMed

    González-Pliego, José Angel; Gudiño-Amezcua, Diego Armando; Celis, Alfredo; Gutiérrez-Díaz, Gonzalo Israel

    2014-01-01

    Introducción: dado que el pronóstico de infarto del miocardio con elevación del segmento ST (IMCEST) depende de su manejo inmediato y de las medidas de prevención secundaria, el no seguir las recomendaciones actuales impide mejorar las expectativas de la población afectada por este padecimiento. El objetivo es describir el perfil clínico-epidemiológico y el proceso de atención del IMCEST en un hospital de tercer nivel. Métodos: se analiza la información clínica, la estratificación de riesgo, la terapia de revascularización y los hábitos de prescripción al egreso de los casos con IMCEST atendidos en un año. Resultados: se incluyeron 246 pacientes con edad promedio de 61 años; el 76 % fueron varones. La mayoría (37.3 %) de IMCEST ocurrió entre los 60 y los 69 años. El sedentarismo fue el factor de riesgo predominante. El 81.7 % de los casos tuvo score TIMI de riesgo bajo. El 35 % tuvo isquemia/viabilidad y en todos los cateterizados se demostraron obstrucciones coronarias. El 76 % se revascularizó con stent, principalmente farmacológico (77.5 %). Al egreso más del 90 % de los casos recibió estatina y antiplaquetarios, mientras otras drogas se prescribieron al 64-82 % de los casos. Conclusiones: el IMCEST predomina en hombres sedentarios de la séptima década. Estratificar el riesgo, buscar isquemia/viabilidad residual y revascularizar con stent farmacológico son prácticas comunes; el cumplimiento de recomendaciones basadas en la evidencia es mejor que en el pasado, pero todavía no es óptimo.

  6. Encefalitis por anticuerpos contra el receptor de NMDA: experiencia con seis pacientes pediátricos. Potencial eficacia del metotrexato

    PubMed Central

    Bravo-Oro, Antonio; Abud-Mendoza, Carlos; Quezada-Corona, Arturo; Dalmau, Josep; Campos-Guevara, Verónica

    2016-01-01

    Introducción La encefalitis por anticuerpos contra el receptor de N-metil-D-aspartato (NMDA) es una entidad cada vez más diagnosticada en edad pediátrica. A diferencia de los adultos, en muchos casos no se asocia a tumores y las manifestaciones iniciales en niños más frecuentes son crisis convulsivas y trastornos del movimiento, mientras que en los adultos predominan las alteraciones psiquiátricas. Casos clínicos Presentamos seis casos pediátricos confirmados con anticuerpos contra la subunidad NR1 del receptor de NMDA en suero y líquido cefalorraquídeo. Cinco de los casos comenzaron con crisis convulsivas como manifestación clínica inicial antes de desarrollar el cuadro clásico de esta entidad. En todos los casos se utilizaron esteroides como primera línea de tratamiento, con los que sólo se observó control de las manifestaciones en uno, por lo que el resto de los pacientes requirió inmunomoduladores de segunda línea. Todos los pacientes recibieron metotrexato como tratamiento inmunomodulador para evitar recaídas y la evolución fue a la mejoría en todos ellos. Conclusiones En nuestra serie de pacientes con encefalitis por anticuerpos contra el receptor de NMDA, ninguno se asoció a tumores. Todos los casos recibieron metotrexato por lo menos durante un año, no observamos eventos adversos clínicos ni por laboratorio, ni hubo secuelas neurológicas ni recaídas durante el tratamiento. Aunque es una serie pequeña y es deseable incrementar el número y tiempo de evolución, consideramos el metotrexato una excelente alternativa como tratamiento inmunomodulador para esta patología. PMID:24150952

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

    PubMed Central

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

    2014-01-01

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

  8. Mortality according to age and burned body surface in the Virgen del Rocio University Hospital.

    PubMed

    Gómez-Cía, T; Mallén, J; Márquez, T; Portela, C; Lopez, I

    1999-06-01

    The application of updated clinical protocols for the treatment of burned patients is showing very good results. The mortality curves according to age and the percentage of burned body surface could be of great use for the comparison of clinical results between different burns units. The probability of survival in 1000 consecutive patients admitted to the Burns Unit of the Virgen del Rocio University Hospital between July, 1993 and August, 1997, is compared, by graphic analysis, with the mortality curves of other centers, obtaining similar results. We conclude that the results of medical attendance in our unit are in line with those considered as a reference.

  9. [Association of stress hyperglycemia and in-hospital complications].

    PubMed

    Galindo-García, Gerardo; Galván-Plata, María Eugenia; Nellen-Hummel, Haiko; Almeida-Gutiérrez, Eduardo

    2015-01-01

    Introducción: la hiperglucemia de estrés es la elevación de la glucosa sérica que se encuentra a la admisión hospitalaria de un paciente. El objetivo fue evaluar el impacto de la hiperglucemia de estrés al ingreso en el desenlace de pacientes no críticos hospitalizados en un servicio de Medicina Interna. Métodos: estudio de cohorte prospectivo y analítico realizado en pacientes de Medicina Interna del Hospital de Especialidades del Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, de septiembre de 2011 a febrero de 2012. Resultados: se incluyeron 89 pacientes con niveles séricos de glucosa < 110 mg/dL (grupo A) y 90 pacientes con niveles de glucosa > 110 mg/dL (grupo B). La diabetes mellitus fue más frecuente en el grupo B (p < 0.001). La hemoglobina glucosilada mayor a 6.5 % se encontró en el 36.4 % de los pacientes del grupo B y en el 8.7 % del grupo A, (p < 0.001). Los pacientes del grupo B tuvieron mayor puntuación en el APACHE II (p = 0.02) y tendencia a mayor frecuencia de complicaciones. Conclusiones: la hiperglucemia de estrés se asocia a una mayor puntuación de APACHE II, y tiende a una mayor frecuencia de enfermedad crítica, sepsis, infección de vías urinarias, neumonía y uso de aminas vasopresoras. Los predictores independientes de muerte fueron la presencia de hipertensión arterial y el score APACHE II.

  10. [Comparative profile of medications at the "Hospital Infantil de México" and the "Instituto Mexicano del Seguro Social"].

    PubMed

    Jasso-Gutiérrez, Luis; Santos-Preciado, José Ignacio

    2010-01-01

    Compare the distribution of medications according to therapeutic groups (TGs) as a function of codes, cost, price weighted index (PWI) and volume between the Instituto Mexicano del Seguro Social, a conglomerate of hospitals and family medicine clinics and the Hospital Infantil de México "Federico Gómez" a tertiary care referral pediatric hospital. Medications were classified by TGs according to drug code, purchase cost, PWI, and volumes purchased. TGs showed similar profiles according to cost of purchase, volume and code numbers, not according to PWI. There were only minor differences in cost among the 15 most expensive medications among both institutions. Despite the marked asymmetry between both institutions, drug profiles were not significantly different, to a large extent due to the fact that the Hospital Infantil de Mexico acquires all TGs.

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

    PubMed Central

    Villegas, Dolly; Echandía-Villegas, Connie Alejandra

    2012-01-01

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

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

    PubMed

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

    2012-04-01

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

  13. ["Del governo tecnico sanitario degli Ospedali" (Italian) ("Hospital governance") by E. Ronzani (1877-1943)- Padua (Italy), 1910].

    PubMed

    Renzulli, Lorenzo

    2014-01-01

    This article describes the contents of the first edition of the Italian textbook "Del governo tecnico sanitario degli ospedali" ("Hospital Governance") written by Prof. Enrico Ronzani (1877- 1943) and published in Padua (Italy) in 1910. The textbook contains a a preface by Prof. A. Serafini. Prof. Ronzani, a lecturer in Hygiene and health in 1910, introduced the first university course in "Hygiene and hospital technique" in Italy, in Padua in the academic year 1910-1911. The book focuses principally on the duties and responsibilities inherent in the role of the medical director.

  14. [Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients].

    PubMed

    Más-Sesé, Gemma; Sanchis-Pellicer, M José; Tormo-Micó, Esther; Vicente-Más, Josep; Vallalta-Morales, Manuel; Rueda-Gordillo, Diego; Conejo-Alba, Antonia; Berbegal-Serra, Juan; Martínez-Avilés, Pedro; Oltra-Masanet, Joan A; Femenia-Pérez, Miquel

    2015-03-16

    Introduccion. Un 30-40% de los pacientes con daño cerebral presenta alteraciones del nivel de conciencia, y algunos casos, estados alterados de conciencia: sindrome de vigilia sin respuesta (SVSR) o estado de minima conciencia (EMC). La recuperacion es variable y la supervivencia esta amenazada por multiples complicaciones. Objetivos. Presentar la metodologia de trabajo del Hospital La Pedrera (HLP) para pacientes en SVSR o EMC y analizar las caracteristicas clinicas de los pacientes atendidos, la evolucion, y la situacion funcional y cognitiva en el momento del alta. Pacientes y metodos. Estudio descriptivo prospectivo de pacientes atendidos en el HLP durante el periodo 2009-2013, con diagnostico de SVSR o EMC. Resultados. El HLP trabaja mediante el metodo gestion de caso, ofreciendo una atencion integral por un equipo multidisciplinar. Los pacientes se clasifican segun objetivos asistenciales. Los pacientes con SVSR o EMC se incluyen en el programa de cuidados integrales y adaptacion. Se atendio a 23 pacientes (86,9% varones), con una edad media de 54,9 años. Etiologia: hemorragia cerebral, 30,4%; encefalopatia anoxica, 26,6%; encefalopatia metabolica, 17,3%; y otras causas, 17,3%. El 73,9% ingreso en SVSR y el resto en EMC. Evolucion: el 43,4% mejoro su situacion cognitiva inicial y el 88,8% presentaba una situacion de dependencia total en el momento del alta. Las complicaciones mas frecuentes fueron infecciones respiratorias y urinarias (53,6%). El 65,2% de los casos fueron exitus. Conclusiones. La asistencia en SVSR o EMC es compleja y precisa cuidados multidisciplinares. Casi la mitad de los pacientes mejoro su situacion cognitiva, lo que justifica una actitud proactiva que intente mejorar la calidad de vida de los pacientes y sus familias.

  15. CONHECIMENTO DA LEI GERAL DE SAÚDE – RESPEITO ÀS TRANSFUSÕES SANGUÍNEAS EM MÉDICOS E PACIENTES TESTEMUNHAS DE JEOVÁ DO HOSPITAL DR. DARÍO CONTRERAS DA REPÚBLICA DOMINICANA

    PubMed Central

    SANTANA, ELSA DÍAZ

    2010-01-01

    Este estudo avalia quanto o corpo médico do Hospital Dr. Darío Contreras de República Dominicana conhece, respeita, informa e aplica a Lei Geral de Saúde em relação aos direitos do paciente Testemunha de Jeová de negar-se a ser transfundido (respeito a sua autonomia); também se os Testemunhas de Jeová conhecem a Lei Geral de Saúde e até que ponto têm se beneficiado diante dessa proposição. O estudo revelou que nem médicos, nem Testemunhas de Jeová conhecem de fato essa lei. PMID:20689657

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

    PubMed

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

    2015-07-01

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

  17. [Clinical course and prognosis of patients with urolithiasis in a pediatric hospital].

    PubMed

    Ubillo-Sánchez, José Manuel; Bonilla-Rojas, Jesús; Peña, Luis Alberto; Zurita-Cruz, Jessie Nallely; Cárdenas-Navarrete, Rocío; Serret-Montoya, Juana; Villasís-Keever, Miguel Angel

    2014-01-01

    INTRODUCCIÓN: la litiasis renal se considera poco frecuente en pediatría. La información disponible no es suficiente para determinar con certeza su pronóstico. El objetivo de esta investigación fue describir los signos, síntomas, complicaciones y recurrencia que presentaron los pacientes pediátricos con urolitiasis. MÉTODOS: se identificaron los expedientes de pacientes pediátricos con urolitiasis atendidos en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, en el periodo de 2003 a 2009.

  18. [Hospital admissions due to whooping cough: experience of the del niño hospital in Panama. Period 2001-2008].

    PubMed

    Nieto Guevara, J; Luciani, K; Montesdeoca Melián, A; Mateos Durán, M; Estripeaut, D

    2010-03-01

    Bordetella pertussis (whooping cough) is a worldwide public health problem. It is estimated that there are about 20 to 40 million cases with 200,000-400,000 deaths and is increasing in infants and adults. An observational, retrospective study was made. We reviewed the epidemiologic surveillance notification forms from 2001 to 2008 period at the Epidemiology Department of Hospital Del Niño, a tertiary paediatric reference centre in Panama City. All pertussis (whooping cough) cases confirmed by PCR and cultures were selected. From a total of 759 notifications of suspected whooping cough cases, 180 confirmed cases using PCR and culture were analyzed for this study. The admission rate in all ages was 14.4/10,000 admissions, predominantly in < or =3 months with 42.76/10,000 admissions and which accounted for 75% of the cases. Cough was the most important symptom (91%). Cyanosis, leucocytosis and lymphocytosis were the most characteristic clinical findings when comparing positive pertussis with negative. More than two thirds of the subjects less than 3 months of age had not been vaccinated at the time of admission. The death rate was 8.3%, more than half of them in subjects less than 1 month of age. Whooping cough is an important public health problem. Post-partum vaccination could be a strategy to reduce morbidity and mortality in infants less than 3 months of age. 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  19. [Frequency of peritoneal transport in a population of the Hospital General Regional No. 46, Instituto Mexicano del Seguro Social].

    PubMed

    Chávez Valencia, Venice; Orizaga de la Cruz, Citlalli; Pazarin Villaseñor, Héctor Leonardo; Fuentes Ramírez, Francisco; Parra Michel, Renato; Aragaki, Yuritomo; Márquez Magaña, Isela; García Cárdenas, Mario Alberto; Campos Enrique, Rojas

    2014-12-01

    The peritoneal equilibration test (PET) is a common test used in the adequacy of peritoneal dialysis (PD). To determine the frequency of presentation of different types of peritoneal transport in patients on PD ranking with Twardowski, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) and Hospital de Especialidades del Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente (IMSS-HE, CMNO) and establish themselves. Descriptive and transversal study. Included with PET on PD patients between April 2011 to September 2012; any gender, 16 years or older, in DP minimum of 4 weeks. PEP performed standardized bags of 2.5%. Performed 235 PET. We can classify peritoneal transport with Twardowski in high (H) 34%, high average (HA) 37%, low average (LA) 25%, and low (L) 4% peritoneal transport rates. INCMNSZ percentages H was 34%, HA 32%, LA 23%, and L 11%; using the CMNO HE was H 26%, HA 31%, LA 31%, and L 12%. From our data, the percentage of patients with H was 22%, HA 33%, LA 32%, and L13%. Classifying patients according to type of transport with Twardowski will under-diagnose the low and overestimate high transport, and can alter survival forecasts.

  20. [Visa at a tertiary hospital].

    PubMed

    Martínez-Jiménez, S; Lluch-Colomer, A; Desongles-Corrales, T; Bernal-González, D; Santos-Rubio, M D; Alfaro-Lara, E R; Galván-Banqueri, M

    2013-01-01

    Objetivo: Analizar el procedimiento de visado y su actividad en un hospital de tercer nivel. Material y métodos: Estudio descriptivo del procedimiento de visado durante el período abril 2011-abril 2012. Se diseñó una base de datos y se definieron categorías relativas a las variables de estudio: pacientes y recetas. Para los pacientes atendidos en la Unidad de Visado se registraron las incidencias detectadas en base a una clasificación previamente establecida. Resultados: Se incluyeron 6.738 pacientes (8.465 recetas visadas). Se visaron 170 medicamentos y productos de nutrición diferentes, siendo el mayoritario Tacrolimus. Se detectaron un total de 420 incidencias, siendo las más frecuentes la «Ausencia de documento clínico» (46,67 %) y los «Errores formales de cumplimentación» (28,57%). Conclusiones: El presente trabajo ha permitido un conocimiento más pormenorizado de la actividad, los tipos de incidencias y la identificación de áreas de mejora.

  1. Hypermobility among school children aged five to eight years: the Hospital del Mar Criteria gives higher prevalence for hypermobility than the Beighton score.

    PubMed

    Öhman, A; Westblom, C; Henriksson, M

    2014-01-01

    The purpose was to investigate the distribution of hypermobility among school children aged five to eight years. One hundred and twenty-eight participants were assessed using the Beighton score and the Hospital del Mar criteria. With the Beighton score using the cut-off ≥4, the prevalence was 12%, and with the Hospital del Mar criteria the prevalence was 34%. There were significantly higher scores for females on both the Beighton (p=0.01) and Hospital del Mar criteria (p<0.0001). The youngest children aged five to six years scored higher compared with the seven- and eight-year-olds (p=0.016). The knee flexion was most likely to be hypermobile (97%), followed by shoulder rotation (80%), thumb (31%), elbow (27%), metatarsal-phalangeal (16%), hip (15.5%), fingers (10%) or knee (10%), ankle (6%), trunk (4%) and patella (2%). Gender and probably age must be taken into account when children are assessed for hypermobility. The Hospital del Mar criteria need to be modified for some of the motions.

  2. [Incidence of dentofacial deformities in the Specialty Hospital of the Instituto Mexicano del Seguro Social].

    PubMed

    Delgado Galíndez, Blanca; Villalpaondo Carreón, Mónika

    2005-01-01

    To report the incidence and classification of dentofacial deformities from the Maxillofacial Department at the Specialty Hospital at the 21st Century National Medical Center of the Mexican Institute of Social Security in Mexico City. A descriptive, retrospective and transversal study was carried out. Clinical files from 120 patients were reviewed from May 1997 to May 1998 with the purpose of classifying and determining the types of maxillofacial deformities and also to report whether these deformities were corrected by orthognatic surgery. One hundred twenty clinical files were reviewed and dentofacial deformities were found in 47 (39%). All patients were treated with orthognatic surgery. Surgical treatment was often combined (orthodontia and surgery). Regardless of the type of dentofacial deformities, an individualized treatment protocol must be designed for each patient. It is important to list the priorities and needs of the patients in order to find appropriate solutions, in regard to their importance.

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

    PubMed

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

    2015-03-01

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

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

    PubMed

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

    2014-10-25

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

  5. [Rethinking the surgical approach to intestinal obstruction surgery in neonates. Experience of a third-level hospital].

    PubMed

    Sepúlveda-Vildósola, Ana Carolina; Piedra Buena-Muñoz, Esmeralda; Partida-Justo, Irving; Campos-Lozada, Ileana

    2015-01-01

    Introducción: la elección de una incisión para laparotomía depende del área que necesite ser expuesta, la urgencia del procedimiento y las preferencias del cirujano. En el Hospital de Pediatría del Centro Médico Nacional Siglo XXI del IMSS, tradicionalmente se realiza abordaje por línea media en estos pacientes. Nuestro objetivo fue determinar si el abordaje por línea media es seguro para el manejo de neonatos sometidos a laparotomía por oclusión intestinal. Métodos: estudio retrospectivo que incluyó a todos los neonatos sometidos a laparotomía por oclusión intestinal mediante abordaje por línea media, en un período comprendido entre enero 2010 a enero 2012. Resultados: se estudiaron 34 pacientes. El 88.2 % de los procedimientos fueron de urgencia. Se encontraron complicaciones en 44 % de los pacientes, de las cuales la más frecuentes fueron: infección y dehiscencia de herida. Dentro de las complicaciones respiratorias, el 32.4 % presentó atelectasia y el 14.7 %, neumonía. Tuvieron hernia postincisional al año el 14.7 %. Ninguna de las variables del paciente o la cirugía fueron estadísticamente significativas para el desarrollo de complicaciones. Se presentaron más complicaciones en los procedimientos de urgencia, en pacientes menores a 2000 gramos y con tiempos quirúrgicos mayores a 120 minutos. Conclusiones: la frecuencia de complicaciones inmediatas y mediatas posteriores al evento quirúrgico son mayores a las reportadas en la literatura con abordaje transverso. La frecuencia de hernia postincisional al año es similar a lo reportado con éste último abordaje.

  6. [Urgent stroke care in hospitals with a stroke unit. Quick Project].

    PubMed

    Masjuán, Jaime; Álvarez-Sabín, José; Arias-Rivas, Susana; Blanco, Miguel; de Felipe, Alicia; Escudero-Martínez, Irene; Fuentes, Blanca; Gállego-Culleré, Jaime; Moniche-Álvarez, Francisco; Muñoz, Lucía; Pérez de la Ossa-Herrero, Natalia; Sahuquillo, Patricia; Santamarina, Estevo; Sanz, Borja; Tembl, José I; Zandio, Beatriz

    2016-04-01

    Introduccion. El ictus es una emergencia medica dependiente del tiempo. La rapidez en su reconocimiento y en la atencion que reciben los pacientes es clave en el pronostico. Objetivos. Analizar los tiempos de actuacion medica, evaluar posibles areas de mejora y estudiar la dotacion de recursos de los centros. Pacientes y metodos. Registro prospectivo de pacientes atendidos en ocho unidades de ictus experimentadas españolas con sospecha de ictus y activacion del codigo ictus. Se recogieron los tiempos inicio-puerta, puerta-tomografia computarizada (TC), puerta-aguja, TC-aguja e inicio-aguja. Tambien se recogieron el metodo de trasporte al hospital, el tipo de ictus y las terapias de reperfusion. En cuanto a la dotacion estructural de los centros, se recogieron la ratio de enfermeria, la monitorizacion de camas, la disponibilidad de TC multimodal y resonancia magnetica, y la realizacion de cursos de informacion o formacion. Resultados. Se incluyeron 197 pacientes, de los cuales fueron validos 181 (151 infartos y 30 hemorragias cerebrales). Las medianas (p25-p75) en minutos fueron: inicio-puerta, 104 (70-188); puerta-TC, 27 (19-41); TC-aguja, 30 (21-43); puerta-aguja, 64 (49-83); e inicio-aguja, 156 (129-202). Se aplicaron terapias de reperfusion en 68 pacientes (el 45% de los infartos cerebrales), de los cuales el 81% fueron trombolisis intravenosas; el 7%, tratamientos endovasculares; y el 12%, una combinacion de ambos. Los recursos de los centros estuvieron de acuerdo con lo recomendado por las guias clinicas. Hubo un bajo porcentaje de pacientes estudiados con resonancia magnetica. Conclusion. El porcentaje de pacientes tratados con trombolisis fue muy elevado y los tiempos de los circuitos intrahospitalarios, aunque buenos, tienen margen de mejora.

  7. [Nutritional status at the time of admission among patients admitted to a tertiary-care paediatric hospital].

    PubMed

    Durá Travé, Teodoro; San Martín García, Isabel; González Benavides, Aida; Vaquero Iñigo, Ibone; Herranz Aguirre, Mercedes; Iceta Elízaga, Ainhoa

    2015-06-01

    Objetivo: analizar la situación nutricional de los pacientes en el momento del ingreso hospitalario a lo largo de un año natural e identificar a aquellos pacientes y/o grupos de enfermedades con mayor riesgo de malnutrición. Material y métodos: valoración retrospectiva de la situación nutricional de 852 pacientes hospitalizados durante el año 2013 en un hospital pediátrico (462 varones y 390 mujeres). De cada paciente se registraron el sexo, edad, peso y talla, índice de masa corporal (IMC), estancia hospitalaria y diagnóstico según la Clasificación Internacional de las Enfermedades (CIE-10). Resultados: la prevalencia de malnutrición al ingreso era del 8,2%, y la de sobrepeso/obesidad del 18%. Las enfermedades neurológicas (22,9%), junto con las respiratorias (22,9%), infecciosas (18,6%), malformaciones congénitas (11,4%) y genitourinarias (8,6%) representaban el 84,4% de los casos de malnutrición. Conclusiones: la tasa de prevalencia de malnutrición en los pacientes pediátricos al ingreso era del 8,2%; siendo esta cifra prácticamente similar a las publicadas en los países occidentales. Los pacientes con menor edad y afectos de enfermedades neurológicas y/o respiratorias y, especialmente, con enfermedades congénitas tenían un mayor riesgo de presentar malnutrición, siendo preceptivo realizar un cribado nutricional inicial y un seguimiento durante su hospitalización.

  8. [Analysis of maternal mortality during three periods at Hospital de Ginecología y Obstetricia del Centro Médico Nacional de Occidente].

    PubMed

    Angulo Vázquez, José; Cortés Sanabria, Laura; Torres Gómez, Luís Guillermo; Aguayo Alcaraz, Guadalupe; Hernández Higareda, Salvador; Avalos Nuño, Joel

    2007-07-01

    Most of deceases due to pregnancy, delivery, puerperium and them attention are avoidable with current medicine resources. To analyze some basic elements of epidemiologic behavior of a hospital environment maternal mortality in a third level hospital during a period of 21 years. Analytical cross-sectional study, 222 maternal deaths registered at Hospital de Ginecologia y Obstetricia, Centro Medico Nacional de Occidente del Instituto Mexicano del Seguro Social, were included, during the period 1985-2005. Deaths were analyzed in three periods of 7 years each one. The analysis of results was made based on descriptive statistic. chi2 was used for comparison between periods. Maternal death ratio was 73 per 100,000 live births during the 21 years. Maternal mortality was lower in the group of women under 20 years and increase agreed maternal age. Frequency of direct obstetric deaths decreased when comparing the 3 periods. The main causes of maternal death were preeclampsia/eclampsia and obstetric hemorrhage, which were responsible for almost 50% of maternal deaths. There was no significant difference to anticipation by comparing periods, between 28 and 37% of deaths were foreseen. 98% of deaths occurred at Intensive Care Units. Direct and indirect maternal deaths show very similar values in the third period, which translates in an improvement in anticipation. It must be reinforce the simple and opportune information to the patient with regard to warning signs and the permanent medical training must be a priority at the 3 medical levels.

  9. [Prevalence of undernutrition in hospital patients with unbalanced heart failure; subjective global assessment like prognosis sign].

    PubMed

    Guerra-Sánchez, Luis; Martinez-Rincón, Carmen; Fresno-Flores, Mar

    2015-04-01

    Introducción: Existe una gran variabilidad en los estudios sobre la prevalencia de malnutrición en pacientes con insuficiencia cardiaca crónica. La proporción de pacientes desnutridos depende del método de valoración utilizado y del momento en que se realice. Se ha descrito la relación entre desnutrición y aumento de las complicaciones, de la estancia hospitalaria, de la mortalidad y de reingreso hospitalario. Por lo que merece la pena señalar y tratar a estos pacientes. Objetivos: El objetivo fue aproximarnos a la prevalencia de la desnutrición, en los pacientes con insuficiencia cardiaca crónica ingresados por descompensación, en nuestro medio y analizar cuál de los dos métodos de valoración nutricional utilizados, era mejor predictor de mortalidad. Métodos: Estudio observacional, transversal, en el que se evaluaron mediante la Valoración Subjetiva Global y Mini Nutritional Assesment , el estado nutricional de 377 pacientes ingresados en un hospital terciario de alta complejidad con diagnósticos compatibles con descompensación de insuficiencia cardiaca crónica. Resultados: La edad media fue de 75±10. El 51,5%(n=194) fueron hombres. Según la Valoración Subjetiva Global, el 50,7% (45,6%-55,7%) estaban normonutridos, el 41,9% (37,0%-46,9%) presentaban riesgo o sospecha de desnutrición y el 7,4% (5,2%-10,5%) presentaban desnutrición franca. Conclusiones: La prevalencia de desnutrición de los pacientes hospitalizados por descompensación de Insuficiencia Cardiaca crónica en nuestro ámbito es alta. La Valoración Subjetiva Global es un buen predictor de la mortalidad.

  10. Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

    PubMed

    Aguilar-Bernier, M; González-Carrascosa, M; Padilla-España, L; Rivas-Ruiz, F; Jiménez-Puente, A; de Troya-Martín, M

    2014-03-01

    The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

  11. [Neuroblastoma: prognostic factors and survival. Experience in Hospital de Pediatria del Centro Medico Nacional del Siglo XXI and review of the literature].

    PubMed

    López-Aguilar, Enrique; Cerecedo-Díaz, Fernando; Rivera-Márquez, Hugo; Valdéz-Sánchez, Martha; Sepúlveda-Vildósola, Ana Carolina; Delgado Huerta, Sandra; Vera-Hermosillo, Herlinda; Vázquez-Langle, José Raúl; Wanzke del Angel, Volkmar

    2003-01-01

    Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period, respectively. According to histology there was 91% survival for differentiated and 23% for undifferentiated tumors. The chemotherapeutic regimen reported is effective but not better than that reported by other authors, in which some benefits are seen with use of transplant and immunotherapy. The most important prognostic factors are still considered to be age, stage and histology.

  12. HOSPITAL NUTRITIONAL CARE: PROPOSITIONS ENDORSED BY THE SCIENTIFIC COMMUNITY.

    PubMed

    Diez-Garcia, Rosa Wanda; Zangiacomi Martinez, Edson; Penaforte, Fernanda Rodrigues de Oliveira; Japur, Camila Cremonezi

    2015-09-01

    Antecedentes/objetivos: la incidencia de desnutrición hospitalaria y sus consecuencias tanto para el paciente como para el hospital ha exigido procedimientos que aseguren un servicio de atención nutricional hospitalaria de buena calidad. Basado en los informes de la literatura, este estudio tuvo como objetivo construir proposiciones sobre los cuidados nutricionales hospitalarios, que después fueran evaluados y aprobados por la comunidad científica. Métodos: fueron desarrolladas cuarenta y una proposiciones relativas a la atención nutricional clínica del paciente y a la gestión del servicio de alimentación por el Servicio de Alimentación y Nutrición Hospitalaria. Un total de cien profesionales, investigadores y profesores evaluaron las proposiciones. Para analizar si los evaluadores estaban de acuerdo con las proposiciones se utilizó una escala Likert de cinco puntos (estoy en total desacuerdo, estoy parcialmente en desacuerdo, no tengo opinión, estoy parcialmente de acuerdo, estoy totalmente de acuerdo) asociada a cada proposición. Fue considerada concordancia cuando el 70% o más de los evaluadores estaban de acuerdo (totalmente o parcialmente) con la proposición. Para el análisis estadístico fue utilizado el procedimiento Proc Corresp del software SAS 10, versión 8, estadística descriptiva y análisis de correspondencias. Resultados: más del 90% de los entrevistados estaban total o parcialmente de acuerdo con el 85% (35) de las 41 proposiciones; entre el 80 y 90% de los entrevistados estaban total o parcialmente de acuerdo con el 15% (6) de las 41 proposiciones. Todos los criterios propuestos tuvieron más del 70% de concordancia (total y parcial). El menor valor de concordancia total fue del 70%, atribuido a la proposición que sugiere la participación del paciente en la intervención nutricional. Conclusiones: la comunidad científica presentó alto nivel de concordancia con las proposiciones para la atención nutricional hospitalaria, lo

  13. [Prevalence of gastrointestinal disorders in adults with common variable immunodeficiency at Specialty Hospital Dr. Bernardo Sepulveda].

    PubMed

    Rodríguez-Negrete, Elda Victoria; Mayoral-Zavala, Arturo; Rodríguez-Mireles, Karen Alicia; Díaz de León-Salazar, Oscar Edmundo; Hernández-Mondragón, Oscar; Gómez-Jiménez, Luz María; Moreno-Alcántar, R; González-Virla, Baldomero

    2015-01-01

    Antecedentes: la incidencia de la inmunodeficiencia común variable (IDCV) es de 1 por cada 15,000 a 117,000 casos, sin predominio de género. La incidencia de manifestaciones gastrointestinales en estos pacientes es de 20 a 60% y pueden ser la primera y única manifestación clínica de IDCV. En México existe escasa información en relación con el tipo y frecuencia de alteraciones gastrointestinales que padecen los pacientes adultos con IDCV. Objetivo: determinar la prevalencia de alteraciones gastrointestinales en pacientes adultos con inmunodeficiencia común variable. Material y método: estudio descriptivo, observacional y transversal en el que participaron pacientes con inmunodeficiencia común variable de la Clínica de Inmunodeficiencias del Servicio de Alergia e Inmunología Clínica del Hospital de Especialidades, Centro Médico Nacional Siglo XXI. A todos los pacientes se les aplicó un cuestionario de síntomas gastrointestinales y se les realizaron estudios de laboratorio, gabinete, endoscopia y prueba de aliento para determinar sobrepoblación bacteriana. Resultados: evaluamos 17 pacientes, 8 hombres y 9 mujeres, con edad promedio de 36 años y diagnóstico definitivo de inmunodeficiencia común variable de acuerdo con criterios internacionales. El 59% refirió dolor abdominal, 53% distensión abdominal y 17.6% estreñimiento. El 47% tenía diarrea crónica, en dos de ellos (11.8%) acompañada de pujo rectal. Las enfermedades gastrointestinales de esta población fueron: 18% diarrea crónica, enfermedad celiaca y sobrepoblación bacteriana, 24% trastorno funcional digestivo, 12% estreñimiento, 6% dispepsia. Sólo un paciente (6%) no tenía síntomas gastrointestinales. Conclusión: la prevalencia de las enfermedades gastrointestinales en pacientes adultos con inmunodeficiencia común variable fue de 94%, sin predominio de género. Debido a la frecuencia de manifestaciones gastrointestinales, es importante realizar protocolos de estudio al respecto

  14. Experience of Preimplantation Genetic Diagnosis with HLA Matching at the University Hospital Virgen del Rocío in Spain: Technical and Clinical Overview

    PubMed Central

    Fernández, Raquel María; Peciña, Ana; Lozano-Arana, Maria Dolores; Sánchez, Beatriz; Guardiola, Jordi; García-Lozano, Juan Carlos; Borrego, Salud; Antiñolo, Guillermo

    2014-01-01

    Preimplantation genetic diagnosis (PGD) of genetic diseases, combined with HLA matching (PGD-HLA), is an option for couples at risk of transmitting a genetic disease to select unaffected embryos of an HLA tissue type compatible with that of an existing affected child. Here we present the results of our PGD-HLA program at the Department of Genetics, Reproduction and Fetal Medicine of the University Hospital Virgen del Rocío in Seville. Seven couples have participated in our program because of different indications. Overall, 26 cycles were performed, providing a total of 202 embryos. A conclusive molecular diagnosis and HLA-typing could be assured in 96% of the embryos. The percentage of transfers per cycle was 26.9% and the birth rate per cycle was 7.7% per transfer. Our PGD-HLA program resulted in the birth of 2 healthy babies, HLA-identical to their affected siblings, with successful subsequent haematopoietic stem cell (HSC) transplantations. Both HSC-transplanted children are currently doing well 48 and 21 months following transplantation, respectively. All the procedures, including HSCs umbilical cord transplantation, were performed in our hospital. PMID:24868528

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2012-07-01

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

  17. [Experience in the treatment of patent ductus arteriosus closure at a mexican hospital].

    PubMed

    Márquez-González, Horacio; Castro-Contreras, Uriel; Cerrud-Sánchez, Carmen Emma; López-Gallegos, Diana; Yáñez-Gutiérrez, Lucelli

    2016-01-01

    Introducción: la persistencia del conducto arterioso (PCA) representa una de las enfermedades con mayor prevalencia en los hospitales que atienden cardiopatías congénitas (CC). En la actualidad en pacientes mayores de un año de edad el cierre percutáneo es la terapéutica estándar. El objetivo de este trabajo fue conocer la frecuencia, características y tratamiento de PCA en el servicio de Cardiopatías Congénitas en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Métodos: en el servicio de Cardiopatías Congénitas del Hospital de Cardiología del CMN SXXI se realizó un estudio descriptivo de 2010 a 2015 de los enfermos que fueron tratados con cierre percutáneo y cirugía de PCA. Se dividieron en las siguientes edades: lactantes, preescolares, escolares, adolescentes y adultos. Se registraron las frecuencias absolutas. Resultados: se seleccionaron 187 pacientes, de los cuales los preescolares y escolares representaron el 60% del total de la muestra. El cierre percutáneo por cateterismo intervencionsta se realizó en 90%; se registró un 2% de complicaciones. Conclusiones: en esta clínica de cardiopatías congénitas, la PCA es tratada por cateterismo intervencionista en la mayoría de las etapas del ser humano, lo que ha registrado mínimas complicaciones.

  18. [Cutaneous myiasis by Cochliomyia hominivorax (Coquerel) (Diptera Calliphoridae) in Hospital Universidad del Norte, Soledad, Atlántico].

    PubMed

    de la Ossa, Napoleón; Castro, Luis Eduardo; Visbal, Lila; Santos, Ana María; Díaz, Esther; Romero-Vivas, Claudia M E

    2009-03-01

    Human myiasis is the parasitism of human tissues by fly larvae. Diagnoses are based on clinical pattern of tissue damage and presence of insect stages. Herein, a case myiasis is described in a seven-year-old female child. She presented with fever associated with abscessed scalp lesions containing exposed larvae. Severe pediculosis was also observed. The patient was hospitalized and treated with clindamycin, gentamicin (for bacterial secondary infections) and ivermectin (treatment for lice) after which the patient showed clinical improvement and was discharged four days later. Since human myiasis can be caused by a number of different species, larvae were collected from the patient and identified as those of Cochliomyia hominivorax (Diptera: Calliphoridae). Because other cases of coinfestation of flies and lice are on record, health workers are to be alerted about the possible pediculosis-myasis risk.

  19. [Drugs having latex and therapeutic alternatives in hospital formulary].

    PubMed

    Damas Fuentes, Rosa María; Pérez León, Moisés; Piñero González, Marta; Sangil Monroy, Nayra; Molero Gómez, Rafael; Domínguez Lantigua, Pablo

    2015-01-01

    Objetivo: Analizar el contenido en látex de los medicamentos en la guía farmacoterapéutica y establecer alternativas en un hospital de tercer nivel. Método: Se seleccionaron los medicamentos susceptibles de contener látex en su material de acondicionamiento, se solicitó al laboratorio fabricante información y se buscaron posibles alternativas incluidas en guía farmacoterapéutica. Resultados: De las 618 especialidades seleccionadas se obtuvo información escrita del laboratorio para 605 (97.9%) y en ficha técnica para 8. De las 57 (9,2%) especialidades con riesgo en pacientes con alergia al látex se encontró una alternativa en guía para el 43,9%. Conclusiones: Conocer las especialidades con látex aumenta la seguridad en la prescripción, mientras que la disponibilidad de una tabla de equivalencias terapéuticas facilita la validación. Los datos publicados vienen a actualizar la información del contenido en látex de los medicamentos para pacientes y personal sanitario, generalmente escasa y variable.

  20. [Cultural adaptation and Argentine validation of the Northwick Park Neck Pain Questionnaire in the hospitals of the Autonomous City of Buenos Aires].

    PubMed

    Aguirre, Mariana V; Rodríguez, Matias G; Clarett, Martín; Iribarne, Juan I; Martínez, Marianela; Battistotti, Romina; López de Arcaute, Ana S; Adarves, Romina; Orsini, Esteban

    2013-01-01

    Objetivo: realizar la adaptación cultural y validación del Cuestionario Northwick Park (NPQ) en Argentina, determinando sus propiedades psicométricas, en pacientes con dolor cervical de origen mecánico derivados al Servicio de Kinesiología del Hospital D. F. Santojanni. Materiales y Métodos: Se solicitó la autorización del autor original del NPQ, luego se realizó la adaptación lingüística y prueba piloto. Las propiedades psicométricas incluyeron: confiabilidad test-retest (coeficiente de correlación intraclase, CCI), validez (coeficiente de correlación de Pearson NPQ-Escala Análoga Visual, EVA), consistencia interna (alfa de Cronbach) y sensibilidad al cambio (prueba T para pruebas pareadas NPQ-EVA). Se incluyeron consecutivamente 60 pacientes de septiembre de 2007 a febrero de 2009 con dolor cervical mecánico. Se midieron las variables porcentaje de discapacidad (NPQ) y dolor (EVA) al día del ingreso, a las 24 horas y al alta. Resultados: Veintiséis pacientes completaron el estudio, 4 fueron eliminados y 30 no completaron la 3° medición. Se obtuvo una buena confiabilidad test-retest (ICC 0.8979) y una alta consistencia interna (alfa de Cronbach 0.86). La validez mostró una buena correlación (r= 0,678). La sensibilidad al cambio fue buena (r=0.661). Conclusión: El NPQ es un instrumento válido, confiable y sensible para evaluar la discapacidad asociada al dolor cervical de origen mecánico en pacientes atendidos en el ámbito hospitalario de la Ciudad Autónoma de Buenos Aires.

  1. Comparison of del Nido cardioplegia and St. Thomas Hospital solution – two types of cardioplegia in adult cardiac surgery

    PubMed Central

    Mishra, Prashant; Jadhav, Ranjit B.; Khandekar, Jayant; Raut, Chaitanya; Ammannaya, Ganesh Kumar; Seth, Harsh S.; Singh, Jaskaran; Shah, Vaibhav

    2016-01-01

    Introduction St. Thomas’ cardioplegic solution No. 2 (ST), although most widely used in adult cardiac surgery, needs to be given at short intervals, causing additional myocardial injury. Aim To determine whether del Nido (DN) cardioplegia, with longer periods of arrest, provides equivalent myocardial protection as compared to ST. Material and methods The study population comprised 100 patients who underwent elective coronary artery bypass grafting (CABG) or double valve replacement (DVR) surgery between January 2015 and January 2016. The patients were divided into two groups based on the type of cardioplegia administered during surgery: 1) intermittent ST (ST, n = 50) and 2) DN cardioplegia (DN, n = 50). We compared the aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times, number of intra-operative DC shocks required, and postoperative changes in left ventricular ejection fraction (LVEF) in the two groups. Results The aortic cross clamp and bypass times were shorter with DN (110.15 ±36.84 vs. 133.56 ±35.66 and 158.60 ±39.92 vs. 179.81 ±42.36 min respectively, p < 0.05). Fewer cardioplegia doses were required in the DN group vs. the ST group (1.38 ±0.59 vs. 4.15 ±1.26; p = 0.001), while a single cardioplegia dose was given to 35 DN patients (70%) vs. 0 ST patients (p < 0.001). Postoperative LVEF was better preserved in the DN group. Conclusions The use of DN leads to shorter cross clamp and CPB times, reduces cardioplegia dosage, and provides potentially better myocardial protection in terms of LVEF preservation, with a safety profile comparable to ST cardioplegia. PMID:28096823

  2. [Clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño].

    PubMed

    Ormeño Julca, Alexis Jose; Alvarez Murillo, Carlos Melchor; Amoretti Alvino, Pedro Miguel; Florian Florian, Angel Aladino; Castro Johanson, Rosa Aurora; Celi Perez, Maria Danisa; Huamán Prado, Olga Rocío

    2017-01-01

    The hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHN) are distinct pulmonary vascular complications of portal hypertension (PHT) and are associated with increased morbidity and mortality. To describe the clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño. We included patients with HTP hospitalized from January 2012 to June 2013 and that during its evolution progressed with SHP or HTPP. For analysis, they were divided into a first group of patients with liver cirrhosis and a second group with extrahepatic portal vein obstruction. Of 22 patients with HPT 45.5% were male and the age range was between 1 month and 17 years. The etiology in the group of cirrhosis (n=14) was: autoimmune hepatitis (35.7%), cryptogenic cirrhosis (35.7%), inborn error of metabolism (14.3%), chronic viral hepatitis C (7.15%) virus and atresia extra-hepatic bile ducts (7.15%). Pulmonary vascular complications more frequently occurred in patients with liver cirrhosis (1 case of HPS and a case of PPHTN). They most often dyspnea, asthenia, edema, malnutrition, ascites, hypersplenism and gastrointestinal bleeding from esophageal varices was found. Also, they had elevated ALT values, alkaline phosphatase and serum albumin values decreased. In children with pulmonary hypertension, pulmonary vascular complications are rare. In the evaluation of these patients pulse oximetry should be included to detect hypoxemia and ubsequently a Doppler echocardiography and contrast echocardiography necessary. Dueto the finding of systolic pulmonary hypertension it is necessary to perform right heart catheterization.

  3. Kawasaki disease: a rare pediatric pathology in Mexico. Twenty cases report from the Hospital Infantil del Estado de Sonora.

    PubMed

    Sotelo, Norberto; González, Luis Antonio

    2007-01-01

    Kawasaki disease (KD) is an etiological illness that is relatively unknown and scarcely identified in Mexico; it affects children mainly aged 1-4 years, evolves with fever, vasculitis in diverse organs, and in the heart the disease mainly affects the coronary arteries. Our aim was to inform the clinical findings and evolution of 20 patients diagnosed with KD. We reviewed the patient clinical files retrospectively and descriptively to obtain information with regard to age, sex, clinical signs, laboratory and consultory results, echocardiography findings, complications, evolution during hospitalization, followup, and out-patient ambulatory consultations. Eighteen patients were male, two were female, six developed coronary damage, two aortic mitral-valve insufficiency, one pericardial shedding, and one, myocarditis. All patients received gamma globulin treatment with aspirin, and 16 were controlled during 6-8 months after the acute medical profile. The opportune clinical diagnostic it is fundamental to establish an early treatment with gammmaglobuline to avoid injuries in the arterial coronary level. This injury may cause eventualy ischemia or myocardial infarct

  4. [Clinico-radiological profile of acute disseminated encephalomyelitis in the childhood population. A retrospective analysis of a series of 20 patients in a tertiary hospital].

    PubMed

    Tomás-Vila, Miguel; Menor, Francisco; Otero-Reigada, M Carmen; Pérez-Tamarit, Amparo; Téllez de Meneses, Montserrat; Pitarch-Castellanos, Inmaculada

    2014-01-01

    Introduccion. La encefalomielitis aguda diseminada (EAD) es un trastorno inflamatorio del sistema nervioso central mediado inmunologicamente y de patogenia desconocida. Puede presentarse en cualquier edad, pero es mucho mas frecuente en niños. La EAD no tiene marcador biologico especifico y el diagnostico se basa en hallazgos clinicos y neurorradiologicos. Objetivo. Mejorar el conocimiento del perfil clinicorradiologico de esta enfermedad. Pacientes y metodos. Estudio retrospectivo con inclusion de pacientes menores de 14 años ingresados en un hospital terciario en los ultimos 15 años con el diagnostico de EAD. Se revisaron antecedentes, signos clinicos de presentacion, datos analiticos en sangre/liquido cefalorraquideo y la semiologia radiologica. En 16 casos se realizo un seguimiento medio de 25 meses. Resultados. Se revisaron 20 pacientes, un 70% niños, con una edad media de 4,4 años. El 40% tuvo un episodio febril previo. El 85% presento fiebre o vomitos, y el 70%, afectacion del estado de consciencia. Predominaron los deficits motores (45%), las convulsiones (35%) y la afectacion de pares craneales (30%). Tres niños presentaron una evolucion recidivante, y otros tres, secuelas motoras. Los estudios de resonancia magnetica mostraron lesiones hiperintensas en secuencias T2, con patron de realce escaso o nulo, que predominaron en los talamos (70%), la medula (67%) y la sustancia blanca subcortical (50%). En dos pacientes se diagnostico EAD hemorragica. Conclusiones. La EAD representa una entidad con importante afectacion general y repercusion neurologica, que muestra un potencial secuelar considerable. Los datos clinicoanaliticos y la resonancia magnetica cerebral y medular son relevantes para el diagnostico inicial y seguimiento de pacientes con EAD.

  5. [Incurable disease in Spain during the 19th century. The Hospital para Hombres Incurables Nuestra Señora del Carmen].

    PubMed

    Zaragoza, Juan Manuel

    2012-01-01

    This paper examines the State's assumption of medical care for patients with "permanent needs" in 19th century Spain. These patients were the incurably ill, the chronically ill and the elderly. This process is contextualized within the liberal reforms of the Spanish healthcare system in the reign of Isabel 11 (1833-1868). The goal of these reforms was the creation and consolidation of a national health system that would gradually replace the religious health charities. Healthcare reform became necessary due to the increase in migration that started in the 1830's and intensified in the 1850's. Traditional care networks formed by the family, local community and religious charities were no longer available to those who had left their village or town. In addition, many religious charities were bankrupted by the seizure of their properties in a programme of confiscation. Similar healthcare reform processes were taking place in the United Kingdom, France and Germany, among other European countries, and involved significant changes in the lives of patients, who became strictly controlled and medicalised. My aim was to identify changes in the patients' experience of illness through a case study of the living conditions of inmates at the Nuestra Señora del Carmen Hospital for Incurable Men, based in Madrid from 1852 to 1949. This was one of the institutions devoted to caring for patients with "permanent needs" and was under the direct control of the General State Administration.

  6. Experience of Preimplantation Genetic Diagnosis for Hemophilia at the University Hospital Virgen Del Rocío in Spain: Technical and Clinical Overview

    PubMed Central

    Fernández, Raquel M.; Peciña, Ana; Sánchez, Beatriz; Lozano-Arana, Maria Dolores; García-Lozano, Juan Carlos; Pérez-Garrido, Rosario; Núñez, Ramiro; Antiñolo, Guillermo

    2015-01-01

    Hemophilia A and B are the most common hereditary hemorrhagic disorders, with an X-linked mode of inheritance. Reproductive options for the families affected with hemophilia, aiming at the prevention of the birth of children with severe coagulation disorders, include preimplantation genetic diagnosis (PGD). Here we present the results of our PGD Program applied to hemophilia, at the Department of Genetics, Reproduction and Fetal Medicine of the University Hospital Virgen del Rocío in Seville. A total of 34 couples have been included in our program since 2005 (30 for hemophilia A and 4 for hemophilia B). Overall, 60 cycles were performed, providing a total of 508 embryos. The overall percentage of transfers per cycle was 81.7% and the live birth rate per cycle ranged from 10.3 to 24.1% depending on the methodological approach applied. Although PGD for hemophilia can be focused on gender selection of female embryos, our results demonstrate that methodological approaches that allow the diagnosis of the hemophilia status of every embryo have notorious advantages. Our PGD Program resulted in the birth of 12 healthy babies for 10 out of the 34 couples (29.4%), constituting a relevant achievement for the Spanish Public Health System within the field of haematological disorders. PMID:26258137

  7. [Complete process of implantation of a nutritional risk screening system in the University Hospital La Paz, Madrid].

    PubMed

    Gómez-Candela, Carmen; Serrano Labajos, Ruth; García-Vazquez, Natalia; Valero Pérez, Marlhyn; Morato Martínez, Marina; Santurino Fontecha, Cristina; González Madroño, Ana; Palma-Milla, Samara

    2013-11-01

    La malnutrición asociada a la enfermedad (MAE) está presente en un porcentaje muy elevado de los pacientes que ingresan en los hospitales y su repercusión es diversa y de mucha trascendencia. Objetivo. Desde la Unidad de Nutrición del Hospital Universitario la Paz, en colaboración con todos los miembros de la Comisión de Nutrición, nos planteamos implantar algún método de cribado en nuestro centro, que permitiese abarcar al mayor número posible de pacientes. Resultados. Debido al gran tamaño de nuestro centro, con cerca de 1500 camas, unido a una escasez de recursos humanos en nuestra unidad, optamos por utilizar el sistema de cribado CONUT (Control Nutricional) 100 % automático y basado en parámetros analíticos, muy fácil de manejar, de bajo coste y cuya validez está confirmada, adaptándolo a nuestras necesidades. El método recoge información de las bases de datos del servicio de Admisión (filiación, edad, fecha) y del Laboratorio (albúmina, colesterol, linfocitos totales) y genera, en el informe de resultados de los análisis clínicos, la información sobre la alerta de riesgo nutricional de cada paciente, así como las recomendaciones nutricionales a seguir en función del riesgo detectado en cada caso. Para llegar su implantación se llevaron a cabo diferentes evaluaciones que nos permitieron conocer previamente la carga extra de trabajo que podría generar su implantación y nuestra capacidad para asumirlas, así como numerosas actividades formativas encaminadas a que los médicos y profesionales sanitarios del hospital asumieran cada vez más responsabilidades en el proceso del tratamiento nutricional de sus pacientes. Este sistema de cribado funciona desde Junio del año 2010 y detecta riesgo de desnutrición en el 32 % de los pacientes evaluados. En general, sólo en los casos en los que la alerta corresponde a una situación de Alto riesgo nutricional, hecho que se da aproximadamente en el 10 % del total, se requirió la intervenci

  8. [Medicines reconciliation at hospital admission into an electronic prescribing program].

    PubMed

    Villamayor-Blanco, Lucía; Herrero-Poch, Leticia; De-Miguel-Bouzas, Jose Carlos; Freire Vazquez, M Carmen

    2016-09-01

    Objetivo: Describir y analizar los resultados obtenidos durante un año con un nuevo procedimiento de conciliación de la medicación al ingreso hospitalario basado en un programa de prescripción electrónica asistida. Método: Estudio observacional, prospectivo, no aleatorizado y no controlado de 12 meses de duración, en el que se incluyeron todos los pacientes que ingresaron, durante ese año, en un hospital general concertado de 450 camas. Para la conciliación de la medicación se utilizó el programa de prescripción electrónica como medio para el abordaje multidisciplinar (enfermería, médicos y farmacéuticos). La conciliación se realizó al ingreso hospitalario y se midieron los errores de conciliación. Resultados: Se incluyeron 23.701 pacientes, conciliándose 53.920 medicamentos, de los cuales no tenían discrepancias 48.744 (90,4%) y 5.176 (9,6%) presentaban discrepancias: 4.731 (8,8 % de los fármacos) justificadas y 445 (0,8% de los fármacos) no justificadas. La mayor parte de las discrepancias no justificadas, (n = 310; 69,7%) se debieron a errores en el registro de la medicación domiciliaria al ingreso: medicación no registrada o errores de medicamentos, dosis, frecuencia o vía de administración, omisiones de prescripción, 23,6% (n = 105) y duplicidades, 6,7% (n = 30). En ningún caso el error de conciliación llegó al paciente. Conclusiones: Mediante las ayudas informáticas incluidas en el programa de prescripción electrónica asistida y el abordaje multidisciplinar del proceso de conciliación se consigue realizar la conciliación de la medicación al ingreso en el 98% de los pacientes en el momento del ingreso, evidenciando errores de conciliación solo en el 1,3% de los pacientes.

  9. [Patient satisfaction when seen in the Emergency room of San Juan de Dios del Aljarafe Hospital (Spain)].

    PubMed

    Ruiz Romero, V; Fajardo Molina, J; García-Garmendia, J L; Cruz Villalón, F; Rodríguez Ortiz, R; Varela Ruiz, F J

    2011-01-01

    To find out the level of satisfaction of patients seen in the Emergency room of the of San Juan de Dios Hospital, Aljarafe; to identify the determining factors and to define the areas that need improvement and reinforcement in order to improve the quality of care. A telephone survey was carried out between July and September, 2008, containing 44 questions, 2 with a closed response, 3 with yes/no answers and the remaining questions scored based on a Likert type scale of 1 (most negative answer) to 5 (most positive answer). Observations were also recorded. Overall satisfaction was 84.7%: 82% would recommend this Emergency room, and 59.6% considered it better than others. The aspects to be emphasised are: respect (97.6%), cleanliness (97.1%) and intimacy (94.6%). Following these were: the doctor's disposition to listen (93.1%); the preparation of the professionals (from 92.3% for the administration professionals to 88.6% for auxiliary nurses); kindness (from 91.8% for doctors to 89.9% for nurses); and the ease of getting orientated (90%). The information given was evaluated positively by 70.3%, and 87% acknowledged understanding this information. However, 52.4% of patients were satisfied with the information given during triage related to the stay in the emergency room, and, 22.3% as regards the probable waiting period. The satisfaction with the waiting between triage and first medical consultation was higher in the one-two-triage patients and was lower in the four-triage ones; in the waiting between first medical consultation and the discharge, the one-triage patients were more satisfied than the rest. Nevertheless, there were no statistically significant differences with satisfaction with the waiting until the triage. The percentages of satisfaction was greater than 80% in 23 of the 34 items, with certain aspects having a satisfaction rate over 90%: respect, cleanliness, the doctor's predisposition to listen, qualification and kindness of the personnel. On the

  10. [MALNUTRITION IN THE ELDERLY PATIENT TO HOSPITAL ADMISSION, AN OLD PROBLEM UNSOLVED].

    PubMed

    Rentero Redondo, Lorena; Iniesta Navalón, Carles; Gascón Cánovas, Juan Jose; Tomás Jimenez, Cristina; Sánchez Álvarez, Carmen

    2015-11-01

    Objetivo: determinar la prevalencia de desnutrición en pacientes con edad igual o superior a 65 años al ingreso hospitalario y los factores asociados a su presencia. Analizar el exceso de estancia hospitalaria (EEH), el impacto económico y la tasa de reingresos prematuros asociados a la desnutrición hospitalaria en pacientes de edad avanzada. Material y métodos: estudio retrospectivo realizado en el Hospital Universitario Reina Sofía. Se incluyeron todos los pacientes con edad igual o mayor a 65 años que ingresaron en Medicina Interna durante 2011. Se calculó el tamaño muestral teniendo en cuenta los ingresos del año anterior, y considerando una prevalencia de desnutrición del 50% con un IC 95% y un error del 5%. Para definir el grado de desnutrición se empleó la herramienta Control Nutricional (CONUT), que establece una puntuación basada en la determinación de albúmina, colesterol total y linfocitos. Para determinar los factores asociados a la presencia de desnutrición moderada-grave se realizó un análisis de regresión logística multivariante. Para cada paciente se calculó el EEH, los reingresos prematuros y el coste asociado al EEH. Para todos los análisis se utilizó un dintel de significación estadística de 0,05 y se realizaron con el paquete estadístico SPSS v15.0. Resultados: se incluyeron 310 pacientes, de los cuales el 54,2% fueron mujeres, la edad media fue de 80,1 años (DE: 6,8), con un rango entre 65 y 95 años. En cuanto al diagnóstico al ingreso, el 27,4% correspondían a enfermedades del aparato respiratorio, 22,6% del circulatorio y 11,6% del digestivo. La mediana del Índice de Charlson fue de 2,0, encontrando que el 36,8% de los pacientes presentaban una comorbilidad alta. Las patologías crónicas más prevalentes fueron la diabetes mellitus (44,2%), la enfermedad renal crónica (25,2%) y la demencia (10,6). En relación con el CONUT, el 75,8% de los pacientes presentaban criterios de desnutrición: el 42,6% leve, el 28

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

    PubMed

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

    2017-04-01

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

  12. Criptococosis cutánea primaria en paciente inmunocompetente.

    PubMed

    Vázquez-Osorio, Igor; García-Rodiño, Sara; Rodríguez-Rodríguez, Marta; Labandeira, Javier; Suárez-Peñaranda, José Manuel; Sánchez-Aguilar, MDolores; Vázquez-Veiga, Hugo

    2016-05-15

    La criptococosis cutánea es una micosis propia de pacientes inmunodeprimidos, sobre todo aquellos con infección por el virusde la inmunodeficiencia humana (VIH). Sin embargo, existen casos infrecuentes de criptococosis cutánea en pacientes inmunocompetentes, que suelen simular otras dermatosis, lo que retrasa su diagnóstico y tratamiento. Presentamos el caso de un varón pluripatológico de 79 años, con úlceras dolorosas en dorso de mano derecha que no respondían a tratamientos tópicos. A través del estudio histopatológico y micológico se alcanzó el diagnóstico de criptococosis cutánea primaria, lográndose la remisión de las lesiones tras 6 meses de tratamiento con fluconazol.

  13. [Prevalence of nosocomial infections in a secondary care hospital in Mexico].

    PubMed

    Castañeda-Martínez, Fernando Cain; Valdespino-Padilla, María Guadalupe

    2015-01-01

    Introducción: las infecciones nosocomiales son un problema creciente, de gran repercusión social y económica que afecta a las instituciones hospitalarias. El objetivo de este trabajo fue determinar la prevalencia de infecciones nosocomiales en hospital de segundo nivel. Métodos: estudio transversal, observacional, se calculó un tamaño de muestra para una proporción, se incluyeron pacientes hospitalizados con más de 48 horas de internamiento; se obtiene estadística descriptiva y prueba de hipótesis utilizando prueba exacta de Fisher, se utilizó el software SPSS versión 18. Resultados: se encontró una prevalencia de 9.52 %, con una edad media de 46.59 años; 64.3 % de los pacientes fueron del sexo femenino, 35.7 % masculinos, la prevalencia por servicio fue de 16.27 % en Medicina Interna, y 12.5 % en Cirugía. Conclusiones: 10 de cada 100 pacientes hospitalizados presentan infección nosocomial, comportamiento muy similar a lo reportado en la literatura médica.

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

    PubMed Central

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

    2004-01-01

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

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

    PubMed

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

    2004-08-13

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

  16. [Effectiveness and adequacy of tolvaptan prescription in hospitalized patients].

    PubMed

    Edo Solsona, Ma D; Ruiz Ramos, J; Montero Hernández, M; Font Noguera, I; Poveda Andrés, J L

    2013-01-01

    Objetivo: Analizar la efectividad del uso de tolvaptán y la adecuación de su prescripción en un hospital de tercer nivel. Método: Estudio observacional prospectivo de las prescripciones de tolvaptán desde octubre de 2010 hasta diciembre de 2011. Resultados: Se incluyeron 30 pacientes (60,0% varones), 50,0% diagnosticados de insuficiencia cardíaca y 30,0% de SIADH. Tolvaptán permitió alcanzar niveles de sodio superiores a 135 mEq/L en el 53,3% de los pacientes que partían con una media de 125,3±7,3 mEq/L. La mediana de días de tratamiento fue de 5,0 (rango intercuartílico = 3-45). Se observó un incremento significativo de los niveles de ácido úrico asociado al tratamiento con tolvaptán. La prescripción se adecuó a lo establecido en la GFT en el 63,3% de los casos. Conclusiones: Tolvaptán incrementa un 7,5 mEq/L los niveles de sodio tanto en hiponatremia secundaria al SIADH como en insuficiencia cardiaca.

  17. [Prevalence of sensitization to inhalant allergens in the immunology department from Hospital de Especialidades Pediátricas María, Honduras, 2016].

    PubMed

    Gonzales-González, Victoria Alejandra; Díaz-Flores, Adolfo Martín; Fernández-Zelaya, Karla Zobeyda; Rivera-Reyes, María Félix

    2017-01-01

    Antecedentes: Las enfermedades alérgicas constituyen un problema de salud pública; se estima que entre 30 y 40 % de la población mundial se encuentra afectada por alguna. Conocer la prevalencia de sensibilización a alérgenos permite ofrecer diagnósticos y tratamientos adecuados. En Honduras no se cuenta con estudios en pacientes pediátricos. Objetivos: El objetivo de esta investigación fue identificar el tipo de sensibilización más frecuente en los niños y su correlación con las enfermedades alérgicas más frecuentes en los pacientes en inmunoterapia del Hospital María de Especialidades Pediátricas. Métodos: Estudio retrospectivo transversal descriptivo en el cual se revisaron los expedientes y base de datos de los pacientes en inmunoterapia alérgica del Hospital de Especialidades Pediátricas María entre enero de 2015 y junio de 2016. Resultados: Se evaluaron 215 niños en inmunoterapia, las edades oscilaron entre 3 y 18 años, con una media de 10.8 años. Se identificó que 73.02 % tenía pruebas epicutáneas positivas a aeroalérgenos. Los aeroalérgenos más frecuentes fueron Dermatophagoides farinae y Dermatophagoides psterossynium mix (96.74 %), cucaracha americana (37.21 %) y Aspergillus fumigatus y Homdonderum cladosporioides (16.28 %). Conclusiones: Los ácaros domésticos y la cucaracha americana constituyeron la mayor causa de sensibilización en pacientes en inmunoterapia.

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

    PubMed

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

    2013-01-01

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

  19. [Hospital efficiency measured by bed space use in a secondary care hospital].

    PubMed

    Moreno-Martínez, Roberto; Martínez-Cruz, Rocío Alejandra

    2015-01-01

    Introducción: reconociendo que los recursos disponibles en las unidades médicas forman parte de los factores que condicionan la atención médica de calidad, resulta de importancia medir su aprovechamiento. El objetivo de este estudio fue determinar la eficiencia hospitalaria a través del recurso cama en un hospital de segundo nivel. Métodos: del Sistema de Información Médico Operativo, se examinaron los cuadros de salida mensuales de julio 2012 a junio 2013 que incluyen variables como egresos, días paciente, porcentaje de ocupación y promedio de días de estancia por especialidad y división, se obtuvieron los resultados por cada indicador estratégico y se relacionaron dichos resultados proponiendo supuestos para valorar la eficiencia hospitalaria. Resultados: de manera global, se identifica una óptima eficiencia hospitalaria, sin embargo el análisis por servicio y división señala una eficiencia deteriorada y baja. El resultado global de los cinco indicadores aplicados ignora la saturación de los servicios al interior de la unidad médica. Sin embargo, el análisis en conjunto revela dicha problemática, demostrando la ventaja de evaluar un mismo escenario desde diferentes perspectivas. Conclusiones: incluir indicadores que midan la eficiencia hospitalaria partiendo del recurso cama, permite considerar deficiencias no identificadas, con lo que se fortalece la toma de decisiones en salud.

  20. Analysis of the medication reconciliation process conducted at hospital admission.

    PubMed

    Contreras Rey, María Beatriz; Arco Prados, Yolanda; Sánchez Gómez, Ernesto

    2016-06-01

    fueron y en 93 (29,8%) la aceptación no procedía por un cambio en la situación del paciente. Las mayores oportunidades de mejora se identificaron en los servicios de Digestivo, Medicina Interna y Cirugía General y en los grupos terapéuticos: sangre y órganos hematopoyéticos, sistema cardiovascular y sistema nervioso. Conclusiones: En nuestro hospital solo una tercera parte de las intervenciones fueron aceptadas y reconocidas como errores de conciliación. No obstante, la conciliación de la medicación al ingreso realizada por un farmacéutico mostró ser útil en la identificación y prevención de errores de medicación. Un mejor entendimiento de los casos en los que las intervenciones no fueron aceptadas podría mejorar el resultado en el futuro.

  1. Report of the procedure of voluntary interruption of pregnancy at a university hospital in Uruguay.

    PubMed

    Bentancor, Ana; Hernández, Ana Laura; Godoy, Yamile; Dapueto, Juan J

    2016-07-04

    datos sociodemográficos de las pacientes concordaron con los reportados a nivel nacional: 81,0% de las pacientes que consultaron era mayores de 19 años; 6,2% decidieron continuar con el embarazo; solo 70,0% concurrieron al control posterior y recibieron asesoramiento sobre anticoncepción. Al año de su implementación, en Uruguay, podemos evaluar la experiencia como positiva desde el punto de vista de la salud de las mujeres. Nuestra experiencia como equipo de salud mental en el Hospital de Clínicas, inserto dentro del equipo multidisciplinario de interrupción voluntaria del embarazo, se encuentra en pleno proceso de evaluación y reformulación de prácticas.

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

    PubMed

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

    2012-01-01

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

  3. [Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social].

    PubMed

    Lovato-Salas, F; Luna-Pizarro, D; Oliva-Ramírez, S A; Flores-Lujano, J; Núñez-Enríquez, J C

    2015-01-01

    Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

  4. [Description of the follow-up protocol for idiopathic intracranial hypertension in the neuro-ophthalmological unit of a tertiary hospital].

    PubMed

    González-Hernández, Ayoze; Tandón-Cárdenes, Luis; Cabrera-Naranjo, Fernando; Guzmán-Fernández, María; Fabre-Pi, Óscar; López-Veloso, Carolina

    2013-05-16

    Objetivo. Revisar los resultados de la implantacion de un protocolo de seguimiento de pacientes con hipertension intracraneal idiopatica (HICI) en una unidad de neurooftalmologia (UNO). Pacientes y metodos. Se realizo una revision bibliografica para determinar las exploraciones necesarias que debian incluirse en el protocolo de seguimiento, asi como la frecuencia optima de las visitas y la duracion adecuada del seguimiento. Posteriormente, se revisaron de forma prospectiva los pacientes incluidos desde la creacion de la UNO y se compararon con los pacientes incluidos en el registro de HICI previo a la creacion de la UNO. Resultados. Desde la implantacion del protocolo, en el 100% de los pacientes se ha valorado la agudeza visual y la campimetria visual a los tres meses, a los seis meses y al ano del diagnostico. Ademas, en un 91%, 72,8% y 100% de los pacientes con HICI se realizo una campimetria visual a los tres meses, a los seis meses y al ano del diagnostico, respectivamente. Antes de la implantacion de nuestro protocolo de seguimiento, se habian realizado 190, lo que corresponde a unas tres por paciente. El numero de punciones lumbares realizadas desde la creacion de la UNO es de 11. Conclusiones. La creacion de una UNO multidisciplinar permite optimizar los recursos y mejorar la asistencia a los pacientes con HICI. Esto deberia redundar en una mejoria del pronostico funcional de estos pacientes.

  5. [Septic abortion in the Hospital de Ginecología y Obstetricia no. 3 del Instituto Mexicana de Seguridad Social. Late and early morbidity].

    PubMed

    López Ortiz, E; Sandoval Sevilla, S; Arteaga, V M; Rosas Arceo, J; Ortíz Arroyo, R

    1974-02-01

    268 cases of septic abortion which occurred between 1964-72 in a large metropolitan hospital in Mexico were analyzed retrospecively. There cases represented 0.88% of all cases of abortion during the same time. Most patients were between 21-30, and 48% with parity 2-5; 63% were at their first abortion; only 16 patients declared to have attempted abortion, and most cases were first trimester abortion. Pre- and postoperative procedures and vital signs were carefully taken, and time elapsed from medical treatment to surgery was 4-12 hours. There were 237 curettages, and 28 hysterectomies. Complication from surgery were 4.1%; there were 19 deaths, i.e. 7.5% of patients, of which 10 only 24 hours after hospitalization. Protocol of treatment of septic abortion is discussed, and surgical treatment highly recommended.

  6. Norovirus - hospital

    MedlinePlus

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

  7. Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders.

    PubMed

    Brock, Felipe; Bettinelli, Luiz Antonio; Dobner, Taise; Stobbe, Júlio César; Pomatti, Gabriela; Telles, Cristina Trevizan

    2016-08-08

    apresentavam hipoalbuminemia. a prevalência de hipoalbuminemia mostrou-se elevada, acometendo aproximadamente nove entre dez idosos, sendo que o estado nutricional, da mesma maneira que o tempo de internação , está relacionado à diminuição dos níveis de albumina sérica. Assim, sugere-se monitorar os níveis de albuminemia para avaliar o risco que o paciente tem de desenvolver desnutrição e demais complicações durante a internação hospitalar. estimar la prevalencia de hipoalbuminemia en ancianos hospitalizados, considerando las variables sociodemográficas, estado nutricional y tiempo de internación. estudio transversal, en 200 pacientes internados en hospital de gran porte del sur de Brasil, durante un período de tres meses. Fueron realizadas evaluaciones, análisis de exámenes de laboratorio y se realizó una entrevista usando un cuestionario. el promedio de albuminemia fue 2,9 ± 0,5g/dL. El diagnóstico de hipoalbuminemia, fue encontrado en 173 sujetos (87%), y no revelado en 27 (13%), que presentaron albuminemia normal (p=0,000). Se constató que después de seis días de internación la prevalencia de niveles bajos aumentó significativamente para 90% (p=0,002), con promedio de 2,7 ± 0,5g/dL. Utilizando la Mini Evaluación Nutricional, se observó que 41 pacientes estaban desnutridos, y que de estos, 40 presentaban hipoalbuminemia. la prevalencia de hipoalbuminemia se mostró elevada, afectando aproximadamente nueve entre diez ancianos, siendo que el estado nutricional, de la misma manera que el tiempo de internación, está relacionado a la disminución de los niveles de albúmina sérica. Así, se sugiere monitorizar los niveles de albuminemia para evaluar el riesgo que el paciente tiene de desarrollar desnutrición y demás complicaciones durante la internación hospitalaria.

  8. [Neurosyphilis in the 21st century: a descriptive study in a tertiary hospital in Madrid].

    PubMed

    Villar-Quiles, R N; Porta-Etessam, J

    2016-11-01

    Introduccion. La neurosifilis puede ocurrir en cualquier momento tras la infeccion por Treponema pallidum y su incidencia esta aumentando en los ultimos años. El patron epidemiologico y clinico ha experimentado un cambio sustancial en la era postantibiotica. Objetivo. Describir y analizar la poblacion de pacientes con diagnostico de neurosifilis de un hospital terciario de Madrid desde enero de 2008 a mayo 2015. Pacientes y metodos. Se analizaron retrospectivamente datos demograficos, clinicos, pruebas complementarias –serologia, liquido cefalorraquideo (LCR), neuroimagen– y evolucion de 28 pacientes diagnosticados entre 2008 y 2015. Resultados. La mayoria fueron varones (89,3%), españoles (60,7%), con una edad media de 53 ± 16,4 años. Lo mas frecuente fueron las formas asintomaticas (39,3%), seguidas de sifilis ocular (21%), formas no clasicas (14,3%), deterioro cognitivo y alteraciones neuropsiquiatricas (11%). El 50% presentaba infeccion concomitante por virus de la inmunodeficiencia humana, la mayoria asintomaticos, con una correlacion significativa entre linfocitos T CD4+ y neurosifilis asintomatica. Unicamente el 50% presento VDRL+ en el LCR, basandose el diagnostico en la clinica, la serologia y las alteraciones en el LCR (citobioquimicas o serologicas). La neuroimagen fue inespecifica en la mayoria de los casos. Las formas tempranas y las formas oculares se asociaron a una mejor evolucion clinica. Conclusiones. Respecto a la era preantibiotica, se observa un descenso muy importante en las formas tardias, asi como la aparicion de formas no clasicas que pueden simular otras entidades, como encefalitis viricas. El diagnostico es complejo y se basa en la clinica, la serologia y el estudio del LCR, a menudo con una interpretacion compleja, por lo que la sospecha clinica es fundamental en el diagnostico.

  9. [Tumors of the heart. 16 years experience in Hospital de Cardiología, del Centro Médico Nacional Siglo XXI in Mexico City].

    PubMed

    Alfaro-Gómez, Felipe; Careaga-Reyna, Guillermo; Valero-Elizondo, Guillermo; Argüero-Sánchez, Rubén

    2003-01-01

    We present incidence of primary cardiac tumors diagnosed from 1987 at the Hospital de Cardiología, Centro Médico Nacional Siglo XXI, in Mexico City. We described primary cardiac tumors based on histopathologic diagnosis, frequency, localization, implantation, implantation site, and recurrence. A total of 51 patient files were selected retrospectively. Patients underwent cardiothoracic surgery with primary cardiac tumor established by clinical and echocardiographic parameters with histopathologic corroboration between 1987 and 2002. Statistical analysis of obtained results show frequency, central tendency and standard deviation. Primary cardiac tumors were benign in 84% and malignant in 16%. Among benign tumors, myxoma was present in 74%, (38 cases) followed by papillary fibroelastoma in 6% (three cases); finally, there were two cases (4%) of fibroma. Malignant tumors belonged to two hemangioendothelioma cases (4%) and there were 6 cases of sarcoma (12%). Main affected gender was female in 61%. All cases were taken to surgical resection. There was recurrence four times (8%) belonging to three myxomas and one sarcoma. Average presentation age was 43 +/- 17 years. Cardiac primary tumors represent 0.16% of surgeries taking place at our service. Concordance was found with previous studies regarding frequency, gender, age, localization, and implant site of cardiac primary tumors with greater recurrence in our series.

  10. [Multiorgan transplantation program at the Hospital de Especialidades 71, Unidad Médica de Alta Especialidad 134, Instituto Mexicano del Seguro Social in Torreon].

    PubMed

    Juárez-de-la-Cruz, Federico Javier; Barrios-Reyes, Carmen Yolanda; Cano-López-de-nava, Laura; Adalid-Sainz, Carmen

    2011-09-01

    This is the experience in a program of multiorgan transplant at the Hospital de Especialidades 71 in Torreon, Coahuila. It is a historical overview of the beginning and development of the transplant program. Describes the logistics of the study of patients for transplantation and the test to be carried out in the laboratory of histocompatibility. We analyzed the records of the patients were transplanted in the period from January 1987 until June 2011. We found 2538 in total, of which 1940 were renal (76.4%). The 53% were male and 47% female. Average age of 37 +/- 15 years. The 82% was adult population and 18% pediatric. The most frequent cause of CRF was the chronic glomerulonephritis and 15% of the patients are diabetic. 73.5% were living donor and 26.5% were deceased donor. 7% of recipients of living donor have domino transplants. The incidence of acute rejection was 7.5%. 15% of the patients had infections and 60% was urinary. The immunosuppressive scheme most widely used is tacrolimus + mycophenolate mofetil + prednisone. The overall survival of the patient was 100, 90 and 87% to the first, third and fifth year after the transplant. The overall survival of the graft was 98, 87 and 83% in the first, third and fifth years post-transplant. It has been developed a multiple organ transplant program in Torreon that currently is one of the most important in Mexico with similar results to those obtained at the international level.

  11. [Hospitals and surgeons: Madrid 1940].

    PubMed

    de Quevedo, Francisco Vázquez

    2007-01-01

    The history of the hospitals and general surgeons that best represent the centres in Madrid are here in reviewed, comprising the period between 1940 and the closure of the Hospital Clinico (1957) as well as the Hospital General (General Hospital) (1967), both in Atocha. Other hospitals which are reviewed and highlighted are: the H. de la Princesa (the Princess Hospital), the H. del Nifio Jesus (Hospital of the Child Jesus), the H. Militar (Military Hospital) and the Cruz Roja (Red Cross). Data is provided on the permanent surgeons in the following centres: H. General: J. Goyanes, J. Die, J. de la Villa, T. Rodriguez, E. Diaz, G. Bueno e H. Huerta; H. Clinico: L. de la Peña, L. Cardenal, L. Olivares, R. Argüelles, J. Estella y M. F. Zumel; H. Militar: M. G. Ulla, M. Bastos, M. G. Durán, J. S. Galindo, y A. G. Durán; Hospital de la Cruz Roja: V. M. Noguera, L. Serrada, F. Luque y L. L. Durán; H. de la Princesa: P. Cifuentes, P. G. Duarte, L. Estella y R. Aiguabella; H. del Niño Jesús: J. Garrido Lestache; H. Clinico, last time, Atocha: F. M. Lagos, R. Vara y A. de la Fuente.

  12. [Double-balloon enteroscopy: experience in the Hospital de Especialidades del Centro Médico Nacional Siglo XXI IMSS, Mexico City].

    PubMed

    Blancas Valencia, Juan Manuel; Paz Flores, Víctor Manuel; Yokota, Alejo Miyamoto; Huerta Fosado, Blanca Rosa; Meneses, Luis Fernando; Piccini Larco, Julio Roberto; Mejía Cuan, Luis Alvaro

    2005-01-01

    The methods used for the study of the small bowel are not ideal. Double-balloon enteroscopy is a new alternative with therapeutic potential. Evaluate the utility, efficacy and safety of double-balloon enteroscopy in Mexico. Adult patients seen in the Hospital de Especialidades Centro Médico Nacional Siglo XXI, Mexico City who were being studied for: chronic diarrhea, obscure gastrointestinal hemorrhage, weight-loss and chronic anemia were included in the study. Anterograde (oral) and retrograde (anal) approaches were used and study time, findings and complications were evaluated. Thirty-one enteroscopies were performed, 15 were anterograde, 8 retrograde and 8 were performed via both routes, in 23 patients studied between February and October, 2004; 10 of them were women and 13 men with ages ranging from 25 to 80 years. Fourteen patients were sedated and 9 patients were anesthetized. Study time varied form 55 to 90 minutes. With the anterograde route the ileum was reached in 56.6% of cases, 39.1% the jejunum and only in one patient (4.3%) the whole intestine was explored. With the retrograde route in 62.5% of cases the jejunum was explored and 37.5% the ileum. Four patients with obscure gastrointestinal bleeding and 1 patient with chronic anemia had vascular ecstasies, and in 40% of patients there was no identifiable cause. In 2 patients with intestinal stenosis biopsies revealed intestinal lymphoma in one and ischemic injury in another one. The adverse effects were mild and transitoru. Double-balloon enteroscopy is a safe diagnostic and therapeutic method that is useful in cases of obscure hemorrhage, chronic anemia; small bowel pathology was found in 64.7% of cases.

  13. Diabetes mellitus y atrofia óptica: estudio del síndrome de Wolfram.

    PubMed

    Rivas-Gómez, Bernardette; Reza-Albarrán, Alfredo Adolfo

    2017-01-01

    El síndrome de Wolfram (SW), también conocido por el acrónimo DIDMOAD, es una enfermedad hereditaria rara y progresiva, de transmisión autosómica recesiva, cuyos criterios diagnósticos mínimos son diabetes mellitus y atrofia óptica antes de los 15 años de edad. Describir la presentación clínica, bioquímica y molecular del SW en un hospital de tercer nivel en México. Se revisaron los expedientes de pacientes que cumplían con criterios diagnósticos clínicos mínimos de SW atendidos entre enero de 1987 y mayo de 2015 en un hospital de tercer nivel en -México. Cinco pacientes cumplieron con los criterios de inclusión (tres hombres y dos mujeres). La diabetes mellitus fue la primera manifestación del síndrome en todos ellos, con una media de edad al diagnóstico de 5.8 ± 2.71 años, mientras que el diagnóstico del SW se estableció en promedio a los 15.8 ± 8.37 años. Todos los pacientes tenían atrofia óptica y dos presentaron el espectro DIDMOAD completo. Se describen nuevas asociaciones con hepatitis autoinmunitaria y cáncer de testículo. El presente estudio muestra la variabilidad de presentación clínica del SW y dos asociaciones no descritas previamente. Wolfram syndrome (WS), also known by the acronym DIDMOAD, is a rare and progresive hereditary disease of autosomal recessive inheritance which minimum ascertainment diagnostic criteria are the occurrence together of diabetes mellitus and optic atrophy before 15 years of age. To describe the clinical, biochemical and molecular profile of WS in a tertiary care hospital in Mexico. We reviewed patients records who fulfill the minimum ascertainment diagnostic criteria of WS presenting between January 1987 and May 2015 in a tertiary care hospital in Mexico. Five patients fulfill the inclusion criteria (three male and two female). Diabetes mellitus was the first manifestation of the syndrome in all of them, with a mean age at diagnosis of 5.8 ± 2.71 years, while the WS diagnosis was

  14. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

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

  15. Obstáculos a la adherencia y retención en los sistemas de salud público y privado según pacientes y personal de salud

    PubMed Central

    Arístegui, Inés; Dorigo, Analía; Bofill, Lina; Bordatto, Alejandra; Lucas, Mar; Cabanillas, Graciela Fernández; Sued, Omar; Cahn, Pedro; Cassetti, Isabel; Weiss, Stephen; Jones., Deborah

    2016-01-01

    Resumen Introducción el Programa Nacional de Sida garantiza el acceso universal a los antirretrovirales, aun así las personas que reciben medicamentos a través del sistema público no logran obtener una carga viral indetectable en la misma proporción que los pacientes del sistema privado. Este estudio cualitativo tiene como objeto identificar los factores asociados a la adherencia y retención en la cascada de atención de VIH de los sistemas de salud público y privado de Buenos Aires, según las percepciones de pacientes y del personal de salud. Métodos se registraron datos cualitativos de 12 entrevistas semi-estructuradas a informantes clave y 4 grupos focales de pacientes y personal de salud tanto del sistema público como privado. Se codificaron y analizaron temas predeterminados sobre adherencia, utilizando el software QRS Nvivo9® de análisis de datos cualitativos. Resultados pacientes y personal de salud de ambos sistemas coinciden en la importancia del estigma asociado al VIH, la relación médicopaciente, la comunicación entre ambos y la división de responsabilidades en relación al tratamiento como aspectos fundamentales para la adherencia y retención en la cascada de atención. Se observan diferencias entre los sistemas en la forma en que algunos de estos aspectos actúan. Las barreras estructurales se presentan como principales obstáculos del sistema público. Discusión se resalta la necesidad de intervenciones focalizadas en la díada médico-paciente que considere las particularidades de cada sistema de atención para facilitar el compromiso del paciente en la adherencia. PMID:26878024

  16. Off-label and unlicensed utilization of drugs in a Brazilian pediatric hospital.

    PubMed

    Pereira Gomes, Vanessa; Melo da Silva, Kédma; Oliveira Chagas, Suely; dos Santos Magalhães, Igor Rafael

    2015-05-01

    Objetivo: Describir los patrones de utilizacion de medicamentos off-label y sin licencia en un hospital pediatrico de Brasil. Métodos: La investigacion consistio en un estudio descriptivo, prospectivo y de corte transversal. Resultados: Un total de 1.158 medicamentos fueron prescritos para 320 pacientes, que representan 65 farmacos diferentes. En cuanto a la clasificacion de la utilizacion de medicamentos, la mayoria de los medicamentos fueron prescritos como en la ficha tecnica (57,2%), seguido off-label (36,4%) y por sin licencia (6,3%). Las prevalencias de uso sin licencia y off-label de drogas en la poblacion estudiada fueron 20,9 y 77,8%, respectivamente. La polifarmacia fue muy asociada a ambos off-label y el regimen sin licencia (OR 12,9; IC del 95%: 3,07 a 54,2 y OR 3,68; IC del 95%: 2,02 a 6,69, respectivamente), mientras que los ninos en edad preescolar fueron menos propensos a prescripcion sin licencia (OR 0,39; 95% CI 0,19-,79). El sexo y la duracion de la hospitalizacion no estaban relacionadas con estos resultados. Conclusiones: Son necesarios mas estudios para verificar el impacto de este patron en la ocurrencia de eventos adversos en los medicamentos.

  17. [Experience of the surgical management of the esophageal achalasia in a tertiary care hospital].

    PubMed

    Barajas-Fregoso, Elpidio Manuel; Romero-Hernández, Teodoro; Sánchez-Fernández, Patricio Rogelio; Fuentes-Orozco, Clotilde; González-Ojeda, Alejandro; Macías-Amezcua, Michel Dassaejv

    2015-01-01

    Introducción: la acalasia es un trastorno motor primario del esófago. La sintomatología más frecuente es la disfagia, dolor torácico, reflujo y pérdida de peso. La manometría esofágica es el estándar para su diagnóstico. El objetivo de este trabajo fue determinar la eficacia del manejo quirúrgico de los pacientes con acalasia en nuestro centro hospitalario. Métodos: se realizó un estudio de serie de casos en el que se incluyeron pacientes con acalasia tratados de manera quirúrgica entre enero y diciembre de 2011. Se revisaron los expedientes para obtener los datos y registros del tipo de procedimiento quirúrgico realizado, morbilidad y mortalidad. Resultados: se incluyeron 14 pacientes con edad promedio de 49.1 años. Los síntomas predominantes fueron: disfagia, vómito, pérdida de peso y pirosis. Se realizaron ocho abordajes abiertos y seis laparoscópicos, con una longitud media de cardiomiotomía de 9.4 cm. Once pacientes recibieron un procedimiento antirreflujo concomitante. La efectividad de los procedimientos realizados fue del 85.7 %. Conclusiones: el manejo quirúrgico ofrecido en nuestro centro no difiere de lo reportado en otras series de caso, lo que otorga efectividad y seguridad a los pacientes tratados con acalasia.

  18. Hospital diversification.

    PubMed

    Eastaugh, Steven R

    2005-01-01

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

  19. Nutritional status influences the length of stay and clinical outcomes in patients hospitalized in internal medicine wards.

    PubMed

    Ordoñez, Ana Manuela; Madalozzo Schieferdecker, Maria Eliana; Cestonaro, Talita; Cardoso Neto, João; Ligocki Campos, Antônio Carlos

    2013-01-01

    Objetivo: Vincular el estado nutricional (EN) con la evolución clínica y la duración de la estancia de los pacientes ingresados en las clínicas médicas de un hospital universitario. Métodos: Estudio observacional retrospectivo en el que los datos analíticos se obtuvieron de los pacientes ingresados durante el período de un año. Para la evaluación del EN se utilizaron: la valoración global subjetiva (VGS), el índice de masa corporal (IMC), el pliegue cutáneo triciptal (PCT), la circunferencia muscular del brazo (CMB) y el diagnostico del estado nutricional por la combinación de métodos (VGS, medidas de antropometría y bioquímicas). El análisis estadístico se realizó con el poder de confianza del 95% (p < 0,05). Para las categorías de comparación se utilizó chi-cuadrado. Para examinar la asociación entre la duración de la estancia y variables relacionadas con el EN se utilizaron Mann-Whitney y Kruskal-Wallis con comparaciones múltiples. Resultados: De los 396 sujetos estudiados 57,8% eran adultos. Ser mayor se asoció con la presencia de hipertensión arterial (p <0,001), diabetes mellitus (p = 0,003) y requerir cambios en la consistencia de la dieta (p = 0,003). Al final de la evaluación el 45,7% eran desnutridos. Presentar disminución de la ingesta de alimentos (p = 0,01), malnutrición según el SGA (p = 0,02) y la CMB (p = 0,03) se asoció con mortalidad. Estuvieron más tiempo hospitalizados los pacientes con nivel terciario de atención (p = 0,01), disminución de la ingestión de alimentos (p = 0,001), que murieron (p = 0,004), con un diagnóstico de desnutrición por VGS (p = 0,001) y por la combinación de métodos (p = 0,001). Conclusión: pacientes desnutridos según VGS y con disminución de la ingestión de alimentos al comienzo de la hospitalización se mantuvieron más tiempo en el hospital y tuvieron peores resultados clínicos (mayor número de muertes). El diagnóstico de la desnutrición por CMB también se relacion

  20. [Historical exploration of Acapulco hospitals, Guerrero, Mexico].

    PubMed

    Fajardo-Ortiz, Guillermo; Salcedo-Alvarez, Rey Arturo

    2006-01-01

    This study attempts to recount the history of the main hospitals of the port of Acapulco from colonial times until the end of the 20th century. The Augustine friars began hospital care at the end of the first part of the 16th century. Later, Bernardino Alvarez (1514?-1584), with the support of the Spanish crown, founded the first formal hospital in Acapulco called Hospital de Nuestra Señora de la Consolación (Our Lady of Consolation Hospital). During the 16th and 17th centuries, the sick were attended by friars, and by the end of the 19th century there were physicians and surgeons. From the end of the Independence War until the end of the 19th century, the port did not have any true hospital. The first degreed physicians and surgeons arrived and resided in Acapulco in 1920. In 1938, the Hospital Civil Morelos (Morelos Civil Hospital) began providing services. It was replaced by the Hospital General de Acapulco (General Hospital of Acapulco). At the fourth decade of the past century the Cruz Roja (Red Cross) was created. In 1957 the hospital services of the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute of Social Security), which was founded in 1963, was inaugurated with the Unidad Medico/Social (Medical and Social Unit) of the IMSS in Acapulco. This began the journey of modernity in Acapulco. In 1992, Hospital Regional Vicente Guerrero (Regional Hospital Vicente Guerrero) of the IMSS, initiated its services. In 1960, medical services for civil workers and their families were housed in the Hospital Civil Morelos (Morelos Civil Hospital). Shortly afterwards, the Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE, Security and Social Services Institute for State Employees) had their own hospital. During the 20th century, Acapulco has added other hospital services to care for members of the navy and armed forces, as well as for those persons with financial resources for private care.

  1. [Is necessary to perform a transthoracic echocardiogram in all the patients with cryptogenic stroke during hospitalization?].

    PubMed

    Arias-Rivas, Susana; Rodríguez-Yáñez, Manuel; López-Ferreiro, Ana; Santamaría-Cadavid, María; Fernández-Pajarín, Gustavo; González-Juanatey, José Ramón; Castillo, José; Blanco, Miguel

    2013-05-16

    Introduccion. El 15-30% de los ictus isquemicos son de origen cardioembolico. El ecocardiograma transtoracico desempena un papel fundamental en la evaluacion, diagnostico y manejo de la fuente embolica. La ausencia de recomendaciones oficiales para el empleo del ecocardiograma en pacientes con ictus isquemico lleva a una solicitud universal de la prueba, presentando una baja rentabilidad diagnostica. Objetivo. Analizar la rentabilidad diagnostica del ecocardiograma transtoracico en pacientes con ictus isquemico indeterminado tras la aplicacion de criterios clinicos predefinidos de riesgo. Pacientes y metodos. Se analizan los ecocardiogramas realizados a pacientes con ictus isquemico agudo solicitados durante 2009-2011 desde el servicio de neurologia. Se estudia la rentabilidad diagnostica y su aportacion al estudio etiologico. Se aplican unos 'criterios de seleccion de paciente de alto riego con necesidad de realizacion de la prueba durante el ingreso' (edad < 60 anos, alteraciones en el ecocardiograma basal, cardiomegalia en la radiografia de torax basal, antecedentes de cardiopatia, sospecha clinica de endocarditis o neoplasia activa) y se analiza su validez. Resultados. De 930 pacientes, se realizo ecocardiograma a 201 (21,6%) y se detecto una fuente cardioembolica en el 9,95%. Tras la aplicacion de criterios de seleccion, el numero de ecocardiogramas paso a 97 (10,4%). Los criterios propuestos presentan: sensibilidad, 95%; especificidad, 56,9%; valor predictivo positivo, 19,6%, y valor predictivo negativo, 99%. Conclusiones. La aplicacion de nuestros criterios a pacientes con ictus indeterminado identifica con alta eficiencia la fuente cardioembolica, lo que permite la realizacion del ecocardiograma transtoracico ambulatorio en el resto de los pacientes.

  2. [Risk prescription associated to treatment at home of the elderly patient when admitted to the hospital].

    PubMed

    Iniesta-Navalón, C; Urbieta-Sanz, E; Gascón-Cánovas, J J; Rentero-Redondo, L; Cabello Muriel, A; García-Molina, C

    2013-01-01

    Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009.Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo.

  3. [Description of a series of hospital patients with a spinal fistula].

    PubMed

    Garcia-Cabo, C; Morales-Deza, E S; Martinez-Rodriguez, L; Murias-Quintana, E; Perez-Alvarez, A; Martinez-Ramos, J; Vega-Valdes, P; Suarez-Santos, P; Garcia-Rua, A; Moris, G

    2016-10-01

    Introduccion. Aunque las fistulas espinales suponen el 70% de las malformaciones arteriovenosas espinales, son una entidad infradiagnosticada. El shunt arteriovenoso produce una congestion vascular que da lugar a una mielopatia progresiva, en ocasiones irreversible si no se trata de forma precoz. Objetivo. Describir las caracteristicas clinicorradiologicas de una serie de pacientes con fistula espinal. Pacientes y metodos. Se realizo una busqueda retrospectiva de pacientes con diagnostico de fistula espinal ingresados en el area de neurociencias de un hospital de tercer nivel asistencial. Resultados. Se identificaron 19 pacientes (7 mujeres y 12 varones) con una edad media de 56 años. La fistula espinal fue de tipo I en un 79% de los pacientes y la localizacion dorsal fue la mas frecuente. La mayoria de los casos presento un curso progresivo (90%). Un 74% de los pacientes se diagnostico mediante resonancia magnetica. En cuatro casos fue necesaria la realizacion de una angiografia para llegar al diagnostico, y en uno de ellos se preciso una biopsia intraoperatoria. Se realizaron tres punciones lumbares, en dos de las cuales se objetivo pleocitosis linfocitaria e hiperproteinorraquia. El retraso diagnostico medio fue de nueve meses. Se trato a un 79% de los pacientes, y de ellos solo mejoro el 10%. Conclusiones. Ante una clinica sugestiva de fistula espinal, debe realizarse una angiografia espinal diagnostica aunque el paciente estudiado pueda presentar caracteristicas licuorales atipicas y normalidad en la resonancia magnetica medular.

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

    PubMed

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

    2014-01-01

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

  5. Hospital fundamentals.

    PubMed

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

    2014-07-01

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

  6. [How to prescribe for patients with dysphagia: a review for the adaptation of the pharmaceutical guide in a socio-sanitary hospital].

    PubMed

    Hernández Martín, J; Correa Ballester, M; Vial Escolano, R; Forcano García, M; Gómez Navarro, R; González García, P

    2013-01-01

    Objetivo: Revisar la guía farmacoterapéutica del hospital para incluir formas farmacéuticas adaptadas a pacientes con disfagia y recomendaciones para la administración de medicamentos en estos pacientes. Método: Se realizó una búsqueda bibliográfica para elaborar las recomendaciones generales de administración de medicamentos en disfagia. Se comprobó para cada principio activo: a) si existían comercializadas otras formas farmacéuticas más recomendables; b) si había posibilidad de manipular los comprimidos o cápsulas, y c) si eran compatibles con alimentos. Resultados: Se desarrolló un algoritmo de decisión para ayudar en la selección de la forma farmacéutica y de su método de administración. Se incluyó un apartado de recomendaciones de administración para cada principio activo. La búsqueda supuso la inclusión de once formas bucodispersables, veintiséis líquidas y ocho como polvo. Conclusiones: La revisión mejorará la utilidad de la guía como instrumento para la prescripción, validación y administración de medicamentos en disfagia.

  7. [The functional planning of a enteral nutrition unit for home care at a hospital in Brazil].

    PubMed

    Ribeiro Salomon, Ana Lúcia; Carvalho Garbi Novaes, Maria Rita

    2013-11-01

    Introducción: Con el objeto de garantizar la calidad del producto ofrecido a los clientes en sus domicilios, las unidades hospitalarias necesitan adecuar sus áreas físicas para poder desarrollar todas las actividades especializadas que conlleva la nutrición enteral. Objetivo: Proporcionar una planificación funcional y las herramientas para la reorganización del espacio físico de una unidad de nutrición enteral, describiendo el proceso de preparación, la descripción de sus características y funciones laborales. Métodos. Estudio descriptivo, retrospectivo y documental, proporcionando las herramientas para la planificación funcional y de gestión de calidad en una unidad de preparación de la nutrición enteral en un hospital público del Distrito Federal, Brasil. Los datos fueron recolectados en el período comprendido entre los años 2000 y 2010. Resultados. A través de la creación de un programa de nutrición enteral en el Departamento de Salud Pública del Distrito Federal y según lo dispuesto por la legislación nacional, se efectuó un plan de alta complejidad respecto de la nutrición enteral en atención al perfil demográfico y epidemiológico de la población. Este trabajo consiste en una propuesta de implementación de terapia nutricional dentro de un plan de alta complejidad, y de acuerdo a lo prescrito por la legislación del Ministerio de Salud Brasileño. El número de pacientes atendidos por esta modalidad terapéutica se ha ido incrementando, por consiguiente se hace necesario garantizar la calidad del servicio, por medio de la organización de los espacios funcionales. Conclusión. Por medio de la planificación funcional de un Laboratorio de Nutrición Enteral, se puede garantizar la asistencia nutricional especializada y de calidad, a la población hospitalaria o domiciliaria, tomando las precauciones necesarias en la manipulación de las fórmulas enterales.

  8. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

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

  9. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

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

  10. [Mirizzi syndrome: experience at Spanish Hospital of Veracruz].

    PubMed

    Roesch-Dietlen, Federico; Pérez-Morales, Alfonso Gerardo; Martínez-Fernández, Silvia; Remes-Troche, José María; Jiménez-García, Victoria Alejandra; Romero-Sierra, Graciela

    2013-01-01

    Antecedentes: el síndrome de Mirizzi es una complicación de la litiasis vesicular por cálculos impactados en la bolsa de Hartmann o conducto cístico que comprimen la vía biliar principal; el diagnóstico se establece mediante estudios de imagen, aunque la mayor parte son hallazgos transoperatorios; su tratamiento es la colecistectomía con restauración de la vía biliar. Objetivo: analizar una serie de casos de síndrome de Mirizzi y comparar los resultados con lo publicado en la bibliografía mundial. Casos clínicos: se comunican cuatro casos con síndrome de Mirizzi de una cohorte de 1,034 casos con enfermedad litiásica vesicular del Hospital Español de Veracruz, en 21 años. La frecuencia en esta muestra es de 0.38%, con edad promedio de 32.1 ± 58.4 años; 50% son hombres y 25% tuvo ictericia y coluria con perfil hepático demostrativo. En un caso el ultrasonido sugirió síndrome de Mirizzi; el diagnóstico se corroboró por colangiografía percutánea y tomografía computada. A todos los pacientes se les realizó colecistectomía laparoscópica, y en dos se efectuó colangiografía transcística. Un caso correspondió al tipo I-A y 3 al tipo I-B según la Clasificación de Beltrán y Csendes. La evolución postoperatoria fue satisfactoria y no hubo mortalidad. Conclusiones: el síndrome de Mirizzi debe sospecharse en pacientes con litiasis vesicular con ictericia obstructiva. El cirujano debe extremar las precauciones para evitar lesionar la vía biliar.

  11. Macronutrients and energy content of oral hospital diet prescribed to chronic kidney disease patients on conservative treatment.

    PubMed

    David Silva, Janiara; Louvera Silva, Karine A; Baggio, Sueli R; Morgano, Marcelo A; Aguiar Nemer, Aline S; Quintaes, Késia D

    2014-11-01

    Introducción: La contribución de la dieta y planificación del tratamiento en el tratamiento de la enfermedad renal crónica (ERC) ha sido reconocida por tener un impacto clínico significativo si introducida tempranamente. Objetivo: determinar los niveles de hidratos de carbono, proteínas, lípidos, energía y densidad de energía (DE) en una dieta hospitalaria oral recetada para los pacientes con ERC, y evaluar la adecuación de esta dieta con respecto a las recomendaciones dietéticas. Métodos: Las dietas fueron recogidas en un hospital público brasileño en dos días no consecutivos de seis semanas diferentes. Los contenidos de los hidratos de carbono, proteínas, y lípidos (totales, saturadas, monoinsaturadas, poliinsaturadas, ácidos grasos linoleico, linolénico y trans) fueran determinados en un laboratorio. La cantidad de energía y la DE de las dietas se calcularon utilizando el factor de corrección de Atware, dividiendo la energía total de la dieta en peso, respectivamente. Resultados y Discusión: Fueran analizadas cerca de 14.3% de las dietas producidas y servidas a los pacientes con ERC. La densidad media de las di etas fue baja (0,7 kcal/g). Fue encontrada inadecuación nutricional para el contenido medio en lípidos (15%) y contenido de ácido graso linolénico (0,4%) y de energía (23,4 kcal/kg/día). El contenido de carbohidratos (63,5%) y el contenido de proteínas (1,0 g/kg/día) superaron los niveles de recomendaciones. Conclusiones: La dieta hospitalaria oral preparada para los pacientes con enfermedad renal crónica se muestra desequilibrada y desfavorable para el tratamiento clínico de los pacientes.

  12. Hospital finance.

    PubMed

    Herman, M J

    1998-01-01

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

  13. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

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

  14. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

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

  15. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

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

  16. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

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

  17. State of malnutrition in cuban hospitals; a needed update.

    PubMed

    Santana Porbén, Sergio

    2015-05-01

    Justificación: El Estudio Cubano de Desnutricion Hospitalaria, conducido en el bienio 1999 – 2001 con 1,905 pacientes atendidos en 12 hospitales de 6 provincias del pais, revelo una tasa de desnutricion hospitalaria del 41.2%. Transcurrida una decada de aquella indagacion, se impone la actualizacion de este estimado. Objetivo: Actualizar el estado de la desnutricion hospitalaria en Cuba. Material y método: La presencia de desnutricion en 1,664 pacientes ingresados en 12 hospitales de 8 provincias del pais entre Marzo del 2012 y Marzo del 2014 se documento mediante la Encuesta Subjetiva Global (ESG). El estado de los procesos hospitalarios de cuidados alimentarios y nutricionales se evaluo con la Encuesta de Nutricion Hospitalaria (ENH). Resultados: La tasa corriente de desnutricion hospitalaria fue del 36.9% (Δ = +4.3%; p < 0.05). Las tasas de completamiento de los ejercicios hospitalarios de evaluacion nutricional y de uso de terapias de replecion nutricional fueron superiores. Conclusiones: Transcurridos 10 anos de la primera edicion del Estudio ELAN CUBA, se aprecian modestos avances en la identificacion y el tratamiento de la desnutricion en los hospitales en Cuba. Se percibe que la formacion e insercion de nutricionistas verticalizados en la actuacion hospitalaria haya contribuido al cambio observado. Asimismo, la actividad de la Sociedad Cubana de Nutricion Clinica y Metabolismo en el avance de las disciplinas de la terapia nutricional, la nutricion artificial y el metabolismo puede haber servido para un mejor reconocimiento del problema de salud representado por la desnutricion hospitalaria.

  18. COST-EFFECTIVENESS OF EARLY NUTRITIONAL THERAPY IN MALNOURISHED ADULT PATIENTS IN A HIGH COMPLEXITY HOSPITAL.

    PubMed

    Giraldo Giraldo, Nubia Amparo; Vásquez Velásquez, Johanna; Roldán Cano, Paula Andrea; Ospina Astudillo, Carolina; Sosa Cardona, Yuliet Paulina

    2015-12-01

    Introducción: la malnutrición hospitalaria es un problema frecuente en el mundo que aumenta las complicaciones, los días de estancia, la mortalidad y los costes sanitarios. Objetivos: el objetivo de este estudio fue establecer la coste-efectividad de la terapia nutricional precoz en pacientes malnutridos en un hospital de alta complejidad. Materiales y métodos: este estudio analítico con valoración económica, incluyó 227 adultos hospitalizados y malnutridos según Valoración Global Subjetiva. La cohorte prospectiva recibió Terapia Nutricional Precoz (TNP), mientras que la cohorte retrospectiva recibió Terapia Nutricional Tardía (TNT). Las medidas del coste- efectividad incluyeron costes por: días de estancia, complicaciones y condición de egreso. Resultados: las cohortes fueron similares en cuanto a características clínicas y demográficas, excepto en la mediana de edad; para la TNP fue 61 años (rango intercuartil [RIQ]: 48-71) y para la TNT fue 55 años (RIQ: 44-67) (p=0,024). La TNP se encontró costo-efectiva en la reducción de los días de estancia hospitalaria (11 días, RIQ: 7-17) en comparación con la TNT (18 días, RIQ: 10-28) (p.

  19. [MÉDERI MODEL NUTRITIONAL CARE HOSPITAL].

    PubMed

    Pinzón-Espitia, Olga Lucia; Pardo Oviedo, Juan Mauricio; González Rodríguez, Javier Leonardo

    2015-10-01

    Introducción: la necesidad de modelos en atención nutricional para responder a la problemática de la malnutrición en los hospitales, conlleva desarrollar el modelo Méderi de Atención Nutricional, con el fin de elevar la calidad de la atención en salud y promover buenas prácticas de nutrición clínica. Objetivo: describir el proceso de nutrición y soporte metabólico, orientado a medir la eficacia del modelo, el cual se constituye actualmente en un centro de referencia nacional e internacional. Materiales y métodos: estudio de tipo descriptivo, evaluativo, transversal y observacional. Incluye el análisis de la información consolidada desde la implementación del modelo en el año 2008 hasta el año 2014. El número de sujetos del estudio fue de 163.575 y las variables medidas para probar la eficacia fueron: productividad y calidad percibida de la atención nutricional. Resultados: realizado el análisis de los procedimientos claves en los que se fundamenta el modelo: atención nutricional hospitalaria adulta y neonatal, soporte nutricional, interventoría a servicios de alimentación, y docencia e investigación, se encuentra un aumento en la productividad del servicio de un 591%, así como un incremento del porcentaje de satisfacción de los pacientes del 50 % al 95,8%. Conclusión: el éxito de un modelo de atención nutricional radica en la consolidación de una estructura administrativa y asistencial, que a su vez promueva el desarrollo del talento humano, la docencia y la investigación en nutrición.

  20. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital.

    PubMed

    Botelho, Renata Maria de Oliveira; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Góis, Aécio Flávio Teixeira de; Batista, Ruth Ester Assayag

    2016-11-21

    as taxas de retorno à circulação espontânea utilizou-se o teste Qui-quadrado e a Razão de Verossimilhança, considerando p≤0,05. houve retorno da circulação espontânea em 57,7%, sendo que 92,8% destes pacientes evoluíram para óbito nas 24 horas seguintes. Não houve diferença significativa no retorno à circulação espontânea (p=0,2017) e na ocorrência de óbito (p=0,8112) entre os grupos. os desfechos dos pacientes pós-PCR com e sem a utilização do metrônomo durante a RCP foram semelhantes, não havendo diferença nas taxas de sobrevivência e RCE entre os grupos. comparar la tasa de retorno de la circulación espontánea y de muerte después de parada cardiorrespiratoria, con y sin la utilización de metrónomo durante la resucitación cardiopulmonar. estudio caso-control contenido en estudio de cohorte, con 285 adultos atendidos por parada cardíaca en un servicio de emergencia y sometidos a resucitación cardiopulmonar. Los datos fueron recolectados por medio del In-hospital Utstein Style. El grupo control (n=60) fue seleccionado por emparejamiento de los pacientes considerándose: estado neurológico preparada cardiorrespiratoria; causa inmediata y ritmo inicial de la parada; utilización de epinefrina; y, duración de la resucitación. El grupo caso (n=51) fue sometido a resucitación cardiopulmonar convencional con la utilización de metrónomo con 110pulsaciones/min. Para comparar las tasas de retorno de la circulación espontánea se utilizó el test Chi-cuadrado y la Razón de Verosimilitud, considerando p≤0,05. hubo retorno de la circulación espontánea en 57,7%, siendo que 92,8% de estos pacientes evolucionaron para la muerte en las 24 horas siguientes. No hubo diferencia significativa en el retorno de la circulación espontánea (p=0,2017) y en la ocurrencia de muerte (p=0,8112) entre los grupos. los resultados de los pacientes post PCR con y sin la utilización del metrónomo durante la RCP fueron semejantes, no habi

  1. [Type of treatment and short-term outcome in elderly patients with acute myocardial infarction admitted to hospitals with a primary coronary angioplasty facility. The TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) Registry].

    PubMed

    Bardají, Alfredo; Bueno, Héctor; Fernández-Ortiz, Antonio; Cequier, Angel; Augé, Josep M; Heras, Magda

    2005-04-01

    The nature and outcome of treatment for acute myocardial infarction in elderly patients admitted to Spanish hospitals with primary angioplasty facilities are not well documented. Prospective analysis of registry data on patients > or =75 years old with ST-segment-elevation acute myocardial infarction admitted between April and July 2002 to Spanish hospitals with an active primary angioplasty program. We followed up 410 consecutive patients for 1 month. Their mean age was 80 (4.3) years and 46% were female. The median delay between symptom onset and arrival at hospital was 190 minutes. Around 42% of patients received no reperfusion therapy, 35% were treated by thrombolysis, and 22% by primary angioplasty. Patients who underwent reperfusion therapy were younger, were more frequently male, had a shorter delay from symptom onset to hospital arrival, and had a better initial hemodynamic status (Killip Class). However, they were more likely to have extensive anterior infarctions. Overall, 30-day mortality was 24.9%. Independent predictors of death were age, systolic blood pressure, and Killip class >1, but not use of thrombolysis or primary angioplasty. Over 42% of elderly patients with myocardial infarction admitted to Spanish hospitals with angioplasty facilities did not receive reperfusion therapy. Thrombolysis was the most frequently used reperfusion therapy. However, neither thrombolysis nor primary angioplasty improved 30-day mortality.

  2. [Profile of sensitization to allergens in children with atopic dermatitis assisting to Allergology Service of University Hospital, Nuevo Leon, Mexico].

    PubMed

    Yong-Rodríguez, Adrián; Macías-Weinmann, Alejandra; Palma-Gómez, Samuel; Arias-Cruz, Alfredo; Pérez-Vanzzini, Rafael; Gutiérrez-Mujica, José Julio; González-Díaz, Sandra Nora

    2015-01-01

    Antecedentes: la sensibilización a alergenos observada en la dermatitis atópica aumenta el riesgo del niño a padecer rinitis alérgica y asma. Los estudios recientes indican que entre mayor actividad de proteasas haya en los alergenos a los que se está sensibilizado, hay mayor defecto en la barrera cutánea y mayor gravedad de la enfermedad. Objetivos: conocer el patrón de sensibilización a los alergenos en niños con dermatitis atópica atendidos en el Servicio de Alergología del Hospital Universitario de la Universidad Autónoma de Nuevo León y conocer si estos niños tienen mayor sensibilización a los antígenos con actividad proteolítica. Material y método: estudio retrospectivo en el que revisamos los reportes de las pruebas cutáneas por punción realizadas en nuestro servicio a niños de 5 meses a 16 años de edad, con diagnóstico de dermatitis atópica, de enero de 2012 a enero de 2014. Evaluamos la frecuencia de sensibilización a aeroalergenos y alimentos, así como el tamaño de la roncha en la respuesta cutánea para cada alergeno en particular. Resultados: se incluyeron los reportes de pruebas cutáneas de 66 niños, 30 hombres y 36 mujeres. Cuarenta y seis pacientes estaban sensibilizados a aeroalergenos y 38 a alimentos. Los ácaros del polvo de casa (Dermatophagoides pteronyssinus/Dermatophagoides farinae) fueron los alergenos con mayor frecuencia de respuesta positiva en las pruebas cutáneas. De los niños con sensibilización a alimentos, sólo los niños sensibilizados a la leche de vaca, al huevo y al pescado tuvieron una roncha mayor de 6 mm de diámetro. CONCLUSIÓN: en los niños con dermatitis atópica es común la sensibilización a aeroalergenos con alta actividad de proteasas y la polisensibilización es muy común. La sensibilización a alimentos es común en estos pacientes, pero sólo un pequeño porcentaje de ellos muestra respuestas cutáneas lo suficientemente grandes para relacionarlas con gravedad de la enfermedad.

  3. [Use of fish oil lipid emulsions in hospitalized patients under 18 years old with abnormal results in liver tests associated with total parental nutrition].

    PubMed

    Giraldo Villa, Adriana; Henao Roldan, Catherine; García Loboguerrero, Fanny; Martínez Volkmar, María Isabel; Contreras Ramírez, Mónica María; Ruiz Navas, Patricia

    2014-04-01

    Introducción: La Nutricion Parental Total (NPT) prolongada esta asociada con complicaciones potencialmente mortales en la poblacion pediatrica como lo es la colestasis. Dentro del soporte nutricional, la fuente de acidos grasos, el contenido de fitoesteroles y la dosis de lipidos se han relacionado con el desarrollo de esta complicacion. Objetivo: Describir el comportamiento de las pruebas hepaticas en pacientes pediatricos con NPT en quienes se uso lipidos a base de acidos grasos omega 3 (omegavenR). Métodos: Estudio retrospectivo, en menores de 18 anos con tratamiento intravenoso por minimo 8 dias con acidos grasos omega 3. Los pacientes fueron inicialmente clasificados en dos grupos: colestasis y alteracion de pruebas hepaticas. Se evaluo el comportamiento de la transaminasa glutamico oxalacetica (TGO), transaminasa glutamico piruvica (TGP), bilirrubina total (BT), bilirrubina directa, gama glutamil transferasa (GGT) y fosfatasa alcalina (FA) antes y despues del tratamiento con omegaven R. Resultados: 33 pacientes cumplieron los criterios de inclusion. Al finalizar la administracion de omegavenR, 82,4% de los pacientes que presentaron inicialmente colestasis mostraron resolucion o mejoria. En el grupo de pacientes con alteracion de pruebas hepaticas 18,8% progresaron a colestasis. Conclusiones: Nuestro estudio sugiere que el uso de omegaven R en pacientes pediatricos con NPT y BD ≥ 2 mg/dL, parece revertir o mejorar la colestasis, mientras que en pacientes con alteracion de pruebas hepaticas aun no se tiene claro su efecto.

  4. [Prognostic value of serum homocysteine levels in elderly hospitalized patients].

    PubMed

    Hernández-Betancor, Iván; Martín-Ponce, Esther; Martínez-Riera, Antonio; Viña-Rodríguez, Juan José; González-Reimers, Emilio; de la Vega-Prieto, María José; Santolaria, Francisco

    2015-06-01

    Antecedentes y objetivos: el aumento de la homocisteína se relaciona con la enfermedad vascular y un incremento de la mortalidad. La disminución de la homocisteína se asocia también con un peor pronóstico en enfermos en hemodiálisis; sin embargo, esta relación no ha sido bien estudiada en otro tipo de pacientes. El objetivo del estudio fue analizar el valor pronóstico de los niveles de homocisteína en enfermos ancianos pluripatológicos ingresados en un servicio general de medicina interna Pacientes y métodos: estudiamos a 239 pacientes (121 mujeres y 118 varones; edad media: 78 años) en los que determinamos la homocisteína sérica y la relacionamos con los factores de riesgo vascular, enfermedad vascular: cardiopatía isquémica, ACV isquémico y arteriopatía periférica, estado de nutrición, creatinina, albúmina, ácido fólico y vitamina B12. Resultados: la mortalidad durante el ingreso de los enfermos con homocisteína menor de 9 mol/l fue del 33%, del 9% cuando estaba entre 9 y 20 mol/l y del 17% si era superior a 20 mol/l. La disminución de la homocisteína se relacionó con mayor comorbilidad, pérdida de peso y disminución de la albúmina. A largo plazo, el aumento de la homocisteína se relacionó con mayor mortalidad, especialmente en los pacientes con enfermedad vascular. Conclusión: en los pacientes ancianos pluripatológicos tanto la disminución como el aumento de la homocisteína se asocian con una mayor mortalidad.

  5. Critical access hospitals enter a new era of capital finance.

    PubMed

    Ponton, Kevin T

    2004-08-01

    One day this month, with the grand opening of Rio Grande Hospital in Del Norte, Colo., the healthcare industry will have cause to celebrate the completion of the first critical access hospital (CAH) financed with bonds enhanced by HUD FHA-242 mortgage insurance (average interest rate: 5.45%; rating: AA/Aa/AA).

  6. [Perception of medical emergencies in a private pediatric hospital].

    PubMed

    González-López, Ramón Antonio; Iglesias-Leboreiro, José; Bernárdez-Zapata, Maria Isabel; Testas-Hermo, Manuel; Rendón-Macías, Mario Enrique

    2015-01-01

    Introducción: el objetivo de este trabajo es conocer si la atención de los niños enfermos a su ingreso, coincide con percepción de urgencia real de parte de los padres con la del médico y no por la inquietud percibida en los familiares (urgencias sentidas). Métodos: se analizaron todas las atenciones otorgadas en el servicio de urgencias, del 1 enero del 2009 al 31 diciembre del 2010. Se determinó una urgencia real por consenso según las condiciones del menor. Se compararon las condiciones sociodemográficas de la urgencias reales contra las sentidas. Resultados: se otorgaron 8888 consultas, de las cuales 2024 (22.7 %) cumplieron criterios de urgencias reales. Las principales causas de urgencias reales fueron los procesos infecciosos seguidos de accidentes e intoxicaciones. De las urgencias reales 17 (1 %) requirieron finalmente manejo intensivo. Los factores asociados con una urgencia real fueron: la edad, enfermedades no infecciosas, ocurrencia entre el lunes a viernes, en el turno matutino y en los meses de invierno. Conclusiones: La frecuencia de atención de urgencias reales fue baja para lo informado en otros centros pediátricos. La restructuración de los servicios de preconsulta para la aplicación de una clasificación óptima de pacientes antes de pasar a urgencias ayudaría en gran medida al aprovechamiento máximo del servicio de urgencias, derivando desde antes la entrada de pacientes que realmente lo ameritan.

  7. [Electronic prescription for Primary Care: a reliable tool to conceal medication at hospital admission?].

    PubMed

    Martín González, A; Abajo Del Álamo, C

    2013-01-01

    Objetivo: Analizar la fiabilidad de un programa de prescripción electrónica en receta de atención primaria (Medoracyl®) para conciliar la medicación al ingreso hospitalario. Método: Estudio prospectivo comparativo del tratamiento domiciliario validado de pacientes al ingreso, con el prescrito en Medoracyl®. La medicación al ingreso se obtuvo mediante entrevista clínica, informes médicos y revisión de la medicación aportada; la medicación activa en Medoracyl®, mediante consulta a la aplicación el día del ingreso. Se analizaron las discrepancias entre ambos tratamientos. Resultados Se incluyeron 47 pacientes con 273 líneas de tratamiento domiciliario validado y 274 líneas de tratamiento Medoracyl ®. Resultaron 48/273 líneas discrepantes (17,6% [IC95%: 13,1-21,6]). Se consideraron justificadas 27/48, resultando un riesgo final de no concordancia del 7,8% [IC95%: 4,6-11,0]. Conclusiones: Medoracyl® es una herramienta útil y de fácil acceso que permite conocer más del 90% de la medicación domiciliaria de los pacientes.

  8. Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization.

    PubMed

    Barreto, Maynara Fernanda Carvalho; Dellaroza, Mara Solange Gomes; Kerbauy, Gilselena; Grion, Cintia Magalhães Carvalho

    2016-04-01

    To estimate the cost of hospitalization of patients with severe sepsis or septic shock admitted or diagnosed in the Urgent and Emergency sector at a university hospital and followed until the clinical outcome. An epidemiological, prospective, observational study conducted in a public hospital in southern Brazil for the period of one year (August 2013 to August 2014). Sepsis notification forms, medical records and data of the cost sector were used for the collection of clinical and epidemiological data. The sample comprised 95 patients, resulting in a total high cost of hospitalization (R$ 3,692,421.00), and an average of R$ 38,867.60 per patient. Over half of the total value of the treatment of sepsis (R$ 2,215,773.50) was assigned to patients who progressed to death (59.0%). The higher costs were related to discharge, diagnosis of severe sepsis, the pulmonary focus of infection and the age group of up to 59 years. The high cost of the treatment of sepsis justifies investments in training actions and institution of protocols that can direct preventive actions, and optimize diagnosis and treatment in infected and septic patients. Estimar o custo da internação de pacientes com sepse grave ou choque séptico admitidos ou diagnosticados no setor de Urgências e Emergências de um hospital universitário e seguidos até o desfecho clínico. Estudo epidemiológico, prospectivo e observacional, realizado em um hospital público do sul do Brasil, no período de 1 ano (agosto de 2013 a agosto de 2014). A coleta dos dados clínico-epidemiológicos utilizou fichas de notificação de sepse, prontuários e dados do setor de custos. Foi realizada análise de tendência central, dispersão e quartis dos custos das internações. Amostra composta por 95 pacientes que totalizaram elevado custo da internação (R$ 3.692.421,00), com média de R$ 38.867,60 por paciente. Mais da metade do valor total do tratamento da sepse (R$ 2.215.773,50) destinou-se a pacientes que evoluíram a

  9. Can hospitals compete on quality? Hospital competition.

    PubMed

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

    2015-09-01

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

  10. Changing hospital payments: implications for teaching hospitals.

    PubMed

    Bentley, J D

    1983-09-01

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

  11. Hospital medication errors in a pharmacovigilance system in Colombia.

    PubMed

    Machado Alba, Jorge Enrique; Moreno Gutiérrez, Paula Andrea; Moncada Escobar, Juan Carlos

    2015-11-01

    Objetivos: analizar los errores de medicacion reportados en un sistema de farmacovigilancia en 26 hospitales para pacientes del sistema de salud de Colombia. Métodos: estudio retrospectivo que evaluo las bases de datos sistematizadas de reportes de errores de medicacion entre el 1 de enero de 2008 y el 12 de septiembre de 2013 de los medicamentos dispensados por la empresa Audifarma S.A a hospitales de Colombia. Se utilizo la clasificacion taxonomica del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). El analisis de los datos se realizo mediante SPSS 22.0 para Windows Se determino como nivel de significacion estadistica una p < 0,05. Resultados: se reportaron 9.062 EM en 45 servicios farmaceuticos hospitalarios. El 51,9% (n = 4.707) de los errores realmente se produjeron, de los cuales el 12,0% (n = 567) afectaron al paciente (categorias C a I) y causaron dano (categorias E a I) a 17 (0,36%). El proceso implicado en los EM ocurridos (categorias B a I) con mayor frecuencia fue la prescripcion (n = 1.758, 37,3%), seguido por la dispensacion (n = 1.737, 36,9%), la transcripcion (n = 970, 20,6%) y, por ultimo, la administracion (n = 242, 5,1%). Los errores relacionados con los procesos de administracion aumentaban 45,2 veces el riesgo de que el medicamento erroneo afectara al paciente (IC 95% 20,2-100,9). Conclusiones: es necesario aumentar la cobertura de los sistemas de reporte de errores de medicacion, y crear estrategias para su prevencion, especialmente en la etapa de administracion del medicamento.

  12. Multiple Hospital Systems and the Teaching Hospital.

    ERIC Educational Resources Information Center

    Levitan, Mark S.

    1979-01-01

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

  13. Critical Access Hospitals (CAH)

    MedlinePlus

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

  14. Understanding your hospital bill

    MedlinePlus

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

  15. Going to the Hospital

    MedlinePlus

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

  16. Food intake and nutritional status influence outcomes in hospitalized hematology-oncology patients.

    PubMed

    Calleja Fernández, Alicia; Pintor de la Maza, Begoña; Vidal Casariego, Alfonso; Villar Taibo, Rocío; López Gómez, Juan José; Cano Rodríguez, Isidoro; Ballesteros Pomar, María D

    2015-06-01

    Introducción: la malnutrición en el paciente oncohematológico es importante debido a su prevalencia y a su morbimortalidad asociadas. El objetivo de este estudio fue analizar la prevalencia de malnutrición en el paciente oncohematológico y determinar si la ingesta o la malnutrición afectan a las complicaciones del paciente hospitalizado. Metodología: estudio de corte realizado en todos los pacientes admitidos en las plantas de oncología y hematología durante un periodo de 30 días. La valoración nutricional se realizó durante las 24 primeras horas tras el ingreso y se repitió a los 7 días de hospitalización, incluyendo Valoración Subjetiva Global, antropometría, recuerdo de 24 horas y estimación de las necesidades calóricas y proteicas. Las historias médicas fueron revisadas a los 30 días tras el alta. Resultados: setenta y tres pacientes fueron evaluados al ingreso y 29 a los siete días de su hospitalización. La prevalencia de malnutrición fue 47,7%. Al ingreso, los pacientes consumieron 71,6 (DE 22,0)% de las calorías prescritas y 68,2 (DE 22,0)% de las proteínas prescritas. La tasa de fallecimientos fue 2,8% entre los pacientes que consumieron ≥75% y 17,9% entre aquellos que consumieron.

  17. Malnutrition prevalence in hospitalized elderly diabetic patients.

    PubMed

    Sanz París, Alejandro; García, José M; Gómez-Candela, Carmen; Burgos, Rosa; Martín, Ángela; Matía, Pilar

    2013-01-01

    Introducción: La prevalencia de desnutrición es desconocida entre los ancianos con diabetes mellitus. Objetivos: Determinar la prevalencia de desnutrición en ancianos hospitalizados con diabetes mellitus, y describir su impacto en el pronóstico clínico. Material y métodos: Se llevó a cabo un estudio multicéntrico en 35 hospitales españoles. La desnutrición fue valorada mediante la herramienta Mini Nutritional Assessment (MNA). Los pacientes fueron seguidos hasta el alta. Resultados: Fueron incluidos 1.090 sujetos (78 ± 7,1 años; 50% hombres). 39,1% mostraron riesgo de desnutrición y 21,2% desnutrición establecida. El 15,5% de los sujetos desnutridos y 31,9 % de aquellos en riesgo tenían un IMC ≥30 kg/m(2). En el análisis multivariante, el sexo femenino (OR = 1,38; IC 95%: 1,19-1,11), la edad (OR = 1,04; IC 95%: 1,02-1,06) y la presencia de complicaciones por diabetes (OR = 1,97; IC 95%: 1,52-2,56) se asociaron al diagnóstico de desnutrición. La estancia media fue mayor en sujetos en riesgo y con desnutrición que en los pacientes bien nutridos (12,7 ± 9,9 y 15,7 ± 12.8 días vs 10,7 ± 9,9 días; p < 0,0001). Tras ajustar por edad y sexo, la puntuación del MNA (OR = 0,895; IC 95% 0,814-0,985) y el valor de albúmina (OR = 0,441; IC 95% 0,212-0,915) se asociaron de forma independiente con la mortalidad. La puntuación del MNA se asoció con la probabilidad de alta a domicilio (OR = 1,150; IC 95% 1,084-1,219). Conclusiones: Se observó una elevada prevalencia de desnutrición entre los ancianos hospitalizados con diabetes, independientemente del IMC. El diagnóstico de desnutrición, el valor de albúmina y la puntuación del MNA se asociaron con la estancia media, mortalidad y destino al alta.

  18. [GASTROSTOMY POSITIVELY AFFECTS NUTRITIONAL STATUS AND DIMINISHES HOSPITAL DAYS IN PATIENTS WITH INBORN ERRORS OF METABOLISM].

    PubMed

    Guillén-López, Sara; Vela-Amieva, Marcela; Juárez-Cruz, Merit Valeria; González-Zamora, José Francisco; Monroy-Santoyo, Susana; Belmont-Martínez, Leticia

    2015-07-01

    Introducción: el tratamiento nutricional de los pacientes con errores innatos del metabolismo (EIM) implica el uso permanente de fórmulas modificadas en aminoácidos cuyas características organolépticas pueden dificultar su aceptación por vía oral. Estos pacientes pueden tener alteraciones gastrointestinales y requieren el uso constante de medicamentos, lo cual complica la adherencia al tratamiento, comprometiéndose con ello su estado nutricional y el control de la enfermedad. La gastrostomía es una alternativa para facilitar la alimentación y el tratamiento, pero existen controversias sobre su uso. Objetivo: comparar el estado nutricional y la duración de las hospitalizaciones antes y después de la realización de la gastrostomía en un grupo de pacientes con EIM. Métodos: análisis retrospectivo de datos antropométricos, número de internamientos por descompensación metabólica y su duración en pacientes pediátricos con EIM antes y después de la gastrostomía. Resultados: se analizaron 16 niños; 40% con defectos del propionato, 25% con alteraciones del ciclo de la urea y 35% con otros EIM. Después de la gastrostomía, la proporción de pacientes eutróficos aumentó del 6 al 56% y la desnutrición disminuyó del 94 al 44%. Después de la gastrostomía, la duración de los periodos hospitalarios disminuyó significativamente de 425 a 131 días (p = 0.011); el número de internamientos disminuyó de 33 antes de la intervención a 17, sin embargo, esta diferencia no tuvo significación estadística. Conclusión: en esta muestra, la gastrostomía mejoró el estado nutricional en 56% de los pacientes con EIM, y redujo significativamente los días de hospitalización por descompensación metabólica.

  19. El uso de la neuromodulación para el tratamiento del temblor

    PubMed Central

    Bendersky, Damián; Ajler, Pablo; Yampolsky, Claudio

    2014-01-01

    Introducción: El temblor puede ser un desorden incapacitante y el tratamiento de primera línea para estos pacientes es farmacológico. Sin embargo, este tratamiento puede llevar a una reducción satisfactoria del temblor en sólo el 50% de los pacientes con temblor esencial. La talamotomía era el tratamiento de elección para el temblor refractario al tratamiento médico hasta que comenzó a utilizarse la estimulación cerebral profunda (ECP) del núcleo ventral intermedio (Vim) del tálamo. En la actualidad, raramente se realiza la talamotomía. Métodos: Este artículo es una revisión no sistemática de las indicaciones, resultados, parámetros de programación y técnica quirúrgica de la ECP del Vim para el tratamiento del temblor. Resultados: Aunque los resultados clínicos son similares usando la talamotomía o la ECP del Vim, la primera causa más efectos adversos que la última. Además, la ECP puede ser usada bilateralmente, mientras que la talamotomía tiene un alto riesgo de causar disartria cuando se realiza de ambos lados. La ECP del Vim logró una adecuada mejoría del temblor en varias series de pacientes con temblor causado por temblor esencial, enfermedad de Parkinson o esclerosis múltiple. Además del Vim, hay otros blancos que están siendo usados por varios autores, tales como la zona incerta y las radiaciones prelemniscales. Conclusión: La ECP del Vim es un tratamiento útil para el temblor incapacitante refractario al tratamiento médico. Es esencial realizar una precisa selección de pacientes, así como utilizar una técnica quirúrgica correcta. Aún se desconoce el mejor blanco estereotáctico para el temblor, aunque el Vim es el más usado. PMID:25165613

  20. Specialty hospitals: can general hospitals compete?

    PubMed

    Dummit, Laura A

    2005-07-13

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

  1. Hospital marketing revisited.

    PubMed

    Costello, M M

    1987-05-01

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

  2. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  3. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  4. Hospital libraries in perspective.

    PubMed Central

    Holst, R

    1991-01-01

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

  5. Competition among hospitals.

    PubMed

    Noether, M

    1988-09-01

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

  6. [SATISFACTION WITH HOSPITAL MENU AND INCLUSION OF GOAT CHEESE AS DESSERT COMPARED WITH COW CHEESE].

    PubMed

    Rubio-Martín, Elehazara; Rojo-Martínez, Gemma; Caracuel, Ángel; Soriguer, Federico; Olivas, Lourdes; Libébana, Maribel; Roque, Rosa; Olveira, Gabriel

    2015-10-01

    Introducción: la valoración de los menús hospitalarios debe realizarse periódicamente para adecuarlos a las necesidades de los pacientes. El queso de cabra podría tener ventajas nutricionales, en comparación con el de vaca. Objetivos: evaluar la satisfacción de los pacientes con el menú hospitalario y con la incorporación del queso de cabra, dado como postre en el menú hospitalario vs queso de vaca. Material y métodos: se realizó una encuesta de satisfacción del menú hospitalario y del postre (queso de cabra (QC) vs queso de vaca (QV)) en pacientes con dietas basales. Resultados: se analizaron 334 encuestas. El 46,7% fueron mujeres. La edad media fue de 58,16 ± 15,15 años y la estancia media de 11,21 ± 11,53. La aceptación del menú hospitalario fue valorado como buena en un alto porcentaje de los encuestados (temperatura 91%, presentación 94%, humedad 75% y horario 84%). La satisfacción global del almuerzo (1 al 10) fue 7,31 ± 2,10 en QV vs 7,39 ± 1,75 QC (ns) y del postre 6,93 ± 2,89 vs 6,88 ± 3,52 (ns) respectivamente. Los pacientes que habitualmente no toman queso de cabra (57%) tampoco tomaron postre en el 50% de los casos, frente a los que sí toman en su domicilio (42,98%), que no ingirieron nada del postre solo en el 8% (p < 0.01) Conclusiones: la satisfacción global con el menú hospitalario es alta y la aceptación del nuevo postre (QC) es equivalente a la obtenida con el queso de vaca, por lo que podría incluirse en el código de dietas.

  7. [Current status of alternative therapies renal function at the Instituto Mexicano del Seguro Social].

    PubMed

    Méndez-Durán, Antonio; Ignorosa-Luna, Manuel Humberto; Pérez-Aguilar, Gilberto; Rivera-Rodríguez, Francisco Jesús; González-Izquierdo, José Jesús; Dávila-Torres, Javier

    2016-01-01

    Introducción: el IMSS realiza de manera sistemática la actualización de datos de los pacientes en terapias sustitutivas de la función renal (TSFR) mediante un registro electrónico denominado: Censo de administración de pacientes con Insuficiencia Renal Crónica (CIRC), cuyo objetivo es conocer la prevalencia de pacientes con insuficiencia renal crónica y el comportamiento de las TSFR en el IMSS. Métodos: estudio retrospectivo, incluye 212 hospitales de segundo nivel con programas de diálisis, pacientes pediátricos y adultos. Datos obtenidos del CIRC de enero a diciembre de 2014, cédulas numeral y nominal de diálisis peritoneal (DP) y hemodiálisis (HD). Se identifica prevalencia de pacientes y terapias por delegación, distribución por género y edad, causa de la enfermedad renal, la morbilidad y mortalidad. Resultados: 55 101 pacientes, de los cuales fueron 29 924 masculinos (54 %) y 25 177 femeninos (46 %); edad promedio 62.1 años (rng: 4 a 90); pensionados 20 387 (36.9 %). Las causas de la insuficiencia renal fueron: diabetes 29 054 (52.7 %), hipertensión arterial 18 975 (34.4%), glomerulopatías crónicas 3951 (7.2 %), riñones poliquísticos 1142 (2.1 %), congénitos 875 (1.6 %), y otras 1104 (2 %). La HD se otorgó en 41 % de los pacientes y la DP al 59 % restante; el costo anual fue de 5 608 290 622 pesos. Conclusiones: la prevalencia incrementada de diabetes mellitus e hipertensión arterial repercuten en el inicio de una TSFR, las cuales muestran un panorama financiero catastrófico para el Instituto.

  8. Hospitable Classrooms: Biblical Hospitality and Inclusive Education

    ERIC Educational Resources Information Center

    Anderson, David W.

    2011-01-01

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

  9. The application of hospitality elements in hospitals.

    PubMed

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

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

  10. Hospitals as health educators

    MedlinePlus

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

  11. Help prevent hospital errors

    MedlinePlus

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

  12. [The Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez", and the generation of knowledge].

    PubMed

    Cuevas-García, Carlos

    2016-01-01

    The history of the Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez," formerly called Hospital General del Centro Médico Nacional, has been marked by ups and downs, as well as by the development of cutting-edge medical knowledge. In this supplement we show a series of articles, whose authors belong in their entirety to that hospital.

  13. Hospital Dermatology, Introduction.

    PubMed

    Fox, Lindy P

    2017-03-01

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

  14. [Introducing a mixed nutritional screening tool (CIPA) in a tertiary hospital].

    PubMed

    Suárez Llanos, José Pablo; Benitez Brito, Nestor; Oliva García, José Gregorio; Pereyra-García Castro, Francisca; López Frías, María Alicia; García Hernández, Alberto; Díaz Sirgo, Belarmina; Llorente Gómez de Segura, Ignacio

    2014-05-01

    Introducción: La desnutrición en el paciente hospitalizado es muy prevalente, por lo que es importante incorporar métodos de depistaje. Se ha desarrollado en nuestro centro un método mixto de cribado nutricional (CIPA), que incluye cuatro parámetros: a) control de ingestas 72 h; b) IMC; c) proteínas; y d) albúmina. Objetivos: 1) conocer la prevalencia de desnutrición en pacientes hospitalizados en el servicio de Medicina Interna de nuestro centro; 2) analizar variables asociadas a mayor prevalencia de desnutrición; 3) evaluar su efecto pronóstico clínico. Material y métodos: Se revisaron retrospectivamente los resultados de los test de cribado nutricional efectuados a 305 pacientes ingresados en el servicio de Medicina Interna en el periodo noviembre/2012-octubre/2013. Se analizó la prevalencia de desnutrición hospitalaria y la asociación del resultado positivo en el cribado (al menos un ítem positivo) con las siguientes variables: IMC, edad, sexo, patología subyacente, estancia, reingreso precoz (< de 1 mes) y mortalidad. Resultados: El test fue positivo en un 23% de los pacientes. Los pacientes con cribado positivo presentaban un IMC inferior (24,9 ± 7,2 vs 27,8 ± 6,4 kg/m; p = 0,002). La patología neoplásica e infecciosa se asociaron a mayor positividad (35,3 y 28,9%, respectivamente; p=0,006). El sexo y la edad no se asociaron con el resultado del test de cribado. Los pacientes con cribado positivo presentaban mayor estancia media (26,7 ± 25 vs 19,4 ± 16,5; p = 0,005), tasa de reingresos precoces (18,6 vs 6,8%; p = 0,003) y mortalidad (30 vs 10,3%; p < 0,001). Conclusiones: El test de cribado CIPA es capaz de detectar al paciente malnutrido y predecirle un peor pronóstico clínico (mortalidad, estancia media y reingreso precoz).

  15. Positioning hospitals: a model for regional hospitals.

    PubMed

    Reddy, A C; Campbell, D P

    1993-01-01

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

  16. [RISK OF MALNUTRITION ASSOCIATED WITH POOR FOOD INTAKE, PROLONGED HOSPITAL STAY AND READMISSION IN A HIGH COMPLEXITY HOSPITAL IN COLOMBIA].

    PubMed

    Vesga Varela, Andrea Liliana; Gamboa Delgado, Edna Magaly

    2015-09-01

    Introducción: la desnutrición hospitalaria es altamente prevalente y se relaciona con estancias hospitalarias prolongadas, aumento de costes de la atención y complicaciones clínicas asociadas. Objetivo: determinar el riesgo de desnutrición en pacientes hospitalizados en una institución de cuarto nivel de atención y sus factores asociados. Métodos: se aplicaron los cuestionarios de la iniciativa Nutrition Day a 70 pacientes adultos de una institución de salud de alto nivel de complejidad, en Bucaramanga, Colombia. Los parámetros del estudio incluyeron datos antropométricos y demográficos, historia clínica, factores relacionados a la dieta y percepción del estado de salud. Se aplicó el Malnutrition Screenning Tool (MST, por sus siglas en inglés) para medir el riesgo de desnutrición. Para establecer las razones de prevalencia (RP) se utilizaron modelos de regresión binomial. Resultados: la edad y los días de estancia hospitalaria, en el momento de la medición basal fueron, en promedio, 61,89 ± 15,17 años y 7,96 ± 9,79 días. La prevalencia de riesgo de desnutrición fue 52,86% (IC 95%: 40,55% - 64,91%); 40,91% en mujeres y 58,33% en hombres (p = 0,175). Un 18,57% de los pacientes no consumió alimento alguno en el almuerzo. Un 40,00% de los participantes manifestó haber tenido una ingesta de alimentos menor a la normal, durante la última semana. Las variables asociadas a riesgo de desnutrición, ajustadas por edad y sexo, fueron: ingesta de alimentos al corte del estudio, reingreso y días de estancia hospitalaria al seguimiento. Conclusión: la evidencia sobre la importancia del diagnóstico temprano y el manejo nutricional adecuado de la desnutrición hospitalaria indican la necesidad de implementar intervenciones nutricionales efectivas.

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

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

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

  18. Acerca del moho

    EPA Pesticide Factsheets

    El moho forma parte del medio ambiente natural. Afuera del hogar, el moho juega un papel en la naturaleza al desintegrar materias organicas tales como las hojas que se han caido o los arboles muertos. El moho puede crecer adentro del hogar cuando las espor

  19. [Clinical conditions at hospitalization and its relation with admission to pediatric intensive care unit].

    PubMed

    Rodríguez-Jáuregui, Eva Karina; Blanco-Montero, Andrés; Iglesias-Leboreiro, José; Bernárdez-Zapata, Isabel; Rendón-Macías, Mario Enrique

    2014-01-01

    INTRODUCCIÓN: el ingreso a la unidad de cuidados intensivos pediátricos (UTIP) depende de varios factores, pero el principal es la posibilidad de recuperación del paciente. La mayoría de los pacientes ingresa desde urgencias o el quirófano, sin embargo, un grupo menor es trasladado de las salas de hospitalización. El objetivo de esta investigación fue comparar las condiciones clínicas de niños que ingresaron a la sala de hospitalización con las que presentaron al ser traslados a la UTIP. MÉTODOS: estudio de cohorte retrospectiva de 78 pacientes menores de 17 años de edad con estancia en la sala de hospitalización antes de ingresar a terapia intensiva. Se evaluaron las condiciones respiratorias, cardiovasculares, neurológicas, hidroelectrolíticas y metabólicas al ingreso a la sala y a la UTIP; así como la calificación del Índice de Mortalidad Pediátrica y las diferencias entre las estancias menores y mayores de 24 horas.

  20. Hospital diversification strategy.

    PubMed

    Eastaugh, Steven R

    2014-01-01

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

  1. Descompresión microvascular en neuralgia del trigémino: Reporte de 36 casos y revisión de la literatura

    PubMed Central

    Campero, Alvaro; Ajler, Pablo; Campero, Abraham Agustín

    2014-01-01

    Objetivo: El propósito del presente trabajo es presentar los resultados de 36 pacientes con diagnóstico de neuralgia del trigémino (NT), en los cuales se realizó una descompresión microvascular (DMV). Material y Método: Desde junio de 2005 a mayo de 2012, 36 pacientes con diagnóstico de NT fueron operados por el primer autor (AC), realizando una DMV. Se evaluó: Edad, sexo, tiempo de sintomatología previo a la cirugía, hallazgos intraoperatorios (a través de los videos quirúrgicos), y resultados postoperatorios. Resultados: De los 36 pacientes operados, 25 fueron mujeres y 11 varones. El promedio de edad fue de 48 años. El seguimiento postoperatorio fue en promedio de 38 meses. De los 36 pacientes, 32 (88%) evolucionaron sin dolor hasta la fecha. De los 4 casos con recurrencia de dolor, en dos pacientes se observó como hallazgo intraoperatorio un conflicto venoso. Conclusión: La DMV como tratamiento de la NT es un procedimiento efectivo y seguro. El hallazgo intraoperatorio de una “compresión” venosa podría indicar una evolución postoperatoria desfavorable. PMID:25379343

  2. [A brief historical account of IMSS hospital in Orizaba, Veracruz].

    PubMed

    Fajardo-Ortiz, Guillermo

    2008-01-01

    In 1947, Orizaba City was chosen, due its political, economic and labor importance, for the Instituto Mexicano del Seguro Social (IMSS) to establish its health service in Veracruz State. At the beginning, hospital care was rented out at the Hospital Civil "Ignacio de la Llave." In 1959 a hospital was specifically constructed and had 280 beds. In 1973 a earthquake partially destroyed the hospital building and the medical services were almost discontinued. In 1975 it was rebuilt, and was renamed "Ignacio García Téllez," who had been a founder member of IMSS. At the beginning the main causes of hospital admissions were infectious diseases and gynecologic and obstetric problems; at present the challenges are the chronic diseases and accidents.

  3. Measuring hospital competition.

    PubMed

    White, S L; Chirikos, T N

    1988-03-01

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

  4. Central line infections - hospitals

    MedlinePlus

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

  5. Cirugía de los trastornos del comportamiento: el estado del arte

    PubMed Central

    Yampolsky, Claudio; Bendersky, Damián

    2014-01-01

    Introducción: La cirugía de los trastornos del comportamiento (CTC) se está convirtiendo en un tratamiento más común desde el desarrollo de la neuromodulación. Métodos: Este artículo es una revisión no sistemática de la historia, indicaciones actuales, técnicas y blancos quirúrgicos de la CTC. Dividimos su historia en 3 eras: la primera comienza en los inicios de la psicocirugía y termina con el desarrollo de las tícnicas estereotácticas, cuando comienza la segunda era. Ésta se caracteriza por la realización de lesiones estereotácticas. Nos encontramos transitando la tercera era, que comienza cuando la estimulación cerebral profunda (ECP) comienza a ser usada en CTC. Resultados: A pesar de los errores graves cometidos en el pasado, hoy en día, la CTC está renaciendo. Los trastornos psiquiátricos que se más frecuentemente se tratan con cirugía son: depresión refractaria, trastorno obsesivo-compulsivo y síndrome de Tourette. Además, algunos pacientes con agresividad fueron tratados quirúrgicamente. Hay varios blancos estereotácticos descriptos para estos trastornos. La estimulación vagal puede ser usada también para depresión. Conclusión: Los resultados de la ECP en estos trastornos parecen alentadores. Sin embargo, se necesitan más estudios randomizados para establecer la efectividad de la CTC. Debe tenerse en cuenta que una apropiada selección de pacientes nos ayudará a realizar un procedimiento más seguro así como también a lograr mejores resultados quirúrgicos, conduciendo a la CTC a ser más aceptada por psiquiatras, pacientes y sus familias. Se necesita mayor investigación en varios temas como: fisiopatología de los trastornos del comportamiento, indicaciones de CTC y nuevos blancos quirúrgicos. PMID:25165612

  6. [Nutritional care protocol proposal for patients living with HIV without antiretroviral therapy, treated at the center of diagnostic references of San Martín de Quillota Hospital, Chile].

    PubMed

    Videla Muñoz, Madeleine Andrea; Leiva Martínez, Tamara Denisse; Valenzuela Avendaño, Carina

    2014-11-18

    Introducción: La atención nutricional para pacientes con VIH en Chile constituye un desafío para la Salud Pública al no existir directrices ministeriales que garanticen una atención nutricional estandarizada y oportuna, que contribuya a mejorar la inmunidad y retardar la falla inmunológica desde un enfoque preventivo. Objetivo: Diseñar una propuesta de protocolo de atención nutricional para optimizar el manejo nutricional en un grupo de pacientes viviendo con VIH. Metodología: El diseño contempló un diagnóstico inicial (caracterización de pacientes y de la consulta nutricional en un servicio público secundario de salud) para identificar las necesidades locales, lo que se complementó con antecedentes bibliográficos. Se validó el contenido del protocolo mediante opinión de expertos, utilizando un cuestionario likert que evaluaba tres variables: formato, plan del protocolo de atención nutricional y calidad de contenido. Resultados: La propuesta de protocolo consta de flujogramas de atención, procedimientos de la atención nutricional y material educativo. En la validación participaron cinco expertos, según los cuales se debe asignar más tiempo para la atención de los pacientes, considerar la integración del equipo multidisciplinario en los flujogramas y a corto plazo se debe evaluar la confiabilidad y aplicabilidad del protocolo. Discusión: Esta propuesta es el primer documento orientado al manejo nutricional ambulatorio de pacientes con VIH desde las primeras etapas de la enfermedad en Chile. Es necesario realizar estudios que midan el impacto de la intervención nutricional en pacientes con VIH sin terapia antirretroviral.

  7. [Prevalence of chronic pruritus in patients of a tertiary care hospital].

    PubMed

    Guerrero-Ramos, Brenda; Hernández-Salazar, Amparo; Villaseñor-Ovies, Pablo; Tinoco-Fragoso, Fátima; Esquivel-Pedraza, Lilly; Domínguez-Cherit, Judith

    2014-01-01

    INTRODUCCIÓN: en ocasiones, el prurito crónico es intratable y afecta la calidad de vida. El objetivo de esta investigación fue describir la prevalencia de prurito en pacientes que acudieron a consulta por primera vez al Instituto Nacional de Nutrición y Ciencias Médicas “Salvador Zubirán”. MÉTODOS: estudio observacional y transversal. Se realizaron pre-encuestas a pacientes de nuevo ingreso, para identificar a quienes tenían prurito. Se investigaron características sociodemográficas, comorbilidades, fármacos de base, características del prurito y el impacto que tenía en la calidad de vida.

  8. [Bariatric surgery in adults: variables that facilitate and hinder weight loss from pacients perspective].

    PubMed

    Lecaros-Bravo, Javiera; Cruzat-Mandich, Claudia; Díaz-Castrillón, Fernanda; Moore-Infante, Catalina

    2015-04-01

    Introducción: La obesidad se ha convertido en un problema de salud pública a nivel mundial. Asociado a esto, las cirugías bariátricas han ido en progresivo aumento, dada su efectividad en la baja de peso a corto plazo. Sin embargo, se ha visto que existe un alto porcentaje de reganancia de peso a partir del tercer año post cirugía y existen pocos estudios de seguimiento de estos pacientes. Objetivos: Describir los facilitadores y obstaculizadores de la pérdida de peso, desde la perspectiva de adultos que han sido sometidos a cirugía bariátrica. Métodos: Se utilizó un enfoque cualitativo, descriptivo, basado en la Teoría Fundamentada. Se realizaron entrevistas en profundidad y los datos se analizaron a través de codificación abierta. La muestra estuvo compuesta por 8 mujeres y 3 hombres adultos, intervenidos en clínicas privadas. Resultados: Se generaron cinco categorías de análisis: (1) variables que favorecen la pérdida de peso post cirugía bariátrica, (2) variables que dificultan la pérdida y mantención de peso post cirugía, (3) evaluación de los resultados de la cirugía bariátrica, (4) problematización de la obesidad, y (5) relación con la comida. Discusión: Los principales hallazgos indican que el fracaso y el éxito en la pérdida de peso post cirugía se encuentra asociado a la posibilidad de tener una red de apoyo emocional y social, así como a la posibilidad de comprender y modificar el rol de la comida como mecanismo de regulación emocional.

  9. [Quality care in an intensive therapy unit at private hospital].

    PubMed

    Tejeda-Miranda, Mauricio; Anthon-Mendez, Francisco Javier; Esponda-Prado, Juan Gerardo; Rendón-Macías, Mario Enrique

    2015-01-01

    Introducción: el objetivo es evaluar la calidad de la atención en una unidad de terapia intensiva con índices internacionales de calidad. Métodos: estudio descriptivo, en una unidad de cuidados intensivos de atención privada en México. Se analizan los indicadores de 2012 con un total de 446 pacientes hospitalizados. Los indicadores de calidad fueron acordes a recomendaciones internacionales. La gravedad fue determinada por la escala SAPS III. Resultados: el indicador de neumonías asociadas a ventilación se encontró por debajo del estándar recomendado (11.7 frente a 12 por mil); la bacteremia relacionada a catéter venoso central en rangos aceptados (5.7 frente a 4 por mil). Las acciones de profilaxis de úlceras, prevención de tromboembolia pulmonar y prevención de caídas en altas proporciones de cumplimiento (> 90, > 95 % y 0 caídas). Las tasas de extubación no programada y reintubaciones estuvieron por debajo de los indicadores (< 1 por mil días intubación y < 12 %). La mortalidad fue menor a la estimada por la gravedad. Conclusión: En esta terapia la implementación de acciones recomendadas a nivel internacional ha permitido mantener una adecuada calidad de atención. El esfuerzo a impactado no solo a los pacientes con condiciones agudas de ingreso, sino también a pacientes con alto riesgo de mortalidad.

  10. Virtual Pediatric Hospital

    MedlinePlus

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

  11. [Music in the hospital].

    PubMed

    Bouteloup, Philippe

    2010-01-01

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

  12. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

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

  13. Hospitality Occupations. Curriculum Guide.

    ERIC Educational Resources Information Center

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

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

  14. Hospitality, Tourism, and Recreation.

    ERIC Educational Resources Information Center

    Novachek, James

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

  15. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

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

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

  16. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

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

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

  17. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

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

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

  18. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

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

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

  19. Hospitals are dangerous places.

    PubMed

    de Richemond, Albert L

    2010-01-01

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

  20. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

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

  1. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-01-04

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

  2. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-01-31

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

  3. Hospitality services generate revenue.

    PubMed

    Bizouati, S

    1993-01-01

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

  4. Leading a hospital closure.

    PubMed

    Lucey, Paula A

    2002-01-01

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

  5. Hospital benefit segmentation.

    PubMed

    Finn, D W; Lamb, C W

    1986-12-01

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

  6. Competition among hospitals.

    PubMed

    Gaynor, Martin; Vogt, William B

    2003-01-01

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

  7. Medication safety in hospitals.

    PubMed

    Kirke, C

    2009-01-01

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

  8. DISYUNTIVAS EN LAS CONCEPCIONES SOBRE AUTONOMÍA Y BENEFICENCIA QUE AFECTAN LA TERAPÉUTICA DEL INTENTO SUICIDA1

    PubMed Central

    Mondragón, Liliana; Monroy, Zuraya; Ito, Ma. Emily; Medina-Mora, Dra. Ma. Elena

    2010-01-01

    El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio. La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos. Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos. PMID:20830214

  9. DISYUNTIVAS EN LAS CONCEPCIONES SOBRE AUTONOMÍA Y BENEFICENCIA QUE AFECTAN LA TERAPÉUTICA DEL INTENTO SUICIDA.

    PubMed

    Mondragón, Liliana; Monroy, Zuraya; Ito, Ma Emily; Medina-Mora, Dra Ma Elena

    2010-06-01

    El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.

  10. [Yesterdays and happenings at hospitals of Tehuacán, Puebla, México].

    PubMed

    Fajardo-Ortiz, Guillermo

    2004-01-01

    The history of the hospital of Tehuacán, the second city importance in Puebla State, began in 1744, when the Hospital de San Juan de Dios (Hospital of St. John) was founded; in 1820, it was converted into the Municipal of Civil Hospital. The medical establishement continues to provide services to the poor to this day annual also covers health public workers of services for the municipality. The Hospital de la Cruz Roja Mexicana (The Mexican Red Cross Hospital) was created in 1934 provide medical services for accident victims: The hospital services of the Mexican Institute of Social Security (IMSS) began in 1953; an earthquake destroyed the building in 1973, and a new hospital was inaugurated in 1979; at present, it readers services to 98,000 persons. The Sanatorio del Sagrado Corazón (Sacred Heart Sanatorium) is a private religious institution founded at the beginning of the second half the 20th century. In 1996, the Hospital General (General Hospital) began to provide services, takes care of the poor of the geographical region, and is financed with federal funds. The Instituto de Seguridad y Servicios Sociales para Trabajadores del Estado (Institute of Securtiy and Social Services for the Workers of the State, ISSSTE) has a small hospital with 10 beds, it was founded in 1995.

  11. [Medullary carcinoma experience in breast oncology unit of Hospital Juarez Mexico].

    PubMed

    Jiménez-Villanueva, Xicoténcatl; Hernández-Rubio, Angela; García-Rodríguez, Francisco Mario; García, Rebeca Gil; Moreno-Eutimio, Mario; Herrera-Torre, Analy

    2014-01-01

    Antecedentes: el carcinoma de mama, variante medular, es poco frecuente y de buen pronóstico. Objetivo: conocer las características epidemiológicas y clínicas de la población atendida en el Hosital Juárez de México, saber si se asemejan a las descritas a nivel mundial y si los tratamientos propuestos internacionalmente son aplicables para este centro hospitalario. Material y métodos: estudio retrospectivo y descriptivo de 41 expedientes de pacientes con cáncer de mama tipo medular atendidas entre febrero de 1993 y febrero 2011. Resultados: se encontró que la incidencia de cáncer de mama de tipo medular fue de 3.04% en pacientes originarias de 11 estados mexicanos, con edad promedio de 50 años, nivel socioeconómico medio bajo para 39.02%, sin antecedentes familiares pero sí personales patológicos para: diabetes mellitus tipo 2, hipertensión arterial sistémica y cáncer de mama previo. Eran postmenopáusicas 63.41%. El promedio del tamaño clínico del tumor fue 58 mm, localizado en 63% de los casos en la mama izquierda. Los estadios clínicos fueron: 53.1% en I y II, 46.3% en III y 9.6% no etapificable. El 47% de las pacientes tenía ganglios linfáticos axilares positivos al momento del diagnóstico. La inmunohistoquímica sólo se reportó en 14 de las 41 pacientes; de acuerdo con la clasificación molecular para cáncer de mama: 8 fueron triple negativo, 2 luminal A, 1 luminal B y 3 Her2Neu. Conclusión: la población mexicana tiene características epidemiológicas y clínicas similares a las de las pacientes descritas en estudios internacionales.

  12. Guide to Choosing a Hospital

    MedlinePlus

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

  13. Hospitality as an Environmental Metaphor.

    ERIC Educational Resources Information Center

    Horwood, Bert

    1991-01-01

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

  14. Philanthropy and hospital financing.

    PubMed Central

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

    1995-01-01

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

  15. Hospitals' Internal Accountability

    PubMed Central

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

    2014-01-01

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

  16. [Antimicrobial resistance in uropathogens isolated in a pediatric hospital].

    PubMed

    Pérez-Pérez, Araceli; Peregrino-Bejarano, Leoncio; Camacho-Velázquez, Martha; Miranda-Novales, María Guadalupe

    2014-01-01

    INTRODUCCIÓN: la infección urinaria es una de las más comunes en todas las edades. Recientemente se ha incrementado la resistencia antimicrobiana. El objetivo del estudio fue determinar los agentes etiológicos más frecuentes de infección urinaria y sus perfiles de susceptibilidad antimicrobiana. MÉTODOS: se llevó a cabo una encuesta transversal descriptiva. Se incluyeron los pacientes con infección urinaria identificados durante un año. Se registró tipo de infección, condición de riesgo, tratamientos antimicrobianos, microorganismos y resistencia antimicrobiana. El análisis de los datos se llevó a cabo mediante estadística descriptiva.

  17. Hospitalizations for pediatric anaphylaxis.

    PubMed

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

    2008-01-01

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

  18. Efecto del Programa de Entrenamiento “Manejo del Dolor” en la Documentación de Enfermería en el Expediente Electrónico

    PubMed Central

    Monsiváis, María Guadalupe Moreno; Guzmán, Ma. Guadalupe Interial; Flores, Paz Francisco Sauceda; Arreola, Leticia Vázquez

    2012-01-01

    Resumen En el presente trabajo se muestra la importancia de entrenar al personal de enfermería para mejorar la documentación en el expediente electrónico. Se eligió el manejo del dolor por ser un área prioritaria; una alta proporción de pacientes en período post operatorio cursa con dolor, por lo tanto, la documentación debe ser útil para la toma de decisiones clínicas. Se implementó un programa de entrenamiento denominado “Manejo del Dolor” dirigido al personal de enfermería. Se utilizó la tecnología de la información como herramienta para fortalecer el conocimiento con base en la revisión sistemática de la literatura; el personal de enfermería participante seleccionó la mejor evidencia; posteriormente se trabajó en la transferencia de este conocimiento a la práctica a través del diseño de un protocolo para el manejo del dolor. Se concluye que el conocimiento del manejo del dolor es fundamental para que enfermería documente con mayor precisión sus intervenciones. PMID:24199106

  19. Predicting hospital accounting costs

    PubMed Central

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

    1989-01-01

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

  20. Hospital service recovery.

    PubMed

    Gutbezahl, Cary; Haan, Perry

    2006-01-01

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

  1. Hospital capital funding.

    PubMed

    Hebert, M

    1992-01-01

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

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

    PubMed Central

    Lorenzi, Nancy M.

    1969-01-01

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

  3. Hospital free cash flow.

    PubMed

    Kauer, R T; Silvers, J B

    1991-01-01

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

  4. American Hospital Association

    MedlinePlus

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

  5. General Practitioners in Hospital

    PubMed Central

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

    1970-01-01

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

  6. Home versus hospital confinement

    PubMed Central

    Barry, C. N.

    1980-01-01

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

  7. Objections to hospital philosophers.

    PubMed Central

    Ruddick, W; Finn, W

    1985-01-01

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

  8. Hospital-acquired thrombocytopenia.

    PubMed

    McMahon, Christine M; Cuker, Adam

    2014-10-01

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

  9. Practice Hospital Bed Safety

    MedlinePlus

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

  10. Fast tracking hospital construction.

    PubMed

    Quirk, Andrew

    2013-03-01

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

  11. Managing diversity in hospitals.

    PubMed

    Schwartz, R H; Sullivan, D B

    1993-01-01

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

  12. [Hospital organizational structure].

    PubMed

    Bittar, O J

    1994-01-01

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

  13. Salaries in psychiatric hospitals.

    PubMed

    Pope, D W

    1989-01-01

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

  14. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-02-27

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

  15. Recurrent psychiatric hospitalization.

    PubMed Central

    Voineskos, G.; Denault, S.

    1978-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  17. [Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation].

    PubMed

    Monje-Agudo, Patricia; Borrego-Izquierdo, Yolanda; Robustillo-Cortés, Ma de Las Aguas; Jiménez-Galán, Rocio; Almeida-González, Carmen V; Morillo-Verdugo, Ramón A

    2015-05-01

    Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma “excelente” a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria.

  18. [Psychiatric Hospital San Juan de Dios. One hundred years later].

    PubMed

    Cocula-León, Horacio

    2014-01-01

    Mental health and psychiatric diseases have always attracted people's and health authorities' attention due to its magical approach, the lack of knowledge that surrounds them, and, at the same time, the religious fear they provoke. Both have played an important role in the history of humanity, of public health politics, and of physicians. The places where psychiatric patients were treated are of historical interest, because through the historical knowledge we can identify an approach from the science and the health policies that prevailed in each age. At the beginning of the 20th century, it was developed in México a new model of hospital care attention to psychiatric patients. La Casa de Salud San Juan de Dios para Pacientes Alienados is an example; the concept "alienated patients" suggests a social and cultural perspective. This paper presents a chronological type description of one of the major institutions involved in mental health care in México. Similarly, it shows a review of the events that affected the religious order San Juan de Dios from 1901 to 2012, when the hospitaller order was reinstated in México and established the Casa de Salud San Juan de Dios para Pacientes Alienados in the town of Zapopan, Jalisco, institution that exists up to the present day and keeps participating in the mental health care in the state of Jalisco, with the current name of Servicios de Salud San Juan de Dios.

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

    PubMed

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

    2017-09-01

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

  20. [Healthcare management of an epilepsy clinic: factors involved in the demand for health care and clinical situation of patients].

    PubMed

    García-Martín, Guillermina; Martín-Reyes, Guillermina; Dawid-Milner, Marc Stefan; Chamorro-Muñoz, M Isabel; Pérez-Errazquin, Francisco; Romero-Acebal, Manuel

    2013-05-16

    Introduccion. La epilepsia es una enfermedad cronica que implica un seguimiento periodico del paciente a largo plazo, lo que supone un aumento del numero de pacientes visitados con el tiempo y, por tanto, un coste al sistema sanitario. Objetivo. Determinar los factores implicados en el tiempo para la siguiente visita de un paciente epileptico. Pacientes y metodos. Seleccion de pacientes durante un ano que acuden consecutivamente a consulta de epilepsia de nuestro hospital. Se analiza su situacion clinica y relacion con el consejo medico dado, y los factores implicados en el tiempo transcurrido hasta la siguiente visita mediante modelos econometricos predictivos. Resultados. Existe una clara asociacion entre la situacion clinica del paciente y la modificacion del tratamiento propuesta por el neurologo en la visita anterior. Los factores implicados en el tiempo hasta la siguiente visita fueron frecuencia de crisis, efectos adversos medicamentosos, sobre todo los que afectan a la cognicion, y consejo medico al paciente. No resultaron significativos la politerapia, los trastornos psicoafectivos ni la situacion social del paciente. Conclusiones. El seguimiento en una consulta especifica de epilepsia mejora la situacion del paciente. Se trata del primer analisis de demanda asistencial en pacientes con epilepsia realizado mediante metodos econometricos y desde una perspectiva mixta medico-paciente. Dado que los factores que determinan el tiempo para la siguiente visita son modificables, podria disminuir el numero de visitas al ano, mejorando la situacion clinica de los pacientes. Proponemos una mayor duracion por visita para poder incidir en ello y reducir costes a largo plazo.

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

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

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

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

    PubMed

    Hard, R

    1992-05-20

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

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

    PubMed

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

    2004-01-01

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

  4. [Integration of a software for hospital nutritional support prescription and the electronic medical record].

    PubMed

    Alfaro Martínez, José Joaquín; López Díaz, Mariano; Hernández López, Antonio; Gonzalvo Díaz, César; Botella Romero, Francisco

    2013-01-01

    Introducción: La prescripción y seguimiento de la nutrición parenteral es un acto médico que debe ser correctamente documentado y que precisa de una adecuada comunicación entre médicos, farmacéuticos y personal de enfermería. Dicha prescripción puede realizarse mediante órdenes y formularios en papel o con aplicaciones informáticas, en cuyo caso surge la dificultad de su integración con el resto de la informática hospitalaria. Presentamos la experiencia de nuestro centro en la integración de un programa informático de prescripción de nutrición hospitalaria con la historia clínica electrónica. Material y métodos: Con objeto de desarrollar una aplicación informática de prescripción de nutrición artificial se llevaron a cabo reuniones entre personal de la Unidad de Nutrición Clínica y el Servicio de Informática donde se establecieron las necesidades de los servicios implicados y las características que debía tener la aplicación. Descripción de la aplicación: El programa informático permite la prescripción de nutrición parenteral componente por componente o mediante plantillas prediseñadas, genera alertas en caso de valores extremos de componentes o posible incompatibilidad físico-química, importa y almacena los resultados de las analíti cas de los pacientes y escribe la composición de la fórmula de nutrición parenteral prescrita en la historia clínica electrónica, entre otras características. Discusión: Nuestra experiencia muestra que la colaboración entre los servicios clínicos y de Informática permite desarrollar aplicaciones hospitalarias adaptadas a la forma de trabajo de los equipos clínicos y que pueden integrarse con el resto de los programas informáticos del hospital.

  5. [Characteristics of Hospitalizations of Homeless Persons in Seville, Spain].

    PubMed

    Tornero Patricio, Sebastián; Fernández Ajuria, Alberto; Charris Castro, Liliana

    2016-02-10

    The aim was to determine the characteristics of hospital admissions of homeless persons in Seville, Spain. Observational study of 103,802 hospital admissions of 71,756 patients admitted in the Hospitals "Virgen del Rocío" and "Virgen Macarena" (Seville), in 2013 and 2014. Bivariate analysis were performed using χ2 and t-Student tests and multivariate analysis using binomial logistic regression model. 0.16% (n=163) of admissions were homeless persons and 99.84% (n=103,639) were not. The mean age at admission in homeless patients was 48 years and 76.5% of them were men. Hospital deaths of homeless patients occurred being 23 years younger. 92% of hospital admissions came from emergency departments and 10.0% of their discharges were against medical advice. The average length of stay was 4.8 days longer in homeless persons and the most frequent diagnoses on admission were mental (27.0%), infectious (19.6%) and respiratory diseases (18.4%). Mental disorders were present on 83.7% of homeless patients as secondary diagnose and 77.6% referred drugs consumption. Hospital admissions characteristics of homeless persons were particularly different. Homeless patients were hospitalized and died at a younger age than non-homeless patients. The morbidity and mortality of homeless persons reflect their vulnerable health condition.

  6. [Prevalence of potentially inappropriate medication in hospitalized elderly patients by using explicit criteria].

    PubMed

    Galán Retamal, C; Garrido Fernández, R; Fernández Espínola, S; Ruiz Serrato, A; García Ordóñez, M A; Padilla Marín, V

    2014-07-01

    INTRODUCCIÓN: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y se asocia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. MÉTODO: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM.

  7. [Marianne in hospital].

    PubMed

    Weium, Frode

    2003-12-23

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

  8. [Stress management in hospitals].

    PubMed

    Miki, Akiko

    2002-11-01

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

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

    PubMed

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

    2012-02-01

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

  10. [Standardization of hospital feeding].

    PubMed

    Caracuel García, Ángel Manuel

    2015-05-07

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

  11. Tiered hospital networks.

    PubMed

    Yegian, Jill M

    2003-01-01

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

  12. Marketing the hospital library.

    PubMed

    Bridges, Jane

    2005-01-01

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

  13. Telecommunications and the hospital.

    PubMed

    Tobias, T; Levine, J

    1986-04-01

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

  14. Toward healthier hospitals.

    PubMed

    Mintzberg, H

    1997-01-01

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

  15. [Burden of hospitalization for pneumonia in a Spanish tertiary hospital. Period 2009-2014].

    PubMed

    López-Gobernado, Miguel; Pérez-Rubio, Alberto; López-García, Eva; Mayo-Iscar, Agustín; Eiros, José María

    2017-01-01

    Introducción: el objetivo de este trabajo es estimar la carga de hospitalización por neumonía adquirida en la comunidad y neumonía neumocócica en un hospital de nivel terciario del Sistema Nacional de Salud Español. Métodos: estudio retrospectivo en el que se recogen los datos del Conjunto Mínimo de Datos Básicos que usa códigos clínicos del Código Internacional de Enfermedades, asi como el índice de hospitalización por mil habitantes, la tasa de hospitalización por mil habitantes, el índice de mortalidad y la tasa de letalidad, usando como denominador los datos demográficos de la población del Área de Salud. Resultados: la descarga de 5758 episodios codificados con los códigos CIE 480 a 486 relativos a neumonía, señalan un índice de hospitalización de 3.54 personas hospitalizadas por cada 1000 habitantes, 65.34% del total de ingresos hospitalarios se produce en los Servicios de Medicina Interna y de Neumología. La estancia media hospitalaria por año es de 16.63 días. La tasa bruta de mortalidad es de 69.15 cada 100 000 y la tasa de letalidad de 19.56%, siendo más elevadas en adultos mayores de 65 años. Conclusiones: a pesar de las medidas terapéuticas y preventivas actuales, la incidencia y la mortalidad por neumonía adquirida en la comunidad en adultos se mantienen elevadas, lo que justifica fortalecer y abordar nuevas estrategias de concienciación y prevención.

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

    PubMed

    Melnick, Glenn A; Fonkych, Katya

    2016-01-01

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

  17. Il problema del litio.

    NASA Astrophysics Data System (ADS)

    D'Antona, F.

    1995-03-01

    Contents: 1. Introduzione. 2. La nucleosintesi del Big Bang. 3. Il litio nelle stelle di popolazione II. 4. I modelli stellari standard. 5. Il litio negli ammassi aperti. 6. Meccanismi di distruzione "non standard". 7. I modelli non-standard applicati alla popolazione II. 8. L'evoluzione Galattica del litio. 9. Quali stelle producono litio? 10. Il litio come elemento chiave per dare un nome agli oggetti stellari più minuscoli. 11. Conclusioni.

  18. Espectroscopia del Cometa Halley

    NASA Astrophysics Data System (ADS)

    Naranjo, O.; Fuenmayor, F.; Ferrin, L.; Bulka, P.; Mendoza, C.

    1987-05-01

    Se reportan observaciones espectroscópicas del cometa Halley. Los espectros fueron tomados usando el espectrógrafo del telescopio reflector de 1 metro del Observatorio Nacional de Venezuela. Se utilizó óptica azul, con una red de difracción de 600 lineas/min, obteniéndose una dispersión de 74.2 A/mm y una resolución de 2.5 A, en el rango espectral de 3500 a 6500 A. Seis placas fueron tomadas con emulsión IIa-O y dos con IIa-D. Los tiempos de exposición fueron entre 10 y 150 minutos. El cometa se encontraba entre 0.70 y 1.04 UA del Sol, y entre 1.28 y 0.73 UA de la Tierra. Las emisiones más prominentes en el espectro, son las del CN, C2, y C3. Otras emisiones detectadas corresponden a CH, NH2 y Na. Los espectros muestran un fuerte continuo, indicando un contenido significativo de polvo. Se detectó mayor intensidad del contínuo, en la dirección anti solar, lo cual es evidencia de la cola de polvo.

  19. Cost characteristics of hospitals.

    PubMed

    Smet, Mike

    2002-09-01

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

  20. Hospital restructuring and burnout.

    PubMed

    Greenglass, Esther R; Burke, Ronald J

    2002-01-01

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

  1. Innovations in Hospitality Industry

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  2. In-hospital resuscitation.

    PubMed

    Mason, Christine

    2016-09-21

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

  3. Hospital perceived value.

    PubMed

    Moliner, Miguel A

    2006-01-01

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

  4. Responsible Hospitality. Prevention Updates

    ERIC Educational Resources Information Center

    Colthurst, Tom

    2004-01-01

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

  5. Speech intelligibility in hospitals.

    PubMed

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

    2013-07-01

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

  6. Toilet privacy in hospital.

    PubMed

    Logan, Karen

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

  7. Drama Therapies in Hospitals

    ERIC Educational Resources Information Center

    Goodman, Judith; Prosperi, Mario

    1976-01-01

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

  8. Dying in hospital.

    PubMed

    Pearce, Lynne

    2016-06-22

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

  9. Reengineering hospital materiel management.

    PubMed

    Giunipero, L C

    1995-08-01

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

  10. Mechanical engineering in hospitals.

    PubMed

    Wallington, J W

    1980-10-01

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

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

    PubMed Central

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

    1991-01-01

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

  12. [Clinic of humoral primary immunodeficiencies in adults. Experience in a tertiary hospital].

    PubMed

    Cambray-Gutiérrez, Julio César; Herrera-Sánchez, Diana Andrea; Blancas-Galicia, Lizbeth; O'Farrill-Romanillos, Patricia María

    2016-01-01

    Antecedentes: Las inmunodeficiencias primarias (IDP) son trastornos de los componentes del sistema inmune. Las deficiencias humorales representan el 50%. Las más comunes son el déficit selectivo de IgA, agammaglobulinemia de Bruton y la inmunodeficiencia común variable (IDCV). Objetivo: Describir las características epidemiológicas y clínicas de adultos con IDP humorales, atendidos en una Clínica de Inmunodeficiencias Primarias Humorales. Métodos: Estudio descriptivo trasversal que abarcó un año de análisis, en el que se incluyeron 35 pacientes con IDP humoral. Los datos se analizaron con estadística descriptiva. Resultados: De 35 pacientes estudiados, 31 tuvieron IDCV (88.5%) y 4 (11.5%) agammaglobulinemia de Bruton; 21 fueron hombres y 14 mujeres. La edad al inicio de los síntomas fue de 22.7 años y el tiempo de retraso en el diagnóstico fue de 7.2 años; 11.4% de los pacientes con IDCV fallecieron durante el estudio; 4 padecieron neoplasias, 22.8% enfermedades autoinmunes y 48.5% alteraciones gastrointestinales. Los pacientes con agammaglobulinemia de Bruton no presentaron comorbilidades. Conclusiones: A diferencia de lo informado en la literatura, la IDCV fue la causa más común de IDP humoral en el grupo estudiado, con predominio en hombres; la alteración gastrointestinal más común fue el trastorno funcional intestinal.

  13. Patient safety in organizational culture as perceived by leaderships of hospital institutions with different types of administration.

    PubMed

    Silva, Natasha Dejigov Monteiro da; Barbosa, Antonio Pires; Padilha, Kátia Grillo; Malik, Ana Maria

    2016-01-01

    To identify the perceptions of leaderships toward patient safety culture dimensions in the routine of hospitals with different administrative profiles: government, social and private organizations, and make correlations among participating institutions regarding dimensions of patient safety culture used. A quantitative cross-sectional study that used the Self Assessment Questionnaire 30 translated into Portuguese. The data were processed by analysis of variance (ANOVA) in addition to descriptive statistics, with statistical significance set at p-value ≤ 0.05. According to the participants' perceptions, the significant dimensions of patient safety culture were 'patient safety climate' and 'organizational learning', with 81% explanatory power. Mean scores showed that among private organizations, higher values were attributed to statements; however, the correlation between dimensions was stronger among government hospitals. Different hospital organizations present distinct values for each dimension of patient safety culture and their investigation enables professionals to identify which dimensions need to be introduced or improved to increase patient safety. Identificar percepções das lideranças sobre as dimensões da cultura de segurança do paciente no cotidiano de hospitais de diferentes perfis administrativos: públicos, organizações sociais e privados, e realizar correlação entre as instituições participantes, de acordo com as dimensões da cultura de segurança do paciente utilizadas. Estudo transversal de aspecto quantitativo obtido por meio da aplicação do instrumento Self Assessment Questionnaire 30, traduzido para a língua portuguesa. Os dados foram tratados com análise de variância (ANOVA), além das estatísticas descritivas, considerando como de significância estatística valores de p-valor ≤ 0,05. Segundo a percepção dos participantes do estudo, as dimensões significativas para a cultura de segurança do paciente foram Ambiente de

  14. [Leadership in the hospital].

    PubMed

    Schrappe, Matthias

    2009-01-01

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

  15. The frontline hospital.

    PubMed

    Mein, P

    1983-01-01

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

  16. Improving Hospital Discharge Time

    PubMed Central

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

    2015-01-01

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

  17. [The founding of Zemun Hospital].

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    1986-02-01

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

  19. The politics of hospital payment.

    PubMed

    Feder, J; Spitz, B

    1979-01-01

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

  20. How consumers view hospital advertising.

    PubMed

    Johns, H E; Moser, H R

    1988-01-01

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

  1. [A SIMPLE AND RELIABLE TOOL FOR DETECTION OF NUTRITIONAL RISK IN HOSPITALIZED PATIENTS].

    PubMed

    Padilla-Romo, Martha; Martinez-Cordero, Erika; Martinez-Cordero, Claudia

    2015-07-01

    Introducción: la desnutrición hospitalaria se asocia con retraso en la curación, mayor tiempo de hospitalización y gasto económico. Los hospitales requieren un instrumento sencillo para detectar un posible riesgo nutricional. Objetivo: evaluar la concordancia entre un formato de tamizaje utilizado en un hospital de tercer nivel y los instrumentos validados MUST y SGA para diagnosticar el riesgo nutricional. Métodos: pacientes con periodo de hospitalización menor a 36 horas fueron valorados con los tres tamizajes nutricionales. Utilizamos valor kappa para medir la concordancia entre las herramientas de tamizaje; el instrumento SGA fue el estándar de oro. Resultados: el estudio incluyó 100 pacientes (F = 49, M = 51) con una edad media de 49 años. MUST presentó buena concordancia con el SGA (kappa = 0,55). Conclusiones: MUST presentó mayor concordancia con el estándar de oro; por lo tanto, el MUST debería utilizarse para el tamizaje nutricional de los pacientes que ingresan en hospitales debido a su sencillez, fiabilidad y reproducibilidad.

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

    PubMed

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

    2016-11-21

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

  3. Resource Requirements Planning for Hospitals Treating Serious Infectious Disease Cases

    SciTech Connect

    Vugrin, Eric D.; Verzi, Stephen Joseph; Finley, Patrick D.; Turnquist, Mark A.; Wyte-Lake, Tamar; Griffin, Ann R.; Ricci, Karen J.; Plotinsky, Rachel

    2015-02-01

    This report presents a mathematical model of the way in which a hospital uses a variety of resources, utilities and consumables to provide care to a set of in-patients, and how that hospital might adapt to provide treatment to a few patients with a serious infectious disease, like the Ebola virus. The intended purpose of the model is to support requirements planning studies, so that hospitals may be better prepared for situations that are likely to strain their available resources. The current model is a prototype designed to present the basic structural elements of a requirements planning analysis. Some simple illustrati ve experiments establish the mo del's general capabilities. With additional inve stment in model enhancement a nd calibration, this prototype could be developed into a useful planning tool for ho spital administrators and health care policy makers.

  4. [Hospital clinical ethics committees].

    PubMed

    Gómez Velásquez, Luis; Gómez Espinosa, Luis Néstor

    2007-01-01

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

  5. Desgarros del epitelio pigmentario de la retina: factores de riesgo, mecanismo y control terapéutico.

    PubMed

    Clemens, Christoph R; Eter, Nicole

    2017-07-11

    Los desgarros del epitelio pigmentario de la retina (EPR) se asocian en la mayoría de los casos con los desprendimientos vascularizados del EPR debido a una degeneración macular asociada a la edad (DMAE), y normalmente implican una pérdida adversa de la agudeza visual. Estudios recientes indican que ha habido un aumento en la incidencia de desgarros del EPR desde la introducción de fármacos anti-factor de crecimiento del endotelio vascular (anti-VEGF) así como una asociación temporal entre el desgarro y la inyección intravítrea. Dado que el número de pacientes con DMAE y el número de inyecciones anti-VEGF va en aumento, tanto la dificultad de prevenir desgarros del EPR como el tratamiento tras la formación de los desgarros han adquirido una mayor relevancia. De forma paralela, la evolución de la imagenología de la retina ha contribuido de manera significativa a comprender mejor el desarrollo de los desgarros del EPR en los últimos años. Esta revisión resume los conocimientos que se poseen actualmente sobre el desarrollo, los factores pronósticos y las estrategias terapéuticas de los desgarros del EPR antes y después de que estos se formen. © 2017 S. Karger AG, Basel.

  6. Remisión de aneurisma luego de exéresis de MAV con aparición de síndrome del acento extranjero

    PubMed Central

    Sosa, Fidel; Bustamante, Jorge; Rodríguez, Facundo; Argañaraz, Romina; Rubino, Pablo; Lambre, Jorge

    2017-01-01

    Resumen Introducción: Los aneurismas asociados a malformaciones arteriovenosas (MAV) son lesiones vasculares que suelen encontrarse hasta en el 15% de los casos, incrementando el riesgo global de hemorragia. La conducta frente a los aneurismas asociados es dicotómica en la literatura, mientras existen reportes de la desaparición de los mismos luego de la exéresis de la MAV, otros artículos enfatizan su tratamiento precoz. El síndrome del acento extranjero es un raro trastorno neurológico en el que el paciente habla su lengua materna como lo haría una persona extranjera y suena con “acento” extranjero a oídos de los oyentes nativos. Objetivo: Presentar un paciente que desarrolla el síndrome del acento extranjero posterior a la exéresis de una MAV y la evolución de un aneurisma asociado. Presentación de caso: Paciente pediátrico que luego de la exéresis de una MAV fronto-opercular posterior izquierda remite por completo un aneurisma de hiperflujo asociado, presentando en el postquirúrgico el síndrome del acento extranjero. Conclusión: Queda reportado el caso de este raro síndrome y la resolución espontánea de un aneurisma proximal luego de la exéresis de una MAV. PMID:28480115

  7. Nutritional status of patients with gastrointestinal cancer receiving care in a public hospital; 2010-2011.

    PubMed

    Dias do Prado, Corina; Alvares Duarte Bonini Campos, Juliana

    2013-01-01

    Objetivo: Identificar el estado nutricional de los pacientes con cáncer gastrointestinal y verificar su asociación con características demográficas y clínicas. Métodos: Se realizó un estudio transversal, con un diseño de muestreo no probabilístico. Los participantes fueron 143 pacientes adultos con cáncer gastrointestinal, que reciben atención en el Hospital Amaral Carvalho (Jaú-SP, Brasil) entre noviembre de 2010 y octubre de 2011. Se realizó una encuesta para recoger información con el fin de caracterización demográfica y clínica. Para identificar el estado nutricional se aplico la Valoración Subjetiva Global - Generada por el Paciente Score (VSGGP score). La razón de prevalencia (RP) fue estimada. El nivel de significancia adoptado fue de 5%. Resultados: La edad media de los pacientes fue de 57,45 (DE = 9,62) AÑOs, con los estadíos III y IV de la enfermedad es la más frecuente (39,2% y 35,0%). Había 44,8% de prevalencia de la malnutrición. La persona desnutrida tenía problemas más frecuentes para comer. La estadística descriptiva y la prueba de Chi-cuadrado (< 0,001), presentaron menor deseo de comer (p < 0,001), más náuseas (p = 0,001), vómitos (p = 0,006), estreñimiento (p < 0,001) y dolor (p < 0,001) que los pacientes eutróficos y se declararon enfermos por el olor de los alimentos (p = 0,012), dificultad para tragar (p = 0,002) y la saciedad precoz (p = 0,020) com más frecuencia. En cuanto a la proporción de prevalencia, se observó una probabilidad mayor de individuos desnutridos expuestos a una porción más grande de los síntomas relacionados en la puntuación VSG-GP score. Conclusión: La alta prevalencia de desnutrición se observó en pacientes con cáncer gastrointestinal, con asociación significativa con los síntomas clínicos directamente relacionados con el proceso de alimentación.

  8. Hospital Library Development. Hospital Library Handbooks No. 2.

    ERIC Educational Resources Information Center

    Cramer, Anne

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

  9. Hospital Preparedness and SARS

    PubMed Central

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

    2004-01-01

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

  10. Dementia for hospital physicians.

    PubMed

    Harwood, Rowan H

    2012-02-01

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

  11. [Homicide crimes in hospitals].

    PubMed

    Dürwald, W

    1993-02-01

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

  12. Children's Hospital visit

    NASA Image and Video Library

    2011-02-04

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

  13. Hospital nurses' work motivation.

    PubMed

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

    2015-06-01

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

  14. Community Hospital Telehealth Consortium

    DTIC Science & Technology

    2007-04-01

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

  15. Hospital labs go under microscope.

    PubMed

    Aston, Geri

    2014-05-01

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

  16. Hospitals report on cancer centers.

    PubMed

    Rees, T

    2001-01-01

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

  17. [Day Hospital: history and conceptualization].

    PubMed

    Stagnaro, Juan C

    2012-01-01

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

  18. Hospital clowning: a paediatrician's view.

    PubMed

    van Venrooij, Lennard T; Barnhoorn, Pieter C

    2017-02-01

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

  19. The practice of hospital epidemiology.

    PubMed Central

    Hierholzer, W. J.

    1982-01-01

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

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

    PubMed Central

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

    2000-01-01

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

  1. Library Hospitality: Some Preliminary Considerations

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  2. Childrens Hospital Inservice Education Curriculum.

    ERIC Educational Resources Information Center

    Lutz, Joan

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

  3. Childrens Hospital Inservice Education Curriculum.

    ERIC Educational Resources Information Center

    Lutz, Joan

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

  4. Hospitality Studies: Escaping the Tyranny?

    ERIC Educational Resources Information Center

    Lashley, Conrad

    2015-01-01

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

  5. Hospitality Services. Student Activity Book.

    ERIC Educational Resources Information Center

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

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

  6. Library Hospitality: Some Preliminary Considerations

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  7. Hospitality Services. Student Activity Book.

    ERIC Educational Resources Information Center

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

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

  8. Hospitality in College Composition Courses

    ERIC Educational Resources Information Center

    Haswell, Janis; Haswell, Richard; Blalock, Glenn

    2009-01-01

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

  9. Hospitality Studies: Escaping the Tyranny?

    ERIC Educational Resources Information Center

    Lashley, Conrad

    2015-01-01

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

  10. Hospital mergers and market overlap.

    PubMed Central

    Brooks, G R; Jones, V G

    1997-01-01

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

  11. Hospital mergers and market overlap.

    PubMed

    Brooks, G R; Jones, V G

    1997-02-01

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

  12. Mother-baby friendly hospital.

    PubMed

    Aragon-choudhury, P

    1996-01-01

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

  13. Hospital closure and economic efficiency.

    PubMed

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

    2010-01-01

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

  14. An ideal hospital.

    PubMed

    Chandrasiri, Singithi Sidney

    2017-07-03

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

  15. Variations in hospital administrative costs.

    PubMed

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

    2008-01-01

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

  16. Hospital Acquisitions Before Healthcare Reform.

    PubMed

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

    2015-01-01

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

  17. [Success factors in hospital management].

    PubMed

    Heberer, M

    1998-12-01

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

  18. Max Brödel's contributions to otolaryngology-head and neck surgery.

    PubMed

    Papel, I D

    1986-11-01

    Max Brödel arrived in the United States in 1894 to work as a medical illustrator at the Johns Hopkins Hospital. He brought with him an extensive background in medical sciences and illustration. This allowed him to develop an advanced style and technique that would greatly influence the profession of medical illustration. Much of Brödel's work concerned the head and neck region and is of particular interest to otolaryngologists. This article reviews the historical aspects of Brödel's career and highlights his contributions to Otolaryngology-Head and Neck Surgery.

  19. Estudio del CH interestelar

    NASA Astrophysics Data System (ADS)

    Olano, C.; Lemarchand, G.; Sanz, A. J.; Bava, J. A.

    El objetivo principal de este proyecto consiste en el estudio de la distribución y abundancia del CH en nubes interestelares a través de la observación de las líneas hiperfinas del CH en 3,3 GHz. El CH es una molécula de amplia distribución en el espacio interestelar y una de las pocas especies que han sido observadas tanto con técnicas de radio como ópticas. Desde el punto de vista tecnológico se ha desarrollado un cabezal de receptor que permitirá la realización de observaciones polarimétricas en la frecuencia de 3,3 GHz, con una temperatura del sistema de 60 K y un ancho de banda de 140 MHz, y que será instalado en el foco primario de la antena parabólica del IAR. El cabezal del receptor es capaz de detectar señales polarizadas, separando las componentes de polarización circular derecha e izquierda. Para tal fin el cabezal consta de dos ramas receptoras que amplificarán la señal y la trasladarán a una frecuencia más baja (frecuencia intermedia), permitiendo de esa forma un mejor transporte de la señal a la sala de control para su posterior procesamiento. El receptor además de tener características polarimétricas, podrá ser usado en el continuo y en la línea, utilizando las ventajas observacionales y de procesamiento de señal que actualmente posee el IAR.

  20. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

    PubMed

    Torres, Antoni; Niederman, Michael S; Chastre, Jean; Ewig, Santiago; Fernandez-Vandellos, Patricia; Hanberger, Hakan; Kollef, Marin; Li Bassi, Gianluigi; Luna, Carlos M; Martin-Loeches, Ignacio; Paiva, J Artur; Read, Robert C; Rigau, David; Timsit, Jean François; Welte, Tobias; Wunderink, Richard

    2017-09-01

    The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention. Copyright ©ERS 2017.

  1. Use of Web 2.0 tools by hospital pharmacists.

    PubMed

    Bonaga Serrano, B; Aldaz Francés, R; Garrigues Sebastiá, M R; Hernández San Salvador, M

    2014-04-01

    Objetivo: Las herramientas de la Web 2.0 están transformando los canales que los profesionales sanitarios emplean para comunicarse entre sí y con los pacientes por lo que esta situación obliga a un cambio de mentalidad para implementarlas. El objetivo de este estudio fue evaluar el grado de conocimiento y aplicación de las principales herramientas Web 2.0 por parte de farmacéuticos hospitalarios. Método: El estudio se llevó a cabo mediante una encuesta anómina dirigida a todos los miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) a través de la aplicación Google Drive®. Después de completarse los 3 meses del período de estudio, los datos recogidos se analizaron usando SPPS v15.0. Resultados: La tasa de respuesta fue del 7,3%, siendo el 70,5% mujeres y el 76,3 % especialistas. La mayoría de los que respondieron (54,2%) estaban en el rango de edad de 20 a 35 años. Pubmed fue el medio principal de acceder a los artículos publicados. El 65,2% de los farmacéuticos conocía el término “Web 2.0”. El 45,3% eran usuarios de Twitter, de los cuales un 58,9% principalmente para uso profesional. La mayoría creía que Twitter era una buena herramienta para interactuar entre los profesionales y los pacientes. El 78,7% no usaba un agregador, pero cuando lo hacían, Google Reader era el más habitual. Conclusión: Aunque las aplicaciones de la Web 2.0 están ganando popularidad, algunos profesionales sanitarios se resisten a utilizarlas. De hecho, más de la mitad de los farmacéuticos entrevistados manifestaba un nulo conocimiento de las herramientas de la Web 2.0. Sería positivo que los farmacéuticos las usasen adecuadamente durante su práctica profesional para sacarles el máximo partido.

  2. Hospitality and Collegial Community: An Essay.

    ERIC Educational Resources Information Center

    Bennett, John B.

    2000-01-01

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

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

    PubMed

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

    2015-01-01

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

  4. Electronic Cigarettes on Hospital Campuses

    PubMed Central

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

    2015-01-01

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

  5. Electronic Cigarettes on Hospital Campuses.

    PubMed

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

    2015-12-29

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2017-09-14

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

  8. Strategies and performance in hospitals.

    PubMed

    Madorrán García, Cristina; de Val Pardo, Isabel

    2004-01-01

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

  9. The economics of specialty hospitals.

    PubMed

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

    2008-10-01

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

  10. Does outsourcing affect hospital profitability?

    PubMed

    Danvers, Kreag; Nikolov, Pavel

    2010-01-01

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

  11. Union Density and Hospital Outcomes.

    PubMed

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

    2015-01-01

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

  12. Controlling hospital library theft

    PubMed Central

    Cuddy, Theresa M.; Marchok, Catherine

    2003-01-01

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

  13. Breath of hospitality.

    PubMed

    Škof, Lenart

    2016-12-01

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

  14. Controlling hospital library theft.

    PubMed

    Cuddy, Theresa M; Marchok, Catherine

    2003-04-01

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

  15. Accidents on hospital wards.

    PubMed Central

    Levene, S; Bonfield, G

    1991-01-01

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

  16. [Quality and efficiency in hospitals].

    PubMed

    Paganini, J M

    1993-12-01

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

  17. RFID solution benefits Cambridge hospital.

    PubMed

    James, Andrew

    2013-10-01

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

  18. Determinants of Hospital Casemix Complexity

    PubMed Central

    Becker, Edmund R.; Steinwald, Bruce

    1981-01-01

    Using the Commission on Professional and Hospital Activities' Resource Need Index as a measure of casemix complexity, this paper examines the relative contributions of teaching commitment and other hospital characteristics, hospital service and insurer distributions, and area characteristics to variations in casemix complexity. The empirical estimates indicate that all three types of independent variables have a substantial influence. These results are discussed in light of recent casemix research as well as current policy implications. PMID:6799430

  19. Cross hospital bed management system.

    PubMed

    Abedian, S; Kazemi, H; Riazi, H; Bitaraf, E

    2014-01-01

    The lack of adequate numbers of hospital beds to accommodate the injured is a main problem in public hospitals. For control of occupancy of bed, we design a dynamic system that announces status of bed when it change with admission or discharge of a patient. This system provide a wide network in country for bed management, especially for ICU and CCU beds that help us to distribute injured patient in the hospitals.

  20. [Rules for psychiatric emergency hospitalization].

    PubMed

    Pichené, Catherine

    2003-06-01

    The author describe how psychiatric emergencies are dealt with in France. Emergency rooms can admit these patients 24 hours a day particularly somato-psychiatric emergencies as well as situations of existential crisis. Many psychiatric hospitals have also designed a 24 hours a day response to emergencies but with a great diversity depending on local situations. Free-will hospitalization is the most common response but some situations can require commitment to a psychiatric hospital. The author describes in details the enforcement of the law in the case of hospitalization without patients's consent.

  1. Hospital Ethics Committees in Poland.

    PubMed

    Czarkowski, Marek; Kaczmarczyk, Katarzyna; Szymańska, Beata

    2015-12-01

    According to UNESCO guidelines, one of the four forms of bioethics committees in medicine are the Hospital Ethics Committees (HECs). The purpose of this study was to evaluate how the above guidelines are implemented in real practice. There were 111 hospitals selected out of 176 Polish clinical hospitals and hospitals accredited by Center of Monitoring Quality in Health System. The study was conducted by the survey method. There were 56 (50%) hospitals that responded to the survey. The number of HECs members fluctuated between 3 and 16 members, where usually 5 (22% of HECs) members were part of the board committee. The composition of the HECs for professions other than physicians was diverse and non-standardized (nurses-in 86% of HECs, clergy-42%, lawyers-38%, psychologists-28%, hospital management-23%, rehab staff-7 %, patient representatives-3%, ethicists-2%). Only 55% of HECs had a professional set of standards. 98% of HECs had specific tasks. 62% of HECs were asked for their expertise, and 55% prepared <6.88% of the opinions were related to interpersonal relations between hospital personnel, patients and their families with emphasis on the interactions between superiors and their inferiors or hospital staff and patients and their families. Only 12% of the opinions were reported by the respondents as related to ethical dilemmas. In conclusion, few Polish hospitals have HECs, and the structure, services and workload are not always adequate. To ensure a reliable operation of HECs requires the development of relevant legislation, standard operating procedures and well trained members.

  2. Wearing gloves in the hospital

    MedlinePlus

    Infection control - wearing gloves; Patient safety - wearing gloves; Personal protective equipment - wearing gloves; PPE - wearing gloves; Nosocomial infection - wearing gloves; Hospital acquired infection - wearing gloves

  3. Nevado del Huila, Columbia

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Nevado del Huila Volcano in Colombia is actually a volcanic chain running north to south, capped by a glacier. With peaks ranging in height from 2,600 to 5,780 meters (8,530 to 18,960 feet), Nevado del Huila is a stratovolcano composed of alternating layers of hardened lava, solidified ash, and volcanic rocks. Its first recorded eruption occurred in the mid-sixteenth century. The long-dormant volcano erupted again in mid-April 2007. A few months before the eruption, the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) on NASA's Terra satellite captured this image of Nevado del Huila, on February 23, 2007. In this image, the bright white area just east of the central summit is ice. Immediately west of the summit are bare rocks, appearing as blue-gray. West of those rocks, white reappears, but this patch of white results from clouds hovering in the nearby valley. In the east, the colors turn to brown (indicating bare rock) and bright green (indicating vegetation). ASTER photographed Nevado del Huila near the end of a long phase of quietude. On April 17, 2007, local authorities recorded seismic activity associated with rock fracturing on the volcano's central summit, according to the ReliefWeb Website. Activity intensified the following day with an eruption and mudflows, forcing thousands of nearby residents to evacuate. As the Associated Press reported, the eruption caused avalanches and floods that wiped away both houses and bridges. It marked the volcano's first recorded eruption since the Spanish colonized the area five centuries earlier. NASA image created by Jesse Allen, using data provided courtesy of the NASA/GSFC/MITI/ERSDAC/JAROS, and U.S./Japan ASTER Science Team.

  4. [Metabolic syndrome in workers of a second level hospital].

    PubMed

    Mathiew-Quirós, Alvaro; Salinas-Martínez, Ana María; Hernández-Herrera, Ricardo Jorge; Gallardo-Vela, José Alberto

    2014-01-01

    Introducción: las personas con el síndrome metabólico (20-25 % de la población mundial) tienen una probabilidad tres veces mayor de sufrir un ataque cardiaco o un accidente cerebrovascular y una dos veces mayor de morir por esta causa. El objetivo es determinar la prevalencia del síndrome metabólico en trabajadores de un hospital de segundo nivel. Métodos: estudio transversal con 160 trabajadores de un hospital de Monterrey, México. Se obtuvieron datos sociodemográficos, antropométricos y bioquímicos para calcular la prevalencia del síndrome metabólico. Se realizó análisis bivariado y de regresión logística múltiple para evaluar la relación entre el síndrome metabólico y variables sociodemográficas y laborales. Resultados: la prevalencia de síndrome metabólico fue del 38.1 %; el personal de enfermería fue el más afectado con un 32.8 %. El sobrepeso y la obesidad fueron prevalentes en un 78 %. El 69 % de los hombres y el 85 % de las mujeres presentaron obesidad central. En la regresión logística hubo una relación significativa entre el síndrome metabólico y la variante no tener pareja (RM 3.98, IC 95 % [1.54-10.25]) y obesidad (RM 4.69, IC 95 % [1.73-12.73]). Conclusiones: la prevalencia del síndrome metabólico y la obesidad son preocupantes; deben tomarse acciones oportunas para disminuir el riesgo de enfermedad cardiovascular en esta población.

  5. Engaging Chicago hospitals in the baby-friendly hospital initiative.

    PubMed

    Schoenfelder, Samantha L; Wych, Sadie; Willows, Catherine A; Harrington, Joseph; Christoffel, Katherine Kaufer; Becker, Adam B

    2013-11-01

    Breastfeeding is now widely recognized as a vital obesity prevention strategy and hospitals play a primary role in promoting, supporting and helping mothers to initiate and maintain breastfeeding. The Baby-Friendly Hospital Initiative (BFHI) provides an evidence-based model that hospitals can use to plan and implement breastfeeding quality improvement (QI) projects. Funding under Communities Putting Prevention to Work (CPPW), administered by the CDC, brought together key Chicago partners to provide individualized support and technical assistance with breastfeeding QI projects to the 19 maternity hospitals in Chicago. A community organizing approach was taken to mobilize hospital interest in breastfeeding QI projects, leading to successes, e.g. 12/19 (63 %) Chicago hospitals registered with Baby-Friendly USA, Inc. (BFUSA) to pursue official Baby-Friendly designation. Key factors that fostered this success included: involving all levels of hospital staff, financial incentives, and ongoing tailored technical assistance. To assist other communities in similar work, this article discusses the approach the project took to mobilize hospitals to improve breastfeeding support practices based on the BFHI, as well as successes and lessons learned.

  6. Closure of a home hospital program: impact on hospitalization rates.

    PubMed

    Jacobs, Jeremy M; Cohen, Aaron; Rozengarten, Ora; Meiller, Ludmila; Azoulay, Daniel; Hammerman-Rozenberg, Robert; Stessman, Jochanan

    2007-01-01

    Home hospitalization (HH), as a substitute to in-patient care, is an area of growing interest, particularly amongst the elderly. Debate nonetheless exists concerning its economic justification. This study describes a natural experiment that arose following spending cuts and closure of the 400 patient Jerusalem HH program. It examines the hypothesis that HH closure would cause increasing geriatric and general medical hospital utilization amongst the 45,000 beneficiaries of the Jerusalem Clalit Health Fund (HMO) aged 65 years and over. Hospitalization rates were measured prior to and following HH closure, and analysis of variance confirmed the significance of the differences in both geriatric (p<0.0001) and general medical hospitalization rates (p=0.02) over the study period. Linear regression analyses of the hospitalization rates prior to HH closure were performed to determine the expected trajectory of hospitalization rates following HH closure. The observed hospital utilization in the year following HH closure cost 6.2 million US dollars in excess of predicted expenditure; closure of the HH resulted in the saving of 1.3 million USdollars. The ratio of direct increased costs to savings was 5:1 thus confirming the hypothesis that HH closure would result in increased hospital utilization rates among the local elderly population.

  7. [Relationship between age, body mass index, dependency and quality of life in malnourished patients after hospital discharge].

    PubMed

    Casals, Cristina; Vázquez Sánchez, María Ángeles; Casals Sánchez, José Luis; Rioja Vázquez, Rosalía; Martín Salvador, Esperanza; García-Agua Soler, Nuria

    2015-04-01

    Introducción: La evaluación de la calidad de vida significa investigar cómo el paciente percibe la propia enfermedad. Los pacientes con desnutrición presentan unas características especiales que les hacen más vulnerables, por lo que es importante conocer cómo les afectan estos factores en el desarrollo de su vida habitual. Objetivo: Analizar la valoración de la calidad de vida en personas con desnutrición que han estado ingresadas y su asociación con la edad, el índice de masa corporal, el tipo de diagnóstico de desnutrición, y el grado de dependencia. Método: Estudio descriptivo trasversal multicéntrico en 106 pacientes desnutridos hospitalizados. Se realizó una valoración de la calidad de vida (cuestionario SF-12), el IMC, la independencia funcional (índice de Barthel), los factores de morbilidad, y de la evaluación de la ingesta. La asociación entre las distintas variables se analizó mediante correlación no paramétrica de Spearman. Resultados: Los pacientes de este estudio presentaban una media en el SF-12 de 38,32 puntos. La edad se correlaciona de forma significativa con el SF-12 (r= -0,320, p= 0,001). El IMC se correlaciona tanto con el SF-12 (r= 0,251, p= 0,011) como con el componente mental (r= 0,289, p= 0,03). El índice de Barthel también mostró correlaciones estadísticamente significativas con el SF-12 (r= 0,370, p< 0,001). Conclusiones: La autopercepción de la salud en pacientes desnutridos que han tenido un ingreso hospitalario se encuentra por debajo de la media española; además esta calidad de vida se ve afectada por la edad, el IMC y la capacidad funcional del paciente.

  8. Pre-hospital emergency medicine.

    PubMed

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.

  9. Steering Patients to Safer Hospitals? The Effect of a Tiered Hospital Network on Hospital Admissions

    PubMed Central

    Scanlon, Dennis P; Lindrooth, Richard C; Christianson, Jon B

    2008-01-01

    Objective To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals. Data Sources/Study Setting A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety “leaps.” The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner. Study Design Changes in hospital admissions’ patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression. Principal Findings Patients affiliated with the engineers’ union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists’ union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time. Conclusions Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear. PMID:18761676

  10. [Emergency obstetric causes and Immediate Response Team in a secondary hospital].

    PubMed

    López-Ocaña, Luis Rafael; Hernández-Pineda, Norma Angélica; Cruz-Cruz, Polita Rocío; Ramiro-H, Manuel; Pérez Del Valle-Ibarra, Víctor Octavio

    2017-01-01

    Introducción: el objetivo es describir las causas de emergencia obstétrica que motivaron la activación del Equipo de Respuesta Inmediata en un hospital de segundo nivel del Instituto Mexicano del Seguro Social que no tiene Unidad de CuidadosIntensivos del Adulto. Métodos: estudio retrospectivo y observacional de las causas de emergencia obstétrica que se presentaron en los dominios de Admisión, Hospitalización, Labor, Expulsión, Quirófano y Recuperación del Hospital General de Zona No. 53 del IMSS, durante los años 2014 y 2015. Resultados: en 2014 se atendieron por causa obstétrica 3915 mujeres, de esta población, hubo 75 casos de emergencia obstétrica y 3276 nacidos vivos. En 2015, fueron 4390 mujeres y 80 casos de emergencia obstétrica con 3842 nacidos vivos. Los principales dominios en donde actuó el Equipo de Respuesta Inmediata en 2014 y 2015, fueron: Labor, Admisión y Recuperación. En 2014, la preeclampsia-eclampsia-Hellp ocupó el primer lugar como causa de emergencia obstétrica con 42 casos, mientras que en 2015 se presentaron 36 casos; la hemorragia obstétrica se presentó en 28 casos en 2014 y 34 casos en 2015. En 2014, hubo una muerte materna por preeclampsia severa y rotura hepática extensa. Conclusiones: la consolidación del Equipo de Respuesta Inmediata, de acuerdo al entorno sanitario, es fundamental, sobre todo, en la acepción otorgada por los integrantes del mismo.

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

    PubMed

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

    2016-07-21

    To analyze if the adjusted hospital mortality varies according to source of payment of hospital admissions, legal nature, and financing settlement of hospitals. Cros-ssectional study with information source in administrative databases. Specific hospital admission reasons were selected considering the volume of hospital admissions and the list of quality indicators proposed by the North-American Agency for Healthcare Research and Quality (AHRQ). Were analyzed 852,864 hospital admissions of adults, occurred in 789 hospitals between 2008 and 2010, in Sao Paulo and Rio Grande do Sul, applying multilevel logistic regression. At hospital admission level, showed higher chances of death male patients in more advanced age groups, with comorbidity, who used intensive care unit, and had the Brazilian Unified Health System as source of payment. At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System. This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%. In addition to structural characteristics of the hospitals and the profile of the patients, interventions aimed at improving care should also consider the coverage of the population by health plans, the network shared between beneficiaries of plans and users of the Brazilian Unified Health System, the standard of care to the various sources of payment by hospitals and, most importantly, how these factors influence the clinical performance. Analisar se a mortalidade hospitalar ajustada varia segundo fonte de pagamento das internações, natureza jurídica e arranjo de financiamento dos hospitais. Estudo observacional transversal com fonte de informações em bases de dados administrativos. Motivos de internação específicos foram

  12. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Hospitals subject to the hospital outpatient... FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital...

  13. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Hospitals subject to the hospital outpatient... FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital...

  14. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Hospitals subject to the hospital outpatient... FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital...

  15. [Mistreatment of students in hospitals].

    PubMed

    Auslender, Valérie; Fleury, Cynthia

    2017-09-01

    Health care students are abused and mistreated in hospital: humiliation, harassment and bullying of all sorts are daily occurrences, in a highly competitive universe and difficult working environment. It is time for the managerial policy of hospitals to consider the human factor and the well-being of employees and students. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Comparing Candidate Hospital Report Cards

    SciTech Connect

    Burr, T.L.; Rivenburgh, R.D.; Scovel, J.C.; White, J.M.

    1997-12-31

    We present graphical and analytical methods that focus on multivariate outlier detection applied to the hospital report cards data. No two methods agree which hospitals are unusually good or bad, so we also present ways to compare the agreement between two methods. We identify factors that have a significant impact on the scoring.

  17. Facts about Hospital Worker Safety

    MedlinePlus

    ... road map” to implementing a safety and health management system, featuring “success stories” and best practices from a variety of hospitals. Good recordkeeping puts powerful data at your fingertips. The first step toward solving a problem is to understand it. Fortunately, every hospital should ...

  18. Do hospital mergers reduce costs?

    PubMed

    Schmitt, Matt

    2017-03-01

    Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition. These results are robust to a variety of different control strategies, and do not appear to be easily explained by post-merger changes in service and/or patient mix. I then explore several extensions of the results to examine (a) whether the acquiring hospital/system realizes cost savings post-merger and (b) if cost savings depend on the size of the acquirer and/or the geographic overlap of the merging hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. [Obstetric analgesia in Norwegian hospitals].

    PubMed

    Dahl, V; Hagen, I E; Raeder, J C

    1998-04-30

    We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%. Epidural analgesia was much more widely used in university and regional hospitals than in local hospitals (p < 0.001). Five of the local hospitals did not offer epidural analgesia during labour at all. The combination of low-dose local anaesthetic and an opioid (either sufentanil or fentanyl) had not been introduced in nine of the hospitals (20%). The optimal use of epidural analgesia to relieve labour pain was judged to be more frequent by the anaesthetists than by the midwives (19% versus 11%, p < 0.01). In response to what factors limited the frequency of epidural analgesia, the anaesthetists specified factors related to the attitude of the midwife, and the midwives specified factors related to the anaesthetist. Only five of the hospitals provided written information on the various analgesic methods that could be employed during labour. The majority of midwives considered the analgesic methods employed on their maternity ward to be good or excellent. The frequency of Caesarean section was 12%; spinal anaesthesia was used in 55%, epidural anaesthesia in 17%, and general anaesthesia in 28% of the cases.

  20. Faculty Internships for Hospitality Instructors

    ERIC Educational Resources Information Center

    Lynn, Christine; Hales, Jonathan A; Wiener, Paul

    2007-01-01

    Internships can help hospitality faculty build industry relationships while also ensuring the best and most current training for their students. Many hospitality organizations have structured faculty internships available or are willing to work with faculty to provide individualized internship opportunities. Career and technical educators in…

  1. Segmentation in local hospital markets.

    PubMed

    Dranove, D; White, W D; Wu, L

    1993-01-01

    This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that "centers of excellence" have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.

  2. Occupational hazards to hospital personnel

    SciTech Connect

    Patterson, W.B.; Craven, D.E.; Schwartz, D.A.; Nardell, E.A.; Kasmer, J.; Noble, J.

    1985-05-01

    Hospital personnel are subject to various occupational hazards. Awareness of these risks, compliance with basic preventive measures, and adequate resources for interventions are essential components of an occupational health program. Physical, chemical, and radiation hazards; important infectious risks; and psychosocial problems prevalent in hospital workers are reviewed. A rational approach to managing and preventing these problems is offered. 370 references.

  3. Educational Costs to Hospitalized Patients

    ERIC Educational Resources Information Center

    Martz, E. Wayne; Ptakowski, Richard

    1978-01-01

    One of the less obvious costs of educational programs is the increased volume of work-ups and treatment for hospitalized patients that are ordered by residents. In a hospital with both private teaching and private nonteaching floors, a comparison shows that service charges on teaching floors are 60 percent higher than on nonteaching floors.…

  4. Management of the Hospital Environment

    ERIC Educational Resources Information Center

    Turner, Alvis G.

    1976-01-01

    Hospital studies indicate the need for an environmental/sanitarian specialist for control of nosocomial infection and maintenance of a quality environment. The author recommends these requirements for certification as a hospital environmentalist: academic studies including toxicology, epidemiology, hygiene, management, and an internship in…

  5. Suicidal Behavior in Hospitalized Schizophrenics.

    ERIC Educational Resources Information Center

    Prasad, Ashoka Jahnavi; Kumar, Nirmal

    1988-01-01

    Compared 131 hospitalized schizophrenics who had attempted suicide within past year to 70 hospitalized schizophrenics who had not attempted suicide, using the Present State Examination depressive symptoms. Found that schizophrenics who had attempted suicide had significantly higher number of symptoms indicative of a depressive disorder. (Author/NB)

  6. Hospitality Management Education and Training.

    ERIC Educational Resources Information Center

    Brotherton, Bob, Ed.; And Others

    1995-01-01

    Seven articles on hospitality management training discuss the following: computerized management games for restaurant manager training, work placement, real-life exercises, management information systems in hospitality degree programs, modular programming, service quality concepts in the curriculum, and General National Vocational Qualifications…

  7. Management of the Hospital Environment

    ERIC Educational Resources Information Center

    Turner, Alvis G.

    1976-01-01

    Hospital studies indicate the need for an environmental/sanitarian specialist for control of nosocomial infection and maintenance of a quality environment. The author recommends these requirements for certification as a hospital environmentalist: academic studies including toxicology, epidemiology, hygiene, management, and an internship in…

  8. Hospital dispensing. On auto pilot.

    PubMed

    Farrar, Keith; Slee, Ann; Yeats, Michael

    2002-10-10

    An automated dispensing system installed in an acute hospital has halved dispensing errors and released more than 30 per cent of technicians' time for other duties. Reducing medication errors can have a considerable effect on reducing pressure on hospital beds. Automation has considerable advantages in light of the continuing shortage of pharmacists and pharmacy technicians.

  9. Hospital association libraries: an overview.

    PubMed

    Poole, C

    1982-04-01

    Results of a survey conducted by the Library of the American Hospital Association to gather data about library and information services provided by other hospital associations are reported. Topics covered include staffing, funding, collection size, users, and services. The interface of these libraries with other health sciences libraries and the national Biomedical Communications Network (BCN) is discussed.

  10. Hospitality Management Education and Training.

    ERIC Educational Resources Information Center

    Brotherton, Bob, Ed.; And Others

    1995-01-01

    Seven articles on hospitality management training discuss the following: computerized management games for restaurant manager training, work placement, real-life exercises, management information systems in hospitality degree programs, modular programming, service quality concepts in the curriculum, and General National Vocational Qualifications…

  11. Faculty Internships for Hospitality Instructors

    ERIC Educational Resources Information Center

    Lynn, Christine; Hales, Jonathan A; Wiener, Paul

    2007-01-01

    Internships can help hospitality faculty build industry relationships while also ensuring the best and most current training for their students. Many hospitality organizations have structured faculty internships available or are willing to work with faculty to provide individualized internship opportunities. Career and technical educators in…

  12. Practicing Hospitality in the Classroom

    ERIC Educational Resources Information Center

    Burwell, Rebecca; Huyser, Mackenzi

    2013-01-01

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

  13. Practicing Hospitality in the Classroom

    ERIC Educational Resources Information Center

    Burwell, Rebecca; Huyser, Mackenzi

    2013-01-01

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

  14. [Hospitals as vital links].

    PubMed

    Klink, A

    2013-01-01

    The reform of the system in 2006 aimed at reducing waiting lists in an efficient manner. Performance-linked funding and regulated competition did indeed lead to improved efficiency. The other side of the coin is overtreatment, and expensive and not infrequently damaging growth in volume. In order to control costs, three strategies have been determined: agreements with an annual cap on volume; (b) collaboration of regional health-care providers with the mission of improving results in health care (with profit-sharing if costs fall); and (c) fusions reducing the number of hospitals which reduces the burden of injuries (supply no longer creates its own demand). This article comments on these strategies. The author argues for a fourth approach: if the quality of health care improves, the number of complications will fall, overtreatment will decline and the outcome will be a decrease in burden of injuries. This requires the health care insurers to modify the way they manage their contracts and methods of payment, and stimulates competition based on quality.

  15. [Medication safety in hospitals].

    PubMed

    Sleinitz, Annett; Heyde, Christian; Kloft, Charlotte

    2012-04-01

    Drug therapy is one of the most common therapeutic interventions in the medical care of in-patients. It is a complex risk-associated procedure, which is why risk prevention is of top priority in medication safety. Medical care in hospitals is organised via various forms of distribution, e.g. the traditional distribution on the ward or as computerised unit dose drug dispensing system. In order to improve medication safety, the computerised unit dose drug dispensing system was introduced in the Ruppiner Kliniken in 2009. The implementation of the system to the clinic was scientifically evaluated within the scope of a diploma thesis which focused on the examination and analysis of medication safety and its evolvement. Amongst others, medication errors were detected and classified (via DokuPIK). The thesis showed that the implementation of the computerised unit dose system had a positive impact on the reduction of consequences of common and clinically relevant medication errors, thereby enhancing medication safety for the patient.

  16. Hospital transformation and organisational learning.

    PubMed

    Ho, W

    1999-12-01

    Kwong Wah Hospital was founded by the charity organisation Tung Wah Group of Hospitals some 88 years ago, with management transfer to the Hong Kong Hospital Authority in 1991. Capitalizing both from the traditional caring culture of its founder, as well as opportunities in the new management environment, the hospital has scored remarkable successes in service quality, community partnership, organisational effectiveness, and staff development. Underpinning these transformations were Structure, Process, People, and Culture strategies. The learning imperative is heavily mandated or the success of each of these strands of development. Indeed, the embodiment of a learning organisation culture provides the impetus in sustaining the change momentum, towards achieving the Vision of becoming a 'Most Preferred Hospital' in Hong Kong.

  17. Early discharge hospital at home.

    PubMed

    Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

    2017-06-26

    Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes.   DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI

  18. Establishing a Hospital Response Network Among Children's Hospitals.

    PubMed

    Bartenfeld, Michael T; Griese, Stephanie E; Krug, Steven E; Andreadis, Joanne; Peacock, Georgina

    A timely and effective response to public health threats requires a broad-reaching infrastructure. Children's hospitals are focused on evaluating and managing some of the most vulnerable patients and thus have unique preparedness and response planning needs. A virtual forum was established specifically for children's hospitals during the 2014-15 Ebola outbreak, and it demonstrated the importance and utility of connecting these specialty hospitals to discuss their shared concerns. Developing a successful children's hospital response network could build the national infrastructure for addressing children's needs in preparedness and response and for enhancing preparedness and response to high-consequence pathogens. Using the Laboratory Response Network and tiered-hospital network as models, a network of children's hospitals could work together, and with government and nongovernment partners, to establish and refine best practices for treating children with pathogens of public health concern. This network could more evenly distribute hospital readiness and tertiary pediatric patient care capabilities for highly infectious diseases across the country, thus reducing the need to transport pediatric patients across the country and increasing the national capacity to care for children infected with high-consequence pathogens.

  19. The single-hospital county: is its hospital at risk?

    PubMed Central

    Chang, C F; Tuckman, H P

    1991-01-01

    This article focuses on a hospital group that has not received adequate attention in the literature: the sole provider of short-term, acute hospital care located in a county. In Tennessee, SPHs (single provider hospitals) are fewer in number but are present in more counties than multiprovider hospitals (MPHs). They are smaller in size, less labor and capital intensive, more likely to be a government hospital, and more likely to be in a rural area with low income and limited health care resources. SPHs operate with lower costs, charge patients less, and have lower revenue write-offs than MPHs. As a result, their cash flow is sufficient to fund their depreciation and they consistently earn modest returns. Between 1982 and 1988, a total of 16 hospitals failed in Tennessee but only 3 were SPHs. While SPHs have not been profitable enough to make them ideal candidates for takeover by major hospital systems, they are not a population that is unduly at risk. PMID:1905685

  20. [Alcoholism in the general hospital: 4 years mortality and hospitalization].

    PubMed

    Monras, Miquel; Mondon, Silvia; Ortega, Lluisa; Gual, Antoni

    2005-10-08

    We aimed to analyze the mortality, and emergency room and hospital admissions in a sample of alcohol dependent patients during the four years following their identification in a general hospital. 198 inpatients from a general hospital who where identified as alcohol dependent and referred during 1998 to the liaison-psychiatry service. 30.8% had died, at a mean age of 57.5 (11.3). Deaths had a direct relationship to the illness responsible for the initial admission to hospital. 42.6% of patients had previous admissions, and 74% had been previously attended at emergency room departments. During the 4 years of follow up, there were new hospital admissions (54.6%), emergency room visits (72.7%) and repeated liaison-psychiatry consultations (20%). Previous admissions to hospital predicted future admissions. Acceptance of alcohol treatment did not reduce the mortality rates. Mortality correlated with age, it was increased in patients with cognitive deficits and was reduced in those with psychiatric co-morbidity. Late detection of alcohol dependence leads to pour outcomes both in the treatment of alcohol dependence and the concomitant somatic diseases. Early detection strategies of hazardous and harmful alcohol consumption should be implemented in hospital settings.

  1. The single-hospital county: is its hospital at risk?

    PubMed

    Chang, C F; Tuckman, H P

    1991-06-01

    This article focuses on a hospital group that has not received adequate attention in the literature: the sole provider of short-term, acute hospital care located in a county. In Tennessee, SPHs (single provider hospitals) are fewer in number but are present in more counties than multiprovider hospitals (MPHs). They are smaller in size, less labor and capital intensive, more likely to be a government hospital, and more likely to be in a rural area with low income and limited health care resources. SPHs operate with lower costs, charge patients less, and have lower revenue write-offs than MPHs. As a result, their cash flow is sufficient to fund their depreciation and they consistently earn modest returns. Between 1982 and 1988, a total of 16 hospitals failed in Tennessee but only 3 were SPHs. While SPHs have not been profitable enough to make them ideal candidates for takeover by major hospital systems, they are not a population that is unduly at risk.

  2. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  3. Hospitals: Soft Target for Terrorism?

    PubMed

    De Cauwer, Harald; Somville, Francis; Sabbe, Marc; Mortelmans, Luc J

    2017-02-01

    In recent years, the world has been rocked repeatedly by terrorist attacks. Arguably, the most remarkable were: the series of four coordinated suicide plane attacks on September 11, 2001 on buildings in New York, Virginia, and Pennsylvania, USA; and the recent series of two coordinated attacks in Brussels (Belgium), on March 22, 2016, involving two bombings at the departure hall of Brussels International Airport and a bombing at Maalbeek Metro Station located near the European Commission headquarters in the center of Brussels. This statement paper deals with different aspects of hospital policy and disaster response planning that interface with terrorism. Research shows that the availability of necessary equipment and facilities (eg, personal protective clothing, decontamination rooms, antidotes, and anti-viral drugs) in hospitals clearly is insufficient. Emergency teams are insufficiently prepared: adequate and repetitive training remain necessary. Unfortunately, there are many examples of health care workers and physicians or hospitals being targeted in both political or religious conflicts and wars. Many health workers were kidnapped and/or killed by insurgents of various ideology. Attacks on hospitals also could cause long-term effects: hospital units could be unavailable for a long time and replacing staff could take several months, further compounding hospital operations. Both physical and psychological (eg, posttraumatic stress disorder [PTSD]) after-effects of a terrorist attack can be detrimental to health care services. On the other hand, physicians and other hospital employees have shown to be involved in terrorism. As data show that some offenders had a previous history with the location of the terror incident, the possibility of hospitals or other health care services being targeted by insiders is discussed. The purpose of this report was to consider how past terrorist incidents can inform current hospital preparedness and disaster response planning

  4. Hospital law: the changing scene.

    PubMed

    Hirsh, H L

    1978-01-01

    The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the

  5. [Pediatric traumatic injuries requiring hospitalization. A serious health problem].

    PubMed

    Osornio-Ruiz, José Luis; Martínez-Ibarra, Sofía Irene; Torres-González, Rubén; Reyes-Hernández, Raúl Isaac

    2007-01-01

    To identify the age-adjusted prevalence of pediatric traumatic injuries requiring hospitalization. A retrospective, observational cross-sectional study was carried out in the pediatric trauma department at the Hospital Magdalena de las Salinas of Instituto Mexicano del Seguro Social. Data from all pediatric patients hospitalized between January 1998 and December 2005 due to traumatic injuries were included. 5,987 patients analyzed; 66.9% were male, 46.0% were children; 31.3% preschoolers; 18.2% adolescents and 4.4% infants. Regarding the injuries, 48.2% were injured at home, 74.8% suffered closed fractures, particularly among preschoolers and children; 12.4% suffered open fractures. Craneoencephalic trauma occurred in 34.2%, mostly in children and adolescents. Among preschoolers and children supracondylar fractures of the humerus occurred in 23.0%; the commonest was type IV (94%); physeal fractures occurred in 2.6% and lesions due to battered children were in 0.31%. As to the treatment, infants and preschoolers were treated through cast immobilization; closed reduction and internal fixation was common in school-age children (27%) while open reduction and external fixation was used in adolescents (26.8%). Preventive measures should be encouraged in the group with the highest prevalence of traumatic injuries requiring hospital care: male school-age children who predominantly suffer craneoencephalic trauma and supracondylar fractures of the humerus.

  6. Management changes resulting from hospital accreditation.

    PubMed

    Oliveira, João Lucas Campos de; Gabriel, Carmen Silvia; Fertonani, Hosanna Pattrig; Matsuda, Laura Misue

    2017-03-02

    to analyze managers and professionals' perceptions on the changes in hospital management deriving from accreditation. descriptive study with qualitative approach. The participants were five hospital quality managers and 91 other professionals from a wide range of professional categories, hierarchical levels and activity areas at four hospitals in the South of Brazil certified at different levels in the Brazilian accreditation system. They answered the question "Tell me about the management of this hospital before and after the Accreditation". The data were recorded, fully transcribed and transported to the software ATLAS.ti, version 7.1 for access and management. Then, thematic content analysis was applied within the reference framework of Avedis Donabedian's Evaluation in Health. one large family was apprehended, called "Management Changes Resulting from the Accreditation: perspectives of managers and professionals" and five codes, related to the management changes in the operational, structural, financial and cost; top hospital management and quality management domains. the management changes in the hospital organizations resulting from the Accreditation were broad, multifaceted and in line with the improvements of the service quality. analizar las percepciones de gestores y trabajadores sobre los cambios en la gestión hospitalaria resultantes de la Acreditación. estudio descriptivo con aproximación cualitativa. Participaron cinco gestores de calidad hospitalaria y otros 91 trabajadores de las más diversas categorías profesionales, niveles jerárquicos y áreas de actuación de cuatro hospitales del sur de Brasil certificados por la Acreditación nacional de diferentes niveles, que contestaron la pregunta "Cuéntame sobre la gestión de este hospital, antes y después de la Acreditación". Los datos fueron grabados, transcritos por completo y transportados para acceso y manoseo en el software ATLAS.ti, versión 7.1. A seguir, fue aplicado el análisis de

  7. 24 CFR 242.4 - Eligible hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Eligible hospitals. 242.4 Section... INSURANCE FOR HOSPITALS General Eligibility Requirements § 242.4 Eligible hospitals. (a) The hospital to be financed with a mortgage insured under this part shall involve the construction of a new hospital, the...

  8. 2 CFR 200.52 - Hospital.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Hospital. 200.52 Section 200.52 Grants and... AWARDS Acronyms and Definitions Acronyms § 200.52 Hospital. Hospital means a facility licensed as a hospital under the law of any state or a facility operated as a hospital by the United States, a state, or...

  9. 24 CFR 242.4 - Eligible hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Eligible hospitals. 242.4 Section... INSURANCE FOR HOSPITALS General Eligibility Requirements § 242.4 Eligible hospitals. (a) The hospital to be financed with a mortgage insured under this part shall involve the construction of a new hospital, the...

  10. Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital.

    PubMed

    Gouvêa, Marise; Novaes, Cristiane DE Oliveira; Iglesias, Antonio Carlos

    2016-01-01

    : to evaluate the antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital - HUGG. : we conducted a rospective study of a cohort of 256 patients undergoing elective operations between January and September 2014. We collected data on demographics, use or not of prophylactic antibiotic and the antibiotic prophylaxis following characteristics: type of antibiotic used, moment of administration and duration of postoperative use. The analyzed outcomes were "justified use or non-use of antibiotic prophylaxis", "correct antibiotic choice," "administration of the antibiotic at the right time" and "discontinuation of the antibiotic at the right time." : antibiotic prophylaxis was used in 91.8% of cases. The use or non-use of antibiotic prophylaxis was justified in 78.9% of patients, the choice of the administered antibiotic was considered correct in 97.9%, antibiotic administration was made at the right time in only 27.2% of patients and discontinuation of the antibiotic was performed at the correct time in 95.7% of cases. : the surgical antibiotic prophylaxis was not fully adequately performed in the sample. avaliar a antibioticoprofilaxia em pacientes cirúrgicos do Hospital Universitário Gaffrée e Guinle. estudo prospectivo de uma coorte de 256 pacientes submetidos à operações eletivas, entre janeiro e setembro de 2014. Foram coletados dados demográficos dos pacientes, se ocorreu utilização ou não do antibiótico profilático e as seguintes características da antibioticoprofilaxia: tipo de antibiótico utilizado, momento da administração e tempo de duração do uso no pós-operatório. Os desfechos de interesse analisados foram "uso ou não uso justificado da antibioticoprofilaxia", "escolha correta do antibiótico", "administração do antibiótico no tempo correto" e "descontinuação do antibiótico no tempo correto". a antibioticoprofilaxia foi utilizada em 91,8% dos casos. O uso ou não uso da antibioticoprofilaxia foi

  11. Do hospitals cross-subsidize?

    PubMed

    David, Guy; Lindrooth, Richard C; Helmchen, Lorens A; Burns, Lawton R

    2014-09-01

    Despite its salience as a regulatory tool to ensure the delivery of unprofitable medical services, cross-subsidization of services within hospital systems has been notoriously difficult to detect and quantify. We use repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry by cardiac specialty hospitals, we study how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. We estimate that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose. Although entry by single-specialty hospitals may adversely affect the provision of unprofitable uncontested services, these findings warrant further evaluation of service-line cross-subsidization as a means to finance them. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

    PubMed

    Oborn, Eivor

    2008-04-01

    This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

  13. [Hospitals' evolution through the ages].

    PubMed

    de Micheli, Alfredo

    2005-01-01

    The predecessor institutions of modern hospitals--Byzantine nosocómeion, European hospitale and Islamic maristan--were dissimilar both in their patients and their aims. The first charitable organizations in West Europe (Rome) and in the East (Cesarea in Cappadocia) were rather hospices. After the collapse of the Western Roman Empire (476 A.D.), some monastic centers were prepared to provide medical assistance to religious and secular patients. Since the XI and XII Centuries in all of Christian Europe the charitable institutions, designated as hospitale, multiplied. Among the Italian ones, the Roman Santo Spirito (Holy Ghost) Hospital, built in the 1201-1204 period, reached a preeminet position. This one soon became the most important of the entire Christendom (archihospital), with a lot of affiliated hospitals in Europe and later in America. The first American hospital, Saint Nicholas Hospital, opened on December 29, 1503 in Santo Domingo, obtained in 1541 its affiliation to the Santo Spirito archihospital. Regarding continental America, the first health centers were established in Mexico: the Immaculate Conception Hospital and the Saint Lazarus Hospital, both established by Hernán Cortés. For its part, clinical teaching was systematized at the Saint Francis Hospital in Padua and by there moved to Leyden. In Mexico, the chair of medical clinics or practical medicine was established in 1806 at the Saint Andrew Hospital. During the XX century, Dr. Ignacio Chávez was the driving force behind the creation of the modern Mexican Health Institutes. These ones are dedicated to the treatment of poor patients, as well as to medical teaching and research.

  14. The status of hospital information systems in Iranian hospitals.

    PubMed

    Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

    2014-08-01

    The area of e-Health is broad and has an excellent growth potential. An increasing number of experts believe that e-Health will fuel the next breakthroughs in health system improvements throughout the world, but there is frequent evidence of unsustainable use of e-Health systems in medical centres, particularly hospitals, for different reasons in different countries. Iran is also a developing country which is presently adopting this promising technology for its traditional healthcare delivery but there is not much information about the use of e-Health systems in its hospitals, and the weakness and opportunities of utilization of such Hospital Information Systems (HIS). For this research, a number of Hospitals from Isfahan, Iran, are selected using convenient sampling. E-health research professionals went there to observe their HIS and collect required data as a qualitative survey. The design of interview questions was based on the researchers' experiences and knowledge in this area along with elementary interviews with experts on HIS utilization in hospitals. Efficient administration of e-health implementation improves the quality of healthcare, reduces costs and medical errors, makes healthcare resources available to rural areas, etc. However, there are numerous issues affecting the successful utilization of e-health in Hospitals, such as a lack of a perfect HIS implementation plan and well-defined strategy, inadequate IT-security for the protection of e-health-related data, improper training and educational issues, legal challenges, privacy concerns, improper documentation of lessons learned, resistance to the application of new technologies, and finally a lack of recovery plan and disaster management. These results along with some informative stories are extracted from interview sessions to uncover associated challenges of HIS utilization in Iranian hospitals. The utilization of e-health in Iranian hospitals, particularly those in Isfahan, is subject to several

  15. The Status of Hospital Information Systems in Iranian Hospitals

    PubMed Central

    Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

    2014-01-01

    Background: The area of e-Health is broad and has an excellent growth potential. An increasing number of experts believe that e-Health will fuel the next breakthroughs in health system improvements throughout the world, but there is frequent evidence of unsustainable use of e-Health systems in medical centres, particularly hospitals, for different reasons in different countries. Iran is also a developing country which is presently adopting this promising technology for its traditional healthcare delivery but there is not much information about the use of e-Health systems in its hospitals, and the weakness and opportunities of utilization of such Hospital Information Systems (HIS). Methods: For this research, a number of Hospitals from Isfahan, Iran, are selected using convenient sampling. E-health research professionals went there to observe their HIS and collect required data as a qualitative survey. The design of interview questions was based on the researchers’ experiences and knowledge in this area along with elementary interviews with experts on HIS utilization in hospitals. Results: Efficient administration of e-health implementation improves the quality of healthcare, reduces costs and medical errors, makes healthcare resources available to rural areas, etc. However, there are numerous issues affecting the successful utilization of e-health in Hospitals, such as a lack of a perfect HIS implementation plan and well-defined strategy, inadequate IT-security for the protection of e-health-related data, improper training and educational issues, legal challenges, privacy concerns, improper documentation of lessons learned, resistance to the application of new technologies, and finally a lack of recovery plan and disaster management. These results along with some informative stories are extracted from interview sessions to uncover associated challenges of HIS utilization in Iranian hospitals. Conclusion: The utilization of e-health in Iranian hospitals

  16. Potential for Hospital Based Corneal Retreival in Hassan District Hospital

    PubMed Central

    Melsakkare, Suresh Ramappa; Manipur, Sahana R.; Acharya, Pavana; Ramamurthy, Lakshmi Bomalapura

    2015-01-01

    Context In developing countries, corneal diseases are the second leading cause of blindness. This corneal blindness can be treated through corneal transplantation. Though the present infrastructure is strong enough to increase keratoplasty numbers at a required rate, India has largest corneal blind population in the world. So a constant supply of high quality donor corneal tissue is the key factor for reduction of prevalence of corneal blindness. Considering the magnitude of corneal blindness and shortage of donor cornea, there is a huge gap in the demand and supply. Aim To study the potential for hospital based retrieval of donor corneal tissue in Hassan district hospital after analysing the indicated and contraindicated causes of deaths, so that hospital corneal retrieval program in Hassan district hospital can be planned. Materials and Methods The cross-sectional, retrospective and record-based study included all hospital deaths with age group more than two years occurred during one year period (January 2014 to December 2014). Data regarding demographic profile, cause of death, treatment given and presence of any systemic diseases were collected. The causes of deaths which are contraindicated for the retrieval of corneas were analysed and noted. The contraindications were based on the NPCB guidelines for standard of eye banking in India 2009. Results Out of 855 deaths, number of deaths in males (565) was greater than females (290). Numbers of deaths were highest between 41-60 years age group (343). Deaths due to HIV, septicaemia, meningitis, encephalitis, disseminated malignancies were contraindicated for corneal retrieval. Corneas could be retrieved from 736 deaths out of 855. Potential for corneal retrieval in a period of one year in Hassan District hospital was 86%. Conclusion Hospital corneal retrieval program has got a great potential to bridge the gap between the need for the cornea and actually collected corneas which will contribute enormously in

  17. Internet connectivity for hospitals and hospital libraries: strategies.

    PubMed

    Fuller, S S

    1995-01-01

    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator.

  18. Energy audits at 48 hospitals

    NASA Astrophysics Data System (ADS)

    Hirst, E.

    1981-11-01

    Staff at the Oak Ridge Associated Universities (ORAU) conducted energy audits at 48 hospitals in four states (New York, Pennsylvania, Virginia, Tennessee) between 1978 and 1980. Staff at the Oak Ridge National Laboratory (ORNL) and ORAU developed and organized a computerized data base containing information from these audits. This paper describes the ORAU audit process; summarizes the data collected from these audits on hospital characteristics annual energy use, and the audit recommendations; and analyzes the audit data in terms of cost effectiveness, type of recommendations, and the relationship between potential energy saving and characteristics of the individual hospital.

  19. Hospitals, providers collaborate on transitions.

    PubMed

    2012-01-01

    Baystate Health, a three-hospital system with headquarters in Springfield, MA, is partnering with post-acute providers to improve transitions as patients move through the continuum of care. A multidisciplinary post-acute performance team partnered with post-acute providers to determine why patients are readmitted to the hospital and to work on ways to avoid readmissions. Facilities share information with the hospitals how they operate and what they need to ensure patients receive the care they need. The health system's director of post-acute services holds regular meetings with providers to brainstorm on improving patient care.

  20. A computerized hospital maintenance system.

    PubMed

    Kresch, E; Katz, P; Schwartz, H; Hamarman, H

    1985-01-01

    The Biomedical Instrumentation Department at Thomas Jefferson University Hospital maintains most of the clinical equipment owned by the hospital and provides support to six other hospitals, as well. In order to document these services, a computerized support system has been developed. This system maintains the inventory of equipment, documents the occurrence of repair and preventive maintenance procedures, generates lists of items due for maintenance and inspection, and prints reports and summaries of all activities performed by department staff. The system was designed for ease of use and requires a minimum of training for personnel who use it.

  1. The National Demonstration Hospitals Program.

    PubMed

    Alexander, A

    2000-01-01

    Fifty-five public hospitals in all Australian States and Territories participated in the first two phases of National Demonstration Hospitals Program (NDHP). The program was established in 1994 as part of a commitment by the then Department of Health and Family Services to reduce waiting times and improve health outcomes for patients. The program uses a collaborative approach to assist public hospitals to improve service delivery and patient care outcomes. Key results from Phases 1 and 2 of the NDHP have confirmed that identification of industry best practice, collaboration, knowledge sharing and innovation are key elements required to achieve positive health care reforms.

  2. [Adaptation of children to hospitalization].

    PubMed

    Kneist, W; Spangenberg, B

    1979-04-01

    Infants especially of about 1 to 4 years of age are opposed to an unknown environment and to unusual demands when they are admissed to hospital. Literature informes about some characteristic troubles during the first time of adaptation. In addition to those kinds of transitory adaptional difficulties, physical and mental retardation of development may appear when infants become long-time patients. The socalled psychic hospitalism has to be valued as a sign of underprotection and differs from adaptional troubles as a symptom of full strain. The survey shows adequate measures how physicians and nurses may deal with both of the problems in order to ease adaptation and to prevent psychic hospitalism.

  3. New developments in hospital management.

    PubMed

    Welch, J R; Kleiner, B H

    1995-01-01

    Changes in the health care environment over the past ten years have prompted changes in the way hospitals are being managed. The rising cost of health care has affected Medicare reimbursement, caused business to be a discerning selector of medical care, and given birth to alternative forms of health care delivery. All these conditions have resulted in decreased revenue and increased competition for hospitals. Focuses on what hospitals have done to adapt to these changing conditions: cost containment, marketing strategies, and human resource management, since these areas have undergone the most meaningful changes.

  4. A Decomposition of Hospital Profitability

    PubMed Central

    Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

    2015-01-01

    Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO

  5. [Hospital governance and the structure of German hospital supervisory boards].

    PubMed

    Kuntz, L; Pulm, J; Wittland, M

    2014-06-01

    When thinking about corporate governance frequently the supervisory board comes to mind. The aim of this study is to investigate the relationship between the participation of single professions in the supervisory board and hospital financial performance. Based on governance codes, relevant professions that should be part of the supervisory board are identified. With the help of a multiple regression, the relationship between the fractions of these professions in the supervisory board and the return on assets in the year 2009 is examined. The sample consists of 182 hospitals. The study shows that participation of physicians in the supervisory board is related to a higher return on assets. Furthermore, the association between the fractions of nurses and politicians and hospitals financial performance is ­negative. The composition of the supervisory board has a significant effect on hospital performance; it is an important issue for hospital owners. The present study identifies only one positive relationship between the involvement of physicians and financial performance. Other professions could be relevant in achieving other objectives. Further studies are necessary to analyse the effects on other dimensions of hospital performance, e. g., on quality. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Logistics in hospitals: a case study of some Singapore hospitals.

    PubMed

    Pan, Zhi Xiong; Pokharel, Shaligram

    2007-01-01

    The purpose of this paper is to investigate logistics activities in Singapore hospitals. It defines various types of activities handled by a logistics division. Inventory management policy and the use of information and communication technologies (ICT) for logistics purposes are also discussed. The study identifies the nature of strategic alliances in Singapore's health care industry. This study was conducted by utilizing a framework for data collection, pre-testing the questionnaire and conducting interviews. Various relevant literature was reviewed to design the questionnaire. This study finds that logistics division carry out many related activities and some of them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered under various groups to minimize the cost of operation, including the logistics related costs. However, hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of logistics services. The findings also show that Singapore hospitals have a good stocking policy for both medical and non-medical items so that changes in patient mix can be easily handled. Singapore is continuously improving its health care industry and therefore, the findings will help hospitals in other regions to adopt some of the practices, like concentrating on local vendors, outsourcing, clustering, and maximum use of information technology as competitive factors that can improve the service and reduce the cost of operation. The paper suggests motivators and barriers to the use of ICT in logistics in the health care industry.

  7. 78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ...-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of Participation; Corrections AGENCY...

  8. 75 FR 29479 - Medicare and Medicaid Programs: Proposed Changes Affecting Hospital and Critical Access Hospital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-26

    ... Changes Affecting Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoPs... conditions of participation (CoPs) for both hospitals and critical access hospitals (CAHs). These revisions...). [[Page 29480

  9. Ácaros del mango

    USDA-ARS?s Scientific Manuscript database

    Los ácaros constituyen un grupo abundante y diverso que ocupa diferentes hábitats en árboles frutales y la estructura y disposición del follaje y ramas del mango, contribuyen significativamente a que se presente gran diversidad de ácaros benéficos y dañinos asociados a esta especie frutal. En Colomb...

  10. [Prevalence of pain in Andalusian public hospitals].

    PubMed

    Echevarria Moreno, M; Ortega Garcia, J L; Herrera Silva, J; Galvez Mateo, R; Torres Morera, L M; de la Torre Liebanas, R

    2014-12-01

    To determine the prevalence of pain in medical and surgical patients admitted to reference hospitals in Andalusia, as well as their features and the most population groups most affected. A cross-sectional, multicenter epidemiological study was conducted simultaneously on the population admitted to 5 hospitals. Using a structured questionnaire the demographics, hospital area, presence of pain at the time of the interview, and pre- and post-variables related to the intensity of pain and its treatment at 24h were investigated. All patients over 18 years old were included, except those patients with difficulty in understanding the questionnaire, and psychiatric and obstetric patients. Pain intensity was assessed by simple verbal scale. Of the 1,236 patients included, 54.2% were male, with 51.1% of patients aged 65 years, and 69.17% were admitted to medical areas. Pain was observed in 52.9% of patients admitted to the surgical area compared to 29.4% in the medical area. Of the 19.4% who reported having had pain in the last 24h prior to the questionnaire, 57.7% of them were surgical patients and 32% were medical, P<.005), and of the 42.2% who had pain at the time of study, 52.7% were female. The incidence of pain on movement was higher than that observed at rest. The mean resting pain was 1.8 and 1.4 for the surgical and medical patients, respectively (P<.01). The mean pain on movement was 2.2 and 1.6 for the surgical and medical patients, respectively (P<.01). More than one quarter (25.8%) of surgical patients and 16.5% of medical patients had difficulty sleeping (P<.005). Some 12.8% of all patients had no analgesic regimen, and 66.2% and 85.6% of surgical and medical patients, respectively, did not request analgesics (P<.005). The main drugs were prescribed paracetamol analgesic and metamizole, and in 54.4% of patients. We believe that the presence of pain in patients admitted to our study population is high and it is essential to encourage an improvement in the pain

  11. [Mandibular fractures. Experience in a trauma hospital].

    PubMed

    Rojas, René A; Julián, Gerardo; Lankin, Jorge

    2002-05-01

    Facial trauma has reached a peak in the last decades in the world; however, scanty epidemiological information is available in Chile. To report the experience in the treatment of mandibular fractures in the maxillofacial unit at Hospital del Trabajador, Santiago. A retrospective study of patients with mandibular fractures treated in a seven years period (1990-1996). Demographic and clinical aspects of the patients are analyzed, with emphasis in causes of trauma, anatomic distribution of the fractures, treatment and complications. One hundred and sixty patients (aged 14 to 65 years old) sustained 245 mandibular fractures. Road traffic accidents were the most common cause of fractures (46%). The most common mandibular fracture was subcondylar. Thirty eight patients (24%) presented with associated facial fractures, while 34 (21%) had also other non-facial fractures. Open reduction and internal fixation was performed in 88 subjects. Complications occurred in 60 patients (38%). Road traffic accidents are the main cause of mandibular fractures in this series of patients. The most common mandibular fracture is subcondylar, which can be linked to the high rate of occlusal complications observed.

  12. Factors associated with the incidence of pressure ulcer during hospital stay.

    PubMed

    Matozinhos, Fernanda Penido; Velasquez-Melendez, Gustavo; Tiensoli, Sabrina Daros; Moreira, Alexandra Dias; Gomes, Flávia Sampaio Latini

    2017-05-25

    Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers. Estimar a taxa de incidência de úlcera por pressão e verificar fatores associados a essa ocorrência em uma coorte de pacientes hospitalizados. Trata-se de estudo de coorte no qual o desfecho foi a ocorrência da úlcera por pressão. A estimativa do efeito das variáveis para a proporção de incidência acumulada do desfecho foi realizada utilizando o modelo de riscos proporcionais de Cox. A seleção das variáveis ocorreu por meio do teste de hipóteses Logrank. A amostra foi composta de 442 adultos, com 25 casos incidentes de úlcera por pressão. Pacientes com altos escores na escala de Braden apresentaram maior risco de incidência de úlcera por pressão quando comparados com aqueles classificados na categoria de baixo escore. Os resultados reforçam a importância do uso da Escala de Braden para auxiliar na identificação dos pacientes com maior probabilidade de desenvolver úlcera por pressão.

  13. CDC Vital Signs: Hospital Actions Affect Breastfeeding

    MedlinePlus

    ... Read the MMWR Science Clips Hospital Actions Affect Breastfeeding Language: English (US) Español (Spanish) Recommend on ... in many US hospitals do not fully support breastfeeding. Some of the Ten Steps on which hospitals ...

  14. Hospital Room Floors May Harbor 'Superbugs'

    MedlinePlus

    ... fullstory_163886.html Hospital Room Floors May Harbor 'Superbugs' But that area often overlooked when it comes ... Hospital room floors may be more of a "superbug" threat than many hospital staffers realize, new research ...

  15. State tort reforms and hospital malpractice costs.

    PubMed

    Ellington, Charles R; Dodoo, Martey; Phillips, Robert; Szabat, Ronald; Green, Larry; Bullock, Kim

    2010-01-01

    This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability.

  16. Improve Hospital-to-Home Transitions

    MedlinePlus

    ... to the hospital. One study found that seniors hospitalized with heart failure often have multiple medical conditions, and they have the highest hospital readmission rate of all adult patient groups. This indicates a serious breakdown during the ...

  17. [Crisis unit at the general hospital: Determinants of further hospitalization].

    PubMed

    Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

    2016-10-10

    The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

  18. Diversification in the hospital industry.

    PubMed

    Eastaugh, Steven R

    2008-01-01

    An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Hospital diversification and its impact on the operating ratio are studied for 172 hospitals during the period 2002-2007. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependant. Institutional diversification is found to yield better financial position, and the better operating profits allow the institution the wherewithal to diversify. The impact of external government planning and hospital competition is also measured. Some services are in a growth phase, like bariatric weight loss surgery and sleep disorder clinics. Management's attitude concerning risk and reward is considered.

  19. Health Hazards of Hospital Personnel

    PubMed Central

    Clever, Linda Hawes

    1981-01-01

    Health care workers historically have faced serious health problems, such as exposure to patients with tuberculosis. For hospital personnel today, a number of hazards exist. These range from toxic substance exposure to safety hazards presented by patients themselves. PMID:7281652

  20. Play for Children in Hospital

    ERIC Educational Resources Information Center

    Hardgrove, Carol; And Others

    1976-01-01

    Contains six short articles on therapeutic play. Each article is an edited version of a paper delivered at the XIV World Congress of Pediatrics in Buenos Aires on the subject of children in the hospital. (JMB)

  1. Preventing Infections in the Hospital

    MedlinePlus

    ... and your doctor discuss the best way to control your blood sugar before, during, and after your hospital stay. High blood sugar increases the risk of infection noticeably. If you are overweight, losing weight will ...

  2. Aerospace technology and hospital systems

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The use of aerospace medical techniques to improve the quality of earth health care systems is discussed. Data are focused on physiological measurements and monitoring, medical information management, clean room technology, and reliability and quality assurance for hospital equipment.

  3. Public policy regarding specialty hospitals.

    PubMed

    Dowd, Bryan E

    2008-10-01

    Why do we need "public policy" regarding specialty hospitals? What is the rationale for government involvement in decisions by the private sector to invest in specialty hospitals? Two possibilities are reduced access to services primarily by the uninsured (a fairness concern) and changes in the types of patients receiving care resulting from poor consumer information (an efficiency concern). The fairness argument faces logical and empirical difficulties, and even if it proved to be true, it is not clear that limiting the growth of specialty hospitals would be an efficient way to address the problem. However, there is some empirical evidence to support the efficiency concern, and if specialty hospitals result in the treatment of patients with lower expected net benefits from treatment, then it is possible that physician-owned facilities could result in an increasingly inefficient allocation of health care resources, higher insurance premiums, and higher rates of uninsurance.

  4. Recommendations for managing hospital closure.

    PubMed

    van der Wal, R; Bouthillette, F; Havlovic, S J

    1998-01-01

    An acute care hospital was closed by the British Columbia Ministry of Health in 1993. A research study was conducted to investigate the ways closure of the hospital affected hospital employees and to identify ways to facilitate the closure/reorganization process. Unstructured interviews were conducted with 25 employees around the time of closure and six months after the closure. In the category Living with Closure, six themes arose from the qualitative analysis. They related to (1) provision of information; (2) effect of closure on the working environment and colleagues; (3) perceived stress; (4) recognition of one's worth; (5) provision of support services; and (6) the process of having a new job. The authors offer recommendations stemming from the analysis, which are intended to assist others planning for future hospital reorganizations or closures.

  5. Standards for hospital libraries 2002

    PubMed Central

    Gluck, Jeannine Cyr; Hassig, Robin Ackley; Balogh, Leeni; Bandy, Margaret; Doyle, Jacqueline Donaldson; Kronenfeld, Michael R.; Lindner, Katherine Lois; Murray, Kathleen; Petersen, JoAn; Rand, Debra C.

    2002-01-01

    The Medical Library Association's “Standards for Hospital Libraries 2002” have been developed as a guide for hospital administrators, librarians, and accrediting bodies to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information. Specific requirements for knowledge-based information include that the library be a separate department with its own budget. Knowledge-based information in the library should be directed by a qualified librarian who functions as a department head and is a member of the Academy of Health Information Professionals. The standards define the role of the medical librarian and the links between knowledge-based information and other functions such as patient care, patient education, performance improvement, and education. In addition, the standards address the development and implementation of the knowledge-based information needs assessment and plans, the promotion and publicity of the knowledge-based information services, and the physical space and staffing requirements. The role, qualifications, and functions of a hospital library consultant are outlined. The health sciences library is positioned to play a key role in the hospital. The increasing use of the Internet and new information technologies by medical, nursing, and allied health staffs; patients; and the community require new strategies, strategic planning, allocation of adequate resources, and selection and evaluation of appropriate information resources and technologies. The Hospital Library Standards Committee has developed this document as a guideline to be used in facing these challenges. Editor's Note: The “Standards for Hospital Libraries 2002” were approved by the members of the Hospital Library Section during MLA '02 in Dallas, Texas. They were subsequently approved by Section Council and received final approval from the MLA Board of Directors in June 2002. They succeed the Standards for Hospital Libraries

  6. Is there an overprescription of proton pump inhibitors in oncohematologic patients undergoing ambulatory oncospecific treatment?

    PubMed

    Pujal Herranz, Meritxell

    2016-09-01

    Objetivo: El objetivo de este estudio es analizar la prevalencia de inhibidores de la bomba de protones (IBP) en el paciente oncohematologico de dispensacion ambulatoria y el grado de adecuacion de su indicacion. Método: Estudio observacional descriptivo en pacientes oncohematologicos en tratamiento oncoespecifico de dispensacion ambulatoria. Se elaboro un protocolo dirigido al paciente oncohematologico a partir del protocolo de uso racional de IBP de nuestro hospital. Se cuantificaron los pacientes en tratamiento activo con IBP y se analizo la idoneidad de su indicacion. Resultados: Se incluyeron 111 pacientes (71 oncologicos, 40 hematologicos). El 56% de los pacientes oncologicos y el 63% de los hematologicos estaban en tratamiento activo con IBP. Tras revisar las indicaciones de los pacientes con IBP, el 72% de los oncologicos y el 12% de los hematologicos no presentaron una indicacion que justificara el tratamiento. Conclusiones: Es importante que el farmaceutico detecte las prescripciones inadecuadas de IBP especialmente entre la poblacion oncologica y sugiera una deprescripcion del mismo.

  7. Hospital financial performance trends to watch.

    PubMed

    Schuhmann, Thomas M

    2008-07-01

    Hospitals may wish to compare their performance with that of their peers to identify areas for possible improvement. Comparing financial indicators over five years shows directional trends and the influence of environmental factors such as regulatory change. For-profit hospitals appear to outperform their not-for-profit counterparts. Rural hospitals generally exhibit better financial performance than urban hospitals. Nonteaching hospitals show more desirable operating margins than teaching hospitals.

  8. Facility management in German hospitals.

    PubMed

    Gudat, H

    2000-04-01

    Facility management and optimum building management offer for hospitals a chance to reduce costs and to increase quality, process sequences, employee motivation and customer satisfaction. Some years ago simple services such as cleaning, catering or laundry were outsourced. Now, German hospitals progress to more complex fields such as building and medical technology, clinical support processes such as pharmacy, central laboratory and sterilization, goods and logistics services.

  9. What's new in tent hospitals?

    PubMed

    Laufman, H

    1989-06-01

    There will always be a need for some kind of rapidly deployable, easy to assemble, temporary shelter for use in military conflicts, large-scale military disasters, industrial accidents, major construction projects in remote areas, refugee relocation centers, military hospitals, and any temporary outdoor event requiring cover. The history of tenting is essentially a history of man's ingenuity in creating portable, rapidly erected, temporary shelter. This article will be limited to the stages of development of the latest in military tent hospitals.

  10. Parenteral nutrition in hospital pharmacies.

    PubMed

    Katoue, Maram Gamal; Al-Taweel, Dalal; Matar, Kamal Mohamed; Kombian, Samuel B

    2016-07-11

    Purpose - The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service. Design/methodology/approach - A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content. Findings - Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols. Originality/value - This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.

  11. Air handling units for hospitals.

    PubMed

    Amoroso, V; Gjestvang, R

    1989-10-01

    Air handling units should provide proper quality and conditioned air to various hospital areas. Unit capacity should be able to meet limited space functionality or load changes as well as any smoke control requirements. System components should be readily accessible and appropriate for spaces served. In summary, engineers should consider the following: Environmental design criteria for area being served Components desired Unit type required Economic issues affecting design. Using this approach, design engineers can design hospital air handling units methodically and logically.

  12. Nursing Diagnoses of hospitalized patients with heart failure: a longitudinal study.

    PubMed

    Pereira, Juliana de Melo Vellozo; Flores, Paula Vanessa Peclat; Figueiredo, Lyvia da Silva; Arruda, Cristina Silva; Cassiano, Keila Mara; Vieira, Gláucia Cristina Andrade; Guerra, Thais de Rezende Bessa; Silva, Vanessa Alves da; Cavalcanti, Ana Carla Dantas

    2016-01-01

    Identifying Nursing Diagnoses of fatigue, activity intolerance and decreased cardiac output in hospitalized patients with heart failure and verifying the association between the defining characteristics and the Nursing Diagnoses. A longitudinal and prospective study that followed hospitalized patients with heart failure for three weeks. The data collected through interviews and physical examinations were sent to expert nurses for diagnostic inference. Descriptive and inferential statistical analyses were carried out. Of the 72 patients, 68.0% were male and presented the nursing diagnosis of decreased cardiac output (62.5%) in the first week, reducing to 52.8% and 38% in the second and third weeks, respectively. Fatigue only appeared in one patient. Activity intolerance was the diagnosis that had the greatest discrepancy among the experts. Decreased cardiac output was associated to the defining characteristics: dyspnea, edema, jugular venous distension and reduced ejection fraction during all three weeks of evaluation. Decreased cardiac output was more prevalent in hospitalized patients with heart failure, and the associated defining characteristics were determining factors for this nursing diagnosis. Identificar os diagnósticos de enfermagem fadiga, intolerância à atividade e débito cardíaco diminuído em pacientes com insuficiência cardíaca hospitalizados e verificar a associação entre as características definidoras e os diagnósticos de enfermagem. Estudo longitudinal e prospectivo que acompanhou pacientes com insuficiência cardíaca hospitalizados por três semanas. Os dados coletados por entrevista e exame físico foram encaminhados a enfermeiros peritos para inferência diagnóstica. Realizou-se análise estatística descritiva e inferencial. Dos 72 pacientes, 68,0% eram do sexo masculino e apresentaram o diagnóstico de enfermagem débito cardíaco diminuído (62,5%) na primeira semana, reduzindo para 52,8% e 38% na segunda e terceira semana

  13. [Flexibility and safety in hospitals].

    PubMed

    Fara, G M; Barni, M

    2011-01-01

    The paper explains the reasons according to which the newly-planned hospitals must adopt the concept of advanced flexibility (structural, technological, organizational, diagnostic and therapeutic), in order to avoid the risk of being already obsolete at the moment of their opening, and this due to the fact that too much time elapses in this Country between the moment of planning a new hospital and the moment of the start of its activity. Flexibility is needed at different levels: at low or medium levels for what concerns administrative spaces and also patient rooms (except, in this latter case, when differential intensity of care is adopted); at advanced levelfor what concerns diagnostic and therapeutic areas, which must be rapidly adaptable to new solutions offered by advances in technology and organization. From a different standpoint, flexibility applies also to the fact that hospital must increasingly become a node of a large net including territorial health services: the latter devoted to take care of chronicity, while hospitals should concentrate on acute pathology. Of course the territory surrounding the hospital, through its outpatient service and consultories, is in charge also for first level diagnosy and therapy, leaving the hospital to more sophisticated activities.

  14. [Redesigning the hospital discharge process].

    PubMed

    Martínez-Ramos, M; Flores-Pardo, E; Uris-Sellés, J

    2016-01-01

    The aim of this article is to show that the redesign and planning process of hospital discharge advances the departure time of the patient from a hospital environment. Quasi-experimental study conducted from January 2011 to April 2013, in a local hospital. The cases analysed were from medical and surgical nursing units. The process was redesigned to coordinate all the professionals involved in the process. The hospital discharge improvement process improvement was carried out by forming a working group, the analysis of retrospective data, identifying areas for improvement, and its redesign. The dependent variable was the time of patient administrative discharge. The sample was classified as pre-intervention, inter-intervention, and post-intervention, depending on the time point of the study. The final sample included 14,788 patients after applying the inclusion and exclusion criteria. The mean discharge release time decreased significantly by 50 min between pre-intervention and post-intervention periods. The release time in patients with planned discharge was one hour and 25 min less than in patients with unplanned discharge. Process redesign is a useful strategy to improve the process of hospital discharge. Besides planning the discharge, it is shown that the patient leaving the hospital before 12 midday is a key factor. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  15. Random output and hospital performance.

    PubMed

    Barros, Pedro Pita

    2003-11-01

    Many countries are under pressure to reform health care financing and delivery. Hospital care is one part of the health system that is under scrutiny. Private management initiatives are a possible way to increase efficiency in health care delivery. This motivates the interest in developing methodologies to assess hospital performance, recognizing hospitals as a different sort of firm. We present a simple way to describe hospital production: hospital output as a change in the distribution of survival probabilities. This output definition allows us to separate hospital production from patients' characteristics. The notion of "better performance" has a precise meaning: (first-order) stochastic dominance of a distribution of survival probabilities over another distribution. As an illustration, we compare, for an important DRG, private and public management and find that private management performs better, mainly in the range of high-survival probabilities. The measured performance difference cannot be attributed to input prices or to economies of scale and/or scope. It reflects pure technological and organisational differences.

  16. Foodborne listeriosis acquired in hospitals.

    PubMed

    Silk, Benjamin J; McCoy, Morgan H; Iwamoto, Martha; Griffin, Patricia M

    2014-08-15

    Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered to be hospital-acquired was 25% (range, 9%-67%). The median number of outbreak-related illnesses considered to be hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 of 24 (75%) reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods.

  17. Candiduria in hospitalized patients in teaching hospitals of Ahvaz.

    PubMed

    Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B

    2012-12-01

    Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.

  18. Admission avoidance hospital at home.

    PubMed

    Shepperd, Sasha; Iliffe, Steve; Doll, Helen A; Clarke, Mike J; Kalra, Lalit; Wilson, Andrew D; Gonçalves-Bradley, Daniela C

    2016-09-01

    Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review. To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, two other databases, and two trials registers on 2 March 2016. We checked the reference lists of eligible articles. We sought unpublished studies by contacting providers and researchers who were known to be involved in the field. Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data, requested individual patient data from trialists, and relied on published data when this was not available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 16 randomised controlled trials with a total of 1814 participants; three trials recruited participants with chronic obstructive pulmonary disease, two trials recruited participants recovering from a stroke, six trials recruited participants with an acute medical condition who were mainly elderly, and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. Admission avoidance hospital at home probably makes little

  19. [Evaluation of satisfaction of patients hospitalized at the Kairouan Hospital].

    PubMed

    Mtiraoui, Ali; Alouini, Borhane

    2002-03-01

    The patients' satisfaction studies are more and more utilized to underline the health centers' deficiencies and consequently set improvement action plans. Our survey aims to measure inpatients' satisfaction in its different dimensions. A survey centered around a transversal inquiry has been conducted during a period going from February to April 2000 and reached a total number of 817 patients hospitalized in six service units at kairouan hospital. The data has been gathered by structured interviews led by a previously trained social worker. The investigation tool was a standardized questionnaire prepared by a group of experts from WHO in the Oriental Mediterranean region. The main results are as follow: High satisfaction level concerning the global evaluation of the hospital service units was recorded (score = 70%). The patient who are more satisfied are those who have the feeling that their health situation has considerably improved, and who will probably recommend this hospital to their surroundings. Big proportion of the patients (77%) was expecting better services. The main reason behind their unhappiness is the information emanated whether from the nurses or the doctors, the comfort and the cleanness of waiting room, linen, room comfort, food and the emergency. These results showed that the quality of care improvements priorities, according to patient expectations are especially in relation with the quality of information, the relational aspects and the hospital stay conditions.

  20. Hospital network performance: a survey of hospital stakeholders' perspectives.

    PubMed

    Bravi, F; Gibertoni, D; Marcon, A; Sicotte, C; Minvielle, E; Rucci, P; Angelastro, A; Carradori, T; Fantini, M P

    2013-02-01

    Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders' perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders' perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers' rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. [Hospital expenditures for five diseases of high economic impact].

    PubMed

    Zambrana, Marcela; Zurita, Beatriz; Ramírez, Teresita de Jesús; Coria, Irma

    2008-01-01

    to identify by gender and age group, the hospital expenditures of the diseases that have the major economic impact at Instituto Mexicano del Seguro Social through using the diagnosis related groups (DRG) classification system and by estimating their associated costs. DRG system served to estimate hospital expenditures for five diseases: hypertension, type 2 diabetes, chronic renal failure, cervical cancer and HIV/AIDS. DRG allow for better estimation given that consider cost adjustment based on the amount of resources employed in the treatment of different episodes. in the year 2002, 6.7 % of the hospital budget was assigned to the care of these five diseases. 42.6 % of the expenditures were allocated to patients aged 60 years and older and 22.3 % to patients from 50 to 59 years of age. Regarding diabetes mellitus and hypertension, care to patients over the age of 60 reached values of 55 % and 57 % of hospital expenditures respectively. Chronic renal failure and cervical cancer reached 60.5 % and 72.8 % of the expenditures, which were concentrated in patients aged 59 years or less; HIV/AIDS expenditures were distributed among patients from 20 to 50 years of age, the highest percentage (41.7 %) was in the group of 30 to 39 years of age. It is relevant to develop classification and information tools that consider the type of patients receiving hospital care, that are able to monitor changes due to the demographic and epidemiologic transition processes, and that allow for sensitive outcomes measurement. These tools will help in achieving an adequate financing and planning of health expenditures.

  2. [Validation of a method of dispensing nutritional supplements in a tertiary hospital].

    PubMed

    Oliva García, José Gregorio; Pereyra-García Castro, Francisca; Benítez Brito, Néstor; Herrera Rodríguez, Eva María; Suárez Llanos, José Pablo; García Bray, Bruno Francisco; Palacio Abizanda, José Enrique

    2013-01-01

    Introducción: Los suplementos nutricionales constituyen un pilar fundamental del tratamiento de la desnutrición hospitalaria, aunque su coste es elevado. Son precisos métodos que permitan una prescripción racional de los mismos. Objetivos: Analizar la validez de los criterios de dispensación de suplementos nutricionales (SN) utilizados en nuestro centro (empleando como referencia el sistema CONUT). Material y métodos: Se revisaron retrospectivamente los formularios de solicitud de SN remitidos por los distintos servicios durante 15 meses (abril/2010-junio/2011). Se analizaron las siguientes variables: servicio solicitante, patología, IMC, pérdida de peso reciente, disminución de la ingesta mayor del 50%, proteínas totales, albúmina, linfocitos, colesterol total y valoración del grado de desnutrición según sistema CONUT. Se comparó la validez de nuestros criterios de dispensación de SN con el sistema CONUT (empleando el coeficiente Kappa). Resultados: Se recibieron 524 solicitudes (34,9/mes). Patologías: infecciosa (31,1%), tumoral (26,1%), postquirúrgica (19%), otras (23,8%). Había pérdida de peso reciente en el 88,9% de los pacientes, y una disminución de la ingesta superior al 50% en el 83,4%. IMC: 24,8 ± 7,5 kg/m2. Parámetros analíticos: albúmina 2,6 ± 0,7 g/dl, proteínas totales 5,7 ± 2,4 g/dl, colesterol total 152 ± 172 mg/dl, linfocitos 1.561 ± 1.842/mm3. Valoración del grado de desnutrición según sistema CONUT: normal (12%), desnutrición leve (23,1%), moderada (41,6%), grave (23,3%). Cumplimiento de los requisitos de nuestro centro hospitalario para la dispensación de SN: ninguno (6,3%), uno (33,6%), dos (43,1%), los tres (17%). Se comparó el número de dichos requisitos con el grado de desnutrición (sistema CONUT), obteniéndose un índice de concordancia débil (Kappa = 0,207; p < 0,001). 156 pacientes (29,8% de las solicitudes) recibieron SN, a pesar de presentar grado de nutrición normal o desnutrición leve de

  3. Reporting hospital adverse events using the Alfred Hospital's morbidity data.

    PubMed

    Carroll, Rhonda; McLean, Jenny; Walsh, Michael

    2003-01-01

    Hospital morbidity data were analysed to determine their usefulness for reporting adverse events. The entire ICD-10-AM classification system was reviewed in conjunction with the Australian Coding Standards to identify external cause codes and code prefixes associated with adverse events. For the 50,712 separations registered at The Alfred from July 2000-June 2001, 4,740 external cause codes were associated with adverse events. Place of occurrence code CY92.22 was considered the best indicator of the number of separations associated with adverse events. Approximately 4% of all separations were associated with adverse events occurring during an episode of care. Results suggest that hospital morbidity data are useful for monitoring adverse events at hospital level. Reliable reporting across the health care industry requires consistent reporting requirements at state and national levels and the adoption of standard code prefixes nationally.

  4. Hospital readmission and parent perceptions of their child's hospital discharge.

    PubMed

    Berry, Jay G; Ziniel, Sonja I; Freeman, Linda; Kaplan, William; Antonelli, Richard; Gay, James; Coleman, Eric A; Porter, Stephanie; Goldmann, Don

    2013-10-01

    To describe parent perceptions of their child's hospital discharge and assess the relationship between these perceptions and hospital readmission. A prospective study of parents surveyed with questions adapted from the care transitions measure, an adult survey that assesses components of discharge care. Participant answers, scored on a 5-point Likert scale, were compared between children who did and did not experience a readmission using a Fisher's exact test and logistic regression that accounted for patient characteristics associated with increased readmission risk, including complex chronic condition and assistance with medical technology. A tertiary-care children's hospital. A total of 348 parents surveyed following their child's hospital discharge between March and October 2010. None. Unplanned readmission within 30 days of discharge. There were 28 children (8.1%) who experienced a readmission. Children had a lower readmission rate (4.4 vs. 11.3%, P = 0.004) and lower adjusted readmission likelihood [odds ratio 0.2 (95% confidence interval 0.1, 0.6)] when their parents strongly agreed (n = 206) with the statement, 'I felt that my child was healthy enough to leave the hospital' from the index admission. Parent perceptions relating to care management responsibilities, medications, written discharge plan, warning signs and symptoms to watch for and primary care follow-up were not associated with readmission risk in multivariate analysis. Parent perception of their child's health at discharge was associated with the risk of a subsequent, unplanned readmission. Addressing concerns with this perception prior to hospital discharge may help mitigate readmission risk in children.

  5. Hospital benchmarking: are U.S. eye hospitals ready?

    PubMed

    de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S

    2012-01-01

    Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added

  6. Internet connectivity for hospitals and hospital libraries: strategies.

    PubMed Central

    Fuller, S S

    1995-01-01

    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator. PMID:7703936

  7. Regional Hospital Input Price Indexes

    PubMed Central

    Freeland, Mark S.; Schendler, Carol Ellen; Anderson, Gerard

    1981-01-01

    This paper describes the development of regional hospital input price indexes that is consistent with the general methodology used for the National Hospital Input Price Index. The feasibility of developing regional indexes was investigated because individuals inquired whether different regions experienced different rates of increase in hospital input prices. The regional indexes incorporate variations in cost-share weights (the amount an expense category contributes to total spending) associated with hospital type and location, and variations in the rate of input price increases for various regions. We found that between 1972 and 1979 none of the regional price indexes increased at average annual rates significantly different from the national rate. For the more recent period 1977 through 1979, the increase in one Census Region was significantly below the national rate. Further analyses indicated that variations in cost-share weights for various types of hospitals produced no substantial variations in the regional price indexes relative to the national index. We consider these findings preliminary because of limitations in the availability of current, relevant, and reliable data, especially for local area wage rate increases. PMID:10309557

  8. Estimating Influenza Hospitalizations among Children

    PubMed Central

    Grijalva, Carlos G.; Craig, Allen S.; Dupont, William D.; Bridges, Carolyn B.; Schrag, Stephanie J.; Iwane, Marika K.; Schaffner, William; Edwards, Kathryn M.

    2006-01-01

    Although influenza causes more hospitalizations and deaths among American children than any other vaccine-preventable disease, deriving accurate population-based estimates of disease impact is challenging. Using 2 independent surveillance systems, we performed a capture-recapture analysis to estimate influenza-associated hospitalizations in children in Davidson County, Tennessee, during the 2003–2004 influenza season. The New Vaccine Surveillance Network (NVSN) enrolled children hospitalized with respiratory symptoms or fever and tested them for influenza. The Tennessee Emerging Infections Program (EIP) identified inpatients with positive influenza diagnostic test results through review of laboratory and infection control logs. The hospitalization rate estimated from the capture-recapture analysis in children <5 years of age was 2.4 per 1,000 (95% confidence interval 1.8–3.8). When NVSN estimates were compared with capture-recapture estimates, NVSN found 84% of community-acquired cases, EIP found 64% of cases in which an influenza rapid test was performed, and the overall sensitivity of NVSN and EIP for influenza hospitalizations was 73% and 38%, respectively. PMID:16494725

  9. Measuring nutritional risk in hospitals

    PubMed Central

    Rasmussen, Henrik H; Holst, Mette; Kondrup, Jens

    2010-01-01

    About 20%–50% of patients in hospitals are undernourished. The number varies depending on the screening tool amended and clinical setting. A large number of these patients are undernourished when admitted to the hospital, and in most of these patients, undernutrition develops further during hospital stay. The nutrition course of the patient starts by nutritional screening and is linked to the prescription of a nutrition plan and monitoring. The purpose of nutritional screening is to predict the probability of a better or worse outcome due to nutritional factors and whether nutritional treatment is likely to influence this. Most screening tools address four basic questions: recent weight loss, recent food intake, current body mass index, and disease severity. Some screening tools, moreover, include other measurements for predicting the risk of malnutrition. The usefulness of screening methods recommended is based on the aspects of predictive validity, content validity, reliability, and practicability. Various tools are recommended depending on the setting, ie, in the community, in the hospital, and among elderly in institutions. The Nutrition Risk Screening (NRS) 2002 seems to be the best validated screening tool, in terms of predictive validity ie, the clinical outcome improves when patients identified to be at risk are treated. For adult patients in hospital, thus, the NRS 2002 is recommended. PMID:21042553

  10. Report: hospitals need more sophisticated planning efforts.

    PubMed

    Anderson, H J

    1990-09-20

    Sophisticated planning efforts are increasing among hospitals. However, hospital planners and marketers still have far to go before they can match their counterparts in industry. This is according to a report on hospital planning recently released by the Society for Healthcare Planning and Marketing of the American Hospital Association, Chicago.

  11. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital space...

  12. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital space...

  13. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital space...

  14. Hospital pricing policies: the simple economics.

    PubMed

    Robison, G A; Robison, H D

    1986-10-01

    Changes in hospital reimbursement structures and the shrinking inpatient service market are forcing hospitals to reexamine their pricing strategies. This article examines historical hospital pricing, the effect of pricing in a competitive market and considerations for hospitals moving toward competitive pricing for services.

  15. A conflict of interest policy for hospitals.

    PubMed

    McClure, A E

    1993-01-01

    As the environment in which community hospitals operate becomes ever more complex, the opportunity for conflict of interest between the hospital and members of its governing board increases. This article examines the duties and responsibilities of hospital trustees and the ways in which hospitals can identify and manage conflict of interest.

  16. 45 CFR 211.8 - Continuing hospitalization.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Elizabeths Hospital in the District of Columbia, in an appropriate Public Health Service Hospital, or in such other suitable public or private hospital as the Administrator determines is in the best interests of... in need of continuing care and treatment in a hospital cannot be accomplished under § 211.7, or until...

  17. 45 CFR 211.8 - Continuing hospitalization.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Elizabeths Hospital in the District of Columbia, in an appropriate Public Health Service Hospital, or in such other suitable public or private hospital as the Administrator determines is in the best interests of... in need of continuing care and treatment in a hospital cannot be accomplished under § 211.7, or until...

  18. 45 CFR 211.8 - Continuing hospitalization.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Elizabeths Hospital in the District of Columbia, in an appropriate Public Health Service Hospital, or in such other suitable public or private hospital as the Administrator determines is in the best interests of... in need of continuing care and treatment in a hospital cannot be accomplished under § 211.7, or until...

  19. 45 CFR 211.8 - Continuing hospitalization.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Elizabeths Hospital in the District of Columbia, in an appropriate Public Health Service Hospital, or in such other suitable public or private hospital as the Administrator determines is in the best interests of... in need of continuing care and treatment in a hospital cannot be accomplished under § 211.7, or until...

  20. Uninsured Hospitalizations: Rural and Urban Differences

    ERIC Educational Resources Information Center

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu

    2008-01-01

    Context: Few studies have examined hospitalization patterns among the uninsured, especially from the perspective of rural and urban differences. Purpose: To examine whether the patterns of uninsured hospitalizations differ in rural and urban hospitals and to identify the most prevalent and costly diagnoses among uninsured hospitalizations.…

  1. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital...

  2. 46 CFR 108.209 - Hospital spaces.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital...

  3. [Nosocomial infections. Trends over a 12 year-period in a pediatric hospital].

    PubMed

    Zamudio-Lugo, Irma; Espinosa-Vital, Guadalupe Judith; Rodríguez-Sing, Roberta; Gómez-González, Claudia Josefina; Miranda-Novales, María Guadalupe

    2014-01-01

    INTRODUCCIÓN: las infecciones nosocomiales constituyen uno de los principales problemas de salud en los hospitales, por ello, los programas de prevención y control deben ser evaluados con el impacto en las tasas de incidencia. El objetivo de esta investigación fue identificar la tendencia de las infecciones nosocomiales durante un periodo de 12 años en un hospital pediátrico de tercer nivel. MÉTODOS: se llevó a cabo un estudio de cohorte retrospectivo en el que se incluyeron todos los pacientes hospitalizados que presentaron infecciones nosocomiales. El análisis estadístico de los datos incluyó frecuencias simples, proporciones y densidad de incidencia por año, sitio de infección y letalidad.

  4. Increased ultrasensitive C-reactive protein is not associated with obesity in hospitalized heart failure patients.

    PubMed

    Schommer, Vânia Ames; Stein, Airton Tetelbom; Marcadenti, Aline; Wittke, Estefania Inez; Galvão, André Luís Câmara; Rosito, Guido Bernardo Aranha

    2016-01-01

    To evaluate the association between obesity and levels of high-sensitivity C-reactive protein (hs-CRP) in patients with heart failure admitted to a tertiary hospital. Cross-sectional study with a consecutive sampling of hospitalized patients with heart failure. Sociodemographic and clinical data were collected, and the nutritional status was assessed through indicators such as body mass index (in kg/m2), waist circumference (in cm), waist-hip ratio, triceps skinfold (in mm) and subscapularis skinfold (in mm). Neck circumference (in cm) was measured as well as serum levels of hs-CRP, in mg/L. Among 123 patients, the mean age was 61.9±12.3 years and 60.2% were male. The median of hs-CRP was 8.87mg/L (3.34 to 20.01). A tendency to an inverse correlation between neck circumference and hs-CRP was detected (r=-0.167; p=0.069). In the multiple linear regression analysis, after adjustment for age, disease severity (NYHA classification III and IV, low ejection fraction, left ventricular dysfunction during diastole), and infectious conditions there was an inverse association between hs-CRP and neck circumference (ß=-0.196; p=0.03) and subscapularis skinfold (ß=-0.005; p=0.01) in the total sample, which was not maintained after the stratification by sex. Increased levels of hs-CRP in patients hospitalized for heart failure were not associated with obesity. Avaliar a associação entre obesidade e níveis de proteína c-reativa ultrassensível (PCR-us) em pacientes com insuficiência cardiac admitidos em um hospital terciário. Estudo transversal com amostragem consecutiva de pacientes com insuficiência cardíaca hospitalizados. Foram coletados dados sociodemográficos e clínicos, e o estado nutricional foi avaliado por meio de indicadores como índice de massa corporal (em kg/m2), circunferência da cintura (em cm), razão cintura-quadril, dobra cutânea tricipital (em mm) e dobra cutânea subescapular (em mm). Circunferência do pescoço (em cm) foi aferida bem como n

  5. Case Study: del Amo Bioventing

    EPA Science Inventory

    The attached presentation discusses the fundamentals of bioventing in the vadose zone. The basics of bioventing are presented. The experience to date with the del Amo Superfund Site is presented as a case study.

  6. Case Study: del Amo Bioventing

    EPA Science Inventory

    The attached presentation discusses the fundamentals of bioventing in the vadose zone. The basics of bioventing are presented. The experience to date with the del Amo Superfund Site is presented as a case study.

  7. The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data

    PubMed Central

    Maggioni, Aldo Pietro

    2015-01-01

    Objective This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI). Methods The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a “Sistema Locale del Lavoro” (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012–2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity. Results Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001). Conclusions More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity. PMID:26574745

  8. The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data.

    PubMed

    Torbica, Aleksandra; Maggioni, Aldo Pietro; Ghislandi, Simone

    2015-01-01

    This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI). The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a "Sistema Locale del Lavoro" (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012-2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity. Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001). More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity.

  9. [Gene therapy and hospital strategy].

    PubMed

    Leclercq, B

    1993-10-01

    Gene therapy raises strong interrogations among hospital managers. Actually, hospital environment is disturbed and moving as well in a legislative political and statutory level as in an economical (competition, consumerism, proximity of the establishments) and demographic one (ageing, new pathologies). The fast development of medical technologies amplifies this disturbance. In front of that environment, the hospital has to anticipate the arriving of gene therapy without underestimating the deontological, medical, economical and judicial risks. The decisions of implantation have to be taken in a collective way, and seriously planned and estimated on a medical and economical level. The way to train people and to forecast their careers don't have to be underestimated in consideration of the challenge which is represented by the gene therapy.

  10. Enterprise resource planning for hospitals.

    PubMed

    van Merode, Godefridus G; Groothuis, Siebren; Hasman, Arie

    2004-06-30

    Integrated hospitals need a central planning and control system to plan patients' processes and the required capacity. Given the changes in healthcare one can ask the question what type of information systems can best support these healthcare delivery organizations. We focus in this review on the potential of enterprise resource planning (ERP) systems for healthcare delivery organizations. First ERP systems are explained. An overview is then presented of the characteristics of the planning process in hospital environments. Problems with ERP that are due to the special characteristics of healthcare are presented. The situations in which ERP can or cannot be used are discussed. It is suggested to divide hospitals in a part that is concerned only with deterministic processes and a part that is concerned with non-deterministic processes. ERP can be very useful for planning and controlling the deterministic processes.

  11. Light Therapy in Mental Hospitals

    PubMed Central

    Cormac, H. Dove

    1929-01-01

    The position of actinotherapy in Mental Hospitals in this country is reviewed. An investigation of the results of ultra-violet irradiation in mental disorders at Parkside Mental Hospital is described and it is shown that certain types of the psychoses appear to benefit. The physiological action of actinic rays in relation to mental disorders is discussed and their mode of action on the nervous system suggested. Reference is made to substances which sensitize the body tissues to sunlight and ultra-violet radiation. An allusion is made to glass, penetrable by a portion of the actinic rays, and its uses. The need for ultra-violet ray apparatus in every mental hospital is urged both for treatment of mental and physical conditions and for the study of its action. PMID:19986837

  12. SARS in Hospital Emergency Room

    PubMed Central

    Chen, Yee-Chun; Huang, Li-Min; Chan, Chang-Chuan; Su, Chan-Ping; Chang, Ying-Ying; Chen, Mei-Ling; Hung, Chien-Ching; Chen, Wen-Jone; Lin, Fang-Yue; Lee, Yuan-Teh

    2004-01-01

    Thirty-one cases of severe acute respiratory syndrome (SARS) occurred after exposure in the emergency room at the National Taiwan University Hospital. The index patient was linked to an outbreak at a nearby municipal hospital. Three clusters were identified over a 3-week period. The first cluster (5 patients) and the second cluster (14 patients) occurred among patients, family members, and nursing aids. The third cluster (12 patients) occurred exclusively among healthcare workers. Six healthcare workers had close contact with SARS patients. Six others, with different working patterns, indicated that they did not have contact with a SARS patient. Environmental surveys found 9 of 119 samples of inanimate objects to be positive for SARS coronavirus RNA. These observations indicate that although transmission by direct contact with known SARS patients was responsible for most cases, environmental contamination with the SARS coronavirus may have lead to infection among healthcare workers without documented contact with known hospitalized SARS patients. PMID:15200809

  13. Appropriate measures of hospital market areas.

    PubMed Central

    Garnick, D W; Luft, H S; Robinson, J C; Tetreault, J

    1987-01-01

    As public and private policymakers turn to market-oriented strategies to control hospital prices, it is necessary to understand the conceptual underpinnings of hospital market area measurement. This article provides a framework for evaluating which definitions of hospital market areas are suitable for various types of analyses. Hospital market areas can be defined from two perspectives: an individual hospital perspective and that of the overall market. From each perspective, empirical definitions can be based on geopolitical boundaries, distance between hospitals, and patient-origin data. In this article, market areas are compared based on various descriptions using data on California hospitals and patient discharge abstracts. PMID:3570813

  14. HMO penetration: has it hurt public hospitals?

    PubMed

    Clement, J P; Grazier, K L

    2001-01-01

    The purpose of this study is to determine the extent to which health maintenance organization (HMO) penetration within the public hospitals' market area affects the financial performance and viability of these institutions, relative to private hospitals. Hospital- and market-specific measures are examined in a fully interacted model of over 2,300 hospitals in 321 metropolitan statistical areas (MSAs) in 1995. Although hospitals located in markets with higher HMO penetration have lower financial performance as reflected in revenues, expenses and operating margin, public hospitals are not more disadvantaged than other hospitals by managed care.

  15. Conservacion de truchas del Pacifico

    Treesearch

    Brooke E. Penaluna

    2016-01-01

    La historia de las truchas del Pacífico, pertenecientes al género Oncorhynchus, es una historia muy interesante que se basa en la persistencia y diversificación de sus especies debido, en gran parte, al dinamismo propio que existe en su medio ambiente. Desde el oeste de Norteamérica, extendiéndose hasta el este de Asia, las truchas del Pacífico han experimentado la...

  16. [The future of hospitals and the hospitals in the future].

    PubMed

    Illés, S Tamás

    2016-07-01

    By the end of the 20th century the vertically organized hospitals formed into a closed hierarchical system, in which the healthcare supply significantly fragmented. The existing hospitals in the current organization are not prepared for the increase in longevity, nor for the high growth in the number of chronic and long-term illnesses and the multi-morbidity since they were not designed for extended carry treatments. The fast incorporation of high-tech and very expensive technologies into healthcare generates an economic crisis. Solving the supply and economic crisis at the same time cannot be achieved without changing the structure of hospitals. Future hospitals will be organized in a network, conducting special treatments according to disease profiles. According to present knowledge, this is the only structure that allows for economies in scale, the proper spending of the ever-shrinking resources, and to ensure the effective patient care required after the changing of disorder structures and patient corporate identities. Orv. Hetil., 2016, 157(28), 1099-1104.

  17. Hospital-integrated PACS at the University Hospital of Geneva

    NASA Astrophysics Data System (ADS)

    Ratib, Osman M.; Ligier, Yves; Hochstrasser, Denis; Scherrer, Jean-Raoul

    1991-07-01

    The PACS under development at the University Hospital of Geneva is a hospital-wide image management system for radiological as well as non-radiological medical images which is part of one of the widest hospital information systems (HIS) in Switzerland (Diogene system). It is based on a multi-vendor open architecture and a set of widely available industry standards, namely: Unix as the operating system, TCP-IP as network protocol and an SQL-based distributed database (INGRES) that handles both the PACS and the HIS. The PACS is based on a distributed architecture of servers of two types: the archive servers connected to the sources of images and equipped with large optical disk libraries (jukeboxes) and display servers distributed over the hospital. A standard image storage format was developed based on the ACR-NEMA standard. This file format (the PAPYRUS format) allows storage of sets of images as a sequence of ACR-NEMA messages in an 'encapsulated' file structure. In order to provide a more uniform user interface on a variety of different workstations, a common platform for image display and manipulation called OSIRIS is developed based on X-11 windowing system and OSF/Motif extension. Such a platform is designed to be portable to any computer running Unix and equipped with a graphic display system running X-11. Because this software is written in the object-oriented language C++, it is easily expandable and easily adaptable to different needs and requirements.

  18. Pricing objectives in nonprofit hospitals.

    PubMed Central

    Bauerschmidt, A D; Jacobs, P

    1985-01-01

    This article reports on a survey of 60 financial managers of nonprofit hospitals in the eastern United States relating to the importance of a number of factors which influence their pricing decisions and the pricing objectives which they pursue. Among the results uncovered by the responses: that trustees are the single most important body in the price-setting process (doctors play a relatively unimportant role); that hospital pricing goals are more related to target net revenue than profit maximizing; and that regional factors seem to play an important role in management differences. PMID:4008272

  19. Pricing objectives in nonprofit hospitals.

    PubMed

    Bauerschmidt, A D; Jacobs, P

    1985-06-01

    This article reports on a survey of 60 financial managers of nonprofit hospitals in the eastern United States relating to the importance of a number of factors which influence their pricing decisions and the pricing objectives which they pursue. Among the results uncovered by the responses: that trustees are the single most important body in the price-setting process (doctors play a relatively unimportant role); that hospital pricing goals are more related to target net revenue than profit maximizing; and that regional factors seem to play an important role in management differences.

  20. Evaluation methods for hospital projects.

    PubMed

    Buelow, Janet R; Zuckweiler, Kathryn M; Rosacker, Kirsten M

    2010-01-01

    The authors report the findings of a survey of hospital managers on the utilization of various project selection and evaluation methodologies. The focus of the analysis was the empirical relationship between a portfolio of project evaluation(1) methods actually utilized for a given project and several measures of perceived project success. The analysis revealed that cost-benefit analysis and top management support were the two project evaluation methods used most often by the hospital managers. The authors' empirical assessment provides evidence that top management support is associated with overall project success.

  1. Command in a field hospital.

    PubMed

    Bricknell, M C M

    2003-03-01

    This paper examines the challenges involved in commanding a field hospital. There are frequent, dynamic tensions between the military culture that is based on a task-focussed, hierarchical structure and the clinical culture that is based on flat, process-focussed, multidisciplinary teams. The paper outlines the cultural environment of the field hospital and then examines the deployment sequence whereby a functioning clinical facility may be created from a group of disparate individuals. There are a number of tools that may assist with this including the personality of the Commanding Officer, individual skills, the creation of an organizational identity and the choice of command structure.

  2. Field guide to hospital cafeterias.

    PubMed

    Smith, R P

    1986-09-01

    We have all faced the problem of whether or not to venture into that gastronomic wasteland known as the hospital cafeteria. Hospital cafeterias have developed a reputation, deserved or otherwise, as less than ideal places to eat. Many people overlook the fact that this is a direct result of trying to provide patient meals that are salt-free, sugar-free, fiber-free, and taste-free. (Some faint traces of color may, occasionally, be found.) How then does one go about choosing whether to venture in, and how does one survive the encounter once there? The following guide has been assembled to help the reader through this difficult process.

  3. Hospital readmission and parent perceptions of their child's hospital discharge

    PubMed Central

    Berry, Jay G.; Ziniel, Sonja I.; Freeman, Linda; Kaplan, William; Antonelli, Richard; Gay, James; Coleman, Eric A.; Porter, Stephanie; Goldmann, Don

    2013-01-01

    Objective To describe parent perceptions of their child's hospital discharge and assess the relationship between these perceptions and hospital readmission. Design A prospective study of parents surveyed with questions adapted from the care transitions measure, an adult survey that assesses components of discharge care. Participant answers, scored on a 5-point Likert scale, were compared between children who did and did not experience a readmission using a Fisher's exact test and logistic regression that accounted for patient characteristics associated with increased readmission risk, including complex chronic condition and assistance with medical technology. Setting A tertiary-care children's hospital. Participants: A total of 348 parents surveyed following their child's hospital discharge between March and October 2010. Intervention None. Main Outcome Measure Unplanned readmission within 30 days of discharge. Results There were 28 children (8.1%) who experienced a readmission. Children had a lower readmission rate (4.4 vs. 11.3%, P = 0.004) and lower adjusted readmission likelihood [odds ratio 0.2 (95% confidence interval 0.1, 0.6)] when their parents strongly agreed (n = 206) with the statement, ‘I felt that my child was healthy enough to leave the hospital’ from the index admission. Parent perceptions relating to care management responsibilities, medications, written discharge plan, warning signs and symptoms to watch for and primary care follow-up were not associated with readmission risk in multivariate analysis. Conclusions Parent perception of their child's health at discharge was associated with the risk of a subsequent, unplanned readmission. Addressing concerns with this perception prior to hospital discharge may help mitigate readmission risk in children. PMID:23962990

  4. Max Brödel: his art, legacy, and contributions to neurosurgery through medical illustration.

    PubMed

    Patel, Smruti K; Couldwell, William T; Liu, James K

    2011-07-01

    Max Brödel is considered the father of modern medical illustration. This report reviews his contributions to neurosurgery as a medical illustrator. Max Brödel, a young artist from Leipzig, Germany, was hired at Johns Hopkins Hospital in 1894, where he illustrated an operative textbook of gynecology for Howard A. Kelly. Although Brödel did not have any formal medical training, he quickly acquired knowledge of anatomy, pathology, physiology, and surgery. Brödel's extraordinary illustrations were characterized by an aerial perspective that conveyed the surgeon's operative viewpoint and precise surgical anatomy. He masterfully incorporated tissue realism with cross-sectional anatomy to accentuate concepts while maintaining topographical accuracy. Brödel's reputation spread quickly and resulted in collaborations with prominent surgeons, such as Cushing, Halsted, and Dandy. Cushing, who also possessed artistic talent, became a pupil of Brödel and remained a very close friend. In 1911, Brödel was appointed the director of the Department of Art as Applied to Medicine at Johns Hopkins, the first academic department of its kind in the world. For the next several decades, he trained generations of renowned medical illustrators. Just as Osler, Halsted, and Cushing passed their skills and knowledge to future leaders of medicine and surgery, Brödel did the same for the field of medical illustration. The advancement of neurosurgical education has been greatly facilitated by Max Brödel's artistic contributions. His unique ability to synthesize art and medicine resulted in timeless illustrations that remain indispensable to surgeons. The art produced by his legacy of illustrators continues to flourish in neurosurgical literature today.

  5. Hospitalization of hospice patients with cancer.

    PubMed

    Cintron, Alexie; Hamel, Mary B; Davis, Roger B; Burns, Risa B; Phillips, Russell S; McCarthy, Ellen P

    2003-10-01

    To identify factors associated with hospitalization of elderly hospice patients with cancer and to describe their hospital experiences. Retrospective analysis of the last year of life. Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Medicare beneficiaries dying of lung or colorectal cancer between 1988 and 1998 who enrolled in hospice. Hospitalization after hospice entry. For hospitalized patients, we describe admission diagnoses, aggressiveness of care, and in-hospital death. Of the 23608 patients, 1423 (6.0%) were hospitalized after hospice enrollment. Hospitalization declined over time by 7.0% per year of hospice enrollment. Factors associated with higher hospitalization rates were younger age, male gender, black race/ethnicity, local cancer stage at diagnosis, and hospice enrollment within 4 months of cancer diagnosis. The most common reasons for hospital admission were lung cancer, metastatic disease, bone fracture, pneumonia, and volume depletion. Of the 1423 patients hospitalized, 34.6% received aggressive care and 35.8% died in the hospital. The rates of hospitalization for elderly hospice patients with lung or colorectal cancer appear to be declining. However, patients who are hospitalized undergo aggressive care and often die in the hospital rather than at home. This aggressive care may be consistent with changes in patients' care preferences, but could also reflect the current culture of acute care hospitals, which focuses on curative treatment and is ill-equipped to provide palliative care.

  6. Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships

    PubMed Central

    Reddy, Madhu C.; Purao, Sandeep; Kelly, Mary

    2008-01-01

    This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful. PMID:18436901

  7. Mode of delivery trends by hospital type: an 18-year comparison of a military hospital with university and community hospitals.

    PubMed

    Dahlke, Joshua D; Magann, Everett F; Bird, Tommy M; Rohloff, Jesse; Scardo, James A; Morrison, John C

    2014-02-01

    To determine the rate of mode of delivery over 18 years in a military teaching hospital as compared to university and community hospitals. From January 1992 to December 2009, we retrospectively calculated yearly rates for mode of delivery from a military hospital, two university hospitals, a community hospital in South Carolina and all community hospitals in Arkansas. Over the 18-year period, 803,249 deliveries occurred from all hospitals. Overall the cesarean delivery rates have significantly increased across all practice models (22.7% + 0.9 versus 33.0% + 0.9, p = <0.001). The rate of increase has been greatest in university hospitals (21.8-37%) followed by community hospitals (26.7-32.9%) and the military hospital (19.6-29.2%). The rate of forceps-assisted deliveries has decreased dramatically across all practice models (11.6% + 1.3 versus 1.1% + 0.1, p = <0.001). The decline in forceps use was 6.4 to 1.1% in community hospital, 12.6 to 1.4% in university hospitals, and 15.7 to 0.9% in military hospitals. The overall cesarean delivery rate has increased in all practice models but less so in the military. Forceps deliveries have dramatically decreased overall especially in the military hospital. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  8. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospitals subject to the hospital outpatient..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital...

  9. 42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Hospitals subject to the hospital outpatient..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and Services Subject to and Excluded From the Hospital...

  10. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Hospital providers of NF services (swing-bed hospitals). 447.280 Section 447.280 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of...

  11. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Hospital providers of NF services (swing-bed hospitals). 447.280 Section 447.280 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of...

  12. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Hospital providers of NF services (swing-bed... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of NF services (swing-bed hospitals). (a) General rule. If the State plan provides for NF...

  13. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Hospital providers of NF services (swing-bed... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of NF services (swing-bed hospitals). (a) General rule. If the State plan provides for NF...

  14. Social Group Work in Hospitals.

    ERIC Educational Resources Information Center

    Stambler, Moses

    This literature review focuses on social group work in the hospital setting. The first section addresses the need for a holistic approach within a typology of illness, and discusses the social work role and intervention tasks required at different stages of illness, i.e., diagnosis, adaptation to long-term illness, and the ending of the illness…

  15. Antidepressants in the general hospital.

    PubMed Central

    Gelenberg, A. J.

    1979-01-01

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

  16. Antidepressant adherence after psychiatric hospitalization

    PubMed Central

    Zivin, Kara; Ganoczy, Dara; Pfeiffer, Paul N.; Miller, Erin M.; Valenstein, Marcia

    2010-01-01

    Objective Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. Method We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within three and six months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs <0.8) after discharge. Results 20,931 and 23,182 patients met criteria for three and six month MPRs. The mean three month MPR was 0.79 (s.d.=0.37). The mean six month MPR was 0.66 (s.d.=0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Conclusion Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients. PMID:19609666

  17. The PSRO hospital review system.

    PubMed

    Goran, M J; Roberts, J S; Kellogg, M A; Fielding, J; Jessee, W

    1975-04-01

    The 1972 Social Security amendments contained the landmark Professional Standards Review Organization (PSRO) provisions as well as several sections upgrading existing utilization review (UR) requirements under Medicare and Medicaid. With issuance of the PSRO Program Manual and the recent publication of the new UR regulations, HEW for the first time has brought Medicare and Medicaid hospital review requirements into conformity and made them compatible with and supportive of the PSRO program. This article defines the PSRO hospital review system, describes how the three major components-concurrent review, medical care evaluation studies, and profile analysis-interrelate and provides examples of each of these components. Under utilization review requirements or PSRO, hospitals will be required to implement an integrated system of review designed to assure appropriate utilization practices and improve the quality of care. These aims are to be accomplished through the application of concepts of peer review, the use of norms, criteria, and standards, the identification of deficiencies in the quality, administration, or appropriateness of health care services, and their correction through linkage with programs of continuing medical education. Although PSROs are initially responsible for review in hospitals, they will likely provide the locus for a community-wide system of peer review for all services provided under National Health Insurance.

  18. Social Group Work in Hospitals.

    ERIC Educational Resources Information Center

    Stambler, Moses

    This literature review focuses on social group work in the hospital setting. The first section addresses the need for a holistic approach within a typology of illness, and discusses the social work role and intervention tasks required at different stages of illness, i.e., diagnosis, adaptation to long-term illness, and the ending of the illness…

  19. Scurvy in hospitalized elderly patients.

    PubMed

    Raynaud-Simon, A; Cohen-Bittan, J; Gouronnec, A; Pautas, E; Senet, P; Verny, M; Boddaert, J

    2010-06-01

    The aim of this study was to systematically screen hospitalized elderly patients for clinical symptoms of scurvy and to confirm the diagnosis with biological measures. Geriatric acute care ward. Scurvy symptoms (one or more among perifollicular hyperkeratosis, petechiae or bruises, haemorrhagic features caused by venous puncture, severe gingivitis). We compared associated diseases, nutritional status, need for assistance for feeding, serum albumin, transthyretin, B9 and B12 vitamins, iron status and Serum Ascorbic Acid Level (SAAL) and outcome (in-hospital mortality) between scurvy and scurvy free patients. 18 patients with clinical symptoms of scurvy (scurvy group) were identified out of 145 consecutive patients (12%). They were compared to 23 consecutive control patients with no clinical symptoms of scurvy (scurvy-free group). SAAL was significantly lower (1.09 +/- 1.06 vs 4.87 +/- 4.2 mg x L-1, p < .001) and vitamin C deficiency more frequent (94 vs 30 %, p < .001) in the scurvy group. Moreover, in scurvy group, coronary heart disease (39 vs 9 %, p=.028), need for assistance for feeding (56 vs 13 %, p=.006) and in-hospital deaths (44 vs 9 %, p=.012) were more frequent. Ninety-four percent of patients with clinical symptoms of scurvy had vitamin C deficiency. Our results suggest that in hospitalized elderly patients, clinical symptoms allow scurvy diagnosis. Scurvy could be a frequent disease in elderly patients admitted to acute geriatric ward.

  20. National Hospital Input Price Index

    PubMed Central

    Freeland, Mark S.; Anderson, Gerard; Schendler, Carol Ellen

    1979-01-01

    The national community hospital input price index presented here isolates the effects of prices of goods and services required to produce hospital care and measures the average percent change in prices for a fixed market basket of hospital inputs. Using the methodology described in this article, weights for various expenditure categories were estimated and proxy price variables associated with each were selected. The index is calculated for the historical period 1970 through 1978 and forecast for 1979 through 1981. During the historical period, the input price index increased an average of 8.0 percent a year, compared with an average rate of increase of 6.6 percent for overall consumer prices. For the period 1979 through 1981, the average annual increase is forecast at between 8.5 and 9.0 percent. Using the index to deflate growth in expenses, the level of real growth in expenditures per inpatient day (net service intensity growth) averaged 4.5 percent per year with considerable annual variation related to government and hospital industry policies. PMID:10309052

  1. National hospital input price index.

    PubMed

    Freeland, M S; Anderson, G; Schendler, C E

    1979-01-01

    The national community hospital input price index presented here isolates the effects of prices of goods and services required to produce hospital care and measures the average percent change in prices for a fixed market basket of hospital inputs. Using the methodology described in this article, weights for various expenditure categories were estimated and proxy price variables associated with each were selected. The index is calculated for the historical period 1970 through 1978 and forecast for 1979 through 1981. During the historical period, the input price index increased an average of 8.0 percent a year, compared with an average rate of increase of 6.6 percent for overall consumer prices. For the period 1979 through 1981, the average annual increase is forecast at between 8.5 and 9.0 per cent. Using the index to deflate growth in expenses, the level of real growth in expenditures per inpatient day (net service intensity growth) averaged 4.5 percent per year with considerable annual variation related to government and hospital industry policies.

  2. Bibliography for the Hospitality Industry.

    ERIC Educational Resources Information Center

    Nelson, Elizabeth A.

    This annotated bibliography is a sample collection of reference materials in the hospitality industry suitable for a small academic library. It is assumed that the library has a general reference collection. Publication dates range from 1992-96, with two publication dates in the 1980s. No periodicals are included. The 41 reference materials are…

  3. Making hospitals safer at night.

    PubMed

    Chapman, Caroline

    2016-08-17

    In the middle of the night, when the rest of the country is asleep, ward nurses up and down the UK are calling the Hospital at Night service. They may be looking for a technician to take a blood sample, or calling for medical help as a patient suddenly deteriorates.

  4. The Johns Hopkins Hospital Network

    PubMed Central

    Tolchin, Stephen G.; Barta, Wendy; Harkness, Kenneth

    1985-01-01

    The Johns Hopkins Hospital has initiated an ambitious program to apply modern technologies to the development of a new, comprehensive clinical information system. One component of this system is a networking technology for supporting the integration of diverse and functionally distinct information systems. This paper discusses the selection of the networking technology implemented at JHH, issues and problems, networking concepts, protocols and reliability.

  5. Emergency contraception and Catholic hospitals.

    PubMed

    Bucar, L; Nolan, D

    1999-01-01

    The "Ethical and Religious Directives for Catholic Health Care," which outline policies for Catholic hospitals in the US, are ambiguous on the topic of emergency contraception. Recent evidence suggests that, in the absence of definitive guidelines, Catholic hospitals are erring on the side of not providing emergency contraception. A survey of 589 US Catholic hospitals conducted by Catholics for a Free Choice found that 82% refused to supply emergency contraception--even to rape victims. Directive 36, which governs cases of sexual assault, could be argued to sanction the provision of emergency contraception. It states, "A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum." Because the process of conception takes approximately 2 days, it would be consistent with the Catholic Church's position to offer emergency contraception within 24 hours of a rape. Since no currently available test can confirm or deny conception as early as 72 hours after unprotected intercourse, the timetable for emergency contraception, Catholic hospitals should be able to provide this service to all women and still abide by the directives.

  6. [Obstetric analgesia in Norwegian hospitals].

    PubMed

    Barratt-Due, Andreas; Hagen, Inger; Dahl, Vegard

    2005-09-22

    Experience from our hospital has shown a significant increase in the use of epidural analgesia during labour. We wanted to see if this was a general trend in Norway, and wanted to find out for what kind of labour analgesia was offered in the different labour wards. A questionnaire concerning obstetric analgesia and anaesthetic methods for caesarean section was sent to chief anaesthetists and head midwives in Norwegian hospitals. The information was compared to an identical questionnaire from 1996. In addition, data concerning obstetric analgesia was collected from the Norwegian Medical Birth Register. 77% of the anaesthetic departments and 88% of the labour wards responded to the questionnaire. The use of epidural analgesia was on an average 20.6% (range 0-40.5%), which is twice as much as in 1996. 75% answered that the parturients' wish for epidural analgesia was reason enough to give an epidural. 84% of caesarean sections were performed in regional anaesthesia and 16% were done in general anaesthesia. This represents a significant reduction in the use of general anaesthesia. 85% of the labour wards offered acupuncture, which is a tremendous increase compared to 1996. Systemic opioids are still widely used, and pethidine is still the most frequently used opioid. Pethidine's negative side effect profile has been widely focused on during the past decade. The hospital's information on the various analgesic methods available for labour analgesi, is clearly improved since 1996. Obstetric analgesia in Norwegian hospitals has improved substantially since the last survey.

  7. Hospital mutual aid evacuation plan.

    PubMed

    Phillips, R

    1997-02-01

    Health care facilities need to be prepared for disasters such as floods, tornadoes and earthquakes. Rochester, NY, and its surrounding communities devised a hospital mutual aid evacuation plan in the event a disaster occurs and also to comply with the Joint Commission. This document discusses the plan's development process and also provides the end result.

  8. Hospital hygiene in Great Britain.

    PubMed

    Emmerson, A M

    1996-12-01

    ICT's in the UK are experienced, well trained and are enthusiastic. However, their efforts are frustrated through lack of resources. Infection Control is now a quality issue and defined separate budgets are being established and hospital contracts now contain elements of infection control as part of the service. Infection control is coming of age in the UK after 25 years of earnest effort.

  9. Third molar complications requiring hospitalization.

    PubMed

    Kunkel, Martin; Morbach, Thomas; Kleis, Wilfried; Wagner, Wilfried

    2006-09-01

    The aim of this study was to describe demographic and clinical patterns of subjects hospitalized with complications associated with third molars (M3). The investigation was designed as a prospective cohort study composed of subjects admitted to hospital for management of M3-associated complications. The predictor variable was "clinical status of the M3" defined as (A) prophylactic M3 removal, (B) nonelective M3 removal, or (C) M3 present at the time of admission. Outcome variables were infection parameters, treatment costs, length of hospital stay, and days of disability. Postoperative complications (A and B) were compared to complications based on pericoronitis (C). Complications due to prophylactic removal (A) were compared to those arising from pericoronitis or from the removal of symptomatic teeth (B and C). From January 2003 to December 2004, 45 deep space infections, 6 mandibular fractures, 2 lingual nerve injuries, 1 parapharyngeal tooth luxation, and 1 osteomyelitis were noticed. Fifteen complications resulted from prophylactic surgery (A), 25 from nonelective removal (B), and 15 from pericoronitis (C). Direct treatment costs were 147,000 euro (A: 42,000 euro; B: 74,000 euro; C: 31,000 euro). In 10 of the 15 patients of group C, deep space involvement resulted immediately from the first episode of pericoronitis. Neither clinical markers of infection nor economic parameters showed significant differences between the groups. Within the catchment area of our institution, the majority of third molar-related hospitalizations resulted from diseased third molars or their removal.

  10. What is your hospitality quotient?

    PubMed

    DeSilets, Lyn

    2015-03-01

    In addition to the behind-the-scenes work involved with planning and implementing continuing nursing education activities, there are additional ways we can enhance the learner's experience. This article presents ideas on how to improve your hospitality quotient. Copyright 2015, SLACK Incorporated.

  11. Hospital autopsy: Endangered or extinct?

    PubMed Central

    Turnbull, Angus; Osborn, Michael; Nicholas, Nick

    2015-01-01

    Aim To determine the hospital autopsy rate for the UK in 2013. Methods A study of data from a ‘Freedom of Information’ request to all (n=186) acute NHS Trusts within England (n=160), NHS Boards in Scotland (n=14) and Wales (n=7) and Social Care Trusts in Northern Ireland (n=5). Hospital autopsy rates were calculated from the number of hospital autopsies performed in 2013 as a percentage of total inpatient deaths in the Trust that year. Results The UK response rate was 99% (n=184), yielding a mean autopsy rate of 0.69%. The mean rates were 0.51% (England), 2.13% (Scotland), 0.65% (Wales) and 0.46% (Northern Ireland). 23% (n=38) of all included respondents had a rate of 0% and 86% (n=143) a rate less than 1%. Conclusions The decline in hospital autopsy has continued relentlessly and, for better or for worse, the practice is on the verge of extinction in the UK. The study highlights to health professionals and policy makers the magnitude of this decline. Further research should investigate the impact of this on patient safety, clinical audit, public health and medical education. PMID:26076965

  12. Hospital autopsy: Endangered or extinct?

    PubMed

    Turnbull, Angus; Osborn, Michael; Nicholas, Nick

    2015-08-01

    To determine the hospital autopsy rate for the UK in 2013. A study of data from a 'Freedom of Information' request to all (n=186) acute NHS Trusts within England (n=160), NHS Boards in Scotland (n=14) and Wales (n=7) and Social Care Trusts in Northern Ireland (n=5). Hospital autopsy rates were calculated from the number of hospital autopsies performed in 2013 as a percentage of total inpatient deaths in the Trust that year. The UK response rate was 99% (n=184), yielding a mean autopsy rate of 0.69%. The mean rates were 0.51% (England), 2.13% (Scotland), 0.65% (Wales) and 0.46% (Northern Ireland). 23% (n=38) of all included respondents had a rate of 0% and 86% (n=143) a rate less than 1%. The decline in hospital autopsy has continued relentlessly and, for better or for worse, the practice is on the verge of extinction in the UK. The study highlights to health professionals and policy makers the magnitude of this decline. Further research should investigate the impact of this on patient safety, clinical audit, public health and medical education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Hospital strategy and financial performance.

    PubMed

    Eastaugh, S R

    1992-01-01

    Five archetype strategies are studied involving productivity, diversification, or a hybrid approach. Manager opinions, staffing ratios, and profitability data bring the strategy effectiveness issue into perspective. Hospitals employing the productivity/defender strategy, specializing in fewer product lines, experienced less decline in profitability in recent years. Excess diversification appears to exhibit the most rapid declines in profitability.

  14. Patients' expectations of hospital chaplains.

    PubMed

    Piderman, Katherine M; Marek, Dean V; Jenkins, Sarah M; Johnson, Mary E; Buryska, James F; Mueller, Paul S

    2008-01-01

    To evaluate patients' expectations of hospital chaplains. From April 6, 2006, through April 25, 2006, we surveyed by mail 1500 consecutive medical and surgical patients within 3 weeks of their discharge from the hospital. The survey included questions related to demographics, duration and area of hospitalization, awareness of chaplain availability, expectations regarding chaplain visits, and reasons for wanting to see a chaplain. Measured characteristics were summarized by calculating means and SDs for continuous variables and proportions for categorical variables. Proportions were statistically compared via Fisher exact tests or Monte Carlo estimates. Surveys were returned by 535 of the 1500 patients to whom they were sent. Most of those who returned surveys had been hospitalized for less than 1 week (398/514 [77.4%]) and were male (265/510 [52.0%]), married (396/528 [75.0%]), 56 years or older (382/532 [71.8%]), or affiliated with either the Lutheran (177 [33.3%]) or Catholic (133 [25.0%]) churches. Most (78.9%) were aware of the availability of chaplains, and 62.3% would have appreciated chaplain visitation at least every few days. More than half (52.9%) reported that they were visited, and 86.4% reported that this visit was important to them. The primary reason selected for wanting to see a chaplain was "to be reminded of God's care and presence." Items related to ritual, prayer, and pastoral support were also highly endorsed. Some results were dependent on sex, age, religious affiliation, or duration of stay. Hospitalized patients value visitation by chaplains and appreciate both religious and supportive interventions. Opportunities for patient care, education, and research are apparent.

  15. Hospitalizations in elderly glioblastoma patients.

    PubMed

    Moroney, Claire; Perry, James R; Tsang, Derek S; Bilodeau, Denise; Mueller, Chris; Soliman, Hany; Myrehaug, Sten; Sahgal, Arjun; Tseng, Chia-Lin; Tsao, May N

    2017-08-11

    Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162,479.78 (CAN) and $125,511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI: 1.44-3.7; P=0.0005) and 2.19 (95% CI: 1.28-3.74; P=0.004), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI: 1.06-2.77; P=0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98-2.26; P=0.0623) for hospital admission as compared to patients with ECOG 4. A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.

  16. Peptic ulcers: mortality and hospitalization.

    PubMed

    Riley, R

    1991-01-01

    This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

  17. Nursing: the hospital's competitive edge.

    PubMed

    Shaffer, F A; Preziosi, P

    1988-09-01

    The health care marketplace is becoming increasingly competitive. The hospital has a built-in marketing force with the nursing department, because nurses are in constant, direct contact with the customer. Nursing must identify the case mix profile of the community and focus the hospital product lines to meet community needs. The nursing department should decentralize, change, measure, and innovate the staff mix needed to operationalize these product lines. The development of nursing practice standards for the case mix will help to identify the staff mix needed and create systems to efficiently manage the product lines. Nursing management must become aware of cross-subsidization and downward skill substitution of nursing personnel. Nursing information systems must generate quality reports that invoke cost consciousness on the part of nursing staff. Quality assurance programs must become unit based and complete with frequent audits to correlate length of stay with nursing quality. Correlations must be determined between nursing productivity and case mix to determine the hospital's niche in the marketplace. The transformation of health care into a competitive business industry has created many opportunities for nursing. The health care industry's incentives for efficiency along with the decreasing demand for inpatient hospital services will be the forces driving health care toward a competitive marketplace. The hospital's nursing department should be strategically positioned to become accountable for increasing market share and enhancing quality patient outcomes. The focus has shifted from the theoretical to the tactical, which is a step in the right direction, particularly for nursing. Nursing, if strategically positioned, will not only thrive but will also excel in this chaotic environment by capturing the opportunities and being innovative.

  18. Using Same-Hospital Readmission Rates to Estimate All-Hospital Readmission Rates

    PubMed Central

    Gonzalez, Andrew A.; Shih, Terry; Dimick, Justin B.; Ghaferi, Amir A.

    2014-01-01

    Background Since October of 2012, Medicare’s Hospital Readmissions Reduction Program has fined 2,200 hospitals a total of $500 billion. While the program penalizes readmission to any hospital, many institutions can only track readmissions to their own hospitals. We sought to determine the extent to which same-hospital readmission rates may be used to estimate all-hospital readmission rates following major surgery. Study Design We evaluated 3,940 hospitals treating 741,656 Medicare fee-for-service beneficiaries undergoing coronary artery bypass grafting, hip fracture repair, or colectomy between 2006 and 2008. We used hierarchical logistic regression to calculate risk- and reliability-adjusted rates of 30-day readmission to the same hospital and to any hospital. We next evaluated the correlation between same-hospital and all-hospital rates. To analyze the impact on hospital profiling, we compared rankings based on same-hospital rates to those based on all-hospital rates. Results The mean risk- and reliability-adjusted all-hospital readmission rate was 13.2% (SD 1.5%) and mean same-hospital readmission rate was 8.4% (SD 1.1%). Depending upon operation, between 57% (colectomy) and 63% (coronary artery bypass grafting) of hospitals were reclassified when profiling was based on same-hospital readmission rates instead of on all-hospital readmission rates. This was particularly pronounced in the middle three quintiles where 66–73% of hospitals were reclassified. Conclusions In evaluating hospital profiling under Medicare’s Hospital Readmissions Reduction Program, same-hospital rates provide unstable estimates of all-hospital readmission rates. To better anticipate penalties, hospitals require novel approaches for accurately tracking the totality of their post-operative readmissions. PMID:25159017

  19. Markets for hospital services in Zambia.

    PubMed

    Nakamba, Pamela; Hanson, Kara; McPake, Barbara

    2002-01-01

    Hospital reforms involving the introduction of measures to increase competition in hospital markets are being implemented in a range of low and middle-income countries. However, little is understood about the operation of hospital markets outside the USA and the UK. This paper assesses the degree of competition for hospital services in two hospital markets in Zambia (Copperbelt and Midlands), and the implications for prices, quality and efficiency. We found substantial differences among different hospital types in prices, costs and quality, suggesting that the hospital service market is a segmented market. The two markets differ significantly in their degree of competition, with the high cost inpatient services market in Copperbelt relatively more competitive than that in the Midlands market. The implications of these differences are discussed in terms of the potential for competition to improve hospital performance, the impact of market structure on equity of access, and how the government should address the problem of the mine hospitals.

  20. Hospital Capital Investment During the Great Recession.

    PubMed

    Choi, Sung

    2017-01-01

    Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal.

  1. Measuring efficiency among US federal hospitals.

    PubMed

    Harrison, Jeffrey P; Meyer, Sean

    2014-01-01

    This study evaluates the efficiency of federal hospitals, specifically those hospitals administered by the US Department of Veterans Affairs and the US Department of Defense. Hospital executives, health care policymakers, taxpayers, and federal hospital beneficiaries benefit from studies that improve hospital efficiency. This study uses data envelopment analysis to evaluate a panel of 165 federal hospitals in 2007 and 157 of the same hospitals again in 2011. Results indicate that overall efficiency in federal hospitals improved from 81% in 2007 to 86% in 2011. The number of federal hospitals operating on the efficiency frontier decreased slightly from 25 in 2007 to 21 in 2011. The higher efficiency score clearly documents that federal hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the health care industry. This research examines benchmarking strategies to improve the efficiency of hospital services to federal beneficiaries. Through the use of strategies such as integrated information systems, consolidation of services, transaction-cost economics, and focusing on preventative health care, these organizations have been able to provide quality service while maintaining fiscal responsibility. In addition, the research documented the characteristics of those federal hospitals that were found to be on the Efficiency Frontier. These hospitals serve as benchmarks for less efficient federal hospitals as they develop strategies for improvement.

  2. Variation in the rates of adverse events between hospitals and hospital departments.

    PubMed

    Zegers, Marieke; De Bruijne, Martine C; Spreeuwenberg, Peter; Wagner, Cordula; Van Der Wal, Gerrit; Groenewegen, Peter P

    2011-04-01

    The objective of this study was to analyze the variation in the rates of adverse events (AEs), and preventable AEs, between hospitals and hospital departments in order to investigate the room for improvement in reducing AEs at both levels. In addition, we explored the extent to which patient, department and hospital characteristics explain differences in the rates of AEs. Structured retrospective patient record review of hospital admissions. Twenty-one Dutch hospitals. Population A representative random sample of 7113 hospital admissions in 2004. Variation in AEs, and preventable AEs, between hospitals and hospital departments and the explanatory factors of the variation. The rates of AEs varied between hospitals (P = 0.05) and hospital departments (P < 0.05). The rates of preventable AEs only varied significantly between hospital departments. The clustering of preventable AEs in hospital departments was more than twice that found in hospitals (ICC 9.5 versus 3.5%). The type of hospital explained 35% of the inter-hospital variance in AEs. Patient and department characteristics explained 23% of the inter-department variance in preventable AEs. In addition to interventions to improve the overall patient safety within a hospital, interventions tailored for specific departments are necessary to reduce their patient safety risks. Monitoring and comparing the performance of hospitals should not be limited to the hospital level, but should be extended to the individual department since there can be significant differences in the rates of preventable AEs between different departments within the same hospital.

  3. 42 CFR 412.22 - Excluded hospitals and hospital units: General rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES... Costs and Inpatient Capital-Related Costs § 412.22 Excluded hospitals and hospital units: General...

  4. 42 CFR 412.22 - Excluded hospitals and hospital units: General rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES... Costs and Inpatient Capital-Related Costs § 412.22 Excluded hospitals and hospital units: General...

  5. 42 CFR 412.22 - Excluded hospitals and hospital units: General rules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES... Costs and Inpatient Capital-Related Costs § 412.22 Excluded hospitals and hospital units: General...

  6. 42 CFR 412.22 - Excluded hospitals and hospital units: General rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES... Costs and Inpatient Capital-Related Costs § 412.22 Excluded hospitals and hospital units: General...

  7. Malnutrition among hospitalized patients in King Khalid University Hospital, Riyadh.

    PubMed

    Bani, I A; Al-Kanhal, M A

    1998-09-01

    The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM). Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, serum albumin and total lymphocyte count. Anthropometric measurements, weight for height and midarm circumference reflected malnutrition (PCM) of 33.8% and 30% respectively. The overall prevalence of obesity was 21%. A higher proportion (23.9%) of medical cases were found to be obese compared to surgical cases (19.7%). If malnutrition can be documented on hospital admission, attempts can be made to reverse malnutrition in the high risk patients.

  8. Hospital advertising in California, 1991-1997.

    PubMed

    Town, Robert J; Currim, Imran

    2002-01-01

    This paper examines the advertising behavior of California hospitals from 1991 to 1997. Using highly detailed hospital-level information, we found that hospital advertising in California increased dramatically: annual spending on advertising grew (inflation adjusted) more than sixfold over the period. In addition, advertising expenditures varied significantly across hospitals. We found that hospital advertising increased with market concentration; with the number of nearby potential patients; with the percentage of nearby patients insured through Medicare, health maintenance organizations (HMOs), and indemnity insurance; and with chain affiliation. For-profit hospitals were not found to advertise more than their not-for-profit counterparts.

  9. Toward hospital library standards in Canada.

    PubMed Central

    Flower, M A

    1978-01-01

    A report is given on Canadian hospital library standards as recently developed and incorporated in a new Guide to Hospital Accreditation, 1977. The new Canadian standards are compared with MLA recommendations to the Joint Commission on Accreditation of Hospitals. Their development is sketched and the contribution from Quebec of a model of hospital classification is examined. This model provides differential minimal library standards based on the function of the hospital rather than on its size alone. Use of these minimal standards as a practical means of developing hospital libraries is discussed and their implications for accreditation visits are underlined. PMID:678698

  10. [Hospital admissions due to varicella in a tertiary hospital].

    PubMed

    Guzmán Laura, K P; Periañez Vasco, A; Falcón Neyra, M D; Croche Santander, B

    2014-06-01

    Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011. A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  11. El libro del Relogio del Palacio de las Horas

    NASA Astrophysics Data System (ADS)

    Morales, J. D.

    2009-08-01

    This paper resume the investigation entitled ``El libro del Relogio del Palacio de las Horas''. That consist in an edition of the original text of the book of the Clock of the Palace of the Hours from the Books of the knowledge of Astronomy of Alfonso X (Manuscript 156, Complutense University). And a description of the astronomical functionality of the Clock of the Palace of the Hours. It includes a geometric description of the positional astronomy on which the operation of the Palace is based.

  12. Mold remediation in a hospital.

    PubMed

    Lee, Tang G

    2009-01-01

    As occupants in a hospital, patients are susceptible to air contaminants that can include biological agents dispersed throughout the premise. An exposed patient can become ill and require medical intervention. A consideration for patients is that they may have become environmentally sensitive and require placement in an environment that does not compromise their health. Unfortunately, the hospital environment often contains more biological substances than can be expected in an office or home environment. When a hospital also experiences water intrusion such as flooding or water leaks, resulting mold growth can seriously compromise the health of patients and others such as nursing staff and physicians (Burge, Indoor Air and Infectious Disease. Occupational Medicine: State of the Art Reviews, 1980; Lutz et al., Clinical Infectious Diseases 37: 786-793, 2003). Micro-organism growth can propagate if the water is not addressed quickly and effectively. Immunocompromised patients are particularly at risk when subjected to fungal infection such that the US Center for Disease Control issued guideline for building mold in health care facilities (Centers for Disease and Control [CDC], Centers for Disease and Control: Questions and Answers on Stachybotrys chartarum and Other Molds, 2000). This paper is based on mold remediation of one portion of a hospital unit due to water from construction activity and inadequate maintenance, resulting in mold growth. A large proportion of the hospital staff, primarily nurses in the dialysis unit, exhibited health symptoms consistent with mold exposure. Unfortunately, the hospital administrators did not consider the mold risk to be serious and refused an independent consultant retained by the nurse's union to examine the premise (Canadian Broadcasting Corporation [CBC], Nurses file complaints over mold at Foothills. Canadian Broadcasting Corporation, 2003). The nurse's union managed to have the premise examined by submitting a court order of

  13. The marketing of partial hospitalization.

    PubMed

    Millsap, P; Brown, E; Kiser, L; Pruitt, D

    1987-09-01

    Health-care professionals are currently operating in the context of a rapidly changing health-care delivery system, including the move away from inpatient services to outpatient services in order to control costs. Those who practice in partial-hospital settings are in a position to offer effective, cost-efficient services; however, there continue to be obstacles which hinder appropriate utilization of the modality. The development and use of a well-designed marketing plan is one strategy for removing these obstacles. This paper presents a brief overview of the marketing process, ideas for developing a marketing plan, and several examples of specific marketing strategies as well as ways to monitor their effectiveness. Partial-hospital providers must take an active role in answering the calls for alternative sources of psychiatric care. A comprehensive, education-oriented marketing approach will increase the public's awareness of such alternatives and enable programs to survive in a competitive environment.

  14. Ultrasonic cleaning in the hospital.

    PubMed

    Detwiler, M S

    1989-04-01

    Ultrasonic cleaning can prolong the life of expensive instruments. In the past, many fine instruments were discarded due to stiffening hinges and box locks, or sticking plungers. Hand scrubbing and spray washing could not thoroughly clean these areas. Ultrasonic cleaners effectively remove dried and baked blood, serums and medications from these instruments. Also, hinged instruments and syringes operate more smoothly during use in surgery when cleaned using ultrasonics. In addition, the use of ultrasonics alleviates the necessity for hand scrubbing of contaminated surgical instruments and laboratory apparatus, a procedure which could lead to injury or infection. The superb cleaning powers of ultrasonic cleaners, their speed and simplicity of operation, and their ability to remove blood, tissue, bacteria and microorganisms within minutes, makes them a valuable addition to any operating room suite, central service department, or emergency room. Their cost-effectiveness is considerable for the small hospital, and compelling for the large hospital.

  15. Nutritional Alert in hospitalized patients.

    PubMed

    Brieux, Humberto Fernán Mandirola; Kaminker, Diego; Campos, Fernando; Guillen, Sebastian; Alejandris, Javier; Luna, Daniel; Baum, Analia; de Quirós, Fernán Gonzalez Bernaldo

    2014-01-01

    The objective of the study is to assess a nutritional risk alert using an Informatics System in hospitalized patients versus the conventional methodology. We studied 400 medical patients at the Belgrano Hospital Critical Care Unit. We considered two groups of 200 patients. In the first the group (Control Group), nutritional risk was diagnosed in a traditional way. In the second group (Alarm Group), nutritional risk was diagnosed with an alert system. The alert was triggered when a patient showed low levels of, at least, two of the following variables: albumin, cholesterol, triglyceride, lymphocyte or low body mass index (BMI). Nutritional risk was detected in 20.3% of the Control Group patients while, in the Alert Group, nutritional risk was detected in 34.3% of the patients; the difference between the two groups was significant (p<0.001), with a sensitivity rate of 99% and a specificity rate of 98%. Malnutrition is more easily detected when using an alert system.

  16. [Pericarditis in a general hospital].

    PubMed

    Faintuch, J J; Friedmann, A A

    1996-01-01

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

  17. Business Intelligence in Hospital Management.

    PubMed

    Escher, Achim; Hainc, Nicolin; Boll, Daniel

    2016-01-01

    Business intelligence (BI) is a worthwhile investment, and will play a significant role in hospital management in the near future. Implementation of BI is challenging and requires resources, skills, and a strategy, but enables management to have easy access to relevant analysis of data and visualization of important key performance indicators (KPI). Modern BI applications will help to overcome shortages of common "hand-made" analysis, save time and money, and will enable even managers to do "self-service" analysis and reporting.

  18. Delirium in hospitalized older patients.

    PubMed

    Inouye, S K

    1998-11-01

    Delirium is a common, serious problem for hospitalized older patients. Recognition of delirium poses challenges requiring cognitive assessment and knowledge of the clinical course. Delirium often is of multiple causes and is associated with a poor long-term prognosis. Nonpharmacologic approaches for delirium management are recommended; pharmacologic management should be reserved for patients who pose a danger to themselves or others. Importantly, delirium and its complications may be preventable through a targeted risk factor approach.

  19. Observations on Hospitalized Dengue Patients

    DTIC Science & Technology

    1987-01-01

    DENGUE PATIENTS IN MANILA Carman. R. Min oto* be" S. Siqpo Ommon D. Leus** Curds G. Ibyes* INTRODUCION to the Hospital of Infant Jesus between October...31, 1983 and March 31, 1984: Criteria for the diagnosis of dengue Dengue hemorrhagic fever (DHF) has been recognized infection were based on the...titer of later sample < 1:640. DHF epidemic.4𔃿 Since that time, there have only been a few- was differentiated from dengue fever (DF), and DHF was

  20. Salmonella isolation from hospital areas.

    PubMed Central

    Harvey, R. W.; Price, T. H.; Joynson, D. H.

    1979-01-01

    Evidence of the presence of salmonellas in a paediatric ward, a special care baby unit, a maternity unit and a hospital kitchen was obtained by culture of sewer swabs, faeces and food samples. The survey was designed to cause as little administrative interference as possible. The technical aspects of the survey did not strain laboratory facilities. Minimal secondary spread of salmonella infection was experienced. PMID:390044