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Sample records for teaching hospital enugu

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

    PubMed

    Nwankwo, Okechukwu Emmanuel

    2008-04-01

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

  2. Investigating Groundwater Contamination Following the Disposal of Hospital Wastes in a Government Reserved Area, Enugu, Nigeria.

    PubMed

    Eze, C T; Nwagwe, O R; Ogbuene, E B; Eze, H I

    2017-02-01

    This study investigated the probable contamination of groundwater following hospital wastes disposal in a Government Reserved Area, Enugu, Nigeria. The ground water samples were collected from three distinct locations denoted as GW1, GW2 and GW3 at distances of about 100, 200 and 350 m respectively from the hospital location. The samples were collected during the dry season (December 2015, January and February 2016) and wet season (June, July and August 2016) and analyzed with standard procedures. The level of contamination of groundwater in the area was generally higher in the wet season than in dry season. The degree of contamination varies with distance and hence in the following order GW1 > GW2 > GW3 in both seasons. The study revealed the presence of both pathogenic and non-pathogenic organisms and values of the determined physicochemical ranged from (0.02 ± 0.01-272 ± 2.22 mg/L) in both seasons. The hospital management should develop effective ways to manage their wastes to protect the environment and public health.

  3. Accidental Childhood Poisoning in Enugu, South-East, Nigeria

    PubMed Central

    Edelu, BO; Odetunde, OI; Eke, CB; Uwaezuoke, NA; Oguonu, T

    2016-01-01

    Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications. PMID:27398248

  4. 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.

  5. Developing Marketing Strategies for University Teaching Hospitals.

    ERIC Educational Resources Information Center

    Fink, Daniel J.

    1980-01-01

    University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, consumerism, and a declining urban population base. New marketing strategies are seen as ways in which teaching hospitals can achieve better relationships with institutions, practitioners, and surrounding communities and…

  6. Paracetamol use (and/or misuse) in children in Enugu, South-East, Nigeria

    PubMed Central

    2012-01-01

    Background Paracetamol (also known as acetaminophen) is the commonest available analgesic and anti-pyretic. It is readily accessed from pharmacy, patent medicine and provision shops as over the counter drug making it a potential drug of abuse, especially in children. We sought to find its use and/or misuse in children seen at the paediatric outpatient clinic of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu. Objective To determine the dosage, formulation, and frequency of paracetamol administration to children by caregivers and factors associated with its use and/or misuse. Method An observational prospective study involving 231 children and their caregivers seen at the paediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku - Ozalla, Enugu between June and November 2011 was undertaken. Data on paracetamol use before presentation to the clinic, in addition to demographic and other data were obtained from the caregivers using a structured questionnaire. Ethical consent for the study was obtained from the Hospital Ethics and Research Committee and informed consent was further obtained from the caregivers of the children. Results A total of 231 children aged six weeks to 16 years and their caregivers participated in this study. The mean ages of the children and their caregivers were 3.8 and 33.9 years, respectively. One hundred and thirty three of the children studied were males while 98 were females. Most of the children (75.6%) received paracetamol at home before presenting. Paracetamol tablet alone or in combination with the syrup was mostly used (60%) and this observation was made across all age groups. The commonest reason for using paracetamol tablet instead of the syrup was that it was more effective. Most caregivers relied on past experience (71.2%) rather than on enclosed information leaflet to decide the appropriate dosage. Half of the children also received other medications, mainly anti-malarials and

  7. Implementing medical teaching policy in university hospitals.

    PubMed

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

    2016-11-16

    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.

  8. Educational Facilities in the Hospital for Teaching.

    ERIC Educational Resources Information Center

    Green, Alan C.

    1965-01-01

    Planning and design criteria are established for educational facilities in VA hospitals, rendering them more effective for medical education. Rather than developing plans for prototype teaching hospitals, guidelines are presented which may be utilized to meet the needs of a particular situation. Three broad categories of facilities are…

  9. Determinants of Noncompliance to Clinic Appointments and Medications among Nigerian Children with Epilepsy: Experience in a Tertiary Health Facility in Enugu, Nigeria.

    PubMed

    Ibekwe, Roland Chidi; Ndukuba, Appolos Chidi; Aronu, Ann Ebele; Eke, Christopher Bismarck; Ibekwe, MaryAnn Ugochi; Ojinnaka, Ngozi Chinyelu

    2016-01-01

    Purpose. To determine the frequency and determinants of noncompliance to clinic appointment and medication among Nigerian children with epilepsy. Method. This is a cross-sectional survey of noncompliance to clinic appointments and medication among 113 consecutive children with epilepsy attending the Paediatric Neurology Clinic of University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Results. Noncompliance to clinic appointment and medication was 23% and 15.3%, respectively. The major reasons given were lack of finance, clashing with school time, and forgetting to take the drugs. Children whose mothers were less educated and unemployed were more likely to miss clinic appointments. Noncompliance to medication was associated with poor seizure control. Children that were on phenobarbitone were more likely to be noncompliant with medication than those on sodium valproate and/or carbamazepine. Conclusion. Missed clinic appointment and medication noncompliance are common among Nigerian children with epilepsy and financial constraint is the most common reason.

  10. Health Care Practices for Medical Textiles in Government Hospitals

    ERIC Educational Resources Information Center

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  11. Types of anaemic crises in paediatric patients with sickle cell anaemia seen in Enugu, Nigeria

    PubMed Central

    Juwah, A; Nlemadim, E; Kaine, W

    2004-01-01

    Background: Anaemic crises in paediatric patients with sickle cell anaemia are major causes of morbidity and mortality. Some children admitted to hospitals' emergency rooms or paediatric wards of the hospitals with severe anaemia die before blood transfusion. Aims and Methods: A total of 108 episodes of anaemic crises were prospectively evaluated in 108 patients with sickle cell anaemia attending the paediatric sickle cell clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Results: Hyper-haemolytic crises were the commonest types of anaemic crises in the patients studied. The mean haemoglobin concentration of 44.66 (SD 6.42) g/l in crises was significantly lower than the mean steady state level of 78.69 (SD 8.50) g/l. Reticulocytes, unconjugated serum bilirubin concentrations, and the presence of nucleated red blood cells were also increased. About 4.6% of patients were not jaundiced at presentation even though they were profoundly anaemic. Their haematological indices gradually returned to normal without marked changes in their serum bilirubin concentrations. These patients were probably in the early recovery phase of aplastic crises. The classical presentation of acute splenic sequestration crisis with a rapidly enlarging spleen and hypotension was not observed. This was probably because of its precipitate nature and accompanying circulatory collapse, which carried a high mortality rate. Minor forms of sequestration crises may have occurred in the liver and spleen. Conclusions: Malaria appeared to have played a role in precipitating some of the hyper-haemolytic episodes. Further studies to elucidate this role are required so that appropriate recommendations regarding malaria prophylaxis can be made in patients with sickle cell anaemia. PMID:15155406

  12. Success factors in merging teaching hospitals.

    PubMed

    Thier, Samuel O; Kelley, William N; Pardes, Herbert; Knight, Amy Wimpey; Wietecha, Mark

    2014-02-01

    Merger has served as a major strategy for the leaders of academic medical centers (i.e., teaching hospitals) who are pursuing health system development for their institutions. Applying hindsight to their personal experience, the authors explore common themes in several mergers that have survived the test of time. Although many elements influence merger outcomes, experience suggests several of unique importance. These include effective leadership in the areas of creating trust, managing uncertainty, ensuring medical staff stability, and bridging cultural divides across the organizations. While a quantitative business case should support any merger, the authors' experiences underscore the importance of successfully assessing and managing organizational and individual dynamics when bringing together major teaching hospitals.

  13. Availability of Instructional Materials at the Basic Education Level in Enugu Educational Zone of Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Chukwu, Leo C.; Eze, Thecla A. Y.; Agada, Fidelia Chinyelugo

    2016-01-01

    The study examined the availability of instructional materials at the basic education level in Enugu Education Zone of Enugu State, Nigeria. One research question and one hypothesis guided the study. The research question was answered using mean and grand mean ratings, while the hypothesis was tested using t-test statistics at 0.05 level of…

  14. Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria

    PubMed Central

    Ekwochi, Uchenna; Osuorah, D Chidiebere; Ndu, Ikenna K; Ezenwosu, Osita U; Amadi, Ogechukwu F; Nwokoye, Ikenna C; Odetunde, O Israel

    2014-01-01

    Background Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families’ livelihoods. Aim This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases. Methods This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses. Results A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US$223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US$61), ₦10,000–49,999 (US$61–306), and ₦50,000–100,000 (US$306–612) and more than ₦100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn’s illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US$144±92], P=0.001), low birth weight (₦39,863±24,003 [US$224±147], P=0.001), severe anemia (₦40,504±13,923 [US$248±85], P=0.001), transient tachypnea

  15. The Enormity of Chronic Kidney Disease in Nigeria: The Situation in a Teaching Hospital in South-East Nigeria

    PubMed Central

    Ulasi, Ifeoma I.; Ijoma, Chinwuba K.

    2010-01-01

    Background. The magnitude of the problem of chronic kidney disease (CKD) is enormous, and the prevalence keeps rising. To highlight the burden of CKD in developing countries, the authors looked at end-stage renal disease (ESRD) patients seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Method. ESRD patients seen from 01/05/1990 to 31/12/2003 were recruited. Records from A&E Department, medical-out-patients, wards and dialysis unit were used. Results. A total of 1001 male versus 537 female patients were reviewed. About 593 male versus 315 female patients had haemodialysis. The mean age was 42.55 ± 15.43 years and 86.5% were <60 years. Primary renal disease could not be determined in 51.6% while hypertension and glomerulonephritis accounted for −17.2% and 14.6%, respectively. Death from renal causes constituted 22.03% of medical deaths. Conclusion. The prognosis for CKD patients in Nigeria is abysmal. Only few patients had renal-replacement-therapy (RRT). The prohibitive cost precludes many patients. This underscores the need for preventive measures to reduce the impact of CKD in the society. PMID:20613945

  16. [Nursing personnel downsizing in a teaching hospital].

    PubMed

    Fakih, Flávio Trevisan; Carmagnani, Maria Isabel Sampaio; Cunha, Isabel Cristina Kowal Olm

    2006-01-01

    The objective of this study was to adjust the downsizing of nursing personnel in a teaching hospital to the resolution of Federal Nursing Council no. 293/2004. The classification of patients in levels of complexity care was done and the required time for the nurse care also was verified. The present number of employees was compared to the measured one. The outcomes showed the levels of patients'care complexity is on intermediate care (42%), and the required time to the nurse care was greater on intensive care patients (42%). The present staff has a deficit of 205 nurses and an exceding of 284 professionals of techinical college level.

  17. Antibiotic misuse in a pediatric teaching hospital.

    PubMed Central

    Schollenberg, E.; Albritton, W. L.

    1980-01-01

    Antibiotic use at a pediatric teaching hospital was reviewed for a month. A total of 188 courses of therapy were evaluated with respect to choice of antibiotic, dosage and necessity of treatment. Errors in therapy were noted in 30% of the medical orders and 63% of the surgical orders. The most frequent error, unnecessary therapy, was found in 13% and 45% of the medical and surgical orders respectively. Error rates were highest for the most frequently ordered antibiotics, notably the penicillins. The magnitude of the problem appeared to be similar to that previously reported from general ana adult hospitals. The difficulties with solutions such as educational programs and compulsory consultation are discussed. PMID:7363195

  18. Analysis on antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital.

    PubMed

    Sun, Ziyong; Li, Li; Zhu, Xuhui; Ma, Yue; Li, Jingyun; Shen, Zhengyi; Jin, Shaohong

    2006-01-01

    The distinction of antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital was investigated. Disc diffusion test was used to study the antimicrobial resistance of isolates collected from county hospitals and a teaching hospital. The data was analyzed by WHONET5 and SPSS statistic software. A total of 655 strains and 1682 strains were collected from county hospitals and a teaching hospital, respectively, in the year of 2003. The top ten pathogens were Coagulase negative staphylococci (CNS), E. coli, Klebsiella spp., S. areus, P. aeruginosa, Enterococcus spp., Enterobacter spp., otherwise Salmonella spp., Proteus spp., Shigella spp. in county hospitals and Streptococcus spp., Acinetobacter spp., X. maltophilia in the teaching hospital. The prevalence of multi-drug resistant bacteria was 5% (4/86) of methicillin-resistant S. areus (MRSA), 12% (16/133) and 15.8% (9/57) of extended-spectrum beta-lactamases producing strains of E. coli and Klebsiella spp., respectively, in county hospitals. All of the three rates were lower than that in the teaching hospital and the difference was statistically significant (P < 0. 01). However, the incidence of methicillin-resistant CNS (MRCNS) reached to 70% (109/156) in the two classes of hospitals. Generally, the antimicrobial resistant rates in the county hospitals were lower than those in the teaching hospital, except the resistant rates of ciprofloxacin, erythromycin, clindamycin, SMZco which were similar in the two classes of hospitals. There were differences between county hospitals and the teaching hospital in the distribution of clinical isolates and prevalence of antimicrobial resistance. It was the basis of rational use of antimicrobial agents to monitor antimicrobial resistance by each hospital.

  19. Hospital management principles applicable to the veterinary teaching hospital.

    PubMed

    Harris, Donna L; Lloyd, James W; Marrinan, Mike

    2004-01-01

    The Skills, Knowledge, Aptitude, and Attitude (SKA) Subcommittee of the National Commission on Veterinary Economic Issues (NCVEI) has identified the need for veterinary teaching hospitals (VTH) to be at the forefront of progressive business management to serve as a model for both students and practitioners to emulate. To provide a foundation for developing a model, this study reviewed pertinent literature applicable to the management of a VTH. Much of the literature relevant to VTH management relates to work completed for the human side of medicine (academic health centers, or AHCs) or to the private sector. This review explores management practices in strategic planning, financial management, human resource management, marketing, pricing, operations, and legal issues. It is concluded that strategic management is important to provide the foundation for success in the VTH. In addition, periodic financial reports are recommended, as are the development and use of benchmarks for financial management. Establishing positive, motivating human resource practices is also suggested, along with development of a marketing plan based on a clear understanding of VTH core competencies and the market's specific needs.

  20. Planned Parenthood services in teaching hospitals.

    PubMed

    1973-06-01

    As a contribution to the continuing discussion stimulated by the WHO Study Group on education and training for family planning in health services (December 1971, Geneva), the Regional Medical Executive Committee of IPPF commissioned articles on planned parenthood services and training in the university hospital context in both Austria and Belgium. In Vienna, Graz, and Innsbruck medical students receive regular instruction in the physiology and pathology of reproduction and contraceptive methods. Training in methods of fertility regulation is integrated into the gynecology curriculum in both lectures and group discussion. Planned parenthood and social medicine are at present not essential examination subjects. In obligatory practical work in gynecology clinics there are only 2 periods of 6 days in which the student can obtain only a very superficial picture of gynecology and obstetrics. If a qualified physician remains in a university clinic to specialize in these fields, instruction includes complete training in family planning with the possibility of comprehensive practical experience. In Belgium the introduction of planned parenthood into departmental policy and the attainment of national uniformity in thinking and application are recent, due mainly to the coincidence the present chairmen of most departments of obstetrics and gynecology regard planned parenthood as socially indispensable. It is imperative that the education and training of both providers and users be not limited to technical knowledge but expanded to include the all- important psychological, socioeconomic, and health aspects and implications of sexuality. The theory and practice of family planning must be transmitted to the mediical profession, the paramedical professions, and such nonmedical professions as pharmacy. It is noted that the most important new accomplishments of the teaching hospitals lie in the provision of planned parenthood service.

  1. Estimating the mission-related costs of teaching hospitals.

    PubMed

    Koenig, Lane; Dobson, Allen; Ho, Silver; Siegel, Jonathan M; Blumenthal, David; Weissman, Joel S

    2003-01-01

    Academic health centers and other teaching hospitals face higher patient care costs than nonteaching community hospitals face, because of their missions of graduate medical education (GME), biomedical research, and the maintenance of standby capacity for medically complex patients. We estimate that total mission-related costs were dollar 27 billion in 2002 for all teaching hospitals, with GME (including indirect and direct GME) and standby capacity accounting for roughly 60 and 35 percent of these costs, respectively. To assure their continued ability to perform important social missions in a competitive environment, it may be necessary to reassess the way in which these activities are financed.

  2. Electrocardiographic findings in a cross-sectional study of human immunodeficiency virus (HIV) patients in Enugu, south-east Nigeria

    PubMed Central

    Njoku, PO; Ejim, EC; Anisiuba, BC; Ike, SO; Onwubere, BJC

    2016-01-01

    Summary Background Electrocardiographic (ECG) abnormalities are prevalent in subjects with human immunodeficiency virus (HIV) infection. In this study, three groups of subjects were investigated and the prevalence of ECG abnormalities was analysed. Methods A cross-sectional study was carried out on adults between November 2010 and November 2011 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. One hundred HIV-infected patients on highly active anti-retroviral therapy (HAART), 100 HIV-infected HAART-naïve patients and 100 HIV-negative controls were recruited. Twelve-lead electrocardiograms were done on all subjects. Data were analysed using the chi-squared, Student’s t-, one-way ANOVA and Duncan post hoc tests. Results Left-axis deviation was seen in 15 (16%) of the HIV-positive subjects on HAART, 10 (13.7%) of the HAART-naïve subjects and eight (21%) of the controls (p = 0.265). Eight (11%) subjects with left ventricular hypertrophy (p <0.001) and two (2.7%) with ST-segment elevation were found among the HIV-positive HAART-naïve subjects (p = 0.134). Prolonged QTc interval was seen in 17 (18.2%) of the HIV-positive patients on HAART, 12 (16.4%) of the HIV-positive HAART-naïve patients and four (10.5%) of the controls (p = 0.012). Conclusion The prevalence of ECG abnormalities was higher in the HIV-positive patients on HAART (93%) and the HIV-positive HAART-naïve patients (73%) compared to the controls. PMID:27841913

  3. Hurricane Katrina's Impact on Tulane's Teaching Hospitals

    PubMed Central

    Taylor, Ian L.

    2007-01-01

    On Monday, August 29, 2005 Hurricane Katrina passed east of New Orleans causing minimal damage to Tulane's Medical Center. Later that day, levees that protected the city failed and several feet of water entered the hospitals and school buildings. Emergency generators provided power for 36 hours before running out of fuel. Temperatures in the hospitals soared into the upper 90's and conditions were made intolerable by 100% humidity and backed-up sewage. For several days, faculty, residents, nurses and hospital personnel performed heroically, caring for patients in appalling conditions, hand-ventilating critically ill patients in shifts. Approximately 200 patients, and 1500 additional personnel would be evacuated on Wednesday and Thursday from a makeshift heliport on Tulane's parking garage. Current disaster plans may be inadequate should facilities be inaccessible for months because of damage or contamination. Contingency plans also need to be made should outside disaster relief be markedly delayed as was the case with Katrina. PMID:18528490

  4. Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan.

    PubMed

    Sato, Daisuke; Fushimi, Kiyohide

    2012-11-01

    Teaching hospitals require excess medical resources to maintain high-quality care and medical education. To evaluate the appropriateness of such surplus costs, we examined the impact of teaching intensity defined as activities for postgraduate training, and academic status as functions of medical research and undergraduate teaching on medical resource utilization. Administrative data for 47,397 discharges from 40 academic and 12 non-academic teaching hospitals in Japan were collected. Hospitals were classified into three groups according to intern/resident-to-bed (IRB) ratio. Resource utilization of medical services was estimated using fee-for-service charge schedules and normalized with case mix grouping. 15-24% more resource utilization for laboratory examinations, radiological imaging, and medications were observed in hospitals with higher IRB ratios. With multivariate adjustment for case mix and academic status, higher IRB ratios were associated with 10-15% more use of radiological imaging, injections, and medications; up to 5% shorter hospital stays; and not with total resource utilization. Conversely, academic status was associated with 21-33% more laboratory examinations, radiological imaging, and medications; 13% longer hospital stays; and 10% more total resource utilization. While differences in medical resource utilization by teaching intensity may not be associated with indirect educational costs, those by academic status may be. Therefore, academic hospitals may need efficiency improvement and financial compensation.

  5. [Teaching and research in high specialty hospitals].

    PubMed

    Lifshitz, Alberto

    2011-01-01

    Education and research are strategic activities leading to development and progress of a hospital, so planning on this matter is fundamental, both in terms of structure and infrastructure. Investment on faculty development and on researchers should be considered beyond the short term. Education should respond to the necessities and research to health priorities through formal agreements with universities and institutes.

  6. Dealing with the complex dynamics of teaching hospitals.

    PubMed

    van Rossum, Tiuri R; Scheele, Fedde; Scherpbier, Albert J J A; Sluiter, Henk E; Heyligers, Ide C

    2016-04-05

    Innovation and change in postgraduate medical education programs affects teaching hospital organizations, since medical education and clinical service are interrelated.Recent trends towards flexible, time-independent and individualized educational programs put pressure on this relationship. This pressure may lead to organizational uncertainty, unbalance and friction making it an important issue to analyze.The last decade was marked by a transition towards outcome-based postgraduate medical education. During this transition competency-based programs made their appearance. Although competency-based medical education has the potential to make medical education more efficient, the effects are still under debate. And while this debate continues, the field of medical education is already introducing next level innovations: flexible and individualized training programs. Major organizational change, like the transition to flexible education programs, can easily lead to friction and conflict in teaching hospital organizations.This article analyses the organizational impact of postgraduate medical education innovations, with a particular focus on flexible training and competency based medical education. The characteristics of teaching hospital organizations are compared with elements of innovation and complexity theory.With this comparison the article argues that teaching hospital organizations have complex characteristics and behave in a non-linear way. This perspective forms the basis for further discussion and analysis of this unexplored aspect of flexible and competency based education.

  7. Maximizing Financial Resources in Veterinary Medical Teaching Hospitals.

    ERIC Educational Resources Information Center

    Walker, Terry S.

    1979-01-01

    The University of California at Davis Veterinary Medical Teaching Hospital created a healthier environment with inexpensive business procedures. Reported are: removal of billing responsibilities from faculty, separation of discharge functions from receptionist's functions, billing system/medical records system, and use of credit cards and…

  8. Medicare and Medicaid Reimbursement of Teaching Hospitals and Faculty Physicians.

    ERIC Educational Resources Information Center

    Hitchner, Carl H.

    1983-01-01

    The funding of postgraduate medical education through the "approved educational activities" of teaching hospitals needs to reevaluated. Since it is considered impossible to separate patient case and educational activities, drawing the line for financial purposes between these activities will be controversial and critical for teaching…

  9. [University teaching hospitals hold primacy in graduate medical education].

    PubMed

    Jaspers, Fr C A

    2006-07-01

    The university teaching hospitals are legally commissioned for the development and implementation of the initial medical training for doctors and for the training of specialist registrars, i.e. graduate medical education. They are able to carry out this task partly due to the professionals' collective sense of ambition and a strongly focussed organization that has the necessary critical mass at its disposal.

  10. Innovative Model for Information Assurance Curriculum: A Teaching Hospital

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  11. Epidemiology of systemic inflammatory response syndrome and sepsis in cats hospitalized in a veterinary teaching hospital.

    PubMed

    Babyak, Jonathan M; Sharp, Claire R

    2016-07-01

    OBJECTIVE To describe the epidemiology of the systemic inflammatory response syndrome (SIRS) and sepsis in cats hospitalized in a veterinary teaching hospital. DESIGN Observational study. ANIMALS 246 client-owned cats. PROCEDURES During a 3-month period, daily treatment records were evaluated for all hospitalized cats. Information extracted included signalment, temperature, heart rate, respiratory rate, diagnostic test results, diagnosis, duration of hospitalization, and outcome (survival or death). Cats were classified into 1 of 4 disease categories (sepsis [confirmed infection and SIRS], infection [confirmed infection without SIRS], noninfectious SIRS [SIRS without a confirmed infection], and no SIRS [no SIRS or infection]). RESULTS Of the 246 cats, 26 and 3 were hospitalized 2 and 3 times, respectively; thus, 275 hospitalizations were evaluated. When SIRS was defined as the presence of ≥ 2 of 4 SIRS criteria, 17 cats had sepsis, 16 had infections, 81 had noninfectious SIRS, and 161 were classified in the no SIRS category at hospital admission. The prevalence of sepsis at hospital admission was 6.2 cases/100 admissions. Four cats developed sepsis while hospitalized, resulting in a sepsis incidence rate of 1.5 cases/100 hospital admissions. Four of 17 cats with sepsis at hospital admission and 3 of 4 cats that developed sepsis while hospitalized died or were euthanized, resulting in a mortality rate of 33.3% for septic cats; 239 hospitalizations resulted in survival, 28 resulted in euthanasia, and 8 resulted in death. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that many hospitalized cats have evidence of SIRS and some have sepsis. In cats, sepsis is an important clinical entity with a high mortality rate.

  12. Financial Pressures Prompt Teaching Hospitals to Cut Costs, Raising Fears about Medical Education and Patient Care.

    ERIC Educational Resources Information Center

    Grassmuck, Karen

    1991-01-01

    Financial pressures are forcing the closure of some teaching hospitals and retrenchment using such strategies as development of ambulatory care and satellite facilities, merging with or acquiring other hospitals, and shortening patient hospital stays. A table lists revenues and profit margins for the 20 largest university-owned teaching hospitals.…

  13. Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease

    PubMed Central

    McCavit, Timothy L.; Lin, Hua; Zhang, Song; Ahn, Chul; Quinn, Charles T.; Flores, Glenn

    2014-01-01

    Sickle cell disease (SCD) accounts for ~100,000 hospitalizations in the US annually. Quality of care for hospitalized SCD patients has been insufficiently studied. Therefore, we aimed to examine whether four potential determinants of quality care, [1] hospital volume, [2] hospital teaching status, [3] patient socioeconomic status (SES), and [4] patient insurance status are associated with three quality indicators for patients with SCD: [1] mortality, [2] length of stay (LOS), and [3] hospitalization costs. We conducted an analysis of the 2003–2005 Nationwide Inpatient Sample (NIS) datasets. We identified cases using all ICD-9CM codes for SCD. Both overall and SCD-specific hospital volumes were examined. Multivariable analyses included mixed linear models to examine LOS and costs, and logistic regression to examine mortality. About 71,481 SCD discharges occurred from 2003 to 2005. Four hundred and twenty five patients died, yielding a mortality rate of 0.6%. Multivariable analyses revealed that SCD patients admitted to lower SCD-specific volume hospitals had [1] increased adjusted odds of mortality (quintiles 1–4 vs. quintile 5: OR, 1.36; 95% CI, 1.05, 1.76) and [2] decreased LOS (quintiles 1–4 vs. quintile 5, effect estimate −0.08; 95% CI, −0.12, −0.04). These are the first data describing associations between lower SCD-specific hospital volumes and poorer outcomes. PMID:21442644

  14. Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

    PubMed Central

    Okafor, II; Arinze-Onyia, SU; Ohayi, SAR; Onyekpa, JI; Ugwu, EO

    2015-01-01

    Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before

  15. Teaching hospital performance: towards a community of shared values?

    PubMed

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

    2014-01-01

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

  16. Relationship between organizational structure and creativity in teaching hospitals

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  18. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  19. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  1. A survey of the necessity of the hospitalization day in an Italian teaching hospital.

    PubMed

    Apolone, G; Alfieri, V; Braga, A; Caimi, V; Cestari, C; Crespi, V; Crosti, P F; De Filippi, F; Gelosa, M; Lanzi, E

    1991-01-01

    To assess the extent of inappropriate hospital use in an adult in-patients population we used a modified version of the Appropriateness Evaluation Protocol (A.E.P.) to evaluate retrospectively a cross-section of 273 patient-days in a large teaching hospital in the Greater Milan area. Overall, 41% were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate hospital use was significantly associated with admitting specialty, ranging from 12% for surgery, to 20% for cardiology and to about 60% in psychiatric, geriatrics and neurology departments (p less than 0.01). Hospital days of patients with longer stays were more frequently inappropriate: a statistically significant trend of inappropriateness emerged ranging from 30% among patients with total length of stay (LOS) of 1-10 days to 60% among those with LOS greater than 30 days (p less than 0.01). This study confirms that there is a substantial rate of unnecessary use of hospitals but that such inappropriateness does not seem in most cases to be easily modifiable through "simple" organizational changes.

  2. Tuberculosis treatment outcomes among hospital workers at a public teaching and national referral hospital in Kenya

    PubMed Central

    Makori, L.; Gikera, M.; Wafula, J.; Chakaya, J.; Edginton, M. E.; Kumar, A. M. V.

    2013-01-01

    Setting: Kenyatta National Hospital (KNH), Nairobi, Ken-ya, a large referral and teaching hospital. Objective: 1) To document tuberculosis (TB) case notification rates and trends; 2) to describe demographic, clinical and workplace characteristics and treatment outcomes; and 3) to examine associations between demographic and clinical characteristics, HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) treatment and anti-tuberculosis treatment outcomes among hospital workers with TB at KNH during the period 2006–2011. Design: A retrospective cohort study involving a review of medical records. Results: The TB case notification rate among hospital staff ranged between 413 and 901 per 100 000 staff members per year; 51% of all cases were extra-pulmonary TB; 74% of all cases were among medical, paramedical and support staff. The TB-HIV coinfection rate was 60%. Only 75% had a successful treatment outcome. Patients in the retreatment category, those with unknown HIV status and those who were support staff had a higher risk of poor treatment outcomes. Conclusion: The TB case rate among hospital workers was unacceptably high compared to that of the general population, and treatment outcomes were poor. Infection control in the hospital and management of staff with TB requires urgent attention. PMID:26393055

  3. A comparative analysis of the CVP structure of nonprofit teaching and for-profit non-teaching hospitals.

    PubMed

    Liu, Li-Lin; Forgione, Dana A; Younis, Mustafa Z

    2012-01-01

    Due to the market turbulence facing the hospital industry, the financial viability of teaching hospitals has been severely threatened. Their missions of education, research, and patient care even strengthen this crisis. Therefore, the objective of this study is to conduct a comparative analysis of the cost, volume, and profit (CVP) structure between large nonprofit urban teaching hospitals and small for-profit rural/suburban non-teaching hospitals. The following two hypotheses were developed: (1) large nonprofit urban teaching hospitals tend to have higher fixed cost, lower variable cost, lower total revenue adjusted by case mix index (CMI), and lower return on total assets (ROA); and (2) small for-profit rural/suburban non-teaching hospitals tend to have lower fixed cost, higher variable cost, higher total revenue adjusted by CMI, and higher ROA. Using 117 teaching hospitals and 102 non-teaching hospitals selected from the Medicare Cost Report database in 2005, the results from multiple regression indicated that large nonprofit teaching hospitals located in urban areas are more likely to have higher fixed cost and lower variable cost. While such cost structure doesn't necessarily affect their total revenue adjusted by CMI, it does lead to a lower return on hospitals' total assets. The results support our hypotheses in terms of fixed cost percentage, variable cost percentage, and ROA, but not total revenue adjusted by CMI. The results suggest that cost structure is significantly associated with hospitals' performance. Also, as teaching hospitals' portfolios of services and programs increase (e.g., provision of uncompensated care to Medicare and Medicaid patients and doing research), it becomes strategically necessary and critical to manage the allocation of resources or investments into the fixed capital that supports the business.

  4. Preparing clinical nurse leaders in a regional Australian teaching hospital.

    PubMed

    Williams, Ann K; Parker, Vicki T; Milson-Hawke, Sally; Cairney, Karen; Peek, Carmel

    2009-12-01

    The need to develop nurses as managers and leaders is crucial to the retention of registered nurses at a time of work force shortages and an increasingly aging work force in most Western industrialized countries. This article describes a creative and collaborative educational initiative developed at a large regional teaching hospital in New South Wales, Australia, designed to address this need. Based on a competency assessment process designed around face-to-face education, resource materials, and individualized mentoring from nurse unit managers, the aim of this multifaceted educational program is to develop effective team leaders in the clinical setting as well as a new generation of nursing leaders.

  5. Neural tube defects at Korle Bu Teaching Hospital, Accra, Ghana.

    PubMed

    Anyebuno, M; Amofa, G; Peprah, S; Affram, A

    1993-09-01

    This study involved a retrospective analysis of 19094 delivery records of all infants born at the Korle Bu Teaching Hospital in Accra, Ghana, between January 1991 to December 1992. During this two year period, the prevalence of neural tube defects (NTDs) was 1.15/1000 births. Anterior neural tube defects (anencephaly) accounted for 73% and posterior neural tube defects (spina bifida) accounted for 27% of all cases of NTDs. We conclude that NTDs occurs commonly in our subregion. Current available data strongly indicate that periconception folic acid supplementation significantly reduces the prevalence of NTDs. Some of this data is discussed. We strongly recommend preconception folate supplementation in our sub-region.

  6. Outcome of ruptured uterus at University Teaching Hospital Aleppo, Syria.

    PubMed

    Bakour, S; Nassif, B; Nwosu, E C

    1998-09-01

    A 10-year review of ruptured gravid uterus at the University Teaching Hospital, Aleppo, Syria showed an incidence of one ruptured uterus in 565 deliveries. This is an average figure compared with published studies but is still high compared with developed countries. Sixty-four per cent of the cases of ruptured uterus had no antenatal care. It is no surprise therefore that maternal and fetal mortality was highest amongst the unbooked labouring women. In survivors the morbidity was also higher. Ruptured uterus is therefore a major cause of maternal and perinatal mortality and morbidity in Syria. The overall hospital maternal and perinatal mortalities for the period under review were 4.3% and 2.6% respectively. The main risk factor identified is scarring from previous caesarean sections. Other risk factors are discussed.

  7. Awareness and practice of patients' rights among hospitalized patients at Wad-Medani Teaching Hospital, Sudan.

    PubMed

    Younis, Abobaker A H; Hassan, Amal H A; Dmyatti, Eylaph M E H; Elmubarak, Mehad A H; Alterife, Rahma A A; Salim, Rawan E O; Mohamed, Samar A B; Ahmed, Wefag S A M

    2017-03-30

    Patients' rights are a fundamental human right and an important part of modern health care practice. This is a cross-sectional descriptive analytic study, conducted amongst 263 patients at Wadi-Medani Teaching Hospital, Sudan, in March-April 2015. Most patients (95.2%) did not know about the Bill of Rights and most of them (92.8%) were not able to mention any of the patients' rights. The most practiced rights were: the right to be asked for permission before examination (88.1%), proper handling (87.8%), safety of the hospital (87%), presence of a third person when examining a female by a male doctor (85.6%), and admission file confidentiality (75.5%). The awareness of Sudan FMOH Patients' Bill of Rights was very low among patients at Wad-Medani Teaching Hospital, yet they showed a high satisfaction rate probably due to their low socioeconomic status, educational level and expectations. Therefore, awareness of patients' rights must be increased.

  8. Nurses awareness of patients rights in a teaching hospital

    PubMed Central

    Mohammad Nejad, Esmaeil; Begjani, Jamaloddin; Abotalebi, Ghasem; Salari, Amir; Ehsani, Seyyedeh Roghayeh

    2011-01-01

    Patients’ rights observance is one of the effective measures of patients’ satisfaction of health care services. We performed this study at the aim of evaluation of nurses’ awareness of patients’ rights in a teaching hospital in Tehran. This cross-sectional study was conducted in 2010. In this study 156 nurses were randomly selected. Two-part questionnaire was used for data collection. The validity and reliability of questionnaire was determined and then it was distributed between subjects. The data were analyzed by SPSS version 15 using descriptive and inferential statistics. Our results showed that %58.33, %39.10 and % 2.56 of nurses have good, medium, and poor levels of awareness respectively. We observed a significant relationship between nurses awareness and work experience (P=0.008) and concurrent work in public and private hospitals (P=0.01). The most of the nurses (%95.51) were aware of “right to privacy protection and ensure confidentiality of information” and the least of them (%33.97) were aware of “right to receiving necessary information about the health care providers, the rate of tariff and insurance coverage”. According to our survey it is concluded that implementation of Patients’ Right Charter in this hospital is accompanied by some limitations which necessitates promotion of the nurses’ awareness about patients’ rights. Taken together in order to enhance nurses’ awareness special measures and strategies should be considered. PMID:23908744

  9. Introduction of Minimally Invasive Esophagectomy in a Community Teaching Hospital

    PubMed Central

    Dali, Dante; Howard, Trent; Mian Hashim, Hanif; Goldman, Charles D.

    2017-01-01

    Background and Objectives: The safety of minimally invasive esophagectomy (MIE) outside of high-volume centers has not been studied. Therefore, we evaluated our experience with the introduction of MIE in the setting of a community teaching hospital. Methods: A retrospective cohort of all elective esophagectomy patients treated in a community hospital from 2008 through 2015 was evaluated (n = 57; open = 31 vs MIE = 26). Clavien-Dindo complication grades were recorded prospectively. Results: Mean age was 63 ± 11 years (range, 30–83), mean Charlson comorbidity index was 4.5 ± 1.7 and proportion of ASA score ≥3 was 87%. The groups did not differ in age, gender distribution, or comorbidity indices. There were 108 complications observed, including 2 deaths (3.5%, both coronary events). Postoperative complication rate was 77.1% and serious complication rate (grades 3 and 4) was 50.8% in the entire cohort. The rate of serious complications was similar (58% for open vs 42% for MIE group; 2-sided P = .089). MIE operations were longer (342 ± 109 vs 425 ± 74 minutes; P = .001). Length of stay trended toward not being significantly shorter among MIE cases (15 ± 13 vs 12 ± 12 days; P = .071). Logistic regression models including MIE status were not predictive of complications. Conclusions: Introduction of MIE esophagectomy in our community hospital was associated with prolonged operative time, but no detectable adverse outcomes. Length of stay was nonsignificantly shortened by the use of MIS esophagectomy. PMID:28144128

  10. [Foreign body aspiration in Kigali University Teaching Hospital, Rwanda].

    PubMed

    Van Steirteghem, S; Umuhoza, C; Casimir, G

    2013-01-01

    We present the case of a 12-year-old girl referred to Kigali University Teaching Hospital (KUTH) for persistent cough, fever and haemoptysis. Respiratory symptoms started acutely with a stridor at age 4. Thereafter she developed a chronic cough with intermittent fever. She was treated ambulatory in the health care centre with oral antibiotics and finally referred to the district hospital at age 7. The chest X-ray then suggested tuberculosis for which a 6 month treatment was given with no improvement. The cough persisted and haemoptysis appeared so the patient was referred to the reference hospital (KUTH). Chest X-ray showed diffuse lesions of the left lung with bronchiectasis. Bronchoscopy revealed the presence of a foreign body in the left intermediary bronchus and a piece of plastic was extracted. Symptoms rapidly disappeared with antibiotic treatment. This case illustrates how important it is to include foreign body inhalation in the differential diagnosis of respiratory disease in children. Bronchoscopy plays a key role in diagnosis and treatment. The authors point out the advantages of the joint efforts of the Belgian Development Aid Agency (BTC) and the Université libre de Bruxelles (ULB) in the development of this activity in the Rwandese context.

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

    ERIC Educational Resources Information Center

    Evans, Alison

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

  12. Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress.

    PubMed

    Yarmohammadian, Mohammad H; Ebrahimipour, Hossein; Doosty, Farzaneh

    2014-01-01

    In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.

  13. Family Physicians and Teaching Hospitals: A Litany of Woes

    PubMed Central

    Hansen, Niels H.

    1984-01-01

    Retreat of family physicians from caring for their patients in teaching hospitals has been partly imposed and partly passively accepted. Confusion of patient, family doctor and consultant relationships has resulted. Town/gown and family physician/specialist communication problems disrupt a proper model of care. Family physicians need to take individual and group action to initiate change, but little action has been evident. Everyone is the loser. We should reinstitute a model in which family physicians are the closest professionals to their patients, wherever they are in the health care system. Demonstrating the value of family physician coordination of care and continuity of care will positively affect the current financial `loss leader' status of this work. PMID:21279057

  14. Methicillin-resistant Staphylococcus pseudintermedius in a veterinary teaching hospital.

    PubMed

    Sasaki, Takashi; Kikuchi, Ken; Tanaka, Yoshikazu; Takahashi, Namiko; Kamata, Shinichi; Hiramatsu, Keiichi

    2007-04-01

    We surveyed methicillin-resistant coagulase-positive staphylococcus (MRCPS) strains from 57 (26 inpatient and 31 outpatient) dogs and 20 veterinary staff in a veterinary teaching hospital. From the staff, three MRCPS strains were isolated, and two were methicillin-resistant Staphylococcus aureus (MRSA). In contrast, 18 MRCPS strains were detected in both inpatient (12 of 26 [46.2%]) and outpatient (6 of 31 [19.4%]) dogs. Among them, only one strain was MRSA. Using direct sequencing of sodA and hsp60 genes, the 18 MRCPS strains other than MRSA from a staff and 17 dogs, were finally identified as Staphylococcus pseudintermedius, a novel species of Staphylococcus from a cat. All of the methicillin-resistant S. pseudintermedius (MRSP) strains were multidrug resistant to erythromycin, clindamycin, trimethoprim-sulfamethoxazole, and levofloxacin. Most of the MRSP strains showed high-level resistance to oxacillin (>/=128 mug/ml, 15 of 18 [83.3%]), and 10 of 15 (66.7%) high-level oxacillin-resistant MRSP strains carried type III SCCmec. DNA fingerprinting of MRSP strains by pulsed-field gel electrophoresis yielded eight clusters: clone A with four subtypes, clone B with four subtypes, clone C with three subtypes, and five other different single clones. MRSP strains from the staff and some inpatient and outpatient dogs shared three major clones (clones A, B, and C), but the strains of the other five different clusters were distributed independently among inpatient or outpatient dogs. This genetic diversity suggested that the MRSP strains were not only acquired in this veterinary teaching hospital but also acquired in primary veterinary clinics in the community. To our knowledge, this is the first report of MRSP in dogs and humans in a veterinary institution.

  15. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  16. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  17. 42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  18. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.162 Determining payment for physician...

  19. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.162 Determining payment...

  20. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.162 Determining payment...

  1. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE...) SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.162 Determining payment...

  2. Collaboration: a Simple Recipe for Improving Research Productivity in the Community Teaching Hospital Setting.

    PubMed

    Friedman, Yelena; Sills, Meagan

    The Medical Library and the Department of Research of the Staten Island University Hospital developed a collaborative project aimed at improving research and scholarly productivity in the community teaching hospital setting to meet teaching program accreditation requirements. The project opens a new venue for hospital librarians seeking new and innovative roles within their institutions while helping to strengthen the library's position and demonstrate the value of library services to health professionals.

  3. Collaboration: a Simple Recipe for Improving Research Productivity in the Community Teaching Hospital Setting

    PubMed Central

    Friedman, Yelena; Sills, Meagan

    2016-01-01

    The Medical Library and the Department of Research of the Staten Island University Hospital developed a collaborative project aimed at improving research and scholarly productivity in the community teaching hospital setting to meet teaching program accreditation requirements. The project opens a new venue for hospital librarians seeking new and innovative roles within their institutions while helping to strengthen the library’s position and demonstrate the value of library services to health professionals. PMID:26848287

  4. Research Utilization among Nurses at a Teaching Hospital in Kenya

    PubMed Central

    Kyalo Mutisya, Albanus; KagureKarani, Anna; Kigondu, Christine

    2015-01-01

    Introduction: In the era of evidence based practice (EBP), health care delivery should be grounded on new or validated knowledge and evidence from research. The aim of the study was to assess research utilization by nurses and the influencing factors at Kenyatta National Hospital (KNH), the largest teaching hospital in Kenya. Methods: The study employed a descriptive design that utilized both quantitative and qualitative methods of data collection. It incorporated the Barriers to Research Utilization Scale. It was conducted in six specialized care areas at KNH. Data was collected using questionnaires, Focus Group Discussion and in-depth interviews. Data was analyzed using SPSS version 13 and qualitative data analyzed using themes. Results: The study found that 20.6% of the nurses were participating in research related to their work and 53.6% of these were implementing research findings to practice. Over 2/3 (70.5%) of the respondents were basing their evidence for practice on the knowledge gained during their nursing school. The three greatest barriers to research utilization were that research reports are not readily available (68.7%), unclear implications for practice (66.5%) and inadequate facilities for implementation (66.4%). Conclusion: It is recommended that sensitization trainings on nursing research/ utilization of findings in nursing practice be established to create awareness, motivate and enhance nurses' abilities and also facilities should be provided to enable implementation. PMID:26161364

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

    PubMed Central

    Amarneh, Basil Hameed

    2017-01-01

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

  6. Knowledge of nutritional and health needs of children among rural residents of Enugu north senatorial zone in Enugu State, Nigeria.

    PubMed

    Okoye, Uzoma O; Ngwu, Christopher N; Tanyi, Perpetua L

    2015-01-01

    The article assessed knowledge of the nutritional and health needs of children among rural dwellers in Nigeria. Focus group discussions were conducted with all male and female groups in four purposively chosen rural communities in Nsukka Senatorial zone of Enugu State. These generated data on participants' knowledge on the nutritional and health needs of the children as well as their socio-demographic characteristics. All the participants were married with mean age of 41 and 36 years for males and females, respectively. The participants had six and four children on the average for male and female participants, respectively. Findings show that participants demonstrate knowledge of basic dietary needs of children; however, actual practice is lacking. Men believe women have the sole responsibility for children's nutrition. Exclusive breastfeeding is not adhered to by participants. Some reservation still exists about immunization. Sustained health education on exclusive breastfeeding and child immunization targeting both sexes is still needed.

  7. Marital Stress and Extraversion Personality as Predicators of Job Satisfaction among Married Women Teachers in Enugu, Nigeria

    ERIC Educational Resources Information Center

    Elom, Sampson Omena; Egba, Nwamaka A.

    2015-01-01

    The study investigated marital stress and extraversion personality as predictors of job satisfaction among married women teachers in Enugu, Nigeria. One hundred and eighty eight married women teachers in Enugu, Nigeria participated in the study. Three instruments were used to gather information in this study. They included marital stress inventory…

  8. Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress

    PubMed Central

    Yarmohammadian, Mohammad H.; Ebrahimipour, Hossein; Doosty, Farzaneh

    2014-01-01

    In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of “BPM” approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in “Qaem Teaching Hospital” in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level. PMID:25540784

  9. Evaluation of ureteroscopy outcome in a teaching hospital

    PubMed Central

    Al-Naimi, Abdulla; Alobaidy, Abdulqadir; Majzoub, Ahmad; Ibrahim, Tarek Ahmed Amin

    2016-01-01

    Objective To evaluate factors affecting semi-rigid ureteroscopy (URS) results highlighting the influence of teaching on its outcomes. Material and methods We reviewed the files of 891 adult patients who had undergone 1182 ureteroscopies at our institute during the period from July 2008 to June 2011. The outcomes of all URSs were evaluated. Outcomes were measured by stone- free rate and presence of complications, which were assessed using the Clavien-Dindo system. Patients were divided into 2 groups; Group 1 (favorable outcome) became stone- free after the first URS and had no documented complications, while Group 2 (unfavorable outcome) had residual stones and/or complications. Group 2 was subdivided according to the skill level of the operating surgeon into two subgroups. Patients belonging to subgroup A had their procedures performed by urology trainees under direct supervision of expert urologists, while those in subgroup B had their procedures performed by the expert urologists themselves. All groups were compared using univariate (chi-square and t tests) and multivariate (logistic regression) statistical tests to identify significant risk factors. All data was analyzed using SPSS. Results A total of 1182 URSs were evaluated. 958 patients had a favorable outcome (Group 1) while 224 patients had an unfavorable outcome (Group 2). Factors associated with an unfavorable outcome include location of the presenting stone (p<0.001) and presence of stone impaction (p<0.001). No statistically significant differences were detected in the overall complication rate between trainees and expert urologists. Trainees stone- free rate was comparable to that of experts; 90.3% vs. 91.1%, respectively, p=0.6. Conclusion Factors such as stone impaction and proximal location are associated with an unfavorable surgical outcome. In a high- volume teaching hospital, semi-rigid URS done by trainees under direct supervision is safe and their outcome is comparable to literature findings

  10. Improved blood culture identification by FilmArray in cultures from regional hospitals compared with teaching hospital cultures.

    PubMed

    Inglis, Timothy J J; Bzdyl, Nicole; Chua, I-Ly Joanna; Urosevic, Nadezda M; Leung, Michael J; Geelhoed, Elizabeth

    2016-01-01

    Rapid identification of bacteria isolated from blood cultures by direct matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is now in wide spread use in major centres but is not yet feasible in smaller hospital laboratories. A FilmArray multiplex PCR panel for blood culture isolate identification (BCID) provides an alternative approach to near point-of-care microbial identification in regional hospitals. We assessed the accuracy and time to identification of the BCID FilmArray in a consecutive series of 149 blood cultures from 143 patients in a teaching hospital and smaller regional hospitals, currently identified by direct MALDI-TOF and proprietary molecular methods. The BCID FilmArray contained 18 of 34 species and 20 of 23 species isolated from teaching and regional hospital, respectively. Overall, 85 % of the teaching hospital and 100 % of the regional hospital monomicrobial blood cultures were identified, compared with 60 and 68 %, respectively, for direct MALDI-TOF on the same cultures. There were no incorrect results from blood cultures containing Staphylococcus aureus, streptococci, Pseudomonas aeruginosa or Enterobacteriaceae. The three discrepant results were all in mixed cultures. The mean reduction in time to identification of blood culture isolates was 53 h, which did not include the time required to transport cultures from regional centres to a central laboratory. The overall performance of the BCID FilmArray is stronger in blood cultures from smaller regional hospitals that encounter a narrower range of bacterial species dominated by the commonest species. This approach is more suited to smaller clinical laboratories than the MALDI-TOF direct method.

  11. Pediatric pain: prevalence, assessment, and management in a teaching hospital

    PubMed Central

    Linhares, M.B.M.; Doca, F.N.P.; Martinez, F.E.; Carlotti, A.P.P.; Cassiano, R.G.M.; Pfeifer, L.I.; Funayama, C.A.; Rossi, L.R.G.; Finley, G.A.

    2012-01-01

    The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients' pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child's pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals. PMID:22983181

  12. Evaluation of drug administration errors in a teaching hospital

    PubMed Central

    2012-01-01

    Background Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Methods Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Results Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care. Conclusion Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions. PMID:22409837

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

    ERIC Educational Resources Information Center

    Wimberly, Anne E. Streaty

    2004-01-01

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

  14. A pilot study comparing the level of sickle cell disease knowledge in a university in southeastern Texas and a university in Enugu, Enugu State, Nigeria, West Africa.

    PubMed

    Ogamdi, S O; Onwe, F

    2000-01-01

    Sickle cell disease is the most commonly inheritable blood disorder in man. Sickle cell anemia affects approximately one in 375 Blacks in the United States. There is yet no known cure for this disease. Families of sickle cell patients continue to be financially and emotionally devastated by sickle cell disease complications. A high level of sickle cell disease knowledge will encourage non-directional sickle cell disease counseling that would reduce the incidence of this disease. A pilot study to determine the level of sickle cell disease knowledge in a university in southeastern Texas and a university in Enugu, Enugu State, Nigeria, West Africa found that there was a need to improve retention of sickle cell disease factual information.

  15. Hospital waste management status in Iran: a case study in the teaching hospitals of Iran University of Medical Sciences.

    PubMed

    Farzadkia, Mahdi; Moradi, Arash; Mohammadi, Mojtaba Shah; Jorfi, Sahand

    2009-06-01

    Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed(-1) day(-1), which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended.

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

    PubMed

    Ojo, Adebowale I; Popoola, Sunday O

    2015-01-01

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

  17. Parents' and Teachers' Preferred Medium of Instruction in Primary Schools in Enugu, Nigeria

    ERIC Educational Resources Information Center

    Amadi, Eugenia Ada

    2012-01-01

    This study which investigated parents' and teachers' preferred medium of instruction in primary schools was conducted in Enugu, South East, Nigeria. It employed the descriptive survey research method. 500 respondents were used for the study. 250 teachers were selected through simple random sampling technique. Two researcher-designed questionnaires…

  18. Ethnobotanical Potentials of Common Herbs in Nigeria: A Case Study of Enugu State

    ERIC Educational Resources Information Center

    Aiyeloja, A. A.; Bello, O. A.

    2006-01-01

    Research was carried out on the ethnobotanical potentials of common herbs in Nigeria using Enugu State as a case study. A total of 200 questionnaires were administered on herb sellers in major herb markets in the state. In all, 96 different plant species were encountered in the markets. Attempts were made to write the names of the species both in…

  19. Nasalseptal hematoma/abscess: management and outcome in a tertiary hospital of a developing country

    PubMed Central

    Nwosu, Jones N; Nnadede, Peter C

    2015-01-01

    Background Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency. Objective To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution. Method Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated. Results Fifty-three patients (37 males and 16 females), age 5–65 years (with mean age of 23.10 years), were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases. Conclusion Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess. PMID:26251577

  20. [The contracting of teaching hospitals in the Brazilian Unified Health System].

    PubMed

    Lima, Sheyla Maria Lemos; Rivera, Francisco Javier Uribe

    2012-09-01

    This study identifies the potential and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health service network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It is a case study of four teaching hospitals and their contracting State Health Departments. According to the hospital managers, the association is weak between contracting and the presence of mechanisms for hospital insertion into the health service network with practices and structures for managerial and healthcare qualification in the hospital. More structured hospitals in managerial and healthcare terms were more structured between contracting and the State Health Department. There was an increase in production of medium complexity outpatient care and a decrease in primary healthcare procedures. The proposal is for ongoing managerial development of the hospital and of the State Health Department, review of the operational plan, budgeting, monitoring mechanisms and an incentive system, bonding in the teams, among others.

  1. A Statewide Strategy for Expanding Graduate Medical Education by Establishing New Teaching Hospitals and Residency Programs.

    PubMed

    Nuss, Michelle A; Robinson, Ben; Buckley, Peter F

    2015-09-01

    The graduate medical education (GME) system in the United States is in need of reform to ensure that the physician workforce being trained is able to meet the current and future health care needs of the population. However, GME funding to existing teaching hospitals and programs relies heavily on support from Medicare, which was capped in 1997. Thus, new, innovative models to expand GME are needed. To address physician shortages, especially in primary care and general surgery and in rural areas, the state of Georgia implemented a statewide initiative. They increased medical school enrollment by 600 students from 2000 to 2010 and committed to establishing new GME programs at new teaching hospitals to train 400 additional residents by 2018. As increasing the capacity of GME programs likely increases the number of physicians practicing in the state, these efforts aim to encourage trainees to practice in Georgia. Although new teaching hospitals, like these, are eligible for new Medicare funding, this approach to expanding GME also incorporates state funding to cover the start-up costs associated with establishing a new teaching hospital and GME program.In this article, the authors provide background on the current state of GME funding in the United States and on the physician workforce and medical education system in Georgia. They then outline the steps taken to expand GME by establishing new teaching hospitals and programs. They conclude by sharing outcomes to date as well as challenges faced and lessons learned so that others can follow this novel model.

  2. What can Yelp teach us about measuring hospital quality?

    PubMed Central

    Ranard, Benjamin L.; Werner, Rachel M.; Antanavicius, Tadas; Schwartz, H. Andrew; Smith, Robert J.; Meisel, Zachary F.; Asch, David A.; Ungar, Lyle H.; Merchant, Raina M.

    2016-01-01

    Little is known about how real-time online rating platforms such as Yelp may complement the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the U.S. standard for evaluating patient experiences after hospitalization. We compared the content of Yelp narrative reviews of hospitals to the domains covered by HCAHPS. While the domains included in Yelp reviews covered the majority of HCAHPS domains, Yelp reviews covered an additional twelve domains not reflected in HCAHPS. The majority of Yelp topics most strongly correlated with positive or negative reviews are not measured or reported by HCAHPS. Yelp provides a large collection of patient and caregiver-centered experiences that can be analyzed with natural language processing methods to identify for policy makers what measures of hospital quality matter most to patients and caregivers while also providing actionable feedback for hospitals. PMID:27044971

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

    PubMed

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

    2006-05-01

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

  4. Improving health service quality from within: the case of United Leeds Teaching Hospitals NHS Trust.

    PubMed

    Lewisohn, C; Reynoso, J

    1995-01-01

    Illustrates how the implementation of the internal customer concept has assisted United Leeds Teaching Hospitals NHS Trust to establish a culture for quality. Explains the conceptual framework on which the notion of the internal customer is derived. Describes how, from 1992 to date, the Trust's quality management approach was designed to apply these management principles in a large teaching hospital setting. Outlines how this quality management approach has been successful in enabling departmental managers to recognize, develop and improve internal customer/supplier relationships. Concludes by explaining that business process re-engineering is now being applied as a prime quality tool to help deliver a major culture change throughout the organization.

  5. Estimates of costs by DRG in Sydney teaching hospitals: an application of the Yale cost model.

    PubMed

    Palmer, G; Aisbett, C; Fetter, R; Winchester, L; Reid, B; Rigby, E

    1991-01-01

    The results are reported of a first round of costing by DRG in seven major teaching hospital sites in Sydney using the Yale cost model. These results, when compared between the hospitals and with values of relative costs by DRG from the United States, indicate that the cost modelling procedure has produced credible and potentially useful estimates of casemix costs. The rationale and underlying theory of cost modelling is explained, and the need for further work to improve the method of allocating costs to DRGs, and to improve the cost centre definitions currently used by the hospitals, is emphasised.

  6. Workload Impact of Medical Subspecialties in the Teaching Hospital

    ERIC Educational Resources Information Center

    Van Peenen, Hubert J.

    1973-01-01

    This paper documents, using a single test as a model, the significant increase in clinical laboratory workload which occurred in a university hospital when strong sections of nephrology, hematology-oncology, and immunology-rheumatology were added to the department of medicine. (Author)

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Pouragha, Behrouz; Zarei, Ehsan

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Young, Philip E.

    1976-01-01

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

  11. Introducing interventional pain services in a large african teaching hospital: challenges and opportunities.

    PubMed

    Suleiman, Zakari; Burton, Allen W

    2013-11-01

    There is a need for interventional pain management in the developing world; however, there are many barriers to the introduction of interventional pain therapies. This brief report describes one approach to the introduction of interventional pain medicine to a Nigerian teaching hospital. Although many barriers exist, interventional pain medicine can be brought to the developing world, as demonstrated in this case series.

  12. Foreign Body Impaction in the Esophagus: A Review of 10 Years Experience in a Teaching Hospital

    PubMed Central

    Fajolu, Oluwole

    1986-01-01

    This report reviews 271 cases of impacted foreign bodies in the esophagus seen at the Lagos University Teaching Hospital between January 1973 and January 1983. In 270 patients, esophagoscopy was employed to relieve the obstructions. One patient had a prolonged impaction requiring a surgical procedure. The diagnosis in two patients was made at autopsy. ImagesFigure 2 PMID:3783753

  13. Critical Incident Reporting System in Teaching Hospitals in Turkey: A Survey Study

    PubMed Central

    Şalvız, Emine Aysu; Edipoğlu, Saadet İpek; Sungur, Mukadder Orhan; Altun, Demet; Büget, Mehmet İlke; Seyhan, Tülay Özkan

    2016-01-01

    Objective Critical incident reporting systems (CIRS) and morbidity–mortality meetings (MMMs) offer the advantages of identifying potential risks in patients. They are key tools in improving patient safety in healthcare systems by modifying the attitudes of clinicians, nurses and staff (human error) and also the system (human and/or technical error) according to the analysis and the results of incidents. Methods One anaesthetist assigned to an administrative and/or teaching position from all university hospitals (UHs) and training and research hospitals (TRHs) of Turkey (n=114) was contacted. In this survey study, we analysed the facilities of anaesthetists in Turkish UHs and TRHs with respect to CIRS and MMMs and also the anaesthetists’ knowledge, experience and attitudes regarding CIs. Results Anaesthetists from 81 of 114 teaching hospitals replied to our survey. Although 96.3% of anaesthetists indicated CI reporting as a necessity, only 37% of departments/hospitals were reported to have CIRS. True definition of CI as “an unexpected /accidental event” was achieved by 23.3% of anaesthetists with CIRS. MMMs were reported in 60.5% of hospitals. Nevertheless, 96% of anaesthetists believe that CIRS and MMMs decrease the incidence of CI occurring. CI occurrence was attributed to human error as 4 [1–5]/10 and 3 [1–5]/10 in UHs and TRHs, respectively (p=0.005). In both hospital types, technical errors were evaluated as 3 [1–5]/10 (p=0.498). Conclusion This first study regarding CIRS in the Turkish anaesthesia departments/hospitals highlights the lack of CI knowledge and CIRS awareness and use in anaesthesia departments/teaching hospitals in Turkey despite a safety reporting system set up by the Turkish Ministry of Health. PMID:27366560

  14. Computed tomographic studies of the head in a teaching hospital and a community hospital: a comparison

    SciTech Connect

    McNeil, B.J.; Kirkwood, J.R.; Hanley, J.A.; Polak, J.; Wilkinson, R.; Funkenstein, H.H.

    1982-11-01

    This investigation compared the use of computed tomography (CT) of the head at a large primary medical-school-affiliated hospital and at a large community hospital. There were two aims: first, to study the intrinsic characteristics of the patients in an attempt to determine the protential for developing accurate discrimination algorithms; and second, to study the patterns of neurodiagnostic tests used at these facilities. The results indicated that separability of patients into normal and abnormal categories at both institutions was extremely small. In addition, there was no significant difference in the numbers or types of ancillary tests used at both institutions. Overall, these data once more confirm the difficulty of altering CT usage patterns in primary or secondary hospitals without significantly affecting the number of abnormal patients identified.

  15. Prevalence of auditory changes in newborns in a teaching hospital

    PubMed Central

    Guimarães, Valeriana de Castro; Barbosa, Maria Alves

    2012-01-01

    Summary Introduction: The precocious diagnosis and the intervention in the deafness are of basic importance in the infantile development. The loss auditory and more prevalent than other joined riots to the birth. Objective: Esteem the prevalence of auditory alterations in just-born in a hospital school. Method: Prospective transversal study that evaluated 226 just-been born, been born in a public hospital, between May of 2008 the May of 2009. Results: Of the 226 screened, 46 (20.4%) had presented absence of emissions, having been directed for the second emission. Of the 26 (56.5%) children who had appeared in the retest, 8 (30.8%) had remained with absence and had been directed to the Otolaryngologist. Five (55.5%) had appeared and had been examined by the doctor. Of these, 3 (75.0%) had presented normal otoscopy, being directed for evaluation of the Evoked Potential Auditory of Brainstem (PEATE). Of the total of studied children, 198 (87.6%) had had presence of emissions in one of the tests and, 2 (0.9%) with deafness diagnosis. Conclusion: The prevalence of auditory alterations in the studied population was of 0,9%. The study it offers given excellent epidemiologists and it presents the first report on the subject, supplying resulted preliminary future implantation and development of a program of neonatal auditory selection. PMID:25991933

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

    PubMed

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

    2013-01-01

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

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

    PubMed

    Zhang, R

    2015-04-22

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

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

    PubMed

    Wray, J L; Sadowski, S M

    1998-04-01

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

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

    PubMed Central

    Ojo, Adebowale I; Popoola, Sunday O

    2015-01-01

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

  20. Epidemiology and antibiotic resistance in a large Italian teaching hospital.

    PubMed

    Esposito, Silvano; Pascale, Renato; Esposito, Isabella; Noviello, Silvana; Russo, Enrico; Simone, Giuseppe De; Vitolo, Matilde; Rega, Maria Rosaria; Massari, Angelo

    2015-06-01

    We focused our attention on susceptibility profile of Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. isolated from biological specimens at the University Hospital of Salerno between June 2011 and October 2012. Acinetobacter, with a prevalence of Acinetobacter baumannii (97%) presented a high range of resistance to the antimicrobials considered, excluding colistin (COL). Klebsiella spp. isolates, with a prevalence of Klebsiella pneumoniae (90%), presented a variable pattern of resistance [from 9·8% for COL to 50% for levofloxacin (LEV)]. Extended-spectrum beta-lactamases production was detected in 15% of isolates. Most Pseudomonas isolates were P. aeruginosa with a high rate of resistance (95% to amoxicillin/clavulanate and trimethoprim/sulfamethoxazole, and <50% to the other antibiotics). Colistin remained the most effective drug tested. This study provided useful information of the local bacterial epidemiology hopefully permitting to establish a more effective empirical therapy, preventing the inappropriate use of antibacterial agents and possibly limiting the diffusion of antibacterial resistance.

  1. Prevalence of auditory changes in newborns in a teaching hospital.

    PubMed

    Guimarães, Valeriana de Castro; Barbosa, Maria Alves

    2012-04-01

    Introdução: O diagnóstico e a intervenção precoces na surdez são de fundamental importância no desenvolvimento infantil. A perda auditiva e mais prevalente que outros distúrbios encontrados ao nascimento.Objetivo: Estimar a prevalência de alterações auditivas em recém-nascidos em um hospital escola.Método: Estudo transversal prospectivo que avaliou 226 recém-nascidos, nascidos em um hospital público, entre maio de 2008 a maio de 2009.Resultados: Dos 226 triados, 46 (20,4%) apresentaram ausência de emissões, sendo encaminhados para a segunda emissão. Das 26 (56,5%) crianças que compareceram no reteste, 8 (30,8%) permaneceram com ausência e foram encaminhadas ao otorrinolaringologista. Cinco (55,5%) compareceram e foram examinadas pelo médico. Destas, 3 (75,0%) apresentaram otoscopia normal, sendo encaminhadas para avaliação do Potencial Evocado Auditivo de Tronco Encefálico (PEATE). Do total de crianças estudadas, 198 (87,6%) tiveram presença de emissões em um dos testes e, 2 (0,9%) com diagnóstico de surdez.Conclusão: A prevalência de alterações auditivas na população estudada foi de 0,9%. O estudo oferece dados epidemiológicos relevantes e apresenta o primeiro relatório sobre o tema, fornecendo resultados preliminares para futura implantação e desenvolvimento de um programa de triagem auditiva neonatal.

  2. Organ donation after circulatory death in a university teaching hospital.

    PubMed

    Sidiropoulos, S; Treasure, E; Silvester, W; Opdam, H; Warrillow, S J; Jones, D

    2016-07-01

    Although organ transplantation is well established for end-stage organ failure, many patients die on waiting lists due to insufficient donor numbers. Recently, there has been renewed interest in donation after circulatory death (DCD). In a retrospective observational study we reviewed the screening of patients considered for DCD between March 2007 and December 2012 in our hospital. Overall, 148 patients were screened, 17 of whom were transferred from other hospitals. Ninety-three patients were excluded (53 immediately and 40 after review by donation staff). The 55 DCD patients were younger than those excluded (P=0.007) and they died from hypoxic brain injury (43.6%), intraparenchymal haemorrhage (21.8%) and subarachnoid haemorrhage (14.5%). Antemortem heparin administration and bronchoscopy occurred in 50/53 (94.3%) and 22/55 (40%) of cases, respectively. Forty-eight patients died within 90 minutes and proceeded to donation surgery. Associations with not dying in 90 minutes included spontaneous ventilation mode (P=0.022), absence of noradrenaline infusion (P=0.051) and higher PaO2:FiO2 ratio (P=0.052). The number of brain dead donors did not decrease over the study period. The time interval between admission and death was longer for DCD than for the 45 brain dead donors (5 [3-11] versus 2 [2-3] days; P<0.001), and 95 additional patients received organ transplants due to DCD. Introducing a DCD program can increase potential organ donors without reducing brain dead donors. Antemortem investigations appear to be acceptable to relatives when included in the consent process.

  3. [Route taken by families of children hospitalized in a teaching hospital].

    PubMed

    de Oliveira, Kézia; Veronez, Marly; Marques, Camilla Delavalentina Cavalini; Higarashi, Ieda Harumi; Marcon, Sonia Silva

    2014-01-01

    Exploratory and descriptive study, of qualitative nature, developed with the purpose of knowing the route of the child's family admitted to the hospital. The data were collected at the pediatric unit of the Regional University Hospital of Maringá (HUM), through semi-structured interviews with the accompanying family members. After analysis of content, two categories emerged: the role of the family in the identification of deviations in the child's health, and the (un)readiness of the health services: impacts on the child health attendance. The study evidenced an expectation of the family in face of the child's illness, searching for alternative strategies and late seeking for health services. These, in turn, show gaps along the attendance process, from diagnosis to treatment, thus raising familiar stress and increasing the possibilities of aggravation of the clinical condition of the child.

  4. Re-engineering surgical services in a community teaching hospital.

    PubMed

    Cohen, M M; Wreford, M; Barnes, M; Voight, P

    1997-04-01

    The Grace Hospital Surgical Services redesign project began in December 1995 and concluded in November 1996. It was led by the Chief of Surgery, the Surgical/Anesthesia Services Director, and the Associate Director of Critical Care/Trauma. The project was undertaken in order to radically redesign the delivery of surgical services in the Detroit Medical Center (DMC) Northwest Region. It encompassed the Grace Hospital Main Operating Room (10 operating theatres) and Post-Anesthesia Recovery Unit, and a satellite Ambulatory Surgery Center in Southfield, Michigan. The four areas of focus were materials management, case scheduling, patient flow/staffing, and business planning. The guiding objectives of the project were to improve upon the quality of surgical services for patients and physicians, to substantially reduce costs, and to increase case volume. Because the Grace Surgical Services redesign project was conducted in a markedly open communicative, and inclusive fashion and drew participation from a broad range of medical professionals, support staff, and management, it created positive ripple effects across the institution by raising staff cost-consciousness, satisfaction, and morale. Other important accomplishments of the project included: Introduction of block scheduling in the ORs, which improved room utilization and turnaround efficiencies, and greatly smoothed the boarding process for physicians. Centralization of all surgical boarding, upgrading of computer equipment to implement "one call" surgery scheduling, and enlarging the capacity for archiving, managing and retrieving OR data. Installation of a 23-hour, overnight recovery unit and provision of physician assistants at the Ambulatory Surgery Center, opening the doors to an expanded number of surgical procedures, and enabling higher quality care for patients. Reduction of FTE positions by 27 percent at the Ambulatory Surgery Center. This yielded a total cost reduction of +1.5 million per annum in the

  5. Telemedicine activity at a Canadian university medical school and its teaching hospitals.

    PubMed

    Aires, L M; Finley, J P

    2000-01-01

    Dalhousie University Medical School and its teaching hospitals have been providing clinical telemedicine services since 1987. The object of the present study was to assess the extent and growth of telemedicine at the medical school and teaching hospitals, as well as to evaluate the obstacles to its deployment. This was achieved by conducting structured personal interviews with telemedicine providers. Twenty telemedicine programmes were identified, of which 15 were operational and five were being planned. The number of established telemedicine projects had doubled in the six months preceding the study. A wide variety of telemedicine services were provided, ranging from clinical consultations in a number of medical specialties to patient education, grand rounds and continuing medical education. These services were provided to sites in a wide area in the Maritime region and internationally. The three most important obstacles to the implementation of telemedicine were a lack of knowledge about telemedicine (80% of respondents), time constraints (75%) and funding (70%).

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

    PubMed

    Palmer, Sheri P; Heaston, Sondra

    2009-03-01

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

  7. A Physician's Practice Profile: Application for a Teaching Hospital Ambulatory Care Setting

    PubMed Central

    Retchin, Sheldon M.; Blish, Christine S.

    1984-01-01

    A computer generated report (Practice Profile) summarizing epidemiologic, demographic and utilization data from a general internal medicine practice, was developed and implemented in a teaching hospital setting. Using a computerized medical record system, the Profile displays individual and group practice data. It is used for enhancing the physicians' understanding of their ambulatory practices and for raising important quality assurance issues. The Practice Profile is also used for improving educational activities in the residency program and for stimulating research opportunities within the practice.

  8. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    PubMed Central

    2012-01-01

    Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error

  9. Febrile morbidity and hospital stay in high-risk cesarian section patients at a non-teaching hospital.

    PubMed

    Persad

    1998-07-01

    Objective: The objective of the study was to determine the incidence of postcesarian febrile morbidity and relate this to hospital stay in a high-risk indigent population treated at a private non-teaching hospital.Methods: This was a retrospective chart review of all patients done between January 1995 and December 1996. Discharge summaries, antepartums, progress notes, and labs were reviewed for each patient. Of 257 charts reviewed, 5 were inadequate for various reasons. Board-certified surgeons performed and assisted in the operations. Twenty-one patients had scant prenatal care and 6 had no prenatal care. All patients had the abdomen scrubbed with Betadine soap prior to painting. No shaving was done. Gloves were changed after closure of uterine incision. The pelvis was copiously irrigated with 3-4 L of saline. The subcutaneous layer was irrigated from a height of 6-12" with 12 to 1 L of fluid. After this step, this layer is not touched by anything from the operating field.Results: Of 162 patients with primary cesarian, 20 had postoperative fever, 18 with endometritis, 2 with wound infections. All but 5 of these patients had labor as ruptured membranes of 12 hours or more. Four had prolonged 2nd stage. Of 28 failed VBACs, 2 had fever vs none for 59 elective repeat cesarians. The average hospital stay for febrile patients was 4.4 days vs 2.7 for afebrile patients. The incidence of wound infection was 0.8%. The incidence of fever was 12.2% for primary cesarians and 8.8% in the total study group of 249 patients.Conclusion: This study demonstrates that the adoption of simple measures presented in Methods can dramatically decrease the incidence and severity of postcesarian fever, especially wound infection, thereby allowing safe, early hospital discharge.

  10. [Women hospitalized due to abortion in a maternity teaching hospital in Recife, Brazil].

    PubMed

    da Ramos, Karla Silva; Ferreira, Ana Laura Carneiro Gomes; de Souza, Ariani Impieri

    2010-09-01

    This cross-sectional study was performed with 160 women between 2005-2006. The objective was to describe the social-demographic and reproductive characteristics of women hospitalized due to abortions, and their knowledge about contraceptive methods and abortion induction. In order to determine the association between the abortion classification and social-demographic variables, Pearson's chi-square test was used, with a significance level of 5%. A frequency of 56.3% was found for probably induced abortions. Most cases of abortion occurred before 12 weeks (55.7%). As for the women's profiles: 48.9% were between 20-29 years old, 72.0% had eight years or more of schooling, 90.1% had a partner, 52.0% had 1-3 children, 100% knew about oral contraceptives and condoms and 80.0% had heard about misoprostol. The social-demographic and reproductive profile of women hospitalized at the referred service due to abortion did not change over the last years. Misoprostol remains the most known method for abortion induction.

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

    PubMed

    Pizzo, Philip A

    2008-09-01

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

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

    PubMed

    Rohde, Tarald; Martinez, Robert

    2015-01-01

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

  13. Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital.

    PubMed

    Alrifai, S B; Alsaadi, A; Mahmood, Y A; Ali, A A; Al-Kaisi, L A

    2009-01-01

    A cross-sectional hospital-based study was carried out at Tikrit teaching hospital, Iraq, from October 2004 to September 2005, to identify the prevalence and etiology of nosocomial infectious diarrhoea among children under 5 years of age. Of 259 children admitted to the paediatric ward for reasons other than diarrhoea and hospitalized for more than 3 days, clinical and laboratory analysis of stool samples showed nosocomial diarrhoea in 84 children (32.4%). The most common causative agents were enteropathogenic Escherichia coli (25.9%), Clostridium difficile (21.0%) and rotavirus (18.5%). Single infectious agents caused 63.1% of the cases, while mixed infections were detected in 16.7%; in 20.2% of children the cause remained unknown.

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

    PubMed Central

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

    2016-01-01

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

  15. Seroprevalence and Correlates of Hepatitis C Virus Infection in Secondary School Children in Enugu, Nigeria

    PubMed Central

    Eke, CB; Ogbodo, SO; Ukoha, OM; Muoneke, VU; Ibekwe, RC; Ikefuna, AN

    2016-01-01

    Background: Although children comprise a small fraction of the burden of hepatitis C virus (HCV) infections, which is a major global health challenge, a significant number of them develop chronic HCV infection and are at risk of its complications. Aim: The aim of the current study was to determine the prevalence and associated factors of HCV infection in school children in Enugu urban. Subjects and Methods: This was a cross-sectional seroepidemiological study involving children aged 10–18 years selected using multistage systematic sampling in Enugu metropolis, Southeast Nigeria. The anti-HCV was tested using a 3rd generation enzyme-linked immunosorbent assay. Data were analyzed using SPSS Version 16.0 with the level of significance set at P < 0.05. Results: Four hundred and twenty children were selected and screened comprising 210 (50.0%) males and females. The seroprevalence of anti-HCV was 4 (1.0%). Three (75%) out of the four positive cases for the anti-HCV were females while one was a male giving a male to female ratio of 0.3–1. Traditional scarifications/tattoos were the putative risk factors observed to be significantly associated with anti-HCV seropositivity. Conclusion: This study has demonstrated an anti-HCV seroprevalence of 1.0% among children aged 10–18 years in Enugu with traditional scarification as the predominant associated risk factor. Proper health education including school health education and promotion of behavioral change among the public on the practice of safe scarifications/tattoos should be encouraged in our setting. PMID:27398246

  16. Dyslipidaemia and Medical Outcome (Health Related Quality of Life) in Patients with Schizophrenia Taking Antipsychotics in Enugu, Nigeria

    PubMed Central

    Edet, John; Igwe, Monday Nwite; Chukwujekwu, Donald Chidozie; Aguocha, Miriam Chinyere

    2017-01-01

    Aim. Determine association between use (and type) of antipsychotics and dyslipidaemia in newly diagnosed schizophrenia patients attending Federal Neuropsychiatric Hospital, Enugu. Methods. From sixty antipsychotic naive patients with schizophrenia and sixty first-degree relatives matched for gender and age, fasting blood lipid profiles were measured at baseline and after twelve weeks. Medical Outcome Study Short Form General Health Survey was administered to patients on both occasions. Fasting lipid profile changes of both groups were compared. Results. Mean endpoint of total cholesterol (TC), low density lipoprotein (LD), and triglycerides (TG) in mmol/l for cases was significantly higher than initial values (TC 4.5 versus 4.3, t = 4.3, p < 0.0001), (LDL 2.8 versus 2.6, t = 14.3, p < 0.0001), and (TG 1.3 versus 1.0, t = 12.1, p < 0.0001). Mean endpoint of high density lipoprotein (HDL) in mmol/l for cases was significantly lower than initial values (1.1 versus 1.2, t = 12.1, p < 0.0001). Prevalence of dyslipidaemia for cases was 13%. Mean endpoint of TC, LDL, TG, and HDL in mmol/l for controls was not significantly different from initial values (TC 4.30 versus 4.27, t = 1.09, p = 0.279), (LDL 2.49 versus 2.46, t = 1.28, p = 0.205), (TG 0.96 versus 0.94, t = 1.27, p = 0.207), and (HDL 1.37 versus 1.38, t = 1.61, p = 0.113). Subjects on atypical antipsychotics had higher risk for dyslipidaemia. Conclusion. Use of antipsychotics was significantly associated with dyslipidaemia. PMID:28316973

  17. Hospital clonal dissemination of Enterobacter aerogenes producing carbapenemase KPC-2 in a Chinese teaching hospital.

    PubMed

    Qin, Xiaohua; Yang, Yang; Hu, Fupin; Zhu, Demei

    2014-02-01

    Carbapenems are first-line agents for the treatment of serious nosocomial infections caused by multidrug-resistant Enterobacteriaceae. However, resistance to carbapenems has increased dramatically among Enterobacteriaceae in our hospital. In this study, we report clonal dissemination caused by carbapenem-resistant Enterobacter aerogenes (CREA). In 2011, CREA was identified from 12 patients admitted to the neurosurgical ward. All 12 clinical isolates were non-susceptible to cefotaxime, ceftazidime, cefoxitin, ertapenem, imipenem or meropenem. All isolates carried the gene encoding Klebsiella pneumoniae carbapenemase-2 (KPC-2), except for the isolate E4. However, a remarkably lower expression level of the porin OmpF was detected in the non-KPC-2-producing isolate E4 on SDS-PAGE compared with the carbapenem-susceptible isolate. Epidemiological and molecular investigations showed that a single E. aerogenes strain (PFGE type A), including seven KPC-2-producing clinical isolates, was primarily responsible for the first isolation and subsequent dissemination. In a case-control study, we identified risk factors for infection/colonization with CREA. Mechanical ventilation, the changing of sickbeds and previous use of broad-spectrum antibiotics were identified as potential risk factors. Our findings suggest that further studies should focus on judicious use of available antibiotics, implementation of active antibiotic resistance surveillance and strict implementation of infection-control measures to avoid the rapid spread or clonal dissemination caused by carbapenem-resistant Enterobacteriaceae in healthcare facilities.

  18. Patient Safety in Obstetrics and Gynecology Departments of two Teaching Hospitals in Delhi

    PubMed Central

    Gupta, Bindiya; Guleria, Kiran; Arora, Renu

    2016-01-01

    Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS), respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10) were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error. PMID:27385879

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

    PubMed Central

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

    2015-01-01

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

  20. Personality Traits and Socio-Demographic Variables as Correlates of Counselling Effectiveness of Counsellors in Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Onyekuru, Bruno U.; Ibegbunam, Josephat

    2015-01-01

    Quality personality traits and socio-demographic variables are essential elements of effective counselling. This correlational study investigated personality traits and socio-demographic variables as predictors of counselling effectiveness of counsellors in Enugu State. The instruments for data collection were Personality Traits Assessment Scale…

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

    PubMed Central

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

    2015-01-01

    Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094

  2. Knowledge and power necessary to reconstruct nursing after management changes at a teaching hospital.

    PubMed

    Bernardino, Elizabeth; Felli, Vanda Elisa Andres

    2008-01-01

    This study was carried out at a teaching hospital in Southern Brazil, which adopted a management model that provoked the dismantling of the nursing service and the disbandment of nursing professionals. Its general goal was to promote changes that would be implemented in the re-organization of nursing work. It is a case study with a historical-dialectic approach, whose data were collected in March and April 2005 through the focal group technique. The study subjects were eight nurses, two technicians and two nursing auxiliaries. Data were analyzed through thematic content analysis. Results evidenced that the greatest challenges nursing faced at this hospital were: to construct a new identity, carry out teamwork while maintaining its professional identity, acquire visibility in the institution, change care and expand management.

  3. An assessment of internship at the teaching hospitals of the University of the Witwatersrand.

    PubMed

    Touyz, R M; Kelly, A; Tollman, S; Milne, F J

    1988-08-20

    Medical internship can be a physically exhausting and emotionally traumatic experience. This study assesses various aspects of internship, including continuing medical education, workload and stress, at the five Johannesburg teaching hospitals during 1985 and 1986. Data were analysed from a confidential questionnaire. Eighty-two interns completed the questionnaire at the end of 1985 and 120 at the end of 1986. Problem areas defined were excessive patient load, sleep deprivation and severe stress. The commonest symptoms of stress were fatigue, irritability and weight loss. In 1985, 53% of interns stated that they could not cope, and in 1986 this increased to 65%. Forty-eight per cent of 1985 and 69% of 1986 interns lost interest in medicine during their intern year. The implications of these results are discussed and the importance and impact on the medical profession and hospital services analysed.

  4. The passing of the night watch: night nursing reform in the London teaching hospitals, 1856-90.

    PubMed

    Helmstadter, C

    1994-01-01

    At the beginning of the nineteenth century a separate team of women called the "night watch" was responsible for the night nursing in the London teaching hospitals. Rough, uneducated, and frequently the "scrubbers," or charwomen, who cleaned the halls and stairways in the hospitals in the daytime, the night watchers came to be closely identified with Dickens's Sarah Gamp. As the century progressed, the expanding capabilities of the new academic medicine forced an improvement in the standard of nursing. The difficulty in finding clinically experienced nurses who were willing to work nights at an affordable price, however, made it possible for the night watchers to remain in the new professionally organized hospital long after such unskilled and undisciplined workers had been phased out of other areas of the late Victorian workforce. By the end of the century when hospitals began rotating partially trained probationer, or student, nurses onto nights, the night watchers finally disappeared from the teaching hospitals.

  5. Evaluation of pharmacy information system in teaching, private and social services Hospitals in 2011

    PubMed Central

    Saghaeiannejad-Isfahani, Sakineh; Mirzaeian, Razieh; Jannesari, Hasan; Ehteshami, Asghar; Feizi, Awat; Raeisi, Ahmadreza

    2014-01-01

    Objective: Supporting a therapeutic approach and medication therapy management, the pharmacy information system (PIS) acts as one of the pillars of hospital information system. This ensures that medication therapy is being supported with an optimal level of safety and quality similar to other treatments and services. Materials and Methods: The present study is an applied, cross-sectional study conducted on the PIS in use in selected hospitals. The research population included all users of PIS. The research sample is the same as the research population. The data collection instrument was the self-designed checklist developed from the guidelines of the American Society of Health System Pharmacists, Australia pharmaceutical Society and Therapeutic guidelines of the Drug Commission of the German Medical Association. The checklist validity was assessed by research supervisors and PIS users and pharmacists. Findings: The findings of this study were revealed that regarding the degree of meeting the standards given in the guidelines issued by the Society of Pharmacists, the highest rank in observing input standards belonged to Social Services hospitals with a mean score of 32.75. Although teaching hospitals gained the highest score both in process standards with a mean score of 29.15 and output standards with a mean score of 43.95, the private hospitals had the lowest mean score of 23.32, 17.78, 24.25 in input, process and output standards, respectively. Conclusion: Based on the findings, it can be claimed that the studied hospitals had a minimal compliance with the input, output and processing standards related to the PIS. PMID:25013832

  6. Questionnaire survey of working relationships between nurses and doctors in University Teaching Hospitals in Southern Nigeria

    PubMed Central

    Ogbimi, Roseline I; Adebamowo, Clement A

    2006-01-01

    Background Smooth working relationships between nurses and doctors are necessary for efficient health care delivery. However, previous studies have shown that this is often absent with negative impact on the quality of health care delivery. In 2002, we studied factors that affect nurse-doctor working relationships in University Teaching Hospitals (UTH) in Southern Nigeria in order to characterize it and identify managerial and training needs that might be used to improve it. Method Questionnaire survey of doctors and nurses working in four UTH in Southern Nigeria was done in 2002. The setting and subjects were selected by random sampling procedures. Information on factors in domains of work, union activities, personnel and hospital management were studied using closed and open-ended questionnaires. Results Nurse-doctor working relationships were statistically significantly affected by poor after-work social interaction, staff shortages, activist unionism, disregard for one's profession, and hospital management and government policies. In general, nurses had better opinion of doctors' work than doctors had about nurses' work. Conclusion Working relationships between doctors and nurses need to be improved through improved training and better working conditions, creation of better working environment, use of alternative methods of conflict resolution and balanced hospital management and government policies. This will improve the retention of staff, job satisfaction and efficiency of health care delivery in Nigeria. PMID:16504039

  7. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital

    PubMed Central

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-01-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  8. Simulation-Based Dysphagia Training: Teaching Interprofessional Clinical Reasoning in a Hospital Environment.

    PubMed

    Miles, Anna; Friary, Philippa; Jackson, Bianca; Sekula, Julia; Braakhuis, Andrea

    2016-06-01

    This study evaluated hospital readiness and interprofessional clinical reasoning in speech-language pathology and dietetics students following a simulation-based teaching package. Thirty-one students participated in two half-day simulation workshops. The training included orientation to the hospital setting, part-task skill learning and immersive simulated cases. Students completed workshop evaluation forms. They filled in a 10-question survey regarding confidence, knowledge and preparedness for working in a hospital environment before and immediately after the workshops. Students completed written 15-min clinical vignettes at 1 month prior to training, immediately prior to training and immediately after training. A marking rubric was devised to evaluate the responses to the clinical vignettes within a framework of interprofessional education. The simulation workshops were well received by all students. There was a significant increase in students' self-ratings of confidence, preparedness and knowledge following the study day (p < .001). There was a significant increase in student overall scores in clinical vignettes after training with the greatest increase in clinical reasoning (p < .001). Interprofessional simulation-based training has benefits in developing hospital readiness and clinical reasoning in allied health students.

  9. Use of non-formulary drugs in children at a Brazilian teaching hospital: a descriptive study

    PubMed Central

    Tramontina, Mariana Y.; Heineck, Isabela; Dos Santos, Luciana

    Objective To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions (ADRs), drug interactions, and prescription of potentially hazardous medicines. Methods A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as approved, off-label, or not approved for use in children according to Brazilian compendia. Electronic health records were actively searched for ADRs and the possibility of moderate to severe interactions between non-formulary drugs and other medicines was determined with the Micromedex® database. Results Overall, 109 children or neonates received non-formulary drugs. Of these drugs, 54% were approved for use in children, 12.2% were used off-label, and 33.8% were not approved for use in children. Non-formulary drugs accounted for 13.4% of total prescriptions; 5.3% of drugs had a potential for interactions and five were possibly associated with ADRs. Conclusions Prescription of non-formulary drugs not approved for use in children was common at the study hospital. Studies such as this provide information on the use of medicines for special indications and permit assessment of the relevance of hospital formularies for the paediatric population. PMID:24155845

  10. Night shift fatigue among anaesthesia trainees at a major metropolitan teaching hospital.

    PubMed

    Lancman, B M

    2016-05-01

    Night shifts expose anaesthesia trainees to the risk of fatigue and, potentially, fatigue-related performance impairment. This study examined the workload, fatigue and coping strategies of anaesthesia trainees during night shifts. A blinded survey-based study was undertaken at a major single centre metropolitan teaching hospital in Australia. All ten anaesthesia trainees who worked night shifts participated. The survey collected data on duration of night shifts, workload, and sleep patterns. Fatigue was assessed using the Karolinska Sleepiness Scale (KSS). There were 93 night shifts generating data out of a potential 165. Trainees tended to sleep an increasing amount before their shift as the nights progressed from 1 to 5. Night 1 was identified as an 'at risk' night due to the amount of time spent awake before arriving at work (32% awake for U+003E8 hours); on all other nights trainees were most likely to have slept 6-8 hours. The KSS demonstrated an increase in sleepiness of 3 to 4 points on the scale from commencement to conclusion of a night shift. The Night 1 conclusion sleepiness was markedly worse than any other night with 42% falling into an 'at-risk' category. The findings demonstrate fatigue and inadequate sleep in anaesthesia trainees during night shifts in a major metropolitan teaching hospital. The data obtained may help administrators prepare safer rosters, and junior staff develop improved strategies to reduce the likelihood of fatigue.

  11. Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy

    PubMed Central

    2014-01-01

    Background Malaria treatment policy recommends regular monitoring of drug utilization to generate information for ensuring effective use of anti-malarial drugs in Nigeria. This information is currently limited in the retail sector which constitutes a major source of malaria treatment in Nigeria, but are characterized by significant inappropriate use of drugs. This study analyzed the use pattern of anti-malarial drugs in medicine outlets to assess the current state of compliance to policy on the use of artemisinin-based combination therapy (ACT). Methods A prospective cross-sectional survey of randomly selected medicine outlets in Enugu urban, southeast Nigeria, was conducted between May and August 2013, to determine the types, range, prices, and use pattern of anti-malarial drugs dispensed from pharmacies and patent medicine vendors (PMVs). Data were collected and analyzed for anti-malarial drugs dispensed for self-medication to patients, treatment by retail outlets and prescription from hospitals. Results A total of 1,321 anti-malarial drugs prescriptions were analyzed. ACT accounted for 72.7%, while monotherapy was 27.3%. Affordable Medicines Facility-malaria (AMFm) drugs contributed 33.9% (326/961) of ACT. Artemether-lumefantrine (AL), 668 (50.6%) was the most used anti-malarial drug, followed by monotherapy sulphadoxine-pyrimethamine (SP), 248 (18.8%). Median cost of ACT at $2.91 ($0.65-7.42) per dose, is about three times the median cost of monotherapy, $0.97 ($0.19-13.55). Total cost of medication (including co-medications) with ACT averaged $3.64 (95% CI; $3.53-3.75) per prescription, about twice the mean cost of treatment with monotherapy, $1.83 (95% CI; $1.57-2.1). Highest proportion 46.5% (614), of the anti-malarial drugs was dispensed to patients for self-treatment. Treatment by retail outlets accounted for 35.8% while 17.7% of the drugs were dispensed from hospital prescriptions. Self-medication, 82%, accounted for the highest source of monotherapy and

  12. Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali

    PubMed Central

    Sangare, Samba Adama; Maiga, Almoustapha Issiaka; Guindo, Ibrehima; Maiga, Aminata; Camara, Namory; Dicko, Oumar Agaly; Dao, Sounkalo; Diallo, Souleymane; Bougoudogo, Flabou; Andremont, Antoine; Maiga, Ibrahim Izetiegouma; Armand-Lefevre, Laurence

    2017-01-01

    The worldwide dissemination of extended-spectrum beta-lactamase producing Enterobacteriaceae, (ESBL-E) and their subset producing carbapenemases (CPE), is alarming. Limited data on the prevalence of such strains in infections from patients from Sub-Saharan Africa are currently available. We determined, here, the prevalence of ESBL-E/CPE in bacteriemic patients in two teaching hospitals from Bamako (Mali), which are at the top of the health care pyramid in the country. During one year, all Enterobacteriaceae isolated from bloodstream infections (E-BSI), were collected from patients hospitalized at the Point G University Teaching Hospital and the pediatric units of Gabriel Touré University Teaching Hospital. Antibiotic susceptibility testing, enzyme characterization and strain relatedness were determined. A total of 77 patients had an E-BSI and as many as 48 (62.3%) were infected with an ESBL-E. ESBL-E BSI were associated with a previous hospitalization (OR 3.97 95% IC [1.32; 13.21]) and were more frequent in hospital-acquired episodes (OR 3.66 95% IC [1.07; 13.38]). Among the 82 isolated Enterobacteriaceae, 58.5% were ESBL-E (20/31 Escherichia coli, 20/26 Klebsiella pneumoniae and 8/15 Enterobacter cloacae). The remaining (5 Salmonella Enteritidis, 3 Morganella morganii 1 Proteus mirabilis and 1 Leclercia adecarboxylata) were ESBL negative. CTX-M-1 group enzymes were highly prevalent (89.6%) among ESBLs; the remaining ones being SHV. One E. coli produced an OXA-181 carbapenemase, which is the first CPE described in Mali. The analysis of ESBL-E relatedness suggested a high rate of cross transmission between patients. In conclusion, even if CPE are still rare for the moment, the high rate of ESBL-BSI and frequent cross transmission probably impose a high medical and economic burden to Malian hospitals. PMID:28245252

  13. Surveillance of ESBL producing multidrug resistant Escherichia coli in a teaching hospital in India

    PubMed Central

    Rath, Shakti; Dubey, Debasmita; Sahu, Mahesh C.; Padhy, Rabindra N

    2014-01-01

    Objective To record nosocomial and community-acquired accounts of antibiotic resistance in Escherichia coli (E. coli) strains, isolated from clinical samples of a teaching hospital by surveillance, over a period of 39 months (November 2009-January 2013). Methods Clinical samples from nosocomial sources, i.e., wards and cabins, intensive care unit (ICU) and neonatal intensive care unit (NICU), and community (outpatient department, OPD) sources of the hospital, were used for isolating strains of E. coli, which were subjected for testing for production of ‘extended spectrum beta-lactamase’-(ESBL) enzyme as well as determining antibiotic sensitivity pattern with 23 antibiotics. Results Of the total 1642 (100%) isolates, 810 (49.33%) strains were from OPD and 832 (50.66%) were from hospital settings. Occurrence of infectious E. coli strains increased in a mathematical progression in community sources, but in nosocomial infections, such values remained almost constant in each quarter. A total of 395 (24.05%) ESBL strains were isolated from the total 810 isolates of community; of the total of 464 (28.25%) isolates of wards and cabins, 199 (12.11%) were ESBL strains; and among the total of 368 (22.41%) isolates of ICU and NICU, ESBLs were 170 (10.35%); the total nosocomial ESBL isolates, 369 (22.47%) were from the nosocomial total of 832 (50.66%) isolates. Statistically, it was confirmed that ESBL strains were equally distributed in community or hospital units. Antibiogram of 23 antibiotics revealed progressive increases of drug-resistance against each antibiotic with the maximum resistance values were recorded against gentamicin: 92% and 79%, oxacillin: 94% and 69%, ceftriaxone: 85% and 58%, and norfloxacin 97% and 69% resistance, in nosocomial and community isolates, respectively. Conclusions This study revealed the daunting state of occurrence of multidrug resistant E. coli and its infection dynamics in both community and hospital settings.

  14. Factors associated with the patient safety climate at a teaching hospital1

    PubMed Central

    Luiz, Raíssa Bianca; Simões, Ana Lúcia de Assis; Barichello, Elizabeth; Barbosa, Maria Helena

    2015-01-01

    Objectives: to investigate the association between the scores of the patient safety climate and socio-demographic and professional variables. Methods: an observational, sectional and quantitative study, conducted at a large public teaching hospital. The Safety Attitudes Questionnaire was used, translated and validated for Brazil. Data analysis used the software Statistical Package for Social Sciences. In the bivariate analysis, we used Student's t-test, analysis of variance and Spearman's correlation of (α=0.05). To identify predictors for the safety climate scores, multiple linear regression was used, having the safety climate domain as the main outcome (α=0.01). Results: most participants were women, nursing staff, who worked in direct care to adult patients in critical areas, without a graduate degree and without any other employment. The average and median total score of the instrument corresponded to 61.8 (SD=13.7) and 63.3, respectively. The variable professional performance was found as a factor associated with the safety environment for the domain perception of service management and hospital management (p=0.01). Conclusion: the identification of factors associated with the safety environment permits the construction of strategies for safe practices in the hospitals. PMID:26487138

  15. Rotavirus Infection in Children with Diarrhea at Korle-Bu Teaching Hospital, Ghana.

    PubMed

    Damanka, Susan; Adiku, Theophilus K; Armah, George E; Rodrigues, Onike; Donkor, Eric S; Nortey, David; Asmah, Richard

    2016-07-22

    Human rotavirus infection was studied over a 13-month period (January 2004 to January 2005) in children <5 years of age admitted with severe diarrhea at the Korle-Bu Teaching Hospital in Accra, Ghana. During this period, 206 hospitalizations for diarrhea were recorded, with 34.0% (70/206) being positive for rotavirus infection. Infection occurred throughout the year, with peak rotavirus infection occurring during the month of March. Hospitalization associated with rotaviruses was most common in the 6-8 month age group. The case fatality rate of rotavirus infection was 2.9% (2/70) and occurred in children <12 months of age. Four rotavirus VP7 genotypes (G1, G2, G3, and G9) were detected. The predominant genotypes were G2 (22.9%), G1 (17.1%), G9 (17.1%) and G3 (12.9%). Mixed G types were also detected. The predominant VP4 genotypes (P types) were P[6] (38.6%), P[8] (21.4%), P[4] (4.3%) and P[9] (1.4%). The predominant rotavirus strains infecting children in Accra were G9P[6] (10.0%) and G1P[8] (8.6%). Strains with unusual genotypes such as G2P[8] and G(2/3)P[6] were also detected.

  16. Role of Organizational Climate in Organizational Commitment: The Case of Teaching Hospitals

    PubMed Central

    Bahrami, Mohammad Amin; Barati, Omid; Ghoroghchian, Malake-sadat; Montazer-alfaraj, Razieh; Ranjbar Ezzatabadi, Mohammad

    2015-01-01

    Objective The commitment of employees is affected by several factors, including factors related to the organizational climate. The aim of this study was to investigate the relationship between organizational commitment of nurses and the organizational climate in hospital settings. Methods A cross-sectional study was conducted in 2014 at two teaching hospitals in Yazd, Iran. A total of 90 nurses in these hospitals participated. We used stratified random sampling of the nursing population. The required data were gathered using two valid questionnaires: Allen and Meyer's organizational commitment standard questionnaire and Halpin and Croft's Organizational Climate Description Questionnaire. Data analysis was done through SPSS 20 statistical software (IBM Corp., Armonk, NY, USA). We used descriptive statistics and Pearson's correlation coefficient for the data analysis. Results The findings indicated a positive and significant correlation between organizational commitment and organizational climate (r = 0.269, p = 0.01). There is also a significant positive relationship between avoidance of organizational climate and affective commitment (r = 0.208, p = 0.049) and between focus on production and normative and continuance commitment (r = 0.308, p = 0.003). Conclusion Improving the organizational climate could be a valuable strategy for improving organizational commitment. PMID:27169007

  17. BPA and environmental estrogen in potable water sources in Enugu municipality, South-East, Nigeria.

    PubMed

    Ignatius, C Maduka; Francis, E Ezeonu; Emeka, E Neboh; Elvis, N Shu; Ebele, J Ikekpeazu

    2010-11-01

    BPA and environmental estrogen levels were assayed in potable water samples (38 tap water, 36 well water, 18 river water and 24 rain water samples) that were randomly collected from the different parts of Enugu metropolis, south-east Nigeria. The mean ± SD estrogen levels in tap, well, river and rain water samples were 0.10 ± 0.09, 0.05 ± 0.02, 0.05 ± 0.02 and 0.05 ± 0.02 μg/L respectively. Also, the mean BPA levels (μg/L) in the different water sources were 0.20 ± 0.07, 0.21 ± 0.07, 0.18 ± 0.04, and 0.40 ± 0.16, respectively. There was statistically significant difference (p = 0.0227) in BPA levels between the harvested rain water and the drinking tap water.

  18. Severe maternal morbidity in the intensive care unit of a havana teaching hospital,1998 to 2004.

    PubMed

    Pérez, Albadio; Bacallao, Jorge; Alcina, Serafín; Gómez, Yamilka

    2008-07-01

    Introduction In recent years, several reports have appeared in the international literature concerning evolution and prognosis for obstetric patients whose illnesses have led to admission to intensive care units (ICUs). The term severe maternal morbidity has been proposed to refer to life-threatening complications that occur during pregnancy, delivery or postpartum. Objective Characterize severe maternal morbidity in obstetric patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana from 1998 to 2004. Methods From 1998 to 2004, we conducted a prospective, descriptive, and observational study of 312 patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana, Cuba. Patients were included whose length of stay was >24 hours, and whose family members provided written informed consent. A data collection form was developed to record general characteristics, personal and family medical history, cause of ICU admission, diagnosis, obstetric condition at the onset of illness and at admission, pregnancy outcome, surgeries performed and patient's ICU discharge status (survivor or non-survivor), the latter a dependent variable. An Excel database was compiled and processed using SPSS 13.0. Percentages were used to summarize qualitative variables. A Chi-square test was used for univariate analysis between these qualitative variables and patient discharge status; t-test was used for quantitative analyses. Results Overall mortality in the cohort was 7.4% (23 patients), greater among women aged <20 years, those with a history of previous illnesses, and those subjected to several surgical interventions. Obstetric hemorrhage, pre-eclampsia/eclampsia, and postpartum sepsis were the most commonly diagnosed obstetric disorders. Non-obstetric disorders diagnosed included severe asthma, pneumonia and peritonitis. Amniotic fluid embolism, postpartum sepsis, early postpartum hemorrhage and pre-eclampsia/eclampsia were associated with

  19. Development of an effective risk management system in a teaching hospital

    PubMed Central

    2012-01-01

    Background Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. Methods WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. Results The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The “non-punitive responses to error” had lowest positive score with 21.2 percent. Conclusion It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate

  20. Nurses' attitudes to a medical emergency team service in a teaching hospital

    PubMed Central

    Jones, D; Baldwin, I; McIntyre, T; Story, D; Mercer, I; Miglic, A; Goldsmith, D; Bellomo, R

    2006-01-01

    Background Cultural barriers including allegiance to traditional models of ward care and fear of criticism may restrict use of a medical emergency team (MET) service, particularly by nursing staff. A 1‐year preparation and education programme was undertaken before implementing the MET at the Austin Hospital, Melbourne, Australia. During the 4 years after introduction of the MET, the programme has continued to inform staff of the benefits of the MET and to overcome barriers restricting its use. Objective To assess whether nurses value the MET service and to determine whether barriers to calling the MET exist in a 400‐bed teaching hospital. Methods Immediately before hand‐over of ward nursing, we conducted a modified personal interview, using a 17‐item Likert agreement scale questionnaire. Results We created a sample of 351 ward nurses and obtained a 100% response rate. This represents 50.9% of the 689 ward nurses employed at the hospital. Most nurses felt that the MET prevented cardiac arrests (91%) and helped manage unwell patients (97%). Few nurses suggested that they restricted MET calls because they feared criticism of their patient care (2%) or criticism that the patient was not sufficiently unwell to need a MET call (10%). 19% of the respondents indicated that MET calls are required because medical management by the doctors has been inadequate; many ascribed this to junior doctors and a lack of knowledge and experience. Despite hospital MET protocol, 72% of nurses suggested that they would call the covering doctor before the MET for a sick ward patient. However, 81% indicated that they would activate the MET if they were unable to contact the covering doctor. In line with hospital MET protocol, 56% suggested that they would make a MET call for a patient they were worried about even if the patient's vital signs were normal. Further, 62% indicated that they would call the MET for a patient who fulfilled MET physiological criteria but did not look

  1. Analysis of the quality of hospital information systems in Isfahan teaching hospitals based on the DeLone and McLean model

    PubMed Central

    Saghaeiannejad-Isfahani, Sakineh; Saeedbakhsh, Saeed; Jahanbakhsh, Maryam; Habibi, Mahboobeh

    2015-01-01

    Background: Quality is one of the most important criteria for the success of an information system, which refers to its desirable features of the processing system itself. The aim of this study was the analysis of system quality of hospital information systems (HIS) in teaching hospitals of Isfahan based on the DeLone and McLean model. Materials and Methods: This research was an applied and analytical-descriptive study. It was performed in teaching hospitals of Isfahan in 2010. The research population consisted of the HIS's users, system designers and hospital information technology (IT) authorities who were selected by random sampling method from users’ group (n = 228), and system designers and IT authorities (n = 52) using census method. The data collection tool was two researcher-designed questionnaires. Questionnaires’ reliability was estimated by using Cronbach's alpha was calculated. It was 97.1% for the system designers and IT authorities’ questionnaire and 92.3% for system users’ questionnaire. Results: Findings showed that the mean of system quality score in a variety of HIS and among different hospitals was significantly different and not the same (P value ≥ 0.05). In general, Kosar (new version) system and Rahavard Rayaneh system have dedicated the highest and the lowest mean scores to themselves. The system quality criterion overall mean was 59.6% for different HIS and 57.5% among different hospitals respectively. Conclusion: According to the results of the research, it can be stated that based on the applied model, the investigated systems were relatively desirable in terms of quality. Thus, in order to achieve a good optimal condition, it is necessary to pay particular attention to the improving factors of system quality, type of activity, type of specialty and hospital ownership type. PMID:25767816

  2. Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.

    PubMed

    Olufolabi, Adeyemi J; Atito-Narh, Evans; Eshun, Millicent; Ross, Vernon H; Muir, Holly A; Owen, Medge D

    2015-06-01

    Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.

  3. Investigation of Seclusion in one of the Psychiatric Wards in Razi Teaching Hospital of Tabriz.

    PubMed

    Vahidi, Maryam; Hosseinzadeh, Mina

    2014-12-01

    Seclusion is one of the methods in controlling violent behavior of inpatients in psychiatric wards. In current descriptive analytic study, data collection instrument included the seclusion list of inpatients by considering individual, social and clinical characteristics in one of the psychiatry wards In the Razi teaching hospital of Tabriz in the first six months of 2012. Among 264 admitted patients, 24 patients (9.1%) had been secluded and a total of 29 isolated incidents were recorded. Most of secluded incidents occurred on weekdays (75.9%), first week of inpatient (87.7%), and during the evening shifts (48.3%). The results obtained in this study demonstrate that in 55.2% cases, the duration of isolation was two hours and the most common cause of seclusion was aggressive behaviors. Most of secluded patients (66.7%) were diagnosed with mood disorders.

  4. Pregnancy and cirrhosis: four cases at the Lome campus university teaching hospital (Togo).

    PubMed

    Bagny, A; Akolly, D A E; Lawson-Ananisoh, L M; Bouglouga, O; Douaguibe, B; El Hadji Yacoubou, R; Koffi, S; Lawson Evi, K; Guedenon, K M; Atakouma, Y D; Akpadza, K; Redah, D

    2016-11-01

    To evaluate the hepatic and obstetric complications in pregnant women with cirrhosis. We report the cases of four pregnant women with cirrhosis treated in the gastroenterology and obstetrics-gynecology departments of the Lome Campus University Teaching Hospital between 2013 and 2015. The women's mean age was 32 years. Three were in the first trimester of pregnancy. Almost all had signs of advanced cirrhosis, including ascites (50%), lower-limb edema (75%), and jaundice (25%). All (100%) had liver failure and anemia. Cirrhosis was due to hepatitis virus B infection for 3 women. All had singleton pregnancies. Two mothers died; fetal outcome included one fetal loss and one stillbirth. This study shows the high risk associated with the combination of pregnancy and cirrhosis. Prognosis is poor for both mother and fetus.

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  6. Investigation of mechanisms and molecular epidemiology of linezolid nonsusceptible Enterococcus faecalis isolated from a teaching hospital in China.

    PubMed

    Li, Bin; Ma, Chuan-Ling; Yu, Xiao; Sun, Yao; Li, Mei-Mei; Ye, Jian-Zhong; Zhang, Ya-Pei; Wu, Qing; Zhou, Tie-Li

    2016-08-01

    The epidemiological and molecular characteristics of eight linezolid nonsusceptible Enterococcus faecalis isolated from a teaching hospital in China (January to July 2014) were investigated. The target site modifications and cfr gene associated with linezolid resistance were not found. Results of the epidemiological investigation indicated that linezolid resistance possibly occurred on several independent occasions and was often not related to linezolid administration.

  7. Development and use of DNA archives at veterinary teaching hospitals to investigate the genetic basis of disease in dogs.

    PubMed

    Castelhano, Marta G P; Acland, Gregory M; Ciccone, Penelope A; Corey, Elizabeth E; Mezey, Jason G; Schimenti, John C; Todhunter, Rory J

    2009-01-01

    The DNA archives developed at veterinary medical teaching hospitals will be important resources for mapping disease loci and identifying underlying genes. The most important feature of a DNA archive is accurate identification or exclusion of diseases in each animal. Such archives will be complimentary resources to tissue banks that are currently available.

  8. Applications of ultrasound to veterinary diagnostics in a veterinary teaching hospital.

    PubMed

    Miller, C W; Wingfield, W E; Boon, J A

    1982-01-01

    Animal patients at Colorado State University's Veterinary Teaching Hospital as well as beagles at the Collaborative Radiological Health Laboratory (CRHL) have been routinely evaluated using a variety of ultrasonic procedures that are commonplace in human medicine. The results from these clinical investigations have provided diagnostic information which in many cases has not been available using other clinical testing methods. Dogs, cats, horses, and cattle have been the primary animals evaluated, but more exotic subjects such as rabbits, ferrets, goats, and armadillos have also been examined. Standard M mode echocardiographic and classic contact scanning have been used to evaluate the heart and abdominal-pelvic areas respectively. Recently, real time scanning has been added to our capabilities for evaluating animal subjects. These clinical studies, while obviously adding to veterinary diagnostics have also become an exciting new area in the veterinary teaching program. Ultrasound has shown potential in a variety of studies employing animal models, i.e., aging effects on the heart in beagles and anthracycline-induced myocardial dysfunction in rabbits.

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

    PubMed

    Shaikh, Masood Ali; Ali, Mir Shabbar

    2016-07-01

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

  10. [Bacterial epidemiology in the burns unit at military teaching hospital Mohamed V of Rabat].

    PubMed

    Essayagh, Touria; Zohoun, Alban; Essayagh, Meriem; Elameri, Abdelouahab; Zouhdi, Mimoun; Ihrai, Hsain; Elhamzaoui, Sakina

    2011-01-01

    We aimed to establish the ecology of the Burns Unit of the Military Teaching Hospital Mohammed V of Rabat. We present results of a retrospective study of four years (March 2006-June 2010) on all micro-organisms isolated from patient samples. During the study period, we analyzed 307 samples corresponding to isolate bacterial strains from 288 non-redundant and 5 yeasts among which 4 corresponded to Candida albicans. The bacteriological profile of the isolated stumps showed a change between 2006 and 2010. Staphylococcus aureus in 2007 and 2008 (52.3%, 33.9%) was in 3rd position in 2010 (10.5%). Acinetobacter baumannii found in 3rd position or below (3.7%, 11.6%, 15.3%), between 2006 and 2008, reached the summit in 2009 and 2010 (22.6% and 23.7%). Pseudomonas aeruginosa, strain dominant in 2006 (33.3%) maintained its second position in 2007, 2008 and 2010 (19.8%, 18.6%, 18.4%) while it was third in 2009 (14.3%). Study of the resistance in antibiotics of the main isolated bacteria showed a stability of the profile of resistance. In conclusion, an epidemiological surveillance of bacteria is necessary, in the burns unit and in the hospital, to guide better the probability antibiotic treatment.

  11. T cell subset profile in healthy Zambian adults at the University Teaching Hospital

    PubMed Central

    Chisenga, Caroline Cleopatra; Kelly, Paul

    2016-01-01

    Introduction Symptom-free human immunodeficiency virus antibody-negative Zambian adults (51 subjects, aged 20 to 62 years, 33.3% women and 66.7% men) were studied to establish T cell subset reference ranges. Methods We carried out across sectional study at the University Teaching Hospital, Lusaka. Blood samples were collected from healthy donor volunteers from hospital health care staff, between February and March 2015. Immunopheno typing was undertaken to characterize Tcell subsets using the markers CD3, CD4, CD8, α4β7, Ki67, CD25, CCR7, CD54RA, CD57, CD28, CD27 and HLA-DR. Results Among 51 volunteers, Women had significantly higher absolute CD4 count (median 1042; IQR 864, 1270) than in men (671; 545, 899) (p=0.003). Women also had more CD4 cells expressing homing, naïve, effector and effector memory T cell subsets compared to men. However, in the CD8 population, only the effector cells were significantly different with women expressing more than the males. Conclusion We provide early reference range for T cell subsets in Zambian adults and conclude that among the African women some T cell subsets are higher than men. PMID:27231509

  12. Empathy from the Nurses' Viewpoint in Teaching Hospitals of Tabriz University of Medical Sciences, Iran

    PubMed Central

    Parvan, Kobra; Ebrahimi, Hossein; Zamanzadeh, Vahid; Seyedrasooly, Alehe; Dadkhah, Delavar; Jabarzadeh, Faranak

    2014-01-01

    Introduction: Empathy is the ability to put one in the place of others and to better understand their feelings and experiences. According to researchers, there is a type of challenge in using this concept in nursing field. In most cases, the term empathy substitutes other concepts. Regarding this point, it seems quite necessary to research and discuss different dimensions of this concept in different studies. This study aimed to determine empathy regarding the nurses' point of view. Methods: In this descriptive study sample size was selected according to study population or in the other hand all the nurses in 3 general hospital was selected because they are the most important teaching hospital in Tabriz. LEP (La Monica Empathy Profile) was used as empathy tool. Data were analyzed by SPSS Ver. 13.0. Results: In nonverbal behavior dimension, touching the patient was considered as the most effective methods. On the other hand, nurses could not always be able to control stress and they could not always being with patients to show their empathy. Many people believe that nurses showed very little feelings while raggedly the reflective enclosure and they occasionally had to change their schedules to talk to patients. Conclusion: In most cases the nurses support nonverbal behavior, such as reflective, close and touching encountering in establishing relationship with the patient. However, to improve this situation, planning for nurses to become familiar with the ways through which they can express their interest to show empathy would be effective PMID:25276746

  13. Response to the meningococcal meningitis epidemic (MME) at Aminu Kano Teaching Hospital, Kano (2008-2009).

    PubMed

    Iliyasu, G; Lawal, H; Habib, A G; Hassan-Hanga, F; Abubakar, I S; Bashir, U; Tanko-Yakasai, U; Abubakar, S; Abba, M S; Rano, I S; Abdu, H; Musa, B; Gwarzo, G D

    2009-01-01

    In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.

  14. Patient Experience of Nursing Quality in a Teaching Hospital in Saudi Arabia

    PubMed Central

    Al Momani, M; Al Korashy, H

    2012-01-01

    Background: Examining the quality of nursing care from the patient's perspective is an important element in quality evaluation. The extent to which patients’ expectations are met will influence their perceptions and their satisfaction with the quality of care received. Methods: A cross-sectional survey was conducted among admitted patients at King Khalid Teaching Hospital, Riyadh, Saudi Arabia. Data were collected (from January 2011 to March 2011) from a convenience sample of 448 patients using a 42-items questionnaire assessing six dimensions of the nursing care provided to, during hospitalization. Results: On a four–point scale (4-higly agree,3-agree, 2-disagree, and 1-higly disagree). The individual items of nursing care showing the lowest means were the information received from the nurses about self-help (2.81), the information about the laboratory results (2.76) and the way the nurse shared the patient's feeling (2.72). A strong correlation existed between the overall perception level and the variables of gender (P=0.01), and the types of department (0.004). Conclusion: The findings of this study demonstrate negative experiences of patients with nursing care in dimensions of information, caring behavior, and nurse competency and technical care. Awareness of the importance of these dimensions of nursing care and ongoing support to investigate patients’ perception periodically toward quality of nursing care are critical to success the philosophy of patient centered health care. PMID:23113223

  15. A review of cleft lip and palate management: Experience of a Nigerian Teaching Hospital

    PubMed Central

    Efunkoya, Akinwale Adeyemi; Omeje, Kelvin Uchenna; Amole, Ibiyinka Olushola; Osunde, Otasowie Daniel; Akpasa, Izegboya Olohitae

    2015-01-01

    Background: Cleft lip (CL) and palate (CLP) management is multidisciplinary. A cleft team was formed in a Nigerian Tertiary Hospital to address the health needs of cleft patients in the centre. Aim: This paper aims at documenting the Aminu Kano Teaching Hospital (AKTH) management protocol for orofacial clefts and also to review our experience with CLP surgeries performed at AKTH since our partnering with Smile Train. Materials and Methods: A retrospective review of all the cleft patients surgically treated from January 2006 to December 2014 under Smile Train sponsorship was undertaken. A descriptive narrative of the cleft team protocol was also given. Results: One hundred and fifty-five patients (80 males, 75 females) had surgical repairs of either the lip or palate. CL patients were 83 (53.55%), while CLP patients were 45 (29.03%) and isolated cleft palate patients were 27 (17.42%). Conclusion: The inclusion of various specialities in the cleft team is highly desirable. Poverty level amongst our patients frequently limits our management to surgical treatment sponsored by the Smile Train, despite the presence of other residual problems. PMID:26712291

  16. Descriptions of Acute Transfusion Reactions in the Teaching Hospitals of Kermanshah University of Medical Sciences, Iran

    PubMed Central

    Payandeh, Mehrdad; Zare, Mohammad Erfan; Kansestani, Atefeh Nasir; Pakdel, Shirin Falah; Jahanpour, Firuzeh; Yousefi, Hoshang; Soleimanian, Farzaneh

    2013-01-01

    Background Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. Unnecessary discontinuation of blood is a major wastage of scarce blood, as well as man, hours and funds. The aim of the present study was to describe the main characteristics of acute transfusion reactions reported in the 4 hospital of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. Material and Methods The study was carried out at 4 teaching hospital of Kermanshah University of Medical Sciences, Kermanshah, Iran, over18 months from April 2010. All adult patients on admission in the hospitals who required blood transfusion and had establish diagnosis and consented were included in the study. Results In the year 2010 until 2012, a total of 6238 units of blood components were transfused. A total of 59 (0.94%) cases of transfusion reaction were reported within this 3 years period. The commonest were allergic reactions which presented with various skin manifestations such as urticarial, rashes and pruritus (49.2%), followed by increase in body temperature of > 1°C from baseline which was reported as febrile non-hemolytic transfusion reaction (37.2%). pain at the transfusion site (6.8%) and hypotension (6.8%). Conclusion It is important that each transfusion of blood components to be monitor carefully. Many transfusion reactions are not recognized, because signs and symptoms mimic other clinical conditions. Any unexpected symptoms in a transfusion recipient should at least be considered as a possible transfusion reaction and be evaluated. Prompt recognition and treatment of acute transfusion reaction are crucial and would help in decreasing transfusion related morbidity and mortality, but prevention is preferable. PMID:24505522

  17. Physicians and the teaching of breast self-examination: implications from a survey at a university teaching hospital.

    PubMed Central

    O'Malley, M S; Fletcher, S W; Bunce, L A

    1985-01-01

    We surveyed 80 physicians from four specialties (Family Medicine, General Medicine, General Surgery, Ob-Gyn) to investigate how they taught breast self-examination (BSE). Only half reported personally teaching BSE. Few MDs reported routinely using techniques to assess BSE competency. Most (72 per cent) claimed no formal training in teaching BSE; 10 per cent claimed no training at all. Techniques used to teach BSE may vary, and physicians may lack the training to teach BSE. PMID:4003638

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2010-01-01

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

  20. Water quality assessment of the Asata River catchment area in Enugu Metropolis, Southeast Nigeria

    NASA Astrophysics Data System (ADS)

    Osinowo, Olawale Olakunle

    2016-09-01

    Hydrogeochemical mapping of the Asata River Catchment area in the Enugu metropolis, southeast Nigeria was carried out in order to assess the quality of the surface and groundwater and based on the analyses of the hydrogeochemical data, establish the level of chemical contaminations which inhibit the availability of potable water in the area. Forty (40) water samples comprising five (5) springs, nineteen (19) surface (streams/rivers) and sixteen (16) groundwater (well/borehole) samples were collected and analysed for the presence and degree of contamination of nine (9) major chemical contaminants. Hydrochemical analyses indicate that Electrical Conductivity (EC) which has a linear relationship with Total Dissolved Solid (TDS) ranges between 015 and 887 μS/cm, pH between 4.4 and 8.3, nitrate (NO3-) ranges between 40 and 130 mg/l and chloride (Cl-) between 7 and 130 mg/l. The concentrations of the dissolved chemical constituents defined the pollution trend and the rate of dispersion of contaminants. The degree of contaminants followed a simple trend, where the level of contamination of the dissolved chemical constituents is least in sampled spring water, with measured chemical constituents of EC, pH, NO3- and Cl- range from 15 to 354 μS/cm; 6.4-6.5; 4.0-70 mg/l and 8-36 mg/l, respectively. However, the value of the measured chemical constituent of EC, pH, NO3- and Cl- gradually increases down the stream in both the surface (63-354 μS/cm; 4.5-7.7; 7.1-110 mg/l; 8-41 mg/l) and groundwater (56-531 μS/cm; 4.5-7.5; 40-130 mg/l; 7-130 mg/l), respectively. Noticeable peaks in contamination levels characterised sections of the study area where human population or their activities is highest. The result of the hydrogeochemical mapping indicate that Enugu coal mine operation, the industrial activities, fertilizer applied to plants cultivated on river banks and domestic human wastes which are indiscriminately dumped along river channels are the major sources of chemical

  1. Bacteriological features of infectious spondylodiscitis at Mohammed V Military Teaching Hospital of Rabat.

    PubMed

    Zohoun, A; Ngoh Akwa, E; El Ochi, M; Oragwu, N; Akhaddar, A; Albouzidi, A; El Ouennass, M

    2012-10-01

    To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006-2009) at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70%) were male. The patients were predominantly hospitalized in neurosurgery department (15/30) followed by rheumatology department (10/30). The site of infection was lumbar in 21 cases (21/30), dorsal in 7 cases (7/30). 26 cultures were positive of which 19 (19/26) were monomicrobial. Tuberculosis (TB) was implicated in 10 cases (10/30) including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species). Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15) revealed simple organisms including Gram-positive cocci in 9 cases (9/12) with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12) with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for non-specific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis.

  2. Bacterial Safety of Commercial and Handmade Enteral Feeds in an Iranian Teaching Hospital

    PubMed Central

    Baniardalan, Mahtash; Sabzghabaee, Ali Mohammad; Jalali, Mohammad; Badri, Shirinsadat

    2014-01-01

    Background: This study aimed to investigate and compare the bacterial safety of handmade and commercial ready-to-use enteral feeding formulas used in an Iranian teaching hospital. Methods: In this experimental study, a total number of 70 samples (21 handmade formulas sampled at two sampling times, i.e. the time of preparation and 18 h after preparation, and 28 commercial ready-to-use formulas) were studied. Total count of viable microorganisms, coliform count and Staphylococcus aureus count for all samples were conducted. Results: Out of 42 handmade samples, 16 samples (76%) had total viable counts greater than 103 CFU/g in the first sampling time and 17 samples (81%) had total viable counts greater than 103 CFU/g in the second sampling time. Also, 11 (52%) had coliform contamination in the first sampling time which reached 76% (16 samples) in the second sampling time. Regarding contamination with S. aureus, 5 samples (24%) were contaminated in the first- and 13 samples (62%) were contaminated in the second-sampling time. Out of 28 commercial formulas, 27 samples (96%) had total viable counts greater than 103 CFU/g. Also, 24 samples (86%) were contaminated with S. aureus and 27 samples (96%) were contaminated with coliforms. In order to compare these two formulas, the results of Mann-Whitney test showed that contamination of ready-to-use formulas in all three microbiological samples was significantly more than that for handmade samples. Conclusions: The results of the present study indicate that the microbial safety of enteral feeding solutions in this hospital is much lower than standard values, demonstrating that the development of protocols for clean techniques in the preparation, handling and storage of both commercial and handmade enteral feeds is necessary. PMID:24932392

  3. Clinical impact of diagnostic imaging discrepancy by radiology trainees in an urban teaching hospital emergency department

    PubMed Central

    2013-01-01

    Background To characterize clinically significant diagnostic imaging (DI) discrepancies by radiology trainees and the impact on emergency department (ED) patients. Methods Consecutive case series methodology over a 6-month period in an urban, tertiary care teaching hospital. Emergency physicians (EPs) were recruited to flag discrepant DI interpretations by radiology trainees that the EP deemed clinically significant. Cases were characterized using chart review and EP interview. Results Twenty-eight discrepant reports were identified (representing 0.1% of 18,185 images interpreted). The mean time between provisional discrepant diagnosis (PDDx) and revised diagnosis (RDx) by attending radiology staff was 8.6 h (median 4.8 h, range 1.1-48.4), and 67.9% (n = 19) of the patients had left the ED by time of notification. The most frequently reported PDDx was CT abd/pelvis (32.1%, n = 9) and CT head (28.6%, n = 8). The impact of RDx was deemed major in 57.1% (n = 16) for reasons including altered admitting status (32.1%, n = 9), immediate subspecialty referral (n = 16, 57.1%), impact on management (25%, n = 7), and surgical management (21.4%, n = 6). EPs reported likely perceived impact of PDDx as resulting in increased pain (17. 9%, n = 5), morbidity (10.7%, n = 3), and prolonged hospitalization (25%, n = 7), but not altered long-term outcome or mortality. Conclusions Relatively few clinically important discrepant reads were reported. Revised diagnosis (RDx) was associated with major clinical impact in 57.1% of reports, but few patients experienced increased morbidity, and none increased mortality. The importance of expedient communication of discrepant reports by staff radiologists is stressed, as is EP verification of patient contact information prior to discharge. PMID:23866048

  4. Antimicrobial use in paediatric patients in a teaching hospital in Ethiopia

    PubMed Central

    Kebede, Hafte Kahsay; Gesesew, Hailay Abrha; Woldehaimanot, Tewodros Eyob; Goro, Kabaye Kumela

    2017-01-01

    Background Antibiotics use in in children are different from adults due to a lack of data on pharmacokinetics, pharmacodynamics, efficacy and safety of drugs, different physiological spectrum, pediatrics populations being vulnerable to the majority of the illnesses, and the adverse effect of their irrational use is more serious. However, antibiotic use is not explored much in a paediatric population. The current study focused on antibiotic use among pediatric population using data from a tertiary hospital in Ethiopia. Methods A retrospective cross-sectional study collated data from 614 pediatrics patients admitted in pediatrics ward at Jimma University Teaching Hospital, Southwest Ethiopia. Descriptive analyses were performed to describe the type and pattern of antibiotics. The number of prescriptions per a patient was also compared with the WHO standard. Data analysis was carried out using SPSS version 20 for mackintosh. Results Antimicrobials were prescribed for 407(86.4%) patients of which 85.9% were in the form of injectables. A total of 1241 (90%) medicines were administered parenterally followed by oral 110 (8%). The maximum number of medicines per prescription was eight for all types of drugs in general, and five for antimicrobials in particular. All antimicrobials were prescribed empirically without any microbiological evidence. Pneumonia, sepsis and meningitis were the main reasons for antimicrobial use in the ward. Out of the total of 812 antibiotics prescribed; Penicillin G crystalline was the most (20%) frequently prescribed, followed by gentamicin (19%) and ampicillin (16). Conclusions Majority of the prescribed antibiotics were antimicrobials, and was in the form of injectables. Antimicrobials were over prescribed and the number of drugs per prescription was also far from WHO recommendation. Strict prescribing standard guidelines and treatment habits should be developed in the country, to prevent antimicrobial resistance. PMID:28264021

  5. Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

    PubMed Central

    Hassan, Mairo; Awosan, Kehinde Joseph; Panti, Abubakar Abubakar; Nasir, Sadiya; Tunau, Karima; Umar, Amina Gambo; Shehu, Constance Egondu; Ukwu, Aeron Eze; Sulaiman, Bilal

    2016-01-01

    Introduction Sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. Methods It was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients’ biodata, and relevant details on the cases were extracted from the patients’ case files and analyzed. Results Out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients’ ages ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%). Conclusion Although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children’s movement, and stringent laws should be enacted and enforced to curb this heinous act. PMID:28154687

  6. Motorcycle-related injuries at a university teaching hospital in north central Nigeria

    PubMed Central

    Elachi, Itodo C.; Okunola, Benjamin B.; Yongu, Williams T.; Onyemaechi, Ndubuisi OC; Odatuwa-Omagbemi, Odoyoh D.; Ahachi, Chukwukadibia N.; Mue, Daniel D.

    2014-01-01

    Background: Motorcycle-related injuries lead to considerable morbidity and mortality. The aim of this study is to determine the pattern and outcome of motorcycle-related injuries at Benue State University Teaching Hospital, Makurdi, Nigeria. Patients and Methods: Case records of all patients who presented to the accident and emergency department with motorcycle-related injuries between July 2012 and June 2013 were analysed for age, gender, injury host status (i.e. rider, pillion or pedestrian), nature of collision (motorcycle versus other vehicles, motorcycle versus motorcycle, motorcycle versus pedestrian or lone riders), body region injured, injury severity score (ISS) at arrival, length of hospital stay (LOS) and mortality. Results: Seventy - nine patients with motorcycle-related injuries were included in the study. They consisted of 63 males (61.8%) and 16 females (15.7%). The age range was 5-65 years with a mean of 32.4 ± 14.0. Motorcycle versus vehicle collisions were the most common mechanism of injury (n = 46, 58.2%). Musculoskeletal injuries constituted the most common injuries sustained (n = 50, 47.6%) and the tibia was the most frequently fractured bone (n = 14, 35.9%). The majority of patients (57.0%) sustained mild/moderate injuries (ISS ≤ 15). There was no statistically significant difference between the sexes for sustaining mild/moderate injuries or severe/profound injuries (P > 0.05). Mortality rate was 6.3% with head injuries being involved in all cases. Conclusion: Young males were mostly injured in motorcycle-related trauma. Musculoskeletal injuries were the most common injuries sustained and head injuries were involved in all the deaths. Enforcement of motorcycle crash bars and helmet usage is recommended. PMID:25538360

  7. Pain perception among parturients at a University Teaching Hospital, South-Western Nigeria

    PubMed Central

    Aduloju, Olusola Peter

    2013-01-01

    Introduction: Labour pain is a universal experience. Relief of labour pains and companionship in labour are important aspects of quality of care in labour. Objectives: To evaluate perception of labour pains among parturients, their knowledge and awareness of pain relief during labour, the types of obstetric analgesia available and the outcome of their labour at the Ekiti State University Teaching Hospital, Ado-Ekiti. Materials and Methods: A cross-sectional study using questionnaire administered to pregnant women between 37 and 42 weeks gestational age in labour ward of the hospital. Results: The study revealed that 75.2% of the parturients experienced severe labour pains and 35.3% of them received analgesia in labour with Pentazocine injection being the only analgesic used. Only 18.3% had maximum relief of their pains. Parturients with increasing parity, higher social class and educational attainment and who had antenatal education on labour pains were associated with severe perception of labour pains with P values of 0.03, 0.03, 0.02 and 0.01, respectively. Parturients who were given Pentazocine injection for pains and had relief in labour had more spontaneous vaginal deliveries, P = 0.030 and better outcome for their babies, P = 0.028. Majority of the women reported that the practice of companionship and back rubbing in labour helped them to cope better with the labour process. Conclusion: Most women desire relief of pains of labour but the practice is still suboptimal in this centre. Efforts should be made towards developing the practice of obstetric analgesia and companionship in labour in this environment. PMID:24249944

  8. Clinical Setting Influences Off-Label and Unlicensed Prescribing in a Paediatric Teaching Hospital

    PubMed Central

    Czarniak, Petra; Bint, Lewis; Favié, Laurent; Parsons, Richard; Hughes, Jeff; Sunderland, Bruce

    2015-01-01

    Purpose To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia. Methods A 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code. Results A total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were prescribed more off-label drugs than outpatients or Emergency Department patients (p < 0.0001). Most off-label prescribing occurred in infants and children (31.7% and 35.9% respectively) and the highest percentage of unlicensed prescribing (7.2%) occurred in infants (p < 0.0001). There were 25.7% of off-label and 2.6% of unlicensed medications prescribed across all three settings. Common reasons for off-label prescribing were dosage (47.4%) and age (43.2%). Conclusion This study confirmed off-label and unlicensed use of drugs remains common. Further, that prevalence of both is influenced by the clinical setting, which has implications in regards to medication misadventure, and the need to have systems in place to minimise medication errors. Further, there remains a need for changes in the regulatory system in Australia to ensure that manufacturers incorporate, as it becomes available, evidence regarding efficacy and safety of their drugs in children in the

  9. Drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea in a teaching hospital

    PubMed Central

    Nath, Swapan K; Salama, Suzette; Persaud, Devia; Thornley, James H; Smith, Ian; Foster, Gary; Rotstein, Coleman

    1994-01-01

    A case-control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic clone of toxigenic C difficile were compared with controls. Eighty controls were selected from a group of 290 controls randomly chosen from the outbreak period. The controls were matched to cases according to age, admitting diagnosis and unit of admission. Seventy (88%) patients in the case group received at least one antibiotic before diarrhea, compared with 37 (46%) patients in the control group. Major risk factors implicated in the development of C difficile diarrhea in hospitalized patients were the following antimicrobial agents: ceftazidime (adjusted odds ratio [aor]=26.01, 95% ci 5.67 to 119.19, P=0.0001); cefuroxime (aor=5.17, ci 1.86 to 14.36, P=0.005); ciprofloxacin (aor=3.81, ci 1.05 to 13.79, P=0.04); and clindamycin (aor=15.16, ci 2.93 to 78.44, P=0.004). This is the first time that the use of ciprofloxacin has been linked to the development of C difficile diarrhea. Use of gastrointestinal drugs (ranitidine, famotidine, cimetidine, omeprazole and sucralfate) was also an added risk (aor=3.20, ci 1.39 to 7.34, P=0.01); however, antineoplastic therapy was not significant (P<0.53). Recognition of the specific high risk drugs may spur more restricted use of these agents, which may help in controlling C difficile diarrhea in hospitalized patients. PMID:22346513

  10. Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement

    PubMed Central

    Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen

    2016-01-01

    Background Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Methods Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Results Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. Discussion MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. PMID:28039294

  11. [Emergency of vancomycin-resistant Enterococcus infections in a teaching hospital in Chile].

    PubMed

    Fica, Alberto; Jemenao, María Irene; Bilbao, Paola; Ruiz, Gloria; Sakurada, Andrea; Pérez de Arce, Edith; Zúñiga, Isabel; Gompertz, Macarena

    2007-12-01

    An active surveillance of vancomycin-resistant enterococci (VRE) intestinal colonization in selected group of patients has been developed in Chile since year 2000. Nevertheless, no reports of clinical cases have been published. Aim. To describe main clinical and microbiological features of patients infected by VRE in a tertiary-level teaching Hospital. Patients and methods. Intestinal and clinical samples positive to VRE were provided by laboratory, and a retrospective analysis of potential risk factors, clinical features, treatment and outcomes was performed. Study encompassed years 2001 to 2006. Main results. 23 cases of infections were identified, all cases occurring during 2005 and 2006. Incidence rate was 0.07 and 0.09 cases per 1000 occupied bed-days, respectively. The mean age was 62.0 +/- 17 years. A significant proportion of patients had cancer (39.1%), recent surgical procedures (54.1%), were on dialysis (26.1%), or were using steroids (26.1%). Most patients had received 2 or more antimicrobial (87%), almost a third represented transfers from other hospitals and an additional 22% readmissions before 30 days of latest discharge. Patients were mainly hospitalized in the ICU (60.9%) but nearly 30% were associated exclusively to nephrological or onco-hematological wards. Clinical manifestations included bacteremia (30.4%), surgical site infections or abscesses (26.1%), urinary tract infections (26.1%) and others. . Three patients (13%) did not have symptoms. After identification was possible, all isolates were identified as E. faecium (82.6% of total), the rest as Enterococcus sp. Most strains showed intermediate susceptibility to vancomycin (66.7%). For 14 strains studied both with vancomycin and teicoplanin, , phenotype Van B was predominant (85.7%), followed by VanA (7.1%) and VanB/VanD type (7.1%). No molecular studies were performed. Fifteen patients (65.4%) received a surgical and/or medical treatment. A favorable response was observed in 80% of these

  12. Social impact of HIV/AIDS on clients attending a teaching hospital in Southern Nigeria.

    PubMed

    Johnson, Ofonime E

    2012-01-01

    People living with human immunodeficiency virus and acquired immune deficiency syndrome (PLWHA) face numerous social challenges. The objectives of this study were to assess the level of self-disclosure of status by PLWHA, to describe the level and patterns of stigma and discrimination, if any, experienced by the PLWHA and to assess the effect of sero-positivity on the attitude of friends, family members, health workers, colleagues and community. This was a cross-sectional descriptive study carried out among PLWHA attending the University of Uyo Teaching Hospital, Uyo, Southern Nigeria. Information was obtained using an interviewer-administered semi-structured questionnaire, which was analysed using the Epi 6 software. A total of 331 respondents were interviewed. A majority, 256 (77.3%), of the respondents were within the age range of 25-44 years. A total of 121 (36.6%) PLWHA were single and 151 (46.6%) were married, while the rest were widowed, divorced or separated. A majority, 129 (85.4%), of the married respondents disclosed their status to their spouses and 65 (50.4%) were supportive. Apart from spouses, disclosure to mothers (39.9%) was highest. Most clients (57.7%) did not disclose their status to people outside their immediate families for fear of stigmatization. Up to 111 (80.4%) of the respondents working for others did not disclose their status to their employers. Among those whose status was known, discrimination was reported to be highest among friends (23.2%) and at the workplace (20.2%). Attitudes such as hostility (14.5%), withdrawal (11.7%) and neglect (6.8%) were reported from the private hospitals. Apart from disclosure to spouses, the level of disclosure to others was very low. Those whose status was known mainly received acceptance from their families but faced discriminatory attitudes such as hostility, neglect and withdrawal from friends, colleagues and hospital workers. There is a need for more enlightenment campaigns on HIV/AIDS by

  13. Identification and molecular characterization of Escherichia coli blaSHV genes in a Chinese teaching hospital.

    PubMed

    Zhu, Mei; Yang, Guangjian; Li, Ailing; Zong, Li; Dong, Zhaoguang; Lu, Junwan; Zhang, Kaibo; Cheng, Cong; Chang, Qingli; Wu, Xiuying; Ying, Jianchao; Li, Xianneng; Ding, Li; Zheng, Haixiao; Yu, Junping; Ying, Jun; Xu, Teng; Yi, Huiguang; Li, Peizhen; Li, Kewei; Wu, Songquan; Bao, Qiyu; Wang, Junrong

    2017-02-05

    Escherichia coli (E. coli) commonly reside in human intestine and most E. coli strains are harmless, but some serotypes cause serious food poisoning. This study identified and molecularly characterized blaSHV genes from 490 E. coli strains with multi-drug resistance in a hospital population. PCR and molecular cloning and southern blot were performed to assess functions and localizations of this resistant E. coli gene and the pulsed-field gel electrophoresis (PFGE) was utilized to demonstrate the clonal relatedness of the positive E. coli strains. The data showed that 4 of these 490 E. coli strains (4/499, 0.8%) carried blaSHV genes that included EC D2485 (blaSHV-5), EC D2487 (blaSHV-5), EC D2684 (blaSHV-11) and EC D2616 (blaSHV-195, a novel blaSHV). Analysis of blaSHV open-reading frame showed that blaSHV-5 had a high hydrolysis activity to the broad-spectrum penicillin (ampicillin or piperacillin), ceftazidime, ceftriaxone, cefotaxime and aztreonam. blaSHV-195 and blaSHV-11 had similar resistant characteristics with high hydrolysis activities to ampicillin and piperacillin, but low activities to cephalosporins. Moreover, the two blaSHV-5 genes were located on a transferable plasmid (23kb), whereas the other two blaSHV variants (blaSHV-11 and blaSHV-195) seemed to be located in the chromosomal material. Both EC D2485 and EC D2487 clones isolated in 2010 had the same DNA finger printing profile and they might be the siblings of clonal dissemination. The data from the current study suggest that the novel blaSHV and clonal dissemination may be developed, although blaSHV genes were infrequently identified in this hospital population. The results of the work demonstrate the necessity for molecular surveillance in tracking blaSHV-producing strains in large teaching hospital settings and emphasize the need for epidemiological monitoring.

  14. Drug utilization study in ophthalmology outpatients at a tertiary care teaching hospital.

    PubMed

    Jadhav, Pradeep R; Moghe, Vijay V; Deshmukh, Yeshwant A

    2013-12-22

    In view of the advancement in drug development and availability of new ocular therapeutics in the discipline of ophthalmology, we attempted to study the drug utilization and describe the prescribing practices of ophthalmologists in a tertiary care teaching hospital. Method. A prospective, cross-sectional, observational study was conducted on patients attending Outpatient Department of Ophthalmology for curative complaints. Prescriptions of 600 patients treated were analyzed by the WHO prescribing indicators and additional indices. Results. Analysis showed that the average number of drugs per prescription was 1.49. Percentage of drugs prescribed by generic name was 2.35%. Percentage of encounters with antibiotics was 44.83%. Percentage of drugs prescribed from National Essential drug list (NEDL)/National Formulary of India (NFI) was 19.48%. Patient's knowledge of correct dosage was 93.83%. Antimicrobial agents were the most commonly prescribed drugs followed by antiallergy drugs and ocular lubricants. Fluoroquinolones accounted for 60% of the total antimicrobial drugs, of which gatifloxacin was the most frequently prescribed fluoroquinolone. Conclusion. The study indicated an awareness of polypharmacy, but showed ample scope for improvement in encouraging the ophthalmologists to prescribe by generic name and selection of essential drugs from NEDL/NFI.

  15. Prevalence of canine hip dysplasia in a veterinary teaching hospital population.

    PubMed

    Rettenmaier, J L; Keller, G G; Lattimer, J C; Corley, E A; Ellersieck, M R

    2002-01-01

    The purpose of this study was to determine the prevalence of canine HD in a population in which there was minimal or no prior screening of radiographs for the disorder. Patient information was obtained from the radiographic database at the University of Missouri-Columbia Veterinary Teaching Hospital during the five-year period of 1991-1995. The coxofemoral joints on ventrodorsal radiographs of the pelvis were independently evaluated by three veterinary radiologists. A consensus evaluation of normal, borderline, or dysplastic was compiled. There were 2885 dogs identified representing 116 breeds and the mixbreds. There were 2236 purebred dogs (1071 males and 1165 females) and the prevalence of HD was 19.7%. There were 649 mixbred dogs (340 males and 309 females) and the prevalence of HD was 17.7%. There was no significant difference in the prevalence of HD between sexes or between purebred and mixbred dogs (P = 0.16; P = 0.29). Degenerative joint disease (DJD) was the most common radiographic manifestation of HD and there appeared to be a threshold at 12 months of age after which the presence of DJD was the primary diagnostic criteria.

  16. An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

    PubMed Central

    Kim, Do Yeun; Lee, Sang Min; Lee, Kyoung Eun; Lee, Hye Ran; Kim, Jee Hyun; Lee, Keun-Wook; Lee, Jong Seok

    2006-01-01

    Purpose We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not-resuscitate (DNR) consent on the use of intravenous nutrition during the patient's last week of life and at the time of death. Materials and Methods The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient's last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated. Results In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient's surrogates did not have any effect on reducing the use of parenteral nutrition. Conclusion The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care. PMID:19771245

  17. Cracked tooth syndrome: characteristics and distribution among adults in a Nigerian teaching hospital.

    PubMed

    Udoye, Christopher I; Jafarzadeh, Hamid

    2009-03-01

    This study highlighted the characteristics and distribution of cracked tooth syndrome (CTS) and the associated factors in adult attendees in the University of Nigeria Teaching Hospital. Three hundred seventy patients aged 18 years to 77 years with CTS-like conditions were included and studied over 12 months. The following information was recorded: suspected tooth and the dental arch, restorative status of the tooth, age and sex of the patient, results of bite test and transillumination, and the pulpal and periapical status of the tooth. CTS was seen most often in the 41 to 50 years age band (36.4%), in molars (63.6%), and in the maxillary arch (51.5%). Also, it was more frequent in men (55.8%). About 82% of CTS occurred in amalgam-restored teeth. All cases had a positive response to the bite test and a normal response to the electric pulp test. Only 10% gave a positive history of masticatory accident as against none with history of bruxism habits. It was concluded that patients with unexplained pain in a vital, amalgam-restored tooth (especially in maxillary molars), with or without a history of a masticatory accident, may have a cracked or fractured tooth.

  18. Factors associated with knowledge of the nursing staff at a teaching hospital on blood transfusion 1

    PubMed Central

    Tavares, Jordânia Lumênia; Barichello, Elizabeth; Mattia, Ana Lúcia De; Barbosa, Maria Helena

    2015-01-01

    Abstract Objective: to determine whether there is an association between knowledge of the nursing professionals about blood transfusion and the variables related to the professional aspects. Method: this is an observational, cross-sectional and quantitative study, carried out at a large general teaching hospital. The sample consisted of 209 nursing professionals, obtained by simple random sampling. For data collection, a checklist was used. In the univariate analysis, descriptive statistics and central trend and dispersion measures were used. In the bivariate analysis, Student's t-Test, analysis of variance and Pearson's correlation were used. To determine the predictors, multiple linear regression was applied. The Institutional Review Board (Opinion number 2434) approved the study. Results: the overall average knowledge score was 52.66%; in the Pre-transfusion Step, it corresponded to 53.38%; in the Transfusion Step 51.25% and, in the Post-transfusion Step, 62.68%. The factors related to knowledge were professional category and received training and/or guidance to accomplish the transfusion process (p<0.01). Conclusion: this study showed the influence of training and guidance on the knowledge and provided a diagnosis to identify the professionals' difficulties regarding the transfusion process. PMID:26444160

  19. Population Structure of Candida albicans from Three Teaching Hospitals in Ghana.

    PubMed

    Adjapong, Gloria; Hale, Marie; Garrill, Ashley

    2016-02-01

    Previous studies on Candida species in a clinical setting in Ghana have shown a prevalence of Candida albicans. Despite this, very little is known about the various strain types and their population genetic structure. In this study three microsatellite loci, CAI, CAIII and CAVI, were used to investigate the population genetic structure of C. albicans from clinical isolates in Ghana. In all, 240 clinically unrelated C. albicans isolates were recovered from patients reporting at three teaching hospitals. All the isolates were heterozygous for at least one of the three loci, except for one isolate, which was homozygous for all three loci. Sixty-seven unique alleles and 240 different genotypes were generated by the three polymorphic microsatellite loci, resulting in a very high discriminatory potential of approximately 0.98. There was no significant difference in allele frequencies from the small number of anatomical sites sampled, regardless of the host conditions although high genotypic diversities were observed among the isolates. There was evidence for clonal reproduction, including over-expression of observed heterozygotes across the populations. The populations deviated significantly from Hardy-Weinberg equilibrium and pair-wise genotypic linkage disequilibria comparisons across the three loci were significant, also suggesting a clonal population. The overall Wright FIS for the three loci was negative, and the overall FST value was not significantly different from zero for the three loci analyzed, indicating a clonal and homogeneous population across the three sampling locations from Ghana.

  20. Intestinal parasitic infections among patients attending Nepal Medical College Teaching Hospital, Kathmandu, Nepal.

    PubMed

    Agrawal, P K; Rai, S K; Khanal, L K; Ghimire, G; Banjara, M R; Singh, A

    2012-06-01

    This study was conducted to find out the prevalence of intestinal parasitic infection among patients attending Nepal Medical College Teaching Hospital, Kathmandu from July 2011 to February 2012. A total of 312 stool samples collected in a clean, dry screw capped plastic container were examined using the formal-ether concentration and sucrose-flotation techniques. Overall parasite positivity rate was 30.1% with significant difference between males (34.2%) and Female (26.3%) (p < 0.05). Out of total positive, 90.4% had single parasitism whereas 9.6% had multiple parasitism. Children aged < or = 5 years were found to be highly infected (35.8%), followed by 6-15 years (32.1%) and > 15 years old (26.9%). Rate of infection was significantly higher among patients from inside Kathmandu Valley (31.1%) than outside valley (17.4%) (p < 0.05). E. histolytica (38.5%) and Hookworm (10.6%) were the commonest protozoa and helminthes respectively. Other parasites detected were G. lamblia (26.0%), E. coli (1.0%), T. trichiura (7.7%), A. lumbricoides (6.7%), H. nana (5.8%) and Taenia species (3.8%). Out of total parasites detected, 65.4% were protozoa and 34.6% were helminthes. Positive rate was higher in Dalit (37.5%) and Aadibasi-Janjati (34.3%) than Brahman-Chhetri (22.6%) (p < 0.05).

  1. The transition to electronic documentation on a teaching hospital medical service.

    PubMed

    Payne, Thomas H; Perkins, Monica; Kalus, Robert; Reilly, Dom

    2006-01-01

    The transition to electronic medical records (EMRs) often includes the transition from paper to electronic documentation, a topic less well described in the literature than other aspects of EMR adoption. As part of a broader EMR project, we have participated in the transition to electronic notes on the Medicine service of a teaching hospital affiliated with the University of Washington. During a one year period beginning in February 2005 we adopted the use of semi-structured documentation templates permitting both encoded and narrative text components for admission, progress, and procedure notes, and for some discharge summaries. Currently over 1400 notes are entered each week. Fifty eight percent are entered by residents, 20% by attending physicians, and the remainder by other trainees and staff. The period of greatest change from paper to electronic notes occurred (by design) during the late spring and summer. Leadership, application functionality, speed, note writing time requirements, data availability, training needs, and other factors influenced adoption of this important part of our EMR.

  2. Screening for Imported Diseases in an Immigrant Population: Experience from a Teaching Hospital in Barcelona, Spain

    PubMed Central

    Bocanegra, Cristina; Salvador, Fernando; Sulleiro, Elena; Sánchez-Montalvá, Adrián; Pahissa, Albert; Molina, Israel

    2014-01-01

    The objective of this study was to describe the screening for imported diseases among an immigrant population. This retrospective observational study was of all adult immigrants attended at the Tropical Medicine Unit of the Vall d'Hebron Teaching Hospital from September of 2007 to March of 2010. The screening strategy was adjusted by symptoms, country of origin, and length of residence in Europe. Overall, 927 patients were included. The median age was 34.5 years, and 42.1% of patients were male. A diagnosis was made in 419 (45.2%) patients. The most frequent diagnoses were Chagas disease, anemia, latent tuberculosis infection, intestinal parasitosis, hepatitis B virus (HBV) infection, and human immunodeficiency virus (HIV) infection. After screening, more diseases were identified in immigrants from sub-Saharan Africa (new diagnoses in 56.6% of patients) than patients from other geographic areas. The geographic origin and length of residence in a developed country determine the prevalence of diseases; hence, screening protocols must be based on this information. PMID:25331805

  3. Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

    PubMed Central

    Ferreira, Carolina Justus Buhrer; Plodek, Caroline Koga; Soares, Franciny Kossemba; de Andrade, Rayza Assis; Teleginski, Fernanda; da Rocha, Maria Dagmar

    2016-01-01

    Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes. PMID:27276019

  4. Gastrointestinal pathology in the University Teaching Hospital, Lusaka, Zambia: review of endoscopic and pathology records.

    PubMed

    Kelly, Paul; Katema, Mwamba; Amadi, Beatrice; Zimba, Lameck; Aparicio, Sylvia; Mudenda, Victor; Baboo, K Sridutt; Zulu, Isaac

    2008-02-01

    There is a shortage of information on the epidemiology of digestive disease in developing countries. In the belief that such information will inform public health priorities and epidemiological comparisons between different geographical regions, we analysed 2132 diagnostic upper gastrointestinal endoscopy records from 1999 to 2005 in the University Teaching Hospital, Lusaka, Zambia. In order to clarify unexpected impressions about the age distribution of cancers, a retrospective analysis of pathology records was also undertaken. No abnormality was found in 31% of procedures, and in 42% of procedures in children. In patients with gastrointestinal haemorrhage, the common findings were oesophageal varices (26%), duodenal ulcer (17%) and gastric ulcer (12%). Gastrointestinal malignancy was found in 8.8% of all diagnostic procedures, in descending order of frequency: gastric adenocarcinoma, oesophageal squamous carcinoma, Kaposi's sarcoma, oesophageal adenocarcinoma. Data from endoscopy records and pathology records strongly suggest that the incidence in adults under the age of 45 years is higher than in the USA or UK, and pathology records suggest that this effect is particularly marked for colorectal carcinoma.

  5. Ovarian Cancer in Ghana, a 10 Year Histopathological Review of Cases at Korle Bu Teaching Hospital.

    PubMed

    Akakpo, Patrick K; Derkyi-Kwarteng, Leonard; Gyasi, Richard K; Quayson, Solomon E; Anim, Jehoram T

    2015-12-01

    To determine the histopathological types, age distribution, presenting signs and symptoms of ovarian cancers diagnosed at the Korle-Bu Teaching Hospital, Ghana. All histopathology slides and request cards of ovarian cancers diagnosed over a ten-year period (2001 to 2010) were reviewed and the cancers classified according to the World Health Organization 1999 classification. Biographical and clinical data of the patients were collected and results entered into Epi-info to determine the frequency, age distribution and clinical presentation of the various types of ovarian cancer. There were 192 (27.2%) ovarian cancers out of 706 ovarian tumours. Epithelial cancers were the most common: 100 (52.1%), followed by sex cord stromal cancers 66 (34.4%). Majority of epithelial cancers were serous adenocarcinomas (71/100) while most sex cord stromal cancers were adult granulosa cell tumours 46 (69.7%). The mean age of patients with adenocarcinoma was 49 years while that of the 46 adult granulosa cell tumours was 46.5 years. Patients present with varying combinations of symptoms and signs and ovarian cancers present at an earlier age compared to other populations, with the age of presentation being slightly lower for sex cord stromal cancers compared to adenocarcinomas. There are no specific symptoms or signs associated with ovarian cancer at presentation, to assist with diagnosis.

  6. Multidrug Resistance of Acinetobacter Baumannii in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

    PubMed Central

    Odewale, G.; Adefioye, O. J.; Ojo, J.; Adewumi, F. A.; Olowe, O. A.

    2016-01-01

    Acinetobacter baumannii is a ubiquitous pathogen that has emerged as a major cause of healthcare-associated infections at Ladoke Akintola University Teaching Hospital. Isolates were assayed according to standard protocol. The isolates were subjected to molecular techniques to detect blaOXA, blaTEM, blaCTX-M, and blaSHV genes in strains of the A. baumannii isolates. The prevalence of A. baumannii was 8.5% and was most prevalent among patients in the age group 51–60 (36%); the male patients (63.6%) were more infected than their female counterparts. Patients (72.7%) in the intensive care unit (ICU) were most infected with this organism. The isolates showed 100% resistance to both amikacin and ciprofloxacin and 90.9% to both ceftriaxone and ceftazidime, while resistance to the other antibiotics used in this study were: piperacillin (81.8%), imipenem (72.7%), gentamycin (72.2%), and meropenem (63.6%). None of the isolates was, however, resistant to colistin. PCR results showed that blaOXA, blaTEM, and blaCTX-M genes were positive in some isolates, while blaSHV was not detected in any of the isolates. This study has revealed that the strains of A. baumannii isolated are multiple drug resistant. Regular monitoring, judicious prescription, and early detection of resistance to these antibiotics are, therefore, necessary to check further dissemination of the organism. PMID:27766173

  7. Intestinal parasitosis: data analysis 2006-2011 in a teaching hospital of Ancona, Italy.

    PubMed

    Silvestri, Carmela; Greganti, Gianfranco; Arzeni, Daniela; Morciano, Angela; Castelli, Pamela; Barchiesi, Francesco; Cirioni, Oscar; Giacometti, Andrea

    2013-03-01

    Intestinal parasites are a serious problem in developing countries, but should not be underestimated in industrialised countries either. Between January 2006 and December 2011, stool specimens and the scotch tests of 5323 Italian and non Italian patients (adults and children) attending the laboratory of our Infectious Diseases Clinic in a teaching Hospital at Ancona were analyzed specifically for intestinal parasites. The present study shows that, over a six-year period, of a total of 5323 patients 305 harboured at least one species of parasite (5.7%). Among the pathogenic protozoa Giardia lamblia was the most common, the overall prevalence of giardiasis being 1.8 % (99/5323). Helminths were found in 0.9% of the patients (48/5323). In particular, Hymenolepis nana, Strongyloides stercoralis and Trichuris trichiura were most commonly recovered in non-Italian children, suggesting that certain intestinal parasites are restricted to endemic areas in the tropics. Eighteen of the 305 infected patients had more than one parasite in their stools. Our study demonstrates that intestinal parasites must be considered even in industrialised areas and stool examination should be supported by epidemiological data and clinical features.

  8. Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

    PubMed Central

    Orioli, Riccardo; Marani, Alessandra; Sarlo, Maria Giuditta; Prestigiacomo, Claudio; De Luca, Assunta; Orsi, Giovanni Battista

    2017-01-01

    Health care workers (HCW) are particularly at risk of acquiring tuberculosis (TB), even in countries with low TB incidence. Therefore, TB screening in HCW is a useful prevention strategy in countries with both low and high TB incidence. Tuberculin skin test (TST) is widely used although it suffers of low specificity; on the contrary, the in vitro enzyme immunoassay tests (IGRA) show superior specificity and sensitivity but are more expensive. The present study reports the results of a three-year TB surveillance among HCW in a large teaching hospital in Rome, using TST (by standard Mantoux technique) and IGRA (by QuantiFERON-TB) as first- and second-level screening tests, respectively. Out of 2290 HCW enrolled, 141 (6.1%) had a positive TST; among them, 99 (70.2%) underwent the IGRA and 16 tested positive (16.1%). The frequency of HCW tested positive for TB seems not far from other experiences in low incidence countries. Our results confirm the higher specificity of IGRA, but, due to its higher cost, TST can be considered a good first level screening test, whose positive results should be further confirmed by IGRA before the patients undergo X-ray diagnosis and/or chemotherapy. PMID:28337457

  9. Patterns of paging medical interns during night calls at two teaching hospitals.

    PubMed Central

    Harvey, R; Jarrett, P G; Peltekian, K M

    1994-01-01

    OBJECTIVE: To assess the patterns of paging medical interns during night calls. DESIGN: Descriptive study; diaries were used to log calls between 7 pm and 7 am for 1 week in February 1991. SETTING: Two teaching hospitals in Halifax. PARTICIPANTS: All 10 interns assigned to the 15 medical units and nurses from 3 representative medical units. MAIN OUTCOME MEASURES: Number and nature of calls. RESULTS: The overall response rate was 90%. A total of 309 calls were logged by the interns and 107 by the nurses. Each intern had 17 calls on average (range 6 to 33) per 12-hour period. Of the calls 27% occurred after midnight, 25% disrupted sleeping, and 19% interrupted direct patient contact. Overall, the most common reasons for paging interns were related to prescribing of medications (42% of the calls), direct patient assessment (25%) and reporting of laboratory results (18%). According to the nurses, there were no delays in the interns' responding to the pages, and 61% of the calls led to a new physician order. CONCLUSIONS: Paging frequently interrupts interns during work and rest on night calls. Assessment of paging patterns may be useful in identifying specific interventions to reduce the number of calls so that interns will have fewer interruptions during patient encounters and more rest. The collection of data from nurses in a routine nursing audit may be useful for evaluating the communication between interns and nurses and, indirectly, for assessing interns' workload. PMID:8039084

  10. Post-operative pain therapy: prescription patterns in two Nigerian teaching hospitals.

    PubMed

    Faponle, A F; Soyannwo, O A

    2002-01-01

    In order to evaluate doctors prescriptions in post-operative pain management, a precoded, structured and pretested questionnaire was administered to resident doctors working in the department of surgery in two teaching hospitals in Nigeria. The questionnaires were completed voluntarily by all the doctors involved. Fifty-five completed questionnaires were analysed. Fifty-three per cent of the doctors aimed at relieving just enough pain for the patient to be comfortable. The others aimed at complete pain relief. Drug availability was the most important factor determining what the doctors prescribed. Anaesthetists had little or no influence on their choice of drugs. Forty-five per cent of the doctors thought that they had been adequately educated in pain control. However, the level of training did not influence the response (p > 0.05). Intramuscular opioid, 6-8 hourly, was the most preferred route of drug administration. It was concluded that prescribing patterns for post-operative pain therapy in Nigeria has changed little in the last decade. The new treatment modalities, which are being utilized in developed countries, are still not being used in this country.

  11. "Laparoscopic Cholecystectomy: A Single Surgeon's Experience in some of the Teaching Hospitals of West Bengal".

    PubMed

    Bhattacharjee, Prosanta Kumar; Halder, Shyamal Kumar; Rai, Himanshu; Ray, Rajendra Pd

    2015-12-01

    Laparoscopic cholecystectomy has revolutionized the management of symptomatic gallstone disease since its introduction more than 20 years ago. It has gained widespread acceptance and is presently the gold standard for its management. This large study spanned over last 10 years and includes prospective data on 950 elective cases of laparoscopic cholecystectomy since 2002. All cases were operated personally by the author in different teaching hospitals of West Bengal. The following were looked into: profiles of the patients including major comorbidities requiring special precautions, the frequency of "difficult cholecystectomies," conversion rate, and operative and postoperative complications. The results showed that 75 % of the patients were females. The mean age of the female patients was 35 years (range15-75), while that of the male patients was 42 (range 18-68). Thirty-two patients had major comorbidities which required special precautions in the perioperative period. Twenty-six percent of the cases were categorized as "difficult," and 6 % of the cases had to be converted to open procedure. Major complications occurred in 11 patients of which five had to be converted. Fifty-five patients had port-site infection due to atypical mycobacteria species of which majority occurred in the last 1 year of the study. All of them responded to second-line antitubercular medications.

  12. A survey of anthropometry of rural agricultural workers in Enugu State, south-eastern Nigeria.

    PubMed

    Obi, Okey Francis; Ugwuishiwu, Boniface O; Adeboye, Busayo S

    2015-01-01

    In developed countries, large amount of anthropometric data are available for reference purposes; however, anthropometric data of Nigerian populace are lacking. As a result, most agricultural machines and equipment used are designed using anthropometric data from other populations of the world. A total of 377 rural agricultural workers within the age limit of 18-45 years, who are involved in different agricultural activities, were selected from six rural agriculture-based communities in Enugu state. Thirty-six anthropometric body dimensions were measured including age and body weight. A comparison between the male and female data indicated that data obtained from male agricultural workers were higher than that obtained from their female counterparts in all body dimensions except chest (bust) depth, abdominal breadth and hip breadth (sitting). In terms of design parameters, it was observed that the data from Nigerian agricultural workers were different from that obtained from agricultural workers in north-eastern India. Practitioner Summary. Anthropometric data of Nigeria populace are lacking. As a result, most agricultural machines and equipment used are designed using anthropometric data from other populations of the world. It was observed that the data from Nigerian agricultural workers were different from that obtained from agricultural workers in north-eastern India.

  13. Anaemia in pregnancy: a public health problem in Enugu, southeast Nigeria.

    PubMed

    Ezugwu, E C; Mbah, B O; Chigbu, C O; Onah, H E

    2013-07-01

    The aim of the study was to determine the prevalence of anaemia in pregnancy at booking and to determine factors associated with its occurrence in order to proffer solutions. This was a 12-month cross-sectional study of pregnant women attending the antenatal clinic for the first time (booking visit) at ESUTTH, Enugu, Nigeria from 1 April 2009 to 31 March 2010. Sociodemographic characteristics of the mothers were extracted using an already prepared proforma. The blood haemoglobin concentration and HIV status of the women were determined and the results were analysed. The prevalence rate of anaemia in pregnancy was 64.1%. Based on severity, 94.6%, 4.3%, 1.1% of them had mild, moderate and severe anaemia. The mean age of the anaemic women was significantly lower than that of the non-anaemic women (p = 0.0001). Those that had no formal education and those that booked for antenatal care in the 3rd trimester had a significantly higher prevalence of anaemia. HIV-positive pregnant women had a significantly higher prevalence of anaemia than HIV-negative pregnant women (p = 0.0072, odds ratio 2.37). It was concluded that the prevalence of anaemia in pregnancy from the study is unacceptably high. To achieve Millennium Development Goals 4 and 5, efforts must be geared towards its prevention to ensure a healthy baby and mother.

  14. Nitrate and nitrite content of well water in Enugu, Southeast Nigeria.

    PubMed

    Ogbu, Innocent S I; Echebiri, Vitalis C

    2003-09-01

    Water samples from 20 artesian wells, chosen by the multistage sampling procedure from 5 zones in the city of Enugu, Southeast Nigeria, were analyzed by the disulfonic acid method in duplicate for the presence of nitrate (NO3) and nitrite (NO2). The zonal mean values for NO3 were 0.45 mmol/l, 0.46 mmol/l, 0.55 mmol/l, 0.59 mmol/l, and 0.65 mmol/l (mean = 0.54 mmol/l), and for NO2 the values were 0.34 mmol/l, 0.32 mmol/l, 0.21 mmol/l, 0.14 mmol/l, and 0.20 mmol/l (mean = 0.24 mmol/l), respectively. The mean values were reciprocally related (r = -.7356, p = 0.0002), indicating fecal contamination of well water. There were no significant differences between the mean values and the sum of the NO3 and NO2 values of the samples (p > 0.05), indicating uniform nitrogen content in the region. The mean value for NO3 (0.54 mmol/l) was below the guideline values set by the World Health Organization, but the mean NO2 concentration of 0.24 mmol/l was much higher (290%) than what is considered safe for humans.

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

    PubMed

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

    2014-07-01

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

  16. Impact of waste management training intervention on knowledge, attitude and practices of teaching hospital workers in Pakistan

    PubMed Central

    Kumar, Ramesh; Somrongthong, Ratana; Ahmed, Jamil

    2016-01-01

    Objective: To evaluate the sustainability and effectiveness of training as an intervention to improve the knowledge, attitude and practices of hospital workers on health care waste management. Method: We conducted this quasi-experimental study in two tertiary care teaching hospitals in Rawalpindi in October 2013. Training, practical demonstrations and reminders on standard waste management were given to 138 hospital workers in one hospital and compared with 137 workers from the control hospital. We collected data 18 months after intervention through a structured questionnaire to assess the impact of the intervention. We used paired t-test to compare the scores on knowledge, attitude and practices at baseline and first follow up and final impact assessment. Chi square test was used to compare group variables between intervention and control groups. Results: After 18 months since intervention the mean scores on knowledge attitude and practices differed statistically significantly since baseline and intervention group had statistically significantly better knowledge positive attitudes and good health care waste management practices (p < 0.001). Health care and sanitary workers in intervention group scored statistically significantly higher (p < 0.001). Conclusion: Trainings of health and sanitary workers on health care waste management guidelines were sustainable among the intervention group after 18 months which shows the positive impact of our intervention. It is recommended that the trainings as intervention be included in the overall policies of the public and private sector hospitals in Pakistan and other similar settings. PMID:27375718

  17. The nursing shortage crisis in Québec's McGill University affiliated teaching hospitals: strategies that can work.

    PubMed

    Ferrante, A

    1993-01-01

    A frequently recurring theme expressed in both the professional health literature and other multimedia sources is the current nursing shortage crisis. This shortage is an ever present reality that is of serious concern and that will continue to escalate unless innovative and creative strategies are implemented. This article will specifically address one hospital's approach to the nursing shortage crisis in Québec's McGill University affiliated teaching hospitals. The pivotal issues of retention, recruitment and attraction of nursing as a profession are examined. Recommendations for dealing with these issues include: 1) restructuring nursing salaries, 2) redefining the types of nursing personnel resources, 3) flexibility in work schedule, 4) recognition, 5) providing an accurate public image of nursing, and 6) recruitment of males and mature persons. This article provides nursing administrators in the hospital, community, and educational settings with potential strategies that they can explore and apply in their own settings.

  18. The experience of implementing the board of trustees’ policy in teaching hospitals in Iran: an example of health system decentralization

    PubMed Central

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

    2015-01-01

    Background: In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods: We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results: Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion: The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization

  19. [Evolution of neonatal mortality at the Blida University Teaching Hospital (Algeria) between 1999 and 2006].

    PubMed

    Bezzaoucha, A; El Kebboub, A; Aliche, A

    2010-02-01

    Within the framework of the active information system set up by the department of epidemiology on hospital mortality at the Blida (Algeria) University Teaching Hospital (CHU), a study was carried out to assess the importance and evolution of neonatal mortality recorded at the CHU in the last eight years (1999-2006) as well as the causes of neonatal death. The International Classification of Diseases (ICD-9) was used to encode the nature of the causal disease. Using the software EpiInfo™ in its sixth version performed data entry, monitoring and analysis. On the whole, 2,167 neonatal deaths were recorded at the CHU during the study period, representing a proportional mortality of 25.4%. Early neonatal mortality (0-6 days) accounted for 83.4% of all neonatal mortality. Nearly two thirds of early neonatal deaths occurred in the first three days of life. The monthly evolution of the number of early neonatal deaths revealed a significant rising trend during the study period (P < 0.05) without identification of seasonal effect. The sex ratio was practically the same for early and late neonatal mortality, respectively 1.4 and 1.5. Prematurity accounted for 42.1% of the deaths in early neonatal deaths, followed by respiratory distress syndrome and infection, respectively 17.0 and 14.4%. Infections, with a relative frequency of 36.2%, represented the most common cause for the late neonatal mortality. The rate of early neonatal mortality during the study period, when this one took for denominator the number of newborns admitted in neonatology to express the mortality of service, was 15.6%. Throughout the study period, the rate of early neonatal mortality, without counting the deaths among transferred newborms, could be estimated at 19.2 per 1,000 live births, while the overall neonatal mortality rate could be estimated at 22.3 per 1,000 live births. No significant temporal tendency was pointed out. The CHU of Blida is not characterized by a lower risk of neonatal mortality

  20. Traumatic upper cervical spinal fractures in teaching hospitals of China over 13 years

    PubMed Central

    Wang, Hongwei; Ou, Lan; Zhou, Yue; Li, Changqing; Liu, Jun; Chen, Yu; Yu, Hailong; Wang, Qi; Zhao, Yiwen; Han, Jianda; Xiang, Liangbi

    2016-01-01

    Abstract To investigate the incidence and pattern of patients managed for traumatic upper cervical spinal fractures (TUCSFs) in teaching hospitals in China over 13 years. We retrospectively reviewed 351 patients with TUCSF admitted to our teaching hospitals. Incidence rates were calculated with respect to age, gender, etiologies of trauma, anatomical distribution, anatomical classification, American spinal injury association impairment scale (ASIA) classification of neurological deficit and associated injuries. There were 260 male and 91 female patients, with a mean age of 44.2 ± 16.3 years. The mean age of the patients significantly increased by year of admission, from 35.2 ± 14.5 years to 47.5 ± 17.2 years (P = 0.005). Motor vehicle accidents (MVAs) (n = 132, 37.6%) and high falls (n = 104, 29.6%) were the 2 most common mechanisms. The number of C2 fractures (n = 300, 85.5%) was significantly higher than that of C1 (n = 99, 28.2%) (P < 0.001). High falls resulted in significantly more Type I C1 fractures than other etiologies (all P < 0.001). MVAs resulted in many more Type II and Type III C1 fractures and Type II and Type III C2 fractures than other etiologies. High falls were the most common injury type (n = 44, 36.4%) resulting in neurological deficits. Patients who presented with Landell classification Type I single C1 fracture (n = 6, 42.9%) had the highest rate of neurological deficits. Eighty-two patients had combined injuries; the most common pattern was cervical + cervical spine (n = 44, 12.5%), followed by cervical + thoracic spine (n = 27, 7.7%). A total of 121 patients (34.5%) suffered neurological deficits. Of all patients with TUCSF without combined injuries, single C2 fractures accounted for the highest rate of neurological deficits (n = 62, 32.0%). Multivariate logistic regression analysis indicated that sex (OR = 1.876, 95% CI: 1.022–3.443, P = 0.042), etiology (MVA pedestrians vs high fall: OR = 0.187, 95% CI: 0

  1. Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital

    PubMed Central

    Singh, Swati; Ahmed, Ekele Bissallah; Egondu, Shehu Constance; Ikechukwu, Nwobodo Emmanuel

    2014-01-01

    Background: Hypertensive disorders in pregnancy (HDP) represent a group of conditions associated with high blood pressure during pregnancy. It is an important cause of feto-maternal morbidity and mortality, particularly in developing countries. The aims of the study were to find the prevalence of hypertensive disorders and its associated risk factors among women attending the antenatal clinic of Usmanu Danfodiyo University Teaching Hospital,(UDUTH) Sokoto. Materials and Methods: A longitudinal study of 216 consecutively recruited women that were less than 20 weeks pregnant at booking was carried out. Blood pressure was measured for each woman at booking and at subsequent visits. Urinalysis was done at booking and whenever blood pressure was elevated. Patients were followed-up to delivery and 6 weeks postpartum. Data entry and analysis was done using Statistical Analysis System (SAS) statistical package. Results: The prevalence of HDP in the study was 17% while preeclampsia was 6%. Previous history of preeclampsia (P < 0.001; Relative risk (RR) 4.2; conficence interval (CI) 2.144-6.812), multiple gestation (P < 0.03; RR 3.8; CI 1.037-6.235), gestational diabetes (P < 0.02; RR 4.8; CI 1.910-6.751) and obesity (P < 0.002; RR 2.7; CI 1.373-5.511) were the significant risk factors in the development of HDP among the study population. Conclusion: The prevalence of HDP in the study group is high. Therefore, paying attention to the risk factors will ensure early detection and prevention of the progression of the disease and its sequelae. PMID:25298602

  2. Clinico-Epidemiological Patterns of Cutaneous Leishmaniasis Patients Attending the Anuradhapura Teaching Hospital, Sri Lanka

    PubMed Central

    Galgamuwa, Lahiru Sandaruwan; Sumanasena, Buthsiri; Yatawara, Lalani; Wickramasinghe, Susiji; Iddawela, Devika

    2017-01-01

    Cutaneous leishmaniasis (CL) caused by Leishmania donovani is an endemic vector-borne disease in Sri Lanka. Over 2,500 cases have been reported since 2000 and the number of CL cases has dramatically increased annually. Total 57 clinically suspected CL patients attending the dermatology clinic in Anuradhapura Teaching Hospital were recruited from January to June 2015. Slit skin smears and skin biopsies were taken from each of the subjects. Clinical and epidemiological data were obtained using interviewer administered questionnaire. Forty-three (75.4%) patients among 57 were confirmed positive for L. donovani. The majority of infected patients was males (P=0.005), and the most affected age group was 21–40 years. Soldiers in security forces, farmers, and housewives were identified as high risk groups. The presence of scrub jungles around the residence or places of occupation (P=0.003), the presence of sandflies (P=0.021), and working outsides more than 6 hr per day (P=0.001) were significantly associated with CL. The number of lesions ranged from 1–3, and the majority (76%) of the patients had a single lesion. Upper and lower extremities were the prominent places of lesions, while the wet type of lesions were more prevalent in females (P=0.022). A nodular-ulcerative type lesion was common in both sexes. The presence of sandflies, scrub jungles, and outdoor activities contributed to spread of Leishmania parasites in an endemic pattern. Implementation of vector control programs together with health education with regard to transmission and prevention of CL are necessary to control the spread of this infection. PMID:28285499

  3. Proton Beam Radiotherapy for Uveal Melanomas at Nice Teaching Hospital: 16 Years' Experience

    SciTech Connect

    Caujolle, Jean-Pierre; Mammar, Hamid; Chamorey, Emmanuel Phar; Pinon, Fabien; Herault, Joel; Gastaud, Pierre

    2010-09-01

    Purpose: To present the results of uveal melanomas treated at Nice Teaching Hospital. Methods and Materials: This retrospective study included 886 consecutive patients referred to our clinic for the treatment of uveal melanomas by proton beam radiotherapy from June 1991 to December 2007. Survival rates were determined by using Kaplan-Meier estimates, and prognostic factors were evaluated using the log-rank test or Cox model. Results: The number (percent total) of subjects staged according to the TNM classification system (6th edition) of malignant tumors included 39 stage T1 (4.4%), 420 stage T2 (47.40%), 409 stage T3 (46.16%), and 18 stage T4 (2.03%) patients. The median follow-up was 63.7 months. The Kaplan-Meier overall survival rate at 5 years according to the sixth edition TNM classification was 92% for T1, 89% for T2, 67% for T3, and 62% for T4; and at 10 years, 86% for T1, 78% for T2, 43% for T3, and 41% for T4. Five factors were found to be associated with an increased death rate: advanced age, tumor thickness, largest tumor basal diameter, tumor volume, and tumor volume-to-eyeball volume ratio. The metastasis-free survival rates were 88.3 % at 5 years and 76.4 % at 10 years. The local control rates were 93.9% at 5 years and 92.1% at 10 years. The ocular conservation rates were 91.1% at 5 years and 87.3% at 10 years. Conclusions: We report the results of a large series of patients treated for uveal melanomas with a very long follow-up. Despite the large tumor volume treated, our results were similar to previously published findings relating to proton beam therapy.

  4. Is there a weekend effect in hip fracture patients presenting to a United Kingdom teaching hospital?

    PubMed Central

    Mathews, John Abraham; Vindlacheruvu, Madhavi; Khanduja, Vikas

    2016-01-01

    AIM To compare mortality and time-to-surgery of patients admitted with hip fracture to our teaching hospital on weekdays vs weekends. METHODS Data was prospectively collected and retrospectively analysed for 816 hip fracture patients. Multivariate logistic regression was carried out on 3 binary outcomes (time-to-surgery < 36 h; 30-d mortality; 120-d mortality), using the explanatory variables time-of-admission; age; gender; American Society of Anesthesiologist (ASA) grade; abbreviated mental test score (AMTS); fracture type; accommodation admitted from; walking ability outdoors; accompaniment outdoors and season. RESULTS Baseline characteristics were not statistically different between those admitted on weekdays vs weekends. Weekend admission was not associated with an increased time-to-surgery (P = 0.975), 30-d mortality (P = 0.842) or 120-d mortality (P = 0.425). Gender (P = 0.028), ASA grade (P < 0.001), AMTS (P = 0.041) and accompaniment outdoors (P = 0.033) were significant co-variates for 30-d mortality. Furthermore, age (P < 0.001), gender (P = 0.011), ASA grade (P < 0.001), AMTS (P < 0.001) and accompaniment outdoors (P = 0.033) all significantly influenced mortality at 120 d. ASA (P < 0.001) and season (P = 0.014) had significant effect on the odds of undergoing surgery in under 36 h. CONCLUSION Weekend admission was not associated with increased time-to-surgery or mortality in hip fracture patients. Demographic factors affect mortality in accordance with previous published reports. PMID:27795950

  5. Factors influencing heartworm, flea, and tick preventative use in patients presenting to a veterinary teaching hospital

    PubMed Central

    Gates, Maureen C.; Nolan, Thomas J.

    2009-01-01

    The introduction of modern heartworm, flea, and tick preventatives has provided a safe and effective means of controlling companion animal endoparasites, but achieving good owner compliance remains an ongoing challenge for the veterinary profession. Based on a sample of patients from the veterinary teaching hospital at the University of Pennsylvania, this study retrospectively examined factors associated with preventative use and areas of potential weakness in client communication. Between 1999 and 2006, records of 5,276 canine and 1,226 feline patients were searched for signalment, survey results for heartworm, flea, and tick preventative use, date of visit, presenting complaint, vaccination history, and owner zip code. Data were analyzed using bivariate and multivariate techniques. Overall, only 13 - 23 % of patients were questioned about heartworm, flea, or tick preventative use during routine medical history taking. Patients with a prior history of parasites, younger patients, or those presenting with signs of cardiac disease were no more likely to be questioned about preventative use than healthy animals. Patients presenting to a specialty service were also less likely to be questioned. Approximately 74 - 79% of dogs and 12 – 38 % of cats in the sample were on preventative products at any given time. There was a distinct seasonality to preventative use corresponding to the heartworm transmission season from June through November in the northeastern United States. Only 50% of patients seen for a yearly physical examination in winter were reported to be using preventative products when surveyed later in the year, compared to the roughly 85% on patients in heartworm preventatives when they received their routine physical exam in spring. Month of presentation and neuter status were the only signalment factors significantly (P<0.05) associated with preventative use in the multivariate analysis. Findings from this study emphasize target areas for increasing owner

  6. Genital mycoplasmas in women attending the Yaoundé University Teaching Hospital in Cameroon

    PubMed Central

    Njunda, Anna L.; Nsagha, Dickson S.; Assob, Jules C.N.; Palle, John N.; Kamga, Henri L.; Nde, Peter F.; Ntube, Mengang N.C.; Weledji, Patrick E.

    2011-01-01

    Genital mycoplasmas are implicated in pelvic inflammatory diseases, puerperal infection, septic abortions, low birth weight, nongonococcal urethritis and prostatitis as well as spontaneous abortion and infertility in women. There is paucity of data on colonisation of genital mycoplasma in women and their drug sensitivity patterns. The aim of our study was to determine the prevalence of genital mycoplasmas (Ureaplasma urealiticum and Mycoplasma hominis) infection and their drug sensitivity patterns in women. A mycofast kit was used for biochemical determination of mycoplasma infection in 100 randomly selected female patients aged 19–57 years, attending the University of Yaoundé Teaching Hospital (UYTH) from March to June 2010. Informed consent was sought and gained before samples were collected. Genital mycoplasmas were found in 65 patients (65%) [95% CI=55.7–74.3%] and distributed as 41 (41%) [95% CI=31.4–50.6%] for U. urealiticum and 4 (4%) [95% CI=0.20– 7.8%] for M. hominis while there was co-infection in 20 women (20%) [95% CI=12.16–27.84%]. In our study, 57 (57%) [95% CI=47.3–67%] had other organisms, which included C. albicans (19 [19%]), G. vaginalis (35 [35%]) and T. vaginalis (3 [3%]). Among the 65 women with genital mycoplasma, the highest co-infection was with G. vaginalis (33.8%). Pristinamycine was the most effective antibiotic (92%) and sulfamethoxazole the most resistant (8%) antibiotic to genital mycoplasmas. We conclude that genital mycoplasma is a problem in Cameroon and infected women should be treated together with their partners. PMID:28299057

  7. Worldwide Lineages of Clinical Pneumococci in a Japanese Teaching Hospital Identified by DiversiLab System.

    PubMed

    Kashiwaya, Kiyoshi; Saga, Tomoo; Ishii, Yoshikazu; Sakata, Ryuji; Iwata, Morihiro; Yoshizawa, Sadako; Chang, Bin; Ohnishi, Makoto; Tateda, Kazuhiro

    2016-06-01

    Pneumococcal Molecular Epidemiology Network (PMEN) clones are representatives of worldwide-spreading pathogens. DiversiLab system, a repetitive PCR system, has been proposed as a less labor-and time-intensive genotyping platform alternative to conventional methods. However, the utility and analysis parameters of DiversiLab for identifying worldwide lineages was not established. To evaluate and optimize the performance of DiversiLab for identifying worldwide pneumococcal lineages, we examined 245 consecutive isolates of clinical Streptococcus pneumoniae from all age-group patients at a teaching hospital in Japan. The capsular swelling reaction of all isolates yielded 24 different serotypes. Intensive visual observation (VO) of DiversiLab band pattern difference divided all isolates into 73 clusters. Multilocus sequence typing (MLST) of representative 73 isolates from each VO cluster yielded 51 different STs. Among them, PMEN-related lineages accounted for 63% (46/73). Although the serotype of PMEN-related isolates was identical to that of the original PMEN clone in 70% (32/46), CC156-related PMEN lineages, namely Greece(6B)-22 and Colombia(23F)-26, harbored various capsular types discordant to the original PMEN clones. Regarding automated analysis, genotyping by extended Jaccard (XJ) with a 75% similarity index cutoff (SIC) showed the highest correlation with serotyping (adjusted Rand's coefficient, 0.528). Elevating the SIC for XJ to 85% increased the discriminatory power sufficient for distinguishing two major PMEN-related isolates of Taiwan(19F)-14 and Netherlands(3)-31. These results demonstrated a potential utility of DiversiLab for identifying worldwide lineage of pneumococcus. An optimized parameters of automated analysis should be useful especially for comparison for reference strains by "identification" function of DiversiLab.

  8. Evaluation of the peer teaching program at the University Children´s Hospital Essen - a single center experience.

    PubMed

    Büscher, Rainer; Weber, Dominik; Büscher, Anja; Hölscher, Maite; Pohlhuis, Sandra; Groes, Bernhard; Hoyer, Peter F

    2013-01-01

    Since 1986 medical students at the University Children's Hospital Essen are trained as peers in a two week intensive course in order to teach basic paediatric examination techniques to younger students. Student peers are employed by the University for one year. Emphasis of the peer teaching program is laid on the mediation of affective and sensomotorical skills e.g. get into contact with parents and children, as well as manual paediatric examination techniques. The aim of this study is to analyse whether student peers are able to impart specific paediatric examination skills as good as an experienced senior paediatric lecturer. 123 students were randomly assigned to a group with either a senior lecturer or a student peer teacher. Following one-hour teaching-sessions in small groups students had to demonstrate the learned skills in a 10 minute modified OSCE. In comparison to a control group consisting of 23 students who never examined a child before, both groups achieved a significantly better result. Medical students taught by student peers almost reached the same examination result as the group taught by paediatric teachers (21,7±4,1 vs. 22,6±3,6 of 36 points, p=0,203). Especially the part of the OSCE where exclusively practical skills where examined revealed no difference between the two groups (7,44±2,15 vs. 7,97±1,87 of a maximum of 16 points, p=0,154). The majority of students (77%) evaluated peer teaching as stimulating and helpful. The results of this quantitative teaching study reveal that peer teaching of selected skills can be a useful addition to classical paediatric teaching classes.

  9. Is an urban legend true in the teaching hospital that "you will get hurt if you go to hospital at the beginning of the fiscal year"?

    PubMed

    Inoue, Satoki; Abe, Ryuichi; Tanaka, Yu; Kawaguchi, Masahiko

    2015-02-01

    An urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year" is in circulation, because people in general suppose that inexperienced newcomers start to work at clinical practice during that time period. We tried to determine whether this urban legend was true or not by using data from our operation management system. We retrospectively conducted a study to investigate whether the number of cannulation failures, which was used as an index of patient disadvantages at clinical practice, could be affected by the volume of residents in clinical participation. The number of insertion trials per case was not prominent in the first month of the fiscal year. However, the number of insertion trials per case increased in proportion to the average number of residents per day. It seems that there was no evidence to support the urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year." However, our results suggest that rather than an urban legend, we are now confronting the fact that patients may suffer from medical disadvantages in the teaching hospitals.

  10. Monitoring gully erosion at Nyaba river of Enugu state southeastern Nigeria, using remote sensing

    NASA Astrophysics Data System (ADS)

    Okwu-Delunzu, V. U.; Enete, I. C.; Abubakar, A. S.; Lamidi, S.

    2013-10-01

    Erosion is a natural, gradual and continuous process of earth surface displacement caused by various agents of denudation. It is also caused by some anthropogenic activities. Erosion rate of an area at any point in time is dependent mainly on climate and geological factors. Physical aspects of the erosive force experienced in gullies are mainly dependent on the local prevailing climate condition. In this study, remotely sensed data was used in the analysis of gully erosion progression at Nyaba River in Enugu Urban, aimed at mapping and monitoring gully erosion at the study site. Methodologies employed include; data acquisition from field observation and satellite images; data processing and analyses using ilwis 3.7 and Arc GIS 9.3 software. The result showed that gully progressed from 578,713,735 square meters in 1986 to 1, 002,819,723 in 2011. Prediction showed that the magnitude of the gully area is expected to increase as the years go by if measures are not taken to control the expansion rate. The forecast put the expected coverage of gully erosion at Nyaba River to be 45,210,440 square meters by the year 2040. Consequently, recommendations made include: constant monitoring to detect early stages of gully formation; regulation of grazing of pasture in the area; restriction of sand mining from the river bank and construction of water ways to stabilize river flow. In conclusion, monitoring clearly showed that there was a geometric progression in gully formation at Nyaba over years; the expansion was aided more by anthropogenic activities than natural factors.

  11. 78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ... & Medicaid Services (CMS) for consideration of Infirmary West Hospital's and Montgomery Hospital's full time... and Montgomery Hospital of Morristown, PA. The purpose of this notice is to notify the public of the... \\3\\. 31.84 \\4\\. ] 390108 Montgomery Morris-town, PA 37964 October 16, 17.16-0.60 = 15.33....

  12. Traditions and Customs in Community Development: The Case of Nkanu West and Nkanu East Local Government Areas of Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Adekola, G.; Egbo, Nwoye Charles

    2016-01-01

    This study examined the influence of traditions and customs on community development in Nkanu West and Nkanu East Local Government Areas of Enugu State. The study was carried out with three objectives and three null hypotheses. The research adopted descriptive survey design with a population of 2,125 members of community Based Organizations in the…

  13. Strategies for Dealing with Low Adoption of Agricultural Innovations: A Case Study of Farmers in Udenu L.G.A. of Enugu State, Nigeria

    ERIC Educational Resources Information Center

    Uguru, Chike; Ajayi, S. L.; Ogbu, Oliver C.

    2015-01-01

    A study to access the level of acceptance/adoption of agricultural innovations by farmers in Udenu Local Government Area of Enugu State was carried out. The aim was to find out the reasons behind the low acceptance/adoption of agricultural innovations by farmers in the area and to suggest possible strategies to address this ugly situation; as a…

  14. Nutritional screening in surgical patients of a teaching hospital from Southern Brazil: the impact of nutritional risk in clinical outcomes

    PubMed Central

    Garcia, Rosane Scussel; Tavares, Léa Regina da Cunha; Pastore, Carla Alberici

    2013-01-01

    ABSTRACT Objective: To assess the prevalence of nutritional risk in surgical patients of a teaching hospital and its associated factors. Methods: A cross-sectional study with secondary data of surgical ward patients of the Hospital Escola da Universidade Federal de Pelotas, from April to October, 2010. Patients were evaluated up to 36 hours after admission using the Malnutrition Screening Tool. Results: The study included 565 patients, with a mean age of 52.8±15.6 years, and the majority (51%) was female. More than 30% of the patients presented with an average or high nutritional risk, and 7% of them were at high risk. Associated with the greater risk were aging, cancer surgery, and mortality. The length of hospital stay showed a linear increase according to nutritional risk. Conclusion: The Malnutrition Screening Tool is a simple and effective tool for nutritional screening that does not require anthropometric measurements. In this study, average or high nutritional risk was prevalent in one third of the sample, and was related to increased mortality, hospital stay, cancer, and aging. Nutritional care outpatients’ protocols could be used prior to elective surgery to reduce the nutritional risk of these patients, improving clinical outcomes and reducing length and costs of hospital stay. PMID:23843052

  15. Bed Capacity Planning Using Stochastic Simulation Approach in Cardiac-surgery Department of Teaching Hospitals, Tehran, Iran

    PubMed Central

    TORABIPOUR, Amin; ZERAATI, Hojjat; ARAB, Mohammad; RASHIDIAN, Arash; AKBARI SARI, Ali; SARZAIEM, Mahmuod Reza

    2016-01-01

    Background: To determine the hospital required beds using stochastic simulation approach in cardiac surgery departments. Methods: This study was performed from Mar 2011 to Jul 2012 in three phases: First, collection data from 649 patients in cardiac surgery departments of two large teaching hospitals (in Tehran, Iran). Second, statistical analysis and formulate a multivariate linier regression model to determine factors that affect patient's length of stay. Third, develop a stochastic simulation system (from admission to discharge) based on key parameters to estimate required bed capacity. Results: Current cardiac surgery department with 33 beds can only admit patients in 90.7% of days. (4535 d) and will be required to over the 33 beds only in 9.3% of days (efficient cut off point). According to simulation method, studied cardiac surgery department will requires 41–52 beds for admission of all patients in the 12 next years. Finally, one-day reduction of length of stay lead to decrease need for two hospital beds annually. Conclusion: Variation of length of stay and its affecting factors can affect required beds. Statistic and stochastic simulation model are applied and useful methods to estimate and manage hospital beds based on key hospital parameters. PMID:27957466

  16. Optimal allocation of public water supply to the urban sectors of Enugu, Nigeria: a linear programming approach

    NASA Astrophysics Data System (ADS)

    Ezenwaji, Emma E.; Anyadike, Raymond N. C.; Igu, Nnaemeka I.

    2014-03-01

    Recent studies in water supply in Enugu urban area have observed that there is a persistent water supply shortage relative to demand. One of the strategies for achieving a good water supply under the circumstance is through efficient water allocation to consumers. The existing allocation system by the Enugu State Water Corporation is not achieving the desired goal, because it is not based on any scientific criteria. In this study, we have employed the linear programming modelling technique to optimise the allocation of 35,000,000 L of water produced daily by the State Water Corporation and supplied to the four sectors of the town. The result shows that the model allocated 27,470,000 L to the residential sector, 3,360,000 L to commercial, 3,120,000 L to industrial and 882,000 L to public institutions sectors leaving a balance of 168,000 L to be utilised in emergency situations. This allocation pattern departs sharply from the present management technique adopted by the corporation. It is then suggested that for urban water supply to be sustainable in the town, the corporation should rely on this technique for water supply.

  17. Perceived versus Observed Patient Safety Measures in a Critical Care Unit from a Teaching Hospital in Southern Colombia

    PubMed Central

    Montenegro, Jorge Hernan; Romero, Adriana Fernanda; Tejada, Paola Andrea; Olaya, Sandra Ximena; Rubiano, Andres Mariano

    2016-01-01

    Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM) in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM), placement of central catheters (PCC), other invasive procedures (OIP), infection control (IC), and endotracheal intubation (ETI). Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia. PMID:26989508

  18. Guide to Choosing a Hospital

    MedlinePlus

    ... your condition? Should you consider a specialty hospital, teaching hospital (usually part of a university), community hospital, ... been approved by Medicare. Hospitals may choose either method of evaluation. You can check with a hospital ...

  19. Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

    PubMed Central

    Al-Temimi, Mohammed; Kidon, Michael; Johna, Samir

    2016-01-01

    Context Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Objective Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Design Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Main Outcome Measures Knowledge of ACGME core competencies. Results Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1–10 vs > 10), and number of rotations taught per year (1–6 vs 7–12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10–12 rotations per year) were more likely to provide competency-based teaching. Conclusion Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies. PMID:27768565

  20. Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana

    PubMed Central

    Agbenorku, Pius

    2013-01-01

    Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains. PMID

  1. Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

    PubMed Central

    Tessema, Belay; Muche, Abebe; Bekele, Assegedech; Reissig, Dieter; Emmrich, Frank; Sack, Ulrich

    2009-01-01

    Background In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia. Methods We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables. Results From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate. Conclusion The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently. PMID:19799801

  2. Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

    PubMed Central

    Covington, Matthew F.; Agan, Donna L.; Liu, Yang; Johnson, John O.; Shaw, David J.

    2013-01-01

    Background Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care. Methods An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients). Results There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7–1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1–2.7 studies per patient, P  =  .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total. Conclusions A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system. PMID:24404274

  3. Outbreak of NDM-1-Producing Klebsiella pneumoniae Causing Neonatal Infection in a Teaching Hospital in Mainland China

    PubMed Central

    Zhang, XiaoYu; Li, XianPing; Yue, HeJia; Li, PengLing; Liu, YaPing; Cao, Wei; Yao, DongMei; Liu, Li; Zhou, XiaoLan; Zheng, Rong; Bo, Tao

    2015-01-01

    The emergence and spread of bacteria carrying the blaNDM-1 gene has become a worldwide concern. Here, we report eight cases of Klebsiella pneumoniae with blaNDM-1 in the neonatal ward of a teaching hospital in mainland China. Multilocus sequence typing showed that seven isolates were clonally related and confirmed them as sequence type 17 (ST17). One isolate belonged to ST433. These findings suggest continuous spread of blaNDM-1 in mainland China and emphasize the need for intensive surveillance and precautions. PMID:25941224

  4. Outbreak of NDM-1-producing Klebsiella pneumoniae causing neonatal infection in a teaching hospital in mainland China.

    PubMed

    Zhang, XiaoYu; Li, XianPing; Wang, Min; Yue, HeJia; Li, PengLing; Liu, YaPing; Cao, Wei; Yao, DongMei; Liu, Li; Zhou, XiaoLan; Zheng, Rong; Bo, Tao

    2015-07-01

    The emergence and spread of bacteria carrying the bla(NDM-1) gene has become a worldwide concern. Here, we report eight cases of Klebsiella pneumoniae with bla(NDM-1) in the neonatal ward of a teaching hospital in mainland China. Multilocus sequence typing showed that seven isolates were clonally related and confirmed them as sequence type 17 (ST17). One isolate belonged to ST433. These findings suggest continuous spread of bla(NDM-1) in mainland China and emphasize the need for intensive surveillance and precautions.

  5. Meticillin-resistant Staphylococcus aureus: spread of specific lineages among patients in different wards at a Brazilian teaching hospital.

    PubMed

    Cavalcante, F S; Schuenck, R P; Ferreira, D C; da Costa, C R; Nouér, S A; dos Santos, K R N

    2014-02-01

    This study aimed to characterize meticillin-resistant Staphylococcus aureus (MRSA) lineages circulating in a Brazilian teaching hospital. MRSA isolates from nasal swabs were evaluated to assess antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec), Panton-Valentine leucocidin status, pulsed-field gel electrophoresis profile and multi-locus sequence type (MLST) analysis. Eighty-three MRSA isolates were analysed. SCCmec III (43.4%) and IV (49.4%) were predominant. ST1-IV (USA400) was more common in internal medicine (P = 0.002) whereas 'clone M' (SCCmec III) was more common in the medical and surgical intensive care unit (P = 0.004), and all isolates were ST5-IV (USA800) in dermatology (P < 0.001). These data improved the understanding of the MRSA epidemiology inside the hospital and helped to establish effective control measures.

  6. Knowledge, attitudes and practices towards standard precautions (SP) among caregivers at Hassan II University Teaching Hospital in Fes, Morocco.

    PubMed

    Benboubker, Moussa; El Marnissi, Boujemaa; Nhili, Aziz; El Rhazi, Karima

    2017-02-21

    This survey aims at assessing knowledge, attitudes and practices towards standard precautions (SP) among caregivers at Hassan II University Teaching Hospital in Fes. This is a cross-sectional prospective and evaluative study that covers a two-month period. Data were collected using an anonymous and selfadministered questionnaire. Sampling population was divided into 307 nurses (53.8%), 210 hospital doctors (36.77%) and 57 support staff (9.45%), belonging to other various categories working in different departments. This is a young population since 79.7% are under 30 years old. The results have shown that only 28.72% of health care professionals had received training in SP. Moreover, 87.7% claimed to practice hands' hygiene while moving from one patient to another. In contrast, 75.7% emphasized the need to change gloves each time they work on a new patient. However, individual protection measures were rarely mentioned in several risky situations.

  7. [Cerebral toxoplasmosis during AIDS in the infectious diseases department of Point-G Teaching Hospital, Bamako, Mali].

    PubMed

    Goïta, D; Karambe, M; Dembélé, J P; Sogoba, D; Sidibé, A F; Diaby, S; Cisse, I A; Fongoro, S; Dao, S

    2012-01-01

    Cerebral toxoplasmosis is common opportunistic infections of central nervous system in AIDS. It occurs most often in case of severe immunosuppression. The aim of this study is to investigate the general characteristics of cerebral toxoplasmosis during HIV infection and AIDS in hospital area in Bamako. It is a retrospective study of 5 years (form January 2001 to December 2005), conducted in the infectious diseases department of Point G Teaching Hospital of Bamako. It concerned all patients infected with HIV, hospitalized for cerebral toxoplasmosis. The diagnosis of cerebral toxoplasmosis was based on clinical, C T and therapeutic arguments. A total of 745 patients investigated, 26 met cerebral toxoplasmosis diagnostic criteria (14 men and 12 women). The rate of cerebral toxoplasmosis in the study population was 3.5%. The average age was 38.1 years (18-58 years). Focused neurological deficit (73.07%), intracranial hypertension signs (69.20%), meningeal syndrome (15.40%), seizures (57.69%) and consciousness disorders (30.80%) were the clinical characteristics. Hypodensity with or without peripheral enhancement images (93.75%) were found on CT. The average rate of CD4 T cells was 98.7cells/mm3 (5-473 cells/mm3). Oropharyngeal candidiasis in 61.53% of cases, intestinal cryptosporidiosis (11.53%), herpes zoster (3.84%) and Pott's disease (3.84%) were the opportunistic infections associated. Cotrimoxazole was used in 88.46% of patients and 3 patients (11.54%) received the standard treatment (Sulfadiazine-Pyrimethamine). Antitoxoplasmic treatment led to a clinical improvement in 84.61% and 4 deaths (15.39%). were recorded. The technical platform for etiological diagnosis of toxoplasmosis is not available at the Point-G Teaching Hospital, so in case of encephalitis signs in a HIV positive patient, CT should be urgently perform and a treatment trial must begin without delay.

  8. Spectrum of Microbial Diseases and Resistance Patterns at a Private Teaching Hospital in Kenya: Implications for Clinical Practice

    PubMed Central

    Maina, Daniel; Omuse, Geoffrey; Revathi, Gunturu; Adam, Rodney D.

    2016-01-01

    Background Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data. Methods We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014. Results For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci. Conclusions The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally. PMID:26807811

  9. Assessment of knowledge and practice of nutritional and life style risk factors associated with cancer among hospital workers at two university teaching hospitals in Osun State, Nigeria.

    PubMed

    Ojofeitimi, E O; Aderounmu, A O; Lomuwagun, A F; Owolabi, O O; Fadiora, A O; Asa, S S; Bamiwuye, S O; Ihedioha, O D

    2003-01-01

    The objectives of this study were to assess both the predisposing and precipitating risk factors in the aetiology of any form of cancer among hospital workers at two teaching Hospitals in Osun State, Nigeria. Pre-tested and modified questionnaires were administered to 250 respondents. One hundred and seventy questionnaires were duly filled and completed. Less than 9% of the respondents consumed fruits and vegetables on a daily basis; while the highest percentage (65%) regularly consumed butter/margarine, followed with consumption of red meat. Twenty nine percent (29%) from both locations were classified as overweight and obese. Half did physical exercise twice a week. Of the 168 respondents. 34 (20.2%) did meet the criteria for completely emptying their bowels within a specified time of three minutes. It is concluded that whilst predisposing risk factors do not pose a threat to the onset of any form of cancer among respondents, precipitating factors are real major factors that need to be addressed through information, education and communication (I.E.C). Such an I.E.C. should be geared towards promotion of healthy eating and life style strategies. Alter all, 'the first step in cancer prevention is knowing the risk profile'.

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

    PubMed

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

    2015-09-01

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

  11. Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative

    PubMed Central

    Gunn, Jayleen K. L.; Ehiri, John E.; Jacobs, Elizabeth T.; Ernst, Kacey C.; Pettygrove, Sydney; Osuji, Alice; Ogidi, Amaka G.; Musei, Nnabundo; Obiefune, Michael C.; Ezeanolue, Chinenye O.; Ezeanolue, Echezona E.

    2017-01-01

    Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women’s limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17–45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38–0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04–2.28). Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS. PMID:28355302

  12. Prospects of using community directed intervention strategy in delivering health services among Fulani Nomads in Enugu State, Nigeria

    PubMed Central

    2013-01-01

    Background The Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads. Study design and methods This exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area. Results Like sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises. Conclusion Given the definable

  13. Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting

    PubMed Central

    2014-01-01

    Background Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting. Methods A cross-sectional study conducted at three university teaching hospitals in Uganda. Self-guided questionnaires were left at a central location in each of the surgical departments after verbally communicating to the surgeons of the intention of the study. Filled questionnaires were returned at the same location by the respondents for collection by the research team. In addition, 20 in-depth interviews were held with surgeons and a review of 384 patients’ record files for informed consent documentation was done. Results A total of 132 (62.1%) out of 214 questionnaires were completed and returned. Respondents were intern doctors, residents and specialists from General surgery, Orthopedic surgery, Ear, Nose and Throat, Ophthalmology, Dentistry, Obstetrics and Gynaecology departments. The average working experience of respondents was 4.8 years (SD 4.454, range 0–39 years). 48.8% of the respondents said they obtained consent all the time surgery is done while 51.2% did not obtain consent all the time. Many of the respondents indicated that informed consent was not obtained by the surgeon who operated the patient but was obtained either at admission or by nurses in the surgical units. The consent forms used in the hospitals were found to be inadequate and many times signed at admission before diagnosing the patient’s disease. Conclusions Informed consent administration and documentation for

  14. Increasing Trends of Diabetes Mellitus and Body Weight: A Ten Year Observation at Gondar University Teaching Referral Hospital, Northwest Ethiopia

    PubMed Central

    Abebe, Solomon Mekonnen; Berhane, Yemane; Worku, Alemayehu; Alemu, Shitay

    2013-01-01

    Background Diabetes mellitus is becoming one of the major causes of premature adult mortality in developing countries. However, there is a very little documentation of the morbidity trend in such countries. Objective To assess the ten-year trend of diabetes mellitus at Gondar University Teaching Referral Hospital, northwest Ethiopia. Methods A hospital-based retrospective record review was done at the main referral hospital in northwest Ethiopia. Data were obtained from medical records of all registered diabetic patients in the Diabetic Follow up Clinic between 2000 and 2009. An Extended Mantel-Haenzel chi-square test for the linear trend was used to examine the trend over time. Result Out of the total 354,524 patients who visited the Outpatient Department of the hospital during the study period, 1553 (4.4/1000) were diabetes patients, of which 50.1% was type 1 and 49.9% type 2 diabetes mellitus. The average increase in the proportion of both Type 1 and Type 2 diabetes mellitus cases between 2000 and 2009 was 125%. The mean (±SD) age for Type 1 diabetes mellitus was 29.1 (±12), and 53.5 (±12) for Type 2 diabetes. Overall 42.5% of the diabetes mellitus patients were female and 31.7% were rural residents. The mean body mass index for both type of diabetes mellitus increased from 15.9 to 18.3 kg for type 1 and from 23.8 to 24.6 for type 2 between 2000 and 2009, respectively. Conclusion The number of diabetes mellitus cases seen at Gondar Referral Hospital is rising steadily. A comprehensive diabetes prevention, treatment, and care program is needed to improve the quality of life of the increasing diabetes mellitus cases in Ethiopia. PMID:23536904

  15. Antibiotic Resistance Profile and Distribution of Oxacillinase Genes Among Clinical Isolates of Acinetobacter baumannii in Shiraz Teaching Hospitals, 2012 - 2013

    PubMed Central

    Kooti, Sara; Motamedifar, Mohammad; Sarvari, Jamal

    2015-01-01

    Background: The emergence of multidrug-resistant Acinetobacter baumannii complicates the therapy of the related infections. Hospital isolates of A. baumannii are usually multidrug-resistant. The problem is compounded by increasing resistance to broad-spectrum antibiotics including carbapenems. Objectives: The aim of this study was to determine antimicrobial susceptibility patterns and distribution of blaOXA-type carbapenemases genes among A. baumannii isolates from hospitalized patients in Shiraz, Southwest Iran. Materials and Methods: Two hundred A. baumannii isolates were recovered from different clinical specimens in four Shiraz teaching hospitals. Isolates were detected as A. baumannii by Microgen kit and PCR with specific primers of blaOXA-51-like gene. Antimicrobial susceptibility testing was determined by disk diffusion method for all the isolates. Multiplex PCR assays were performed for detection of blaOXA-23-like, blaOXA-24-like and blaOXA-58-like genes. Results: All the isolates were susceptible to colistin and polymyxin B. Moreover, all of them were resistant to piperacillin, piperacillin-tazobactam, ampicillin, ceftazidime, cefoxitin and aztreonam. Eighty (40%) isolates had positive results for blaOXA-23-like, 14 (7%) for blaOXA-24-like and 1 (0.5%) isolate for blaOXA-58-like. The co-existence of studied genes was detected for blaOXA-23-like plus blaOXA-24-like in nine (4.5%) isolates. Conclusions: The prevalence of carbapenem resistant A. baumannii isolates in Shiraz hospitals is high. The blaOXA-23-like gene was the most frequent carbapenemase identified among resistant A. baumannii isolated in Shiraz hospitals. The increasing incidence of A. baumannii is a serious concern, therefore control of this pathogen and taking preventive measures are emphasized. PMID:26464764

  16. Implementation of an enterprise risk-management program in a community teaching hospital.

    PubMed

    Behamdouni, Genefer; Millar, Kathy

    2010-01-01

    As the complexity of healthcare and expectations of comprehensive and transparent public accountability heighten, so too must a hospital's approach to assessing and managing risk. Over a period of two years, the area of patient safety and risk at our hospital has moved from a traditional focus on clinical risk management to an enterprise-wide risk management approach. One of the first community hospitals to embrace enterprise risk management (ERM), St. Joseph's Health Centre, in Toronto, Ontario, has seen early benefits in this transformational journey. This article discusses our approach to the development of an ERM program, tools used and lessons learned.

  17. Effect of Structured Teaching Programme on Levels of Knowledge regarding Narcotic Policy among Staff Nurses in Selected Hospitals of Bangalore.

    PubMed

    Swapna, Mary A; Parvathy, Mohan

    2014-01-01

    This study aims to determine the level of knowledge among staff nurses on Narcotic policy and ascertain their knowledge by structured teaching programme with pre-test, post-test method The study attempted to assess the knowledge on Narcotic policy among staff nurses before and after structured teaching programme; evaluate the effectiveness of structured teaching programme on narcotic policy among staff nurses; and to find out the association between post level of knowledge among staff nurses on narcotic policy and selected demographic variables. A quasi-experimental study was carried out with 60 staff nurses from BGS & Jeevani Sarvodaya Hospital, Bangalore. A structured knowledge questionnaire was used to evaluate the knowledge level on narcotic policy before & after an STP. Data were analysed with chi-square and t test. The result showed that there was a significant difference between pre-test and post-test knowledge scores as assessed by the paired t-test value at 36.766 (HS p = 0.001). There was significant association between knowledge and the selected demographic variables (age, area of experience and years of experience (p ≤ 0.05). Thus for this study one can conclude that STP could be an effective strategy to improve the knowledge of staff nurses on narcotic policy.

  18. Time trends and risk factors for diabetes mellitus in cats presented to veterinary teaching hospitals.

    PubMed

    Prahl, Annalisa; Guptill, Lynn; Glickman, Nita W; Tetrick, Mark; Glickman, Larry T

    2007-10-01

    Veterinary Medical Data Base records of cats with diabetes mellitus (DM) from 1970 through 1999 were reviewed to identify trends in hospital prevalence of DM and potential host risk factors. Hospital prevalence increased from eight cases per 10,000 in 1970 to 124 per 10,000 in 1999 (P < 0.001). Case fatality percent at first visit decreased from 40% to 10% (P < 0.001). Hospital prevalence increased in all age groups (P < 0.002). There was no apparent seasonal pattern in hospital prevalence. Significant risk factors included male gender, increasing age for both genders (P < 0.001), increasing weight for males (P < 0.001), and mixed vs pure breed for females (P = 0.006).

  19. Effect of Concept Mapping and Outline Note-Taking Patterns in Students Academic Achievement in Geography in Secondary Schools in Enugu South Lga of Enugu State

    ERIC Educational Resources Information Center

    Okafor, Gabriel A.

    2016-01-01

    The WAEC Chief Examiner's report of 2013 pointed out that mass failure in geography had badly affected students who have the desire to study science related subjects in our Universities. The poor image of geography among students was attributed partly to its wide content and partly to the old fashioned approach to its teaching. This study…

  20. [Epidemiological features of multidrug resistant bacteria isolated from urine samples at the Mohammed V Military Teaching Hospital in Rabat, Morocco].

    PubMed

    Zohoun, A; Ngoh, E; Bajjou, T; Sekhsokh, Y; Elhamzaoui, S

    2010-08-01

    Hospital-acquired multidrug resistant bacteria infections are a serious public health issue causing increased morbidity, mortality and care cost. These risks underscore the need for health care institutions to maintain active panels to monitor, prevent, and manage hospital-acquired infections. The purpose of this study was to assess the epidemiology of urinary tract infection involving multidrug resistant bacteria at the Microbiology Laboratory of the Mohammed-V Military Teaching Hospital in Rabat. Study was carried out retrospectively on bacteria isolated from 10,243 urinary samples collected from January 1 to December 31, 2008. A total of 1,439 non-redundant bacteria (14.1%) meeting the criteria of urinary infection were identified. One hundred and three of the 1,439 bacteria isolated (7%) were multidrug resistant. Multidrug-resistant bacteria were more common in in-patients (63.1%). Mean patient age was 53.8 +/- 18.2 and the M/F sex ratio was 2.2. The most common multi-drug resistant bacteria were Enterobacteria producing extended spectrum bêta-lactamase (54.4% including 40.8% of Klebsiella pneumonia) and non-fermenting bacteria (45.6% including 26.2% of Pseudomonas aeruginosa. and 19.4% of Acinetobacter baumannii. These bacteria were resistant to the most commonly used antibiotics but remained highly sensitive to colistin, imipenem and amikacin.

  1. Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods.

    PubMed

    Drake, Gareth; de C Williams, Amanda C

    2017-02-01

    The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings.

  2. Antimicrobial resistance pattern of gram-negative bacteria of nosocomial origin at a teaching hospital in the Islamic Republic of Iran.

    PubMed

    Khalili, H; Soltani, R; Safhami, S; Dashti-Khavidaki, S; Alijani, B

    2012-02-01

    The emergence of antimicrobial resistance is a global problem in the community and in hospitals. Antibiotic resistance of Gram-negative bacteria from nosocomial infections were evaluated during a 6-month period at Shariati teaching hospital, Tehran, Islamic Republic of Iran. Susceptibility tests were performed on 570 Gram-negative isolates obtained from clinical samples of patients infected after at least 72 hours stay in the hospital. Escherichia coli was the most frequently isolated Gram-negative organism (42.6%). The highest rate of resistance in Gram-negative isolates was seen in the intensive care unit, with Acinetobacter spp. as the most resistant organisms. Gentamicin was the most effective antibiotic against E. coli and all other isolates, while ciprofloxacin was also effective against a wide range of other species. Antibiotic resistant Gram-negative nosocomial infection is prevalent in this teaching hospital in Tehran.

  3. Population-based prevalence of high blood pressure among adults in an urban slum in Enugu, South East Nigeria.

    PubMed

    Ezeala-Adikaibe, B A; Orjioke, C; Ekenze, O S; Ijoma, U; Onodugo, O; Okudo, G; Okwara, C; Chime, P; Mbadiwe, N; Eddy, A; Onyekonwu, C; Onyebueke, G; Ulasi, I; Mba, A U

    2016-04-01

    In sub-Saharan Africa (SSA), rapid urbanization and changing lifestyle have modified the profile and pattern of various medical disorders. Apart from high prevalence rates, recent trends with regard to hypertension in Africa include: low levels of awareness, treatment and control. Although a large number of studies provide data about hypertension in SSA, few studies focused on special populations such as urban slum dwellers. The WHO STEP-wise approach to surveillance of noncommunicable diseases was used to access the prevalence of hypertension among adults in one of the urban slums in Enugu. Out of the 811 individuals aged 20 years and above surveyed, 774 (95.4%) cases were analyzed. About 4.7% and 2.7% reported a past history of diabetes and stroke, respectively, whereas 15% had a positive family history of hypertension. The mean (95% confidence interval (CI)) body mass index (BMI) was 23.7 (23.2-24.2) kg m(-2) among males and 26.6 (25.7-26.7) kg m(-2) among females (P<0.0001). The prevalence of hypertension was 52.5% (95% CI: 48.9-56.0) and 55.4% (95% CI: 49.5-61.3) in males and 50.8% (95% CI: 46.4-55.1) in females (P=0.23). It increased with age peaking at 45-54 years in females and ⩾55 years in males. About 40.1% were aware of their hypertension and 28.8% of those aware had normal blood pressure. In regression analysis, systolic (R(2)=0.192) and diastolic (R(2)=0.129) blood pressures increased with age and BMI. The prevalence of high blood pressure among adults in Enugu slums is very high and a cause for concern, and calls for urgent attention.

  4. University teaching hospital and private clinic collaboration to enhance veterinary educational opportunities at Mississippi State University.

    PubMed

    Tyner, C Lee; Harkness, John; Hoblet, Kent; Zumwalt, Lauren; Templeton, Karen; McLaughlin, Ron

    2014-01-01

    The College of Veterinary Medicine at Mississippi State University established a not-for-profit corporation (MSU-CVM-COS) to develop and manage private specialty clinics that would enhance teaching and student learning, increase caseload, and generate revenue. The corporation currently operates the Animal Emergency and Referral Center (AERC) and the Veterinary Specialty Center (VSC) as affiliates of Mississippi State University. These privately managed facilities provide access to advanced medical equipment, enhance clinical service and teaching, and promote the College's One Health initiative.

  5. Reducing red cell transfusion by audit, education and a new guideline in a large teaching hospital.

    PubMed

    Garrioch, M; Sandbach, J; Pirie, E; Morrison, A; Todd, A; Green, R

    2004-02-01

    Safety concerns combined with the greatly increased costs and difficulties of maintaining the blood supply are major considerations for transfusion services. Previous local surveys demonstrated that hospital blood use at our hospital could be improved. Excessive cross-matching, unnecessary transfusion and high return rates of unused blood were commonplace. Transfusion practice was audited over a 3-month period. An education package with guidelines for transfusion was delivered to all clinician groups within the hospital, over the following 9 months. The audit was repeated exactly 1 year later at the same time period. During the second audit, inpatient hospital numbers increased by 1.02% (from n = 7262 to n = 7336) but no differences in length of stay, cardiovascular morbidity or mortality were demonstrated. Twenty percent (n = 254, 2002; n = 316, 2001) fewer patients received blood, and the number of red cell packs used reduced by 19% (from n = 1093 to n = 880). Total number of patients transfused reduced from 4.4% to 3.5% which, as an absolute difference, is a reduction of 0.9% (CI 0.3-1.5, P = 0.006). The audit, guideline and education package had a major impact on red cell use within the hospital with no adverse effects. Blood use can be improved by the implementation of a suitable education package and guideline. If it is possible to replicate the results of this education programme nationwide, the effect on blood use, with subsequent savings and enhanced patient safety could be significant.

  6. Clinical benefits, referral practice and cost implications of an in-hospital pain service: results of a service evaluation in a London teaching hospital

    PubMed Central

    Sussman, Maya; Goodier, Elizabeth; Fabri, Izabella; Borrowman, Jessica; Thomas, Sarah; Guest, Charlotte; Bantel, Carsten

    2016-01-01

    Background: In-hospital pain services (IPS) are commonplace, but evidence of efficacy is inadequate, and patients’ pain management in any hospital ward remains problematic. This service evaluation aimed to measure the effect of a contemporary IPS, its appropriate use and cost-efficacy. Methods: Records of 249 adults reviewed by the IPS in an inner London Teaching Hospital over an 8-month period were analysed for demographic data, interventions, workload and change in pain intensity measured by numerical rating scale (NRS). Non-parametric tests were used to evaluate differences between initial and final NRS. Spearman’s rank correlation analysis was used to create a correlation matrix to evaluate associations between all identified independent variables with the change in NRS. All strongly correlated variables (ρ > 0.5) were subsequently included in a binary logistic regression analysis to identify predictors of pain resolution greater than 50% NRS and improvement rather than deterioration or no change in NRS. Finally, referral practice and cost of inappropriate referrals were estimated. Referrals were thought to be inappropriate when pain was not optimised by the referring team; they were identified using a set algorithm. Results: Initial median NRS and final median NRS were significantly different when a Wilcoxon signed-rank test was applied to the whole cohort; Z = –5.5 (p = 0.000). Subgroup analysis demonstrated no significant difference in the ‘mild’ pain group; z = –1.1 (p = 0.253). Regression analysis showed that for every unit increase in initial NRS, there was a 62% chance of general and a 33% chance of >50% improvement in final NRS. An estimated annual cost-saving potential of £1546 to £4558 was found in inappropriate referrals and patients experiencing no benefit from the service. Discussion: Results suggest that patients with moderate to severe pain benefit most from IPS input. Also pain management resources are often

  7. Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India.

    PubMed

    Sonkar, Kamlesh Kumar; Bhoi, Sanjeev Kumar; Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha Kant

    2017-04-01

    Myasthenia gravis (MG) requires lifelong treatment. The cost of management MG is very high in developed countries but there is no information on the cost of management of MG in the developing countries. This study reports the direct and indirect cost and predictors of cost of MG in a tertiary care teaching hospital in India. In a prospective hospital based study, from a tertiary hospital in India 66 consecutive patient during 2014-2015 were included. The age of the patients ranged between 6 and 75years. The severity of MG was assessed by myasthenia gravis foundation association (MGFA) class (MGFA) I-V. The patient data was collected s and their direct cost was calculated from the computerized Hospital information system. The indirect cost was calculated from patient's memory, checking the bills of transportation and wages loss by the patient or the care giver. Total annual cost of MG ranged between INR (4560-532227) with median INR 61390.5 (US$911.64). The median cost of outpatient department (OPD) consultation of 16 patients was INR 20439.9 (US$303.53), of 50 admitted patients was INR 44311.8 (US$658.03) and 21 intensive care unit (ICU) patients was INR 59574.3 (US$ 884.6) and the direct cost of thymectomy was INR 45000 (US$ 668.25). Direct cost was related to indirect cost (r=0.55; p=0.0001). Predictors of patient outcome were severity of MG, ICU admission, and thymectomy. The total median cost for management of myasthenia gravis was INR 61390.5 (4560-532227, US$911.64) per year, and the cost was mainly determined by the severity of MG.

  8. Molecular Diagnostics for Lassa Fever at Irrua Specialist Teaching Hospital, Nigeria: Lessons Learnt from Two Years of Laboratory Operation

    PubMed Central

    Hass, Meike; Gabriel, Martin; Ölschläger, Stephan; Becker-Ziaja, Beate; Folarin, Onikepe; Phelan, Eric; Ehiane, Philomena E.; Ifeh, Veritas E.; Uyigue, Eghosasere A.; Oladapo, Yemisi T.; Muoebonam, Ekene B.; Osunde, Osagie; Dongo, Andrew; Okokhere, Peter O.; Okogbenin, Sylvanus A.; Momoh, Mojeed; Alikah, Sylvester O.; Akhuemokhan, Odigie C.; Imomeh, Peter; Odike, Maxy A. C.; Gire, Stephen; Andersen, Kristian; Sabeti, Pardis C.; Happi, Christian T.; Akpede, George O.; Günther, Stephan

    2012-01-01

    Background Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH) in the central senatorial district of Edo State struggled with this challenge for many years. Methodology/Principal Findings A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12%) tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization—often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005), had lower body temperature (p<0.0001), and had higher creatinine (p<0.0001) and blood urea levels (p<0.0001) than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed—within lineage II—a separate clade that could be further subdivided into three clusters. Conclusions/Significance Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients. PMID:23029594

  9. [Antibacterial activity of antiseptics used at Military Teaching Hospital Mohamed V of Rabat].

    PubMed

    Essayagh, Touria; Elameri, Abdouelouhab; Zohoun, Alban; Miloudi, Mouhcine; Elhamzaoui, Sakina

    2010-01-01

    Antiseptics have a major role against the infections and their prevention. The good management of antiseptics allows the reduction of antibiotics use and thus the emergence of resistant bacterial strains. The evaluation of the antibacterial activity of three antiseptics (povidone iodine [PVPI], iodized alcohol and alcohol 70 degrees) used at HMIMV and taken from pharmacy was based on AFNOR method NF T 72-150. The analysis of their chemical properties were done by standardized methods (manganimetry, Bunsen's method, test to determine sodium thiosulfate levels [or sodium thiosulfate test] and Guy Lussac alcoholmeter). Our results were compared with those obtained in another two university hospitals of Rabat: Hospital of Speciality and Ibn Sina. The frequencies of resistant bacterial strains were respectively 4.6%, 30.7% and 15.4% to PVPI, alcohol iodized and alcohol 70 degrees . Our results have shown that the PVPI is the best antiseptic in our hospital.

  10. A review of opioid prescription in a teaching hospital in Colombia

    PubMed Central

    Moyano, Jairo; Figueras, Albert

    2012-01-01

    Introduction: Review of opioid prescriptions in a hospital provides valuable information to health care professionals which may contribute to proper pain management; opioid utilization studies may help uncover factors that can be improved for better prescribing. To evaluate the use of opioid analgesics in a university hospital, a review of opioids prescribed in hospitalized patients was developed. Methods: Information was obtained from the pharmacy database and medical records. The study period was 1 month. Results: Medical records of 1156 patients admitted in July 2009 were analyzed. The most widely prescribed opioid was tramadol; the preferred administration route was intravenous; the main indication was severe pain; and major prescribers were from surgical departments. Discussion: Underutilization of potent opioids for acute and chronic pain seems to occur. Conclusion: Most prescribers prefer weak opioids, given intravenously to treat acute and chronic pain, while some patients may benefit from the prescription of more potent opioids. PMID:23049273

  11. French 2010-2011 measles outbreak in adults: report from a Parisian teaching hospital.

    PubMed

    Caseris, M; Houhou, N; Longuet, P; Rioux, C; Lepeule, R; Choquet, C; Yazdanpanah, Y; Yeni, P; Joly, V

    2014-04-01

    We reviewed 80 adult cases of measles seen in a Parisian hospital during the French 2010-2011 outbreak. Fifty per cent had at least one complication: pneumonia and hepatitis were the most frequent. Forty per cent of hospitalized cases did not have any complications, suggesting clinically poor tolerance of measles in adults. The outcome was always favourable. Subjects were younger, were more often French nationals and had a higher socio-economic status than the overall population. This report suggests that immunity resulting from natural disease in patients from an area where the disease is endemic is protective in the long term.

  12. Cefotaxime-resistant Citrobacter freundii in isolates from blood in a tertiary teaching hospital in Northern Taiwan.

    PubMed

    Liu, Chang-Pan; Weng, Li-Chuan; Tseng, Hsiang-Kuang; Wang, Nai-Yu; Lee, Chun-Ming

    2007-10-01

    From January 2002 to December 2003, 12 patients in a tertiary teaching hospital in northern Taiwan had bloodstream infections caused by Citrobacter freundii. Seven of the 12 isolates were resistant to cefotaxime. Using polymerase chain reaction and DNA sequencing, 3 of the 7 cefotaxime-resistant C. freundii isolates were found to carry extended-spectrum beta-lactamase (ESBL). AmpC beta-lactamase genes were also detected in all strains of C. freundii. All strains of C. freundii with MICs >or=4 mg/L for cefepime were positive for ESBL. Rather than performing PCR on all cefotaxime-resistant C. freundii isolates, assessment of the MIC for cefepime might be a practical way to choose between treatment with cefepime or with carbapenems.

  13. Antimicrobial resistance and prevalence of canine uropathogens at the Western College of Veterinary Medicine Veterinary Teaching Hospital, 2002-2007.

    PubMed

    Ball, Katherine R; Rubin, Joseph E; Chirino-Trejo, M; Dowling, Patricia M

    2008-10-01

    Between January 2002 and June 2007, uropathogens were isolated from 473 of 1557 canine urine samples submitted to Prairie Diagnostic Services from the Western College of Veterinary Medicine Veterinary Teaching Hospital. Culture and susceptibility results were analyzed, retrospectively, to estimate the prevalence of common bacterial uropathogens in dogs with urinary tract infections and to identify changes in antimicrobial resistance. The most common pathogens identified were Escherichia coli, Staphylococcus intermedius, Enterococcus spp., and Proteus spp. Antimicrobial resistance increased during the study period, particularly among recurrent E. coli isolates. Using the formula to help select rational antimicrobial therapy (FRAT), bacterial isolates were most likely to be susceptible to gentamicin, fluoroquinolones, amoxicillin-clavulanic acid, and groups 4 and 5 (third generation) cephalosporins.

  14. Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services. Teaching Case

    ERIC Educational Resources Information Center

    Tan, Kar Way; Shankararaman, Venky

    2014-01-01

    It was 2:35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH's Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90%…

  15. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India.

    PubMed

    Deorukhkar, Sachin C; Saini, Santosh

    2016-01-01

    Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient's underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.

  16. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India

    PubMed Central

    Deorukhkar, Sachin C.; Saini, Santosh

    2016-01-01

    Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient's underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp. PMID:26904115

  17. Attitudes about Death, Dying, and Terminal Care: Differences among Groups at a University Teaching Hospital.

    ERIC Educational Resources Information Center

    Hatfield, C. B.; And Others

    1983-01-01

    Studied attitudes of eight hospital groups on several aspects of terminal care by means of a questionnaire. Responses of the groups, which included physicians, residents, nurses, aides, and orderlies, did not differ on general statements about terminal care. On more specific statements perception of personal involvement influenced responses.…

  18. An outbreak of a nosocomial NDM-1-producing Klebsiella pneumoniae ST147 at a teaching hospital in mainland China.

    PubMed

    Wang, Xiaojuan; Xu, Xiuli; Li, Zongwei; Chen, Hongbin; Wang, Qi; Yang, Peihong; Zhao, Chunjiang; Ni, Ming; Wang, Hui

    2014-04-01

    A total of 1,870 nonduplicate clinical Enterobacteriaceae from 13 teaching hospitals located in 11 provinces of mainland China from 2011 to 2012 were screened for the presence of the blaNDM gene. The high-throughput MiSeq sequencing method and comparative genomics were used to analyze the genetic environment of blaNDM among these isolates. Three blaNDM-1-carrying Klebsiella pneumoniae (0.16%, 3/1,870), isolated from a teaching hospital in Xi'an, exhibited high levels of resistance to all β-lactams, but remained susceptible to amikacin, tigecycline, and polymyxin B. These three isolates, belonging to ST147, presented an identical pulsed-field gel electrophoresis pattern. The IncX3 plasmid, pNDM-SX04 (KC876051) showed 99% identity with plasmid pNDM-HN380 (JX104760). Comparative analysis of the genetic environment of blaNDM-1 with previously published plasmids revealed the same 7,830-bp basic mobile element, which may have been derived from Acinetobacter spp. Partial ISAba125, ISAba125 promoter, blaNDM-1, and bleMBL could serve as the minimal mobile vehicle facilitating horizontal transfer of the blaNDM-1 gene. To our knowledge, this is the first report of an outbreak of blaNDM-1-carrying ST147 K. pneumoniae. Although the prevalence spread by the blaNDM-1 gene prevalence is at a low frequency in mainland China, a dynamic national surveillance of this gene is needed due to its potential transferability.

  19. A 3-Year Review of Cranial Nerve Palsies from the University of Port Harcourt Teaching Hospital Eye Clinic, Nigeria

    PubMed Central

    Pedro-Egbe, Chinyere Nnenne; Fiebai, Bassey; Awoyesuku, Elizabeth Akon

    2014-01-01

    Purpose: To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital. Materials and Methods: A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cerebrovascular disease. Exclusion criteria included medical charts with incomplete data. Data was analyzed using Epi-info Version 6.04D. Statistical significance was indicated by P < 0.05. Results: Twenty-four patients had cranial nerve palsies. There were 11 males and 13 females with a mean age of 34.50 ± 18.41 years. Four patients (26.6%) had exotropia while three patients (20%) had esotropia. Complete ophthalmoplegia was noted in two patients (13.3%). The 3rd and 6th cranial nerves were affected in seven patients each (29.2%) and five patients (20.8%) had 7th cranial nerve palsy. Approximately 38% of patients with cranial nerve palsies had systemic disorders (16.7% systemic hypertension; 12.5% DM). The relationship between cranial nerve palsy and systemic disorder was statistically significant (P < 0.01). Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6th cranial nerve palsy. PMID:24791110

  20. Hepatitis B virus genotypes among chronic hepatitis B patients reporting at Korle-Bu teaching hospital, Accra, Ghana

    PubMed Central

    Dongdem, Anthony Zunuo; Dzodzomenyo, Mawuli; Asmah, Richard Harry; Nyarko, Kofi Mensah; Nortey, Priscillia; Agyei, Adwoa; Adjei, David Nana; Kenu, Ernest; Adjei, Andrew Anthony

    2016-01-01

    Introduction Knowledge of hepatitis B virus (HBV) genotype is an important predictive variable which might have an impact in management and treatment of patients with chronic hepatitis B infection. In Ghana very little information is available on hepatitis B genotypes. This study was conducted to determine the distribution of HBV genotypes circulating among chronic hepatitis B patients reporting at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. Methods Blood samples (10 ml) were collected from 250 consenting patients. DNA was extracted and amplified using polymerase chain reaction technique. Restriction fragment length polymorphism (RFLP) was used for the detection of genotypes. Results Out of the 250 chronic hepatitis B patients who were HBsAg positive, 91 (36.4%) were males aged 29.8 ± 9.1 and 159 (63.6%) females aged 33± 12.1 years. HBV DNA was detected in 111 (44.4%) but only 58 (52%) of these were typeable. These were classified as genotype A, 8 (7.2%); genotype D, 3 (2.7%) and genotype E, 47 (42.3%). Our results did not show any association between the infecting genotype and age (X2= 0.923; p-value=0.623) or gender (X2= 0.283, p= 0.579). Conclusion Consistent with similar studies worldwide, the results suggest that genotypes A, D and E were the genotypes circulating among chronic hepatitis B patients who reported to the Korle-Bu Teaching Hospital with genotype E being the most predominant and therefore constitutes an important public health concern. We recommend further epidemiological studies to understand the implication of genotype E in terms of disease progression and treatment. PMID:28210373

  1. Prevalence and Factors Associated with Renal Dysfunction in HIV Positive and Negative Adults at the University Teaching Hospital, in Lusaka

    PubMed Central

    Banda, Justor; Mweemba, Aggrey; Siziya, Seter; Mweene, Morgan; Andrews, Ben; Lakhi, Shabir

    2013-01-01

    Background Despite having the highest disease burden of HIV, Sub-Saharan Africa has limited data on HIV related kidney disease with most available data coming from the developed countries. Kidney disease is a recognised complication in HIV infected patients presenting with acute renal failure (ARF) or chronic kidney disease (CKD). This study investigated the prevalence and risk factors associated with renal dysfunction among hospitalised HIV infected patients at the University Teaching Hospital (UTH), Lusaka. Methodology We conducted a cross sectional study at the University Teaching Hospital Lusaka, in Zambia. Inclusion criteria were hospitalised patients aged 16years and above who consented to the study. Both HIV infected and uninfected patients were included in the study. After obtaining demographic information, study participants were screened for HIV upon their consenting for the test. A full clinical history and examination was done by study physician to determine factors associated with renal dysfunction. Results Of the 300 recruited hospitalised patients in this cross sectional study, 142(47%) were HIV infected. We observed a high prevalence of renal dysfunction among hospitalised HIV infected patients compared to uninfected patients (42% vs. 27%, adjusted OR 1.99, 95% CI 1.20–3.28). They had a twofold increased likelihood of developing kidney dysfunction (OR 1.96,95 CI%; 1.21–3.17). The presence of vomiting was strongly associated with renal dysfunction in both HIV positive (AOR 7.77, 95% CI 2.46-24-53) and negative (AOR4.83, 95%CI 1.40–16.66) subgroups. WHO stage III was associated with renal dysfunction in HIV infected patients. Tenofovir use, (a first line antiretroviral drug in Zambia) and hypotension were not significant factors associated with kidney disease after adjusting for other clinical parameters. Conclusion Renal dysfunction is significantly higher among hospitalised HIV infected compared to uninfected, however tenofovir and hypotension

  2. Emergence of Vancomycin-resistant Enterococci at a Teaching Hospital, Saudi Arabia

    PubMed Central

    Alotaibi, Fawzia E; Bukhari, Elham E

    2017-01-01

    Background: Vancomycin-resistant enterococci (VRE) are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units (ICUs) patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia. Methods: A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection. Data were collected using laboratory results and the medical records of admitted patients and were analyzed using SPSS version 19.0 statistical software. Results: In a one-year period, 231 enterococci were isolated from blood, urine, exudates, sputum, stool, and body fluid. There were 191 (82.7%) vancomycin-sensitive enterococci (VSE) and 40 (17.3%) isolates were VRE. The Enterococcus species included E. faecalis 168 (72.7%), E. faecium, 53 (22.8%) E. gallinarum 5 (2.2%), and E. avium 5 (2.2%). VRE were more significant from blood specimens (P < 0.0001) while VSE were significantly more predominant from urine specimens (P < 0.0001). VRE were more commonly isolated from patients in ICUs and oncology unit (P = 0.0151 and P < 0.001, respectively) while VSE were more predominant in the medical and surgical areas (P = 0.0178 and P = 0.0178, respectively). Conclusions: This study highlights the high prevalence of VRE in the hospital and the association of enterococcal infections with high-risk areas and oncology units, which warrant more studies looking for better management of these infections. PMID:28139519

  3. Molecular epidemiology of environmental MRSA at an equine teaching hospital: introduction, circulation and maintenance.

    PubMed

    van Balen, Joany; Mowery, Jade; Piraino-Sandoval, Micha; Nava-Hoet, Rocio C; Kohn, Catherine; Hoet, Armando E

    2014-03-19

    The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contamination over time using molecular epidemiological analyses. For this purpose, a yearlong active MRSA surveillance was performed targeting the environment and incoming patients. Antimicrobial susceptibility testing, SCCmec typing, PFGE typing, and dendrographic analysis were used to characterize and analyze these isolates. Overall, 8.6% of the surfaces and 5.8% of the horses sampled were positive for MRSA. The most common contaminated surfaces were: computers, feed-water buckets, and surgery tables-mats. Ninety percent of the isolates carried SCCmec type IV, and 62.0% were classified as USA500. Molecular analysis showed that new pulsotypes were constantly introduced into the hospital throughout the year. However, maintenance of strains in the environment was also observed when unique clones were detected for 2 consecutive months on the same surfaces. Additionally, pulsotypes were circulating throughout several areas and different contact surfaces of the hospital. Based on these results, it is evident that MRSA is constantly introduced and frequently found in the equine hospital environment, and that some contact surfaces could act as "hot-spots". These contaminated surfaces should be actively targeted for strict cleaning and disinfection as well as regular monitoring.

  4. Coproduction of KPC-2 and IMP-10 in Carbapenem-Resistant Serratia marcescens Isolates from an Outbreak in a Brazilian Teaching Hospital

    PubMed Central

    Silva, Kesia Esther; Cayô, Rodrigo; Carvalhaes, Cecilia Godoy; Patussi Correia Sacchi, Flávia; Rodrigues-Costa, Fernanda; Ramos da Silva, Ana Carolina; Croda, Julio; Gales, Ana Cristina

    2015-01-01

    We describe an outbreak caused by KPC-2- and IMP-10-producing Serratia marcescens isolates in a Brazilian teaching hospital. Tigecycline was the only active antimicrobial agent tested. The blaIMP-10 gene was located in a new class 1 integron, named In990, carried by a nonconjugative plasmid, in contrast to blaKPC-2. PMID:25878341

  5. Enhanced surveillance of meticillin-resistant Staphylococcus aureus bacteraemia in a London teaching hospital.

    PubMed

    Jeyaratnam, D; Edgeworth, J D; French, G L

    2006-08-01

    In 2001, the UK Department of Health introduced mandatory surveillance of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias (blood-culture-positive episodes) in English hospitals. We performed enhanced surveillance in their hospital between April 2001 and March 2003 to determine the epidemiology of MRSA bacteraemia across different specialities. There were 267 MRSA-blood-culture-positive episodes, giving a rate of 0.37 per 1000 occupied bed-days (OBD). Thirty-three (12.4%) episodes were false positives due to contaminants and 15 (5.6%) originated in the community or at another institution. Thirty-one (11.6%) episodes were in outpatients or occurred after recent discharge and were designated 'hospital associated'. The remaining 188 cases were clinically significant hospital-acquired episodes in inpatients, with a rate of 0.26 per 1000 OBDs. The highest rates were in the intensive therapy unit (ITU; 2.74 per 1000 OBDs) and the high-dependency unit (HDU; 1.68 per 1000 OBDs). Fifty-five non-ITU, non-HDU episodes occurred in patients who had been discharged from ITU or HDU prior to the development of bacteraemia but during the same admission. The number of MRSA bacteraemias related to ITU/HDU suggests that these wards may be hubs of MRSA infection. Haematology, oncology and renal (HOR) patients had the greatest number of hospital-associated episodes. The most common source of MRSA bacteraemia was a vascular access device (VAD) (108 episodes, 57%, 64% of which were central lines). The high bacteraemia rates in ITU, HDU and HOR patients were associated with high usage of VADs. The majority of episodes occurred in patients who were newly colonized with MRSA after admission. Thus, in this hospital, VADs and stays in ITU or HDU are important risk factors for bacteraemia, and VAD care and prevention of cross-infection are priorities for intervention. We recommend that the mandatory national surveillance scheme should collect additional data on MRSA bacteraemia to

  6. A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru

    PubMed Central

    Kumar, M. Shashi; Goud, B. Ramakrishna; Joseph, Bobby

    2014-01-01

    Introduction: The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital. Objectives of the Study: To identify existing practices and occupational safety and health (OSH) measures in the Laundry Department and to assess the use of personal protective equipments (PPEs) among health care workers. Materials and Methods: A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study. Results: The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department. PMID:25006311

  7. Improving diagnosis of pulmonary tuberculosis among HIV/AIDS patients: literature review and experience in a teaching hospital in Indonesia.

    PubMed

    Rewata, Lidya; Rutherford, Merrin; Apriani, Lika; Janssen, Willem; Rahmadi, Andri; Parwati, Ida; Yuwono, Arto; van Crevel, Reinout

    2009-07-01

    HIV infection hampers diagnosis of pulmonary tuberculosis (PTB) because many pathogens cause pulmonary infection in HIV people and the load of Mycobacterium tuberculosis is lower in HIV patients. We conducted a literature review and prospectively examined clinical, radiological, and laboratory diagnosis of PTB in 71 HIV-patients (29 inpatients and 42 outpatients) in a teaching hospital in West Java, Indonesia. For both in- and outpatients, signs and symptoms were sensitive but not specific for PTB. Chest X-ray (CXR) was sensitive but less specific. Among hospitalized PTB suspects, 28,8% could not expectorate sputum. Compared to culture, ZN had a sensitivity of 11.1% and 66.7% for in- and outpatients, respectively. From the literature, fluorescence microscopy, liquid culture, and nucleic acid assays can improve diagnosis of PTB in HIV, while IFNg-release assays lack sensitivity, especially in advanced HIV. The current practice of using CXR and microscopy lacks sensitivity for diagnosing PTB in HIV patients. Sputum culture is more sensitive but slow. Fluorescence microscopy might be a quick, relatively sensitive and feasible option in Indonesia. However, because of the frequent absence of sputum, especially in patients with advanced HIV-AIDS patients, there is an urgent need for alternative diagnostic methods using blood or urine.

  8. Managerial control vs professional autonomy: an empirical study on perceptions and expectations of physicians at teaching hospitals in Turkey.

    PubMed

    Kilic, Mustafa; Arslan, Mahmut; Leblebici, Dogan Nadi; Aydin, Mehmet Devrim; Oktem, M Kemal

    2008-04-01

    This study investigates the effects of work context on professional job processes in large organizations in general, and the differences of perceptions and expectations of physicians for professional autonomy in different work environments in specific. An empirical study was conducted on "perceptions and expectations of physicians" in terms of their control over diagnosis and treatment process in different teaching hospitals in Turkey. Results exhibit that the difference between expectation and perception on "the control over diagnosis and treatment process", one of the crucial elements in professional autonomy of physicians, is statistically significant among the surveyed hospitals. The reason of this difference seems to be the managerial practices of each organization. Thus, the study emphasizes the need of assessing the problematic job procedures and of changing them with the most effective ones to create a synergy instead of conflict in the work setting. This synergy in the health care organizations means a balance between managerial control and professional autonomy and a better health service to the patient.

  9. Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

    PubMed

    Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W

    2016-06-01

    This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases.

  10. [Security agents on the front line against Ebola: roles, perceptions and knowledge in Fann Teaching Hospital, Dakar, Senegal].

    PubMed

    Lanièce, C; Sow, K; Desclaux, A

    2016-10-01

    Security agents are on the front line when patients arrive at health facilities, giving them a potential role to play in an Ebola virus disease (EVD) outbreak. The position of security agents within health services is poorly documented. A survey was conducted to clarify their understanding of Ebola pathology, to assess their need for information and to determine their role in patient management. The survey included both qualitative and quantitative aspects. 80 security agents of the Fann teaching hospital (Dakar) completed questionnaires, and 11 were interviewed. Qualitative analysis was performed with Dedoose and the quantitative analysis using Excel. The results show that security agents' activities go beyond their mission of security and control. They are involved in informing, orienting and assisting patients and those accompanying them in the hospital. The security agents have basic knowledge of EVD, but overestimate the risk of transmission. They want to be more informed and to have access to protective material. These results suggest that these professionals should be taken into account when developing response strategies to Ebola outbreaks. Their knowledge of and protection against the disease must be strengthened. Non-health professionals working in health facilities should be trained in order to be able to relay information to the public.

  11. Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital

    PubMed Central

    Alvim, Mariana Macedo; da Silva, Lidiane Ayres; Leite, Isabel Cristina Gonçalves; Silvério, Marcelo Silva

    2015-01-01

    Objective To evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs. Methods This cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system. Results The daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%. Conclusion The current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant. PMID:26761473

  12. High incidence of hepatitis B infection after treatment for paediatric cancer at a teaching hospital in Baghdad.

    PubMed

    Al-Jadiry, M F; Al-Khafagi, M; Al-Darraji, A F; Al-Saeed, R M; Al-Badri, S F; Al-Hadad, S A

    2013-02-01

    This study estimated the incidence of viral hepatitis in children treated for cancer, to identify variables that could affect this incidence and to assess the role of hepatitis B virus (HBV) vaccination in preventing infection. Between September 2007 and June 2008, 256 children in the haemato-oncology unit at the Children's Welfare Teaching Hospital, Baghdad, were studied prospectively. Demographic and clinical data and vaccination history were recorded. Patients were tested for HBV at the time of diagnosis (all were negative) and after starting chemotherapy. On admission to the unit, 231 patients (90.2%) were revaccinated. At reassessment after treatment for cancer, HBV infection was found in 70 patients (27.3%). The variables that significantly increased the risk for HBV infection were a diagnosis of leukaemia and receiving more than 3 units of blood. A higher number of HBV vaccinations in hospital reduced the risk for HBV infection. The high rate of acquisition of HBV infection found in this study indicates the need for better screening of blood products and adherence to aseptic techniques in management of this group of patients.

  13. Resource impact of managing suspected Middle East respiratory syndrome patients in a UK teaching hospital.

    PubMed

    Veater, J; Wong, N; Stephenson, I; Kirk-Granger, H; Baxter, L F; Cannon, R; Wilson, S; Atabani, S; Sahota, A; Bell, D; Wiselka, M; Tang, J W

    2017-03-01

    Clinical challenges exist in the management of hospitalized patients returning to the UK with potential Middle East respiratory syndrome coronavirus (MERS-CoV) infection, particularly with its clinical overlap with influenza, as demonstrated in this case-series and cost-analysis review of returning Hajj pilgrims. These patients were hospitalized with acute febrile respiratory illness, initially managed as potential MERS-CoV infections, but were eventually diagnosed with influenza. Additional costs were small, yet enhanced infection prevention measures created significant burdens on isolation rooms and staff time. Planning for predictable events such as Hajj is important for resource management. Here, in-house MERS-CoV diagnostic testing would have facilitated earlier diagnosis and discharge.

  14. Assessment of patient safety culture among healthcare providers at a teaching hospital in Cairo, Egypt.

    PubMed

    Aboul-Fotouh, A M; Ismail, N A; Ez Elarab, H S; Wassif, G O

    2012-04-01

    A previous study in Cairo, Egypt highlighted the need to improve the patient safety culture among health-care providers at Ain Shams University hospitals. This descriptive cross-sectional study assessed healthcare providers' perceptions of patient safety culture within the organization and determined factors that played a role in patient safety culture. A representative sample of 510 physicians, nurses, pharmacists, technicians and labourers in different departments answered an Arabic version of the Agency of Healthcare Research and Quality hospital survey for patient safety culture. The highest mean composite positive score among the 12 dimensions was for the organizational learning for continuous improvement (78.2%), followed by teamwork (58.1%). The lowest mean score was for the dimension of non-punitive response to error (19.5%). Patient safety culture still has many areas for improvement that need continuous evaluation and monitoring to attain a safe environment both for patients and health-care providers.

  15. Environmental Methicillin-Resistant Staphylococcus aureus in a Veterinary Teaching Hospital During a Nonoutbreak Period

    PubMed Central

    Johnson, Amanda; Nava-Hoet, Rocio C.; Bateman, Shane; Hillier, Andrew; Dyce, John; Gebreyes, Wondwossen A.; Wittum, Thomas E.

    2011-01-01

    Abstract Concurrent to reports of zoonotic and nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in veterinary settings, recent evidence indicates that the environment in veterinary hospitals may be a potential source of MRSA. The present report is a cross-sectional study to determine the prevalence of MRSA on specific human and animal contact surfaces at a large veterinary hospital during a nonoutbreak period. A total of 156 samples were collected using Swiffers® or premoistened swabs from the small animal, equine, and food animal sections. MRSA was isolated and identified by pre-enrichment culture and standard microbiology procedures, including growth on Mueller-Hinton agar supplemented with NaCl and oxacillin, and by detection of the mecA gene. Staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis profile were also determined. MRSA was detected in 12% (19/157) of the hospital environments sampled. The prevalence of MRSA in the small animal, equine, and food animal areas were 16%, 4%, and 0%, respectively. Sixteen of the MRSA isolates from the small animal section were classified as USA100, SCCmec type II, two of which had pulsed-field gel electrophoresis pattern that does not conform to any known type. The one isolate obtained from the equine section was classified as USA500, SCCmec type IV. The molecular epidemiological analysis revealed a very diverse population of MRSA isolates circulating in the hospital; however, in some instances, multiple locations/surfaces, not directly associated, had the same MRSA clone. No significant difference was observed between animal and human contact surfaces in regard to prevalence and type of isolates. Surfaces touched by multiple people (doors) and patients (carts) were frequently contaminated with MRSA. The results from this study indicate that MRSA is present in the environment even during nonoutbreak periods. This study also identified specific surfaces in

  16. Environmental methicillin-resistant Staphylococcus aureus in a veterinary teaching hospital during a nonoutbreak period.

    PubMed

    Hoet, Armando E; Johnson, Amanda; Nava-Hoet, Rocio C; Bateman, Shane; Hillier, Andrew; Dyce, John; Gebreyes, Wondwossen A; Wittum, Thomas E

    2011-06-01

    Concurrent to reports of zoonotic and nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in veterinary settings, recent evidence indicates that the environment in veterinary hospitals may be a potential source of MRSA. The present report is a cross-sectional study to determine the prevalence of MRSA on specific human and animal contact surfaces at a large veterinary hospital during a nonoutbreak period. A total of 156 samples were collected using Swiffers(®) or premoistened swabs from the small animal, equine, and food animal sections. MRSA was isolated and identified by pre-enrichment culture and standard microbiology procedures, including growth on Mueller-Hinton agar supplemented with NaCl and oxacillin, and by detection of the mecA gene. Staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis profile were also determined. MRSA was detected in 12% (19/157) of the hospital environments sampled. The prevalence of MRSA in the small animal, equine, and food animal areas were 16%, 4%, and 0%, respectively. Sixteen of the MRSA isolates from the small animal section were classified as USA100, SCCmec type II, two of which had pulsed-field gel electrophoresis pattern that does not conform to any known type. The one isolate obtained from the equine section was classified as USA500, SCCmec type IV. The molecular epidemiological analysis revealed a very diverse population of MRSA isolates circulating in the hospital; however, in some instances, multiple locations/surfaces, not directly associated, had the same MRSA clone. No significant difference was observed between animal and human contact surfaces in regard to prevalence and type of isolates. Surfaces touched by multiple people (doors) and patients (carts) were frequently contaminated with MRSA. The results from this study indicate that MRSA is present in the environment even during nonoutbreak periods. This study also identified specific surfaces in a

  17. [Implementation of a safety and health planning system in a teaching hospital].

    PubMed

    Mariani, F; Bravi, C; Dolcetti, L; Moretto, A; Palermo, A; Ronchin, M; Tonelli, F; Carrer, P

    2007-01-01

    University Hospital "L. Sacco" had started in 2006 a two-year project in order to set up a "Health and Safety Management System (HSMS)" referring to the technical guideline OHSAS 18001:1999 and the UNI and INAIL "Guidelines for a health and safety management system at workplace". So far, the following operations had been implemented: Setting up of a specific Commission within the Risk Management Committee; Identification and appointment of Departmental Representatives of HSMS; Carrying out of a training course addressed to Workers Representatives for Safety and Departmental Representatives of HSMS; Development of an Integrated Informative System for Prevention and Safety; Auditors qualification; Inspection of the Occupational Health Unit and the Prevention and Safety Service: reporting of critical situations and monitoring solutions adopted. Short term objectives are: Self-evaluation through check-lists of each department; Sharing of the Improvement Plan among the departments of the hospital; Planning of Health and Safety training activities in the framework of the Hospital Training Plan; Safety audit.

  18. The choice of antibiotic in open fractures in a teaching hospital in a developing country.

    PubMed

    Alonge, T O; Salawu, S A; Adebisi, A T; Fashina, A N

    2002-06-01

    Open fracture wounds may be contaminated, and the use of an appropriate antibiotic in the early stages of management reduces the risk of osteomyelitis developing. Environmental factors influence both the type of micro-organisms that are isolated from these wounds and the antibiotics that are chosen to manage the wounds. Before this study, the choice of antibiotic in the management of open fractures in our hospital was based on tradition and 'best guess' antibiotics. In a prospective study of 52 open fractures seen in the accident and emergency unit of University College Hospital, Ibadan, between January and June 2000, the positive bacterial culture yield was more than 70%. Staphylococcus aureus was the commonest microbial isolate, accounting for 37.5% of total isolates. The antibiotic sensitivity pattern revealed high efficacies for pefloxacin, ciprofloxacin and ceftriaxone against the isolated micro-organisms. In comparative costs, these antibiotics are cheaper than the combination of the 'best guess' antibiotics that were used previously. On the strength of this finding, we have suggested a change in the antibiotic policy of the hospital with regard to the antibiotic regimen to be used to complement the surgical management of open fractures.

  19. A prospective review of the labor analgesia programme in a teaching hospital

    PubMed Central

    Sikdar, Indranil; Singh, Shivinder; Setlur, Rangraj; Mohan, C.V.R.; Datta, Rashmi; Patrikar, S.R.

    2013-01-01

    Background The structured labor analgesia programme in our tertiary care hospital has been in place for the past few years. We undertook this study to analyze the programme and to draw conclusions to further improve the outcomes. Methods A prospective analysis of the data pertaining to 200 patients participating in an ongoing labor analgesia programme in a tertiary care hospital from Nov 2008 to Aug 2009 was performed. Results Mean visual analog score (VAS) before epidural block was 8.34 ± 0.79. Post procedure the average VAS score was 2.20 ± 0.79. One hundred and fifty six (78%) parturients delivered vaginally, 18 (9%) required instrumentation with vacuum including 1 forceps delivery in a multiparous parturient. In 17parturients (8.7%) fetal distress led to a decision to perform LSCS for delivery. Multiparous patients were significantly more satisfied as compared to nulliparous patients (p = 0.010). Conclusion The study demonstrated excellent pain relief and patient satisfaction with minimal complications. The safety and efficacy of epidural bupivacaine in concentrations less than 0.625% combined with 25 mcg of fentanyl demonstrated in our study should be considered are commendation for the widespread adoption of the procedure in tertiary care hospitals. PMID:24600144

  20. Utilization study of antidiabetic agents in a teaching hospital of Sikkim and adherence to current standard treatment guidelines

    PubMed Central

    Satpathy, Sushrut Varun; Datta, Supratim; Upreti, Binu

    2016-01-01

    Objective: Diabetes has gradually emerged as one of the most serious public health problems in our country. This underlines the need for timely disease detection and decisive therapeutic intervention. This prospective cross-sectional observational study aims at analyzing the utilization pattern of antidiabetic agents in a remote North-East Indian tertiary care teaching hospital in the perspective of current standard treatment guidelines. Materials and Methods: Diabetic patients receiving antidiabetic medication, both as outpatients and inpatients in our hospital over a period of 12 months (May 2013–May 2014), were included in this study. The data obtained were sorted and analyzed on the basis of gender, type of therapy, and hospital setting. Results: A total of 310 patients were included in the study. Metformin was the single most frequently prescribed antidiabetic agent (66.8%) followed by the sulfonylureas group (37.4%). Insulin was prescribed in 23.2% of the patients. Combination antidiabetic drug therapy (65.1%) was used more frequently than monotherapy (34.8%). The use of biguanides (P < 0.0001) and sulfonylureas (P = 0.02) in combination was significant as compared to their use as monotherapy. A total of 48% of all antidiabetic combinations used, comprised metformin and sulfonylureas (n = 96). Insulin use was significantly higher as monotherapy and in inpatients (P < 0.0001). The utilization of drugs from the National List of Essential Medicines was 51.2%, while 11% of antidiabetics were prescribed by generic name. Conclusion: The pattern of utilization largely conforms to the current standard treatment guidelines. Increased use of generic drugs is an area with scope for improvement. PMID:27413351

  1. Bacteriological Profile and Antibiotic Susceptibility Pattern of Neonatal Sepsis at a Teaching Hospital in Bayelsa State, Nigeria

    PubMed Central

    Peterside, Oliemen; Pondei, Kemebradikumo; Akinbami, Felix O

    2015-01-01

    Background: Sepsis is one of the most common causes of neonatal hospital admissions and is estimated to cause 26% of all neonatal deaths worldwide. While waiting for results of blood culture, it is necessary to initiate an empirical choice of antibiotics based on the epidemiology of causative agents and antibiotic sensitivity pattern in a locality. Objective: To determine the major causative organisms of neonatal sepsis at the Niger Delta University Teaching Hospital (NDUTH), as well as their antibiotic sensitivity patterns, with the aim of formulating treatment protocols for neonates. Methods: Within a 27-month period (1st of October 2011 to the 31st of December 2013), results of blood culture for all neonates screened for sepsis at the Special Care Baby Unit of the hospital were retrospectively studied. Results: Two hundred and thirty-three (49.6%) of the 450 neonates admitted were screened for sepsis. Ninety-seven (43.5%) of them were blood culture positive, with 52 (53.6%) of the isolated organisms being Gram positive and 45 (46.4%) Gram negative. The most frequently isolated organism was Staphylococcus aureus (51.5%) followed by Escherichia coli (16.5%) and Klebsiella pneumoniae (14.4%). All isolated organisms demonstrated the highest sensitivity to the quinolones. Conclusion: Neonatal sepsis is a significant cause of morbidity among neonates admitted at the NDUTH. There is a need for regular periodic surveillance of the causative organisms of neonatal sepsis as well as their antibiotic susceptibility pattern to inform the empirical choice of antibiotic prescription while awaiting blood culture results. PMID:26543394

  2. Feasibility of Energy Medicine in a Community Teaching Hospital: An Exploratory Case Series

    PubMed Central

    Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J.; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill

    2015-01-01

    Abstract Background: Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. Objective: This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Design: Feasibility study, including a prospective case series. Settings: Inpatient units and emergency department. Outcome measures: To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Participants: Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. Results: EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non–pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. Conclusions: This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated

  3. An analysis of serious adverse drug reactions at a tertiary care teaching hospital

    PubMed Central

    Prajapati, Kinjal; Desai, Mira; Shah, Samidh; Panchal, Jigar; Kapadia, Jigar; Dikshit, Ramkumar

    2016-01-01

    Objective: The objective of this study was to analyze the various aspects of serious adverse drug reactions (serious ADRs) such as clinical presentation, causality, severity, and preventability occurring in a hospital setting. Materials and Methods: All serious ADRs reported from January 2010 to May 2015 at ADR Monitoring Centre, Department of Pharmacology, B. J. Medical College and Civil Hospital, Ahmedabad, were selected as per the World health Organization –Uppsala Monitoring Center (WHO-UMC) criteria. A retrospective analysis was carried out for clinical presentation, causality (as per the WHO-UMC scale and Naranjo's algorithm), severity (Hartwig and Siegel scale), and preventability (Schumock and Thornton criteria). Results: Out of 2977 ADRs reported, 375 were serious in nature. The most common clinical presentation involved was skin and appendageal disorders (71, 18.9%). The common causal drug group was antitubercular (129, 34.4%) followed by antiretroviral (76, 20.3%) agents. The criteria for the majority of serious ADRs were intervention to prevent permanent impairment or damage (164, 43.7%) followed by hospitalization (158, 42.1%). Majority of the serious ADRs were continuing (191, 50.9%) at the time of reporting, few recovered (101, 26.9%), and two were fatal. The majority of serious ADRs were categorized as possible (182, 48.8%) followed by probable (173, 46.1%) in nature. Conclusion: Antitubercular, antiretroviral, and antimicrobial drugs were the most common causal drug groups for serious ADRs. This calls for robust ADR monitoring system and education of patients and prescribers for identification and effective management. PMID:27843794

  4. Pharmacovigilance study of Ayurvedic medicine in Ayurvedic Teaching Hospital: A prospective survey study

    PubMed Central

    Ajanal, Manjunath N.; Nayak, Shradda U.; Kadam, Avinash P.; Prasad, B. S.

    2015-01-01

    Introduction: Though Ayurveda is practiced in the Indian subcontinent since centuries, there is a paucity of systematic documentation related to the occurrence of adverse drug reactions (ADR) and other issues regarding the safety of Ayurveda medicines. Aim: To monitor and analyze the pattern and frequency of ADR to Ayurvedic medicines in an Ayurvedic hospital setup. Materials and Methods: In this prospective study, ADR monitoring was done in KLE Ayurveda Secondary Care Hospital, Belgaum, Karnataka, India by spontaneous and intensive monitoring technique for a span of 1-year (June 2010 to May 2011). Data pertaining to patient demography, drug and reaction characteristics, organ system involved and reaction outcomes were collected and evaluated. The reaction severity and predisposing factors were also assessed. Results: In a span of one year, 84 adverse drug events were reported out of which 52 confirmed as ADR. The overall incidence of ADR in the patient population was 1.14%, out of which 23 (44.23%) were related to Panchakarma (detoxification process), 13 (25.00%) related to the herbal formulations and 06 (11.53%) were of Rasa Aushadhi (mineral or herbo-mineral formulations). The commonly affected organ systems were gastrointestinal system 24 (46.15%) and skin 15 (28.84%). The majority of the reactions were moderate 30 (57.69%) to mild 20 (38.46%) in severity. Most patients recovered from the incidence. Conclusion: The present work has documented the incidence and characteristic of ADR to Ayurvedic medicine in a typical Ayurveda hospital setup. This will help in developing various strategies for boosting pharmacovigilance in Ayurveda, thereby ensuring safer use of Ayurveda medicines. PMID:27011712

  5. Case series of naturally acquired Plasmodium knowlesi infection in a tertiary teaching hospital.

    PubMed

    Azira, N M S; Zairi, N Z; Amry, A R; Zeehaida, M

    2012-09-01

    Plasmodium knowlesi is a simian malaria parasite and is recently recognized as the fifth malaria parasite infecting humans. Manifestation of the infection may resemble other infection particularly dengue fever leading to inappropriate management and delay in treatment. We reported three cases of naturally acquired P. knowlesi in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Clinical manifestations were quite similar in those cases. Microscopically, the diagnosis might be challenging. These cases were confirmed by polymerase chain reaction method which serves as a gold standard.

  6. Setting up robotic surgery in gynaecology: the experience of the Strasbourg teaching hospital.

    PubMed

    Sananès, N; Garbin, O; Hummel, M; Youssef, C; Vizitiu, R; Lemaho, D; Rottenberg, D; Diemunsch, P; Wattiez, A

    2011-06-01

    Teleoperated surgical robots could provide a genuine breakthrough in laparoscopy and it is for this reason that the development of robot-assisted laparoscopy is one of the priorities of the Strasbourg University Hospitals' strategic plan. The hospitals purchased a da Vinci S(®) robot in June 2006 and Strasbourg has, in IRCAD, one of the few robotic surgery training centres in the world. Our experience has, however, revealed the difficulties involved in setting up robotic surgery, the first of which are organizational issues. This prospective work was carried out between December 2007 and September 2008, primarily to examine the possibility of setting up robotic surgery on a regular basis for gynaecological surgical procedures at the Strasbourg University Hospitals. We maintained a "logbook" in which we prospectively noted all the resources implemented in setting up the robotic surgery service. The project was divided into two phases: the preparatory phase up until the first hysterectomy and then the second phase with the organization of subsequent hysterectomies. The first surgical procedure took 5 months to organize, and followed 25 interviews, 10 meetings, 53 telephone conversations and 48 e-mails with a total of 40 correspondents. The project was presented to seven separate groups, including the hospital medical commission, the gynaecology unit committee and the surgical staff. Fifteen members of the medical and paramedical team attended a two-day training course. Preparing the gynaecology department for robotic surgery required freeing up 8.5 days of "physician time" and 12.5 days of "nurse time". In the following five months, we performed five hysterectomies. Preparation for each procedure involved on average 5 interviews, 19 telephone conversations and 11 e-mails. The biggest obstacle was obtaining an operating slot, as on average it required 18 days, four telephone calls and four e-mails to be assigned a slot in the operating theatre schedule, which is

  7. "The City of the Hospital": On Teaching Medical Students to Write.

    PubMed

    Hellerstein, David J

    2015-12-01

    "The City of the Hospital" is a creative nonfiction writing workshop for medical students, which the author has conducted annually since 2002. Part of the required preclinical Narrative Medicine curriculum at the Columbia University College of Physicians and Surgeons, this six-week intensive workshop includes close readings of literary works and in-class assignments that are then edited by fellow class members and rewritten for final submission. Over the years, students have produced a wide range of compelling essays and stories, and they describe the class as having an effect that lasts throughout their further medical training. This special section includes selected works from class members.

  8. Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

    PubMed

    Enosolease, M E; Imarengiaye, C O; Awodu, O A

    2004-08-01

    Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

  9. A Spectrum of Urological Emergency Reported at a Tertiary Care Teaching Hospital: An Experience

    PubMed Central

    Banerjee, Indraneel; Teli, Ramdayal; Agarwal, Neeraj; Vyas, Nachiket; Priyadarshi, Shivam; Yadav, Shersingh; Tomar, Vinay

    2015-01-01

    Introduction A substantial number of urology admissions constitute of emergency cases and sizeable proportion are urology emergency referral cases. There have been few studies conducted on this aspect but there lie geographical variations in the presentations of urological emergencies. Hence, this study was conducted to analyse various urological emergency presentations and their interventions. Objective To estimate the proportion of urological emergencies and analyse the different type of urological emergencies with the required management. Materials and Methods A hospital based observational descriptive study was undertaken in our institution over a period of one year. Results A total of 11,139 cases were admitted in the urology department; of which a significant percentage (21.05%) was from emergency room. Majority of cross references came from the Department of Medicine (22.59 %). Renal colic (24.2%) happened to be the most common presentation in emergency room followed by acute urinary retention (14.7%). Among referred cases, hematuria was the leading presentation with 17.75% followed by traumatic catheterization (11.97%). Most common urological intervention in referred cases was supra pubic catheterization (27.20%) while it was percutaneous nephrostomy (32.78%) in directly admitted cases. Conclusion Urological emergencies constitute a significant proportion of total urology admissions (27.18%). The most common non-traumatic injury was renal colic whereas traumatic was traumatic catheterization in our study. Most common surgical intervention in direct admitted emergency cases was percutaneous nephrostomy whereassuprapubic catheterization in within hospital emergency referral cases. PMID:26675409

  10. Nosocomial infections by Klebsiella pneumoniae carbapenemase producing enterobacteria in a teaching hospital

    PubMed Central

    Seibert, Gabriela; Hörner, Rosmari; Meneghetti, Bettina Holzschuh; Righi, Roselene Alves; Forno, Nara Lucia Frasson Dal; Salla, Adenilde

    2014-01-01

    Objective To analyze the profile of patients with microorganisms resistant to carbapenems, and the prevalence of the enzyme Klebsiella pneumoniae carbapenemase in interobacteriaceae. Methods Retrospective descriptive study. From the isolation in bacteriological tests ordered by clinicians, we described the clinical and epidemiological characteristics of patients with enterobacteria resistants to carbapenems at a university hospital, between March and October 2013. Results We included 47 isolated patients in this study, all exhibiting resistance to carbapenems, including 9 patients who were confirmed as infected/colonized with K. pneumoniae carbapenemase. Isolation in tracheal aspirates (12; 25.5%) predominated. The resistance to ertapenem, meropenem, and imipenem was 91.5%, 83.0% and 80.0%, respectively. Aminoglycosides was the class of antimicrobials that showed the highest sensitivity, 91.5% being sensitive to amikacin and 57.4% to gentamicin. Conclusion The K. pneumoniae carbapenemase was an important agent in graun isotaling in hospital intection. The limited therapeutic options emphasize the need for rapid laboratory detection, as well as the implementation of measures to prevent and control the spread of these pathogens. PMID:25295446

  11. Undetected Bacillus pseudo-outbreak after renovation work in a teaching hospital.

    PubMed

    Ohsaki, Yoshinobu; Koyano, Shin; Tachibana, Mineji; Shibukawa, Kiyoko; Kuroki, Masako; Yoshida, Itsuro; Ito, Yoshihisa

    2007-06-01

    A 602-bed capacity hospital underwent complete renovation from 1999 to 2004. In April 2005, the Infection Control Team was informed of the occurrence of three consecutive cases of Bacillus cereus bacteremia in a ward for patients with hematologic malignancies. A retrospective analysis of patients with Bacillus isolates was initiated. We found more Bacillus cereus isolates from blood samples in 2004 compare to the preceding years. Swab samples were collected in the particular ward from the surface of a working desk, filter unit of the air-conditioners, entrance of air inlet ducts, exit of the air outlet ducts and three-way valves of the particular ward under the consideration of iatrogenic contamination. Towels and gowns used in the ward were examined. Dens dust was noted in the filter of the air-conditioner and inlets/outlets of the air-ventilation system of the ward. Bacillus cereus was isolated from the dust, and from cleaned towels and gowns. PFGE fingerprinting differed among four patients' sample. We considered the present case as an undetected Bacillus cereus pseudo-outbreak that lasted for about one year after the renovation work of the hospital. We also considered that filters of the HVAC-system and towels and gowns were probable sources of the outbreak.

  12. What prognosis for Ebstein's anomaly without surgery? Hassan II teaching hospital experience.

    PubMed

    Garba, Moumouni; Atmani, Samir; Sani, Rabiou; Nouhou, Kaled Adamou

    2016-04-01

    Background From the first description in 1886, significant progress was made on the treatment of Ebstein disease by mono and bi-ventricular surgery. Aim To highlight the prognosis of Ebstein's anomaly in the pediatric department of Hassan II hospital in Fez. Methods This is a descriptive and retrospective study of 4 years. Results We collected nine patients (seven boys and two girls) with a mean age of 5.3 years. Cyanosis was the main mode of revelation of the disease. In three patients Ebstein's anomaly was part of a malformative syndrome. All patients had only symptomatic medical treatment. Five patients are still alive at a follow up of one to six years. Conclusion Symptomatic medical treatment of Ebstein malformation may improve the prognosis of the disease.

  13. Nurses' autonomy level in teaching hospitals and its relationship with the underlying factors.

    PubMed

    Amini, Kourosh; Negarandeh, Reza; Ramezani-Badr, Farhad; Moosaeifard, Mahdi; Fallah, Ramezan

    2015-02-01

    This study aimed to determine the autonomy level of nurses in hospitals affiliated to Zanjan University of Medical Sciences, Iran. In this descriptive cross-sectional study, 252 subjects were recruited using systematic random sampling method. The data were collected using questionnaire including Dempster Practice Behavior Scale. For data analysis, descriptive statistics and to compare the overall score and its subscales according to the demographic variables, t-test and analysis of variance test were used. The nurses in this study had medium professional autonomy. Statistical tests showed significant differences in the research sample according to age, gender, work experience, working position and place of work. The results of this study revealed that most of the nurses who participated in the study compared with western societies have lower professional autonomy. More studies are needed to determine the factors related to this difference and how we can promote Iranian nurses' autonomy.

  14. Iatrogenic illness in the paediatric intensive care unit at Gharian teaching hospital, Libya.

    PubMed

    Ismail, A M; Shedeed, S A

    2012-02-01

    The aim of this prospective follow-up study wasto determine the incidence and risk factors of iatrogenic illness and the outcome among cases admitted to the paediatric intensive care unit in ateaching hospital in Libya. The incidence of iatrogenic complications was 22.9% among 423 cases admitted over a 1-year period. Human error (18.4%) followed by machine defects (4.5%) were the most common causes of complications. The overall mortality rate was 7.6% and was significantly higher in iatrogenic cases than others (13.4% versus 5.8%). Paediatric risk of mortality (PRISM) score was a good predictor of risk of iatrogenic illness. Both mortality and occurrence of iatrogenic illness were significantly associated with: higher PRISM score, use of mechanical ventilation, higher bed occupancy rate in the unit, presence of respiratory and neurological diseases, prolonged duration of stay in the intensive care unit and younger age of the child.

  15. Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC.

    PubMed

    Yeruva, Sri Lakshmi Hyndavi; Sinha, Archana; Sarraf-Yazdy, Mariam; Gajjala, Jhansi

    2016-06-01

    As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment.

  16. [Survey on the cost of the admission process of nursing technicians in a teaching hospital].

    PubMed

    Okano, Helena Isuku Horibe; Castilho, Valeria

    2007-09-01

    This study was aimed at contributing to the cost management of the admission process of nursing technicians by mapping and measuring the direct cost of the main activities in this process. The exploratory, retrospective, documental study on the modality of case study was carried out at the Educational Support Service of the University of São Paulo's Hospital Universitário. The admission process was divided into five sub-processes: planning, recruiting, selection, hiring and admission training. Results showed that the direct total cost of the admission process was R$ 6359.90, and that, within the sub-processes, selection was the one that consumed most resources--R$ 3416.40, amounting to 53.72% of the total. Each hired candidate cost R$ 635.99.

  17. Using lean methodology to teach quality improvement to internal medicine residents at a safety net hospital.

    PubMed

    Weigel, Charlene; Suen, Winnie; Gupte, Gouri

    2013-01-01

    The overall objective of this initiative was to develop a quality improvement (QI) curriculum using Lean methodology for internal medicine residents at Boston Medical Center, a safety net academic hospital. A total of 90 residents and 8 School of Public Health students participated in a series of four, 60- to 90-minute interactive and hands-on QI sessions. Seventeen QI project plans were created and conducted over a 4-month period. The curriculum facilitated internal medicine residents' learning about QI and development of positive attitudes toward QI (assessed using pre- and post-attitude surveys) and exposed them to an interprofessional team structure that duplicates future working relationships. This QI curriculum can be an educational model of how health care trainees can work collaboratively to improve health care quality.

  18. Interest of including trauma photography in the picture archiving and communication system of a teaching hospital.

    PubMed

    Bronsard, N; Chignon Sicard, B; Amoretti, N; Rottier, H; Ertz, P; de Peretti, F

    2015-05-01

    Digital imaging is a daily practice in traumatology. Such photographs should remain confidential. However, there is a need for objectivity concerning the circumstances and clinical follow-up for trauma patients. This paper describes how to conserve these photographs within the picture archiving and communication system (PACS) safely as regards identity and confidentiality. A computer converts the photographs into DICOM files. The DICOM image is associated to a reconciliation layer, validated by the physician in charge, and then included in the hospital PACS. This improves transmission from one medical team to another, both initially and after the accident if an expert medical opinion is required. The literature has demonstrated the value of photographs in modern medicine, but the technical and legal challenges are many. They enhance the computerized medical records. Identification, confidentiality and integration in the PACS are obstacles that we have now overcome.

  19. Problems and perceived needs for medical ethics education of resident physicians in Alexandria teaching hospitals, Egypt.

    PubMed

    Mohamed, A M; Ghanem, M A; Kassem, A

    2012-08-01

    There is a call for greater preparation for the ethical challenges encountered by physicians in their future professional duties. This study in Egypt aimed to reveal problems and perceived needs for medical ethics education of resident physicians working at University of Alexandria hospitals. In a descriptive, cross-sectional survey, 128 residents answered a self-administered questionnaire. More than half were of the opinion that their medical ethics course was ineffective; 56.3% mentioned poor curricular planning. The majority complained that the subject was not tailored to specialties, the course was too short, there was a shortage of resources to facilitate the educational process and that assessment was done for knowledge but not for skills. Problems related to staffing were low staff:student ratios and staff lack of experience. Trainees, regardless of clinical discipline, felt that there was a great need for improvement to their medicalethics education.

  20. Knowledge and attitude toward interdisciplinary team working among obstetricians and gynecologists in teaching hospitals in South East Nigeria

    PubMed Central

    Iyoke, Chukwuemeka Anthony; Lawani, Lucky Osaheni; Ugwu, George Onyemaechi; Ajah, Leonard Ogbonna; Ezugwu, Euzebus Chinonye; Onah, Paul; Onwuka, Chidinma Ifechi

    2015-01-01

    Background Interdisciplinary team working could facilitate the efficient provision and coordination of increasingly diverse health services, thereby improving the quality of patient care. The purpose of this study was to describe knowledge of interdisciplinary team working among obstetricians and gynecologists in two teaching hospitals in South East Nigeria and to determine their attitude toward an interdisciplinary collaborative approach to patient care in these institutions. Methods This was a questionnaire-based cross-sectional study. Data analysis involved descriptive statistics and was carried out using Statistical Package for the Social Sciences software version 17.0 for Windows. Results In total, 116 doctors participated in the study. The mean age of the respondents was 31.9±7.0 (range 22–51) years. Approximately 74% of respondents were aware of the concept of interdisciplinary team working. Approximately 15% of respondents who were aware of the concept of interdisciplinary team working had very good knowledge of it; 52% had good knowledge and 33% had poor knowledge. Twenty-nine percent of knowledgeable respondents reported ever receiving formal teaching/training on interdisciplinary team working in the course of their professional development. About 78% of those aware of team working believed that interdisciplinary teams would be useful in obstetrics and gynecology practice in Nigeria, with 89% stating that it would be very useful. Approximately 77% of those aware of team working would support establishment and implementation of interdisciplinary teams at their centers. Conclusion There was a high degree of knowledge of the concept and a positive attitude toward interdisciplinary team working among obstetricians and gynecologists in the study centers. This suggests that the attitude of physicians may not be an impediment to implementation of a collaborative interdisciplinary approach to clinical care in the study centers. PMID:26064058

  1. Adverse drug reactions due to cancer chemotherapy in a tertiary care teaching hospital

    PubMed Central

    Wahlang, Julie Birdie; Laishram, Purnima Devi; Brahma, Dhriti Kumar; Sarkar, Chayna; Lahon, Joonmoni; Nongkynrih, Banylla Shisha

    2016-01-01

    Background: An adverse drug reaction (ADR) is defined by World Health Organization (WHO) as ‘Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy’. ADRs associated with cancer chemotherapy warrant analysis on their severity and preventability. The outcome would create awareness among health care providers and prevent their recurrence. We have performed a hospital-based prospective observational study designed to analyze the pattern of ADRs to chemotherapeutic agents in cancer patients of a tertiary care hospital. Methods: A total of 119 cancer patients were monitored for suspected ADRs during the course of chemotherapy from November 2014 to December 2015. Clinical events were recorded and analyzed with regard to the demographics and drug details of the patients. Results: A total of 106 ADRs were recorded from 119 cases. The ADRs commonly encountered included constipation, nausea, vomiting, alopecia and hematological changes. Cisplatin, cyclophosphamide, paclitaxel and 5-FU were used for the treatment of commonly found cancers in this region affecting the lungs, esophagus and lymphomas. Naranjo’s causality assessment showed 86.7% possible (score 4) and 13.2% probable (score 5–6). Severity of adverse reactions showed 77.4% mild, 18.9% moderate and 3.8% severe. A total of 45.3% of ADRs were preventable reactions such as nausea, vomiting and constipation. Conclusions: This study highlights the role of active monitoring as an important tool for early detection, assessment and timely management of ADRs in patients undergoing cancer chemotherapy. The observed ADRs were preventable although ADRs such as hiccough, anemia, neutropenia and alopecia were not preventable.

  2. Comparing the Perspectives of Managers and Employees of Teaching Hospitals About Job Motivation

    PubMed Central

    Mohebbifar, Rafat; Kiaei, Mohammad Zakaria; Khosravizadeh, Omid; Mohseni, Mohammad

    2014-01-01

    Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospitals in Qazvin province of Iran were selected through Quota-Random sampling and studied along with all 49 Managers. Lawrence Lindale questionnaire with 10 factors where used in order to determine motivational priorities. The results indicated that among the 10 studied motivational factors, from employees’ viewpoint; “Good wages”, “Good Working Conditions” and “Job Security” have the greatest roles in motivating employees. In the context of perspective agreement amongst employees and managers, the results showed 20 percent agreement. In this study, results of “Independent T” test showed a significant difference in comparison, between prioritizing employees’ view and prediction of managers in the factors of “Job Security” (p = 0.031) and “Interesting Work” (p = 0.001). With respect to increase disagreement in the views of managers and employees as compared to previous studies, Managers need to pay more attention to cognition of motivational factors and make their viewpoints closer to actual motivational need of their employees. Attention to this fact can be a great help to the growth and productivity of the organization, making the organizational and individual goals closer and also keeping managers safe from execution of constant and undue motivational patterns. PMID:25363113

  3. Outpatient Waiting Time in Health Services and Teaching Hospitals: A Case Study in Iran

    PubMed Central

    Mohebbifar, Rafat; Hasanpoor, Edris; Mohseni, Mohammad; Sokhanvar, Mobin; Khosravizadeh, Omid; Isfahani, Haleh Mousavi

    2014-01-01

    Background: One of the most important indexes of the health care quality is patient’s satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. Methods: This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. Results: Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. Conclusion: by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time. PMID:24373277

  4. Comparing the perspectives of managers and employees of teaching hospitals about job motivation.

    PubMed

    Mohebbifar, Rafat; Zakaria Kiaei, Mohammad; Khosravizadeh, Omid; Mohseni, Mohammad

    2014-07-15

    Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospitals in Qazvin province of Iran were selected through Quota-Random sampling and studied along with all 49 Managers. Lawrence Lindale questionnaire with 10 factors where used in order to determine motivational priorities. The results indicated that among the 10 studied motivational factors, from employees' viewpoint; "Good wages", "Good Working Conditions" and "Job Security" have the greatest roles in motivating employees. In the context of perspective agreement amongst employees and managers, the results showed 20 percent agreement. In this study, results of "Independent T" test showed a significant difference in comparison, between prioritizing employees' view and prediction of managers in the factors of "Job Security" (p = 0/031) and "Interesting Work" (p = 0/001). With respect to increase disagreement in the views of managers and employees as compared to previous studies, Managers need to pay more attention to cognition of motivational factors and make their viewpoints closer to actual motivational need of their employees. Attention to this fact can be a great help to the growth and productivity of the organization, making the organizational and individual goals closer and also keeping managers safe from execution of constant and undue motivational patterns.

  5. Emergence of Hospital Acquired Carbapenem Resistant Non-Fermenters in Teaching Institute

    PubMed Central

    Katare, Neeraj; Pandey, Aparna; Bhatambare, Ganesh Shivmurti; Bajpai, Trupti

    2016-01-01

    Introduction Non-Fermenting Gram Negative Bacilli (NFGNB) are emerging now-a-days because of their tendency to colonize various surfaces and inherent resistance to commonly used disinfectants. They are responsible for multi-drug resistant hospital acquired infections. Detection of carbapenem resistance mechanisms is essential for treatment and infection control purpose as can spread to other organisms causing hospital outbreaks. Aim To characterize non-fermenters from various clinical samples and to detect different carbapenem resistance mechanisms in meropenem resistant isolates. Materials and Methods The prospective study was conducted at Sri Aurobindo Medical College and Post Graduate Institute, Indore over a period of one and half year from December 2014 to May 2016. A total of 1310 samples were collected from Ventilator Associated Pneumonia (VAP), Surgical Site Infection (SSI), Urinary Tract Infection (UTI), septicaemia, Lower Respiratory Tract Infection (LRTI) and middle ear infected patients. Non-fermenters were identified by standard microbiological tests. Meropenem resistance was determined by Kirby-Bauer disk diffusion method and resistant isolates were further tested by Modified Hodge test, Combined disc test and AmpC disc test. Results Isolation rate of non-fermenters was 13.82% (181/1310). Colistin, amikacin and imipenem were the antibiotics with maximum sensitivity. Overall meropenem resistance was found to be 44.2% (80/181). Metallo-β-lactamase and AmpC-β-lactamase were produced by 56.82% (25/44) and 72.22% (26/36) of meropenem resistant Pseudomonas and Acinetobacter species respectively. Conclusion Detection of carbapenem resistance mechanisms and implementation of antibiotic policy are needed to prevent the emergence of non-fermenter infections. PMID:28208857

  6. Medication errors in a paediatric teaching hospital in the UK: five years operational experience

    PubMed Central

    Ross, L; Wallace, J; Paton, J; STEPHENSON, T.

    2000-01-01

    BACKGROUND—In the past 10 years, medication errors have come to be recognised as an important cause of iatrogenic disease in hospital patients.
AIMS—To determine the incidence and type of medication errors in a large UK paediatric hospital over a five year period, and to ascertain whether any error prevention programmes had influenced error occurrence.
METHODS—Retrospective review of medication errors documented in standard reporting forms completed prospectively from April 1994 to August 1999. Main outcome measure was incidence of error reporting, including pre- and post-interventions.
RESULTS—Medication errors occurred in 0.15% of admissions (195 errors; one per 662 admissions). While the highest rate occurred in neonatal intensive care (0.98%), most errors occurred in medical wards. Nurses were responsible for most reported errors (59%). Errors involving the intravenous route were commonest (56%), with antibiotics being the most frequent drug involved (44%). Fifteen (8%) involved a tenfold medication error. Although 18 (9.2%) required active patient intervention, 96% of errors were classified as minor at the time of reporting. Forty eight per cent of parents were not told an error had occurred. The introduction of a policy of double checking all drugs dispensed by pharmacy staff led to a reduction in errors from 9.8 to 6 per year. Changing the error reporting form to make it less punitive increased the error reporting rate from 32.7 to 38 per year.
CONCLUSION—The overall medication error rate was low. Despite this there are clear opportunities to make system changes to reduce error rates further.
 PMID:11087283

  7. Gastrointestinal and urinary tract pathogenic infections among HIV seropositive patients at the Komfo Anokye Teaching Hospital in Ghana

    PubMed Central

    2012-01-01

    Background Gastrointestinal and urinary tract pathogenic infections are aggravating the incidence and progression of the Human Immunodeficiency Virus (HIV) infection into Acquired Immune Deficiency Syndrome (AIDS) more especially in the developing countries. This study was conducted to assess the common gastrointestinal and urinary infections among HIV/AIDS patients at the Komfo Anokye Teaching Hospital (KATH) in Ghana between April and December 2008. Findings This work reports on gastrointestinal and urinary tract pathogenic infections among 500 HIV seropositive and 300 HIV seronegative patients. There was a 35% (175/500) prevalence of intestinal parasites among HIV seropositive patients compared to 4.3% (13/300) in HIV seronegative patients. Giardia lamblia and Cryptosporidium accounted for 19% (95/500) and 14% (70/500) respectively, while Schistosoma mansoni, Strongyloides stercoralis and hookworm together accounted for 2% (10/500) of intestinal parasitic infections among the HIV seropositive patients. There was no significant difference (p > 0.05) in urinary parasitic infection between HIV seropositive 1% (2/500) and seronegative patients 0.7% (2/300). Most, 60 (86%) out of 70, of the urinary tract infection among the HIV seropositive patients was due to bacteria with E. coli being the most predominant isolate, 28 (47%) out of 60. There was no significant difference in infections based on age and gender. Conclusion G. lamblia and Cryptosporidium were the most common gastrointestinal parasites detected while bacteria accounted for majority of the urinary tract infections among the HIV seropositive patients at the hospital. PMID:22909315

  8. Clinical, Microbiological, and Genetic Characteristics of Heteroresistant Vancomycin-Intermediate Staphylococcus aureus Bacteremia in a Teaching Hospital

    PubMed Central

    Di Gregorio, Sabrina; Perazzi, Beatriz; Ordoñez, Andrea Martinez; De Gregorio, Stella; Foccoli, Monica; Lasala, María Beatriz; García, Susana; Vay, Carlos; Famiglietti, Angela

    2015-01-01

    The emergence of vancomycin intermediate Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) is of major concern worldwide. Our objective was to investigate the prevalence, phenotypic and molecular features of hVISA strains isolated from bacteremic patients and to determine the clinical significance of the hVISA phenotype in patients with bacteremia. A total of 104 S. aureus blood isolates were collected from a teaching hospital of Argentina between August 2009 and November 2010. No VISA isolate was recovered, and 3 out of 92 patients (3.3%) were infected with hVISA, 2 of them methicillin-resistant S. aureus (MRSA) (4.5% of MRSA). Macro Etest and prediffusion method detected 3/3 and 2/3 hVISA respectively. Considering the type of bacteremia, the three cases were distributed as follows: two patients had suffered multiple episodes of bacteremia (both hVISA strains recovered in the second episode), while only one patient had suffered a single episode of bacteremia with hVISA infection. MRSA bloodstream isolates exhibiting the hVISA phenotype were related to HA-MRSA Cordobes clone (ST5-SCCmec I-spa t149) and MRSA Argentinean pediatric clone (ST100-SCCmec IVNV-spa t002), but not to CA-MRSA-ST30-SCCmec IV-spa t019 clone that was one of the most frequent in our country. Although still relatively infrequent in our hospital, hVISA strains were significantly associated with multiple episodes of bacteremia (p=0.037) and genetically unrelated. PMID:25535825

  9. The barriers to the application of the research findings from the nurses’ perspective: A case study in a teaching hospital

    PubMed Central

    Bahadori, Mohammadkarim; Raadabadi, Mehdi; Ravangard, Ramin; Mahaki, Behzad

    2016-01-01

    Background: The application of the nursing research findings is one of the most important indicators of development in the nursing profession, which leads to providing efficient and effective patient care and improving the quality of nursing care. According the result of some studies, transferring the evidence-based findings to the nurses’ practice and education in the world has been slow and sometimes unsuccessful. This study aimed to investigate the most important barriers to the application of research findings from the nurses’ perspective. Materials and Methods: This cross-sectional study conducted on a sample of 210 nurses in a teaching hospital in Tehran in 2013. The data were collected using a researcher-made questionnaire consisted of two parts, including items about nurses’ demographic characteristics and 30 items to identify the most important barriers to the application of research findings from the studied nurses’ perspective. Results: “The lack of sufficient time for reading the studies,” “the lack of sufficient time to implement the new ideas,” “the lack of adequate facilities to implement the ideas,” “nurses’ little interest in conducting studies,” and “the lack of authority to change the methods and patterns of care” with, respectively, 85%, 84.6%, 83.8%, 83.4%, and 80.5% agreement with the existence of barriers were the most barriers to application of research findings from the studied nurses’ perspective. Conclusion: The lack of time was the most important barrier to the use of research findings from the perspective of studied nurses. Therefore, some effective strategies should be used by hospital managers and health policy makers to overcome this barrier. Some of these strategies can be employing new personnel and hiring skilled and efficient human resources in order to decrease the workload of nurses, organizing the nurses’ work shifts, providing right balance between patients and nurses in the wards, etc. PMID

  10. [Respiratory syncytial virus (RSV) infections in the pediatric teaching hospital Charles de Gaulle of Ouagadougou, Burkina Faso].

    PubMed

    Ouédraogo Yugbaré, S O; Ouédraogo, R; Nenebi, A; Traoré, B; Congo, L; Yonli, F; Kima, D; Bonané, P; Yé, D; Plantier, J-C; Vabret, A; Marguet, C; Gueudin, M

    2016-02-01

    Human respiratory syncytial virus (RSV) infections are little known in Burkina Faso. The objective of our work is to study the epidemiological and clinical aspects of RSV infections in infants in the Pediatric Teaching Hospital Charles de Gaulle of Ouagadougou. Between July 1(st) 2010 and June 30(th) 2011, we analyzed by direct immunofluorescence and PCR nasopharyngeal swabs from children from 0 to 36 months old. All in all, 210 patients among whom 74 from the external consultation (35.2%) and 136 hospitalized (64.7%) benefited from a nasopharyngeal aspiration. The motives for consultation were cough (91.7%), rhinitis (79.2%), fever (79.2%) and respiratory distress syndrome (66.7%). The evoked diagnoses were predominantly the acute bronchiolitis in 14 cases (58.3%) followed by the acute pulmonary disease in 7 patients (26.2%) then flue in 1 patient (16.7%). We detected by direct immunofluorescence the antigens of the respiratory viruses in 21 nasopharyngeal aspirations with 10 cases of respiratory syncytial virus (RSV) infections (47.6%). The PCR realized on 208 samples allowed to identify 153 positive samples (73.2%) with 24 RSV, i.e. a global prevalence of 16.1% with a peak of 18 cases (75%). In October, all the patients benefited from an often multiple antibiotic treatment of at least 10 days which was not still necessary. The evolution was favorable for all patients. This study confirms the important place of the viruses which are detected in 70% of the cases. The PCR multiplex, certainly expensive but effective and successful, deserves to be used in our developing countries to avoid the irrational prescription of antibiotic.

  11. Clinical and Microbiological Characteristics of Heteroresistant and Vancomycin-Intermediate Staphylococcus aureus from Bloodstream Infections in a Brazilian Teaching Hospital.

    PubMed

    da Costa, Thaina Miranda; Morgado, Priscylla Guimarães Migueres; Cavalcante, Fernanda Sampaio; Damasco, Andreia Paredes; Nouér, Simone Aranha; Dos Santos, Kátia Regina Netto

    2016-01-01

    This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca). Macromethod Etest® and Etest® Glicopeptides Resistance Detection were also used. VISA and hVISA isolates were confirmed by the population analysis profile then typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Medical data from the patients were obtained from their medical records. Among 110 consecutive isolates, 31 (28%) were MRSA and carried the SCCmec type II (15 isolates) or IV (16 isolates). Vancomycin MIC50 and MIC90 were 1 and 2 mg/L, respectively. MRSA isolates had increased non-susceptibility to daptomycin (p = 0.0003). Six (5%) isolates were VISA, four of which were MRSA, three SCCmec type II/USA100/ST5 and one type IV/USA800/ST3192. One MRSA SCCmec II isolate grew on agar BHIa3, BHIa4 and BHIa4ca, and it was confirmed as hVISA. Among the six VISA isolates, five (83%) grew on BHIa3 and three (50%) on BHI4ca. Four of the six VISA isolates and the one hVISA isolate were from patients who had undergone dialysis. Thus, a possible dissemination of the SCCmec II/USA100/ST5 lineage may have occurred in the hospital comprising the VISA, hVISA and daptomycin non-susceptible S. aureus Brazilian isolates from health care associated bloodstream infections.

  12. Utilization Study of Antihypertensives in a South Indian Tertiary Care Teaching Hospital and Adherence to Standard Treatment Guidelines

    PubMed Central

    Datta, Supratim

    2016-01-01

    Aim: Hypertension represents a major health problem primarily because of its role in contributing to the initiation and progression of major cardiovascular diseases. Concerns pertaining to hypertension and its sequelae can be substantially addressed and consequent burden of disease reduced by early detection and appropriate therapy of elevated blood pressure. This cross-sectional observational study aims at analyzing the utilization pattern of antihypertensives used for the treatment of hypertension at a tertiary care hospital in perspective of standard treatment guidelines. Materials and Methods: Prescriptions were screened for antihypertensives at the medicine outpatient department of a tertiary care teaching hospital. Medical records of the patients were scrutinized after which 286 prescriptions of patients suffering from hypertension were included. The collected data were sorted and analyzed on the basis of demographic characteristics and comorbidities. Results: The calcium channel blockers were the most frequently used antihypertensive class of drugs (72.3%). Amlodipine (55.6%) was the single most frequently prescribed antihypertensive agent. The utilization of thiazide diuretics was 9%. Adherence to the National List of Essential Medicines (NLEMs) was 65%. The combination therapy was used more frequently (51.5%) than monotherapy (48.8%). The use of angiotensin-converting enzyme inhibitors/angiotensin 2 receptor blockers (ACE-I/ARB) was 41.4% in diabetes. Conclusions: The treatment pattern, in general, conformed to standard treatment guidelines. Few areas, however, need to be addressed such as the underutilization of thiazide diuretics, need for more awareness of drugs from the NLEMs and enhanced use of ACE-I/ARB in diabetic hypertensives. PMID:28104972

  13. Clinical and Microbiological Characteristics of Heteroresistant and Vancomycin-Intermediate Staphylococcus aureus from Bloodstream Infections in a Brazilian Teaching Hospital

    PubMed Central

    da Costa, Thaina Miranda; Morgado, Priscylla Guimarães Migueres; Cavalcante, Fernanda Sampaio; Damasco, Andreia Paredes; Nouér, Simone Aranha; dos Santos, Kátia Regina Netto

    2016-01-01

    This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca). Macromethod Etest® and Etest® Glicopeptides Resistance Detection were also used. VISA and hVISA isolates were confirmed by the population analysis profile then typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Medical data from the patients were obtained from their medical records. Among 110 consecutive isolates, 31 (28%) were MRSA and carried the SCCmec type II (15 isolates) or IV (16 isolates). Vancomycin MIC50 and MIC90 were 1 and 2 mg/L, respectively. MRSA isolates had increased non-susceptibility to daptomycin (p = 0.0003). Six (5%) isolates were VISA, four of which were MRSA, three SCCmec type II/USA100/ST5 and one type IV/USA800/ST3192. One MRSA SCCmec II isolate grew on agar BHIa3, BHIa4 and BHIa4ca, and it was confirmed as hVISA. Among the six VISA isolates, five (83%) grew on BHIa3 and three (50%) on BHI4ca. Four of the six VISA isolates and the one hVISA isolate were from patients who had undergone dialysis. Thus, a possible dissemination of the SCCmec II/USA100/ST5 lineage may have occurred in the hospital comprising the VISA, hVISA and daptomycin non-susceptible S. aureus Brazilian isolates from health care associated bloodstream infections. PMID:27575698

  14. Patterns of Complementary and Alternative Medicine Use, Perceived Benefits, and Adverse Effects among Adult Users in Enugu Urban, Southeast Nigeria

    PubMed Central

    Okoronkwo, Ijeoma; Onyia-pat, Jane-lovena; Okpala, Pat; Agbo, Mary-Ann; Ndu, Afam

    2014-01-01

    The use of complementary and alternative medicine (CAM) is now on the increase. Evidence from studies carried out globally has established that CAM use is very common and varies among populations. This study investigated patterns of CAM use, perceived benefits, and associated harm with CAM use among adults. A cross-sectional study was conducted in three local government areas of Enugu urban, Southeast Nigeria. An interviewer-administered questionnaire was used to collect data from all consenting adult participants aged between 18 and 65 years. Of the 732 participants interviewed, 62.8% were females while 37.2% were males. Majority (84.7%) of the participants had used CAM at one time or another. The most commonly used CAM product was the biological products, followed by spiritual therapy. The major route of administration for CAM products was oral and about 40% of the participants combined CAM with conventional medicine. Majority (78.6%) of CAM users benefited from CAM products after using them while a few complained of adverse reactions. As CAM is gaining widespread acceptance and use, there is need for clinical trial on the benefits and adverse effects associated with the use of CAM to facilitate proof of efficacy and safety of the products. PMID:24803945

  15. Clients’ Willingness to Pay for Immunization Services in the Urban and Rural Primary Health Centers of Enugu State, Nigeria

    PubMed Central

    Ossai, Edmund Ndudi; Fatiregun, Akinola Ayoola

    2015-01-01

    Our study aims at determining the pattern of willingness of clients to pay for childhood immunization services in urban and rural primary health centers of Enugu state, Nigeria. Using a cross-sectional design, 800 clients who presented with their children/wards to receive childhood immunization services were selected at the primary health center in rural and urban local government areas of the state. The mean age was 28.9±4.5 and 26.7±5.1 years in the urban and rural areas respectively. About 54.5% of clients in the urban and 55.3% in the rural area were willing to pay for immunization services. The clients willingness to pay was influenced by: non satisfaction with immunization services, (OR=0.3, 95%CI: 0.2-0.5), younger age, (OR=1.4, 95%CI: 1.0-2.0) marital status (OR=2.8, 95%CI: 1.2-6.5), proximity to health centers (OR=0.6, 95%CI: 0.4-0.8), and delivering in a private health facility (OR=0.4, 95%CI: 0.1-0.9). The study suggests that the economic value that clients give to immunization services was similar in the rural and urban areas, and this could be increased by improving the level of clients’ satisfaction for the services among others. PMID:28299135

  16. Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: A cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban

    PubMed Central

    2011-01-01

    Background Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008. Methods Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes. Results Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes. Conclusions Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low

  17. 'Teaching on the Run' with Australian midwives in a tertiary maternity hospital.

    PubMed

    Hauck, Yvonne; Lewis, Lucy; Pemberton, Alissa; Crichton, Caroline; Butt, Janice

    2017-01-01

    Teaching On The Run (TOTR) is an Australian program for health professionals involved in clinical supervision. An amended TOTR program was evaluated with midwives acting as preceptors assisting learners integrate theory with clinical practice. A mixed method study was employed to compare midwives' perceived skills and confidence before and after completion of TOTR workshops. A secondary aim explored midwifery learners' (students and new graduates) perceptions of support from preceptors during the implementation of TOTR. Sixty five midwives completed the TOTR workshops with 46 providing data before program enrolment and 1-3 months after completion of the final TOTR workshop. Significant improvements were found for midwifery preceptors with before and after comparisons using Preceptor Self-Efficacy and Self-Evaluation Questionnaires. Using the Nursing Facilitator Clinical Questionnaire, preceptees or midwifery learners (n = 49) scored the 'qualities of their preceptors', 'their clinical practice', 'clinical learning' and 'how feedback was provided' highly with no changes between 2013 and 2014. Nineteen students then participated in three focus group interviews, analyzed using a six step systematic process. One overarching theme, 'Guiding me through' emerged with four themes: 'Getting to know each other'; 'Willingness to share knowledge'; 'Leading by example'; and 'The system acknowledging and valuing the preceptor role'.

  18. Out-of-hospital cardiac arrest: the teaching of experience at the SAMU of Lyon.

    PubMed

    Gueugniaud, P Y; Vaudelin, T; Gaussorgues, P; Petit, P

    1989-01-01

    Because of the improvement resuscitation techniques have shown since the 1960s and because of the development of the out-of-hospital medical care, a cardiac arrest is no longer synonymous with death in every case. However the cardiac arrest resuscitation is only relevant if its adverse consequences can be limited. That is mainly the neurological after-effects and the cellular anoxia. Therefore, the "Service d'Aide Medicale Urgente" (SAMU) of Lyon has been concentrating its research aiming at: (a) Shortening the duration of cardiopulmonary resuscitation to limit the cerebral anoxia. (b) Analysing and treating some of the causes responsible for the aggravation of anoxia. On the basis of several studies in Lyon, here are some suggestions: (1) The use of high doses of epinephrine that unables a better percentage of primary recoveries (47.5% vs. 39%) (P less than 0.05) and secondary recoveries (21.3% vs. 14.8%) (P less than 0.01) without modifying the qualitative survival at long term. (On the basis of: 5 mg intravenous bolus repeated every 3 min in case of asystole instead of 1 mg every 5 min as it is usually recommended). (2) The choice of a peripheral intravenous line instead of a central intravenous line each time it is possible for the administration of drugs since it is as efficient as the second one. (40.7% vs. 33.4%) (P:NS). (3) The alkalinisation of the prolonged cardiac arrest in order to keep the acid-base balance. Most of the survivors show a pH equal or superior to the normal standard. (On the basis of 1 mmol/kg of sodium bicarbonate if the cardiac arrest lasts for more than 10 min). (4) The abolition of the dextrose solution as maintaining infusion the patients who are in a "coma depasse" (brain death) after the resuscitation have an average glycemia superior to the survivors without after-effects. (19.7 vs. 14.8 mmol/l) (P less than 0.05). (5) The monitoring at once at the hospital of the intra-cranial pressure. It reveals the frequency of high pression

  19. Pattern of Adverse Drug Reactions Reported with Cardiovascular Drugs in a Tertiary Care Teaching Hospital

    PubMed Central

    Palaniappan, Muthiah; George, Melvin; Subramaniyan, Ganesan; Dkhar, Steven Aibor; Pillai, Ajith Ananthakrishna; Jayaraman, Balachander; Chandrasekaran, Adithan

    2015-01-01

    Background Cardiovascular diseases (CVD) are one of the leading causes of non-communicable disease related deaths globally. Patients with cardiovascular diseases are often prescribed multiple drugs and have higher risk for developing more adverse drug reactions due to polypharmacy. Aim To evaluate the pattern of adverse drug reactions reported with cardiovascular drugs in an adverse drug reaction monitoring centre (AMC) of a tertiary care hospital. Settings and Design Adverse drug reactions related to cardiovascular drugs reported to an AMC of a tertiary care hospital were included in this prospective observational study. Materials and Methods All cardiovascular drugs related adverse drug reactions (ADRs) received in AMC through spontaneous reporting system and active surveillance method from January 2011 to March 2013 were analysed for demographic profile, ADR pattern, severity and causality assessment. Statistical Analysis used The study used descriptive statistics and the values were expressed in numbers and percentages. Results During the study period, a total of 463 ADRs were reported from 397 patients which included 319 males (80.4%) and 78 females (19.6%). The cardiovascular drug related reports constituted 18.1% of the total 2188 ADR reports. In this study, the most common ADRs observed were cough (17.3%), gastritis (7.5%) and fatigue (6.5%). Assessment of ADRs using WHO-causality scale revealed that 62% of ADRs were possible, 28.2% certain and 6.8% probable. As per Naranjo’s scale most of the reports were possible (68.8%) followed by probable (29.7%). According to Hartwig severity scale majority of the reports were mild (95%) followed by moderate (4.5%). A system wise classification of ADRs showed that gastrointestinal system (20.7%) related reactions were the most frequently observed adverse reactions followed by respiratory system (18.4%) related adverse effects. From the reported ADRs, the drugs most commonly associated with ADRs were found to be

  20. Invasive Candidiasis in Severe Acute Pancreatitis: Experience from a Tertiary Care Teaching Hospital

    PubMed Central

    Baronia, Arvind Kumar; Azim, Afzal; Ahmed, Armin; Gurjar, Mohan; Marak, Rungmei S. K.; Yadav, Reema; Sharma, Preeti

    2017-01-01

    Background: Invasive candidiasis (IC) is associated with increased morbidity in severe acute pancreatitis (SAP). There is limited information regarding the predisposing factors, Candida species distribution and in vitro susceptibility. Methodology: Current data have been derived from a larger prospective nonintervention study conducted on 200 critically ill patients which was done to study the antifungal prescription practices, collect epidemiological data, and perform an external validation of risk prediction models for IC under senior research associateship program of Council of Scientific and Industrial Research New Delhi. Of these critically ill patients, thirty had SAP and were included for analysis. Results: There were 23 males and 7 females. Out of eight patients (27%) who developed IC, three had isolated candidemia, two had isolated deep-seated candidiasis while three had both candidemia and deep-seated candidiasis. SAP patients with IC had a longer duration of Intensive Care Unit stay, hospital stay, days on mechanical ventilation and duration of shock. Mortality was not different between SAP patients with or without IC. Conclusion: There is a high rate of Candida infection in SAP. More studies are needed to generate epidemiological data and develop antifungal stewardship in this subset of high-risk population. PMID:28197050

  1. Epidemiology and antifungal susceptibilities of yeasts causing vulvovaginitis in a teaching hospital.

    PubMed

    Gamarra, Soledad; Morano, Susana; Dudiuk, Catiana; Mancilla, Estefanía; Nardin, María Elena; de Los Angeles Méndez, Emilce; Garcia-Effron, Guillermo

    2014-10-01

    Vulvovaginal candidiasis is one of the most common mycosis. However, the information about antifungal susceptibilities of the yeasts causing this infection is scant. We studied 121 yeasts isolated from 118 patients with vulvovaginal candidiasis. The isolates were identified by phenotypic and molecular methods, including four phenotypic methods described to differentiate Candida albicans from C. dubliniensis. Antifungal susceptibility testing was performed according to CLSI documents M27A3 and M27S4 using the drugs available as treatment option in the hospital. Diabetes, any antibacterial and amoxicillin treatment were statistically linked with vulvovaginal candidiasis, while oral contraceptives were not considered a risk factor. Previous azole-based over-the-counter antifungal treatment was statistically associated with non-C.albicans yeasts infections. The most common isolated yeast species was C. albicans (85.2 %) followed by C. glabrata (5 %), Saccharomyces cerevisiae (3.3 %), and C. dubliniensis (2.5 %). Fluconazole- and itraconazole-reduced susceptibility was observed in ten and in only one C. albicans strains, respectively. All the C. glabrata isolates showed low fluconazole MICs. Clotrimazole showed excellent potency against all but seven isolates (three C. glabrata, two S. cerevisiae, one C. albicans and one Picchia anomala). Any of the strains showed nystatin reduced susceptibility. On the other hand, terbinafine was the less potent drug. Antifungal resistance is still a rare phenomenon supporting the use of azole antifungals as empirical treatment of vulvovaginal candidiasis.

  2. Birth weight pattern in the only referral teaching hospital in Manipur.

    PubMed

    Akoijam, B S; Thangjam, N D; Singh, K T; Devi, S R; Devi, R K P

    2006-01-01

    Birth weight is an important determinant for child development and survival. Birth weight has been reported to be increasing with the passing years. There is no such accurate documentation from the state of Manipur. This cross sectional study has been attempted to see the birth weight pattern in the largest referral hospital in Manipur. Birth weights of four reference years in the last 15 years have been extracted from the records and analysed. There were 19478 singleton deliveries in the four reference years. The mean birth weight showed a gradual increase in these years. There was a gain of 88.9 g in 2000 since 1986 in term deliveries. There were significant differences in the mean birth weights among the four years, even after stratifying for gestation. However, there was no significant decrease in the percentage of low birth weight babies in these years. Low birth weight showed significant association with parity, age of the mother, booking status, haemoglobin level, and literacy of the mother. Since there was no significant decrease in low birth weight babies in spite of increasing birth weight, there is a need for continued and committed effort to realize the goals of RCH.

  3. Uterine Fibroid Embolization for Symptomatic Fibroids: Study at a Teaching Hospital in Kenya

    PubMed Central

    Mutai, John Kiprop; Vinayak, Sudhir; Stones, William; Hacking, Nigel; Mariara, Charles

    2015-01-01

    Objective: Characterization of magnetic (MRI) features in women undergoing uterine fibroid embolization (UFE) and identification of clinical correlates in an African population. Materials and Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations between short-term imaging features and mid-term symptom scores was also done. Results: UFE resulted in statistically significant reduction (P < 0.001) of dominant fibroid, uterine volumes, and reduction of symptom severity scores, which were 43.7%, 40.1%, and 37.8%, respectively. Also, 59% of respondents had more than 10 fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome. Conclusion: The response of uterine fibroids to embolization in the African population is not different from the findings reported in other studies from the west. The presence of multiple and large fibroids in this study is consistent with the case mix described in other studies of African-American populations. Patient counseling should emphasize the independence of volume reduction and symptom improvement. Though volume changes are of relevance for the radiologist in understanding the evolution of the condition and identifying potential technical treatment failures, it should not be the main basis of evaluation of treatment success. PMID:25883858

  4. Phenotypic and molecular characterization of multidrug resistant Klebsiella pneumoniae isolated from a university teaching hospital, China.

    PubMed

    Du, Jikun; Li, Peipei; Liu, Helu; Lü, Dongyue; Liang, Hong; Dou, Yuhong

    2014-01-01

    The multidrug-resistant rate of Klebsiella pneumoniae has risen rapidly worldwide. To better understand the multidrug resistance situation and molecular characterization of Klebsiella pneumoniae, a total of 153 Klebsiella pneumoniae isolates were collected, and drug susceptibility test was performed to detect its susceptibility patterns to 13 kinds of antibiotics. Phenotypic tests for carbapenemases ESBLs and AmpC enzyme-producing strains were performed to detect the resistance phenotype of the isolates. Then PCR amplification and sequencing analysis were performed for the drug resistance determinants. The results showed that 63 strains harbored bla CTX-M gene, and 14 strains harbored bla DHA gene. Moreover, there were 5 strains carrying bla KPC gene, among which 4 strains carried bla CTX-M, bla DHA and bla KPC genes, and these 4 strains were also resistant to imipenem. Our data indicated that drug-resistant Klebsiella pneumoniae were highly prevalent in the hospital. Thus it is warranted that surveillance of epidemiology of those resistant isolates should be a cause for concern, and appropriate drugs should be chosen.

  5. Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital

    PubMed Central

    Baqain, Zaid H; Sawair, Faleh A; Tamimi, Zaid; Bsoul, Nazzal; Al Edwan, Ghazi; Almasad, Jamal K; Abbadi, Abdalla A

    2010-01-01

    INTRODUCTION We describe our experience with oncology patients on a frequent dosing schedule of intravenous (i.v.) bisphosphonates at the Jordan University Hospital (JUH). PATIENTS AND METHODS Patients treated by i.v. bisphosphonates in the medical oncology unit at the JUH were examined for bisphosphonate-related osteonecrosis of the jaws (BRONJ). Diagnosis was made according to the guidelines of the American Association of Oral and Maxillofacial Surgeons (AAOMS) original position paper. RESULTS Of the 41 patients, four developed BRONJ, two in maxilla, one in mandible and one bimaxillary. Patients with BRONJ were older; mean age was 69.3 ±3.1 years compared to 62.8 ± 12.5 years (P = 0.022). Dental co-morbidities were more commonly present in patients with the disease (P = 0.038). Patients who developed BRONJ were on treatment for a longer duration of time; the mean duration of treatment was 23.5 ± 8.4 months compared to 11.9 ± 13.4 months (P = 0.10). CONCLUSIONS The results of this case series demonstrated that age and poor oral health status are significant risk factors of BRONJ for oncology patients on long-term frequent dosing schedule of i.v. bisphosphonates. PMID:20522306

  6. Adverse drug reaction profile of anti-snake venom in a rural tertiary care teaching hospital

    PubMed Central

    Deshpande, Rushikesh Prabhakar; Motghare, Vijay Motiram; Padwal, Sudhir Laxman; Pore, Rakesh Ramkrishna; Bhamare, Chetanraj Ghanshyam; Deshmukh, Vinod Shivaji; Pise, Harshal Nutan

    2013-01-01

    Objectives The study was carried out with the aim of evaluation of the adverse drug reaction profile of anti-snake venom serum (ASV) in a rural tertiary care hospital. Methods An observational study was conducted in SRTR Medical College, Ambajogai, Maharashtra, India. A total number of 296 indoor case papers of snake bite from February to September 2011 and June to August 2012 were retrieved from the record section and the antivenom reactions were assessed. In addition, basic epidemiological data and prescribing practices of ASV were also analyzed. Results Vasculotoxic snake bites were more common (50.61%) than neuroparalytic ones (22.56%). Mild envenomation was the commonest presentation. A total of 92 (56.10%) patients who received ASV suffered from antivenom reactions. The most common nature of reaction was chills, rigors (69.56%) followed by nausea and vomiting (34.8%). 10-15% patients suffered from moderate to severe reactions like hypotension and sudden respiratory arrest. We did not find any dose response relationship of ASV to risk of reactions (odds ratio 0.37). Intradermal sensitivity test was performed in about 72% cases. Conclusion Our study showed a higher incidence of reactions to ASV at our institute. PMID:24396245

  7. Denture care practice among patients attending the prosthetic clinic in a Nigerian teaching hospital

    PubMed Central

    Ogunrinde, Tunde Joshua; Opeodu, Olanrewaju Ige

    2015-01-01

    Background: Good denture care practice by individuals using Removable Partial Denture (RPD) is an important component of oral health measures. An assessment of denture care practice of such individuals by dental care practitioners is necessary. Objective: To evaluate the denture care practice among prosthetics patients attending a tertiary Hospital Dental Centre in Nigeria. Materials and Methods: An interviewer administered questionnaire was used to obtain information from RPD wearers that were willing to participate. The questionnaire assessed among other things, patients’ bio-data, frequency, techniques and device used for cleaning their dentures. Data was analyzed using Chi-square test (P < 0.05). Results: One hundred and ninety eight denture wearers consisting of 100 (50.5%) males and 98 (49.5%) females participated in the study. Majority 110 (55.6%) cleaned their dentures once daily and toothbrush and pastes were used by 105 (53%) of the participants. More than 70% of the respondents removed their dentures at night. One hundred and sixty-six (83.8%) visited the dentist only when they needed treatment. There was a statistical significant relationship between frequency and technique of cleaning denture, and denture cleanliness (P < 0.05). Conclusion: This study shows that once daily cleaning of dentures and cleaning the denture with rest of the teeth are ineffective in prevention of plaque accumulation. PMID:26229229

  8. Phenotypic and Molecular Characterization of Multidrug Resistant Klebsiella pneumoniae Isolated from a University Teaching Hospital, China

    PubMed Central

    Liu, Helu; Lü, Dongyue; Liang, Hong; Dou, Yuhong

    2014-01-01

    The multidrug-resistant rate of Klebsiella pneumoniae has risen rapidly worldwide. To better understand the multidrug resistance situation and molecular characterization of Klebsiella pneumoniae, a total of 153 Klebsiella pneumoniae isolates were collected, and drug susceptibility test was performed to detect its susceptibility patterns to 13 kinds of antibiotics. Phenotypic tests for carbapenemases ESBLs and AmpC enzyme-producing strains were performed to detect the resistance phenotype of the isolates. Then PCR amplification and sequencing analysis were performed for the drug resistance determinants. The results showed that 63 strains harbored blaCTX-M gene, and 14 strains harbored blaDHA gene. Moreover, there were 5 strains carrying blaKPC gene, among which 4 strains carried blaCTX-M, blaDHA and blaKPC genes, and these 4 strains were also resistant to imipenem. Our data indicated that drug-resistant Klebsiella pneumoniae were highly prevalent in the hospital. Thus it is warranted that surveillance of epidemiology of those resistant isolates should be a cause for concern, and appropriate drugs should be chosen. PMID:24740167

  9. Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan

    PubMed Central

    Irfan Ahmed, Sheikh; Raza, Amir; Khurshid, Ayesha; Chishti, Uzma

    2016-01-01

    Objective Review of obstetric cases admitted to the intensive care unit. Design Ten year retrospective review of individual patients' medical records. Participants Records of obstetric patients admitted from 2005–2014. Setting Aga Khan University Hospital Karachi Main Outcome measures Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality. Findings A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay was 24 hours and maximum stay was 53 days. Sixty one percent of patients were admitted to with organ system failure. The overall mortality rate was 21.64% (42/194). The mortality rate was five times more likely in patients who had gastro-intestinal complication {Odds Ratio=4.87; 95%CI: 1.65-14.36}. The largest group of patients {28.4%} presented with hematological diagnosis. Conclusion When the intensive care unit admission became essential, primary diagnosis included: postpartum hemorrhage, hypertensive disorders, sepsis and infectious diseases. An increased vigilance of high-risk pregnant women and a stabilization of their condition before intervention is administered, improves the outcome of these women. PMID:27895930

  10. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in north India.

    PubMed

    Mehta, Manjula; Dutta, Priya; Gupta, Varsha

    2005-06-01

    Bloodstream infections are associated with significant patient morbidity and mortality worldwide. In this study, we examined antimicrobial susceptibility patterns by reviewing the data on 5,704 blood samples that were collected from patients with fever/sepsis admitted to Government Medical College and Hospital, Chandigarh, India, over a period of 1 year from August 2003 to July 2004. Among the 567 qualifying samples, Pseudomonas aeruginosa (19.75%), Escherichia coli (15.17%), Klebsiella pneumoniae (14.99%), and Salmonella enterica serovar Typhi (12.87%) were the most frequently isolated Gram-negative bacteria other than Citrobacter, Acinetobacter, Proteus, and Enterobacter spp. collectively accounting for 80.96% of the isolates. Staphylococus aureus (13.86%) and Enterococcus feacalis (2.35%) were most frequently isolated Gram-positive bacteria other than other Streptococcus and Staphylococcus spp. collectively accounting for 18% of the isolates. Among the antibiotics used for susceptibility testing of Gram-negative isolates, amikacin showed higher activity (76.61%) against Enterobacteriaceae and ciprofloxacin (65.17%) against non-fermenters. However, cefoperazone + sulbactum showed the highest activity (82.66%) among all Gram-negative isolates. For Gram-positive isolates, vancomycin (100%), ciprofloxacin (89.74%) showed the highest activity against Staphylococcus spp. Combinations of antibiotics are often prescribed as emperic therapy for bacteremia, especially for Gram-negative pathogens. Hence the antibiotic susceptibility patterns of blood isolates reported here may be a useful guide for physicians initiating emperic therapy with antibiotics.

  11. Dyslipidemia in Patients with a Cardiovascular Risk and Disease at the University Teaching Hospital of Yaoundé, Cameroon

    PubMed Central

    Ama Moor, Vicky Jocelyne; Ndongo Amougou, Sylvie; Ombotto, Sebastien; Ntone, Felicien; Wouamba, Doriane Edna

    2017-01-01

    Objective. To determine the frequency of lipid abnormalities in patients with a cardiovascular risk and disease at the University Teaching Hospital (UTH) of Yaoundé. Materials and Methods. We conducted a cross-sectional study from 1 March to 31 May 2015 at the UTH of Yaoundé. We included all patients seen in the outpatient department with a diagnosis of a cardiovascular disease or a risk factor for cardiovascular disease. Patients who accepted to participate in the study were asked to answer a questionnaire; after that a blood sample was taken for lipid profile. An informed consent was signed by all the participants and the study has received approval from the national ethic committee. Results. We recruited 264 patients of which 119 were men and 145 were women with a sex ratio of 0.82. Mean age was 61.36 years. The frequency of lipid profiles abnormalities was as follows: low HDL cholesterol (44.3%), hypertriglyceridemia (18.9%), high LDL cholesterol (3.8%), and high total cholesterol 3.4%). Hypertriglyceridemia was strongly associated with type 2 diabetes mellitus. Conclusion. Low levels of HDL cholesterol and hypertriglyceridemia are more prevalent in our study population. More studies are needed to confirm this finding in our environment. PMID:28163932

  12. Obstetric predictors of hypertension: A cross-sectional study of women attending the postnatal clinic of Jos University Teaching Hospital

    PubMed Central

    Agbo, Hadiza A.; Okeahialam, Basil N.; Daru, Patrick H.

    2016-01-01

    Background: Hypertensive disease in pregnancy (HDP) accounts for high mother and child morbi-mortality and predict future cardiometabolic diseases. This study aimed to identify obstetric predictors of HDP needing preventive action to reduce its consequences; when women present to antenatal clinic (ANC). Materials and Methods: Cross-sectional descriptive this was an Interviewer-administered semi-structured questionnaire-based study of the anthropometric, and blood pressure measurementsin attendees at the postnatal clinic (PNC) of Jos University with ANC records. Setting: Six weeks postnatal clinic (PNC) of Jos University Teaching Hospital (JUTH). Results: The following indices proved predictive of HDP and subsequent hypertension: weight (P = 0.009), hip circumference (P = 0.018), parity (P = 0.043), waist circumference (P = 0.00), abdominal height (P = 0.040), waist/height (P = 0.020), history of developing hypertension in previous pregnancy (P = 0.000), birth weight of baby (P = 0.02), and mode of delivery (P = 0.05). Conclusion: To initiate preventive action on ANC registration in mitigating effects of or outrightly preventing HDP, careful check on anthropometry as well as history of hypertension or operative/preterm delivery in a previous pregnancy is necessary PMID:27942098

  13. Emerging Perils of Extended Spectrum β-Lactamase Producing Enterobacteriaceae Clinical Isolates in a Teaching Hospital of Nepal

    PubMed Central

    Maharjan, Pooja; Joshi, Govardhan; Khanal, Puspa Raj

    2016-01-01

    Introduction. Infections due to extended spectrum β-lactamase producing Enterobacteriaceae are on the rise. They pose serious public health problems due to their resistance to large number of antibiotics. However, little is known about the genotypes of ESBL from Nepal. Therefore, the study presents results of phenotypic and molecular characterization of ESBL producing Escherichia coli and Klebsiella spp. isolated from various clinical specimens in a tertiary care teaching hospital of Nepal. Methods. A total of 172 Enterobacteriaceae clinical isolates recovered from various clinical specimens were analyzed for their antibiotic susceptibility test. Detection of ESBLs was carried out using combination disk test and multiplex PCR for their genotypes (CTX-M, SHV, and TEM). Results. Out of 172 clinical isolates, 70 (40.6%) of them were found ESBL producers. The major source of ESBL producers was urinary tract samples and the highest ESBL production was observed in Escherichia coli (46.5%). Among ESBL genotypes, CTX-M (91.4%) was most predominant, followed by TEM (65.7%) and SHV (11.4%) in both of the isolates. Conclusions. High level of drug resistance and ESBL production was observed among the clinical isolates. There is a need for longitudinal and nationwide surveillance for drug resistance in clinical isolates and antimicrobial stewardship is necessary to guide the appropriate and judicious antibiotic use. PMID:28119921

  14. Sensitivity profile of Staphylococcus spp. and Streptococcus spp. isolated from toys used in a teaching hospital playroom☆

    PubMed Central

    Boretti, Vanessa Stolf; Corrêa, Renata Nunes; dos Santos, Silvana Soléo Ferreira; Leão, Mariella Vieira Pereira; Silva, Célia Regina Gonçalves e

    2014-01-01

    Objective: To evaluate the presence of microorganisms of the genus Staphylococcus and Streptococcus on toys in the playroom of a teaching hospital, as well to as analyze the antimicrobial resistance from isolated strains. Methods: Samples were collected from 60 toys, using wet swabs, soon after being used by the children. The samples were inoculated in enriched and selective agar for isolation and later identification of the microorganisms. Antibiogram testing was performed by agar diffusion technique. Results: The genus Staphylococcus was present in 87.0% (52/60) of the toys. Seventy-three strains were isolated, with 29.0% (21/73) coagulase-positive and 71.0% (52/73) coagulasenegative. Among the coagulase-negative strains, 90.4% were resistant to penicillin, 65.4% to oxacillin, 28.8% to clarithromycin, 61.5% to clindamycin, and none to vancomycin. Among the coagulase-positive strains, 76.2% were resistant to penicillin, 23.8% to oxacillin, 23.8% to clarithromycin, 47.6% to clindamycin, and none to vancomycin. The genus Streptococcus was not detected in any of the evaluated toys. Conclusions: Toys can be contaminated with potentially pathogenic bacteria with antimicrobial resistance, representing a possible source of nosocomial infection for patients who are already debilitated. PMID:25479842

  15. Bacterial Epidemiology and Antimicrobial Resistance in the Surgery Wards of a Large Teaching Hospital in Southern Italy

    PubMed Central

    Esposito, Silvano; Gioia, Renato; De Simone, Giuseppe; Noviello, Silvana; Lombardi, Domenico; Di Crescenzo, Vincenzo Giuseppe; Filippelli, Amelia; Rega, Maria Rosaria; Massari, Angelo; Elberti, Maria Giovanna; Grisi, Lucilla; Boccia, Giovanni; De Caro, Francesco; Leone, Sebastiano

    2015-01-01

    Objectives Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011–2013. Methods Data concerning non-duplicate bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek 2 database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used. Results In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. A. baumannii showed high rates of resistance to carbapenems (with values of 100% in 2011 and 2012) and low rates of resistance to tigecycline, colistin and amikacin. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated. The rate of MRSA isolates ranged from 66% to 75% during the study period. Conclusions Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data. PMID:26075047

  16. Impact of Checklist Use on Wellness and Post-Elective Surgery Appointments in a Veterinary Teaching Hospital.

    PubMed

    Ruch-Gallie, Rebecca; Weir, Heather; Kogan, Lori R

    2016-10-25

    Cognitive functioning is often compromised with increasing levels of stress and fatigue, both of which are often experienced by veterinarians. Many high-stress fields have implemented checklists to reduce human error. The use of these checklists has been shown to improve the quality of medical care, including adherence to evidence-based best practices and improvement of patient safety. Although it has been recognized that veterinary medicine would likely demonstrate similar benefits, there have been no published studies to date evaluating the use of checklists for improving quality of care in veterinary medicine. The purpose of the current study was to evaluate the impact of checklists during wellness and post-elective surgery appointments conducted by fourth-year veterinary students within their Community Practice rotation at a US veterinary teaching hospital. Students were randomly assigned to one of two groups: those who were specifically asked to use the provided checklists during appointments, and those who were not asked to use the checklists but had them available. Two individuals blinded to the study audiotaped and reviewed all appointments in each study group to determine the amount and type of medical information offered by veterinary students. Students who were specifically asked to use the checklists provided significantly more information to owners, with the exception of keeping the incision clean. Results indicate the use of checklists helps students provide more complete information to their clients, thereby potentially enhancing animal care.

  17. Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan

    PubMed Central

    Bokhari, Syed Akhtar Hussain; Suhail, Agha Mohammad; Malik, Abdul Razzaq; Imran, Mian Farrukh

    2015-01-01

    Background: Investigators have identified an association of socio-demographic and medical factors with periodontal risk. This study observed status and association of periodontal disease and associated risk factors/indictors. Materials and Methods: All patients attending a dental teaching hospital were interviewed for socio-demographic and medical information through a structured questionnaire. Participants were examined for periodontal status using the community periodontal index (CPI), by a single examiner during September to November 2012. An association of age, gender, smoking habit, systemic conditions, and oral hygiene measures with periodontal status ([periodontitis CPI score ≥3]/nonperiodontitis [CPI score ≤2]) was analyzed by applying Chi-square test and forward selection stepwise regression analysis. Results: One thousand nine hundred and eighteen patients were examined during the study period. The findings revealed that 63.5% of the subjects had CPI score ≤2 (nonperiodontitis), while 34.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, cardiovascular disease, kidney disease, stress, medications, and oral hygiene habits of using tooth powder or tooth brushing were significantly (P ≤ 0.037) associated with periodontal status. Regression analysis showed a significant association of age, occupation, and smoking with periodontitis. Conclusion: This study observed prevalence of periodontitis in one-fourth of study sample. The study confirmed various socio-demographic risk factors/indictors associated with increased risk of periodontitis. PMID:26941520

  18. Phenotypic Detection of Genitourinary Candidiasis among Sexually Transmitted Disease Clinic Attendees in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

    PubMed Central

    Obisesan, Oluranti J.; Olowe, Olugbenga A.; Taiwo, Samuel S.

    2015-01-01

    The management of genitourinary candidiasis (GC) is fraught with challenges, especially, in an era of increasing antifungal resistance. This descriptive cross-sectional study conducted between May 2013 and January 2014 determined the prevalence and characteristics of GC and the species of Candida among 369 attendees of a Sexually Transmitted Disease (STD) clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Appropriate urogenital specimen collected from each attendee was examined by microscopy and culture for Candida, with preliminary species identification by CHROMAgar Candida and confirmation by Analytical Profile Index (API) 20C AUX. The age range of attendees was 1-80 years, mean age was 36.32 ± 11.34 years, and male to female ratio was 1 to 3. The prevalence of genitourinary candidiasis was 47.4%, with 4.9% in males and 42.5% in females (p < 0.0001). The age groups 31–45 and 16–30 have the highest prevalence of 23.3% and 16.8%, respectively. The species of Candida recovered include Candida glabrata 46.9%, Candida albicans 33.7%, Candida dubliniensis 9.7%, Candida tropicalis 5.7%, Candida krusei 1.7%, Candida lusitaniae 1.7%, and Candida utilis 0.6%. This study reported non-C. albicans Candida, especially C. glabrata, as the most frequently isolated species in GC, contrary to previous studies in this environment and elsewhere. PMID:26064140

  19. Stifle Lameness in Cattle at Two Veterinary Teaching Hospitals: A Retrospective Study of Forty-two Cases

    PubMed Central

    Ducharme, N. G.; Stanton, M. E.; Ducharme, G. R.

    1985-01-01

    Records of two veterinary teaching hospitals from January 1, 1976 to June 1, 1982 were searched for diagnoses of stifle lameness. Forty-two records were found and information was recorded regarding signalment, history and clinical presentation. The following abnormalities were associated with stifle lameness: subchondral bone cyst (18 cases), joint instability (15 cases), degenerative joint disease (12 cases), cranial cruciate ligament injury (9 cases), cytological or bacteriological evidence of sepsis (9 cases), collateral ligament injury (3 cases), femorotibial luxation (2 cases) and intra-articular fracture (2 cases). The duration of lameness presentation ranged from 0.3 to 24 weeks and the mean follow-up period was 20.47 ± 11.44 months (three animals were lost to follow-up). Animals (n = 15) with subchondral bone cysts as the sole association with lameness presented at an early age (range — 6 to 18 months) and apparently regardless of treatment, had a good prognosis as determined by 75% (three lost to follow-up) returning to their intended function. Cattle (n = 9) with septic arthritis were presented at an age ranging from two months to seven years and only 22.2% returned to function. Cattle (n = 15) with joint instability presented at an age varying from nine months to 13 years also did poorly as only 26.6% returned to function. ImagesFigure 1.Figure 2. PMID:17422551

  20. Phenotypic Detection of Genitourinary Candidiasis among Sexually Transmitted Disease Clinic Attendees in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria.

    PubMed

    Obisesan, Oluranti J; Olowe, Olugbenga A; Taiwo, Samuel S

    2015-01-01

    The management of genitourinary candidiasis (GC) is fraught with challenges, especially, in an era of increasing antifungal resistance. This descriptive cross-sectional study conducted between May 2013 and January 2014 determined the prevalence and characteristics of GC and the species of Candida among 369 attendees of a Sexually Transmitted Disease (STD) clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Appropriate urogenital specimen collected from each attendee was examined by microscopy and culture for Candida, with preliminary species identification by CHROMAgar Candida and confirmation by Analytical Profile Index (API) 20C AUX. The age range of attendees was 1-80 years, mean age was 36.32 ± 11.34 years, and male to female ratio was 1 to 3. The prevalence of genitourinary candidiasis was 47.4%, with 4.9% in males and 42.5% in females (p < 0.0001). The age groups 31-45 and 16-30 have the highest prevalence of 23.3% and 16.8%, respectively. The species of Candida recovered include Candida glabrata 46.9%, Candida albicans 33.7%, Candida dubliniensis 9.7%, Candida tropicalis 5.7%, Candida krusei 1.7%, Candida lusitaniae 1.7%, and Candida utilis 0.6%. This study reported non-C. albicans Candida, especially C. glabrata, as the most frequently isolated species in GC, contrary to previous studies in this environment and elsewhere.

  1. Integration of services for victims of child sexual abuse at the university teaching hospital one-stop centre.

    PubMed

    Chomba, Elwyn; Murray, Laura; Kautzman, Michele; Haworth, Alan; Kasese-Bota, Mwaba; Kankasa, Chipepo; Mwansa, Kaunda; Amaya, Mia; Thea, Don; Semrau, Katherine

    2010-01-01

    Objective. To improve care of sexually abused children by establishment of a "One Stop Centre" at the University Teaching Hospital. Methodology. Prior to opening of the One Stop Centre, a management team comprising of clinical departmental heads and a technical group of professionals (health workers, police, psychosocial counselors lawyers and media) were put in place. The team evaluated and identified gaps and weaknesses on the management of sexually abused children prevailing in Zambia. A manual was produced which would be used to train all professionals manning a One Stop Centre. A team of consultants from abroad were identified to offer need based training activities and a database was developed. Results. A multidisciplinary team comprising of health workers, police and psychosocial counselors now man the centre. The centre is assisted by lawyers as and when required. UTH is offering training to other areas of the country to establish similar services by using a Trainer of Trainers model. A comprehensive database has been established for Lusaka province. Conclusion. For establishment of a One Stop Centre, there needs to be a core group comprising of managers as well as a technical team committed to the management and protection of sexually abused children.

  2. Common causes of poisoning in dogs and cats in a Brazilian veterinary teaching hospital from 1998 to 2000.

    PubMed

    Xavier, Fabiana Galtarossa; Kogika, Márcia Mery; de, SouzaSpinosaHelenice

    2002-04-01

    A retrospective study at the University Veterinary Teaching Hospital of São Paulo city, Brazil, describes the pattern of poisoning that occurred from 1998 to 2000. During this period 5,136 animals were sent to the emergency sector, and 250 of these cases were reported as poisonings: 203 dogs (81.2%) and 47 cats (18.8%). The common causes of poisoning in dogs were 28.9% therapeutic products (86.4% non-steroidal anti-inflammatory drugs, 6.8% other drugs, 3.4% antibiotics, 3.4% tranquilizing agents), 15.8% rodenticides, 13.9% pesticides for farm use (39.3% organophosphorous and 35.7% carbamate insecticides, 25.0% amitraz), 11.8% unknown agents, 8.4% plants, 6.8% industrial products, and 5.0% pesticides for domestic use. The common causes of poisoning in cats were 29.9% therapeutic products (50.0% non-steroidal anti-inflammatory drugs, 42.8% others, 7.2% antibiotics), 27.6% pesticides for farm use (46.1% carbamate insecticides, 38.5% organophosphorous insecticides, 15.4% others), 14.9% pesticides for domestic use, 12.8% unknown agents, 10.6% rodenticides, and 4.2% industrial products. These data show it is essential to create an awareness of the toxicity of these agents to reduce poisoning incidence.

  3. Radiological assessment of the structural shielding adequacy of the radiotherapy facility at Korle-Bu Teaching Hospital, Accra, Ghana.

    PubMed

    Adu, Simon; Emi-Reynolds, Geoffrey; Schandorf, Cyril; Darko, Emmanuel O; Gyekye, Prince K

    2012-04-01

    A (60)Co radiotherapy source with an initial activity of 185 TBq has exhausted its useful half-life and has been replaced with a 222 TBq (60)Co source at the Korle-Bu Teaching Hospital; a radiological assessment was performed to ascertain the shielding integrity of the facility. Dose rate at selected critical positions were calculated for the old and new sources. Dose rate measurements were also performed at these critical locations for the new source. The dose rates at all the critical locations of the public and staff access areas were within the recommended dose rate limit of 0.5 and 7.5 µSv h(-1) for the public and controlled area, respectively. The concrete biological shielding at the facility at the moment is adequate enough to attenuate the gamma photons from the new 222 TBq (60)Co source. High dose rates were recorded at the entrance to the treatment room, it is therefore recommended that optimisation of procedures should be encouraged to restrict activities in this area.

  4. A Prospective Study of Burn Trauma in Adults at the University of Calabar Teaching Hospital, Calabar (South Eastern Nigeria)

    PubMed Central

    Asuquo, Maurice E.; Ekpo, R.; Ngim, Ogbu; Agbor, C.

    2008-01-01

    Background: Burn injuries are among the most devastating injuries seen in the emergency units. The epidemiology of this injury varies from one part of the world to another. This is a 3-year report in an attempt to provide information on the current epidemiology of burns in this center. Method: Patients admitted into the University of Calabar Teaching Hospital, with burn injuries were prospectively studied between February 2005 and January 2008. Results: The 59 patients (33 males and 26 females) accounted for 3.7% of trauma patients and their ages ranged from 15 to 70 years (mean 29.4 years). Flame burn was the commonest injury seen in 48 (81.3%) patients because of petrol and kerosene, whereas chemical burn that involved 7 (11.9%) patients ranked second. Morbidity included burns wound infection in 13 (22%) patients and contractures in 6 (10.2%) patients. The outcome was fatal in 15 (25.4%) patients. Conclusion: The establishment of burn support groups dedicated to publicity on prevention based on areas of risk highlighted in this study and provision of financial aid as well as provision of modern burn care facilities would improve outcome. PMID:18716653

  5. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran

    PubMed Central

    Vazin, Afsaneh; Zamani, Zahra; Hatam, Nahid

    2014-01-01

    This study was conducted with the purpose of determining the frequency of medication errors (MEs) occurring in tertiary care emergency department (ED) of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5%) MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2%) and antimicrobial (23.6%) medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6%) and wrong time error (4.4%) were the most frequent administration errors. The less-experienced nurses (P=0.04), higher patient-to-nurse ratio (P=0.017), and the morning shifts (P=0.035) were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction of MEs in EDs. PMID:25525391

  6. Computer and internet use by first year clinical and nursing students in a Nigerian teaching hospital

    PubMed Central

    Ajuwon, Grace Ada

    2003-01-01

    Background The internet is an important source of up-to-date medical information. Although several studies in different countries have explored the extent to which health science students use the computer and the internet, few researches are available on this subject in Nigeria. The aim of this study was to assess the uptake of computer and internet by health science students studying in the country. Methods One hundred and eighty three first year medical and nursing students of the University College Hospital, Ibadan, Nigeria, completed a-25 item questionnaire during routine Library Orientation Program in the medical library. The EPI-Info software was used for data analysis. Results The mean ages for medical students and the student nurses were 22 and 24.6 years respectively. Overall, 42.6% of the entire sample could use the computer, 57.4% could not. While more than half (58%) of the medical students are computer literate, majority (75.9%) of the student nurses are not. Slightly more than two thirds (60.7%) of the entire students had ever used the internet, 33. 9% had not. E-mail was the most popular of internet services used by the students (76.4%) and the cyber café was the common place where students had accessed these services. The students' mean scores on a 15-point perceived self-efficacy scale for internet-related tasks was 3.8 for medical and 0.7 for nursing students (p = 0.00). Students who are computer literate had superior mean scores (4.8) than those without (0.6) (p = 0.000). Conclusion First year clinical and nursing students in Ibadan Nigeria have not fully utilised the opportunity that the use of computer and internet offer for medical education. Improved efforts such as inclusion of computer education in medical and nursing curricular and establishment of computer laboratories are required to increase the student's access to computers and internet. PMID:14498997

  7. Epidemiological profiling of methicillin-resistant Staphylococcus aureus-positive dogs arriving at a veterinary teaching hospital.

    PubMed

    Hoet, Armando E; van Balen, Joany; Nava-Hoet, Rocio C; Bateman, Shane; Hillier, Andrew; Dyce, Jonathan; Wittum, Thomas E

    2013-06-01

    Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important zoonotic and nosocomial pathogen in veterinary settings. Even though human risk factors for MRSA infection and colonization are well known, this information in animals is lacking. The objective of this study was to identify risk factors associated with MRSA carrier dogs on their arrival at a veterinary teaching hospital. A total of 435 dogs were enrolled in the MRSA active surveillance program at The Ohio State University-Veterinary Medical Center over a 1-year period. Dogs were screened for MRSA on arrival, regardless of health status, sex, breed, or age. In addition, an epidemiological survey and medical history were obtained for each dog to identify potential risk factors up to 1 year prior to the appointment. Of 435 dogs included in the study, 25 (5.7%) were MRSA positive, with 86.5% of the isolates classified staphylococcal chromosome cassette mec (SCCmec) type II and USA100. Four of the 25 MRSA carrier dogs were healthy, 20 had health issues unrelated to MRSA, and 1 had an active MRSA infection. MRSA was detected in the nares (72%, 18/25), skin lesions (24%, 6/25), and the perianal area (16%, 4/25). Except for previous surgery <90 days (odds ratio [OR]=4.9; 95% confidence interval [CI] 1.4-17.6; p value 0.01), none of the variables related to the previous medical history, dog's management, home environment, and other potential exposures were associated with the MRSA carrier status. However, the profession of the owner was significantly associated, and dogs owned by veterinary students were 20.5 times (95% CI 4.5-93.6; p value≤0.01) more likely to be MRSA positive than dogs owned by clients with different occupations. MRSA-positive dogs were dispersed in different categories, preventing the creation of an epidemiological profile that would allow their early recognition upon arrival to a veterinary hospital. However, the association between veterinary students with MRSA

  8. Knowledge, attitudes, and practice of doctors to adverse drug reaction reporting in a teaching hospital in India: An observational study

    PubMed Central

    Khan, Sarfaraz Alam; Goyal, Chhaya; Chandel, Nitibhushansingh; Rafi, Mohammed

    2013-01-01

    Background: Underreporting of spontaneous adverse drug reaction (ADR) is a threat to pharmacovigilance. Various factors related with the knowledge and attitudes are responsible for underreporting of ADRs. Aims: The study was aimed at investigating the knowledge and attitudes of doctors to ADR reporting. Materials and Methods: It was a questionnaire-based cross-sectional study. One hundred and eight questionnaires were administered to doctors working in a teaching hospital with an ADR monitoring center. Statistical Analysis Used: The descriptive statistics were used for responses to evaluate the knowledge and attitudes toward ADR reporting. Pearson's Chi-square test was used to observe the association of knowledge and attitude with experience and position. Results: The response rate was 62.9%. Spontaneous reporting rate was found to be 19.1%. The major factors found to be responsible for underreporting of ADR include inadequate risk perception about newly marketed drugs (77.9%), fear factor (73.5%), diffidence (67.7%), lack of clarity of information on ADR form about reporting (52.9%), lethargy (42.7%), insufficient training to identify ADRs (41.2%), lack of awareness about existence of pharmacovigilance program (30.9%) and ADR monitoring center in the institute (19.1%), and inadequate risk perception of over-the-counter (OTC) product (20.6%) and herbal medicines (13.2%). Experience and position did not influence the knowledge and attitudes of doctors. Conclusion: The deficiencies in knowledge and attitudes require urgent attention not only to improve the rate of spontaneous reporting, but also for enhanced safety of the patients and society at large. PMID:23633861

  9. Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana.

    PubMed

    Burton, Nicole T; Forson, Audrey; Lurie, Mark N; Kudzawu, Samuel; Kwarteng, Ernest; Kwara, Awewura

    2011-12-01

    Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated for TB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7; 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2; 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.

  10. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    PubMed Central

    Yang, Ping; Chen, Na; Wang, Rong-Rong; Li, Lu; Jiang, Sai-Ping

    2016-01-01

    Background With the increasing incidence rate of chronic kidney disease (CKD), inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure. Objective The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients. Methods A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified. Results Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56), contraindicated (n=46), and cautiously used medicines (n=161) accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056). Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%), cardiovascular drugs (n=61, 23.19%), and antimicrobial drugs (n=55, 20.91%) represented the top three medicine categories in CKD patients. Conclusion The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. PMID:27785039

  11. Identification and characterization of CTX-M-15 producing Klebsiella pneumoniae clone ST101 in a Hungarian university teaching hospital.

    PubMed

    Melegh, Szilvia; Schneider, György; Horváth, Marianna; Jakab, Ferenc; Emődy, Levente; Tigyi, Zoltán

    2015-09-01

    We investigated the molecular epidemiology of extended spectrum β-lactamase (ESBL) producing Klebsiella pneumoniae isolates derived from the teaching hospitals of University of Pécs, Pécs, Hungary in the time period 2004-2008. Molecular typing, antimicrobial susceptibility testing, detection of common β-lactamase genes (bla(CTX-M), bla(TEM) and bla(SHV)) and virulence associated traits (hypermucoviscosity, magA, k2a, rmpA, siderophores, type 1 and 3 fimbria, biofilm formation, serum resistance) were performed for 102 isolates. The results showed the presence of three major ciprofloxacin resistant CTX-M-15 producing clones (ST15 n = 69, ST101 n = 10, and ST147 n = 9), of which ST15 was predominant and universally widespread. Considering distribution in time and place, ST101 and ST147 were detected at fewer inpatient units and within a narrower time frame, as compared to ST15. Beside major clones, eleven minor clones were identified, and were shown to harbour the following β-lactamase genes: six clones carried bla(CTX-M), four clones harboured bla(SHV-5) and one clone possessed both bla(CTX-M) and ESBL type bla(SHV). Among the SHV-5 producing K. pneumoniae clones a novel sequence type was found, namely ST1193, which harboured a unique infB allele. Different virulence factor content and peculiar antimicrobial susceptibility profile were characteristic for each clone. In contrast to major clone isolates, which showed high level resistance to ciprofloxacin, minor clone isolates displayed significantly lower MIC values for ciprofloxacin suggesting a role for fluoroquinolones in the dissemination of the major K. pneumoniae clones. This is the first description of the CTX-M-15 producing K. pneumoniae clone ST101 in Hungary.

  12. Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil.

    PubMed

    Torres, Rafael Garcia; Etchebehere, Renata Margarida; Adad, Sheila Jorge; Micheletti, Adilha Rua; Ribeiro, Barbara de Melo; Silva, Leonardo Eurípedes Andrade; Mora, Delio Jose; Paim, Kennio Ferreira; Silva-Vergara, Mario León

    2016-10-05

    Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.

  13. Radiographic technical quality of root canal treatment performed by undergraduate dental students at the Academy Dental Teaching Hospital, UMST, Sudan

    PubMed Central

    Awooda, Elhadi M.; Siddig, Reem I.; Alturki, Ruaa S.; Sanhouri, Nada M.

    2016-01-01

    Aim: To radiographically evaluate the technical quality of root canal treatment performed by undergraduate dental students and compare the findings with other institution's work. Materials and Methods: A retrospective, cross-sectional study was conducted at the Academy Dental Teaching Hospital involving postoperative periapical radiographs of patients who were endodontically treated by batch #14 undergraduate dental students of final year (2013–2014) from UMST, Sudan. The total number of the students was 21, while periapical radiographs fulfilling the required criteria were 173. The radiographs of each case were evaluated in terms of length, density, and taper of the root canal filling. Procedural errors such as presence of a ledge, perforation, and a separated instrument were also recorded. Chi-square test was used to determine statistically significant differences between variables, with the level of significance set at P ≤ 0.05. Results: The overall quality of performed root canal treatment was adequate in almost half (55.5%) of the evaluated teeth. The length and taper of the root canal filling were found to be significantly associated with maxillary and mandibular posterior teeth with P = 0.018 and 0.006, respectively. No associations were found between the density and presence of separated instrument in the maxillary and mandibular posterior teeth, P = 0.314 and 0.480, respectively. Conclusion: The radiographic quality of root canal treatment performed by undergraduate students of batch #14 UMST was acceptable in 55.5% of the cases. Special emphasis must be placed on the educational methods and training of students for providing root canal treatment on molar teeth. PMID:28032048

  14. Infective endocarditis in a Finnish teaching hospital: a study on 326 episodes treated during 1980–2004

    PubMed Central

    Heiro, M; Helenius, H; Mäkilä, S; Hohenthal, U; Savunen, T; Engblom, E; Nikoskelainen, J; Kotilainen, P

    2006-01-01

    Objectives To evaluate potential changes of infective endocarditis (IE) in patients treated in a Finnish teaching hospital during the past 25 years. Patients 326 episodes of IE in 303 patients treated during 1980–2004 were evaluated for clinical characteristics and their changes over time. Results The mean age of the patients increased with time (from 47.2 to 54.5 years, p  =  0.003). Twenty‐five (7.7%) episodes were associated with intravenous drug use (IVDU), with a significant increase of these episodes after 1996 (from 0 to 19 (20%), p < 0.001). Viridans streptococci were the most common causative agents of IE during 1980–1994, but after that Staphylococcus aureus was the most common pathogen (p  =  0.015). The proportion of IE of the aortic valve decreased during the study (from 30 (49%) to 26 (27%), whereas the proportions of mitral (11 (18%) to 33 (35%) and tricuspid valve IE (0 to 13 (14%) increased correspondingly (p  =  0.001). This was mainly due to more patients with IVDU. Chronic dialysis for renal failure as an underlying condition increased over time (from 0 to 7 (7.4%), p  =  0.015) but no other predisposing conditions changed. Complications such as neurological manifestations and heart failure did not change in frequency, but the incidence of lung emboli increased (from 0% to 10.5%, p < 0.001); 83% of these emboli occurred in patients with IVDU. The proportion of patients requiring surgical treatment and mortality due to IE did not change. Conclusions During these 25 years, the causative agents, affected valves and complications of IE changed to some degree. These changes were mainly attributed to the increase of IVDU‐associated IE. Except for the increase in age, the clinical presentation and outcome in non‐addicts remained substantially unchanged. PMID:16644858

  15. Prevalence of Needlestick Injuries Among Healthcare Workers in the Accident and Emergency Department of a Teaching Hospital in Nigeria

    PubMed Central

    Isara, AR; Oguzie, KE; Okpogoro, OE

    2015-01-01

    Background: Healthcare workers (HCWs) are continually exposed to hazards from contact with blood and body fluids of patients in the healthcare setting. Aim: To determine the prevalence of needlestick injuries (NSIs) and associated factors among HCWs in the Accident and Emergency Department of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Subjects and Methods: This was a cross-sectional study. Data were collected using a structured, self-administered questionnaire and analyzed using IBM SPSS version 20. Univariate, bivariate, and binary logistic regression analyses were done. The level of significance was set at P < 0.05. Results: The prevalence of NSIs 12 months preceding the study was 51.0% (50/98). Doctors 8/10 (80.0%) and nurses 28/40 (70.0%) had the highest occurrence. Recapping of needles 19/50 (38.0%) and patient aggression 13/50 (26.0%) were responsible for most injuries. The majority 31/50 (62.0%) of the injuries were not reported. The uptake of postexposure prophylaxis (PEP) was low 11/50 (22.0%). The factors that were significantly associated with NSI include age 30 years and above (odds ratio [OR] =0.28, confidence interval [CI] = 0.11–0.70), work duration of three years and above (OR = 0.29, CI = 0.11–0.75), and being a nurse (OR = 3.38, CI = 1.49–9.93) or a paramedic (OR = 0.18, CI = 0.06–0.52). Conclusion: The high prevalence of NSIs among the HCWs, especially in doctors and nurses is an indication that HCWs in UBTH are at great risk of contracting blood-borne infections. Efforts should be made to ensure that injuries are reported and appropriate PEP undertaken following NSIs. PMID:27057376

  16. Treatment of Non-ST Elevation Myocardial Infarction: A Process Analysis of Patient and Program Factors in a Teaching Hospital.

    PubMed

    Shepple, Benjamin I; Thistlethwaite, William A; Schumann, Christopher L; Akosah, Kwame O; Schutt, Robert C; Keeley, Ellen C

    2016-09-01

    As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay. A total of 242 patients with type 1 non-STEMI were included. The majority of patients received aspirin early after presentation to the emergency department; however, there was significant variability in the time from presentation to administration of other medications, including anticoagulation and P2Y12 therapy, even after an elevated troponin level was documented in the chart. Lack of a standardized non-STEMI admission order set, inconsistency regarding whether the emergency department physician or the cardiology admitting team order these medications after the diagnosis is made, and per current protocol, the initial call regarding the patient made to the cardiology fellow, not the admitting house staff, were identified as possible contributors to the delay. Patients who presented during "nighttime" hours had higher rates of atypical symptoms (P = 0.036) and longer delays to coronary angiography (46.5 versus 24 hours, P < 0.001) even in those deemed intermediate to high risk. A process analysis revealed considerable variation in non-STEMI treatment in our teaching hospital and identified specific areas for quality improvement measures.

  17. 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)

  18. Methicillin-Resistant Staphylococcus aureus spa Type t002 Outbreak in Horses and Staff at a Veterinary Teaching Hospital after Its Presumed Introduction by a Veterinarian

    PubMed Central

    Masarwa, Samira; Tirosh-Levy, Sharon; Gleser, Dan; Kelmer, Gal; Adler, Amos; Carmeli, Yehuda; Schwaber, Mitchell J.

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization, involving MRSA strains which differ from common human health care-associated clones, have become serious emerging conditions in equine veterinary hospitals. In 2010, MRSA spa type t535 caused an outbreak involving both horses and personnel in a veterinary teaching hospital in Israel. Since then, surveillance continued, and occasional MRSA isolation occurred. Two years later, MRSA of another spa type, t002, was isolated from a veterinarian and, 3 weeks later, from a horse. The appearance of spa type t002, a common clone in human medicine in Israel, among both personnel and horses, prompted a point-prevalence survey of hospital personnel and hospitalized horses. Fifty-nine staff members (n = 16 equine; n = 43, other) and 14 horses were screened. Ten of 59 staff members (16.9%) and 7 of 14 horses (50%) were MRSA carriers. Among the staff, 44% of large animal department (LAD) personnel, compared with only 7% of non-LAD personnel, were carriers. Isolates from all horses and from 9 of 10 personnel were found to be of MRSA spa type t002. This clone was later isolated from an infected postoperative wound in a hospitalized horse. Measures were taken to contain transmission between horses and personnel, as was done in the previous outbreak, resulting in reduction of transmission and, finally, cessation of cross-transmission between horses and personnel. PMID:26085620

  19. Evaluation of a primary-care setting at a veterinary teaching hospital by a student business group: implementing business training within the curriculum.

    PubMed

    Louisa Poon, W Y; Covington, Jennifer P; Dempsey, Lauren S; Goetgeluck, Scott L; Marscher, William F; Morelli, Sierra C; Powell, Jana E; Rivers, Elizabeth M; Roth, Ira G

    2014-01-01

    This article provides an introduction to the use of students' business skills in optimizing teaching opportunities, student learning, and client satisfaction in a primary health care setting at a veterinary teaching hospital. Seven veterinary-student members of the local chapter of the Veterinary Business Management Association (VBMA) evaluated the primary-care service at the University of Georgia (UGA) veterinary teaching hospital and assessed six areas of focus: (1) branding and marketing, (2) client experience, (3) staff and staffing, (4) student experience, (5) time management, and (6) standard operating procedures and protocols. For each area of focus, strengths, weaknesses, opportunities, and threats were identified. Of the six areas, two were identified as areas in need of immediate improvement, the first being the updating of standard operating protocols and the second being time management and the flow of appointments. Recommendations made for these two areas were implemented. Overall, the staff and students provided positive feedback on the recommended changes. Through such a student-centered approach to improving the quality of their education, students are empowered and are held accountable for their learning environment. The fact that the VBMA functions without a parent organization and that the primary-care service at UGA functions primarily as a separate entity from the specialty services at the College of Veterinary Medicine allowed students to have a direct impact on their learning environment. We hope that this model for advancing business education will be studied and promoted to benefit both veterinary education and business practice within academia.

  20. Health-care waste incineration and related dangers to public health: case study of the two teaching and referral hospitals in Kenya.

    PubMed

    Njagi, Nkonge A; Oloo, Mayabi A; Kithinji, J; Kithinji, Magambo J

    2012-12-01

    There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level, [2006] for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units.

  1. Detecting and managing drug-related problems in the neurology ward of a tertiary care teaching hospital in Iran: A clinical pharmacist's intervention

    PubMed Central

    Foroughinia, Farzaneh; Tazarehie, Seyyed Ramtin; Petramfar, Peyman

    2016-01-01

    Objective: Nowadays, the role of clinical pharmacists has become more prominent by more clinical pharmacists joining the health-care teams. This study was aimed to assess the role of a clinical pharmacist specialist in detecting and managing drug-related problems (DRPs) in the neurology ward of a tertiary care teaching hospital in Iran. Methods: This is a prospective cross-sectional study conducted on 123 hospitalized patients admitted to the neurology ward of a teaching hospital. The clinical pharmacist visited the patients and filled out the designed pharmacotherapy sheet for each patient. Then, the general pharmacist checked the patients' files and pharmacotherapy sheets and categorized DRPs using modified method of “The Pharmaceutical Care Network Europe classification, Version 5.01.” Findings: A total of 168 errors were found and 346 interventions were done by the clinical pharmacist during the study period. The most common form of errors in our study was “drug choice problems” (57.76%). The acceptance rate of interventions was 41.91% among physicians. Conclusion: The large number of interventions reported in several studies, as well as this study, revealed that clinical pharmacy services could contribute to a rationalization of drug therapy and may eventually lead to more medication safety. PMID:27843966

  2. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    PubMed

    2014-08-22

    are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

  3. Predictors of hypertension in an urban HIV-infected population at the University of Calabar Teaching Hospital, Calabar, Nigeria

    PubMed Central

    Okpa, Henry Ohem; Bisong, Elvis Mbu; Enang, Ofem Egbe; Monjok, Emmanuel; Essien, Ekere James

    2017-01-01

    Background The introduction of highly active antiretroviral therapy (HAART) has remarkably improved the prognosis of human immunodeficiency virus (HIV)-infected patients, at the expense of the development of long-term complications such as cardiovascular and renal diseases. Hypertension (HTN) is a major risk factor for cardiovascular diseases and its associated mortality. In this study, we aimed to determine the prevalence of HTN and to identify possible predictors among HIV-infected patients attending the HIV Special Treatment Clinic at the University of Calabar Teaching Hospital, Calabar. Materials and methods A cross-sectional study was carried out over a 5-month period from February to July 2016. A total of 112 HIV-infected persons were consecutively recruited and their blood pressures were measured in two consecutive clinic visits. They were compared with the HIV-negative control group (n=309). Data collected were analyzed with SPSS 18, and statistical significance was set at P<0.05. Results There was a female preponderance in both the HIV-infected individuals and HIV-negative control group (57.5% vs. 57.4%). The mean ages were 39.3 and 33.9 years in HIV-infected and HIV-negative subjects, respectively. The risk factors that were associated with HTN in both groups were older age (>40 years), increased weight and body mass index (BMI), and presence of obesity. Male sex and duration of exposure to HAART and CD4 count levels >200 cells/mm3 were associated with HTN in HIV-infected patients, whereas the absence of family history of HTN was significantly associated with HTN in both groups. However, in a multivariate logistic regression, the predictors of HTN in both groups are absence of family history of HTN and older age in HIV-infected patients and HIV-negative subjects, respectively. Conclusion Traditional risk factors such as older age, increased BMI, and obesity were linked to HTN in both HIV-infected and HIV-negative subjects, but higher CD4 count level and

  4. Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

    PubMed Central

    Lee, Hooi Leng; Chua, Siew Siang; Mahadeva, Sanjiv

    2016-01-01

    Background and purpose Clinical guidelines recommend the prescribing of gastroprotective strategies in nonsteroidal anti-inflammatory drug (NSAID) users with risk factors for gastrointestinal (GI) ulcer or ulcer complications. However, these guidelines are not often translated into clinical practice. Therefore, the aim of this study was to investigate the utilization of gastroprotective strategies for NSAID-induced upper GI events in at-risk users in a major teaching hospital. Patients and methods A cross-sectional, observational, pharmacy-based study was conducted in a major Asian institution with both primary and secondary health care services. This study involved the screening of prescriptions for regular NSAIDs, and patients who met the inclusion criteria were recruited and interviewed using a questionnaire. Results Of the 409 participants recruited, 83.1% had at least one GI risk factor, of whom 70.3% did not receive appropriate gastroprotection. The most common GI risk factor was the use of high-dose NSAIDs (69.2%), followed by participants aged 65 years and older (22%) and concomitant use of low-dose aspirin (11.7%). Appropriate gastroprotective strategies utilized consisted of the use of a cyclooxygenase (COX)-2 inhibitor alone or a nonselective NSAID plus a proton pump inhibitor (PPI) in the moderate-risk group and a COX-2 inhibitor plus a PPI in the high-risk group. Gastroprotective strategies were underutilized in 67.1% of at-risk participants and overutilized in 59.4% of those without risk factors. Co-prescription of a histamine-2 receptor antagonist at lower-than-recommended doses constituted 59% of the inappropriate gastroprotective agents used. Logistic regression analysis revealed patients aged 65 years and older (odds ratio, 1.89; 95% CI =1.15–3.09) as a predictor for the prescribing of gastroprotection by the clinicians. Conclusion Approximately 70% of at-risk NSAID users, mainly on high-dose NSAIDs, were not prescribed appropriate

  5. Glucose-6-phosphate dehydrogenase deficiency among children attending the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

    PubMed

    Isaac, Iz; Mainasara, As; Erhabor, Osaro; Omojuyigbe, St; Dallatu, Mk; Bilbis, Ls; Adias, Tc

    2013-01-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This present study was conducted with the aim of determining the prevalence of G6PD deficiency among children visiting the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital for pediatric-related care. The study included 118 children, made up of 77 (65.3%) males and 41 (34.7%) females aged ≤5 years with mean age of 3.26 ± 1.90 years. Randox G6PD quantitative in vitro test screening was used for the diagnosis of G6PD deficiency. Of the 118 children tested, 17 (14.4%) were G6PD-deficient. Prevalence of G6PD deficiency was concentrated predominantly among male children (22.1%). Male sex was significantly correlated with G6PD deficiency among the children studied (r = 7.85, P = 0.01). The highest prevalence occurred among children in the 2- to 5-year age-group. Of the 17 G6PD-deficient children, twelve (70.2%) were moderately deficient, while five (29.4%) were severely deficient. Blood film from G6PD-deficient children indicated the following morphological changes; Heinz bodies, schistocytes, target cells, nucleated red cells, spherocytes, and polychromasia. This present study has shown a high prevalence of G6PD deficiency among children residing in Sokoto in the northwestern geopolitical zone of Nigeria. The study indicated a male sex bias in the prevalence of G6PD deficiency among the children studied. There is a need for the routine screening of children for G6PD deficiency in our environment, to allow for evidence-based management of these children and to ensure the avoidance of food, drugs, and infective agents that can potentially predispose these children to oxidative stress as well as diseases that deplete micronutrients that protect against oxidative stress. There is need to build capacity in our

  6. Evaluation of the process of introducing a quality development program in a nursing department at a teaching hospital: the role of a change agent.

    PubMed

    Petro-Nustas, W

    1996-12-01

    The CIPP model of evaluation was used through its Context, Input, Process and Product elements, to evaluate the process of introducing a quality development program established in a nursing department within a teaching referral hospital in Amman, Jordan. The evaluation was intended to test whether the development program had achieved its overall goals: Management within a static state of nursing manpower; improvement in the general patterns of communication; management of some operational and organizational level problems and enhancement of measures to facilitate staff development. Several sets of action were suggested and implemented within the period of the quality development program. The results indicated partial achievement of the overall goals with certain difficulties remaining. The hospital's overall strict budget remained the major operational problem to be resolved. Other research was recommended to be carried out to specifically test the effectiveness of each set of actions (measures) included in the study.

  7. A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre-post intervention study.

    PubMed

    Yu, Dongmei; Ma, Yuqin; Sun, Qingwen; Lu, Gendi; Xu, Ping

    2015-08-01

    We aimed to evaluate the effectiveness of a nursing care classification system for re-assessing nurse workload and determining staffing needs. Adequate bed-nurse ratios help manage hospital cost-efficiency, quality of care and patient safety. A prospective pre-post intervention study was conducted from January 2010 to December 2012 in 16 medical-surgical units of a tertiary teaching hospital. Nursing tasks were classified into four grades of care reflecting actual workload. Units were re-staffed accordingly and bed-nurse ratios compared with government-authorized bed-nurse ratios. Patient satisfaction, hospital stays and mortality were evaluated pre- and poststaffing changes. Average bed-nurse ratio (1:0.41) exceeded the national standard (1:0.40) in 16 units, but was inadequate in five units. Re-staffing increased average bed-nurse ratio from 1:0.41 to 1:0.48. Patients' satisfaction increased from 96.9% to 97.6%, and hospital stays decreased significantly. Nursing care classification effectively distributes nurse staffing to match patients' care levels, improving patient outcomes.

  8. Prevalence and characterization of Staphylococcus aureus and Staphylococcus pseudintermedius isolated from companion animals and environment in the veterinary teaching hospital in Zambia, Africa.

    PubMed

    Youn, Jung-Ho; Park, Yong Ho; Hang'ombe, Bernard; Sugimoto, Chihiro

    2014-03-01

    The Republic of Zambia consists of only one veterinary teaching school at the University of Zambia (UNZA) where students and veterinarians are exposed to many bacterial pathogens including Staphylococcus aureus (SA) and Staphylococcus pseudintermedius (SP). The aim of this study was the characterization and antimicrobial susceptibility profile of eleven SA and 48 SP isolates from the veterinary hospitals' in- and outpatients and the environment. No isolate was resistant to cefoxitin by disk diffusion test and the corresponding resistance gene mecA was not found. In contrast, the resistance rates of SA to penicillin (63.6%) and trimethoprim-sulfamethoxazole (36.4%) and SP to penicillin (52.1%) and tetracycline (25.0%) were the highest. A variety of sequence types (STs) without a predominant type including numerous novel types were determined, especially for SP (39.6%). The spa typing provided a clonal assignment for all SAs (100%) and 24 SPs (50%) with three and two novel types, respectively. This study has provided an overview of SA and SP in the veterinary teaching hospital at UNZA. However, for a better understanding of these species regarding pathogenesis and transmission, further studies on the prevalence and characterization of SA and SP from veterinary staff, pet owners, and farm animals in Zambia is needed.

  9. Drug therapy of epileptic seizures among adult epileptic outpatients of University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia

    PubMed Central

    Birru, Eshetie Melese; Shafi, Miftah; Geta, Mestayet

    2016-01-01

    Objective The aim of this study was to assess the practice of pharmacotherapy of epilepsy and its treatment outcomes in adult epileptic outpatients at the University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia. Methods An institution based, retrospective cross-sectional study was conducted from the medical charts of 336 adult epileptic patients at the outpatient epileptic clinic of Neurology Department of University of Gondar Teaching Hospital from May 2014 to April 2015. Reviewing follow-up information from the medical charts was used to evaluate antiepileptic drug (AED) prescribing patterns and treatment outcome. Data were collected by using data collection format and analyzed using SPSS software version 16. Results The most common type of seizure diagnosed was generalized tonic–clonic seizure (n=245, 72.91%). Monotherapy with an AED accounted for 80.35% of the cases, whereas dual therapy and polytherapy with three AED combinations accounted for 16.37% and 3.28%, respectively. The most frequently prescribed AED was phenobarbitone (62.47%) followed by carbamazepine (17.91%). From the total epileptic cases, 277 (82.4%) had well-controlled seizure status in the last three consecutive months. Conclusion Most of the patients were maintained by monotherapy, and largely this was by the older antiepileptic drug, phenobarbitone. Considering the development of pharmacotherapy of epilepsy and other patient related factors, the standard treatment guideline for Ethiopia needs to be revised periodically. PMID:28053533

  10. Individual Potentials Related to Evidence-Based Nursing among Nurses in Teaching Hospitals Affiliated to Tabriz University of Medical Sciences, Tabriz, Iran

    PubMed Central

    Seyyedrasooli, Alehe; Zamanzadeh, Vahid; Valizadeh, Leila; Tadaion, Farideh

    2012-01-01

    Introduction: Knowledge, attitude, and skills of nurses regarding evidence-based medicine are some of the important individual potentials in the implementation of these cares. There is no evidence indicating Iranian nurses to have these individual potentials. Therefore, the aim of this study was to determination the perceptions of nurses about individual potentials in evidence-based nursing and its related factors. Methods: In this descriptive correlational study, all nurses (n = 600) working in teaching hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran were included. Valid and reliable translated questionnaires were used to collect data. Descriptive and inferential statistics were employed in SPSS to analyze the data. Results: Based on our findings, moderate levels of knowledge, attitude, and skills were possessed by 274 (45.7%), 394 (65.7%), and 411 (68.5%) nurses, respectively. In addition, male nurses (p = 0.002) and those with a master's degree (p = 0.001) were more knowledgeable. Likewise, more positive attitudes were demonstrated by females (p = 0.004) and nurses with a master's degree (p = 0.04). A statistically significant difference was found between skills and employment status of nurses (p = 0.002). Conclusion: The moderate level of attitude among nurses can provide a good potential in promoting evidence-based nursing in teaching hospitals affiliated to Tabriz University of Medical Sciences. Therefore, more attention should be paid to enhance the awareness and skills of nurses toward evidence-based care. PMID:25276682

  11. A Study of Utilization of Antimicrobial Agents in Patients on Ventilator in Intensive Care Unit (ICU) at Tertiary Care Teaching Hospital, India

    PubMed Central

    Gandhi, Anuradha M; Patel, Prakruti P

    2014-01-01

    Objective: To study the use of antimicrobial agents in patients on ventilator in ICU. Materials and Methods: Study was conducted at tertiary care teaching hospital Ahmedabad, India. Total 300 patients admitted in ICU and prescribed antimicrobial agents were included in the study. The data were recorded in preformed Case Record Form (CRF) and were analysed by Z and x2 Test. Results: Patients were divided into group A (patients on ventilator support) and group B (patients without ventilator support). In all the patients antimicrobial agents were prescribed empirically and more than two antimicrobial agents were prescribed in both groups. It was observed that above 60% antimicrobial agents were prescribed according to WHO, National and State Essential Medicine List (EML). Restricted antimicrobial agents (according to antimicrobial policy of tertiary care teaching hospital) were prescribed significantly (p<0.05) higher in group A as compared to group B. Resistance to antimicrobial agents by Pseudomonas aeruginosa and Kleibsella shown significantly (p<0.05) higher in group A as compared to group B. Change of antimicrobial therapy after Culture Sensitivity Test (CST) was significantly (p<0.05) higher in group A as compared to group B. Conclusion: Number of antimicrobial agents, antimicrobial resistance and change of antimicrobial therapy after CST were higher in patients on ventilator support. PMID:25584243

  12. Assessing the Performance of a Modified LACE Index (LACE-rt) to Predict Unplanned Readmission After Discharge in a Community Teaching Hospital

    PubMed Central

    Nam, Seungree; Woollard, Susan

    2017-01-01

    Background The LACE index was designed to predict early death or unplanned readmission after discharge from hospital to the community. However, implementing the LACE tool in real time in a teaching hospital required practical unavoidable modifications. Objective The purpose of this study was to validate the implementation of a modified LACE index (LACE-rt) and test its ability to predict readmission risk using data in a hospital setting. Methods Data from the Canadian Institute for Health Information’s Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the hospital electronic medical record for one large community hospital in Toronto, Canada, were used in this study. A total of 3855 admissions from September 2013 to July 2014 were analyzed (N=3855) using descriptive statistics, regression analysis, and receiver operating characteristic analysis. Prospectively collected data from DAD and NACRS were linked to inpatient data. Results The LACE-rt index was a fair test to predict readmission risk (C statistic=.632). A LACE-rt score of 10 is a good threshold to differentiate between patients with low and high readmission risk; the high-risk patients are 2.648 times more likely to be readmitted than those at low risk. The introduction of LACE-rt had no significant impact on readmission reduction. Conclusions The LACE-rt is a fair tool for identifying those at risk of readmission. A collaborative cross-sectoral effort that includes those in charge of providing community-based care is needed to reduce readmission rates. An eHealth solution could play a major role in streamlining this collaboration. PMID:28274908

  13. Short-term and one-year outcome of infective endocarditis in adult patients treated in a Finnish teaching hospital during 1980–2004

    PubMed Central

    Heiro, Maija; Helenius, Hans; Hurme, Saija; Savunen, Timo; Engblom, Erik; Nikoskelainen, Jukka; Kotilainen, Pirkko

    2007-01-01

    Background Previous studies on factors predicting the prognosis of infective endocarditis have given somewhat conflicting results. Our aim was to define the factors predicting the outcome of patients treated in a Finnish teaching hospital. Methods A total of 326 episodes of infective endocarditis in 303 patients treated during 1980–2004 were evaluated for short-term and 1-year outcome and complications. Results Infection of 2 native valves and the occurrence of neurological complications, peripheral emboli, or heart failure significantly predicted both in-hospital and 1-year mortality, while age ≥65 years or the presence of a major criterion or vegetation on echocardiography predicted death within 1 year. A significant trend was observed between the level of serum C-reactive protein (CRP) on admission and both the short-term and 1-year outcome. In the patients who had CRP values ≥100 mg/l on admission, the hazard ratio for in-hospital death was 2.9-fold and the hazard ratio for 1-year death was 3.9-fold as compared to those with lower CRP values. Male sex and age < 64 years significantly predicted a need for both in-hospital and 1-year surgery, as did the development of heart failure or the presence of a major criterion or vegetation on echocardiography. Peripheral emboli were associated with a need for in-hospital surgery, while Streptococcus pneumoniae as the causative agent or infection of 2 native valves predicted a need for surgery within 1 year from admission. Conclusion Some of the factors (e.g. heart failure, neurological complications, peripheral emboli) predicting a poor prognosis and/or need for surgery were the same observed in previous studies. A new finding was that high CRP values (≥100 mg/l) on admission significantly predicted both short-term and 1-year mortality. PMID:17640339

  14. Impact of implementing an Internal Bed Regulation Committee on administrative and care indicators at a teaching hospital

    PubMed Central

    Rodrigues, Luciane Cristine Ribeiro; Juliani, Carmen Maria Casquel Monti

    2015-01-01

    Objective To compare hospital indicators before and after implementing an Internal Bed Regulation Committee at a reference hospital. Methods It is an quantitative, evaluation, exploratory, descriptive and cross-sectional research. The data was gathered from the hospital administrative reports for the period 2008-2013, provided by the Information Technology Center of the Complexo FAMEMA. Results The indicators improved after implementation of the Internal Bed Regulation Committee. Conclusion The individuals involved in the process acknowledged the improvement. It is necessary to carry on the regulatory actions, especially in a comprehensive and complex healthcare system, such as the brazilian Sistema Único de Saúde. PMID:25993075

  15. Epidemiology of Multi-Drug Resistant Organisms in a Teaching Hospital in Oman: A One-Year Hospital-Based Study

    PubMed Central

    Balkhair, Abdullah; Al-Farsi, Yahya M.; Al-Muharrmi, Zakariya; Al-Rashdi, Raiya; Al-Jabri, Mansoor; Neilson, Fatma; Al-Adawi, Sara S.; El-Beeli, Marah

    2014-01-01

    Background. Antimicrobial resistance is increasingly recognized as a global challenge. A few studies have emerged on epidemiology of multidrug resistant organisms in tertiary care settings in the Arabian Gulf. Aim. To describe the epidemiology of multi-drug resistant organisms (MDRO) at Sultan Qaboos University Hospital, a tertiary hospital in Oman. Methods. A retrospective review of MDRO records has been conducted throughout the period from January 2012 till December 2012. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method. Results. Out of the total of 29,245 admissions, there have been 315 patients registered as MDRO patients giving an overall prevalence rate of 10.8 (95% CI 9.3, 12.4) MDRO cases per 1000 admissions. In addition, the prevalence rate of MDRO isolates was 11.2 (95% CI 9.7, 12.9) per 1000 admissions. Overall, increasing trends in prevalence rates of MDRO patients and MDRO isolates were observed throughout the study period. Conclusion. Antimicrobial resistance is an emerging challenge in Oman. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to prevent proliferation of MDRO. Along such quest, stringent antibiotic prescription guidelines are needed in the country. PMID:24526881

  16. The quality of medical record documentation and External cause of fall injury coding in a tertiary teaching hospital.

    PubMed

    Cunningham, Janet; Williamson, Dianne; Robinson, Kerin M; Carroll, Rhonda; Buchanan, Ross; Paul, Lindsay

    2014-01-01

    This paper reviews the documentation and coding of External causes of admitted fall cases in a major hospital. Intensive analysis of a random selection of 100 medical records included blind re-coding in the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM), Fifth Edition for External causes to ascertain whether: (i) the medical records contained sufficient information for assignment of specific External cause codes; and (ii) the most appropriate External cause codes were assigned per available documentation. Comparison of the hospital data with the state-wide Victorian Admitted Episodes Database (VAED) data on frequency of use of External cause codes revealed that the index hospital, a major trauma centre, treated comparatively more falls involving steps, stairs and ladders. The hospital sample reflected lower usage, than state-wide, of unspecified External cause codes and Other specified activity codes; otherwise, there was similarity in External cause coding. A comparison of researcher and hospital codes for the falls study sample revealed differences. The ambulance report was identified as the best source of External cause information; only 50% of hospital medical records contained sufficient information for specific code assignation for all three External cause codes, mechanism of injury, place of occurrence and activity at time of injury. Whilst all medical records contained mechanism of falls injury information, 16% contained insufficient details, indicating a deficiency in medical record documentation to underpin external cause coding. This was compounded by flaws in the ICD-10-AM classification.

  17. Updates on the Epidemiology and Pattern of Traumatic Maxillofacial Injuries in a Nigerian University Teaching Hospital: A 12-Month Prospective Cohort In-Hospital Outcome Study

    PubMed Central

    Olusanya, Adeola Adenike; Adeleye, Amos Olufemi; Aladelusi, Timothy Olukunle; Fasola, Abiodun Olubayo

    2014-01-01

    Many studies have been undertaken in Nigeria on maxillofacial trauma. However, only a few have considered both the skeletal and soft tissue injuries (in general) involving all the aspects of the maxillofacial region or considered other etiological sources of trauma apart from road traffic crashes. Fewer still have reviewed the outcome of management of facial injuries in our low-resource environment. This study sets out to examine the recent trends in both the clinical and epidemiological patterns of all facial injuries from all causes seen in a low-resource practice of a developing country. It also assessed the in-hospital treatment outcomes, and the levels of the patients' satisfaction with treatment received in this setting. Over a 12-month period, the clinical records of consecutive patients who were evaluated and treated for maxillofacial injuries in our unit were prospectively acquired, entered into predesigned forms and subsequently analyzed. There were 259 patients (79.5% males) during the study period. The mean age was 32.21( ± 16.588) years. Overall, motor bike crashes, 42.1%, were the commonest source of these traumas; and armed robbery was the commonest form (69.0%) of assault. Mandibular fractures were the commonest maxillofacial fractures (37.8%) whereas head injury had the highest frequency among the associated injuries (71.4%). Closed reduction and immobilization was deployed in 88.0% of those who had treatment and majority was satisfied with the esthetic outcome of the treatment received. Mean length of hospital stay was 12.6 ( ± 4.423) days. Maxillofacial trauma poses a significant socioeconomic burden on affected individuals in this study population. This is made worse by the presence of associated injuries in the other body systems. More local studies on the outcome of management of maxillofacial trauma will improve the available literature in this region. PMID:25709753

  18. Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa.

    PubMed

    Pakyz, Amy L; Oinonen, Michael; Polk, Ronald E

    2009-05-01

    Many hospital antimicrobial stewardship programs restrict the availability of selected drugs by requiring prior approval. Carbapenems may be among the restricted drugs, but it is unclear if hospitals that restrict availability actually use fewer carbapenems than hospitals that do not restrict use. Nor is it clear if restriction is related to resistance. We evaluated the relationship between carbapenem restriction and the volume of carbapenem use and both the incidence rate and proportion of carbapenem-resistant Pseudomonas aeruginosa isolates from 2002 through 2006 in a retrospective, longitudinal, multicenter analysis among a consortium of academic health centers. Carbapenem use was measured from billing records as days of therapy per 1,000 patient days. Hospital antibiograms were used to determine both the incidence rate and proportion of carbapenem-resistant P. aeruginosa isolates. A survey inquired about restriction policies for antibiotics, including carbapenems. General linear mixed models were used to examine study outcomes. Among 22 hospitals with sufficient data for analysis, overall carbapenem use increased significantly over the 5 years of study (P < 0.0001), although overall carbapenem resistance in P. aeruginosa did not change. Hospitals that restricted carbapenems (n = 8; 36%) used significantly fewer carbapenems (P = 0.04) and reported lower incidence rates of carbapenem-resistant P. aeruginosa (P = 0.01) for all study years. Fluoroquinolone use was a potential confounder of these relationships, but hospitals that restricted carbapenems actually used fewer fluoroquinolones than those that did not. Restriction of carbapenems is associated with both lower use and lower incidence rates of carbapenem resistance in P. aeruginosa.

  19. Pandemic influenza A(H1N1)2009 in Morocco: experience of the Mohammed V Military Teaching Hospital, Rabat, 12 June to 24 December 2009.

    PubMed

    Lahlou Amine, I; Bajjou, T; El Rhaffouli, H; Laraqui, A; Hilali, F; Menouar, K; Ennibi, K; Boudlal, M; Bouaiti, E A; Sbai, K; Rbai, M; Hachim, M; Zouhair, S

    2011-06-09

    On 12 June 2009, Morocco was the first country in North Africa to report a laboratory-confirmed case of influenza A(H1N1)2009 virus infection. This study describes the epidemiological and clinical characteristics of 240 laboratory-confirmed cases among 594 outpatients with influenza-like illness at the Mohammed V Military Teaching Hospital, Rabat, from 12 June to 24 December 2009. Real-time reverse transcription-PCR was used to confirm the infection. The epidemic peaked in weeks 47 to 49 (16 November to 6 December 2009). The mean age of cases was 23 years (standard deviation: 14 years). Cough was the most common symptom in 200 cases (83%), followed by fever (≥38 °C) in 195 (81%). Diarrhoea or vomiting was reported in 12 (5%) patients. None of the cases developed any complications and no deaths occurred during the study period.

  20. [Prevalence of Acinetobacter baumannii and Pseudomonas aeruginosa isolates resistant to imipenem by production of metallo-β-lactamases in Rabat Military Teaching Hospital Mohammed V].

    PubMed

    Gildas Comlan Zohoun, Alban; Moket, Danièle; El Hamzaoui, Sakina

    2013-01-01

    We studied the production of metallo-β-lactamases (MBL) in Acinetobacter baumannii and Pseudomonas aeruginosa strains resistant to imipenem at the Rabat Mohammed V military teaching hospital, according to Yong et al.'s method, using a sterilized solution of EDTA 0.5 M pH 8. One hundred and five bacterial strains (48 A. baumannii and 57 P. aeruginosa) were identified. 45 (42.9%) with 34 A. baumannii and 11 P. aeruginosa were resistant to imipenem. The prevalence of MBL producing strains was 22.2% (10/45). The existence of this isolates resistant to imipenem by producing metallo-β-lactamases is an emerging public health problem. It is necessary to implemente infection control programs to avoid spreading of multidrug resistant bacteria.

  1. [Seroprevalence of HBV and HCV in blood donors at the Blood Transfusion Center of Mohammed V Military Teaching Hospital in Rabat Morocco].

    PubMed

    Zohoun, A; Hadef, R; Zahid, H; Benkirane, M

    2011-10-01

    The purpose of this report is to present the findings of a retrospective study (2008-2009) to determine the seroprevalence of hepatitis B and C virus in blood donors at the Blood Transfusion Center of Military Teaching Hospital Mohammed V in Rabat, Morocco. Samples from 19,801 consecutive blood donors were analyzed by the immuno-enzymatic method (Enzyme Linked Immunosorbent Assay, third generation). The overall seroprevalence of HBV and HCV was 0.8% and 0.2% respectively. A total of 98 units were rejected because of elevated alanine transaminase. No case of co-infection was found. From 1991 to 2010, HBV and HCV seropositivity showed a significant declining trend. In spite of the low prevalence observed, this study confirms that the risk of transfusion transmitted infection exists and thus underlines the need to implement preventive strategies to improve blood transfusion safety.

  2. Implementing an Online Reporting System in the Anatomical Pathology Department of a Tertiary Care Teaching Hospital in India: A Case Study

    PubMed Central

    Radhakrishna, Kedar; Correa, Marjorie; Thounaojam, Deepak; Raj, Tony D. S.

    2013-01-01

    This article presents a case study in designing, developing, and implementing a web-enabled reporting application for the anatomical pathology (histopathology) department of a tertiary care teaching hospital in India. The article describes workflows, requirements assessment, and implementation methods that the investigators adopted for deploying the solution. The primary focus of the study was to demonstrate the requirements assessment performed, the strategies adopted, and the challenges encountered during the development and implementation. The study demonstrates a successful deployment as well as successful adoption of healthcare information technology by the end users. Factors that played a crucial role in adoption included the combination of people, processes, and technology. The lessons learned from this study would help application developers design efficient systems that suit the requirements of the end users while keeping in mind the ever-changing need for workflows and scalability in a developing country. PMID:23861673

  3. In Vitro Activities of Ceftazidime-Avibactam and Aztreonam-Avibactam against 372 Gram-Negative Bacilli Collected in 2011 and 2012 from 11 Teaching Hospitals in China

    PubMed Central

    Wang, Xiaojuan; Zhang, Feifei; Zhao, Chunjiang; Wang, Zhanwei; Nichols, Wright W.; Testa, Raymond; Li, Henan; Chen, Hongbin; He, Wenqiang; Wang, Qi

    2014-01-01

    Ceftazidime-avibactam, aztreonam-avibactam, and comparators were tested by reference broth microdilution against 372 nonrepetitive Gram-negative bacilli (346 unselected plus 26 selected meropenem-nonsusceptible Enterobacteriaceae isolates) collected from 11 teaching hospitals in China in 2011 and 2012. Meropenem-nonsusceptible isolates produced extended-spectrum β-lactamases (ESBLs; e.g., CTX-M-14/3), AmpCs (e.g., CMY-2), and/or carbapenemases (e.g., KPC-2 and NDM-1). Avibactam potentiated the activity of ceftazidime against organisms with combinations of ESBLs, AmpCs, and KPC-2. Aztreonam-avibactam was active against all β-lactamase producers (including producers of NDM-1 and IMP-4/8) except blaOXA-containing Acinetobacter baumannii and some Pseudomonas aeruginosa isolates. PMID:24342639

  4. Appendicular bilharzioma: An unusual cause of acute intestinal obstruction in childhood (a case report at Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou).

    PubMed

    Wandaogo, Albert; Ouédraogo, Isso; Tapsoba, Toussaint Wendlamita; Bandré, Emile; Ouédraogo, Francis Somkieta; Béré, Bernadette; Elie, Balima

    2016-01-01

    The authors report the case of a 12-year-old boy admitted to the surgical emergency department of Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou for acute abdominal pain. A strangulation of the terminal ileum by a tumour-like appendix wound around the bowel loop was seen during operation. The histological examination of the removed appendix disclosed eggs of Schistosoma haematobium and concluded to bilharzian appendicitis. A course of praziquantel treatment was instituted, and the patient underwent an event-free recovery. Such cases report are infrequent, even in areas where bilharzia-related diseases are endemic. It is important to recognise them and to treat them in an aetiological manner so as to prevent any potential complications. The diagnosis is always an operatory and histological curiosity. Appendectomy and treatment with a course of praziquantel seem quite suitable for this situation.

  5. Appendicular bilharzioma: An unusual cause of acute intestinal obstruction in childhood (a case report at Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou)

    PubMed Central

    Wandaogo, Albert; Ouédraogo, Isso; Tapsoba, Toussaint Wendlamita; Bandré, Emile; Ouédraogo, Francis Somkieta; Béré, Bernadette; Elie, Balima

    2016-01-01

    The authors report the case of a 12-year-old boy admitted to the surgical emergency department of Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou for acute abdominal pain. A strangulation of the terminal ileum by a tumour-like appendix wound around the bowel loop was seen during operation. The histological examination of the removed appendix disclosed eggs of Schistosoma haematobium and concluded to bilharzian appendicitis. A course of praziquantel treatment was instituted, and the patient underwent an event-free recovery. Such cases report are infrequent, even in areas where bilharzia-related diseases are endemic. It is important to recognise them and to treat them in an aetiological manner so as to prevent any potential complications. The diagnosis is always an operatory and histological curiosity. Appendectomy and treatment with a course of praziquantel seem quite suitable for this situation. PMID:28051054

  6. Embedding research in clinical practice: differences in attitudes to research participation among clinicians in a tertiary teaching hospital.

    PubMed

    Paget, S P; Lilischkis, K J; Morrow, A M; Caldwell, P H Y

    2014-01-01

    Despite a drive to increase research in healthcare settings, clinician participation in research remains infrequent. This paper describes an online survey comparing attitudes with research participation among clinicians (doctors, nurses and allied health professionals) at an Australian tertiary children's hospital. Differences between professional groups support the existence of different professional cultures surrounding research, suggesting that multiple strategies are required to improve participation in research.

  7. The prevalence and determinants of HIV seroconversion among booked ante natal clients in the University of Uyo teaching hospital, Uyo Akwa Ibom State, Nigeria

    PubMed Central

    Nyoyoko, Nsikak Paul; Umoh, Augustine Vincent

    2016-01-01

    Introduction The Prevention of Mother to Child transmission (PMTCT) of HIV, an important intervention in the fight against HIV/AIDS can only be of benefit if the HIV status of the mother is known. Unfortunately, some women receive HIV counseling and testing (HCT) during the window period or prior to new infection in pregnancy and therefore, miss-out on the gains of PMTCT. A repeat HIV test would identify this later seroconversion and ensure early intervention. This study aimed at determining the prevalence of HIV seroconversion during pregnancy and assessing the factors associated with HIV seroconversion in clients who attended ante-natal clinic (ANC) in University of Uyo Teaching Hospital, Uyo. Methods A descriptive cross-sectional design was used to study 502 HIV negative clients who consecutively presented for ANC in the University of Uyo Teaching Hospital Uyo over a 3 months period (July -September 2013). Results Fifteen (3%) of the 502 women who were HIV negative at booking visit tested positive (seroconverted) to HIV. Determinants of seroconversion at multivariate level were age bracket of 25-29 years (OR: 3.20; 95%CI: 2.39-4.29) clients’ partners who had sexually transmitted infections, as evidenced by penile discharge (OR: 0.09; 95%CI: 0.01-0.45); Clients in polygamous setting (OR: 3.98; CI: 1.64-9.65); those taking alcohol (OR: 0.12; CI: 0.20-0.80) and those with partners taking recreational drugs (OR: 0.05, 95%CI: 0.002-0.995). Conclusion The study revealed a high seroconversion rate. Re-screening of pregnant women after the booking HCT is a very cost effective and beneficial strategy for the elimination of mother to child transmission of HIV. PMID:28293363

  8. A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status

    PubMed Central

    Patel, Achint A.; Benjo, Alexandre; Pathak, Ambarish; Kar, Jitesh; Jani, Vishal B.; Annapureddy, Narender; Agarwal, Shiv Kumar; Sabharwal, Manpreet S.; Simoes, Priya K.; Konstantinidis, Ioannis; Yacoub, Rabi; Javed, Fahad; El Hayek, Georges; Menon, Madhav C.; Nadkarni, Girish N.

    2015-01-01

    Background and Purpose: With the “weekend effect” being well described, the Brain Attack Coalition released a set of “best practice” guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a “weekend effect” in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. Materials and Methods: We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. Results: Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. Conclusion: Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care. PMID:27053981

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

    ERIC Educational Resources Information Center

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

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

  10. A Cost Analysis of an Introduction to Clinical Medicine Course in a Non-University Teaching Hospital.

    ERIC Educational Resources Information Center

    Tai, Lee W.; Tulley, John E.

    1997-01-01

    Analysis of direct costs to teach a 10-week Introduction to Clinical Medicine course to 26 students in the spring of 1995 found that attending physicians worked a total of 736.5 hours, for a cost of $37,303; residents worked 314 hours, at a cost of $4,396; and miscellaneous costs totaled $2,019. The per-student cost was $1,681. (Author/MSE)

  11. Directly observed short course therapy for tuberculosis--a preliminary report of a three-year experience in a teaching hospital.

    PubMed Central

    Erhabor, Gregory E.; Adewole, Olufemi; Adisa, Adewale O.; Olajolo, Olufadeke A.

    2003-01-01

    SETTING: The Chest Clinic of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, southwest Nigeria is a referral center for tuberculosis patients in the region. Directly Observed Treatment Short Course (DOTS) has been in operation in the center since 1996. OBJECTIVE: To review the outcome of patients on DOTS with the aim of determining factors that may influence compliance. METHODS: Tuberculosis patients were placed on different treatment regimens according to the recommendation of the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Nigerian Tuberculosis and Leprosy Control Program (NTBLCP). The results were recorded and evaluated periodically by the clinic staff under central supervision. The outcome of treatment over a three-year period (1996-1999) was reviewed. RESULTS: Five-hundred-seventy-one patients were treated during this period. Cure/treatment completed rate was 86.1%, and compliance rate was 93.8%. Age, sex category of treatment, and distance from hospital had no significant influence on drug compliance. CONCLUSION: DOTS is an effective means of administering anti-TB drugs. Efforts should be channeled towards developing strategies for implementing DOTS in a more efficient way. PMID:14651375

  12. Does labour epidural slow the progress of labour and lead to complications? Obstetricians’ perception working in private and public sector teaching hospitals in a developing country

    PubMed Central

    Sohaib, Muhammad; Ismail, Samina

    2015-01-01

    Background and Aims: Obstetricians play a major role in the decision making for provision of analgesia for the woman in labour. As epidural analgesia (EA) is the most preferred technique, it is important to know obstetricians' perception regarding its effect on progress of labour and associated complications. Methods: The 6 months cross-sectional study included 114 obstetricians from teaching hospitals. After informed consent, obstetricians were asked to fill a predesigned questionnaire containing 13 close ended questions regarding their perception on the effect of EA on progress of labour, EA complications and whether they would recommend EA to their patients or not. Other variables included age, gender, training in EA, practice type and hospital settings (private or public sector). Results: Majority of the obstetricians had the perception of EA prolonging the first stage (89.5%) and second stage (98.2%) of labour, increasing the rate of caesarean section (87.7%), instrumental delivery (58.8%) and increasing the incidence of backache (85.5%). None of the obstetricians received any formal training in EA. Majority (84.2%) were not sure if they would recommend EA to their patients. When these responses were compared between public and private sector, a statistically higher percentage (P < 0.001) of public sector obstetricians had negative perception of EA. Conclusion: Perception of obstetrician regarding EA is contrary to the current evidence. There is a need to introduce formal curriculum on EA in obstetric training program and conduct regular refresher courses. PMID:26903670

  13. International study on antidepressant prescription pattern at 20 teaching hospitals and major psychiatric institutions in East Asia: Analysis of 1898 cases from China, Japan, Korea, Singapore and Taiwan.

    PubMed

    Uchida, Naoki; Chong, Mian-Yoon; Tan, Chay Hoon; Nagai, Hiroshi; Tanaka, Mariko; Lee, Min-Soo; Fujii, Senta; Yang, Shu-Yu; Si, Tainmei; Sim, Kang; Wei, Hao; Ling, He Yan; Nishimura, Ryoji; Kawaguchi, Yoshichika; Edwards, Glen; Sartorius, Norman; Shinfuku, Naotaka

    2007-10-01

    The purpose of the present study was to review the prescription patterns of antidepressants in different countries in East Asia. The survey was conducted in China, Japan, Korea, Singapore and Taiwan from October 2003 to March 2004 using the unified research protocol and questionnaire. Twenty teaching hospitals and major psychiatric hospitals participated and a total of 1898 patients receiving antidepressants were analyzed. The survey provided a number of interesting characteristics on the prescription patterns of antidepressant in East Asia. Out of 56 antidepressants listed in the Anatomical Therapeutic Chemical Classification (ATC) index by the World Health Organization (WHO) Collaborating Center for Drug Statistics Methodology (Oslo), only 26 antidepressants were prescribed in participating countries in East Asia. On average 38.4% of prescriptions of antidepressants were for patients with diagnoses other than depressive disorders. The availability and commonly prescribed antidepressants varied greatly by country. The selective serotonin re-uptake inhibitors (SSRI) and other newer antidepressants were prescribed in approximately 77.0% of all cases. At the time of the survey, only two SSRI medications were available in Japan. However, five types of SSRI were available and were often prescribed in Korea.

  14. In Vitro antimicrobial susceptibilities of Streptococcus pneumoniae isolated from two teaching hospitals in Taiwan, 1989-1995.

    PubMed

    Su, J Y; Chang, S C; Luh, K T; Hsieh, W C

    1995-08-01

    The susceptibility of 46 pneumococcal isolates collected during October 1989 to May 1995 from National Taiwan University Hospital and Taipei Municipal Yang Ming Hospital was studied. Among these isolates, the resistant rate of penicillin G was 21.7%; the penicillin G-resistant strains were more frequently resistant than the penicillin-sensitive strains to other beta-lactam antimicrobial drugs. The minimum bactericidal concentrations (MBCs) of penicillin G for all isolates were equal to, or one dilution higher than, minimum inhibitory concentrations (MICs). Three strains were false positive for penicillin resistance among isolates of Streptococcus pneumoniae screened with oxacillin. On the other hand, resistance to penicillin G was often independent of resistance to erythromycin. Vancomycin was the most active agent tested.

  15. Comparative Assessment of Patient Care Expenses among Intensive Care Units of a Tertiary Care Teaching Hospital using Cost Block Method

    PubMed Central

    Kundury, Kanakavalli Kiranmai; Mamatha, H. K.; Rao, Divya

    2017-01-01

    Introduction: Intensive care services of a hospital are found to consume major chunk of hospital resources as well draining the savings of patients. Implementing proper control measures facilitates effective functioning of critical care services. Aim: Identify various costs involved in operating Surgical Intensive Care Unit (SICU) and Respiratory Intensive Care Unit (RICU); also find out the running cost of the same. Methodology: Retrospective data was collected for 12 months period and prospectively through informal interactions with staff. Results: Construction and estate costs of the respective ICU's were found to be high, followed by laboratory charges. Running cost of RICU was found to be more than SICU. Conclusion: Costing of intensive care service is essential for controlled operations and to provide efficient patient care. PMID:28250603

  16. [Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)].

    PubMed

    Minta, D K; Traoré, A M; Soucko, A K; Dembélé, M; Coulibaly, Y; Dicko, M S; Coulibaly, I; Diany, N; Maboune, N G E; Ba-Sall, B; Traoré, A K; Koné, N; Traoré, H A

    2012-02-01

    Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

  17. Profile of Patients Admitted in a Large Teaching Hospital as a Result of Earthquake in Kashmir During October 2005

    PubMed Central

    Yatoto, GH; Syed, AT; Rangrez, RA; Singh, Dara

    2009-01-01

    Background: Among natural calamities Earthquakes are more devastating, as much of the life and property is affected. Methods: The study was carried- out in Accident & Emergency Department of SKIMS, to determine personnel and medical profile of earthquake victims of October 2005, when the state was rattled by a major tremor. Data was obtained from Accident & Emergency Department. Total no of patients Admitted were 166, which were followed from admission to discharge/Death. Each patient was subjected to a pretested questionnaire indicating age, sex, rural/urban distribution, Glasgow coma score, out come of treatment and referral to other care facility. Results: The study revealed that children were mostly affected, being the valnerable group. Most of the patients had head and bone injuries. 143 patients out of 166 patients had a Glasgow coma score of 15. Only 9 patients died. The reason for better end result was because of initial first Aid, Rapid transportatation to Hospital and prompt treatment in the Hospital. Conclusion: As Jammu and Kashmir falls in seismic zone 5, it needs a central trauma centre, having all the specialties and sub specialties under one roof. This will save precious time, as cross referral to other hospitals will not be needed PMID:21475539

  18. Susceptibility Pattern and Distribution of Oxacillinases and blaPER-1 Genes among Multidrug Resistant Acinetobacter baumannii in a Teaching Hospital in Iran

    PubMed Central

    Bagheri Josheghani, Sareh; Moniri, Rezvan; Firoozeh, Farzaneh; Sehat, Mojtaba; Dasteh Goli, Yasaman

    2015-01-01

    Acinetobacter baumannii (A. baumannii) is an important nosocomial pathogen in healthcare institutions. β-Lactamase-mediated resistance is the most common mechanism for carbapenem resistance in A. baumannii. The aim of this study was to determine the antibiotic resistance pattern, to detect OXA encoding genes, class A, blaPER-1, and to detect the presence of ISAba1. A total of 124 A. baumannii isolates were collected from hospitalized patients in a teaching hospital in Kashan, Iran. The susceptibility of isolates to different antibiotics was determined by disk-diffusion method. PCR was used to detect blaPER-1, blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, and ISAba1 genes. All isolates were resistant to ceftazidime, ceftriaxone, and cefotaxime. All of the isolates revealed susceptibility to polymyxin B and colistin. Ninety-six percent of the isolates were extensive drug resistance (XDR), 5.6% extended spectrum beta-lactamase (ESBL), and 54.8% metallo-beta-lactamase (MBL). All isolates were positive for blaOXA-51 and ISAba1. blaOXA-23,  blaOXA-24, and blaOXA-58 were found in 79.8%, 25%, and 3.2%, respectively. The frequency rate of blaPER-1 gene was 52.4%. Multidrug resistant A. baumannii isolates are increasing in our setting and extensively limit therapeutic options. The high rate presence of class D carbapenemase-encoding genes, mainly blaOXA-23 carbapenemases, is worrying and alarming as an emerging threat in our hospital. PMID:26881082

  19. Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009-2013).

    PubMed

    Zou, Y M; Ma, Y; Liu, J H; Shi, J; Fan, T; Shan, Y Y; Yao, H P; Dong, Y L

    2015-04-01

    The purpose of this investigation was to describe the effect of antibacterial stewardship and evaluate the trends and correlation of antibacterial resistance and usage from 2009 to 2013 in a tertiary-care teaching hospital in northwest China. Antibacterial usage was expressed as defined daily doses per 100 patients per day (DDDs/100 PDs). Hospital-wide population-level data and time series analysis were used to evaluate the trends and determine associations between antibacterial exposure and acquisition of resistance. Yearly consumption of overall antibacterials significantly decreased from 66.54 to 28.08 DDDs/100 PDs (β = -10.504, p < 0.01). The resistant rates of the five most frequently isolated species (including Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae) significantly decreased or remained stable, and none of them showed a statistically significant upward trend. The medical quality indicators got better or remained stable. Autoregressive integrated moving average (ARIMA) models demonstrated that the monthly resistance rate of P. aeruginosa to imipenem was strongly correlated with antipseudomonal carbapenems usage (β = 34.94, p < 0.001), as did the correlation of P. aeruginosa to meropenem with antipseudomonal third-generation cephalosporins usage (β = 32.76, p < 0.01) and K. pneumoniae to amikacin with aminoglycosides usage (β = 22.01, p < 0.001). The decreased antibacterial use paralleled the improved bacterial resistance without deteriorating medical quality indicators during antimicrobial stewardship. It also suggests that optimum antibiotic use is necessary to alleviate the threat posed by resistant microorganisms at the hospital level.

  20. 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…

  1. Occurrence and antimicrobial resistance of pathogenic Escherichia coli and Salmonella spp. in retail raw table eggs sold for human consumption in Enugu state, Nigeria

    PubMed Central

    Okorie-Kanu, O. Josephine; Ezenduka, E. Vivienne; Okorie-Kanu, C. Onwuchokwe; Ugwu, L. Chinweokwu; Nnamani, U. John

    2016-01-01

    Aim: This study was conducted to investigate the occurrence of pathogenic Escherichia coli and Salmonella species in retail raw table eggs sold for human consumption in Enugu State and to determine the resistance of these pathogens to antimicrobials commonly used in human and veterinary practices in Nigeria. Materials and Methods: A total of 340 raw table eggs comprising 68 composite samples (5 eggs per composite sample) were collected from five selected farms (13 composite samples from the farms) and 10 retail outlets (55 composite samples from the retail outlets) in the study area over a period of 4-month (March-June, 2014). The eggs were screened for pathogenic E. coli and Salmonella species following standard procedures within 24 h of sample collection. Isolates obtained were subjected to in-vitro antimicrobial susceptibility test with 15 commonly used antimicrobials using the disk diffusion method. Results: About 37 (54.4%) and 7 (10.3%) of the 68 composite samples were positive for pathogenic E. coli and Salmonella species, respectively. The shells showed significantly higher (p<0.05) contaminations than the contents for both microorganisms. The eggs from the farms showed higher contamination with pathogenic E. coli than eggs from the retail outlets while the reverse was the case for Salmonella species even though they were not significant (p>0.05). The organisms obtained showed a multiple drug resistance. They were completely resistant to nitrofurantoin, sulfamethoxazole/trimethoprim, penicillin G and oxacillin. In addition to these, Salmonella spp. also showed 100% resistance to tetracycline. The pathogenic E. coli isolates obtained were 100% susceptible to gentamicin, neomycin, ciprofloxacin, and amoxicillin-clavulanic acid while Salmonella spp. showed 100% susceptibility to erythromycin, neomycin, and rifampicin. Both organisms showed varying degrees of resistance to streptomycin, amoxicillin, vancomycin, and doxycycline. Conclusion: From the results of

  2. A multicentre survey of the current acute post-operative pain management practices in tertiary care teaching hospitals in Maharashtra

    PubMed Central

    Khatib, Samina Khaliloddin; Razvi, Syed Shamim; Kulkarni, Sadhana Sudhir; Parab, Swapnil

    2017-01-01

    Background and Aims: Undertreated pain can have negative consequences on patients' health as well as the health-care system. The present study was aimed at identifying the current trends in post-operative pain management and availability of acute pain services (APS). In addition, it is also an attempt to assess the availability of analgesia for non-surgical cases, and the attitudes, beliefs, and perceptions of clinicians regarding acute pain management in the tertiary hospitals in the state of Maharashtra (India). Methods: This was a cross-sectional, multicentre questionnaire survey involving the anaesthesiologists and surgeons. Percentages, median, interquartile ranges were calculated and compared by employing a Wilcoxon sign rank test. Results: Data from thirty centres revealed that the surgeons played a major role in treating pain, while most of the anaesthesiologists treated pain primarily in the operation theatre and recovery room. An APS was operational in seven hospitals. The most frequently employed techniques to achieve analgesia were the administration of non-steroidal anti-inflammatory drugs, opioids and epidural analgesia. The majority of the centres had no written protocol and dedicated staff for pain management, pain assessment was not adequately stressed, and only five out of the thirty centres included in the study provided ongoing pain education to health professionals even when the hospitals claimed to provide APS. The major hurdles in providing optimal analgesia and implementing APS were a lack of pain education, equipment and administrative problems. Conclusion: Thus, the tertiary centres in Maharashtra fall short of providing optimal acute post-operative pain management.

  3. A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India

    PubMed Central

    Dubey, Debasmita; Rath, Shakti; Sahu, Mahesh C.; Rout, Subhrajita; Debata, Nagen K.; Padhy, Rabindra N.

    2013-01-01

    Objective To investigate the infection of hospital- and community-acquired “erythromycin-induced clindamycin resistant” strains or D-test positives of clinical isolates of Staphylococcus aureus (S. aureus) (with and without methicillin resistance) in a hospital. Methods Strains of S. aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling. Results Of the total 278 isolates, 140 (50.35%) were D-test positives and the rest were D-test negatives. Further, of 140 (100%) positives, 87 (62.14%) and 53 (37.85%) strains were from males and females, respectively. Of 140 (100%) positives, 117 (83.57%) were methicillin resistant S. aureus and 23 (16.42%) were methicillin sensitive S. aureus; of 140 strains, 103 (73.57%) strains from persons with and 37 (26.42%) were without related infections; of 140 strains, 91 (65%) and 49 (35%) were from hospital- and community-acquired samples, respectively. In 140 strains, 118 (84.28%) with comorbidities and 22 (15.71%) without comorbidities cases were recorded; similarly, persons with prior antibiotic uses contributed 108 (77.14%) and without 32 (22.85%) positive strains. These binary data of surveillance were analyzed by a univariate analysis. It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity, corroborated by low P values, P=0.001 1 and 0.002 4, respectively. All isolates (278) were resistant to 17 antibiotics of nine groups, in varying degrees; the minimum of 28% resistance for vancomycin and the maximum of 97% resistance for gentamicin were recorded. Further, of 278 strains, only 42 (15.1%) strains were resistant constitutively to both antibiotics, erythromycin resistant and clindamycin resistant, while 45 (16.2%) strains were constitutively sensitive to both antibiotics (erythromycin sensitive and clindamycin sensitive). Further, of the rest 191 (68.7%) strains were with erythromycin resistant and

  4. Teaching literacy and mathematics skills to adult psychiatric inpatients: an evaluation of the adult literacy program at Hawaii State Hospital.

    PubMed

    Schirmer, Todd N; Meyer, Kim A; Samarasinghe, Roshani

    2005-01-01

    The Adult Literacy Program at Hawaii State Hospital utilized techniques drawn from the Morningside Model of Generative Instruction. In a study involving psychiatric inpatients, participants were taught reading, mathematics, or both over a 6- to 8-month time span. Using the Woodcock-Johnson Psychoeducational Battery-Revised, it was determined that nearly half of the participants demonstrated academic gains during the study period. Further, a behavioral observation system indicated that participants were on-task 80% of the observation time and staff engaged in positive interactions nearly 20% of the observation time. This study is the first of its kind to document any efficacy for academic instruction with a psychiatric inpatient population.

  5. The relationship between the managerial skills and results of "performance evaluation "tool among nursing managers in teaching hospitals of Iran University of Medical Science.

    PubMed

    Isfahani, Haleh Mousavi; Aryankhesal, Aidin; Haghani, Hamid

    2014-09-25

    Performance of different organizations, such as hospitals is mainly influenced by their managers' performance. Nursing managers have an important role in hospital performance and their managerial skills can improve the quality of the services. Hence, the present study was conducted in order to assess the relationship between the managerial skills and the results of their performance evaluation in Teaching Hospitals of Iran University of Medical Science in 2013. The research used the cross sectional method in 2013. It was done by distributing a managerial skills assessment questionnaire, with close-ended questions in 5 choice Likert scale, among 181 managers and head nurses of hospitals of Iran university of Medical Sciences; among which 131 answered the questions. Another data collection tools was a forms to record evaluation marks from the personnel records. We used Pearson and Spearman correlation tests and SPSS for analysis and description (frequency, mean and standard deviation). Results showed that the managerial skills of the nursing mangers were fair (2.57 out of 5) and the results of the performance evaluation were in a good condition (98.44). The mangers' evaluation results and the managerial skills scores were not in a meaningful correlation (r=0.047 np=0.856). The research showed no correlation between different domains of managerial skills and the performance evaluation marks: decision making skills (r=0.074 and p=0.399), leadership (correlation coefficient 0.028 and p=0.654), motivation (correlation coefficient 0.118 and p=0.163), communication  (correlation coefficient 0.116 and p=0.122), systematic thinking  (correlation coefficient 0.028 and p=0.828), time management (correlation coefficient 0.077 and p=0.401) and strategic thinking  (correlation coefficient 0.041 and p=0.756). Lack of any correlation and relation between managers' managerial skills and their performance evaluation results shows need to a fundamental revision at managers

  6. Awareness, Treatment, and Control of Hypertension in Primary Health Care and Secondary Referral Medical Outpatient Clinic Settings at Enugu, Southeast Nigeria

    PubMed Central

    Chijioke, Chioli; Okolo, Teddy; Ekwe, Esther; Eze, Chukwuemeka; Agunyenwa, Charles; Amah, Christopher; Nwadike, Kenneth; Chijioke, Udunma

    2016-01-01

    Essential hypertension is the most common noncommunicable disease (NCD), affecting more than half the adult population in many countries and being the major NCD contributor to the double burden of disease in developing countries. We undertook a survey of the hypertension awareness, treatment, and control in primary and secondary referral health care clinics in Enugu, Nigeria, and compared these data with those obtained in local community surveys. The prevalence of hypertension in the primary care clinic (9.2%) was lower than in a previously reported community survey (42.2%), while, in the referral clinic, 70.3% of patients attending were hypertensive. Hypertension awareness rates were 91.9%, 29.4%, and 93.2% in these respective health care settings. Treatment and control rates (89.9% and 72.9%) were better in the secondary care clinic than in the primary care centre (87.7% and 46.0%). (Chi-square analysis confirmed statistically significant differences between these rates (p < 0.05).) These data may form a useful index of health care system effectiveness in Nigeria. Possible reasons for the differences observed and effective strategies to address the waxing pandemic of hypertension are discussed. PMID:28050277

  7. Emergence of Pseudomonas aeruginosa with KPC-type carbapenemase in a teaching hospital: an 8-year study.

    PubMed

    García Ramírez, Dolores; Nicola, Federico; Zarate, Soledad; Relloso, Silvia; Smayevsky, Jorgelina; Arduino, Sonia

    2013-10-01

    An outbreak of Klebsiella pneumoniae carbapenamase (KPC)-producing K. pneumoniae occurred at our institution. Multiresistant Pseudomonas aeruginosa could have acquired this transmissible resistance mechanism, going unnoticed because its phenotypic detection in this species is difficult. We compared P. aeruginosa isolates obtained before and after the KPC-producing K. pneumoniae outbreak. No bla(KPC) genes were detected in the isolates obtained before the outbreak, whereas 33/76 (43%) of the isolates obtained after the outbreak harboured the bla(KPC) gene. P. aeruginosa may thus become a reservoir of this transmissible resistance mechanism. It is very important to understand the epidemiology of these multiresistant isolates, in order to achieve early implementation of adequate control measures to contain and reduce their dissemination in the hospital environment.

  8. [Secular trends in the etiology of nosocomial infection at a teaching hospital in Taiwan, 1981-1994].

    PubMed

    Chen, M L; Chen, Y C; Pan, H J; Chang, S C; Yang, L S; Ho, S W; Luh, K T; Hsieh, W C; Chuang, C Y

    1995-08-01

    Surveillance system of nosocomial infection was established in 1980 at the National Taiwan University Hospital (NTUH). To identify pathogens and the secular trends in the etiology of nosocomial infection from 1981 to 1994, the prospective, hospital-wide nosocomial surveillance data were analysed. During this period, 22,146 pathogens causing nosocomial infections were isolated. Gram-negative aerobic bacteria remained the major pathogens, but gram-positive cocci and fungi increased rapidly in the past 14 years. When the overall pathogen distribution is examined, Pseudomonas areuginosa was the most frequently isolated pathogen, but Candida albicans and other yeasts have taken the leading position since 1993. Staphylococcus aureus and coagulase-negative staphylococci also increase significantly in recent years. When the pathogens causing infection at the 4 major sites were examined. P. aeruginosa was the pathogen most often associated with respiratory tract and surgical wound infections. In blood stream and urinary tract infections, we observed Escherichia coli was replaced by C. albicans and other yeasts as a most common isolate in these years. In addition, C. albicans and other yeasts and methicillin-resistant S. aureus (MRSA) are emerging as major nosocomial pathogens at NTUH. C. albicans and other yeast increased from 1.8% in 1981 to 14.9% in 1994 in the overall nosocomial infection. The increase was found in the blood stream (2.1% to 16.2%) and urinary tract infections (5.4% to 24.7%). Of 1,742 nosocomial S. aureus isolates, the percentage of MRSA rose from 12.5% in 1981 to 55.2% in 1994. The high percentage of MRSA was observed at 4 major anatomic sites of infection. In summary, significant shifts in the pathogens of nosocomial infection have occurred in the past 14 years at NTUH, and the distribution of nosocomial pathogens was similar to those reported in the United States in recent years.

  9. Administrative measures for preventing Mycobacterium tuberculosis infection among healthcare workers in a teaching hospital in Rio de Janeiro, Brazil.

    PubMed

    da Costa, P Albuquerque; Trajman, A; Mello, F Carvalho de Queiroz; Goudinho, S; Silva, M A Monteiro Vieira; Garret, D; Ruffino-Netto, A; Kritski, A Lineu

    2009-05-01

    Tuberculosis (TB) is an occupational disease of healthcare workers (HCWs). Administrative and engineering interventions simultaneously implemented in hospitals of developed countries have reduced the risk of nosocomial transmission of M. tuberculosis. We studied the impact of administrative infection control measures on the risk for latent TB infection (LTBI) among HCWs in a resource-limited, high-burden country. An intervention study was undertaken in a university-affiliated, inner-city hospital in Rio de Janeiro, where routine serial tuberculin skin testing (TST) is offered to all HCWs. From October 1998 to February 2001, the following infection control measures were progressively implemented: isolation of TB suspects and confirmed TB inpatients, quick turnaround for acid-fast bacilli sputum tests and HCW education in use of protective respirators. Among 1336 initially tested HCWs, 599 were retested. The number of TST conversions per 1000 person-months during and after the implementation of these measures was reduced from 5.8/1000 to 3.7/1000 person-months (P=0.006). The most significant reductions were observed in the intensive care unit (from 20.2 to 4.5, P<0.001) and clinical wards (from 10.3 to 6.0, P<0.001). Physicians and nurses had the highest reductions (from 7.6 to 0, P<0.001; from 9.9 to 5.8, P=0.001, respectively). We conclude that administrative measures for infection control can significantly reduce LTBI among HCWs in high-burden countries and should be implemented even when resources are not available for engineering infection control measures.

  10. Administrative measures for preventing Mycobacterium tuberculosis infection among healthcare workers in a teaching hospital in Rio de Janeiro, Brazil

    PubMed Central

    da Costa, P. Albuquerque; Trajman, A.; de Queiroz Mello, F. Carvalho; Goudinho, S.; Silva, M.A. Monteiro Vieira; Garret, D.; Ruffino-Netto, A.; Kritski, A. Lineu

    2009-01-01

    Summary Tuberculosis (TB) is an occupational disease of healthcare workers (HCWs). Administrative and engineering interventions simultaneously implemented in hospitals of developed countries have reduced the risk of nosocomial transmission of M. tuberculosis. We have studied the impact of administrative infection control measures on the risk for latent TB infection (LTBI) among HCWs in a resource-limited, high-burden country. An intervention study was undertaken in a university-affiliated, inner-city hospital in Rio de Janeiro, where routine serial tuberculin skin test (TST) is offered to all HCWs. From October 1998 to February 2001, the following administrative infection control measures were progressively implemented: isolation of TB suspects and confirmed TB inpatients, quick turnaround for acid-fast bacilli sputum tests and HCW education in use of protective respirators. Among 1336 initially tested HCWs, 599 were retested. The number of TST conversions per 1000 person-months during and after the implementation of these measures was reduced from 5.8/1000 to 3.7/1000 person-months (P = 0.006). The most significant reductions were observed in the intensive care unit (from 20.2 to 4.5, P < 0.001) and clinical wards (from 10.3 to 6.0, P < 0.001). Physicians and nurses had the highest reductions (from 7.6 to 0, P < 0.001; from 9.9 to 5.8, P = 0.001, respectively). We conclude that isolated administrative measures for infection control can significantly reduce LTBI among HCWs in high-burden countries and should be implemented even when resources are not available for engineering infection control measures. PMID:19278753

  11. Incidence, Clinical Outcome and Risk Factors of Intensive Care Unit Infections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria

    PubMed Central

    Iwuafor, Anthony A.; Ogunsola, Folasade T.; Oladele, Rita O.; Oduyebo, Oyin O.; Desalu, Ibironke; Egwuatu, Chukwudi C.; Nnachi, Agwu U.; Akujobi, Comfort N.; Ita, Ita O.; Ogban, Godwin I.

    2016-01-01

    Background Infections are common complications in critically ill patients with associated significant morbidity and mortality. Aim This study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital. Materials and Methods This was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died. Antimicrobial susceptibility testing of isolates was done using CLSI guidelines. Results Seventy-one patients were recruited with a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the intensive care unit. Bloodstream infections (BSI) 49.0% (22/71) and urinary tract infections (UTI) 35.6% (16/71) were the most common infections with incidence rates of 162.9/1000 patient-days and 161.6/1000 patient-days respectively. Staphylococcus aureus was the most common cause of BSIs, responsible for 18.2% of cases, while Candida spp. was the commonest cause of urinary tract infections, contributing 25.0% of cases. Eighty percent (8/10) of the Staphylococcus isolates were methicillin-resistant. Gram-negative multidrug bacteria accounted for 57.1% of organisms isolated though they were not ESBL-producing. Use of antibiotics (OR = 2.98; p = 0.03) and surgery (OR = 3.15, p< 0.05) in the month preceding ICU admission as well as urethral catheterization (OR = 5.38; p<0.05) and endotracheal intubation (OR = 5.78; p< 0.05) were risk factors for infection. Conclusion Our findings demonstrate that healthcare associated infections is a significant risk factor for ICU-mortality and morbidity even after adjusting for APACHE II score. PMID:27776162

  12. Cross-sectional study on the obstetric performance of primigravidae in a teaching hospital in Lagos, Nigeria

    PubMed Central

    Okunade, Kehinde Sharafadeen; Okunola, Halimat; Oyeneyin, Lawal; Habeeb-Adeyemi, Fatimah N.

    2016-01-01

    Background: A woman carrying her first pregnancy is starting a new life, and this is a crucial time in her obstetric career. This study was aimed to compare the obstetric performance of primigravidae to that of the multigravidae with a view to suggesting ways of preventing the associated complications. Patients and Methods: The study was a cross-sectional case-control study carried out among women who delivered in the study center over a year period. Relevant data of primigravid parturients who delivered in the hospital were retrieved from the labor ward register, and an equal number of multigravidae who delivered during the same study were selected by simple random sampling as the control group. Results: Primigravidae constituted 15.3% of the total number of parturients seen during the study period. The age range of the primigravidae was 20–48 years and with a mean age of 28.24 ± 4.28 years. The obstetric complications seen in statistically significant proportion among the primigravidae case group include hypertensive disorder (P = 0.048), prolonged pregnancy (P = 0.039), prolonged labor (P = 0.006), oxytocin augmentation (P = 0.022), cephalopelvic disproportion (P = 0.001), obstructed labor (P = 0.008), instrumental delivery (P = 0.035), cesarean delivery rates (P = 0.011), and increased neonatal unit admission rate (P = 0.002). Conclusion: Primigravidity is a high-risk pregnancy with several associated obstetric complications. Primigravidae should, therefore, be managed by specialists in well-equipped hospitals that will provide comprehensive antenatal and intrapartum care which will eventually result in a satisfactory obstetric outcome. PMID:27833251

  13. A Retrospective Analysis of Reporting of Adverse Drug Reactions in a Tertiary Care Teaching Hospital: One Year Survey

    PubMed Central

    Pathak, Anuj Kumar; Dokania, Shambhu; Mohan, Lalit; Dikshit, Harihar

    2016-01-01

    Introduction Pharmacovigilance (PV) is related to detection, assessment, understanding and prevention of Adverse Drug Reactions (ADRs) which are incurred when drug is made available in the market and used in different physiological conditions. In many countries, ADRs ranks among the top ten leading cause of morbidity and mortality. There is a lack of formal culture for monitoring and reporting of ADRs in India, with ADR reporting rate being only 1% as compared to 5% in world. This type of academic detailing activity helps to create awareness of ADR reporting in the institutions. Aim This study was planned to evaluate and analyse the incidence and patterns of ADRs in various inpatient and outpatient departments of hospital. Materials and Methods This was an observational, retrospective and record based study conducted by analysing the spontaneous ADR forms, collected over a period of 12 months (September 2014 to August 2015) at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Results During the period of one year, 292 ADR forms were collected from 4,34,965 patients attending OPD and inpatients of the hospital. Incidence of ADR was 0.67 per thousand patients and average of around 24 ADR collected per month. Male:Female ratio was 1.30. Adolescent (16-30 yr) was the most common age group affected. Department of Skin and VD reported the maximum number of ADRs (33.22%), followed by the Departments of Oncology (18.84%). Antibiotics were the most common drug implicated followed by anticancer drugs. Conclusion ADR reporting is an ongoing and continuous process. Studies from the institute helps to identify and rectify the problems related to ADR reporting. Pitfalls can be addressed by creating awareness among physicians and the patients to achieve finally the goal of Pharmacovigilant India. PMID:27656459

  14. Users’ Perspectives on a Picture Archiving and Communication System (PACS): An In-Depth Study in a Teaching Hospital in Kuwait

    PubMed Central

    Al-Shamali, Dawood Ameer; Sharma, Prem; Haidar, Salwa; Al-Shawaf, Hamza

    2016-01-01

    Background Picture archiving and communication system (PACS) is a well-known imaging informatics application in health care organizations, specifically designed for the radiology department. Health care providers have exhibited willingness toward evaluating PACS in hospitals to ascertain the critical success and failure of the technology, considering that evaluation is a basic requirement. Objective This study aimed at evaluating the success of a PACS in a regional teaching hospital of Kuwait, from users’ perspectives, using information systems success criteria. Methods An in-depth study was conducted by using quantitative and qualitative methods. This mixed-method study was based on: (1) questionnaires, distributed to all radiologists and technologists and (2) interviews, conducted with PACS administrators. Results In all, 60 questionnaires were received from the respondents. These included 39 radiologists (75% response rate) and 21 technologists (62% response rate), with the results showing almost three-quarters (74%, 44 of 59) of the respondents rating PACS positively and as user friendly. This study’s findings revealed that the demographic data, including computer experience, was an insignificant factor, having no influence on the users’ responses. The findings were further substantiated by the administrators’ interview responses, which supported the benefits of PACS, indicating the need for developing a unified policy aimed at streamlining and improving the departmental workflow. Conclusions The PACS had a positive and productive impact on the radiologists’ and technologists’ work performance. They were endeavoring to resolve current problems while keeping abreast of advances in PACS technology, including teleradiology and mobile image viewer, which is steadily increasing in usage in the Kuwaiti health system. PMID:27307046

  15. A Six-Year Study of the Clinical Presentation of Cervical Cancer and the Management Challenges Encountered at a State Teaching Hospital in Southeast Nigeria

    PubMed Central

    Eze, Justus N.; Emeka-Irem, Esther N.; Edegbe, Felix O.

    2013-01-01

    Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral

  16. Prevalence of anti-hepatitis C virus antibody among pregnant women and blood donors at Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria.

    PubMed

    Hilda, Awoyelu E; Kola, Oloke Julius; Kolawole, Oladipo E

    2016-09-27

    Hepatitis C virus is one of the emerging infectious diseases that can be transmitted through blood-to-blood contact. This study was carried out to determine the prevalence of anti-HCV antibodies among potential blood donors and pregnant women attending Bowen University Teaching Hospital (BUTH), Ogbomoso, Oyo State. This hospital-based study was conducted from December 2014 to September 2015. The study group (N = 279) included potential blood donors and pregnant women. Data on socio-demographic characteristics and potential risk factors were collected using a structured questionnaire. The presence of anti-HCV antibodies in serum samples of the studied subjects were detected using third-generation Enzyme Linked Immunosorbent Assay (ELISA) (WKEA Med Supplies Corp, China). Chisquare test was utilized to assess the association between the socio-demographic variables and HCV status. Logistic regression was done to determine the strength of association between risk factors and HCV status. Statistical significance was set at P ˂ 0.05. Overall seroprevalence of hepatitis C virus infection was found to be 1.79% consisting 0.36% of pregnant women and 1.43% of blood donors. None of the socio-demographic characteristics and potential risk factors among the study groups were significantly associated with hepatitis C virus infection. This study found a seroprevalence of anti-HCV antibody to be 1.79%, thus, screening of pregnant women and blood donors for HCV infections with the use of ELISA is recommended because of its important role in detecting the presence of anti-HCV antibody with utmost specificity and sensitivity. HCV, Pregnant women, Blood donors, Seroprevalence, Socio-demographic factor, BOWEN, Ogbomoso.

  17. Dissemination of IMP-4-encoding pIMP-HZ1-related plasmids among Klebsiella pneumoniae and Pseudomonas aeruginosa in a Chinese teaching hospital

    PubMed Central

    Feng, Wei; Zhou, Dongsheng; Wang, Qian; Luo, Wenbo; Zhang, Defu; Sun, Qiang; Tong, Yigang; Chen, Weijun; Sun, Fengjun; Xia, Peiyuan

    2016-01-01

    A total of 26 blaIMP-4-carrying strains of Pseudomonas aeruginosa and Klebsiella pneumoniae were isolated from 2009 to 2013 in a Chinese teaching hospital, and these strains can be assigned into multiple sequence types or allelic profiles as determined by multilocus sequence typing. Of these strains, P. aeruginosa P378 and K. pneumoniae 1220 harbor the IMP-4-encoding plasmids pP378-IMP and p1220-IMP, respectively, whose complete nucleotide sequences are determined to be genetically closely related to the IncN1-type plasmid pIMP-HZ1. pP378-IMP/p1220-IMP-like plasmids are hinted to be present in all the other blaIMP-4-carrying strains, indicating the dissemination of pIMP-HZ1-related plasmids among K. pneumoniae or P. aeruginosa of different genotypes in this hospital. pP378-IMP carries two distinct accessory resistance regions, a blaIMP-4-carrying class 1 integron In823b, and a truncated Tn3-family unit transposon ΔTn6292-3′ harboring the quinolone resistance gene qnrS1. Massive fragmentation and rearrangement of these accessory genetic contents occur among p1220-IMP and IMP-HZ1 relative to pP378-IMP. blaIMP-4 is also present in the In823b remnants from p1220-IMP and IMP-HZ1, while qnrS1 is located in a Tn6292-derive fragment from pIMP-HZ1 but not found in p1220-IMP. pP378-IMP represents the first fully sequenced IncN-type plasmid from P. aeruginosa. PMID:27641711

  18. Is Prophylactic Drainage of Peritoneal Cavity after Gut Surgery Necessary?: A Non-Randomized Comparative Study from a Teaching Hospital

    PubMed Central

    Rai, Pranil; Misra, Gorakh

    2015-01-01

    Introduction Prophylactic use of intra-peritoneal drain is commonly practiced by surgeons in the hope of early detection of complication and reducing mortality and morbidity. The aim of the study was to determine evidence based value of prophylactic drainage of peritoneal cavity in cases of secondary peritonitis and resection and anastomosis of small and large bowel. Materials and Methods One hundred and seventy one (171) cases were included in the study from March 2012-May 2013 that underwent laparotomy for peptic ulcer perforation (PUP), simple and complicated acute appendicitis (appendicular perforation with localized/generalized peritonitis), small bowel obstruction (SBO) and sigmoid volvulus, traumatic and non-traumatic perforation of small and large bowel. Appropriate management was done after resuscitation and investigation. After completion of operation peritoneal cavity was either drained or not drained according operator’s preference. They were divided into drain and non-drain groups. Surgical outcome and postoperative complications ≤30 days of operation was noted and compared between two groups. Results No significant difference was observed between drained group and non-drained group in terms of age (32.08±15.99 vs. 35.57 ± 16.42 years), Sex (76M: 42F vs. 40M: 13F), weight 50.9 ± 11.75 vs. 48.4 ± 16.1 kg), height (1.6 ± 0.13 vs. 1.5 ± 0.18 Meter), BMI (20 ± 4.7 vs. 20 ± 7.2), ASA score (p= >0.05). However there was significant difference was observed between drained group and non-drained groups in terms of length of hospital stay (9 ± 4 vs 5 ± 3.4 days), operative duration (115.6 ± 41.0 vs. 80 ± 38.1 minutes), infection rates in dirty wound (40.0% vs 12.5%) and overall postoperative complications (35.85% vs16.11%). Conclusion Based on these results, present study suggests that prophylactic drainage of peritoneal cavity after gastrointestinal surgery is not necessary as it does not offer additional benefits for the patients undergoing gut

  19. Large Outbreak Caused by Methicillin Resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention

    PubMed Central

    Grönthal, Thomas; Moodley, Arshnee; Nykäsenoja, Suvi; Junnila, Jouni; Guardabassi, Luca; Thomson, Katariina; Rantala, Merja

    2014-01-01

    Introduction The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP) ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 – January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented. Methods Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing. Results Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3–17.0, P = 0.0003), antimicrobial treatment (OR = 3.8, CI95% 1.0–13.9, P = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1–1.6, P = 0.0007) or in the surgery ward (OR = 1.1, CI95% 1.0–1.3, P = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission. Conclusion Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring

  20. Quality of life and associated factors among poststroke clinic attendees at a University Teaching Hospital in Nigeria

    PubMed Central

    Oni, Osunwale Dahunsi; Aina, Olatunji F.; Ojini, Francis I.; Olisah, Victor O.

    2016-01-01

    Background: Quality of life (QOL) measures are effective in quantifying disease burden after stroke, more so than levels of debility. The objective of this study is to determine QOL and associated factors of stroke survivors in Lagos, Nigeria. Materials and Methods: Seventy stroke survivors (study sample) and seventy stable hypertensive patients (control sample) attending clinics at a Nigerian hospital were recruited for the study. Respondents were assessed using sociodemographic/clinical questionnaires, modified mini-mental state examination, modified Rankin Scale, schedule for clinical assessment in neuropsychiatry, and World Health Organization-QOL-BREF. Results: Mean ages of the study and control respondents were 57.43 (±9.67) years and 57.33 (±9.33) years, respectively. Each sample comprised 38 male and 32 female respondents. Stroke survivors were significantly more likely to: be unemployed (P = 0.001), pay more for healthcare (P = 0.001), consume alcohol (P = 0.02), and have physical impairments (P = 0.001) compared with control. The mean QOL scores of stroke survivors were significantly lower than controls across all spheres. Stroke survivors who were unemployed, younger, female, paying more for healthcare, more disabled, with right stroke lateralization, having comorbidities, and sexual dysfunction had significantly poorer QOL specific grades. Depression or anxiety poststroke was also associated with reduced QOL means scores. Conclusion: Besides, clinical variables such as levels of disability and stroke lesion lateralization, other factors such as unemployment, health costs, age, gender, and emotional problems influenced QOL after stroke. PMID:27833249

  1. Experience in running a Diarrhoeal Training cum Treatment Unit (DTTU) in a state teaching hospital in Calcutta.

    PubMed

    Sengupta, B; Dasgupta, S; Saha, I; Mandal, A K; Palodhi, P K

    1998-04-01

    The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.

  2. Awareness and Practice of Self Breast Examination among Female Nurses at the Federal Teaching Hospital Ido-Ekiti, Nigeria

    PubMed Central

    Ajetunmobi, Oluwaserimi Adewumi; Shabi, Olabode Muftau; Elegbede, Olaide Toyin; Okere, Raymond Akujuobi; Busari, Olusegun Adesola; Dada, Ayokunle Samuel

    2016-01-01

    Breast cancer is the most common female malignancy linked with high levels of morbidity and mortality in developing countries due to delayed diagnosis. This research assessed the knowledge of signs and risk factors of breast cancer and practice of self breast examination (SBE) among female nurses in a rural tertiary Hospital. Eighty-five nurses ages 20 to 60 years were sampled by simple randomization over a period of eight weeks through a self-administered semi-structured questionnaire. The analysis was done using statistical package for social science version 17. Sixteen (15.3%) nurses had adequate knowledge of breast cancer, having a relative with breast cancer (51.8%) and a woman of any age (56.5%) were recognized by majority as risk factors for breast cancer. Majority (68.2%) were not practicing monthly SBE and not confident on how to do it. This study pointed out the gaps in the knowledge and awareness of breast cancer and practice of SBE among the nurses. Opportunity should therefore be sought in various health facilities to educate nurses who are supposed to be closer to the patients. PMID:28299150

  3. Assessment of Knowledge and Practices regarding Injection Safety and Related Biomedical Waste Management amongst Interns in a Tertiary Care Teaching Hospital, Delhi.

    PubMed

    Acharya, Anita Shankar; Priyanka; Khandekar, Jyoti; Bachani, Damodar

    2014-01-01

    Injuries caused by needle sticks and sharps due to unsafe injection practices are the most common occupational hazard amongst health care personnel. The objectives of our study were to determine the existing knowledge and practices of interns and change in their level following an information education and communication (IEC) package regarding safe injection practices and related biomedical waste management and to determine the status of hepatitis B vaccination. We conducted a follow-up study among all (106) interns in a tertiary care teaching hospital, Delhi. A predesigned semistructured questionnaire was used. IEC package in the form of hands-on workshop and power point presentation was used. A highly significant (P < 0.001) improvement in the knowledge of interns was observed after intervention with respect to the "three criteria of a safe injection" and cleaning of injection site. Thus, the baseline knowledge of interns was good in certain aspects of injection safety, namely, diseases transmitted by unsafe injections and their prevention. We conclude that IEC intervention package was effective in significantly improving the interns' knowledge regarding safe injection practices and biomedical waste management. Almost two-thirds of interns were immunised against hepatitis B before the intervention and this proportion rose significantly after the intervention.

  4. High levels of extended-spectrum beta-lactamases in a major teaching hospital in Ghana: the need for regular monitoring and evaluation of antibiotic resistance.

    PubMed

    Obeng-Nkrumah, Noah; Twum-Danso, Kingsley; Krogfelt, Karen A; Newman, Mercy J

    2013-11-01

    Infections with bacteria producing extended-spectrum beta-lactamases (ESBLs) are increasing across Africa. This study reports on ESBL-producing Enterobacteriaceae as significant causes of infections and antibiotic resistance at Korle-Bu Teaching Hospital in Accra, Ghana. Of 300 isolates examined, 49.3% produced ESBLs. The prevalence of ESBLs was significantly high among isolates from neonates (28 of 43, 65.1%; relative risk = 1.62, 95% confidence interval = 1.33-2.13, P = 0.002) and adult patients > 65 years of age (36 of 51, 70.5%; relative risk = 1.89, 95% confidence interval = 1.41-2.40, P = 0.001). A marked increase in minimum inhibitory concentrations of ESBL-positive species was noticed compared with those for the other strains. Using these concentrations, we found that 26 (17%) ESBL producers were resistant to two or more antibiotics (aminoglycosides, fluoroquinolones, sulfonamide, and carbapenems) whereas 5 (3.2%) non-ESBL producers were multidrug resistant. Regular ESBL detection and evaluation of antibiotic resistance may help reduce the spread of ESBLs and antibiotic resistance in Ghana.

  5. [Seroprevalence of viral markers among blood donors at the Blood Donor Center of Mohammed V Military Teaching Hospital of Rabat, Morocco].

    PubMed

    Uwingabiye, Jean; Zahid, Hafidi; Unyendje, Loubet; Hadef, Rachid

    2016-01-01

    This study aims to determine the prevalence of human immunodeficiency virus (HIV) infections and hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among blood donors at the Blood Donor Center, Mohammed V Military Teaching Hospital between 2010 and 2012. We conducted a retrospective study among military blood donors aged 18-50 years, with a male predominance (95%). Pre-donation interview is the first selection barrier for individuals at risk. Biological screening was performed by liquid enzyme immunoassay technique using antibodies and/or antigen. Fourth generation combined HCV and HIV antigen/antibody ELISA (enzyme-linked immunosorbent assay) test was used. The Blood Donor Center and the laboratory of virology used the same technique performed in duplicate to confirm results. Out of 25661 tested samples, the prevalence rate of HBV infections was 3.97 ‰ (n = 102), the prevalence rate of HCV infections was 2.45 ‰ (n = 63) and the prevalence rate of HIV infections was 0.15 ‰ (n = 4). A single case with HBV and HCV virus co-infection (0.039 ‰) was registered, no association between HIV-HBV, HIV-HCV or HBV, HCV and HIV infections was recorded. The low seroprevalence rates of viral markers recorded in our study show improvement in preventive measures for donor selection and screening tests. The registered prevalence encourages the use of combined reagent, which is the only alternative to molecular biology in developing countries.

  6. A study of knowledge, attitudes, and practice of dental doctors about adverse drug reaction reporting in a teaching hospital in India

    PubMed Central

    Khan, Sarfaraz Alam; Goyal, Chhaya; Tonpay, S. D.

    2015-01-01

    Objective: The aim was to investigate the knowledge, attitudes, and practice of dental doctors about adverse drug reaction (ADR) reporting. Materials and Methods: In a cross-sectional study, questionnaire was administered to 95 dental doctors working in a teaching dental hospital attached to a medical college with an ADR monitoring center (AMC). Statistical Analysis Used: Descriptive statistics were used to analyze responses. The association of knowledge and attitude with respect to position of dentists was analyzed with Chi-square test. Results: The response rate and spontaneous reporting rate was found to be 61.0% and 13.7%, respectively. Important factors contributing to under reporting of ADRs include lack of awareness about AMC in the institute (81.0%) and pharmacovigilance program (72.4%), complacency (67.2%), lack of training to identify ADRs (65.5%), fear factor (63.7%), lethargy (58.6%), lack of risk perception of over the counter product related ADR (39.6%), inadequate risk perception of nonallopathic and herbal medicines (31%), indifference (27.5%) and concern that report may be wrong (27.5%). No significant difference in knowledge and attitudes of doctors with respect to position was found except for reporting of ADRs of newly marketed drugs and serious reactions to established product (P < 0.05). Conclusion: The deficiencies in knowledge and attitudes appear to be the underlying factor for under reporting by dental practitioners. It should be addressed urgently in order to increase spontaneous reporting by them. PMID:26229750

  7. Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

    PubMed

    McGettrick, Padraig; Ferguson, Wendy; Jackson, Valerie; Eogan, Maeve; Lawless, Mairead; Ciprike, Vaneta; Varughese, Alan; Coulter-Smith, Sam; Lambert, John S

    2016-03-01

    All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology.

  8. Assessment of Knowledge and Practices regarding Injection Safety and Related Biomedical Waste Management amongst Interns in a Tertiary Care Teaching Hospital, Delhi

    PubMed Central

    Acharya, Anita Shankar; Priyanka; Khandekar, Jyoti; Bachani, Damodar

    2014-01-01

    Injuries caused by needle sticks and sharps due to unsafe injection practices are the most common occupational hazard amongst health care personnel. The objectives of our study were to determine the existing knowledge and practices of interns and change in their level following an information education and communication (IEC) package regarding safe injection practices and related biomedical waste management and to determine the status of hepatitis B vaccination. We conducted a follow-up study among all (106) interns in a tertiary care teaching hospital, Delhi. A predesigned semistructured questionnaire was used. IEC package in the form of hands-on workshop and power point presentation was used. A highly significant (P < 0.001) improvement in the knowledge of interns was observed after intervention with respect to the “three criteria of a safe injection” and cleaning of injection site. Thus, the baseline knowledge of interns was good in certain aspects of injection safety, namely, diseases transmitted by unsafe injections and their prevention. We conclude that IEC intervention package was effective in significantly improving the interns' knowledge regarding safe injection practices and biomedical waste management. Almost two-thirds of interns were immunised against hepatitis B before the intervention and this proportion rose significantly after the intervention. PMID:27433489

  9. Neck masses in paediatric population: An experience with children attended the Central Teaching Hospital of Pediatrics in Baghdad 2008-2009

    PubMed Central

    Al-Mayoof, Ali F.

    2015-01-01

    Background: Pediatric neck mass is a frequent cause for surgical consultation. Neck masses can be simply classified into congenital, inflammatory, and neoplastic. Although most of the cases are due to benign processes, malignant causes must not be overlooked. The aim of this study is to assess the paediatric neck masses in Iraqi patients highlighting the distribution of cases according to their demographic characteristics and etiology. Patients and Methods: A cross-sectional observed study is conducted in the Department of Pediatric Surgery, at the Central Teaching Hospital of Pediatrics in Baghdad from April 2008 to March 2009. Sixty four patients with neck masses aged 14 years and below were examined and managed. The underlying causes of the neck masses were addressed and categorized. Results: Among the 64 patients, 42 (65.6%) were male. The inflammatory group represents 57% of the cases, while the malignant neoplasm accounts for approximately 10% of the conditions mainly due to lymphoma 5 (7.8%). Sixteen patients (25%) fall in the congenital group, in which the thyroglossal duct cyst was the commonest type. Wound infection developed in two patients, while one patient with cystic hygroma showed recurrence. Conclusion: Pediatrics neck masses are distributed in categories that similar in pattern and distribution in the world except the infectious/inflammatory category that shows variation in distribution in respect to the socioeconomic status. The surgical intervention and procedures are related to the facility as well as to the experience. PMID:26168753

  10. Pseudo-outbreak of Mycobacterium gordonae in a teaching hospital: importance of strictly following decontamination procedures and emerging issues concerning sterilization.

    PubMed

    Scorzolini, Laura; Mengoni, Fabio; Mastroianni, Claudio M; Baldan, Rossella; Cirillo, Daniela M; De Giusti, Maria; Marinelli, Lucia; Cottarelli, Alessia; Fattorini, Lanfranco; Vullo, Vincenzo

    2016-01-01

    Aim of this study was to investigate a pseudo-outbreak of Mycobacterium gordonae analyzing isolates detected from clinical and environmental samples. Mycobacterium gordonae was detected in 7 out of 497 broncho-alveolar lavage (BAL) samples after bronchoscopy procedure in patients admitted to a teaching hospital between January and April 2013. During this pseudo-outbreak clinical, epidemiological, environmental and molecular investigations were performed. None of the patients met the criteria for non-tuberculous mycobacterial (NTM) lung disease and were treated for M. gordonae lung disease. Environmental investigation revealed M. gordonae in 3 samples: in tap water and in the water supply channel of the washer disinfector. All the isolates were subjected to genotyping by pulsed-field gel electrophoresis (PFGE). The PFGE revealed that only patients' isolates presented the same band pattern but no correlation with the environmental strain was detected. Surveillance of the outbreak and the strict adherence to the reprocessing procedure and its supplies resulted afterwards in no detection of M. gordonae in clinical respiratory samples. Clinical surveillance of patients was crucial to establish the start of NTM treatment. Regular screening of tap water and endoscopic equipment should be adopted to compare the clinical strains with the environmental ones when an outbreak occurs.

  11. Perception of personal risk of acquiring human immunodeficiency viral infection/acquired immune deficiency syndrome among people attending outpatient clinics in a teaching hospital of Nigeria.

    PubMed

    Adegun, P T; Adegoke, S A; Solomon, O S; Ade-Ojo, I P

    2013-01-01

    The Human Immunodeficiency Virus (HIV) pandemic is on the increase with the highest burden in sub-Saharan Africa. This descriptive cross-sectional study was carried out in 2008 to assess the knowledge, self-perception of risk of contracting HIV infection and risky sexual practices among patients attending some out-patient clinics at the University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria. The knowledge on the modes of transmission and methods of prevention of HIV was high. Although, 53.0% of the study participants perceived themselves not to be at risk of contracting HIV infection, 80.6% were engaged in risky sexual practices within a year preceding the study. Significantly more participants with multiple sexual partners, past and present history of Sexually Transmitted Infections (STI) perceived themselves not to be at risk (P= 0.001, 0.008 and 0.001 respectively). Effective strategies must therefore be developed, to enhance risk-perception since poor risk-perception is known to mitigate behavioral change.

  12. Criterion-referenced evaluation of day one clinical competencies of veterinary students: VOLES-the VMTH (Veterinary Medicine Teaching Hospital) Online Evaluation System.

    PubMed

    Zeck, Steven; Wall, Judy A; Smith, Bradford P; Wilson, W David; Walsh, Donal A

    2012-01-01

    This article describes an extensive online criterion-referenced evaluation system for the assessment of veterinary students' achievement during their final year's Doctor of Veterinary Medicine (or equivalent) clinical education. Data are reported for the 2001 to 2009 University of California at Davis veterinary graduates, for a total of more than 1,100 students. These criterion-referenced evaluations extensively document the level of clinical skills attained and demonstrated during the individual clinical rotations that comprise the fourth-year curriculum. On average, in each of the 17,500 clinical rotations undertaken during this time period, student performance was assessed in at least 11 separate areas of skills, knowledge, and professional attributes. This provided more than 200,000 criterion-referenced judgments of the individual clinical attributes of graduates over nine years. The system is based on a previously detailed and validated definition of the skills, knowledge, and professional attributes that students should have demonstrated before graduation. The extensive database that this system has provided has established that this system, termed VOLES (VMTH [Veterinary Medicine Teaching Hospital] On-Line Evaluation System), is an effective tool to assess the clinical capabilities of veterinary students and their achievement of the "Day One" skills required for entering clinical practice. These expected proficiencies are balanced according to the differing expectations that each area of veterinary clinical practice demands.

  13. Investigation of the Relationship Between Organizational Learning and Organizational Citizen Behavior Among the Staff of Teaching Hospital

    PubMed Central

    Kiaei, Mohammad Zakaria; Hasanpoor, Edris; Sokhanvar, Mobin; Mohseni, Mohammad; Ziaiifar, Hajarbibi; Moradi, Mahin

    2014-01-01

    Background: Today, the concept of organizational learning has attracted the attention of many managers and researchers in scientific and research circles as well as those in the organization-related studies. Taking the organizational learning into account might offer a means of organizational effectiveness that has gone unnoticed. Thus the present study aimed at investigating the relationship between the organizational learning in each of its four aspects as independent variables and organizational citizen behavior of the staff as constituting the dependent variable of the study. Methods: This was a descriptive-analytical study with a practical approach conducted in 2010. The sample included 167 staff members working in educational health centers affiliated with Qazvin University of Medical Sciences. The data were collected via both the organizational learning questionnaire and organizational citizen behavior questionnaire and analyzed by using SPSS software and Spearman test. Results: The results indicated that the mean of organizational learning indicator was 2.9±0.648 and that of organizational citizen behavior 3.78±0.413. In addition, the spearman correlation coefficient ranging from 0.058 to 0.129 between the elements of the organizational learning and the organizational citizen behavior was not statistically significant (p>0.05). The findings also indicated that the correlation between them was average among the staff of Shahid Raja’ee Educational health center (0.319), thus the relationship between the two sets of variables proved significant (p=0.031). However, the same was not true in other centers. Conclusion: It was concluded that management commitment, open space, transfer of knowledge, and systemic vision could all enhance the level of organizational learning in hospitals which calls for focus on the elements of organizational citizen behavior. PMID:25568629

  14. Patients’ bill of rights and effective factors of workplace violence against female nurses on duty at Ilam teaching hospitals

    PubMed Central

    Aivazi, Ali Ashraf; Menati, Waleyeh; Tavan, Hamed; Navkhasi, Sasan; Mehrdadi, Abuzar

    2017-01-01

    Abstract: Background: Workplace violence against female nurses is an increasing problem. In addition, recognizing the rights of patients can reduce such violence against female nurses. Therefore, the aim of the current study was to investigate workplace violence against female nurses in respect of patients' bill of rights at two public hospitals in Ilam in 2012. Methods: In a descriptive cross-sectional research, workplace violence against female nurses was studied. Data were gathered employing a researcher made questionnaire filled out by 106 female nurses. The questionnaire was on workplace, physical and verbal violence of patients and their attendants, and also the patients' rights as respected by nursing staff. Permission of university ethics committee was obtained. Data analyses were done by T-test and ANOVA in SPSS software. Results: Totally, 90.6 % and 15.1 % of the participants were subjected to verbal and physical assaults by patients, respectively during last year of the study. Further, 92.5% and 11.3% of nurses experienced verbal and physical assaults by the patients' attendants, respectively. Most of the nursing staff believed that reporting aggressive attacks to the concerned officials would not be useful. A negative significant correlation was found between the aggressions of patients with age as well as marital status of nurses, (P= 0.04). Furthermore, a significant association was seen between physical violence of patients and the nurses’ recognition of the patients' bill of rights (P= 0.03). Conclusions: Due to high rate of violence against female nurses, some proper and effective actions such as employing a trained security force along with legal punitive charges against violators through responsible officials are highly suggested. PMID:28039684

  15. A retrospective drug use evaluation of cabergoline for lactation inhibition at a tertiary care teaching hospital in Qatar

    PubMed Central

    AlSaad, Doua; ElSalem, Samah; Abdulrouf, Palli Valapila; Thomas, Binny; Alsaad, Tayseer; Ahmed, Afif; AlHail, Moza

    2016-01-01

    Background Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians. Objective The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety. Method A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women’s Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken. Results Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension. Conclusion The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern

  16. Detection of Oxacillin Resistance in Staphylococcus aureus Isolated from the Neonatal and Pediatric Units of a Brazilian Teaching Hospital

    PubMed Central

    Pereira, Valéria Cataneli; Martins, André; de Souza Rugolo, Lígia Maria Suppo; de Lourdes Ribeiro de Souza da Cunha, Maria

    2009-01-01

    Objective: To determine, by phenotypic and genotypic methods, oxacillin susceptibility in Staphylococcus aureus strains isolated from pediatric and neonatal intensive care unit patients seen at the University Hospital of the Botucatu School of Medicine. Methods: A total of 100 S. aureus strains isolated from the following materials were studied: 25 blood cultures, 21 secretions, 12 catheters, 3 cannulae and one chest drain from 62 patients in the neonatal unit, and 36 blood cultures, one pleural fluid sample and one peritoneal fluid sample from 38 patients in the pediatric unit. Resistance of the S. aureus isolates to oxacillin was evaluated by the disk diffusion method with oxacillin (1 μg) and cefoxitin (30 μg), agar screening test using Mueller-Hinton agar supplemented with 6 μg/ml oxacillin and 4% NaCl, and detection of the mecA gene by PCR. In addition, the isolates were tested for β-lactamase production using disks impregnated with Nitrocefin and hyperproduction of β-lactamase using amoxicillin (20 μg) and clavulanic acid (10 μg) disks. Results: Among the 100 S. aureus strains included in the study, 18.0% were resistant to oxacillin, with 16.1% MRSA being detected in the neonatal unit and 21.0% in the pediatric unit. The oxacillin (1 μg) and cefoxitin (30 μg) disk diffusion methods presented 94.4% and 100% sensitivity, respectively, and 98.8% specificity. The screening test showed 100% sensitivity and 98.8% specificity. All isolates produced β-lactamase and one of these strains was considered to be a hyperproducer. Conclusions: The 30 μg cefoxitin disk diffusion method presented the best result when compared to the 1 μg oxacillin disk. The sensitivity of the agar screening test was similar to that of the cefoxitin disk diffusion method and higher than that of the oxacillin disk diffusion method. We observed variations in the percentage of oxacillin-resistant isolates during the study period, with a decline over the last years which might be

  17. 391 Description of Drug Allergy Study Conducted in a Teaching Hospital between October 2007 and March 2011

    PubMed Central

    Rodríguez Martínez, Consuelo Fernanda; Rubio, Alicia Sciaraffia

    2012-01-01

    Background The World Allergy Organization (WAO) in 2003 defined ‘drug allergy’ as an immunologically mediated drug hypersensitivity reaction. The mechanism of drug allergy may be either IgE or non-IgE mediated. The true incidence of drug allergy is not known. There are only few studies/datasets using standardized clinical questionnaires and validated in vivo or in vitro tests to confirm the diagnosis of drug allergy. Here we have analyzed the obtained results of in vivo test in suspected drug allergy patients. Methods Data from the Centre of Allergies of the Clinical Hospital of the Universidad de Chile between the months of October 2007 and March 2011 was obtained. The information of the protocols of drug executed, by defining as Protocol the study of a probable allergy by 2 or more procedures, which can be: Prick Test, intradermal reaction, specific IgE and/or Test Patch. Results For a total of 126 drug protocols, 25% of them were trivírica vaccine, 24% β-lactams, 21% local anaesthetics and 10% to general anesthesia (inductors, muscle relaxants and Latex). Of the total of patients undergoing protocols the most of them were women, there is no clear difference between the number of children and adults. The temporal distribution of protocols was stable between the months of October 2007 and March 2009 (15 protocols/semester), to then become variable, reaching values between 10 and 29 every 6 months. Of total protocols, 30.1% were positive; only one patient presented a mild adverse reaction (local welt). The β-lactams being most often the positive drugs. Protocols involving pethidine 100% was positive, diclofenac 33%, dipyrone, ketoprofen and hydrocortisone each one 25%. The most accomplished protocol was trivírica vaccine, resulting in 100% negative. Of all negative protocols 58% went to provocation, resulting in a 8% positive, including one provocation to the trívirica vaccine. Conclusions Methodologicall study is very important for a possible drug allergy

  18. Knowledge of Radiation Hazards, Radiation Protection Practices and Clinical Profile of Health Workers in a Teaching Hospital in Northern Nigeria

    PubMed Central

    Ibrahim, MTO; Saidu, SA; Ma’aji, SM; Danfulani, M; Yunusa, EU; Ikhuenbor, DB; Ige, TA

    2016-01-01

    Introduction Use of ionizing radiation in medical imaging for diagnostic and interventional purposes has risen dramatically in recent years with a concomitant increase in exposure of patients and health workers to radiation hazards. Aim To assess the knowledge of radiation hazards, radiation protection practices and clinical profile of health workers in UDUTH, Sokoto, Nigeria. Materials and Methods A cross-sectional study was conducted among 110 Radiology, Radiotherapy and Dentistry staff selected by universal sampling technique. The study comprised of administration of standardized semi-structured pre-tested questionnaire (to obtain information on socio-demographic characteristics, knowledge of radiation hazards, and radiation protection practices of participants), clinical assessment (comprising of chest X-ray, abdominal ultrasound and laboratory investigation on hematological parameters), and evaluation of radiation exposure of participants (extracted from existing hospital records on their radiation exposure status). Results The participants were aged 20 to 65 years (mean = 34.04 ± 8.83), most of them were males (67.3%) and married (65.7%). Sixty five (59.1%) had good knowledge of radiation hazards, 58 (52.7%) had good knowledge of Personal Protective Devices (PPDs), less than a third, 30 (27.3%) consistently wore dosimeter, and very few (10.9% and below) consistently wore the various PPDs at work. The average annual radiation exposure over a 4 year period ranged from 0.0475mSv to 1.8725mSv. Only 1 (1.2%) of 86 participants had abnormal chest X-ray findings, 8 (9.4%) of 85 participants had abnormal abdominal ultrasound findings; while 17 (15.5%) and 11 (10.0%) of 110 participants had anemia and leucopenia respectively. Conclusion This study demonstrated poor radiation protection practices despite good knowledge of radiation hazards among the participants, but radiation exposure and prevalence of abnormal clinical conditions were found to be low. Periodic in

  19. Detection of OXA-type carbapenemases and integrons among carbapenem-resistant Acinetobactor baumannii in a teaching hospital in China.

    PubMed

    Hu, Qiaojuan; Hu, Zhidong; Li, Jing; Tian, Bin; Xu, Hairu; Li, Jin

    2011-10-01

    imipenem-resistant A. baumannii isolates. The clonal spread played an important role in the increase of OXA-23 producing IRABs in the hospital environment.

  20. Knowledge and Utilization of Information Technology Among Health Care Professionals and Students in Ile-Ife, Nigeria: A Case Study of a University Teaching Hospital

    PubMed Central

    Bello, Ibrahim S; Sanusi, Abubakr A; Ezeoma, Ikechi T; Abioye-Kuteyi, Emmanuel A; Akinsola, Adewale

    2004-01-01

    Background The computer revolution and Information Technology (IT) have transformed modern health care systems in the areas of communication, teaching, storage and retrieval of medical information. These developments have positively impacted patient management and the training and retraining of healthcare providers. Little information is available on the level of training and utilization of IT among health care professionals in developing countries. Objectives To assess the knowledge and utilization pattern of information technology among health care professionals and medical students in a university teaching hospital in Nigeria. Methods Self-structured pretested questionnaires that probe into the knowledge, attitudes and utilization of computers and IT were administered to a randomly selected group of 180 health care professionals and medical students. Descriptive statistics on their knowledge, attitude and utilization patterns were calculated. Results A total of 148 participants (82%) responded, which included 60 medical students, 41 medical doctors and 47 health records staff. Their ages ranged between 22 and 54 years. Eighty respondents (54%) reportedly had received some form of computer training while the remaining 68 (46%) had no training. Only 39 respondents (26%) owned a computer while the remaining 109 (74%) had no computer. In spite of this a total of 28 respondents (18.9%) demonstrated a good knowledge of computers while 87 (58.8%) had average knowledge. Only 33 (22.3%) showed poor knowledge. Fifty-nine respondents (39.9%) demonstrated a good attitude and good utilization habits, while in 50 respondents (33.8%) attitude and utilization habits were average and in 39 (26.4%) they were poor. While 25% of students and 27% of doctors had good computer knowledge (P=.006), only 4.3% of the records officers demonstrated a good knowledge. Forty percent of the medical students, 54% of the doctors and 27.7% of the health records officers showed good utilization

  1. Bacteriological quality of foods and water sold by vendors and in restaurants in Nsukka, Enugu State, Nigeria: a comparative study of three microbiological methods.

    PubMed

    Nkere, Chukwuemeka K; Ibe, Nnenne I; Iroegbu, Christian U

    2011-12-01

    Bacterial count in prepared food or water is a key factor in assessing the quality and safety of food. It also reveals the level of hygiene adopted by food handlers in the course of preparation of such foods. This comparative study evaluated the bacteriological quality of food and water consumed in Nsukka, Enugu state, Nigeria, using three bacteria enumeration methods. Data obtained are assumed to reflect the level of personal and environmental hygiene in the study population. Ten types of foods--beans, yam, abacha, okpa, moimoi, pear, cassava foofoo, rice, agidi, and garri--and 10 water samples were evaluated for bacteriological quality, precisely determining the level of coliform contamination, using the most probable number (MPN), lactose fermentation count (LFC), and Escherichia coli count (ECC) methods. Bacterial counts differed significantly (p < 0.05) among the various food samples. However, this did not differ significantly in the three methods used for the enumeration of coliforms, suggesting that any of the three methods could be validly used for such studies with confidence. Escherichia coli and Klebsiella pneumoniae were the two major coliforms identified among 98 coliform isolates obtained from the various food samples, of which 78 (79.6%) were assumed to be of human origin on account of their ability to grow at 44 degrees C. The level of coliform contamination in the food samples from vendors and restaurants (geometric mean count 7.64-9.21; MPN > or = 50) were above the accepted 10(4) colony-forming unit/g or MPN < or = 10 limits. The results of the study, therefore, call for stringent supervision and implementation of food-safety practices and regular education on food and personal hygiene among food vendors.

  2. The impact of education on nutrition on the quality of life in patients on hemodialysis: a comparative study from teaching hospitals.

    PubMed

    Aghakhani, Nader; Samadzadeh, Saeei; Mafi, Taher Mohit; Rahbar, Narges

    2012-01-01

    Patients on maintenance hemodialysis (MHD) experience decreased quality of life (QoL) and significantly higher rates of malnutrition, inflammation, hospitalization and mortality when compared with the normal population. The dietary approach in the different phases of chronic renal failure is one of the most important, and yet controversial, topics in the whole history of nephrology, even when dialysis facilities were not easily available. Although much progress has been made in recent years in recognizing the link between malnutrition, different diseases and increased mortality, no consensus has yet been reached concerning the ideal assessment and management of nutritional status in dialysis patients in Iran. In this study, 70 patients on MHD in the teaching hospitals in Urmia were divided into two groups and were requested to fill in the validated SF-36 QoL questionnaire. One group of 35 patients received dietary counseling while the other did not and acted as controls. The SF-36, a short-form QoL scoring system consists of 36 questions that are compressed into eight multi-item scales covering all aspects of QoL. The two groups studied were similar in age, level of education, gender and duration of dialysis treatment; 46.8% of the patients were female and 52% were male. The total SF-36 score was slightly higher in males compared with females, but this difference was not statistically significant (P = 0.05). The scores were higher in the group counseled about diet. Overall, the difference in physical health, in work activities and QoL as a whole, between the two groups, was statistically significant (t = 2.04, df = 34, P = 0.049; t = 2.04, df = 34, P = 0.049; t = 2.28, df = 1.96, P = 0.043, respectively). The QoL was considerably diminished in HD patients, but less so in the group that was educated about their nutrition. Improvement in QoL is achievable in patients if their discomfort is more effectively treated medically. One of the methods for this is education

  3. Pattern of Skin Diseases at University of Benin Teaching Hospital, Benin City, Edo State, South-South Nigeria: A 12 Month Prospective Study

    PubMed Central

    Ukonu, B. A.; Eze, E. U

    2012-01-01

    Background and Objective: This study aims to look at the pattern and incidence of skin diseases seen in Dermatology/Venereology clinic at the University of Benin Teaching Hospital, Benin City, Edo State, South-South Zone, Nigeria and compare it with other zones of Nigeria. Materials and Methods: This was a prospective study on pattern and incidence of skin diseases in new patients presenting at the Dermatology/Venereology outpatient clinic of the University of Benin Teaching Hospital, Benin City, Edo State, South-South, Nigeria, from September 2006 to August 2007. All patients were seen by the researchers. Diagnosis were made clinically and sometimes with the support of histopathology. Results: A total number of 4786 patients were seen during the study period and these comprised 2647 HIV/AIDS patients and 2112 pure Dermatological patients. Out of 4786 patients, 755 (15.8%) were new patients. The new patients comprised 96 (12.7%) children patients (< 15 years) and 659 (83.7%) adult patients (>15years). The ages of the patients ranged from 2 weeks to 80 years and more than two-third were < 40 years. There were 354 males (46.9%) and 401 females (53.1%). This represents female: male ratio of 1.1: 1. Eczematous dermatitis accounted for 20.9% of the skin diseases and was the most common of the skin diseases observed. This is consistent with observation from other zones in Nigeria. Other skin diseases observed in order of frequencies include: Papulosqamous disorder (9.0%), Infectious skin diseases like fungal, viral, bacterial and parasitic infestation, at 7.9%, 7.7%, 2.3% and 2.1% respectively. Pigmentary disorders (5.0%), hair disorders (4.2%) and Benign neoplastic skin disease (6.5%). All the patients that had neurofibromatosis were females (1.9%). HIV-related skin diseases were observed to have increased remarkably (7.9%) with Kaposi’s sarcoma, papular pruritic eruptions and drug eruptions being the commonest mode of presentation. Conclusion: The current pattern of

  4. 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.

  5. A Survey on Awareness about the Role of Anesthesia and Anesthesiologists among the Patients Undergoing Surgeries in a Tertiary Care Teaching Women and Children Hospital

    PubMed Central

    Marulasiddappa, Vinay; Nethra, H. N.

    2017-01-01

    Background: Although anesthesiology has grown tremendously and although anesthesiologists play a crucial role in the perioperative management of patients and also outside operating theater (OT) such as critical care, pain clinic, and labor analgesia, they do not get due recognition. We conducted a study to assess the awareness about the role of anesthesia and anesthesiologists among patients scheduled to undergo surgery in a Government Tertiary Care Teaching Women and Children Hospital. Designs: A prospective cross-sectional survey with a sample size of 100 patients. Materials and Methods: Patients scheduled to undergo elective surgery in the age group of 18–65 years with the American Society of Anesthesiologists (ASA) Grades 1 and 2, who are willing to participate and given written informed consent. Patients whose age <18 years and more than 65 years, ASA health status Class 3 and above were excluded. Analysis: Statistical analysis was done by calculating percentages using Chi-square test. Results: Twenty percent of the participants were illiterate and of the educated, none were graduates or postgraduates. Patients with higher level of education had better knowledge of anesthesiology and role of an anesthesiologist with P < 0.05 than those with lesser education. Forty-eight percent of the participants had no idea about anesthesia despite the majority (62%) having previous surgery with no statistically significant difference (P > 0.05) between those with previous surgery and those without previous surgery regarding their knowledge of anesthesiology and anesthesiologist. Ninety percent did not know the complications, types of anesthesia and 44% did not know that anesthesiologist is a doctor. Conclusion: Most of the participants were not aware of the role of anesthesia and anesthesiologists inside and outside OT. Although this could be attributed to their lower level of education, the fraternity of anesthesiologists has to educate patients and surgeons about the

  6. First-line antiretroviral treatment failure and associated factors in HIV patients at the University of Gondar Teaching Hospital, Gondar, Northwest Ethiopia

    PubMed Central

    Ayalew, Mohammed Biset; Kumilachew, Dawit; Belay, Assefa; Getu, Samson; Teju, Derso; Endale, Desalegn; Tsegaye, Yemisirach; Wale, Zebiba

    2016-01-01

    Background Antiretroviral therapy (ART) restores immune function and reduces HIV-related adverse outcomes. But treatment failure erodes this advantage and leads to an increased morbidity and compromised quality of life in HIV patients. The aim of this study was to determine the prevalence and factors associated with first-line ART failure in HIV patients at the University of Gondar Teaching Hospital. Patients and methods A retrospective study was conducted on 340 adults who had started ART during the period of September 2011 to May 2015. Data regarding patients’ sociodemographics, baseline characteristics, and treatment-related information were collected through review of their medical charts. Data were analyzed using SPSS version 21. Descriptive statistics, cross-tabs, and binary and multiple logistic regressions were utilized. P<0.05 was used to declare association. Results Among the 340 patients enrolled, 205 were females (60.3%). The mean age at ART initiation was 34.4 years. A total of 14 (4.1%) patients were found to have treatment failure. The median duration of treatment failure from initiation of treatment was 17.5 months (8–36 months). Poor adherence to treatment and low baseline CD4 cell count were found to be significant predictors of treatment failure. Conclusion The prevalence of first-line ART failure was 4.1%. Treatment failure was most likely to occur for the patients who had poor drug adherence and those who were delayed to start ART till their CD4 cell count became very low (<100 cells/mm3). PMID:27621669

  7. A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria

    PubMed Central

    Onoh, Robinson Chukwudi; Eze, Justus Ndulue; Ezeonu, Paul Olisaemeka; Lawani, Lucky Osaheni; Iyoke, Chukwuemeka Anthony; Nkwo, Peter Onubiwe

    2015-01-01

    Background The global rise in cesarean delivery rate has been a major source of public health concern. Aim To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction. PMID:25999769

  8. Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana

    PubMed Central

    Abokyi, Samuel; Obiri-Yeboah, Dorcas; Afedo, Daniel; Agyeman, Lawrence Duah; Boadi-Kusi, Samuel Bert

    2016-01-01

    Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including χ2, independent t-test, and ANOVA were done. A p value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell's palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm3. The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders (t = 2.5, p = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders (t = 2.8, p = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders. PMID:28127467

  9. Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.

    PubMed

    Vercheval, C; Gillet, M; Maes, N; Albert, A; Frippiat, F; Damas, P; Van Hees, T

    2016-09-01

    This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4 % vs. 90.3 ± 6.6 %, p = 0.0013; antibiotics documented 87.9 ± 9.0 % vs. 95.6 ± 5.1 %, p < 0.0001; and duration or review date documented 31.9 ± 15.4 % vs. 67.7 ± 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators.

  10. Selected micronutrient levels and response to highly active antiretroviral therapy (HAART) among HIV/AIDS patients attending a teaching Hospital in Addis Ababa, Ethiopia.

    PubMed

    Eshetu, Amare; Tsegaye, Aster; Petros, Beyene

    2014-12-01

    Poor micronutrient levels are associated with an increased risk of progression to AIDS and are also suggested to influence outcome of highly active antiretroviral therapy (HAART), though existing data are inconclusive to support the latter. Few published data are available on micronutrient levels in Ethiopian HIV/AIDS patients taking HAART. The objective of the study was to determine the association of micronutrient levels and response to HAART (CD4(+) T cell count) among adult HIV/AIDS patients attending a teaching Hospital in Addis Ababa. CD4(+) T cell counts and micronutrient (retinol, zinc, and iron) levels for 171 subjects were determined using standard procedures. Some proportions of the study participants were found deficient for retinol (14.03 %), zinc (47.3 %), and iron (2.8 %). Patients who were deficient in retinol had a significantly lower median CD4(+) T cell counts (P = 0.002) compared to non-deficient subjects. Association of micronutrient quartiles with CD4+ T cell count was assessed using adjusted multivariate regression by taking quartile 4 as a reference category. Accordingly, patients who had retinol levels in quartile 4 had a significantly lower mean CD4(+) T cell count compared to quartile 3 (P = 0.02). The significantly higher CD4(+) T cell counts in patients who were non-deficient in retinol imply the role of retinol in improving the production of CD4(+) T cells. However, both lower and higher retinol levels were associated with suppressed immunity (CD4 < 200 cells/mm(3)), suggesting an adverse effect of higher retinol levels. Thus, retinol may be potentially harmful depending on the dose, emphasizing the need for optimized level of retinol in nutrient supplements in patients taking HAART.

  11. Nepal's noble echocardiography-database with video clips and color still images: a single individual's 6 years' experience at the Echocardiography Lab of Nepal Medical College, Teaching Hospital.

    PubMed

    Shrestha, B

    2012-09-01

    Echocardiographic reporting system is very poor in Nepal. No long-term feasibility and efficacy data about the echocardiography database with video clips has been studied. Snazzi Movie Studio S4 was used to convert analog video signals into MPEG2 and color photographs were converted into JPEG format for storage and use for the database. All together 2272 patients' echocardiography were performed by one individual prospectively at the Nepal Medical College Teaching Hospital from 10th January 2007 to 9th January 2012. Echocardiographic findings of these patients were evaluated. Mean age +/- SD were 44.4 +/- 28.7 years. Male female ratio was 0.8:1. Brahman/Chhetri were the usual ethnic group to undergo echocardiography (943, 41.5%), followed byjanajati (631, 27.8%) and newar (496, 21.8%). Age group of 60-69 years was the most common echo users (519, 22.8%). Total time for echocardiography/report writing with database compared to non database was 13.9 +/- 2.4 minutes vs. 12.3 +/- 0.8 minutes, p = 0.51. Out of all lesions, valvular lesions were the most common lesions detected (4885, 215%). Mild tricuspid regurgitation (1213, 53.4%) was the most common valvular lesion followed by mild mitral regurgitation (742, 32.7%). Patent foramen ovale was the most common congenital heart disease (32, 45.7%) followed by atrial septal defect (12, 17.1%). About one seventh of the total patients (318, 13.9%) had systolic dysfunction. Out of total chronic cor pulmonale (383, 16.9%), severe Pulmonary arterial dysfulction (PAH) was noted in more than one third of the patients (169, 44.1%).

  12. An epidemiological study on the predictors of health status of food handlers in food establishments of teaching hospitals of North India

    PubMed Central

    Singh, Arun; Katyal, Rashmi; Chaudhary, Varsha; Narula, Kusum; Upadhayay, Deepak; Singh, Shailendra Pratap

    2015-01-01

    Introduction: The US Centers for Disease Control and Prevention (USDHHS-CDC 1996) revealed that the outbreaks of food borne diseases include inadequate cooking, heating, or re-heating of foods consumption of food from unsafe sources, cooling food inappropriately and allowing too much of a time lapse. As we all know that the food handlers have been working in various types of community kitchen and their health status can affect the status of food hygiene which can lead to contamination of foods attributing to acute gastroenteritis and food poisoning in various subgroups of the population e.g., medical/dental/nursing students. The background characteristics of these food handlers may have important role to affect health status of these handlers. Methods: The indexed study was carried out among the food handlers working in the food establishments the 5 teaching hospitals of Bareilly city in U.P. India during one year i.e., from August 2013 to July 2014. The survey method using schedule was conducted to get information about the background characteristics and food handlers and each food handler was examined clinically for assessing health status. Chi-Square test was used as test of significance and regression analysis was also done to nullifying the effect of confounders. Results: The health status of the mess workers was found to be significantly associated with use of gloves, hand washing after toilet and hand washing before cooking and serving food. Conclusion: The rationale of this study was that though many studies have been carried out to show the health status of the food handlers and their background characteristics, no study has highlighted the association of these background characteristics and personal hygiene practices with the health status of food handlers. PMID:26957813

  13. Neurological findings in pediatric penetrating head injury at a university teaching hospital in Durban, South Africa: a 23-year retrospective study.

    PubMed

    Muballe, Kadhaya David; Hardcastle, Timothy; Kiratu, Erastus

    2016-11-01

    OBJECTIVES Penetrating traumatic brain injuries (TBIs) can be divided into gunshot wounds or stab wounds based on the mechanisms of injury. Pediatric penetrating TBIs are of major concern as many parental and social factors may be involved in the causation. The authors describe the penetrating cranial injuries in pediatric patient subgroups at risk and presenting to the Department of Neurosurgery at the University of KwaZulu-Natal, by assessment of the Glasgow Coma Scale (GCS) score and review of the common neurological manifestations including cranial nerve abnormalities. METHODS The authors performed a retrospective chart review of children who presented with penetrating TBIs between 1985 and 2007 at a university teaching hospital. Descriptive statistical analysis with univariate and multivariate logistic regression was used to assess the variables. RESULTS Out of 223 children aged 16 years and younger with penetrating TBIs seen during the study period, stab wounds were causal in 127 (57%) of the patients, while gunshot injuries were causal in 96 (43%). Eighty-four percent of the patients were male. Apart from abnormal GCS scores, other neurological abnormalities were noted in 109 (48.9%) of the patients, the most common being cranial nerve deficits (22.4%) and hemiparesis. There was a strong correlation between left-sided stab wounds and development of seizures. The mean age of patients with neurological abnormalities was 11.72 years whereas that of patients with no neurological abnormalities was 8.96 years. CONCLUSIONS Penetrating head injuries in children are not as uncommon as previously thought. There was no correlation between the age group of the patients and the mechanism of injury, which implies that stab or gunshot injuries could occur in any of our pediatric population with the same frequency. While gunshot injuries accounted for 56% of the patient population, stab injuries still accounted for 44%. Following penetrating head injuries, neurological

  14. Assessment of stigma and discrimination experienced by people living with HIV and AIDS receiving care/treatment in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.

    PubMed

    Owolabi, Rotimi S; Araoye, Margaret O; Osagbemi, Gordon K; Odeigah, Louis; Ogundiran, Adeniyi; Hussain, Nurudeen A

    2012-01-01

    The research was designed to assess the stigma and discrimination faced by People living with HIV and AIDS (PLWHA) that are receiving treatment in UITH, Ilorin. The study was a descriptive cross-sectional survey conducted on three hundred (300) people living with HIV and AIDS receiving care at the antiretroviral therapy (ART) clinics within University of Ilorin Teaching Hospital (which was the only ART site in Kwara State as at then). A quantitative method through the use of interviewer administered questionnaire was used for data collection. This study was a cross-sectional descriptive study design. All the patients who came to the clinic and met the selection criteria were recruited until the desired sample size was reached. Data were analyzed by EPI-INFO 2005 software package. The mean age of the respondents was 39 years (SD = 9.32), and their age ranged between 19 and 65 years. About two thirds (64.7%) of the respondents were females, 62.7% were married, and 62.9% were from monogamous family settings. Slightly less than half (47.3%) of the respondents were not informed before they were tested for HIV, majority (63.3%) were not counseled before the test, but only 11% did not receive posttest counseling. One quarter of the respondents had experienced stigmatization/discrimination. Various forms of stigmatization/discrimination experienced by the respondents include blame for being responsible for their HIV status, various name callings, telling them that they are no more useful to anybody, violation of confidentiality, social isolation, restriction of their participation in family/religious activities, rejection by their spouses/families, dismissal from place of work, isolating them from other patients, and denying them care at health centers. It is therefore recommended that government at all levels should develop and implement programs to educate health care providers about HIV and AIDS, ethics, and treatment and care; educate the general population on HIV and

  15. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study.

    PubMed

    Al-Jundi, Suhad H

    2004-02-01

    Traumatic dental injuries are emergencies that must be treated promptly and properly in order to reduce the suffering, costs, and time for patients, parents, and health care providers. The aim of this study was to investigate the treatment, long-term prognosis, and number of visits needed to manage cases resulting from complications of late presentation of traumatic dental injuries. The sample consisted of 195 children, all presented with complications of dental trauma at the Pediatric Dentistry Clinics in the Dental Teaching Hospital of Jordan University of Science and Technology in Irbid city, Jordan. Retrospective data relied on trauma forms as well the clinical notes and radiographs in the patients' records. Prospective data was collected by examining patients at recall appointments. The treatment of traumatized teeth in this sample ranged from no active treatment to extraction and prosthetic replacement. It was estimated that the number of visits needed to carry out the planned treatment for these patients ranged between 3 and 17.2 visits according to the type of treatment. Apexification procedure was the most time consuming. Thirty-two per cent of teeth with apexification ended up with root fracture mainly subsequent to another minor trauma episode (in 85%), the rest were reported to be spontaneous fractures. Almost half of the teeth with luxation injuries became necrotic after 3 years. Teeth with avulsion actually kept on deteriorating even at the 36-month follow-up appointment. The long-term prognosis of teeth with middle root fracture was favorable in (80%) of the teeth in the sample, despite the fact that they were splinted late. Luxation injuries led to more necrotic teeth (50%) than uncomplicated crown fractures. Multiple dental trauma episodes (MDTE) were reported in about 30% of the patients in the sample and were responsible for some of the complications noticed in this report. As all cases followed up in this report are late presentation of dental

  16. Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium (INICC).

    PubMed

    Jahani-Sherafat, Somayeh; Razaghi, Maryam; Rosenthal, Victor D; Tajeddin, Elahe; Seyedjavadi, Simasadat; Rashidan, Marjan; Alebouyeh, Masoud; Rostampour, Maryam; Haghi, Arezo; Sayarbayat, Masoumeh; Farazmandian, Somayeh; Yarmohammadi, Tahere; Arshadi, Fardokht K; Mansouri, Nahid; Sarbazi, Mohammad R; Vilar, Mariano; Zali, Mohammad R

    2015-01-01

    Device-associated health care-acquired infections (DA-HAIs) pose a threat to patient safety, particularly in the intensive care unit (ICU). However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections (CLABs) per 1000 central line-days, 7.88 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii, Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and Enterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates

  17. 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…

  18. Quality of Artemisinin-Based Combination Formulations for Malaria Treatment: Prevalence and Risk Factors for Poor Quality Medicines in Public Facilities and Private Sector Drug Outlets in Enugu, Nigeria

    PubMed Central

    Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Ibe, Ogochukwu; El Sherbiny, Mohamed; van Wyk, Albert; Yeung, Shunmay; Swamidoss, Isabel; Green, Michael D.; Dwivedi, Prabha; Culzoni, Maria Julia; Clarke, Siân; Schellenberg, David; Fernández, Facundo M.; Onwujekwe, Obinna

    2015-01-01

    Background Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO) as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296) of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs) in Enugu metropolis, Nigeria, and compared the resulting quality estimates. Methods ACAs were purchased using three sampling approaches - convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified. Results Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200), mystery (n=1,919) and overt (n=905) approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified) and dihydroartemisinin (n=14) monotherapy tablets, not recommended by WHO, were also identified. Conclusion Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained

  19. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.