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

PubMed

Hsiao, Yu-Yu; Cheng, Shou-Hsia

2013-07-01

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

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

PubMed

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

1998-05-01

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

An international survey of physicians regarding clinical trials: a comparison between Kyoto University Hospital and Seoul National University Hospital

PubMed Central

2013-01-01

Background International clinical trials are now rapidly expanding into Asia. However, the proportion of global trials is higher in South Korea compared to Japan despite implementation of similar governmental support in both countries. The difference in clinical trial environment might influence the respective physicians’ attitudes and experience towards clinical trials. Therefore, we designed a questionnaire to explore how physicians conceive the issues surrounding clinical trials in both countries. Methods A questionnaire survey was conducted at Kyoto University Hospital (KUHP) and Seoul National University Hospital (SNUH) in 2008. The questionnaire consisted of 15 questions and 2 open-ended questions on broad key issues relating to clinical trials. Results The number of responders was 301 at KUHP and 398 at SNUH. Doctors with trial experience were 196 at KUHP and 150 at SNUH. Among them, 12% (24/196) at KUHP and 41% (61/150) at SUNH had global trial experience. Most respondents at both institutions viewed clinical trials favorably and thought that conducting clinical trials contributed to medical advances, which would ultimately lead to new and better treatments. The main reason raised as a hindrance to conducting clinical trials was the lack of personnel support and time. Doctors at both university hospitals thought that more clinical research coordinators were required to conduct clinical trials more efficiently. KUHP doctors were driven mainly by pure academic interest or for their desire to find new treatments, while obtaining credits for board certification and co-authorship on manuscripts also served as motivation factors for doctors at SNUH. Conclusions Our results revealed that there might be two different approaches to increase clinical trial activity. One is a social level approach to establish clinical trial infrastructure providing sufficient clinical research professionals. The other is an individual level approach that would provide incentives to encourage doctors to participate in and conduct clinical trials. PMID:24156760

Entering First-Year Residents' Experiences and Knowledge of Infection Control of Hepatitis B and HIV, at Five University-Affiliated Hospitals.

ERIC Educational Resources Information Center

Goetz, Angella; And Others

1992-01-01

A survey of 149 entering first-year medical residents concerning experiences with and knowledge of infection control investigated occurrence and patterns of accidental needle-sticking and reporting, student immunization for Hepatitis B, and instruction in universal precautions. It is concluded that students are at risk for needle-sticking, but…

Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University

PubMed Central

He, Zhehao; Zeng, Liping; Zhang, Chong; Wang, Luming; Wang, Zhitian; Rustam, Azmat; Du, Chengli; Lv, Wang

2017-01-01

Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology. PMID:29302429

Nurses' experiences working with nursing students in a hospital: a phenomenological enquiry.

PubMed

Lapeña-Moñux, Yolanda Raquel; Cibanal-Juan, Luis; Orts-Cortés, M Isabel; Maciá-Soler, M Loreto; Palacios-Ceña, Domingo

2016-01-01

this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital. a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed. three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves. understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations.

Higher Quality and Lower Cost from Improving Hospital Discharge Decision Making*

PubMed Central

Cox, James C.; Sadiraj, Vjollca; Schnier, Kurt E.; Sweeney, John F.

2015-01-01

This paper reports research on improving decisions about hospital discharges – decisions that are now made by physicians based on mainly subjective evaluations of patients’ discharge status. We report an experiment on uptake of our clinical decision support software (CDSS) which presents physicians with evidence-based discharge criteria that can be effectively utilized at the point of care where the discharge decision is made. One experimental treatment we report prompts physician attentiveness to the CDSS by replacing the default option of universal “opt in” to patient discharge with the alternative default option of “opt out” from the CDSS recommendations to discharge or not to discharge the patient on each day of hospital stay. We also report results from experimental treatments that implement the CDSS under varying conditions of time pressure on the subjects. The experiment was conducted using resident physicians and fourth-year medical students at a university medical school as subjects. PMID:28239219

Patients' experience of outsourcing and care related to magnetic resonance examinations.

PubMed

Tavakol Olofsson, Parvin; Aspelin, Peter; Bergstrand, Lott; Blomqvist, Lennart

2014-11-01

Outsourcing radiological examinations from public university hospitals affects the patient, who has to attend a different clinic or hospital for the radiological examination. We currently have a limited understanding of how patients view outsourcing and their care related to MR examinations. To examine the experiences of patients who are sent to private radiology units when their referrals for MR examinations are outsourced from a university hospital, as well as to explore factors which influence patient satisfaction regarding the quality of care related to the MR examination. A group of patients (n = 160) referred for MR examinations and either examined at a university hospital or at an external private unit were interviewed. The interview was designed as a verbal questionnaire. Data were analyzed using Student's t test, analysis of variance (ANOVA), and Pearson's correlation. Sixty-nine percent of the patients could neither choose nor influence the location at which they were examined. For those who could, aspects that influenced the patient's choice of radiology department were: short waiting time 79% (127/160), ease of traveling to the radiology department 68% (110/160), and short distance to their home or work 58% (93/160). For 40% (60/160) of the patients, a short time in the waiting room was related to a positive experience of the MR examination. If patients were informed about outsourcing and could also choose where to have their examination, key factors contributing to patient satisfaction could be met even when MR examinations are outsourced.

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

PubMed

Chabridon, G; Nekrouf, N; Bioy, A

2017-10-01

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

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.

Hospital explores winning balance in perioperative education.

PubMed

Onstott, A T

1998-09-01

Although there are a number of education models used today that expose bachelor of nursing degree students to perioperative nursing, producing nursing graduates who have the education and experience needed to work in the demanding perioperative arena is a challenge for education facilities. The University of Colorado Health Sciences Center, Denver, has developed a perioperative education model that interfaces with one of the university's clinical sites, University Hospital, Denver, to achieve a winning balance between perioperative education and employment. The model provides nursing students with a realistic perspective of the OR and gives the employer an opportunity to thoroughly evaluate potential employees--beyond a resume and references.

The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital.

PubMed

Wang, Hsiu-Ling; Huang, Jun-Ying; Howng, Shen-Long

2011-02-01

The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician-patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.

Academic Achievement of Children in China: The 2002 Fulbright Experience

ERIC Educational Resources Information Center

Phelps, LeAdelle

2005-01-01

The 2002 Fulbright team, led by Zheng Zhou of St. John's University, consisted of 12 professionals in the fields of education, counseling psychology, and school psychology. Spending one month visiting elementary schools, universities, governmental bodies, hospitals, and private schools throughout China, the Fulbright team had an opportunity to…

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

PubMed

Blöndal, Katrin; Zoëga, Sigridur; Hafsteinsdottir, Jorunn E; Olafsdottir, Olof Asdis; Thorvardardottir, Audur B; Hafsteinsdottir, Sigrun A; Sveinsdóttir, Herdis

2014-08-01

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration. © The Author(s) 2014.

Hillary Clinton's visit to Ottawa hospital an exercise in military precision

PubMed Central

Gray, Charlotte

1995-01-01

The Children's Hospital of Eastern Ontario learned that hosting the wife of the US president is more like a military manoeuvre than a typical VIP visit, but Hillary Rodham Clinton brought a unique perspective on universal health care to the Ottawa hospital. CMAJ Contributing Editor Charlotte Gray, who is also vice-chair of the hospital's board of trustees, recounts the experience of listening to “the sharpest, most intense professor of health care management you've ever met.” Imagesp1299-a

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

PubMed

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

2012-01-01

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

[Warning about risk of invasive infections in splenectomized patients. Experiences from University Hospital Brno, Czech Republic, in 2011].

PubMed

Polák, P; Freibergerová, M; Husa, P; Slesinger, P; Svoboda, R; Sťásek, J; Frola, L; Macháček, C

2012-09-01

Syndrome of fulminant sepsis in splenectomized (overwhelming postsplenectomy infection - OPSI) is feared and often fatal infectious complication in patients after splenectomy. The risk of syndrome of fulminant sepsis in splenectomized in these persons persists lifelong and doesn't diminish during the time. Etiologically, encapsulated bacterias like Streptococcus pneumoniae, Haemophilus influenzae group b and Neisseria meningitidis are involved. As the mortality of syndrome of fulminant sepsis in splenectomized is very high, it is indispensable to educate and vaccinate persons in risk. The authors present case reports of three splenectomized patients who were hospitalized for invasive pneumococcal infection in the University Hospital Brno, Czech Republic, in 2011.

From WING to MMSA: experiences with the implementation of a distributed HIS.

PubMed

Michel, A; Marquardt, K; Dudeck, J

1997-01-01

The following paper analyses the transition from a host centered to a client-server based Hospital Information System (HIS) which takes place at the University Hospital of Giessen, Germany, since 1995. It focuses on the overall concept and practical realisation of the cornerstone within this transition, the Macintosh Mosaic Software Architecture (MMSA) which delivers now more than 90% of the clinical data which is entered on the wards and within the operating rooms. Besides the technical problems of the project, the paper also describes some aspects of the organisational challenges which took place within a typical German University Hospital during the last 4 Years and which mainly affect the daily management of a large HIS.

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.

The attitudes of emergency department nurses towards patient safety.

PubMed

Durgun, Hanife; Kaya, Hülya

2017-11-23

This research was planned to identify the attitudes of emergency department nurses towards patient safety. The study was performed as descriptive. The universe of the research the universe comprised hospitals defined as 3rd level according to Turkish health care classification, which provides service to all health disciplines in Istanbul. The sample consisted of emergency department (ED) nurses who work in those hospitals. The data was collected by using tools such as the "Information Questionnaire" and the "Patient Safety Attitudes Scale". In this study, the attitudes of ED nurses towards patient safety were found to be average and was not related to age, gender, education level, nursing experience, ED experience, ED certification, patient safety training, nurse's self sufficiency perception of patient safety, hospital's quality certification or ED quality certification. The attitudes of nurses towards patient safety were compared by age, gender, marital status, education level, ED experience and there was no meaningful difference. However, a meaningful difference was found between the age groups and the "defining stress" sub-dimension of the Patient Safety Attitudes Scale. ED nurses' status of certification for emergency care, patient safety training, training of quality, hospitals' or ED's quality certification status had no significant statistical difference. Copyright © 2017 Elsevier Ltd. All rights reserved.

Patients’ experience of outsourcing and care related to magnetic resonance examinations

PubMed Central

Aspelin, Peter; Bergstrand, Lott; Blomqvist, Lennart

2014-01-01

Background Outsourcing radiological examinations from public university hospitals affects the patient, who has to attend a different clinic or hospital for the radiological examination. We currently have a limited understanding of how patients view outsourcing and their care related to MR examinations. Aim Aim. To examine the experiences of patients who are sent to private radiology units when their referrals for MR examinations are outsourced from a university hospital, as well as to explore factors which influence patient satisfaction regarding the quality of care related to the MR examination. Methods A group of patients (n = 160) referred for MR examinations and either examined at a university hospital or at an external private unit were interviewed. The interview was designed as a verbal questionnaire. Data were analyzed using Student’s t test, analysis of variance (ANOVA), and Pearson’s correlation. Results Sixty-nine percent of the patients could neither choose nor influence the location at which they were examined. For those who could, aspects that influenced the patient’s choice of radiology department were: short waiting time 79% (127/160), ease of traveling to the radiology department 68% (110/160), and short distance to their home or work 58% (93/160). For 40% (60/160) of the patients, a short time in the waiting room was related to a positive experience of the MR examination. Conclusion Conclusion. If patients were informed about outsourcing and could also choose where to have their examination, key factors contributing to patient satisfaction could be met even when MR examinations are outsourced. PMID:25142133

Perceptions of an 'international hospital' in Thailand by medical travel patients: cross-cultural tensions in a transnational space.

PubMed

Whittaker, Andrea; Chee, Heng Leng

2015-01-01

The growing trade in patients seeking health care in other countries, or medical travel, is changing the forms and experiences of health care seeking and producing changes to hospitals in terms of their design, organization and spaces. What is termed in marketing parlance in Thailand as an 'international hospital' oriented to attracting foreign patients, is a hotel-hospital hybrid that is locally produced through the inflexion of local practices to make a therapeutic space for international patients. The paper reports on work undertaken within a Thai hospital in 2012 which included observations and interviews with thirty foreign in-patients and nine informal interviews with hospital staff. Although theorized as a culturally neutral transnational 'space of connectivity', we show how cross-cultural tensions affect the experience of the hospital with implications for the organization of the hospital and notions of 'cultural competence' in care. There is no single universal experience of this space, instead, there are multiple experiences of the 'international hospital', depending on who patients are, where they are from, their expectations and relationships. Such hospitals straddle the expectations of both local patients and international clientele and present highly complex cross-cultural interactions between staff and patients but also between patients and other patients. Spatial organisation within such settings may either highlight cultural difference or help create culturally safe spaces. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pressure ulcer knowledge among nurses in a Brazilian university hospital.

PubMed

Chianca, Tânia Couto Machado; Rezende, Jomara Figueiredo Pinto; Borges, Eline Lima; Nogueira, Vera Lucia; Caliri, Maria Helena Larcher

2010-10-01

 To facilitate the implementation of evidence-based skin and pressure ulcer (PU) care practices and related staff education programs in a university hospital in Brazil, a cross-sectional study was conducted to evaluate nurses' knowledge about PU prevention, wound assessment, and staging. Of the 141 baccalaureate nurses (BSN) employed by the hospital at the time of the study, 106 consented to participate. Using a Portuguese version of Pieper's Pressure Ulcer Knowledge Test (PUKT), participants were asked to indicate whether 33 statements about PU prevention and eight about PU assessment and staging were true or false. For the 33 prevention statements, the average number answered correctly was 26.07 (SD 4.93) and for the eight assessment statements the average was 4.59 (SD 1.62). Nurses working on inpatient clinical nursing units had significantly better scores (P = 0.000). Years of nursing experience had a weak and negative correlation with correct PUKT scores (r = -0.21, P = 0.033) as did years of experience working in the university hospital (r = -.179, P <.071). Incorrect responses were most common for statements related to patient positioning, massage, PU assessment, and staging definitions. The results of this study confirm that nurses have an overall understanding of PU prevention and assessment principles but important knowledge deficits exist. Focused continuing education efforts are needed to facilitate the implementation of evidence-based care.

Introducing students to clinical audit.

PubMed

Parkes, Jacqueline; O'Dell, Cindy

2015-11-01

It is more than a decade since the UK Central Council for Nursing Midwifery and Health Visiting said that engaging with clinical audit is 'the business of every registered practitioner', yet there appears to be little evidence that nursing has embraced the process. To address this issue, Northampton General Hospital and the University of Northampton implemented a pilot project in which two third-year adult nursing students worked on a 'real life' audit. Supported by the hospital's audit department, and supervised by academic tutors with the relevant experience, the students worked on a pressure-ulcer care audit for their final year dissertation. This article describes the process undertaken by the hospital audit team and the university academic team to develop the pilot project and support the students. Based on the positive evaluations, the university has extended the project to a second phase, incorporating two new partner organisations.

The Logistics Of Installing Pacs In An Existing Medical Center

NASA Astrophysics Data System (ADS)

Saarinen, Allan O.; Goodsitt, Mitchell M.; Loop, John W.

1989-05-01

A largely overlooked issue in the Picture Archiving and Communication Systems (PACS) area is the tremendous amount of site planning activity required to install such a system in an existing medical center. Present PACS equipment requires significant hospital real estate, specialized electrical power, cabling, and environmental controls to operate properly. Marshaling the hospital resources necessary to install PACS equipment requires many different players. The site preparation costs are nontrivial and usually include a number of hidden expenses. This paper summarizes the experience of the University of Washington Department of Radiology in installing an extensive digital imaging network (DIN) and PACS throughout the Department and several clinics in the hospital. The major logistical problems encountered at the University are discussed, a few recommendations are made, and the installation costs are documented. Overall, the University's site preparation costs equalled about seven percent (7%) of the total PACS equipment expenditure at the site.

Does the patient's inherent rating tendency influence reported satisfaction scores and affect division ranking?

PubMed

Francis, Patricia; Agoritsas, Thomas; Chopard, Pierre; Perneger, Thomas

2016-04-01

To determine the impact of adjusting for rating tendency (RT) on patient satisfaction scores in a large teaching hospital and to assess the impact of adjustment on the ranking of divisions. Cross-sectional survey. Large 2200-bed university teaching hospital. All adult patients hospitalized during a 1-month period in one of 20 medical divisions. None. Patient experience of care measured by the Picker Patient Experience questionnaire and RT scores. Problem scores were weakly but significantly associated with RT. Division ranking was slightly modified in RT adjusted models. Division ranking changed substantially in case-mix adjusted models. Adjusting patient self-reported problem scores for RT did impact ranking of divisions, although marginally. Further studies are needed to determine the impact of RT when comparing different institutions, particularly across inter-cultural settings, where the difference in RT may be more substantial. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Development of an otitis media strategy in the Pacific: key informant perspectivesThe Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters.

PubMed

Gutenstein, Marc; Kiuru, Sampsa

2018-06-08

We describe a phenomenon of self-reinforcing inequality between New Zealand rural hospitals and urban trauma centres. Rural doctors work in remote geographical locations, with rare exposure to managing critical injuries, and with little direct support when they do. Paradoxically, but for the same reasons, they also have little access to the intensive training resources and specialist oversight of their university hospital colleagues. In keeping with international experience, we propose that using simulation-based education for rural hospital trauma and emergency team training will mitigate this effect. Along with several different organisations in New Zealand, the University of Otago rural postgraduate programme is developing inter-professional simulation content to address this challenge and open new avenues for research.

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

PubMed

Tengilimoglu, Dilaver; Kisa, Adnan

2005-01-01

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

Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

PubMed

Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M

2015-04-01

In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.

A European late starter: lessons from the history of reform in Irish health care.

PubMed

Wren, Maev-Ann; Connolly, Sheelah

2017-12-26

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

Radiation therapy in the treatment of cervical cancer: The University of Chicago/Michael Reese Hospital experience

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

Rader, J.S.; Haraf, D.J.; Halpern, H.J.

1990-07-01

A retrospective analysis was conducted on 307 patients referred for radiation therapy at The University of Chicago and Michael Reese Hospital between 1971 and 1986. Median follow-up was 6.4 years. Treatment techniques varied during the time of the study. Actuarial disease-free survivals were 78%, 64%, 55%, 33%, 41%, and 60% for stage IB, IIA, IIB, IIIA, IIIB, and IVA, respectively. Stage, size of the cervical lesion, and hemoglobin level during treatment were prognostic factors. Treatment technique as well as time dose factors were analyzed with respect to survival, failures, and complications.

Descriptive analysis of breast cancer in African-American women at Howard University Hospital, 1960-1987.

PubMed

Williams, R; Laing, A E; Demenais, F; Kissling, G; Gause, B L; Chen, V; Bonney, G

1993-11-01

This article describes breast cancer cases seen at the Howard University Hospital from 1960 through 1987 using information from the database of the Tumor Registry, established in 1960. Clinical information at presentation is presented as well as a description of reproductive and demographic characteristics. Pre- and postmenopausal women are compared, revealing differences in reproductive experience. This may contribute to the increasing incidence of breast cancer seen among younger women in recent years. This is of particular interest because the classic excess of nulliparous women among breast cancer cases is not seen among the population described here.

Strategic planning in healthcare: the experience of the University of Wisconsin Hospital and Clinics.

PubMed

Sollenberger, Donna K

2006-01-01

In 1999, after 25 years of stable leadership from a single CEO, the University of Wisconsin Hospital and Clinics (UWHC) Authority Board named a new CEO. The 471-bed academic medical center had recently experienced significant change and challenges. In 1996, it had emerged as a public authority, a statutory designation by the state of Wisconsin that moved the hospital and clinics from the University of Wisconsin and the state of Wisconsin, and created it as a quasi-public entity with its own board. In 1999, when the new CEO was named, the hospital was experiencing a loss of revenue and market share, operating deficits, a 22 percent nurse vacancy rate, and patient satisfaction scores below the 40th percentile. The first task assigned to the new CEO by the board was the development of a new strategic plan that would reverse these trends and position UWHC as a premier academic hospital. The CEO began a strategic planning process that involved leaders, physicians, and staff from throughout the hospital and clinics, its affiliated medical school, and the physician practice plan. This article describes the collaborative, integrative, and communicative strategic planning process UWHC used; details the organization of the process; describes the results achieved by UWHC; and lists the lessons learned along the way.

[Evaluation of Research Experience Based on the Type of Degree Completed for the Development of Pharmacist-Scientists].

PubMed

Ikemura, Mai; Hashida, Tohru

2016-01-01

  "Pharmacist-scientists" are needed in the clinical setting. However, research competency, including logical thinking, differs among pharmacists. This difference stems from the varying experience of research during university and graduate school. Thus, to ascertain the research experience within different educational systems, we evaluated pharmacists in Kobe City Medical Center General Hospital. In most instances, there was a direct correlation between the duration of research (in the laboratory at university or graduate school), and research experience gained, such as independent thinking and presentations at seminars or academic conferences. Respondents who graduated from the recently introduced 6-year pharmaceutical science course had less research experience than those who graduated with a combination 4-year degree and subsequent master's course. Conversely, the number of presentations at academic conferences and the number of published papers postgraduation were independent of research experience during university and graduate school. These results indicate that there is a considerable difference in the research experience during university and graduate school among pharmacists, and this is likely to impact their pharmaceutical skills.

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers

PubMed Central

Barati, Omid; Sadeghi, Ahmad; Khammarnia, Mohammad; Siavashi, Elham; Oskrochi, Gholamreza

2016-01-01

Introduction Hospital managers aim to improve the efficiency and effectiveness of their institutions through leadership and guidance of medical personnel. Fulfilling these objectives requires a holistic approach to both the management of people and institutional prioritization. The aim of this study was to identify the skills and competencies that hospital managers must demonstrate in order to achieve their objectives. Methods In 2015, a regional, multi-center qualitative study was undertaken in Shiraz, Iran. Interviews and focus group discussions were conducted with university hospital managers, senior managers, faculty members, and post-graduate students, and the results were analyzed using the content analysis method by MAXQDA software. Results Eight key skill themes (communication, experience, appreciation of institution logistics/infrastructure, management skills, motivation, systematic problem solving, ethics, and financial/legal awareness) were identified among the hospital managers. The common challenges that face hospital institutions include problems with hierarchical and organizational structure, excessive rules and regulations, lack of resources, poor post-graduate education, and overall management. Recurring themes with respect to how these could be addressed included changing the culture and belief structure of the hospital, restructuring the organizational hierarchy, and empowering the people. Conclusion In our cohort, practical skills, such as communication and experience, were considered more important than theoretical skills for the effective management and administration of hospitals. Therefore, we suggest that practical, skill-based training should be emphasized for students of these disciplines so they will be better suited to deal with real world challenges. Further organizational improvements also can be attained by the active and constructive involvement of senior university managers. PMID:27504159

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers.

PubMed

Barati, Omid; Sadeghi, Ahmad; Khammarnia, Mohammad; Siavashi, Elham; Oskrochi, Gholamreza

2016-06-01

Hospital managers aim to improve the efficiency and effectiveness of their institutions through leadership and guidance of medical personnel. Fulfilling these objectives requires a holistic approach to both the management of people and institutional prioritization. The aim of this study was to identify the skills and competencies that hospital managers must demonstrate in order to achieve their objectives. In 2015, a regional, multi-center qualitative study was undertaken in Shiraz, Iran. Interviews and focus group discussions were conducted with university hospital managers, senior managers, faculty members, and post-graduate students, and the results were analyzed using the content analysis method by MAXQDA software. Eight key skill themes (communication, experience, appreciation of institution logistics/infrastructure, management skills, motivation, systematic problem solving, ethics, and financial/legal awareness) were identified among the hospital managers. The common challenges that face hospital institutions include problems with hierarchical and organizational structure, excessive rules and regulations, lack of resources, poor post-graduate education, and overall management. Recurring themes with respect to how these could be addressed included changing the culture and belief structure of the hospital, restructuring the organizational hierarchy, and empowering the people. In our cohort, practical skills, such as communication and experience, were considered more important than theoretical skills for the effective management and administration of hospitals. Therefore, we suggest that practical, skill-based training should be emphasized for students of these disciplines so they will be better suited to deal with real world challenges. Further organizational improvements also can be attained by the active and constructive involvement of senior university managers.

45 CFR 50.4 - Waivers for research.

Code of Federal Regulations, 2011 CFR

2011-10-01

... his/her services would necessitate discontinuance of the program, or a major phase of it. Specific... experience or is occupying a senior staff position in a university, hospital, or other institution. [67 FR...

45 CFR 50.4 - Waivers for research.

Code of Federal Regulations, 2013 CFR

2013-10-01

... his/her services would necessitate discontinuance of the program, or a major phase of it. Specific... experience or is occupying a senior staff position in a university, hospital, or other institution. [67 FR...

45 CFR 50.4 - Waivers for research.

Code of Federal Regulations, 2012 CFR

2012-10-01

... his/her services would necessitate discontinuance of the program, or a major phase of it. Specific... experience or is occupying a senior staff position in a university, hospital, or other institution. [67 FR...

45 CFR 50.4 - Waivers for research.

Code of Federal Regulations, 2010 CFR

2010-10-01

... his/her services would necessitate discontinuance of the program, or a major phase of it. Specific... experience or is occupying a senior staff position in a university, hospital, or other institution. [67 FR...

Career support in medicine - experiences with a mentoring program for junior physicians at a university hospital.

PubMed

Buddeberg-Fischer, Barbara; Vetsch, Esther; Mattanza, Guido

2004-07-01

Until now, mentoring has hardly been used by the medical profession in German-speaking countries as a means of supporting junior physicians in their careers. The aim of the mentoring project described here was to obtain information for promoting and developing future mentoring programs at a university hospital. A new integrated mentoring model was developed and implemented over a 12-month period. Peer groups were advised on the mentoring process by mentors and program managers. A total of eight mentoring groups (40 peers) from four departments of a university hospital took part in the project: four voluntarily, and four on a compulsory basis. The evaluation was carried out using qualitative methods for analysis of the group protocols and the focus group interviews with the participants. Group discussions revealed that individual mentees, young female physicians in particular, developed concrete career plans and initiated further career-relevant steps. Some mentees - again more women than men - were promoted to senior physician posts. Further measurable career steps were increased research and publishing activity, and research fellowships abroad. The group process developed in five typical phases (forming, storming, norming, performing, and finalizing), which differed according to whether the groups had been formed on a voluntary or compulsory basis. In the evaluation interviews, mentees emphasized the following as effective mentoring factors: Concrete definition of own career goals; exchange of experiences within the peer groups; support and motivation from the mentors; and fostering of the group process by the program managers. Participation in mentoring programs has to be voluntary. Mentees are motivated, autonomous, goal-oriented and prepared to take action. Mentors serve as examples and advisers. They derive satisfaction from being held in high esteem, as well as from the advancement of their own careers. Program managers have experience in systems theory and group dynamics, structure the group processes, and evaluate the quality of the results. Hospital management should regard mentoring as a business strategy and a means of staff development and quality management, and provide the necessary resources. The mentoring program presented here is being extended to other departments of the hospital on the basis of the positive experiences it has offered.

Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses.

PubMed

Eide, Helene Dahl; Halvorsen, Kristin; Almendingen, Kari

2015-03-01

To identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly. Undernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant. A focus group study was employed based on a hermeneutic phenomenological methodological approach. Four focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (≥70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding. We identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored. The results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition. The barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to enable undernourished older inpatients to be identified and treated properly. © 2014 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

PubMed

Mousavi, Seyed Mohammad Hadi; Dargahi, Hossein; Mohammadi, Sara

2016-10-01

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.

Dr. Richard J. Whelan: Seeing the Field of Emotional and Behavior Disorders through the Lens of a Pioneer

ERIC Educational Resources Information Center

Kaff, Marilyn S.; Teagarden, Jim; Zabel, Robert H.

2011-01-01

Dr. Richard J. Whelan is a distinguished professor emeritus at the University of Kansas. His earliest professional experiences were at the Children's Hospital (Southard School) of the Menninger Clinic, where he served as a recreational therapist, teacher, and director of education. During his career at the University of Kansas and the KU Medical…

Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study.

PubMed

Fridner, Ann; Belkić, Karen; Minucci, Daria; Pavan, Luigi; Marini, Massimo; Pingel, Birgit; Putoto, Giovanni; Simonato, Pierluigi; Løvseth, Lise T; Schenck-Gustafsson, Karin

2011-08-01

Male and female physicians are at elevated suicide risk. The work environment has become a focus of attention as a possible contributor to this risk. The potential association between work environment and suicidal thoughts has been examined among female physicians in several countries, and significant findings have been reported. The purpose of this study was to examine the role of the work environment in relation to suicidal thoughts among male university hospital physicians in 2 European countries. Cross-sectional multivariate analysis was performed to identify significant associations between work-related factors and suicide risk among male physicians from the Health and Organization among University Hospital Physicians in Europe (HOUPE) study. The dependent variable was termed recent suicidal thoughts, which includes having thought about suicide and/or having thought about specific ways to commit suicide within the previous year. Adjusted odds ratios (ORs) and CIs are reported. Of the 456 Swedish (56%) and 241 Italian (39%) male physicians who participated, 12% of the physicians from each country reported affirmatively regarding recent suicidal thoughts. Degrading work experiences were associated with recent suicidal thoughts for the Swedish and Italian physicians (OR = 2.1; 95% CI, 1.01-4.5; OR = 3.3; 95% CI, 1.3-8.0, respectively). Role conflict was associated with recent suicidal thoughts among the Swedish physicians (OR = 1.6; 95% CI, 1.1-2.2). Support at work when difficulties arose appeared to be protective for the Swedish physicians (OR = 0.7; 95% CI, 0.5-0.96). Italian physicians with little control over working conditions had an increased risk of recent suicidal thoughts, whereas confidential discussions about work experiences appeared to be protective (OR = 0.6; 95% CI, 0.4-0.9). Attention should be paid to the work environment as it relates to suicide risk among male university hospital physicians, particularly to bolstering social support and preventing harassment. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

Kenyan medical student and consultant experiences in a pilot decentralized training program at the University of Nairobi.

PubMed

Kibore, Minnie W; Daniels, Joseph A; Child, Mara J; Nduati, Ruth; Njiri, Francis J; Kinuthia, Raphael M; O'Malley, Gabrielle; John-Stewart, Grace; Kiarie, James; Farquhar, Carey

2014-01-01

Over the past decade, the University of Nairobi (UoN) has increased the number of enrolled medical students threefold in response to the growing need for more doctors. This has resulted in a congested clinical training environment and limited opportunities for students to practice clinical skills at the tertiary teaching facility. To enhance the clinical experience, the UoN Medical Education Partnership Initiative Program Undertook training of medical students in non-tertiary hospitals around the country under the mentorship of consultant preceptors at these hospitals. This study focused on the evaluation of the pilot decentralized training rotation. The decentralized training program was piloted in October 2011 with 29 fourth-year medical students at four public hospitals for a 7-week rotation. We evaluated student and consultant experiences using a series of focus group discussions. A three-person team developed the codes for the focus groups and then individually and anonymously coded the transcripts. The team's findings were triangulated to confirm major themes. Before the rotation, the students expressed the motivation to gain more clinical experience as they felt they lacked adequate opportunity to exercise clinical skills at the tertiary referral hospital. By the end of the rotation, the students felt they had been actively involved in patient care, had gained clinical skills and had learned to navigate socio-cultural challenges in patient care. They further expressed their wish to return to those hospitals for future practice. The consultants expressed their motivation to teach and mentor students and acknowledged that the academic interaction had positively impacted on patient care. The decentralized training enhanced students' learning by providing opportunities for clinical and community experiences and has demonstrated how practicing medical consultants can be engaged as preceptors in students learning. This training may also increase students' ability and willingness to work in rural and underserved areas.

Pooling procurement in the Belgian hospital sector.

PubMed

Hebert, Guy

2011-01-01

The Belgian hospital sector is following the example of a number of other European countries and for more than ten years now, has been striving to pool its medical supplies and equipment purchases in a bid to reduce costs. The various experiments of which we are aware come under both opportunist purchases and initiatives which are designed to encourage local-regional contracts. These attempts have now all come to nothing or are struggling in the absence of a structured and professional approach. In 2005, the Saint Luc University Clinic in Brussels decided to set up a high-performance purchasing department, the aim being to centre its initiatives around TCO or Total Cost of Ownership. Following an analysis of the various experiments into pooling procurement in hospitals in Europe, the Saint Luc University Clinic decided on a central procurement agency model, in accordance with new legislation on public procurement. This article seeks to highlight the prerequisites which are vital for a procurement pooling initiative, without underestimating the risks and limitations of implementing such a change in procurement practices. The Mercure central procurement agency is now the largest interhospital purchasing structure in Belgium.

Necrotizing fasciitis: the Howard University Hospital experience.

PubMed

Walker, M; Hall, M

1983-02-01

All surgical cases from 1965 to 1980 and autopsy cases from 1974 to 1980 diagnosed at Howard University Hospital as necrotizing fasciitis (NF) were reviewed. Eight patient fulfilled the criteria for NF, which included (1) fascial necrosis, (2) spreading cellulitis with undermining of fascial planes, and (3) systemic toxicity as evidenced by altered mental state and hyperthermia. Bacteroides fragilis was commonly found in our most recent cases. Poor prognostic signs included (1) documented bacteremia, (2) preoperative hypotension (systolic blood pressure lower than 80 mmHg), and (3) hypocalcemia (serum calcium less than 7.0 mg/dL). Therapy consisted of wide debridement with systemic antibiotics and delayed skin grafting when needed.

Descriptive analysis of breast cancer in African-American women at Howard University Hospital, 1960-1987.

PubMed Central

Williams, R.; Laing, A. E.; Demenais, F.; Kissling, G.; Gause, B. L.; Chen, V.; Bonney, G.

1993-01-01

This article describes breast cancer cases seen at the Howard University Hospital from 1960 through 1987 using information from the database of the Tumor Registry, established in 1960. Clinical information at presentation is presented as well as a description of reproductive and demographic characteristics. Pre- and postmenopausal women are compared, revealing differences in reproductive experience. This may contribute to the increasing incidence of breast cancer seen among younger women in recent years. This is of particular interest because the classic excess of nulliparous women among breast cancer cases is not seen among the population described here. PMID:8107157

Carolina Care at University of North Carolina Health Care: Implementing a Theory-Driven Care Delivery Model Across a Healthcare System.

PubMed

Tonges, Mary; Ray, Joel D; Herman, Suzanne; McCann, Meghan

2018-04-01

Patient satisfaction is a key component of healthcare organizations' performance. Providing a consistent, positive patient experience across a system can be challenging. This article describes an organization's approach to achieving this goal by implementing a successful model developed at the flagship academic healthcare center across an 8-hospital system. The Carolina Care at University of North Carolina Health Care initiative has resulted in substantive qualitative and quantitative benefits including higher patient experience scores for both overall rating and nurse communication.

[Drug supply chain safety in hospitals: current data and experience of the Grenoble university hospital].

PubMed

Bedouch, P; Baudrant, M; Detavernier, M; Rey, C; Brudieu, E; Foroni, L; Allenet, B; Calop, J

2009-01-01

Drug supply chain safety has become a priority for public health which implies a collective process. This process associates all health professionals including the pharmacist who plays a major role. The objective of this present paper is to describe the several approaches proven effective in the reduction of drug-related problem in hospital, illustrated by the Grenoble University Hospital experience. The pharmacist gets involved first in the general strategy of hospital drug supply chain, second by his direct implication in clinical activities. The general strategy of drug supply chain combines risk management, coordination of the Pharmacy and Therapeutics Committee, selection and purchase of drugs and organisation of drug supply chain. Computer management of drug supply chain is a major evolution. Nominative drug delivering has to be a prior objective and its implementation modalities have to be defined: centralized or decentralized in wards, manual or automated. Also, new technologies allow the automation of overall drug distribution from central pharmacy and the implementation of automated drug dispensing systems into wards. The development of centralised drug preparation allows a safe compounding of high risk drugs, like cytotoxic drugs. The pharmacist should develop his clinical activities with patients and other health care professionals in order to optimise clinical decisions (medication review, drug order analysis) and patients follow-up (therapeutic monitoring, patient education, discharge consultation).

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

PubMed Central

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

2016-01-01

ABSTRACT OBJECTIVE To describe the constitution and operation of a voluntary interruption of pregnancy team of a university hospital, from the outlook of the mental health team. METHODS In this case study, the following aspects were analyzed: 1) historical background; 2) implementation of Law 18,897 of October 22, 2012; and 3) functioning of the program at the Hospital de Clínicas of the Facultad de Medicina (Universidad de la República, Uruguay), taking into account three dimensions: structure, process, and results. RESULTS Between December 2012 and November 2013, a total of 6,676 voluntary interruptions of pregnancy were reported in Uruguay; out of these, 80 were conducted at the Hospital de Clínicas. The patients’ demographic data agreed with those reported at the national level: Of the total patients, 81.0% were aged over 19 years; 6.2% decided to continue with the pregnancy; and only 70.0% attended the subsequent control and received advice on contraception. CONCLUSIONS In its implementation year in Uruguay, we can assess the experience as positive from the point of view of women’s health. Our experience as a mental health team at the Hospital de Clínicas, inserted into the multidisciplinary voluntary interruption of pregnancy team, is in the process of assessment and reformulation of practices. PMID:27384969

Patients’ perceptions of discrimination during hospitalization

PubMed Central

Hudelson, Patricia; Kolly, Véronique; Perneger, Thomas

2009-01-01

Abstract Objective  To identify sources of perceived discrimination during hospitalization and examine the relationship of perceived discrimination to patient and hospital stay characteristics, and to patient ratings of care. Background  Patient experiences of discrimination within the health‐care system are associated with delays in care seeking, non‐adherence to medical advice and poorer health status. Most research to date has focused on race and ethnicity‐based discrimination, and few studies have included hospitalized patients. Methods  Questions about patients’ experiences of discrimination were added to a regular patient opinion survey conducted at the Geneva University Hospitals. Participants were 1537 adult residents of Switzerland discharged from the hospital between 15 February and 15 March 2007. Results  A total of 171 (11.1%) respondents reported at least one source of discrimination. Most (93, 54.4%) reported a single cause of discrimination. The most frequent causes of discrimination were language, age, nationality and having a disease that is viewed negatively by others. Fifteen percentage of non‐European respondents reported at least one of the following types of discrimination: language, nationality, religion and skin colour. Reporting discrimination from any cause was associated with higher Picker Patient Experience problem scores, and patients who reported discrimination were less likely to describe their care as very good or excellent and less likely to recommend the hospital to others. Conclusions  Patient experiences of discrimination during hospitalization are relatively frequent and are associated with lower patient ratings of care. Collection of data on patient experiences of discrimination may contribute to the development of interventions aimed at ensuring respectful, quality care for all patients. PMID:19788555

The aesthetic and cultural interests of patients attending an acute hospital--a phenomenological study.

PubMed

Moss, Hilary; O'Neill, Desmond

2014-01-01

To describe the aesthetic and cultural pursuits of older patients in hospital. Although there is much discussion of the importance of arts - used in this paper to refer to all art forms, as currently listed by the Arts Council of Ireland www.artscouncil.ie - in health, little is known about the salience of aesthetic and cultural pursuits of hospital patients. A qualitative, hermeneutic phenomenological study examined artistic and cultural interests and experiences of older hospital patients and their perceptions of aesthetics of hospital. A phenomenological study was carried out in 2011, using purposeful sampling with 20 inpatients aged over 65. Patients were selected from the geriatric medicine day hospital of a university teaching hospital, 10 had experience of the hospital arts programme. Seven themes identified: loss and the impact of illness on leisure activities; patients' interests and passions; a lack of expectation of arts in hospital; the positive impact of arts in hospital for those who had experienced them; varying preference between receptive and participative arts activity according to phase of illness; aesthetic aspects of the hospital experience; recommendations for changes to improve arts in hospital. Aesthetic and cultural interests are important in the lives of older patients admitted to hospital. Illness can create barriers to artistic engagement. Participation in arts activities may be more important during recovery and rehabilitation, with receptive arts being more popular during the acute phase of illness in hospital. Further research recommended on the role of the aesthetic environment for patients' health and well-being as well as receptive arts in hospital. © 2013 John Wiley & Sons Ltd.

Values and strategies: management of radical organizational change in a university hospital.

PubMed

Orvik, Arne

2017-04-01

Managers' experiences of radical change were studied in a Norwegian university hospital, which was relocated from a traditional building to a new, high-tech building. The university hospital was also accredited as a health promoting hospital. Thirteen managers at different levels in the organization and a personnel safety representative were interviewed as part of a trailing research project. The aim of the study was to elucidate the managers' value orientation and strategies for dealing with value tensions. A combination of a hermeneutical, reflective method and a template for quality, efficiency and integrity guided the analysis. The template was based not only on the main findings but also on the core values of a model of organizational health. The results show that clinical managers focus on quality and top managers, not unexpectedly, focus on efficiency. Managers at both levels were concerned about their own integrity, and also about the integrity of their clinician colleagues, as well as showing concern for the hospital's mission, in terms of organizational effectiveness. The discussion was conducted in terms of dominance, cycling and balancing strategies, of which the last was the most prevalent. However, sustainable strategies for dealing with value tensions also call for value-based management and value-conscious leadership. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Aligning incentives in orthopaedics: opportunities and challenges -- the Case Medical Center experience.

PubMed

Marcus, Randall E; Zenty, Thomas F; Adelman, Harlin G

2009-10-01

For 30 years, the orthopaedic faculty at Case Western Reserve University worked as an independent private corporation within University Hospitals Case Medical Center (Hospital). However, by 2002, it became progressively obvious to our orthopaedic practice that we needed to modify our business model to better manage the healthcare regulatory changes and decreased reimbursement if we were to continue to attract and retain the best and brightest orthopaedic surgeons to our practice. In 2002, our surgeons created a new entity wholly owned by the parent corporation at the Hospital. As part of this transaction, the parties negotiated a balanced employment model designed to fully integrate the orthopaedic surgeons into the integrated delivery system that included the Hospital. This new faculty practice plan adopted a RVU-based compensation model for the physicians, with components that created incentives both for clinical practice and for academic and administrative service contributions. Over the past 5 years, aligning incentives with the Hospital has substantially increased the clinical productivity of the surgeons and has also benefited the Hospital and our patients. Furthermore, aligned incentives between surgeons and hospitals could be of substantial financial benefit to both, as Medicare moves forward with its bundled project initiative.

Mandatory insurance coverage and hospital productivity in Massachusetts: bending the curve?

PubMed

Thompson, Mark A; Huerta, Timothy R; Ford, Eric W

2012-01-01

The aim of this study was to examine whether universal insurance coverage mandates lead to a more productive use of hospital resources. The American Hospital Association's Annual Survey and the Centers for Medicare and Medicaid Services' case mix index for fiscal years 2005 through 2008 were used. A Malmquist approach was used to assess hospitals' productivity in the United States and Massachusetts over the sample period. Propensity score matching is used to "simulate" a randomized control group of hospitals from other markets to compare with Massachusetts. Comparisons are then made to examine if productivity differences are due to universal health insurance coverage mandate. In the early stages, Massachusetts' coverage mandates lead to a significant drop in hospitals' productivity relative to comparable facilities in other states. In 2008, Massachusetts functioned 3.53% below its 2005 level, whereas facilities across the United States have seen a 4.06% increase over the same period. If the individual mandate is implemented nationwide, the Massachusetts' experience indicates that a near-term decrease in overall hospital productivity will occur. As such, current cost estimates of the Patient Protection and Affordable Care Act's impact on overall health spending are potentially understated.

The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

PubMed Central

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2010-01-01

Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

The impact of public hospital closure on medical and residency education: implications and recommendations.

PubMed

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2008-12-01

Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

Strategic acquisitions by academic medical centers: the Jefferson experience as operational paradigm.

PubMed

Schwartz, G F; Stone, C T

1991-01-01

As capital investments in the health care industry have changed in popularity, mergers and acquisitions of and by hospitals have created supersystems of health care that are based on the assumption that economies of scale offer greater protection from a variety of forces. The acquisition of West Park (Jefferson Park) Hospital by Thomas Jefferson University and the infusion of Jefferson management into Methodist Hospital have provided the institution with unique opportunities to broaden its population base for acute care admissions and to permit greater diversification within the entire health care market.

[Hospitality as an expression of nursing care].

PubMed

Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera

2010-01-01

Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.

The Howard University Hospital Experience with Routineized HIV Screening: A Progress Report*

PubMed Central

Scott, Victor F.; Sitapati, Amy; Martin, Sayyida; Summers, Pamela; Washington, Michael; Daniels, Fernando; Mouton, Charles; Bonney, George; Apprey, Victor; Webster, Virginia; Smith, Avemaria; Mountvarner, Geoffrey; Daftary, Monica; Maxwell, Celia J.

2009-01-01

Background: Howard University Hospital (HUH) is the first hospital in the nation to have instituted a hospital-wide routine rapid HIV screening campaign as recommended by the CDC for healthcare settings. Methods: HUH developed a protocol and implemented a hospital-wide routine HIV screening in October 2006. Rapid oral fluid-based HIV testing was conducted throughout the hospital using the OraSure OraQuick Advance Rapid HIV-1/2 Antibody Test. Patients with a preliminarily reactive test result were either referred for confirmatory testing or offered a Western Blot confirmatory test on-site and referred for follow-up care. This is a report on the progress of this program for the first eight months. Results: Of the 9,817 patients offered HIV testing, 5,642 consented. The mean age of the screened population was 40.7 years. Ninety percent of the patients screened were black and 55% were female. A preliminarily reactive test result was identified in 139 patients for a seroprevalence rate of 2.46%. Of these patients, 136, or 98% were black; 63% were male and 37% were female. HIV prevalence in the overall sample, among blacks, and among both black males and females peaked in the 40–54 year old age group. Challenges were experienced initially in securing confirmatory tests. Conclusions: Hospital-wide routine HIV screening is both possible and productive. The routine HIV screening campaign instituted at Howard University Hospital has identified a significant number of previously unidentified HIV positive persons. Success in assuring confirmatory testing and transition to care improved as time progressed. PMID:19768195

The Howard University Hospital experience with routineized HIV screening: a progress report.

PubMed

Scott, Victor F; Sitapati, Amy; Martin, Sayyida; Summers, Pamela; Washington, Michael; Daniels, Fernando; Mouton, Charles; Bonney, George; Apprey, Victor; Webster, Virginia; Smith, Avemaria; Mountvarner, Geoffrey; Daftary, Monica; Maxwell, Celia J

2009-01-01

Howard University Hospital (HUH) is the first hospital in the nation to have instituted a hospital-wide routine rapid HIV screening campaign as recommended by the CDC for healthcare settings. HUH developed a protocol and implemented a hospital-wide routine HIV screening in October 2006. Rapid oral fluid-based HIV testing was conducted throughout the hospital using the OraSure OraQuick Advance Rapid HIV-1/2 Antibody Test. Patients with a preliminarily reactive test result were either referred for confirmatory testing or offered a Western Blot confirmatory test on-site and referred for follow-up care. This is a report on the progress of this program for the first eight months. Of the 9,817 patients offered HIV testing, 5,642 consented. The mean age of the screened population was 40.7 years. Ninety percent of the patients screened were black and 55% were female. A preliminarily reactive test result was identified in 139 patients for a seroprevalence rate of 2.46%. Of these patients, 136, or 98% were black; 63% were male and 37% were female. HIV prevalence in the overall sample, among blacks, and among both black males and females peaked in the 40-54 year old age group. Challenges were experienced initially in securing confirmatory tests. Hospital-wide routine HIV screening is both possible and productive. The routine HIV screening campaign instituted at Howard University Hospital has identified a significant number of previously unidentified HIV positive persons. Success in assuring confirmatory testing and transition to care improved as time progressed.

Junior physicians' workplace experiences in clinical fields in German-speaking Switzerland.

PubMed

Buddeberg-Fischer, Barbara; Klaghofer, Richard; Abel, Thomas; Buddeberg, Claus

2005-01-08

To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field. Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance. There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment. Institutional determinants are crucial factors for the workplace experiences and first career steps of junior physicians. Medical educators, especially those in "A" hospitals, should become more involved in structured residency programs and be aware of potential gender inequalities in the career support of female physicians.

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

PubMed

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

2001-03-01

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

The Lived Experiences of Persons Hospitalized for Construction of an Urgent Fecal Ostomy.

PubMed

Herlufsen, Per; Brødsgaard, Anne

The purpose of this study was to describe the lived experiences of hospital stays for patients undergoing urgent ostomy surgery. Qualitative, descriptive, phenomenological study. Six persons undergoing acute hospital admission and urgent ileostomy or colostomy surgery (either permanent or temporary) participated in the study. Participants were of Danish ethnicity and between the ages of 48 and 75 years. The research setting was the surgical department at a university hospital in the Capital Region of Denmark. Data collection and analyses were guided by a Reflective Lifeworld Research approach; this approach is based on phenomenological philosophy. Data were collected during in-depth interviews using a semistructured interview guide. Their average length was 50 minutes (range, 30-65 minutes). Interviews were digitally recorded and transcribed. Transcriptions were analyzed in 4 phases according to the principles of Reflective Lifeworld Research. The phenomenon we labeled "lived experiences of acute hospitalization with construction of an urgent unplanned fecal ostomy" comprised 4 constituents: (1) undergoing unexpected bodily changes, (2) partnership with professional caregivers, (3) experience of vulnerability, and (4) a lack of continuity. These constituents can be described as a number of challenges due to both hospitalization and ostomy creation. We found that individuals experience a number of challenges due to acute hospitalization and urgent construction of a fecal ostomy. These challenges are due to the unexpected bodily changes and interpersonal and organizational conditions. Nurses should be aware of not only the physical implications of urgent creation of a fecal ostomy but also the individual and psychological implications of this event.

["How can hospitals develop a beneficial relationship with laboratory testing companies?" - Chairmen's introductory remarks].

PubMed

Morita, Toshisuke; Kawano, Seiji

2014-12-01

The symposium was held with the Japanese Society of Laboratory Medicine and JACLaP to discuss the way to develop a beneficial relationship between hospitals and laboratory testing companies with co-chairing by Seiji Kawano, Kobe University and Toshisuke Morita, Toho University. Clinical testing is considered to be essential for medical diagnosis and treatment; however, it is difficult for a hospital to perform all clinical testing for various reasons, including cost-effectiveness. In this session, 4 guest speakers gave a talk from their viewpoints. Doctor Kawano talked about the results of a questionnaire filled out by 114 university hospitals on how to develop a beneficial relationship between hospitalsoand laboratory testing companies. Next, Mr. Shinji Ogawa, president and CEO of SRL, talked about favorable ways to utilize laboratory testing companies, sayingthat such companies, which have a variety of skills, are expected to offer new and advanced technologies to hospitals continuously, and abundant data which laboratory testing companies have should be used for the advancement of community medicine. Professor Koshiba, Hyogo Medical School, expressed his apprehension to develop a so-called branch lab. in university hospitals from his own experience, and concluded that a beneficial relationship with companies to perform tasks required by hospitals should be sought. The last speaker, Yuichi Setoyama, Mitsubishi Chemical Medience, talked about the new relationship between hospitals and laboratory testing companies, and emphasized that hospitals and such companies should know the strong and weak points of each other and build a mutually complementary system. After all presentations were over, a discussion with participants was held. Doctors of clinics said that the role of laboratory testing companies for large hospitals is different from that for small clinics, and such companies are indispensable for his everyday medical activities. Each medical institute has its own medical mission, and, therefore, what constitutes a beneficial relationship varies with each medical institute. The key to the success of building a win-win relationship with laboratory testing companies is held by each hospital. (Review).

Hotel-based ambulatory care for complex cancer patients: a review of the University College London Hospital experience.

PubMed

Sive, Jonathan; Ardeshna, Kirit M; Cheesman, Simon; le Grange, Franel; Morris, Stephen; Nicholas, Claire; Peggs, Karl; Statham, Paula; Goldstone, Anthony H

2012-12-01

Since 2005, University College London Hospital (UCLH) has operated a hotel-based Ambulatory Care Unit (ACU) for hematology and oncology patients requiring intensive chemotherapy regimens and hematopoietic stem cell transplants. Between January 2005 and 2011 there were 1443 patient episodes, totaling 9126 patient days, with increasing use over the 6-year period. These were predominantly for hematological malignancy (82%) and sarcoma (17%). Median length of stay was 5 days (range 1-42), varying according to treatment. Clinical review and treatment was provided in the ACU, with patients staying in a local hotel at the hospital's expense. Admission to the inpatient ward was arranged as required, and there was close liaison with the inpatient team to preempt emergency admissions. Of the 523 unscheduled admissions, 87% occurred during working hours. An ACU/hotel-based treatment model can be safely used for a wide variety of cancers and treatments, expanding hospital treatment capacity, and freeing up inpatient beds for those patients requiring them.

Intranet and HTML at a major university hospital--experiences from Munich.

PubMed

Dugas, M

1997-01-01

Intranet-technology is the application of Internet-Tools in local networks. With this technique electronic information systems for large hospitals can be realized very easily. This technology has been in routine use in 'Klinikum Grosshadern' for more than one year on over 50 wards and more than 200 computers. The following clinical application areas are described: drug information, nursing information, electronic literature retrieval systems, multimedia teaching und laboratory information systems.

Assessing the impact of privatizing public hospitals in three American states: implications for universal health coverage.

PubMed

Villa, Stefano; Kane, Nancy

2013-01-01

Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[Emergency eye care in French university hospitals].

PubMed

Bourges, J-L

2018-03-01

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

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

PubMed

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

2018-05-01

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

PACS industry in Korea

NASA Astrophysics Data System (ADS)

Kim, Hee-Joung

2002-05-01

PACS industry in Korea has been rapidly growing, since government had supported collaborative PACS project between industry and university hospital. In the beginning, PACS industry had focused on developing peripheral PACS solutions, while the Korea PACS society was being formed. A few companies had started developing and installing domestic large-scale full-PACS system for teaching hospitals. Several years later, many hospitals have installed full-PACS system with national policy of reimbursement for PACS exams in November 1999. Both experiences of full-PACS installation and national policy generated tremendous intellectual and technological expertise about PACS at all levels, clinical, hospital management, education, and industrial sectors. There are now more than 20 domestic PACS companies. They have enough experiences which are capable of installing a truly full-PACS system for large-scale teaching hospitals. As an example, a domestic company had installed more than 40 full-PACS systems within 2-3 years. Enough experiences of full-PACS installation in Korea lead PACS industry to start exporting their full-PACS solutions. However, further understanding and timely implementation of continuously evolving international standard and integrated healthcare enterprise concepts may be necessary for international leading of PACS technologies for the future.

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

PubMed

Takamuku, Masatoshi

2015-01-01

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

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

PubMed

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

2010-01-01

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

On Becoming an Involuntary Member in the Antepartum Unit.

PubMed

Peterson, Brittany L

2016-08-01

In this essay, I articulate the ways in which my scholarship and personal life collided when I became an involuntary member in the antepartum unit of a major university hospital. I draw on research examples taken from my dissertation work in prison and my time in the hospital to illustrate the interconnectedness of these involuntary experiences. After I share these stories, I offer a brief interlude to reflect on the meaningfulness of approaching membership from a continuum-based perspective and the relative implications for health communication scholars, before ending with an articulation how this experience brought me to a more crystallized view of involuntary membership.

Using standardized patients to evaluate hospital-based intervention outcomes.

PubMed

Li, Li; Lin, Chunqing; Guan, Jihui

2014-06-01

The standardized patient approach has proved to be an effective training tool for medical educators. This article explains the process of employing standardized patients in an HIV stigma reduction intervention in healthcare settings in China. The study was conducted in 40 hospitals in two provinces of China. One year after the stigma reduction intervention, standardized patients made unannounced visits to participating hospitals, randomly approached service providers on duty and presented symptoms related to HIV and disclosed HIV-positive test results. After each visit, the standardized patients evaluated their providers' attitudes and behaviours using a structured checklist. Standardized patients also took open-ended observation notes about their experience and the evaluation process. Seven standardized patients conducted a total of 217 assessments (108 from 20 hospitals in the intervention condition; 109 from 20 hospitals in the control condition). Based on a comparative analysis, the intervention hospitals received a better rating than the control hospitals in terms of general impression and universal precaution compliance as well as a lower score on stigmatizing attitudes and behaviours toward the standardized patients. Standardized patients are a useful supplement to traditional self-report assessments, particularly for measuring intervention outcomes that are sensitive or prone to social desirability. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2013; all rights reserved.

Medicine at Michigan State (III): Conditioning for Innovation

ERIC Educational Resources Information Center

Walsh, John

1972-01-01

Discusses the reasons why basic science courses are taught in all-university departments'' and the clinical experience is provided in cooperation with community health services, rather than a clinical teaching hospital, in the programs for Doctor of Medicine and Doctor of Osteopathy. (AL)

Residents' Exposure to Educational Experiences in Facilitating Hospital Discharges

PubMed Central

Stickrath, Chad; McNulty, Monica; Calderon, Aaron J.; Chapman, Elizabeth; Gonzalo, Jed D.; Kuperman, Ethan F.; Lopez, Max; Smith, Christopher J.; Sweigart, Joseph R.; Theobald, Cecelia N.; Burke, Robert E.

2017-01-01

Background There is an incomplete understanding of the most effective approaches for motivating residents to adopt guideline-recommended practices for hospital discharges. Objective We evaluated internal medicine (IM) residents' exposure to educational experiences focused on facilitating hospital discharges and compared those experiences based on correlations with residents' perceived responsibility for safely transitioning patients from the hospital. Methods A cross-sectional, multi-center survey of IM residents at 9 US university- and community-based training programs in 2014–2015 measured exposure to 8 transitional care experiences, their perceived impact on care transitions attitudes, and the correlation between experiences and residents' perceptions of postdischarge responsibility. Results Of 817 residents surveyed, 469 (57%) responded. Teaching about care transitions on rounds was the most common educational experience reported by residents (74%, 327 of 439). Learning opportunities with postdischarge patient contact were less common (clinic visits: 32%, 142 of 439; telephone calls: 12%, 53 of 439; and home visits: 4%, 18 of 439). On a 1–10 scale (10 = highest impact), residents rated postdischarge clinic as having the highest impact on their motivation to ensure safe transitions of care (mean = 7.61). Prior experiences with a postdischarge clinic visit, home visit, or telephone call were each correlated with increased perceived responsibility for transitional care tasks (correlation coefficients 0.12 [P = .004], 0.1 [P = .012], and 0.13 [P =  001], respectively). Conclusions IM residents learn to facilitate hospital discharges most often through direct patient care. Opportunities to interact with patients across the postdischarge continuum are uncommon, despite correlating with increased perceived responsibility for ensuring safe transitions of care. PMID:28439351

[Highlights of hospital-based internal medicine in 2010: chief residents' perspective].

PubMed

Uhlmann, Marc; Burnard, Jérôme; Cosma Rochat, Monica; Gabus, Vincent; Micheloud, Valérie Geiser; Gobin, Niels; Laurent, Jean-Christophe; Marino, Laura; Méan, Marie; Merz, Laurent; Regamey, Julien; Stadelmann, Raphaël

2011-02-02

Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.

Newly Licensed RN Retention: Hospital and Nurse Characteristics.

PubMed

Blegen, Mary A; Spector, Nancy; Lynn, Mary R; Barnsteiner, Jane; Ulrich, Beth T

2017-10-01

The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence. A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience. The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay. Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

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

PubMed Central

2014-01-01

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

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

PubMed

Degen, Christiane; Kuntz, Ludwig

2014-04-23

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

On the scene: American University of Beirut Medical Center, Beirut, Lebanon.

PubMed

Mouro, Gladys; Tashjian, Hera; Daaboul, Tania; Kozman, Katia; Alwan, Farah; Shamoun, Anthony

2011-01-01

American University of Beirut Medical Center is the first Magnet hospital in the Middle East. In this article, authors reflect back on the journey to excellence, specifically in establishing shared governance in a challenging cultural and organizational milieu. Perspectives from nurses at different levels are included to highlight their experiences throughout the journey. Evolution of the organization's shared governance model is described and initiatives of the councils are illustrated.

Young people's experiences of managing Type 1 diabetes at university: a national study of UK university students.

PubMed

Kellett, J; Sampson, M; Swords, F; Murphy, H R; Clark, A; Howe, A; Price, C; Datta, V; Myint, K S

2018-04-23

Little is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self-care in students with Type 1 diabetes in all UK universities. Some 1865 current UK university students aged 18-24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models. In total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA 1c levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes-related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19-7.16], illness (OR 3.48, 95% CI 2.06-5.87) and weight management issues (OR 3.19, 95% CI 1.99-5.11) as barriers to self-care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes. The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Light Microsopy Module, International Space Station Premier Automated Microscope

NASA Technical Reports Server (NTRS)

Meyer, William V.; Sicker, Ronald J.; Chiaramonte, Francis P.; Brown, Daniel F.; O'Toole, Martin A.; Foster, William M.; Motil, Brian J.; Abbot-Hearn, Amber Ashley; Atherton, Arthur Johnson; Beltram, Alexander;

Sociodemographic and medical characteristics of involuntary psychiatric inpatients--retrospective study of five-year experience with Croatian Act on Mental Health.

PubMed

Potkonjak, Jelena; Karlović, Dalibor

2008-09-01

The aim of this study was to analyze sociodemographic and medical characteristics of involuntary psychiatric inpatients treated during the five-year period of implementation of the Croatian Act on Mental Health. Data on involuntarily hospitalized patients according to the Croatian Act on Mental Health were singled out from the pool of inpatients treated at University Department of Psychiatry, Sestre milosrdnice University Hospital from January 1, 1998 till December 31, 2002. Data were collected from medical records. Patients were diagnosed according to the International Classification of Diseases, 10th revision criteria. The prevalence of involuntary hospitalization was 2%, including a comparative number of male and female patients. Most patients had secondary school, were living alone, were unmarried, widowed or divorced, and did not work at the time of hospitalization; however, most patients had some kind of health insurance. Schizophrenia was the most common diagnosis in involuntary psychiatric inpatients. In conclusion, scientific evaluation of involuntary hospitalization poses a major problem because of the many different factors that can influence the prevalence of involuntary hospitalization. Some of this factors are type of institution (psychiatric hospital or psychiatry department at a general hospital), organization of psychiatric care in the region, psychiatric morbidity and dynamics of changes in psychiatric morbidity in a specific region, public opinion about people with mental disorders, legal provisions on this very sensitive topic, etc.

[The perception of the risk related to nursing activities in Bachelor student of Modena and Reggio Emilia university: An observational study].

PubMed

Mecugni, Daniela; Serpe, Alessandra; Bravo, Giulia; Iemmi, Marina; Gobba, Fabrizio Maria

2009-01-01

Professional risk and security in the health sector is becoming ever more important : the number of accidents in hospital environments during 2005 was 19,000 and nurses were the most frequently involved category. This study deals with clinical risk perception . A questionnaire was issued to 259 student and 100 professional nurses at the Modena and Reggio Emilia University Hospital., comprising 70 questions regarding 5 dimensions: general risk perception, personal risk perception, nursing skills, observed experience and direct experience. Results were evaluated using the ANOVA and t-tests and showed significant differences among the various groups (first, second and third-year students and professional nurses) in relation to each dimension. On the whole , the perception of risk was relatively low in comparison to its real level in the working environment. Therefore, specific training for a correct perception of health risks is required, not only for students but also for trained nurses, so that the culture of risk management becomes a routine issue.

Quality of life, job satisfaction and their related factors among nurses working in king Abdulaziz University Hospital, Jeddah, Saudi Arabia.

PubMed

Ibrahim, Nahla Khamis; Alzahrani, Nujood Abdulwahed; Batwie, Afnan Ateeg; Abushal, Razan Abdulaziz; Almogati, Ghazwa Ghazzay; Sattam, Munirah Abdulrahman; Hussin, Bodour Khalid

2016-08-01

To assess Quality of Life, job satisfaction and their related factors among nurses working in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. A cross-sectional survey was conducted among 268 nurses, 2014/2015. A validated, confidential data collection sheet was utilized. It contained the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Job Descriptive Index/Job in General (JDI/JIG) scales. The majority of nurses (83.5%) perceived their general QOL as very good and good. Age, marital status, having children, nationality, income, education, residence, working experience, department and shift time were associated with QOL domains (p < 0.05). Similarly, working experience, income, shifts, working in inpatient and surgical departments were associated with job satisfaction. Positive correlations were found between job satisfaction and different QOL domains, and between different JDI/JIG subscales together. Improvement of the modifiable factors as nurses' income and shift time is needed for better QOL and job satisfaction.

[Mental job strain in a university children's hospital--a study on stress experience and the resulting employee health].

PubMed

Hiemisch, A; Kiess, W; Brähler, E

2011-07-01

The aim of the following survey was to evaluate the mental job strain at an university hospital and its effect on the health of the employees. Furthermore the trigger factors should have been identified and optimized after the survey. The data were collected by an employee survey during November/December of 2006. All employees of the Hospital for Children and Adolescents of the University Leipzig were included. Overall 174 questionnaires were evaluated (response rate 51.5%). As standardized methods the Irritations-Scale of Mohr et al. and the shortform of the Gießener Beschwerdebogen GBB-24 of Brähler et al. were used. In addition a self designed scale for the measurement of strain-experience was applied. More than half of the physicians/psychologists, a quarter of the nursing staff and every tenth of the remaining employees suffered from work related mental stress disorder. Especially physicians and psychologists were additionally affected by psychosomatic symptoms. The main strain was caused by an excessive amount of documentation, the manpower shortage and the lack of appreciation. The occupational groups differ as well in their ways of coping with the daily job strain as in its effects on the mental health. The health effect of the daily strain on physicians and psychologists seems to be age dependent. An urge for intervention can be derived from our results. © Georg Thieme Verlag KG Stuttgart · New York.

An investigation of radiographers' mobile phone use and the success of an awareness campaign at reducing the nosocomial infection risks.

PubMed

Crofton, C C; Foley, S J

2018-02-01

Mobile phone use by healthcare workers (HCWs) is widespread. Studies have shown that HCW's mobile phones can harbour pathogens associated with nosocomial infections. This study investigated whether an awareness campaign will result in an improvement in radiographers' phone and hand hygiene practices. Radiographers working in the general department of two university hospitals were invited to participate. One hospital was assigned as the experiment hospital and the other as a control. In the experiment hospital, adenosine triphosphate (ATP) testing of each participant's mobile phone determined the cleanliness of its surface. A corresponding survey was completed to determine their current practices and level of awareness. Subsequently, an infection control poster campaign took place for a one-month period, followed by re-testing. In the control hospital, the ATP testing and survey were also completed before and after a one-month period, but without a poster campaign. Radiographers were generally unaware of the infection risks associated with mobile phone use with 44% of all participants never cleaning their phone. The campaign successfully improved phone hygiene frequency and method in the experiment hospital. However, it did not improve hand hygiene practices and actual phone cleanliness (mean ATP count reductions of 10% (experiment hospital) and 20% (control)). The ATP testing as a less direct form of intervention showed similar levels of success in comparison to the poster campaign. A multifaceted educational approach is likely to be most effective in raising awareness and changing radiographers' phone and hand hygiene practices. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

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.

A survey on the knowledge and attitudes of anaesthesia providers in the United States of America, United Kingdom and Singapore on visual experiences during cataract surgery.

PubMed

Tan, C S H; Kumar, C M; Fanning, G L; Lai, Y C; Au Eong, K G

2006-04-01

To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.

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

PubMed

Nomura, Kyoko

2011-01-01

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

Duration of hospital stay following orthognathic surgery at the jordan university hospital.

PubMed

Jarab, Fadi; Omar, Esam; Bhayat, Ahmed; Mansuri, Samir; Ahmed, Sami

2012-09-01

Major oral and maxillofacial surgery procedures have been routinely performed on an inpatient basis in order to manage both, the recovery from anesthesia and any unpredictable morbidity that may be associated with the surgery. The use of inpatient beds is extremely expensive and if the surgical procedures could be done on an outpatient setting, it would reduce the costs and the need for inpatient care. The aim was to determine the length of hospital stay (LHS) and the factors which influence the LHS following orthognathic surgery at the Jordan University Hospital over 5 years (2005-2009). This was a retrospective record review of patients who underwent orthognathic surgery at Jordan University Hospital between 2005 and 2009. The variables were recorded on a data capture form which was adapted and developed from previous studies. Descriptive and analytical statistical methods were used to correlate these variables to the LHS. Ninety two patients were included in the study and 74% of them were females. The mean age was 23.7 years and the mean LHS was 4 days. The complexity of the procedure, length of operation time, intensive care unit (ICU) stay and year of operation were significantly correlated with a positive LHS (P < 0.05). Patients' hospital stay was directly related to the complexity of the orthognathic procedure, the operation time, time spent in ICU and the year in which the operation was done. There was a significant reduction in the LHS over the progressing years and this could be due to an increase in experience and knowledge of the operators and an improvement in the hospital facilities.

Survival and negotiation: narratives of severe (near-miss) neonatal complications of Syrian women in Lebanon.

PubMed

Wick, Livia

2017-10-01

The World Health Organization has elaborated a maternal and neonatal near-miss reporting, audit and feedback system designed to improve the quality of care during and after childbirth. As part of a four-hospital comparative study in the Middle East, this article discusses the experiences of mothers whose newborns suffered from severe complications at birth in the Rafik Hariri University Hospital, the only public hospital in Beirut. Based on in-depth home interviews several weeks after childbirth, it aims to explore the experience of neonatal near-miss events through the mothers' birth narratives. The central concerns of these vulnerable and marginalised women regarded access to neonatal care, and how to negotiate hospital bureaucracy and debt. It argues that financial and bureaucratic aspects of the near-miss event should be part of the audit system and policy-making, alongside medical issues, in the quest for equitable access to and management of quality perinatal care.

[Humanization through the art of environment of children's emergency in a hospital].

PubMed

Ullán, Ana M; Fernández, Esperanza; Belver, Manuel H

2011-09-01

This article aims to present and discuss a case-study of human betterment through the arts applied to a children's hospital. The experience related to the betterment of these environments took place in the Children's Emergency Service of the University Hospital in Salamanca. After describing the context of the case-study some attention will be devoted to the phases of the process, emphasizing those aspects linked to children's care culture and their families as well as the symbolic dimension of the space and the participation of different professionals in the experience. The case-study is assessed from different standpoints but special importance is given to parents' opinions. 51 parents of children in the emergency unit were interweaved during a month. Parents valued positively the service and stated that artists' intervention had been beneficial for the children's emotional state. The article concludes with a debate about the meaning of the hospital environment and the quality associated with its physical premises.

Patient Blood Management in Europe: surveys on top indications for red blood cell use and Patient Blood Management organization and activities in seven European university hospitals.

PubMed

Bruun, M T; Pendry, K; Georgsen, J; Manzini, P; Lorenzi, M; Wikman, A; Borg-Aquilina, D; van Pampus, E; van Kraaij, M; Fischer, D; Meybohm, P; Zacharowski, K; Geisen, C; Seifried, E; Liumbruno, G M; Folléa, G; Grant-Casey, J; Babra, P; Murphy, M F

2016-11-01

Patient Blood Management (PBM) in Europe is a working group of the European Blood Alliance with the initial objective to identify the starting position of the participating hospitals regarding PBM for benchmarking purposes, and to derive good practices in PBM from the experience and expertise in the participating teams with the further aim of implementing and strengthening these practices in the participating hospitals. We conducted two surveys in seven university hospitals in Europe: Survey on top indications for red blood cell use regarding usage of red blood cells during 1 week and Survey on PBM organization and activities. A total of 3320 units of red blood cells were transfused in 1 week at the seven hospitals. Overall, 61% of red cell units were transfused to medical patients and 36% to surgical patients, although there was much variation between hospitals. The organization and activities of PBM in the seven hospitals were variable, but there was a common focus on optimizing the treatment of bleeding patients, monitoring the use of blood components and treatment of preoperative anaemia. Although the seven hospitals provide a similar range of clinical services, there was variation in transfusion rates between them. Further, there was variable implementation of PBM activities and monitoring of transfusion practice. These findings provide a baseline to develop joint action plans to further implement and strengthen PBM across a number of hospitals in Europe. © 2016 International Society of Blood Transfusion.

[High frequency of cutaneous adverse effects under infliximab. Geneva experience, 1999-2008].

PubMed

Seydtaghia, Floriane; De Saussure, Philippe; Hadengue, Antoine

2011-03-16

Geneva experience, 1999-2008 Infliximab has been used for 10 years in the treatment of chronic inflammatory bowel diseases in the gastroenterology and hepatology department at the University Hospitals of Geneva. This retrospective study shows the follow-up of these patients treated with infliximab and reveals a high rate of cutaneous adverse events, which, although often mild, can sign a definitive intolerance to treatment.

The Influence of Personal Factors and Perceived Work Experiences on Employee Turnover and Absenteeism.

DTIC Science & Technology

1979-11-01

FExperiences onl Employee Turnover and Absenteeism Daniel G. Spencer School of Business University of Kansas Richard M. Steers Graduiate School of...Idenify by block nomber) Turnover Education Organizational dependability Absenteeism Group Attitudes Personal importance Tenure Met expectations Age...perceived work experiences on employee turnover and absenteeism among a sample of 200 clerical and service workers in a Major hospital. It was found that

Clinical experience with orthotic repair of pectus carinatum.

PubMed

Al-Githmi, Iskander S

2016-01-01

Pectus carinatum is a congenital chest wall deformity characterized by protrusion of the sternum and adjacent costal cartilages. Multiple treatment options are available for correction of pectus carinatum. We report our initial experience with first-line treatment using a custom fitted dynamic compression orthosis. Prospective evaluation of all patients seen between November 2013 and December 2014. University hospital. The treatment protocol for patients who had pressure for initial correction.

MRI: unique costing and pricing issues.

PubMed

Schwartz, H W; Jarl, D F

1985-01-01

Acquisition of magnetic resonance imaging (MRI) involves a plethora of costs not traditionally encountered in radiology procedure cost accounting models. Experiences with MRI gained at the University of Minnesota Hospitals and Clinics during 1984 uncovered a wide variety of unique costing issues which were eventually identified at the time when the MRI hospital charge was being established. Our experience at UMHC can provide those radiology departments now acquiring MRI with an earlier awareness of these special costing issues, hopefully resulting in better and more timely data collection. Current reimbursement and pricing issues are also having a dramatic impact on MRI costs at each institution and must be assessed in terms of third-party payor intentions.

Case studies and role play: learning strategies in nursing.

PubMed

Cogo, Ana Luísa Petersen; Pai, Daiane Dal; Aliti, Graziella Badin; Hoefel, Heloísa Karnas; Azzolin, Karina de Oliveira; Busin, Lurdes; Unicovsky, Margarita Ana Rubin; Kruse, Maria Henriqueta Luce

2016-01-01

to report professors' experience in a public university of Southern region of Brazil using case studies and role play as learning strategies for nursing care of hospitalized adults. learning experience report from the Nursing Care of Adults I class of nursing undergraduate course. the development of case studies and role play considered health care needs from epidemiological profile of chronic noncommunicable diseases morbidity and mortality, nursing as an assisting method, and social aspects of hospitalized individuals. Role play planning was made by creating a stage in laboratory of practices and dialogues comprising students and professors interaction. case studies and role play encouraged students to active search for learning and brought theory closer to real health care situations.

Continuity of care: an Italian clinical experience.

PubMed

Tarquini, Roberto; Coletta, Davide; Mazzoccoli, Gianluigi; Gensini, Gian Franco

2013-10-01

Recently, there is a growing interest in the concept of "continuity of care," since patients, being older and more complex, are increasingly seen by an array of providers in a wide variety of organizations and places. Different models of continuity of care have been proposed, yet no single model of care coordination has been proven to be universally applicable across patient (and disease) populations. In the present paper, we introduce a novel model of continuity of care, the Ospedale Santa Verdiana, in Castelfiorentino (Tuscany, Italy), and its first period (1 year) of implementation, since January 2010. There are two main cornerstones: (a) the clinical and urgent need to bridge the gap between primary care and hospital care; and (b) the development and implementation of a model of continuity and coordination of care, which target the so-called complex patient. It is not specific for a single disease but it works "across diseases." There are three driving forces: (a) "primary care" since one of the two Hospital Coordinators is a primary care physician; (b) "hospital care" since patients in the decompensated phase often require hospitalization; and (c) the "University of Florence", which is the "glue". The duties of the Hospital Coordinator, who is an assistant professor at University of Florence, are to guarantee an efficacious and dynamic communication between primary care physicians and hospitalists, and by creating a school for practitioners of the continuity and coordination of care, to make this model exportable.

Role of collaborative academic partnerships in surgical training, education, and provision.

PubMed

Riviello, Robert; Ozgediz, Doruk; Hsia, Renee Y; Azzie, Georges; Newton, Mark; Tarpley, John

2010-03-01

The global disparities in both surgical disease burden and access to delivery of surgical care are gaining prominence in the medical literature and media. Concurrently, there is an unprecedented groundswell in idealism and interest in global health among North American medical students and trainees in anesthesia and surgical disciplines. Many academic medical centers (AMCs) are seeking to respond by creating partnerships with teaching hospitals overseas. In this article we describe six such partnerships, as follows: (1) University of California San Francisco (UCSF) with the Bellagio Essential Surgery Group; (2) USCF with Makerere University, Uganda; (3) Vanderbilt with Baptist Medical Center, Ogbomoso, Nigeria; (4) Vanderbilt with Kijabe Hospital, Kenya; (5) University of Toronto, Hospital for Sick Children with the Ministry of Health in Botswana; and (6) Harvard (Brigham and Women's Hospital and Children's Hospital Boston) with Partners in Health in Haiti and Rwanda. Reflection on these experiences offers valuable lessons, and we make recommendations of critical components leading to success. These include the importance of relationships, emphasis on mutual learning, the need for "champions," affirming that local training needs to supersede expatriate training needs, the value of collaboration in research, adapting the mission to locally expressed needs, the need for a multidisciplinary approach, and the need to measure outcomes. We conclude that this is an era of cautious optimism and that AMCs have a critical opportunity to both shape future leaders in global surgery and address the current global disparities.

Job satisfaction of nurses in Jimma University Specialized Teaching Hospital, Ethiopia.

PubMed

Negussie, Nebiat

2016-03-01

In Ethiopia nurses have played a very important role in providing timely and quality health service in healthcare organizations. However, there is a limited literature in the area of nurses' job satisfaction in Ethiopian public hospitals. The objective of this research is to measure job satisfaction of nurses in Jimma University Specialized Teaching Hospital and to determine the influencing factors. A cross-sectional survey was conducted from January 2012 to June 2012 in Jimma University Specialized Teaching Hospital. All full-time nurses with nonsupervisory management position and more than 1 year of work experience were invited to participate in the study. Minnesota Satisfaction Questionnaire was used to collect the data. A total of 175 copies of the questionnaires were returned out of 186 copies distributed to the respondents. The results indicated that nurses were not satisfied by their job (mean=2.21, SD=0.52). Remuneration (r=0.71, P<0.01) and job advancement (r=0.69, P<0.01) were statically significant and strongly correlated with nurses' job satisfaction. Job security was associated with highest satisfaction (r=0.41, P<0.05) CONCLUSION AND RECOMMENDATIONS: Remuneration and job advancement were the most important factors for nurses' job satisfaction. Hospital administrators as well as health policy makers need to address the two major identified sources of nurses' job dissatisfaction in the study (i.e. remuneration and narrow opportunity of job advancement) and take appropriate measures to overcome their consequences.

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

PubMed Central

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

2007-01-01

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

Paravertebral anaesthesia for breast surgery an initial experience at the University Hospital of the West Indies.

PubMed

Crawford-Sykes, A M; Chin, D E; Hambleton, I R

2004-06-01

Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. This retrospective review was undertaken to report the initial experience with this block. We reviewed the notes of all patients who were given a PVB alone, or in combination with general anaesthesia (GA). Twenty-one patients had P VB: twenty females and one male, with age range of 24 to 90 years. Six were attempted with PVB alone, but two of these needed supplementation with a GA. Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods.

The Virtual Hospital: experiences in creating and sustaining a digital library.

PubMed Central

D'Alessandro, M P; Galvin, J R; Erkonen, W E; Choi, T A; Lacey, D L; Colbert, S I

1998-01-01

A university and its faculty encompass a wealth of content, which is often freely supplied to commercial publishers who profit from it. Emerging digital library technology holds promise for allowing the creation of digital libraries and digital presses that can allow faculty and universities to bypass commercial publishers, retain control of their content, and distribute it directly to users, allowing the university and faculty to better serve their constituencies. The purpose of this paper is to show how this can be done. A methodology for overcoming the technical, social, political, and economic barriers involved in creating, distributing and organizing a digital library was developed, implemented, and refined over seven years. Over the seven years, 120 textbooks and booklets were placed in the Virtual Hospital digital library, from 159 authors in twenty-nine departments and four colleges at The University of Iowa. The digital library received extensive use by individuals around the world. A new paradigm for academic publishing was created, involving a university and faculty owned peer reviewed digital press implemented using digital library technology. The concept has been embraced by The University of Iowa, and it has pledged to sustain the digital press in order to allow. The University of Iowa to fulfill its mission of creating, organizing, and disseminating information better. PMID:9803300

The Effect of Advancing Age on Total Joint Replacement Outcomes

PubMed Central

Noiseux, Nicolas; Linson, Eric; Cram, Peter

2015-01-01

Objective: To describe age-related differences in outcomes among older adults undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design: Retrospective study. Participants: A total of 1792 patients who underwent primary THA or TKA at the University of Iowa Hospitals and Clinics between 2010 and 2013 were identified in the University HealthSystem Consortium Database and University of Iowa Orthopedics Joint Replacement Registry. Main Outcome Measures: Hospital length of stay (LOS), 30-day readmission rate, in-hospital mortality, number of days admitted to intensive care unit (ICU discharge disposition), in-hospital complications (pulmonary embolism, deep vein thrombosis, wound infection, hemorrhage, sepsis, or myocardial infarction), quality of life (measured using Short-Form 36 [SF-36]), discharge disposition (home, home with home health, nursing home, inpatient rehabilitation, transfer to another acute care hospital, and dead), and total patient level observed hospital cost (based on hospital charge information from each revenue code and estimated labor costs). Outcomes were compared in patients stratified by age and categorized by decade (ie, ≤50, 51-60, 61-70, 71-80, and ≥81). Results: A total of 871 THAs and 921 TKAs were performed. The mean age of our cohort was 60.5 years and 56.1% were women. In-hospital complication rates and ICU utilization progressively increased with increasing age. There was also a higher likelihood of skilled nursing facility placement and longer LOS. There was no increase in 30-day readmissions, mortality, or total cost. Improvements in patient reported outcomes (SF-36) scores were similar for all age-groups. Conclusions: Compared to younger patients, older THA and TKA recipients were more likely to experience postoperative complications, admission to the ICU, discharge to a skilled care facility, and had longer hospital LOS. Improvements in patient-related outcomes were similar across all age-groups. These findings may be helpful when counseling older patients regarding elective total joint arthroplasty. PMID:26328232

[Experience of liaison psychiatry in Morocco: transversal study over 24 months].

PubMed

Barrimi, M; Elghazouani, F; Aarab, C; Tliji, A; Rharrabti, S; Lahlou, F; Rammouz, I; Aalouane, R

2014-10-01

Liaison psychiatry is a discipline caring for psychiatric disorders in patients of general hospitals. It involves clinical, educational, and research aspects. The liaison psychiatry supports patients hospitalized for full-time in medical and surgical departments, patients admitted in day-hospital and patients treated in the emergency department. In this transversal study, we assessed the liaison psychiatry impact that is still in development stage in Morocco. This study lasted 24 months, and was conducted at the University Hospital in Fez, Morocco. The goal of this work was to evaluate the prevalence of psychiatric disorders managed by liaison psychiatry, identify those requiring medical and surgical departments of such psychiatric support, and classify the motivations involved in their needs. This transversal study was initiated in January 2010 and has lasted 24 months. The study recruited 180 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fes, Morocco. The psychiatric assessment was based on a psychiatric interview using the MINI. The data were collected by a certified psychiatrist using a questionnaire containing 24 items. After initial psychiatric assessment, the follow-up was proposed to the patient in the psychiatric department. During this study, 22 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (16%) and Nephrology (11%). The most common motivations for psychiatric consultations were respectively psychomotor agitation (17%) and an evaluation of suicide attempts (17%). Depressive and psychotic disorders were the most diagnosed disorders with 47% and 11% respectively. The psychiatric support was based on pharmacological treatment in 60% of cases. Finally, the outcome was favourable in 80% of followed cases. Hospitalized patients in different medical and surgical departments of the University Hospital of Fez have demonstrated a high prevalence of psychiatric disorders. This constitutes a very strong motivation to setup a department of liaison psychiatry. This would allow a better psychiatric support and follow-up of patients. Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Nurses’ experiences of humour in clinical settings

PubMed Central

Ghaffari, Fatemeh; Dehghan-Nayeri, Nahid; Shali, Mahboubeh

2015-01-01

Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it. Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students. PMID:26034735

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

ERIC Educational Resources Information Center

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

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

Comparing and decomposing differences in preventive and hospital care: USA versus Taiwan.

PubMed

Hsiou, Tiffany R; Pylypchuk, Yuriy

2012-07-01

As the USA expands health insurance coverage, comparing utilization of healthcare services with countries like Taiwan that already have universal coverage can highlight problematic areas of each system. The universal coverage plan of Taiwan is the newest among developed countries, and it is known for readily providing access to care at low costs. However, Taiwan experiences problems on the supply side, such as inadequate compensation for providers, especially in the area of preventive care. We compare the use of preventive, hospital, and emergency care between the USA and Taiwan. The rate of preventive care use is much higher in the USA than in Taiwan, whereas the use of hospital and emergency care is about the same. Results of our decomposition analysis suggest that higher levels of education and income, along with inferior health status in the USA, are significant factors, each explaining between 7% and 15% of the gap in preventive care use. Our analysis suggests that, in addition to universal coverage, proper remuneration schemes, education levels, and cultural attitudes towards health care are important factors that influence the use of preventive care. Copyright © 2011 John Wiley & Sons, Ltd.

A first evaluation of a pedagogical network for medical students at the University Hospital of Rennes.

PubMed

Fresnel, A; Jarno, P; Burgun, A; Delamarre, D; Denier, P; Cleret, M; Courtin, C; Seka, L P; Pouliquen, B; Cléran, L; Riou, C; Leduff, F; Lesaux, H; Duvauferrier, R; Le Beux, P

1998-01-01

A pedagogical network has been developed at University Hospital of Rennes from 1996. The challenge is to give medical information and informatics tools to all medical students in the clinical wards of the University Hospital. At first, nine wards were connected to the medical school server which is linked to the Internet. Client software electronic mail and WWW Netscape on Macintosh computers. Sever software is set up on Unix SUN providing a local homepage with selected pedagogical resources. These documents are stored in a DBMS database ORACLE and queries can be provided by specialty, authors or disease. The students can access a set of interactive teaching programs or electronic textbooks and can explore the Internet through the library information system and search engines. The teachers can send URL and indexation of pedagogical documents and can produce clinical cases: the database updating will be done by the users. This experience of using Web tools generated enthusiasm when we first introduced it to students. The evaluation shows that if the students can use this training early on, they will adapt the resources of the Internet to their own needs.

Health Care Delivery Meets Hospitality: A Pilot Study in Radiology.

PubMed

Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe

2015-06-01

The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Financial Analysis of National University Hospitals in Korea.

PubMed

Lee, Munjae

2015-10-01

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

Financial Analysis of National University Hospitals in Korea

PubMed Central

Lee, Munjae

2015-01-01

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

Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient.

PubMed

Haverkort, J J Mark; Minderhoud, A L C Ben; Wind, Jelte D D; Leenen, Luke P H; Hoepelman, Andy I M; Ellerbroek, Pauline M

2016-02-01

The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital's preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery.

Effect of an Electronic Health Record on the Culture of an Outpatient Medical Oncology Practice in a Four-Hospital Integrated Health Care System: 5-Year Experience

PubMed Central

Brockstein, Bruce; Hensing, Thomas; Carro, George W.; Obel, Jennifer; Khandekar, Janardan; Kaminer, Lynne; Van De Wege, Christine; de Wilton Marsh, Robert

2011-01-01

The electronic health record (EHR) was adopted into the NorthShore University HealthSystem, a four-hospital integrated health system located in suburban Chicago, in 2003. By 2005, all chemotherapy and medicine order entry was conducted through the EHR, completing the incorporation of a fully paperless EHR in our hospital-based oncology practice in both the inpatient and outpatient settings. The use of the EHR has dramatically changed our practice environment by improving efficiency, patient safety, research productivity, and operations, while allowing evaluation of adherence to established quality measures and incorporation of new quality improvement initiatives. The reach of the EHR has been substantial and has influenced every aspect of care at our institution over the short period since its implementation. In this article, we describe subjective and objective measures, outcomes, and achievements of our 5-year EHR experience. PMID:22043197

Involvement and emancipation of the worker. Action research in a university hospital.

PubMed

Bolis, Ivan; Brunoro, Claudio; Sznelwar, Laerte Idal

2012-01-01

The present action research article is linked to an ergonomics project in a university hospital. The author's proposal is to focus action on the effective worker involvement required for the creation of spaces/mechanisms within organizations where people can enhance cooperation and deliberation on matters relating to work. For this purpose, a committee was introduced to assist in finding problems and solutions directly in work situations, so that workers could experience relative autonomy allowing them to develop procedures and choose tools appropriate to their own real needs. Based on this organizational implementation and on subsequent interviews, the practical results are analyzed and related to employee involvement. One can conclude that workers in all areas of the organization can be active elements for improving working conditions and productivity in companies.

An Iterative Approach To Development Of A PACS Display Workstation

NASA Astrophysics Data System (ADS)

O'Malley, Kathleen G.

1989-05-01

An iterative prototyping approach has been used in the development of requirements for a new user interface for the display workstation in the CommView system product line. This approach involves many steps, including development of the preliminary concept, validation and ranking of ideas within that concept, prototyping, evaluating, and revising. We describe in this paper the process undertaken to design and evaluate the new user interface. Staff at Abbott Northwestern Hospital, Bowman Gray/Baptist Hospital Medical Center, Duke University Medical Center, Georgetown University Medical Center and Robert Wood Johnson University Hospital participated in various aspects of the study. The subject population included radiologists, residents, technologists and staff physicians from several areas in the hospitals. Subjects participated in in-depth interviews, answered questionnaires, and performed specific tasks, to aid our development process. We feel this method has resulted in a product that will achieve a high level of customer satisfaction, developed in less time than a traditional approach. Some of the reasons we believe in the value of this approach are: • Users may not be able to describe their needs in terms that designers are expecting, leading to misinterpretation; • Users may not be able to choose between options without seeing them; • Users needs and choices evolve with experience; • Users true choices and needs may not seem logical to one not performing those tasks (i.e., the designers).

Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital.

PubMed

Neaman, Keith C; Hansen, Juliana E

2007-03-01

The number of abdominoplasties performed in the United States has been steadily increasing over the past decade. A large proportion of these patients are bariatric patients who remain obese despite prior weight-reduction surgery. This study was done to review the experience of patients undergoing abdominoplasty at a university hospital. A retrospective chart review of 206 consecutive patients was performed. The overall complication rate was 37.4%. Major complications [hematoma requiring surgical intervention, seroma requiring aspiration or surgical drainage, cellulitis or abscess requiring hospitalization and intravenous (IV) antibiotics, deep vein thrombosis (DVT), and pulmonary embolism (PE)] occurred in 16% of patients. The rate of minor complications (hematoma or seroma requiring no intervention, epidermolysis, small-wound dehiscence, neuropathic pain, and minor cellulitis) was 26.7%. Obese patients had a significantly increased risk of developing major complications as compared with nonobese patients (53.4% versus 28.8%, P = 0.001). An in-depth analysis of all complications and risk factors was done.

Coping With Moral Distress in Oncology Practice: Nurse and Physician Strategies.

PubMed

Lievrouw, An; Vanheule, Stijn; Deveugele, Myriam; Vos, Martine; Pattyn, Piet; Belle, Van; Benoit, Dominique D

2016-07-01

To explore variations in coping with moral distress among physicians and nurses in a university hospital oncology setting.
. Qualitative interview study.
. Internal medicine (gastroenterology and medical oncology), gastrointestinal surgery, and day clinic chemotherapy at Ghent University Hospital in Belgium.
. 17 doctors and 18 nurses with varying experience levels, working in three different oncology hospital settings. 
. Patients with cancer were interviewed based on the critical incident technique. Analyses were performed using thematic analysis.
. Moral distress lingered if it was accompanied by emotional distress. Four dominant ways of coping (thoroughness, autonomy, compromise, and intuition) emerged, which could be mapped on two perpendicular continuous axes. Moral distress is a challenging phenomenon in oncology. However, when managed well, it can lead to more introspection and team reflection, resulting in a better interpersonal understanding.
. Team leaders should recognize their own and their team members' preferred method of coping and tailored support should be offered to ease emotional distress.

A cure for the soul? The benefit of live music in the general hospital.

PubMed

Moss, H; Nolan, E; O'Neill, D

2007-01-01

From 2005 to 2006 a professional orchestra (the Irish Chamber Orchestra) performed in a university teaching hospital with the aims of bringing live music to patients who could not access traditional concert venues and of improving quality of life for patients and staff. This was the first time an orchestra was resident in a hospital in the Republic of Ireland. An independent contemporaneous evaluation was carried out to assess the benefit of live music for patients. Live music in hospital was found to enhance the quality of the aesthetic environment of the hospital, with both patients and staff stating that listening to live music helped them to relax, feel happier and more positive. Patients' perception of the hospital was affected positively by live music in waiting areas. Music was found to have strong emotional effect and the individual preferences and experiences of patients need to be carefully taken into account when programming music in hospital. Listening to live music while in hospital has positive benefits with few negative effects.

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal

PubMed Central

Hinkelmann, Jürgen; Volkert, Thomas; Rodde, Sibyll; Hahnenkamp, Klaus

2016-01-01

Background University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. Objective In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. Methods Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production (“industry 4.0”) because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts’ scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention. Results We expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones). Conclusions All measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be presented at conferences and published in journals. PMID:28003176

Communicating with Clinicians: The Experiences of Surrogate Decision Makers for Hospitalized Older Adults

PubMed Central

Torke, Alexia M.; Petronio, Sandra; Purnell, Christianna E.; Sachs, Greg A.; Helft, Paul R.; Callahan, Christopher M.

2012-01-01

Background/Objectives When hospitalized older adults have impaired cognition, family members or other surrogates must communicate with clinicians to provide information and make medical decisions for the patient. The present study describes communication experiences of surrogates who recently made a major medical decision for a hospitalized older adult. Design Semi-structured interviews about a recent hospitalization. Setting Two hospitals both affiliated with 1 large medical school: an urban, public hospital; and a university-affiliated tertiary referral hospital. Participants Surrogates were eligible if they had recently made a major medical decision for a hospitalized patient aged 65 or older and were available for an interview within 1 month (2-5 months if the patient died). Measurements Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory. Results We interviewed 35 surrogates. They were 80% female, 44% white and 56% African American. Three primary themes emerged. We found the Nature of Surrogate/Clinician Relationships was best characterized as a relationship with a “team” of clinicians rather than individual clinicians due to frequent staff changes and multiple clinicians. Surrogates reported their Communication Needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described Trust and Mistrust, which were formed largely through surrogates’ communication experiences. Conclusion In the hospital, surrogates form relationships with a “team” of clinicians rather than with individuals. Yet effective communication and expressions of emotional support frequently occur and are highly valued by surrogates. Future interventions should focus on meeting surrogates’ needs for frequent communication, high levels of information and emotional support. PMID:22881864

Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town: Part II. Laboratory research experience.

PubMed

Hassoulas, J

2012-03-29

Extensive experimental research on various aspects of heart transplantation was undertaken during the first 2 decades. An overview of this work is presented, and some still unpublished work has been included. Experimental laboratory investigation was an integral activity of the cardiac transplantation programme at the University of Cape Town over these years, and has remained so ever since. These studies provided invaluable fundamental information upon which future clinical work was based. It is therefore necessary to briefly mention and discuss this information, most of which has been published in detail by the various investigators concerned.

Smart information system for gachon university gil hospital.

PubMed

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

2012-03-01

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

Smart Information System for Gachon University Gil Hospital

PubMed Central

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

2012-01-01

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

The effect of educational interventions with siblings of hospitalized children.

PubMed

Gursky, Barbara

2007-10-01

Research has demonstrated that siblings of chronically ill children can experience significant emotional and behavior changes; however, few studies have looked at the specific impact of pediatric hospitalization on the nonhospitalized child. Studies also indicate that children who receive age-appropriate information are better equipped to handle the stress and anxiety often associated with hospitalization.This study explored whether siblings of hospitalized children who received educational interventions had lower anxiety levels compared to siblings who did not receive interventions. A pretest-posttest experimental design was used with 50 subjects, ages 6-17 years, recruited from a children's hospital within a university medical center. Subjects were matched according to age, sex, and race, with 25 siblings each in the experimental and control groups. Siblings assigned to the experimental group received interventions from a standardized educational intervention protocol developed by the researcher. Interventions focused on teaching the sibling about hospitalization, illness or injury, and treatment for the patient, based on cognitive stages of development. All interventions were conducted by child life specialists on staff at the hospital with extensive training and experience in preparation and procedural teaching. Results shows that siblings who received educational interventions had significantly lower anxiety levels after interventions, compared to siblings who did not receive interventions. These findings have significant impact on children's health care and supporting family needs when a child is hospitalized.

Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study.

PubMed

Yousefi, Hojatollah; Abedi, Heidar Ali; Yarmohammadian, Mohammad Hossein; Elliott, Doug

2009-09-01

This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical-surgical wards in an Iranian hospital. Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care. This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical-surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes. One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes - A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family - were identified in the data. These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles.

Evaluation of the attitudes of the nurses related to rational drug use in Gaziantep University Sahinbey Research and Practice Hospital in Turkey.

PubMed

Oguz, Elif; Alasehirli, Belgin; Demiryurek, Abdullah Tuncay

2015-02-01

This study aimed to evaluate the attitude of nurses about rational drug use in Gaziantep University Sahinbey Research and Practice Hospital. There are a limited number of studies available on this issue and no studies of this scale were conducted among the nurses in our region. A questionnaire generated by the Rational Drug Use Unit of Turkish Ministry of Health General Directorate of Pharmaceuticals and Pharmacy was carried out to nurses. The study was carried out to 162 nurses. The data obtained from nurses by questionnaire were determined as count, percentage and Chi-square test by SPSS statistical package program. The most common type of medication error was giving the medicine at the wrong time. Medication errors were least common among the 36-50-year age group and with a professional experience of 11 years or longer. Nurses had the highest level of knowledge in the areas of drug administration routes and the intended use. The number of nurses reported having good/very good knowledge was higher with 4 to 10 years of professional experience and with a university degree. The nurses aged between 26 and 35 years and those with professional experience of 4 to 10 years provided drug information to patients more often than others. Forty two percent of the nurses were found to actively report any adverse events. Reporting of adverse events and reporting more than 6 adverse events were most common among university degree holders. Nurses required a more comprehensive education on pharmacology both during their training years and working life since the requests for medicinal products are received by the nurses and preparation and administration of drugs are under the control of nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.

Does autonomization of public hospitals and exposure to market pressure complement or debilitate social health insurance systems? Evidence from a low-income country.

PubMed

Sepehri, Ardeshir

2014-01-01

Granting public hospitals greater autonomy and creating organizational arrangements that mimic the private sector and encourage competition is often promoted as a way to increase efficiency and public accountability and to improve quality of care at these facilities. The existence of good-quality health infrastructure, in turn, encourages the population to join and support the social health insurance system and achieve universal coverage. This article provides a critical review of hospital autonomization, using Vietnam's experience to assess the influence of hospital autonomy on the sustainability of Vietnam's social health insurance. The evidence suggests that a reform process based on greater autonomy of resource mobilization and on the retention and use of own-source revenues can create perverse incentives among managers and health care providers, leading to the development of a two-tiered provision of clinical care, provider-induced supply of an inefficient service mix, a high degree of duplication, wasteful investment, and cost escalation. Rather than complementing social health insurance and helping the country to achieve universal coverage, granting public hospitals greater autonomy that mimics the private sector may indeed undermine the legitimacy and sustainability of social health insurance as health care costs escalate and higher quality of care remains elusive.

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

PubMed

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

2011-12-01

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

Providing leadership to a decentralized total quality process.

PubMed

Diederich, J J; Eisenberg, M

1993-01-01

Integrating total quality management into the culture of an organization and the daily work of employees requires a decentralized leadership structure that encourages all employees to become involved. This article, based upon the experience of the University of Michigan Hospitals Professional Services Divisional Lead Team, outlines a process for decentralizing the total quality management process.

Greek Women's Attitudes to Pregnancy, Labour and Infant: Their Significance for Intervention.

ERIC Educational Resources Information Center

Dragonas, Thalia G.

To aid in focusing preventive interventions at needs perceived by clients, this study investigates Greek women's needs, attitudes, and experiences during the months immediately before and after childbirth. Participants were 156 women attending the out-patient clinic of the Alexandra Maternity University Hospital who completed pre- and postnatal…

International collaboration in pediatric nursing: mutual learning success.

PubMed

Metcalfe, Sharon Elizabeth

2010-01-01

This article describes an innovative international collaboration between a children's hospital in the United Kingdom and a university school of nursing in the United States that created opportunities for networking among nurses in similar specialties. Nurses from two countries joined in an educational partnership to share dialogue and clinical experience in the United Kingdom.

Strontium 89 in the treatment of pain due to diffuse osseous metastases: a university hospital experience.

PubMed Central

Ashayeri, Ebrahim; Omogbehin, Adedamola; Sridhar, Rajagopalan; Shankar, Ravi A.

2002-01-01

More than two-thirds of the patients with osseous metastases experience debilitating bone pain, requiring some form of pain relief. Analgesics are limited in their efficacy. Palliative application of hemi-body external beam radiation therapy in the treatment of multiple osseous metastases also is limited due to toxicity associated with large treatment ports. Intravenous injections of bone seeking radioisotopes are effective in the palliation of pain with fewer side effects. Forty-one patients with multiple osseous metastases due to prostate and breast cancer were treated with strontium chloride 89 (89Sr) at the department of radiation oncology, in a university hospital. A retrospective analysis of these patients indicated that all subjects had severe pain that diminished their quality of life. Most of these patients had multiple co-morbid factors. Many were on opioids leading to adverse effects such as nausea, constipation, and drowsiness that required additional medication. Objective findings and evaluation of the responses were not always available for all patients. Following treatmentwith 89Sr, over two-thirds of the patients responded favorably and required lower doses of opioids. PMID:12152927

[Impact of driving cessation on daily transportation utility in elderly people with cognitive decline: a survey of patients in the memory clinic of an urban university hospital].

PubMed

Kawano, Naoko; Makino, Taeko; Suzuki, Yusuke; Umegaki, Hiroyuki

2009-09-01

In the present study our goal was to explore the impact of driving cessation on daily transportation utility in older people with cognitive decline. A total of 101 older persons participated in our survey of responding of a questionnaire about driving and other methods for traveling, administered at the memory clinic of the geriatric outpatient unit of Nagoya University Hospital. Of this total, 48 (47.5%) still had driving licenses, 16 (15.8%) had licenses that had expired, and 37 (36.6%) had no driving experience. The majority of license holders (77.1%) were active drivers, and we found that license holders tend to utilize public transport loss than older people without driving experience. Furthermore, among those who had ceased driving, there was a contrast in daily transportation utility between those with dementia and those without dementia, with the former accessing public transport less frequently. When clinicians advise drivers with dementia to cease driving, these patients need special attention to assist them in providing alternative ways of transportation.

Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals.

PubMed

Raghavendran, S; Bagry, H S; Leith, S; Budd, J M

2006-09-01

Hospital staff are at risk from occupational exposure to blood-borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.

Experience-based consulting: the value proposition.

PubMed

Pliner, Nicole; Thrall, James; Boland, Giles; Palumbo, Denise

2004-11-01

Consulting is a profession universally accepted and well entrenched throughout the business world. Whether it is providing objective analysis, supplying a specific expertise, managing a project, or simply adding extra manpower, consultants can add value. However, what are the attributes of a good consultant? In health care, with the rapid pace of emerging technologies, economic intricacies, and the complexities of clinical care, hands-on experience is the key. Recognizing the power of consultants with hands-on experience, the Department of Radiology at Massachusetts General Hospital launched the Radiology Consulting Group, an "experience-based" model for consulting that may potentially shift the profession's paradigm.

[Experiences and support needs of parents of hospitalized children with multiple disabilities: a qualitative study].

PubMed

Seliner, Brigitte; Latal, Bea; Spirig, Rebecca

2016-01-01

The hospitalisation of a multiple disabled child is stressful for parents because they continue to carry out demanding care procedures in hospital. Yet, systematic knowledge of the parental experience and of their support needs is missing. How do parents experience the hospitalisation, and which support needs do they identify for this period? Methods: Twenty-six parents (24 mothers, 2 fathers) of 24 children with multiple disabilities have participated in this qualitative study. Between 1 January 2011 and 1 September 2013, semi-structured interviews were conducted in a children's university hospital. A qualitative content analysis formed the basis for the analysis. “Concerns for the child's well-being” was central for the parents and focussed on the areas of “Pain”, “Complications” and “Development”. Perception of the child's well-being governs the extent of the “Parents' Work” and defines the parental “Support needs” to “Receive information and training”, “Be known and experience continuity”, “Be taken seriously and experience communion”, “Be accompanied by experienced nurses”, and “Be relieved and get organisational support”. Parents work hard to safeguard the well-being of their hospitalised child with multiple handicaps. Care professionals can ease the parents' burden by promoting parental confidence in their child's welfare in hospital. This will be successful if continuity of care and competence are ensured, for instance if it is provided by nurses with Advanced Practice background.

Can We Improve Workflows in the OR? A Comparison of Quality Perceptions and Preoperative Efficiency across Institutions in Spine Surgery.

PubMed

Wasterlain, Amy S; Tran, Andrew A; Tang, Chad; Campbell, David R; Braun, Hillary J; Scuderi, Yasmeen A; Scuderi, Gaetano J

2015-03-01

Cost containment and surgical inefficiencies are major concerns for hospitals in this era of declining resources. The primary aim of this investigation was to understand subjective perceptions of perioperative spine surgical quality across three practice settings and to identify potential factors contributing to these perceptions. Subsequently, we objectively evaluated factors that influence the duration of time in which the patient is in the operating room (OR) prior to the surgical incision and assessed the influence of fluoroscopy technician expertise on radiation dose and imaging efficiency. One hundred and eight medical device representatives with at least 1 year of OR experience were surveyed at a national conference. Three distinct healthcare facilities were identified: university, small volume, and large volume private hospitals. Respondents rated facilities on a five-point scale for staff quality; size and consistency of surgical teams; and overall likelihood of recommending the facility. Separately, 140 posterior lumbar procedures from two institutions were retrospectively reviewed. Two time periods were quantified for each surgical case: patient arrival in the OR to induction of anesthesia (T1) and induction to surgical incision (T2). T1 and T2 were compared between university and large private hospital settings using t tests and multivariate analysis. For 44 separate lumbar spine surgical procedures, practice setting, patient BMI, number of vertebral levels requiring imaging, number of localizing fluoroscopy images taken, total fluoroscopy time, total radiation dose, fluoroscopy machine, and whether the fluoroscopist could correctly state his or her role, which was to obtain a lateral lumbar localizing image, were recorded. T-tests were used to compare cases in which the fluoroscopist could and could not correctly state the task. Survey ratings for surgeons were not significantly different across university, large private, and small private hospitals. Fewer circulating nurses were rated as excellent or good in university versus private hospitals (p < 0.001). Small volume private hospital surgical teams were more likely to have worked together before than university teams (p < 0.05), and university teams were larger (p < 0.05). Respondents were more likely to recommend a university or large private hospital for complex instrumentation cases (p < 0.001). On objective measures, university patients were older, less obese, and had higher mean ASA scores (2.5 versus 2.2, p < 0.001). Compared to the university setting, private hospital cases had significantly shorter Time 1 (8 versus 37 min, p < 0.001) and Time 2 (23 versus 30 min, p < 0.001), even after adjusting for ASA score, BMI, and age. Cases in which the fluoroscopist knew the imaging purpose were associated with significantly fewer images (mean 1.8 versus 3.4 images, p < 0.0001) and shorter total exposure times (2.3 versus 4.0 sec, p < 0.001). Operations performed in the university setting were associated with significantly more images (2.7 versus 1.8 images, p < 0.001), longer total exposure times (3.2 versus 2.3 sec, p = 0.0027), and total radiation dose (27.8 versus 53.3 rad, p < 0.001) when compared with those performed in the private setting. The university practice setting was associated with significantly more images (2.7 versus 1.8 images, p < 0.001), longer total exposure times (3.2 versus 2.3 sec, p = 0.003), and total radiation dose (27.8 versus 53.3 rad, p < 0.001) when compared with non-university settings. Large private and university hospitals had higher surgeon ratings. The university setting was associated with larger and less consistent surgical teams and lower nurse ratings. Surgical staff awareness of the procedure and attention to preoperative tasks specific to the procedure reduced pre-operative time spent in the OR as well as fluoroscopy radiation. These data suggest that nurses and support staff make substantial contributions to overall quality of care, and that leadership and interpersonal coordination are especially important within large teams at teaching hospitals.

Hospital integrated parallel cluster for fast and cost-efficient image analysis: clinical experience and research evaluation

NASA Astrophysics Data System (ADS)

Erberich, Stephan G.; Hoppe, Martin; Jansen, Christian; Schmidt, Thomas; Thron, Armin; Oberschelp, Walter

2001-08-01

In the last few years more and more University Hospitals as well as private hospitals changed to digital information systems for patient record, diagnostic files and digital images. Not only that patient management becomes easier, it is also very remarkable how clinical research can profit from Picture Archiving and Communication Systems (PACS) and diagnostic databases, especially from image databases. Since images are available on the finger tip, difficulties arise when image data needs to be processed, e.g. segmented, classified or co-registered, which usually demands a lot computational power. Today's clinical environment does support PACS very well, but real image processing is still under-developed. The purpose of this paper is to introduce a parallel cluster of standard distributed systems and its software components and how such a system can be integrated into a hospital environment. To demonstrate the cluster technique we present our clinical experience with the crucial but cost-intensive motion correction of clinical routine and research functional MRI (fMRI) data, as it is processed in our Lab on a daily basis.

Improving Hospital Services Based on Patient Experience Data: Current Feedback Practices and Future Opportunities.

PubMed

Kaipio, Johanna; Stenhammar, Hanna; Immonen, Susanna; Litovuo, Lauri; Axelsson, Minja; Lantto, Minna; Lahdenne, Pekka

2018-01-01

Patient feedback is considered important for healthcare organizations. However, measurement and analysis of patient reported data is useful only if gathered insights are transformed into actions. This article focuses on gathering and utilization of patient experience data at hospitals with the aim of supporting the development of patient-centered services. The study was designed to explore both current practices of collecting and utilizing patient feedback at hospitals as well as future feedback-related opportunities. Nine people working at different hierarchical levels of three university hospitals in Finland participated in in-depth interviews. Findings indicate that current feedback processes are poorly planned and inflexible. Some feedback data are gathered, but not systematically utilized. Currently, it is difficult to obtain a comprehensive picture of the situation. One future hope was to increase the amount of patient feedback to be able to better generalize and utilize the data. Based on the findings the following recommendations are given: attention to both patients' and healthcare staff's perspectives when collecting feedback, employing a coordinated approach for collecting and utilizing patient feedback, and organizational transformation towards a patient-centric culture.

Vigilance as a caring expression and Leininger's theory of cultural care diversity and universality.

PubMed

Carr, J M

1998-01-01

Vigilance, or the close, protective involvement of families caring for hospitalized relatives, was explored in this study using holistic ethnography. Leininger's theory of cultural care diversity and universality provided direction for the researcher to generate substantive data about the meanings, patterns, and day-to-day experience of vigilance. Five categories of meaning were derived from the data: commitment to care, emotional upheaval, dynamic nexus, transition, and resilience. The research findings expand understanding of vigilance as a caring expression, suggest direction for nursing practice, and contribute to Leininger's theory of cultural care diversity and universality and the development of nursing science.

Keyhole Surgery of the Kidney at Sultan Qaboos University Hospital, Oman

PubMed Central

Al-Marhoon, Mohammed S; Mathew, Josephkunju; Al-Lawati, Hawraa

2007-01-01

Objectives: Percutaneous access surgery of the kidneys was introduced in Sultan Qaboos University Hospital (SQUH) in 1998. We are presenting our early experience in the first 31 patients operated on over an eight year period using the percutaneous approach. Methods: A retrospective review of 25 patients, who underwent percutaneous nephrolithotomy (PCNL) for the treatment of large renal stones and 6 patients who underwent endopyelotomy for the treatment of pelviureteric junction (PUJ) obstruction. Results: In the PCNL group complete stone clearance was achieved in 68% (17/25) patients and the complication rate was 28% (7/25). In the endopyelotomy group the success rate of relief of obstruction of PUJ measured by renogram and relief of symptoms was 83% (5/6 patients). Conclusion: Our early results of PCNL are promising and comparable to international results. PMID:21748093

[Collaboration between science and practice: experiences of conducting a nursing intervention study].

PubMed

Panfil, Eva-Maria; Kirchner, Elisabeth; Bauder-Missbach, Heidi; Haasenritter, Jörg; Eisenschink, Anna Maria

2009-09-01

In a five-year intervention study about the impact of pre-operative mobilisation training session of patients receiving an elective medial laparotomy experiences about the collaboration between practice (University Hospital Ulm) and science (Hessian Institute of Nursing Research) were made. During the project possibilities and borders of clinical nursing research became clear. A research question based on practice experiences of nurses helps to develop and maintain motivation to conduct a study at a nursing unit. There was a lack of nursing knowledge to develop the best possible design, e.g. outcome criteria for mobilisation and standardized assessment instruments. The cooperation with other health care professionals (human movement science, statistics) was important and without difficulties. In Germany, without doctors' agreement and common application it is impossible to conduct nursing intervention studies in hospitals. It is necessary to train nursing specialists with both scientific and clinical competence to explore systematically clinical research questions.

Use of continuous positive airway pressure (CPAP) in neonatal units--a survey of current preferences and practice in Germany.

PubMed

Roehr, C C; Schmalisch, G; Khakban, A; Proquitté, H; Wauer, R R

2007-04-26

There is only limited evidence regarding the equipment or the settings (pressure and flow) at which CPAP should be applied in neonatal care. Aims of this nationwide survey of German neonatal units were to investigate (1) for which clinical indications CPAP was employed, (2) which CPAP equipment was used, (3) which CPAP settings were applied. A questionnaire on the use of CPAP was sent to all children's hospitals in Germany. Data were stratified and compared by level of medical care provided (non-academic children's hospital, academic teaching hospital and university children's hospital). 274 institutions were contacted by mailed questionnaire. The response rate was 86%, 90 non-academic children's hospitals, 119 academic teaching hospitals and 26 university children's hospitals replied. (1) There were no statistically significant difference in CPAP use between the institutions: 231 (98%) used CPAP for treating respiratory distress syndrome, 225 (96%) for treating apnoea-bradycardia-syndrome and 230 (98%) following extubation. (2) Commercial CPAP systems were employed by 71% of units, the others used a combination of different devices. Respirator generated CPAP was most commonly used. Exclusively mononasal CPAP was used by only 9%, and binasal CPAP by 55% of institutions. (3) Median CPAP was 4.5 cm H2O (range 3-7), median maximum CPAP was 7 cm H2O (range 4-10), with no statistically significant differences between the hospitals. Between units, CPAP was given via a broad range of CPAP systems and at varying pressure settings. The reported differences reflects personal experiences and preferences, rather than sound evidence from clinical trials.

Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial.

PubMed

Chan, Aileen W K; Tang, Fiona W K; Choi, Kai Chow; Liu, Ting; Taylor-Piliae, Ruth E

2018-06-05

Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong. To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM). A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher). One university in Hong Kong. Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP). Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience. A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0.005). No significant differences were noted in the other domains. The CPM draws on the strengths of existing clinical learning models and provides complementary methods to facilitate clinical learning for pre-registration nursing students. Additional studies examining this CPM with longer duration of clinical practicum are recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

PubMed

Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung

2016-11-01

Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents for patient-centered services. Further research should be directed at developing sophisticated patient-centered services as a communication tool between the hospital and the patient. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The relationship between the knowledge of nursing staff and their compliance to universal precautions for prevention of hepatitis B viral infection.

PubMed

El-Shafie, I F; Mokabel, F M; Helmy, F E

1995-01-01

This study examined the relationship between the knowledge of nurses working in Tanta Fever Hospital (N = 54) and their compliance to universal precautions as a prevention of HBV. An interview questionnaire and observation checklist were designed to fulfill the aim of the study. The study revealed that nurses' knowledge was below the average score in half of the items studied, while their performance was below the average in all the items except for care of contaminated instruments. Although no significant relation was found between nurses' knowledge and their performance regarding the universal precautions, nurses having less than 5 years of experience had a higher score of performance than those having more than 5 years of experience in 6 items. The study reflects the need for in-service educational and training programs on infection control for nurses.

Gender differences in quality of care experiences during hospital stay: A contribution to patient-centered healthcare for both men and women.

PubMed

Teunissen, T A M; Rotink, M E; Lagro-Janssen, A L M

2016-04-01

Studies demonstrate that there are important gender differences in perceptions of medicinal care. Our aim is to investigate whether there are also gender differences in patients'quality of care experiences during their hospital stay. In a cross-sectional survey, patients who were admitted to a university hospital were invited to complete a questionnaire. Answers were compared between men and women of different ages, education levels, and health assessments, using the independent t-test. A linear regression model was performed to investigate the relationship between patient characteristics and hospital assessments 4169 questionnaires were sent (41.8% returned). Women rated the hospital significantly (P=0.007) lower than men, especially higher educated women and women between the ages of 18 and 44 years. Behaviors of nurses were perceived to be unsatisfactory by significantly more female patients than male patients (P=0.016). One in six women wanted more privacy compared with one in ten men (P<0.001), and ten percent more women suffered from pain (P<0.001). Women, particularly those higher educated and between 45 and 64 years of age, assess hospital care significantly lower than men. To optimize patients' assessments of hospital care, women require more gender-sensitive nursing care, more privacy, and better pain management than they receive at present. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Howard University Hospital finds partner in helping children succeed.

PubMed

Botvin, Judith D

2005-01-01

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

[Introduction of a Clinical Research Experience Program in Hospital Practical Training for Pharmacy Students and Its Evaluation].

PubMed

Takahashi, Katsuyuki; Suda, Yasuki; Kawaguchi, Hiroshi; Nakamura, Yasutaka; Kawabata, Shiho; Kawakami, Noriko; Nishikawa, Takeshi; Nagayama, Katsuya

2015-01-01

Long-term clinical training based on a model core curriculum was conducted to nurture highly competent pharmacists in the clinical field. Pharmacists' responsibilities are expanding, and a system has been developed to help pharmacists gain accreditation, identify specialties, and improve their training. However, this system requires research competency. Therefore clinical research should be considered a part of clinical training to encourage high competency among pharmacists. Because the model core curriculum does not include a section on clinical research. Osaka City University Hospital introduced a hands-on clinical research experience program and evaluated its usefulness. A significant improvement in the level of knowledge and awareness of clinical research was seen among students who underwent the clinical research experience program. In addition, the level of student satisfaction was higher. These findings suggest that a clinical research experience program may be useful to nurture a greater awareness of clinical research and knowledge acquisition among pharmacists.

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

PubMed

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

2017-09-01

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

Blog Analysis: An Exploration of French Students' Perceptions towards Foreign Cultures during Their Overseas Internships

ERIC Educational Resources Information Center

Durand, Sandra

2016-01-01

Increasingly, tourism and hospitality university programs in France include internships which add a vocational dimension to the academic aspects of the course. These internships a) provide exposure to real world professional situations, b) add market value to the student experience, and c) offer a foothold for employment. The field of blog…

The Association of Child Abuse and Neglect with Adult Disability in Schizophrenia and the Prominent Role of Physical Neglect

ERIC Educational Resources Information Center

Gil, Alexei; Gama, Clarissa S.; de Jesus, Danilo Rocha; Lobato, Maria Ines; Zimmer, Marilene; Belmonte-de-Abreu, Paulo

2009-01-01

Objective: To assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia. Method: Ninety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by…

A Collaborative Capstone to Develop a Mobile Hospital Clinic Application through a Student Team Competition

ERIC Educational Resources Information Center

Wong, Wilson; Pepe, James; Stahl, James; Englander, Irv

2013-01-01

A new collaborative capstone model is presented that consists of three synergistic elements: (1) a capstone course component; (2) a business component; and (3) an advanced technical course component geared towards enhancing the student capstone learning experience. The model was fully implemented at Bentley University in spring 2012 with…

The Use of Operational Excellence Principles in a University Hospital.

PubMed

Edelman, Eric R; Hamaekers, Ankie E W; Buhre, Wolfgang F; van Merode, Godefridus G

2017-01-01

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+'s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential.

The Use of Operational Excellence Principles in a University Hospital

PubMed Central

Edelman, Eric R.; Hamaekers, Ankie E. W.; Buhre, Wolfgang F.; van Merode, Godefridus G.

2017-01-01

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+’s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential. PMID:28752089

Maylard incision in gynecologic surgery: 4-year experience in Thammasat University Hospital.

PubMed

Manusook, Sakol; Suwannarurk, Komsun; Pongrojpaw, Densak; Bhamarapravatana, Kornkarn

2014-08-01

To present the results of Maylard incisionfor gynecologic surgery in Thammasat University Hospital during the past four years. A retrospective study of gynecologic surgery performed via the Maylard muscle cutting incision compare to Pfannenstiel muscle splitting and midline incision. Data came from subjects who underwent gynecologic surgey at Thammasat University Hospital, Pathumthani, Thailand friom January 2010 to December 2013. In the period of 4 years, there were 283 cases of elective surgery that performed via Maylard, Pfannenstiel and midline incision by the single experience gynecologic surgeon team. One hundred and six cases were performed via Maylard incision technique. The remaining 59 and 118 cases were performed via Pfannenstiel and midline incision technique, respectively. Two-thirds and one-thirds of cases underwent hysterectomy and conservative surgery, respectively. Benign conditions were the major indicationfor surgery at the percentage of 83.4. Operative results were not significantly different from well-known midline and Pfannenstiel incision in terms of blood loss, time to first meal and postoperative pain. Operative time in Maylard incision was longer than in Pfannenstiel incision. Length of stay in Maylard incision was longer than Pfannenstiel but shorter than midline incision. Overall complications (eoperation, bowel injuries, urinary bladder injuries and blood transfusion rate) were not significantly different. Maylard incision provides similar operative results with midline and Pfannenstiel technique. Even though it takes more time for abdominal entry but it gives more operative exposure than Pfannenstiel incision. In the woman with previous low transverse scar and gynaecologic surgery is needed, Maylard incision could be an optional technique that provides cosmetic and successfud results. Hand on training for Maylard incision from their mentors should be encouraged to more practice.

The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital

PubMed Central

2011-01-01

Background Considering the fact that a significant proportion of high-risk pregnancies are currently referred to tertiary level hospitals; and that a large proportion of low obstetric risk women still seek care in these hospitals, it is important to explore the factors that influence the childbirth experience in these hospitals, particularly, the concept of humanized birth care. The aim of this study was to explore the organizational and cultural factors, which act as barriers or facilitators in the provision of humanized obstetrical care in a highly specialized, university-affiliated hospital in Quebec province, in Canada. Methods A single case study design was chosen. The study sample included 17 professionals and administrators from different disciplines, and 157 women who gave birth in the hospital during the study. The data was collected through semi-structured interviews, field notes, participant observations, a self-administered questionnaire, documents, and archives. Both descriptive and qualitative deductive content analyses were performed and ethical considerations were respected. Results Both external and internal dimensions of a highly specialized hospital can facilitate or be a barrier to the humanization of birth care practices in such institutions, whether independently, or altogether. The greatest facilitating factors found were: caring and family- centered model of care, professionals' and administrators' ambient for the provision of humanized birth care besides the medical interventional care which is tailored to improve safety, assurance, and comfort for women and their children, facilities to provide a pain-free birth, companionship and visiting rules, dealing with the patients' spiritual and religious beliefs. The most cited barriers were: the shortage of health care professionals, the lack of sufficient communication among the professionals, the stakeholders' desire for specialization rather than humanization, over estimation of medical performance, finally the training environment of the hospital leading to the presence of too many health care professionals, and consequently, a lack of privacy and continuity of care. Conclusion The argument of medical intervention and technology at birth being an opposing factor to the humanization of birth was not seen to be an issue in the studied highly specialized university affiliated hospital. PMID:22114870

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

PubMed

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

2016-10-14

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

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal.

PubMed

Hasebrook, Joachim Paul; Hinkelmann, Jürgen; Volkert, Thomas; Rodde, Sibyll; Hahnenkamp, Klaus

2016-12-21

University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production ("industry 4.0") because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts' scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention. We expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones). All measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be presented at conferences and published in journals. ©Joachim Paul Hasebrook, Jürgen Hinkelmann, Thomas Volkert, Sibyll Rodde, Klaus Hahnenkamp. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 21.12.2016.

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

PubMed

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

2011-11-01

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

Remote telepresence surgery: the Canadian experience.

PubMed

Anvari, M

2007-04-01

On 28 February 2003, the world's first telerobotic surgical service was established between St. Joseph's Healthcare Hamilton, a teaching hospital affiliated with McMaster University, and North Bay General Hospital, a community hospital 400 km away. The service was designed to provide telerobotic surgery and assistance by expert surgeons to local surgeons in North Bay, and to improve the range and quality of advanced laparoscopic surgeries offered locally. The two surgeons have collaboratively performed 22 remote telepresence surgeries including laparoscopic fundoplications, laparoscopic colon resections, and laparoscopic inguinal hernia repairs. This article describes the important lessons learned, including the telecommunication requirements, the impact from lack of haptic feedback, surgeons' adaptation to latency, and ethical and medicolegal issues. This is currently the largest clinical experience with assisted robotic telepresence surgery (ARTS) in the world, and the lessons learned will help guide the future design and development of telesurgical robotic platforms. It also will guide the establishment of telesurgical networks connecting various centers in the world, allowing for rapid and safe dissemination of new surgical techniques.

A cross-cultural experience at midnight.

PubMed

Niimura, Junko

2013-04-01

This essay is a story about a cultural interaction between a Japanese mother and a Chinese young mother whose baby was premature. When I was staying in a hospital in Japan to deliver my second son, I shared a room with this mother. She delivered her baby very early-at 25 weeks of pregnancy. Her baby received extensive medical treatment in the neonatal intensive care unit. However, this Chinese young mother appeared bewildered about the communication from the Japanese hospital staff because Japanese hospital's communication about the medical care of premature infants was very different from China. One day at midnight, she spoke with me about having deep uneasiness about the situation and having many unanswered questions. After this cultural experience, I began to think more deeply about cultural differences in terms of health and illness and the influence of universal health insurance on the lives of the families of premature infants. I also recognized that the value of life is not calculated in the same fashion globally. © 2013 Wiley Publishing Asia Pty Ltd.

From Hypothermia to Cephalosomatic Anastomoses: The Legacy of Robert White (1926-2010) at Case Western Reserve University of Cleveland.

PubMed

Manjila, Sunil; Alambyan, Vilakshan; Singh, Gagandeep; Satish, Priyanka; Geertman, Robert T

2018-05-01

Dr. Robert J. White (1926-2010) was an eminent neurosurgeon and bioethicist, renowned for his classic work in hypothermia and pioneering mammalian head transplant experiments. He founded the Division of Neurosurgery at the Cleveland Metropolitan General Hospital (currently MetroHealth Medical Center, a level 1 trauma county hospital) and became the youngest full professor at the Case Western Reserve University in Cleveland, Ohio. With over 500 research articles to his credit, he founded the Brain Research Laboratory at what was then the Cleveland Metropolitan General Hospital, which was also home to future leaders in neurosurgery, neurosciences, and allied specialties. He transferred a healthy monkey head onto a surgically beheaded monkey body under deep hypothermic conditions drawing both laurels and criticisms alike. Despite a largely controversial neurosurgical research career, his original contributions to deep hypothermia have found profound clinical applications in modern trauma and vascular neurosurgery. The new fusogens and myelorrhaphy methods being tried in Europe hold promise for a future of reanastomosing 2 homologous or heterologous tracts in the neuraxis. Copyright © 2018 Elsevier Inc. All rights reserved.

The Regional Autopsy Center: The University of Alabama at Birmingham Experience.

PubMed

Atherton, Daniel Stephen; Reilly, Stephanie

2017-09-01

Rates of autopsied deaths have decreased significantly for the last several decades. It may not be practical for some institutions to maintain the facilities and staffing required to perform autopsies. In recent years, the University of Alabama at Birmingham (UAB) has established contracts to perform autopsies for several regional institutions including the Alabama Department of Forensic Sciences (ADFS), the United States Veterans Affairs, the local prison system, local community hospitals, and with families for private autopsy services. Contracts and autopsy data from 2004 to 2015 were obtained and reviewed. Since 2004, the number of UAB hospital autopsies trended slightly downward. On average, UAB hospital cases comprised most yearly cases, and the ADFS was the second largest contributor of cases. Income generated from outside autopsies performed from 2006 to 2015 totaled just more than 2 million dollars, and most of the income was generated from referred ADFS cases. This study provides evidence that a centralized institution (regional autopsy center [RAC]) can provide regional autopsy service in a practical, feasible, and economically viable manner, and a RAC can benefit both the referring institutions as well as the RAC itself.

PubMed Central

Farneti, P.; Cantore, S.; Macrì, G.; Chuchueva, N.; Cuffaro, L.; Pasquini, L.; Puxeddu, R.

2017-01-01

SUMMARY Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach. PMID:28516972

Managing change in health care institutions. The Austin experience 1973-1983.

PubMed

Price, I

1984-01-01

This article is written by Ian Price who was engaged as a consultant by the Austin Hospital in 1973 to conduct an organisation study. The result of his work was to establish a divisional organisation which integrated the University of Melbourne into the hospital management structure. His work set in train an extensive organisational development program which has become widely known and regarded in the hospital field. After an absence of nine years Ian Price has taken up an appointment with the Austin an Executive Assistant to the General Manager. This article summarises the process which he adopted and the rationale for the changes which were implemented. The article also presents a brief resume of these changes ten years on.

Improving communication between staff and disabled children in hospital wards: testing the feasibility of a training intervention developed through intervention mapping.

PubMed

Gumm, Rebecca; Thomas, Eleanor; Lloyd, Claire; Hambly, Helen; Tomlinson, Richard; Logan, Stuart; Morris, Christopher

2017-01-01

To develop and test the feasibility of a novel parent-inspired training intervention for hospital ward staff to improve communication with disabled children when inpatients. Training content and delivery strategies were informed by the iterative process of Intervention Mapping and developed in collaboration with parents of disabled children. UK University Hospital children's ward. 80 medical, nursing, allied health professionals, clerical and housekeeping staff on a children's ward. Themes identified in previous qualitative research formed the basis of the training. Learning objectives included prioritising communication, cultivating empathy, improving knowledge and developing confidence. Participant feedback was used to refine content and delivery. Intervention documentation adheres to the Template for Intervention Description and Replication checklist. Highlighting mandated National Health Service policies and involving the hospital Patient and Carer Experience Group facilitated management support for the training. Eighty staff participated in one of four 1-hour sessions. A paediatric registrar and nurse delivered sessions to mixed groups of staff. General feedback was very positive. The intervention, fully documented in a manual, includes videos of parent carers discussing hospital experiences, interactive tasks, small group discussion, personal reflection and intention planning. Generic and local resources were provided. It was feasible to deliver this new communication training to hospital ward staff and it was positively received. Early feedback was encouraging and indicates a commitment to behaviour change. Further piloting is required to establish the transferability of the intervention to other hospitals, followed by consideration of downstream markers to evaluate the effects on disabled children's inpatient experience. Organisational and cultural change is required to support individual behaviour change.

Healing environments in cancer treatment and care. Relations of space and practice in hematological cancer treatment.

PubMed

Høybye, Mette Terp

2013-02-01

Given the growing attention to the importance of design in shaping healing hospital environments this study extends the understanding of healing environments, beyond causal links between environmental exposure and health outcome by elucidating how environments and practices interrelate. The study was conducted as an ethnographic fieldwork from March 2011 to September 2011 at the Department of Haematology at Odense University Hospital, Denmark, systematically using participant observation and interviews as research strategies. It included 20 patients, four of who were followed closely over an extended time period. Through thematic analysis five key concepts emerged about the social dynamics of hospital environments: practices of self; creating personal space; social recognition; negotiating space; and ambiguity of space and care. Through these concepts, the study demonstrates how the hospital environment is a flow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients' sense of healing changes with the experience of progression in treatment and the capacity of the hospital space to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Healing environments are complex relations between practices, space and care, where recognition of the individual patient's needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive to the need for flexible spaces in hospitals that recognize the dynamics of healing, by providing individualized care, relating to the particular and changing needs of patients supporting their potential and their challenged condition with the best care possible.

[Teleradiology using uncompressed DICOM format via exclusive fiber-optic system].

PubMed

Okuda, Shigeo; Kuribayashi, Sachio; Hibi, Norihumi; Matsuura, Agato; Tani, Rie; Saga, Yasushi

2005-01-01

We developed a system for teleradiology using exclusive fiber optics for transferring images formatted in uncompressed DICOM. This system was built up with commercially available machines and software provided from various companies. We are now operating the system with five remote hospitals and have had one year of experience. The current system took advantage of the security and transfer efficiency of exclusive fiber optics. Uncompressed DICOM images were useful for the identification of cases and user-friendly for viewing. The reading room is located in our university hospital, and the location is convenient for consultation and discussion of cases.

[Disasters and emergency situations: what have we learned from the past to prepare for the future?].

PubMed

Peleg, Kobi

2010-07-01

Israel has gained extensive experience in the mass casuaLty field, especially from dealing with terrorism events. This special issue of "Harefuah" includes articles that describe and analyze several aspects and approaches related to mass casualty event (MCE) preparedness and response strategies, based on Israel's experience. Feigenberg reports that Magen David Adom (MDA) was able to evacuate all urgent injuries during an MCE from the site to a hospital in 28 minutes, on average. Of the MCE casualties, 71% were evacuated directly to level 1 trauma centers. Rafalowski notes that the ability of MDA to implement organizational and operational Learning processes close to the time of the incident, as well as their modular operational approach, which allows flexibility in responding to simultaneous events, are probably among the reasons that have helped MDA reach a high Level of success in dealing with MCEs. Analysis of terrorism injury data demonstrates that these injuries, suffered by both children and adults, are characterized by increased complexity, with higher severity, higher in-patient mortality rates, and significantly greater use of precious hospital resources such as intensive care, operating rooms, CT, and days of hospitalization. Extensive experience dealing with MCEs has brought managerial insights to the entire health system, for instance in the hospitalization system and clinical management of injuries. In her article, Adini defines five major components for assessing the Israeli health system in emergencies. Shasha's article discusses the principles of hospital preparedness while working under fire. The importance of this subject has in recent years helped bring a more academic approach to emergency and disaster management in the world and in Israel, as enacted at Tel Aviv University's Multidisciplinary Master's Program in Emergency and Disaster Management, and also in other universities that focus on specific disciplines. In summary, achieving improvement requires continuous focus on preparedness, integration of new technologies, routine debriefings, and developing new coping strategies, education, training, and drills. These should all be part of daily preparedness routines. Only in this way can a high quality level of preparedness be maintained over time.

["Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything." Protest masculinity and coping of "rebellious patients" at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization].

PubMed

Schwamm, Christoph

2015-01-01

This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.

Registry of Hospital Das Clínicas of the University of São Paulo Medical School: First Official Solid Organ and Tissue Transplantation Report – 2008

PubMed Central

Azeka, Estela; Auler Júnior, José Otavio Costa; Fernandes, Paulo Manuel Pego; Nahas, Willian Carlos; Fiorelli, Alfredo Inácio; Tannuri, Uenis; Cristofani, Lílian Maria; Caiero, Marcelo Tadeu; Dulley, Frederico Luiz; de Oliveira Paggiaro, André; Bacchella, Telesforo

2009-01-01

OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future. PMID:19219318

Hospital nurses' lived experiences of intelligent resilience: A phenomenological study.

PubMed

Imani, Behzad; Kermanshahi, Sima Mohamad Khan; Vanaki, Zohreh; Kazemnejad Lili, Anoshiravan

2018-05-01

To explore Iranian hospital nurses' lived experiences of intelligent resilience. Nurses do high levels of emotional work when fulfilling patients' and their family members' complex needs. Intelligent resilience can alleviate nurses' stress and enhance their endurance. This study was based on the Husserlian descriptive phenomenology. A purposive sample of ten hospital nurses was drawn from hospitals affiliated with Hamadan University of Medical Sciences, Hamadan, Iran. In-depth semi-structured interviews were held to collect data. The seven-step data analysis approach proposed by Colaizzi was used for the data analysis. In this study, the adherence to consolidated criteria for reporting qualitative guidelines has been followed. The participating hospital nurses' lived experiences of intelligent resilience came into four main themes of patience and wisdom, reverence, situational self-control and appealing to religiosity. Each of the four main themes included two subthemes which were having peace and wise quietness, reverence for the patients, physicians and nurses, distancing themselves from stressful situations and displacing staff who cause stress, and the nurse's trust in God as well as the patient and his family`s trust in God, respectively. Nurses with intelligent resilience are able to bring peace, reverence for others and situational self-control to stressors thereby providing higher quality of care to their patients. Nurses work in unstable and stressful conditions. The findings of this study provide better understanding about the concept of nurses' intelligent resilience and its indicators and attributes. © 2018 John Wiley & Sons Ltd.

Perception of interprofessional conflicts and interprofessional education by doctors and nurses.

PubMed

Lee, Young Hee; Ahn, Ducksun; Moon, Jooyoung; Han, KuemSun

2014-12-01

This study aimed to collect information that is needed to develop interprofessional education curricula by examining the current status of interprofessional conflicts and the demand for interprofessional education. A total of 95 doctors and 92 nurses in three university hospitals in Seoul responded to a survey that comprised questions on past experience with interprofessional conflicts, the causes and solutions of such conflicts, past experience with interprofessional education, and the demand for interprofessional education. We found that 86% of doctors and 62.6% of nurses had no interprofessional education experience. Most of them learned about the work of other health professions naturally through work experience, and many had experienced at least one interprofessional conflict. For doctors, the most popular method of resolving interprofessional conflicts was to let the event pass; for nurses, it was to inform the department head. Further, 41.5% of doctors and 56.7% of nurses expressed no knowledge of an official system for resolving interprofessional conflicts within the hospital, and 62.8% of doctors and 78.3% of nurses stated that they would participate in interprofessional education if the opportunity arose. In Korean hospital organizations, many doctors and nurses have experienced conflicts with other health professionals. By developing an appropriate curriculum and educational training system, the opportunities for health professionals to receive interprofessional education should expand.

Enhancing the strategic management of practice learning through the introduction of the role of Learning Environment Manager.

PubMed

Congdon, Graham; Baker, Tracey; Cheesman, Amanda

2013-03-01

This paper describes a process evaluation project designed to enhance the strategic management of practice learning within a large Hospital in the North of England. The aim of the project was to introduce the role of the Learning Environment Manager with dedicated responsibility for practice learning of undergraduate student nurses within the Hospital's 49 practice-settings. Whilst aspects of this role were already evident in several of these settings, the project sought to locate and standardise responsibilities related to the organisation and management of learning and teaching in practice explicitly within the existing staffing structure of each practice-setting. Focus group interviews were used to explore significant aspects of the project with key stakeholder groups comprising Learning Environment Managers, the Hospital Clinical Educator, Hospital Department Managers, Ward Managers, Mentors, University Link Lecturers and undergraduate Student Nurses. Interview data were analysed using thematic content analysis. The findings of the project suggest that the Learning Environment Manager role affords providers of practice learning with a robust approach to establish organisation-wide benchmarks that standardise the strategic management of practice learning in collaboration with partner Universities. The role incorporated many operational activities previously undertaken by the Hospital Clinical Educator, thus enabling the Hospital Clinical Educator to make a more strategic contribution to the on-going quality monitoring and enhancement of practice learning across the Hospital. The Learning Environment Manager role was found to provide mentors with high levels of support which in turn helped to promote consistent, positive and holistic practice learning experiences for undergraduate student nurses across the Hospital. Importantly, the role offers a potent catalyst for nurses in practice to regain responsibility for practice learning and re-establish the value of practice teaching. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

PubMed

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

2015-10-21

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

Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand.

PubMed

Annear, Peter Leslie; Kwon, Soonman; Lorenzoni, Luca; Duckett, Stephen; Huntington, Dale; Langenbrunner, John C; Murakami, Yuki; Shon, Changwoo; Xu, Ke

2018-05-07

Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an "Asian way to DRGs". We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand. We reviewed the design of case-based payment systems, their experience with implementation, evidence about impact on service delivery, and lessons drawn for the Asian region. We found that countries must first establish adequate infrastructure, human resource capacity and information management systems. Capping of volumes and prices is sometimes essential along with a high degree of hospital autonomy. Rather than introduce a complete classification system in one stroke, these countries have phased in DRGs, in some cases with hospitals volunteering to participate as a first step (Korea), and in others using a blend of different units for hospital payment, including length of stay, and fee-for-service (Japan). Case-based payment systems are not a panacea. Their value is dependent on their design and implementation and the capacity of the health system. Copyright © 2018 Elsevier B.V. All rights reserved.

Race trouble: experiences of Black medical specialist trainees in South Africa.

PubMed

Thackwell, Nicola; Swartz, Leslie; Dlamini, Sipho; Phahladira, Lebogang; Muloiwa, Rudzani; Chiliza, Bonginkosi

2016-12-03

This research aimed to identify and explore the experiences of Black registrars in their training in the Western Cape's academic hospitals in order to identify structures, practices, attitudes and ideologies that may promote or impede the advancement of Black doctors into specialist medicine. This is justified by the requirement for universities to work towards monitoring and evaluating efforts to create non-discriminatory and inclusive training environments. This study employed qualitative research methods. Ten Black African medical specialists were interviewed about their training experiences in two university training hospitals in the Western Cape Province, South Africa. Interview data was collected using open-ended questions and coded and analysed using thematic and critical discursive analysis techniques. Four experiential themes emerged from the interview data, they included: 1) experiences of everyday racism during work hours, 2) the physical and psychological effects of tokenism and an increased need to perform, 3) institutional racism as a result of inconsistent and unclear methods of promotion and clinical competence building, and 4) an organisational culture that was experienced as having a race and gender bias. This is a pilot study and there are limits on the generalizability of the data due to the small sample. What is clear from our participants, though, is the strong experiential component of finding it challenging to be a Black trainee in a White-dominated profession. We are undertaking further research to explore the issues raised in more detail.

Robert Shoemaker, PhD | Division of Cancer Prevention

Cancer.gov

Dr. Robert Shoemaker obtained his PhD in human genetics from the Graduate School of Public Health of the University of Pittsburgh in 1975. Following postdoctoral experience at the Armed Forces Institute of Pathology he moved to the Children's Hospital Medical Center of Akron. His research on pediatric tumors led to an interest in the genetics of drug resistance and new drug

A Program Handbook To Meet the Essential ESL and Literacy Needs of the Baking and Health Care Industries.

ERIC Educational Resources Information Center

Zane, Lawrence F. H.

This handbook contains guidelines for setting up a workplace literacy project through a partnership between business and an educational partner. It is based on the experiences of a workplace literacy partnership of Bakery Europa, Straub Clinic and Hospital, and the University of Hawaii. Information is provided on the following six topics: (1)…

[Patient's Experience with Living Donation: A Questionnaire-Based Survey of 144 Living Kidney Donors].

PubMed

Schieber, Katharina; Gaag, Sonja; Heller, Katharina; Erim, Yesim

2018-05-01

Living organ donation becomes more and more important as the number of patients needing organ transplantation is increasing. The University Hospital of Erlangen initiated a survey of living kidney donors to improve the process of living donation. The survey aimed to assess the donor's needs and experiences during the process of living kidney donation. From 2003 to 2014 n=199 living kidney donations were registered at the University Hospital of Erlangen. A total of n=144 living kidney donors (65.3% females, mean age M=58.7 years) participated in the study. In general, the majority of the living kidney donors were satisfied with the process of donation. Almost all of them (98%) confirmed to donate again, if it was possible. A large part of the living kidney donors denied any negative physical or psychological consequences of the donation. However, around 25% reported still physical problems for example wound healing, pain or long-term hypertension. Furthermore, a lack of pre- and post-operative psychological care or a regular medical follow-up care was reported. Thus, clinical practice needs to be further developed to meet the patient's needs. © Georg Thieme Verlag KG Stuttgart · New York.

Hospitals prepare plans, drill staff to ensure that potential Ebola patients are identified, isolated, and managed safely.

PubMed

2014-12-01

Hospitals around the country have stepped up their efforts to train staff and implement procedures to ensure the safe identification and management of any patients with signs of Ebola virus disease (EVD). Ronald Reagan UCLA Medical Center in Los Angeles, CA, held an "Ebola preparedness exercise" to give staff an opportunity to walk through the hospital's protocol for handling a simulated patient with EVD. The University of Alabama at Birmingham (UAB) Medical Center has held similar exercises, and is now holding twice-weekly meetings of its leadership team to make sure that all new developments in the Ebola outbreak are communicated. UCLA Medical Center has prepared PPE kits based on the practices developed at Emory University Hospital, which has thus far had the most experience in this country in caring for patients with EVD. The UCLA Health System has adjusted its medical record system so that a red flag is placed on the electronic medical record [EMR] of any patient who has recently traveled to a high-risk area. UAB Medical Center has incorporated what had been a paper-and-pencil screening tool for EVD into its electronic medical record. Training on PPE as well as EVD screening is being provided to first-responders and 911 call center dispatchers in the UAB system.

Harassment among university hospital physicians in four European cities. Results from a cross-sectional study in Norway, Sweden, Iceland and Italy (the HOUPE study).

PubMed

Andersen, Gunn Robstad; Aasland, Olaf Gjerlöw; Fridner, Ann; Lövseth, Lise Tevik

2010-01-01

The objective of this cross-national study was to identify work-related factors related to the prevalence of harassment, and identify potential similarities and differences in harassment levels and appointed perpetrators within the same professional group across four European cities. 2078 physicians working in university hospitals in Trondheim, Stockholm, Reykjavik, and Padova participated in the study. Questionnaire comprised items on direct and indirect experience of workplace harassment, appointed perpetrators, psychosocial work environment and basic socio-demographics. Harassment was found to be a relatively frequent work environment problem among physicians in all four European cities, with particular high levels in Padova. Role conflict, human resource primacy, empowerment leadership, and control over work pace were all found to be significantly related to workplace harassment. Differences in harassment prevalence and perpetrators indicated a cultural difference between the Italian and the Nordic hospitals. Harassment followed the line of command in Padova in contrast to being a horizontal phenomenon in the Scandinavian hospitals. This may be explained by national differences in organizational systems and traditions. In order to decrease harassment level and create a positive and productive work environment, each organization must employ different strategies in accordance with their harassment patterns.

Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial

PubMed Central

Ramsay, Pam; Huby, Guro; Merriweather, Judith; Salisbury, Lisa; Rattray, Janice; Griffith, David; Walsh, Timothy

2016-01-01

Objectives To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting Two university-affiliated hospitals in Scotland. Participants 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. Interventions A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. Outcome measures A novel PEQ capturing patient-reported aspects of quality care. Results The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated greater access to physiotherapy, nutritional care and information that cut across disciplinary boundaries and staffing constraints. Patients highly valued its individualisation according to their needs, abilities and preferences. Conclusions Case management by dedicated RAs improves patients' experiences of post-ICU hospital-based rehabilitation and increases perceived quality of care. Trial registration number ISRCTN09412438. PMID:27481624

The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital.

PubMed

Kim, Hongbeom; Chung, Jung Kee; Ahn, Young Joon; Lee, Hae Won; Jung, In Mok

2017-02-01

Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status. The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6-137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%. Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.

The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital

PubMed Central

Kim, Hongbeom; Chung, Jung Kee; Lee, Hae Won; Jung, In Mok

2017-01-01

Purpose Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. Methods From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status. Results The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6–137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%. Conclusion Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness. PMID:28203554

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

PubMed Central

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

2014-01-01

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

Considerations for clinics and practitioners treating foreign patients with assisted reproductive technology: lessons from experiences at Ghent University Hospital, Belgium.

PubMed

De Sutter, Petra

2011-11-01

Cross-border reproductive care (CBRC) is not a new concept, having been around since the beginning of assisted reproductive technology. Countries having taken the lead in developing new technologies have seen an influx of patients from other countries, because of legal limitations or the unavailability of good-quality care in their home country. This paper describes the experience of the Ghent University Hospital fertility centre with Dutch and French patients and tries to set out standards of care for CBRC patients. Dutch patients usually have longer histories, more complex pathology and are better informed, more outspoken and more financially secure. Thus, the care for these patients is challenging. The standards of care should be the same for local patients and CBRC patients; however, the nature of the complexity of the problems they come with will necessitate more time investment. Experience shows that many patients who have no access to treatment in their own country obtain reasonably good results. Some of them, however, are beyond possible help and these patients need a high standard of psychological care. All should be done to avoid that cross-border patients compromise the local care system. Special arrangements should be taken to manage possible complications following treatment. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

[Treatment regulations and treatment limits: factors influencing clinical decision-making].

PubMed

Baberg, H T; Kielstein, R; de Zeeuw, J; Sass, H-M

2002-08-02

Providing or withholding of treatment is based on a variety of factors. We sought for criteria in clinical decision making and reviewed attitudes towards clinical intuition and the patient's will. 503 physicians (25.6 % females; mean age 36.3) in 49 departments at nine hospitals of the universities Bochum and Magdeburg filled in a validated questionnaire. The most important factors in the decision to carry out a therapy were "international standards" and "own experience". The decision to omit a therapy was mainly influenced by the "patient's wish". Physicians with a higher status judged their own experience higher than young physicians, who considered the experience of colleagues more important. "Severe accompanying illnesses" and "multimorbidity" were the most frequently named reasons to withdraw a therapy. Intuitive decision-making was rare, especially in young physicians, although these decisions were seldom risky and often successful. A patient's will plays a prominent role in clinical decision making, especially in decisions to withdraw or to withhold treatment. Cost containment and research interest have been called less important, a remarkable response from research-based university hospitals. Also remarkable is the recognition and importance of clinical intuition in situations of complex or missing information. This important aspect is rarely discussed in the literature or in medical education. The widely voiced concern that priorities in clinical care are guided by scientific interest, financial or technical possibilities could not be confirmed.

Amniotic Membrane Transplantation in Reconstructive and Regenerative Ophthalmology.

PubMed

Röck, Tobias; Bartz-Schmidt, Karl Ulrich; Landenberger, Johanna; Bramkamp, Matthias; Röck, Daniel

2018-03-06

BACKGROUND The goal of this study was to investigate numbers, indications, surgical techniques, and experiences of amniotic membrane transplantation at the University Eye Hospital Tübingen over the last 16 years. MATERIAL AND METHODS Data from all amniotic membrane transplantations from January 2001 to December 2016 were retrospectively analyzed. Data was accessed from the electronic database and the annual reports of the Eye Bank at the University Eye Hospital Tübingen. RESULTS A total of 771 amniotic membrane transplantations were performed between 2001 and 2016 at the University Eye Hospital Tübingen. The mean number of amniotic membrane transplantations was 48 per year (range: 7-81). Overall, the mean number of amniotic membrane transplantations more than doubled, from 31 amniotic membrane transplantations per year during the first 8-year period to 66 amniotic membrane transplantations per year during the second 8-year period (p<0.0001). The most common surgical indications for amniotic membrane transplantation were corneal ulcers and persistent corneal epithelial defects. The inlay, overlay, and sandwich technique became the favored surgical methods for various disorders of the ocular surface. CONCLUSIONS Our study showed a significant increase of amniotic membrane transplantations from 2001 to 2016. This increase is likely influenced by the introduction of different surgical amniotic membrane transplantation techniques, the rising knowledge about containing growth factors, neurotrophins and cytokines, and the demographic change with aging of the population.

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

PubMed

Matsumoto, Akihisa

2007-11-01

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

[Construction and implementation of two quality indicators in nursing services].

PubMed

de Moura, Gisela Maria Schebela Souto; Juchem, Beatriz Cavalcanti; Falk, Maria Lucia Rodrigues; de Magalhães, Ana Maria Muller; Suzuki, Lyliam Midori

2009-03-01

Indicators monitor the quality of services and improve the attention offered to the patients. Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil, has been developing strategies to assess its services according to its institutional management policy of quality The present study aims to report the experience at this university hospital with the construction and implementation of quality indicators in its nursing services. In 2006, four indicators were established: incidence of pressure ulcer, with a goal of < or = 10:1000 patients per day/month and incidence of falls from bed whose goal was established as < or = 2:1000 patients per day/month. Our challenge was to build and implement these indicators as management tools to assess the quality of nursing services, for this is a large hospital.

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

DTIC Science & Technology

2012-01-01

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

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

PubMed

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

2015-01-01

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

Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study.

PubMed

Eassey, Daniela; Smith, Lorraine; Krass, Ines; McLAchlan, Andrew; Brien, Jo-Anne

2016-06-01

The aim of this study was to investigate the consumer's perspectives and experiences regarding medication related problems (MRPs) following discharge from hospital. A cross-sectional study was conducted using an online 80-question survey. Survey participants were recruited through an online market research company. Five hundred and six participants completed the survey. Participants were included if they were aged 50 years or older, taking 5 or more prescription medicines, had been admitted to hospital with a minimum stay of 24 h, admitted to hospital within the last 4 months and discharged from hospital within the last 1 month. The survey comprised questions measuring: health literacy, health status, medication safety (measured by reported MRPs), missed dose(s), role of health professionals, health services and cost, and socio-demographic status. Descriptive and univariate statistics and logistic regression analysis was performed to examine the predictors of experiencing MRPs. Four main risk factors of MRPs emerged as significant: health literacy (P < 0.05), health status (P < 0.05), consumer engagement (P < 0.05) and cost of medicines (P = 0.001). Participants reporting a lack of perceived control over their medicines (OR 6.3; 95% CI: 3.4-11.8) or those who played less of a role in follow-up discussions with their healthcare professionals (OR 7.6; 95% CI: 1.3-45.7) were more likely to experience a self-reported MRP. This study provides insight into consumers' experiences and perceptions of self-reported MRPs following hospital discharge. Results highlight novel findings demonstrating the importance of consumer engagement in developing processes to ensure medication safety on patient discharge. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

The 'indirect costs' of underfunding foreign partners in global health research: A case study.

PubMed

Crane, Johanna T; Andia Biraro, Irene; Fouad, Tamer M; Boum, Yap; R Bangsberg, David

2017-09-16

This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work. MGH: Massachusetts General Hospital; MUST: Mbarara University of Science and Technology; NIH: National Institutes of Health; UCSF: University of California San Francisco; URI: Uganda Research Institute.

Making collaboration work.

PubMed

Sims, Alison

2016-10-07

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

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

PubMed

Miyamoto, Katsuichi

2013-01-01

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

Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members.

PubMed

Nyborg, Ingrid; Danbolt, Lars Johan; Kirkevold, Marit

2017-08-31

The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family's perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives' opportunities to exert influence. The aim of the study was to explore relatives' experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives' age. This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients. The relatives' experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older "invisible" carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers' experiences of influencing decisions with the help of professionals. Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives' age sets terms for opportunities to participate.

Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.

PubMed

Friman, S; Nordén, G; Lennerling, A; Fehrman-Ekholm, I; Felldin, M; Hansson, S; Rydberg, L; Holgersson, J; Rizell, M; Kvarnström, N; Gustafsson, B; Gäbel, M; Olausson, M; Mjörnstedt, L

2011-01-01

The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.

No Mountains...Nor Seashore...Just Hoosier Hospitality: An Elderhostel Case Study at Ball State University.

ERIC Educational Resources Information Center

Murk, Peter J.

The Elderhostel program has provided many older persons with a stimulating learning experience at colleges throughout the United States and 46 other countries since its beginning in 1975. Participants in Elderhostel--who usually are retired, are more likely to be women than men, and range in age from 60 to the mid-90s--study topics of interest to…

Nurse awareness of clinical research: a survey in a Japanese University Hospital

PubMed Central

2014-01-01

Background Clinical research plays an important role in establishing new treatments and improving the quality of medical practice. Since the introduction of the concept of clinical research coordinators (CRC) in Japan, investigators and CRC work as a clinical research team that coordinates with other professionals in clinical trials leading to drug approval (registration trials). Although clinical nurses collaborate with clinical research teams, extended clinical research teams that include clinical nurses may contribute to the ethical and scientific pursuit of clinical research. Methods As knowledge of clinical research is essential for establishing an extended clinical research team, we used questionnaires to survey the knowledge of clinical nurses at Tokushima University Hospital. Five-point and two-point scales were used. Questions as for various experiences were also included and the relationship between awareness and experiences were analyzed. Results Among the 597 nurses at Tokushima University Hospital, 453 (75.9%) responded to the questionnaires. In Japan, registration trials are regulated by pharmaceutical affairs laws, whereas other types of investigator-initiated research (clinical research) are conducted based on ethical guidelines outlined by the ministries of Japan. Approximately 90% of respondents were aware of registration trials and clinical research, but less than 40% of the nurses were aware of their difference. In clinical research terminology, most respondents were aware of informed consent and related issues, but ≤50% were aware of other things, such as the Declaration of Helsinki, ethical guidelines, Good Clinical Practice, institutional review boards, and ethics committees. We found no specific tendency in the relationship between awareness and past experiences, such as nursing patients who were participating in registration trials and/or clinical research or taking a part in research involving patients as a nursing student or a nurse. Conclusions These findings suggest that clinical nurses have only limited knowledge on clinical research and the importance to have chances to make nurses aware of clinical research-related issues is suggested to establish an extended research team. Because of the study limitations, further study is warranted to determine the role of clinical nurses in establishing a suitable infrastructure for ethical pursuit of clinical research. PMID:24989623

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

PubMed

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

2017-02-01

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

Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China.

PubMed

Zhu, Ling-Ling; Li, Wei; Song, Ping; Zhou, Quan

2014-01-01

The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan-do-check-act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety.

Universal Health Coverage and Primary Healthcare: Lessons From Japan

PubMed Central

Bloom, Gerald

2017-01-01

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. PMID:28812806

Course experiences, satisfaction and career intent of final year pre-registration Australian pharmacy students

PubMed Central

Shen, Grace; Fois, Romano; Nissen, Lisa; Saini, Bandana

2013-01-01

Background In Australia, the profession of pharmacy has undergone many changes to adapt to the needs of the community. In recent years, concerns have been raised with evidence emerging of workforce saturation in traditional pharmacy practice sectors. It is not known how current final year pharmacy students’ perceive the different pharmacy career paths in this changing environment. Hence investigating students’ current experiences with their pharmacy course, interaction with the profession and developing an understanding of their career intentions would be an important step, as these students would make up a large proportion of future pharmacy workforce. Objective The objective of this study was thus to investigate final year students’ career perspectives and the reasons for choosing pharmacy, satisfaction with this choice of pharmacy as a tertiary course and a possible future career, factors affecting satisfaction and intention of future career paths. Methods A quantitative cross sectional survey of final year students from 3 Australian universities followed by a qualitative semi-structured interview of a convenience sample of final year students from the University of Sydney. Results ‘Interest in health and medicine’ was the most important reason for choosing pharmacy (n=238). The majority of students were ‘somewhat satisfied’ with the choice of pharmacy (35.7%) as a course and possible future career. Positive associations were found between satisfaction and reasons for joining pharmacy such as ‘felt pharmacy is a good profession’ (p=0.003) while negative associations included ‘joined pharmacy as a gateway to medicine or dentistry’ (p=0.001). Quantitate and qualitative results showed the most frequent perception of community pharmacy was ‘changing’ while hospital and pharmaceutical industry was described as ‘competitive’ and ‘research’ respectively. The highest career intention was community followed by hospital pharmacy. Conclusion Complex factors including university experiences are involved in shaping students’ satisfaction and perception of career. This may relate to challenges in the community pharmacy sector, job opportunities in hospital and limited understanding of the pharmaceutical industry. The results offer insight for the profession in terms of entry into various roles and also to pharmacy educators for their roles in shaping curricula and placement experiences that attract future graduates to defined career pathways in pharmacy. PMID:25035715

Medical Errors and Barriers to Reporting in Ten Hospitals in Southern Iran

PubMed Central

Khammarnia, Mohammad; Ravangard, Ramin; Barfar, Eshagh; Setoodehzadeh, Fatemeh

2015-01-01

Background: International research shows that medical errors (MEs) are a major threat to patient safety. The present study aimed to describe MEs and barriers to reporting them in Shiraz public hospitals, Iran. Methods: A cross-sectional, retrospective study was conducted in 10 Shiraz public hospitals in the south of Iran, 2013. Using the standardised checklist of Shiraz University of Medical Sciences (referred to the Clinical Governance Department and recorded documentations) and Uribe questionnaire, we gathered the data in the hospitals. Results: A total of 4379 MEs were recorded in 10 hospitals. The highest frequency (27.1%) was related to systematic errors. Besides, most of the errors had occurred in the largest hospital (54.9%), internal wards (36.3%), and morning shifts (55.0%). The results revealed a significant association between the MEs and wards and hospitals (p < 0.001). Moreover, individual and organisational factors were the barriers to reporting ME in the studied hospitals. Also, a significant correlation was observed between the ME reporting barriers and the participants’ job experiences (p < 0.001). Conclusion: The medical errors were highly frequent in the studied hospitals especially in the larger hospitals, morning shift and in the nursing practice. Moreover, individual and organisational factors were considered as the barriers to reporting MEs. PMID:28729811

ATACHI. Astronomy activities and workshops for hospitalized children

NASA Astrophysics Data System (ADS)

Alonso-Floriano, F. J.; Cortés-Contreras, M.; Pereira, V.

2015-05-01

Atachi is an educational project aimed to disclose the Astronomy among hospitalized children between 3 and 16 years old, who remain for short and long periods in the Niño Jesús and 12 de Octubre hospitals of Madrid. With the financial support of the Sociedad Española de Astronomía (SEA) and the help provided by the hospitals, we have introduced Astronomy activities in the educational projects of the hospitals with workshops adapted to the ages and capabilities of the hospitalized children. These workshops have been very welcome from the staff of each center and from the parents, who also showed interest and participated in the activities. But above all, from the children, who tried to take apart their illness and showed great interest and curiosity about Astronomy, which helped to power their imagination and to learn more about our Solar System, the Milky Way and the Universe. On the other hand, this project led to a publication in the ``Astronomía" review, which enhances the divulgation interest of this project, which corresponds to the very positive experience that has resulted for us.

Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake

PubMed Central

Bulut, M; Fedakar, R; Akkose, S; Akgoz, S; Ozguc, H; Tokyay, R

2005-01-01

Objectives: This study aimed to provide an overview of morbidity and mortality among patients admitted to the Hospital of the Medicine Faculty of Uludag University, Bursa, Turkey, after the 1999 Marmara earthquake. Methods: Retrospective analysis of the medical records of 645 earthquake victims. Patients' demographic data, diagnosis, dispositions, and prognosis were reviewed. Results: A total of 330 patients with earthquake related injuries and illness admitted to our hospital were included and divided into three main groups: crush syndrome (n = 110), vital organ injuries (n = 57), and non-traumatic but earthquake related illness (n = 55). Seventy seven per cent of patients were hospitalised during the first three days after the earthquake. The rate of mortality associated with the crush syndrome, vital organ injury, and non-traumatic medical problems was 21% (23/110), 17.5% (10/57), and 9% (5/55), respectively. The overall mortality rate was 8% (50/645). Conclusions: In the first 24–48 hours after a major earthquake, hospital emergency departments are flooded with large numbers of patients. Among this patient load, those patients with crush syndrome or vital organ injuries are particularly at risk. Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality. It is hoped that this review of the challenges met after the Marmara earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disasters. PMID:15983085

Does medicine still show an unresolved discrimination against women? Experience in two European university hospitals.

PubMed

Santamaría, A; Merino, A; Viñas, O; Arrizabalaga, P

2009-02-01

Have invisible barriers for women been broken in 2007, or do we still have to break through medicine's glass ceiling? Data from two of the most prestigious university hospitals in Barcelona with 700-800 beds, Hospital Clínic (HC) and Hospital de la Santa Creu i Sant Pau (HSCSP) address this issue. In the HSCSP, 87% of the department chairs are men and 85% of the department unit chiefs are also men. With respect to women, only 5 (13%) are in the top position (department chair) and 4 (15%) are department unit chiefs. Similar statistics are also found at the HC: 87% of the department chairs and 89% of the department unit chiefs are men. Currently, only 6 women (13%) are in the top position and 6 (11%) are department unit chiefs. Analysis of the 2002 data of internal promotions in HC showed that for the first level (senior specialist) sex distribution was similar. Nevertheless, for the second level (consultant) only 25% were women, and for the top level (senior consultant) only 8% were women. These proportions have not changed in 2007 in spite of a 10% increase in leadership positions during this period. Similar proportions were found in HSCSP where 68% of the top promotions were held by men. The data obtained from these two different medical institutions in Barcelona are probably representative of other hospitals in Spain. It would be ethically desirable to have males and females in leadership positions in the medical profession.

[A paradigm change in German academic medicine. Merger and privatization as exemplified with the university hospitals in Marburg and Giessen].

PubMed

Maisch, Bernhard

2005-03-01

1. The intended fusion of the university hospitals Marburg and Giessen in the state of Hessia is "a marriage under pressure with uncalculated risk" (Spiegel 2005). In the present political and financial situation it hardly appears to be avoidable. From the point of the view of the faculty of medicine in Marburg it is difficult to understand, that the profits of this well guided university hospital with a positive yearly budget should go to the neighboring university hospital which still had a fair amount of deficit spending in the last years.2. Both medical faculties suffer from a very low budget from the state of Hessia for research and teaching. Giessen much more than Marburg, have a substantial need for investments in buildings and infrastructure. Both institutions have a similar need for investments in costly medical apparatuses. This is a problem, which many university hospitals face nowadays.3. The intended privatisation of one or both university hospitals will need sound answers to several fundamental questions and problems:a) A privatisation potentially endangers the freedom of research and teaching garanteed by the German constitution. A private company will undoubtedly influence by active or missing additional support the direction of research in the respective academic institution. An example is the priorisation of clinical in contrast to basic research.b) With the privatisation practical absurdities in the separation of research and teaching on one side and hospital care on the other will become obvious with respect to the status of the academic employees, the obligatory taxation (16%) when a transfer of labor from one institution to the other is taken into account. The use of rooms for seminars, lectures and bedside with a double function for both teaching, research and hospital care has to be clarified with a convincing solution in everyday practice.c) The potential additional acquisition of patients, which has been advocated by the Hessian state government, may be unrealistic, when the 4th biggest university hospital in Germany will be created by the merger. University hospitals recrute the patients for high end medicine beyond their region because of the specialized academic competence and advanced technical possibilities. Additional recruitment of patients for routine hospital can hardly be expected.d) A private management will have to consider primarily the "shareholder value", even when investing in infrastructure and buildings, as it can be expected for one partner. On the longterm this will not be possible without a substantial reduction of employees in both institutions. There are, however, also substantial efforts of some private hospital chains in clinical research, e. g. by Helios in Berlin and Rhön Gmbh at the Leipzig Heart Center.e) There is a yet underestimated but very substantial risk because of the taxation for the private owner when academic staff is transferred from the university to hospital care in their dual function as academic teachers and doctors. This risk also applies for the university if the transfer should come from hospital to the university. These costs would add to the financial burden, which has to be carried in addition to the DRGs.

Personalized Medicine and Adverse Drug Reactions: The Experience of An Italian Teaching Hospital.

PubMed

La Russa, Raffaele; Finesch, Vittorio; Di Sanzo, Mariantonia; Gatto, Vittorio; Santurro, Alessandro; Martini, Gabriella; Scopetti, Matteo; Frati, Paola

2017-01-01

The personalized medicine is a model of medicine based on inherent difference given by the genetic heritage that characterizes us, diversity that can affect also our response to administered therapy. Nowadays, the term "adverse drug reaction" is identified with any harmful effect involuntary resulting from the use of a medicinal product; pharmacogenomics, in this field, has the aim to improve the drug response and to reduce the adverse reaction. We analyzed all reports of adverse reaction collected in the Pharmacovigilance Centre database of an Italian University Hospital, at the Sant'Andrea Hospital Sapienza University of Rome, in a period of two years. Comparing the data result from our analysis with several studies found in literature, it is evident that adverse drug reactions represent an important problem in the management of a health care system. However, the development of pharmacogenetics and pharmacogenomics, allowing a personalized treatment, can improve clinical practice. This study highlights the great potential of pharmacogenomics in reducing adverse reactions and suggests the need for further pharmacogenomic clinical trials to better personalize drug treatment and to refine the current pharmacovigilance strategies. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Hospitality Major Vocational High School Students' Expectations on University Education

ERIC Educational Resources Information Center

Chung, Ya-Ting; Yang, Cheng-Cheng

2013-01-01

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

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

ERIC Educational Resources Information Center

Pongpirul, Krit

2011-01-01

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

Apatinib for advanced sarcoma: results from multiple institutions' off-label use in China.

PubMed

Xie, Lu; Guo, Wei; Wang, Ye; Yan, Taiqiang; Ji, Tao; Xu, Jie

2018-04-06

Anti-angiogenesis Tyrosine kinase inhibitors (TKIs) have been proved to show promising effects on prolonging progression-free survival (PFS) for advanced sarcoma after failure of standard multimodal Therapy. Methylsulfonic apatinib is one of those TKIs which specifically inhibits VEGFR-2. This paper summarizes the experience of three Peking University affiliated hospitals in off-label use of apatinib in the treatment of extensively pre-treated sarcoma. We retrospectively analysed files of patients with advanced sarcoma not amenable to curative treatment, who were receiving an apatinib-containing regimen between June 1, 2015 and December 1, 2016. Fifty-six patients were included: 22 osteosarcoma, 10 Ewing's sarcoma, 3 chondrosarcoma and 21 soft tissue sarcoma. With median follow-up time of 6 months (range, 0.7-18.0 m), thirty-five (62.5%) patients had partial response, and disease was stable in 11 (19.6%). The 4-month and 6-month progression-free survival rates were 46.3 and 36.5%, respectively. The median duration of response was 3.8 months (95% CI 1.9-5.6 m), with much variability among disease subtypes. The median overall survival was 9.9 months (95% CI 7.6-12.2 m). Grade 3 and 4 toxicities were observed in 8 (14.3%) patients, the most common being hypertension, pneumothorax, wound-healing problems, anorexia, and rash or desquamation. Apatinib might be effective, with a high objective response rate, in an off-label study of sarcoma patients with advanced, previously treated disease. The duration of response was consistent with reports in different subtypes of sarcomas. Prospective trials of apatinib in the treatment of selected subtypes of sarcomas are needed. Retrospectively registered in the Medical Ethics Committee of Peking University People's Hospital, Peking University Shougang Hospital and Peking University International Hospital. The trial registration number is 2017PHB176-03 and the date of registration is January 20th 2017.

What affects local community hospitals' survival in turbulent times?

PubMed

Chiang, Hung-Che; Wang, Shiow-Ing

2015-06-01

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

Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient

PubMed Central

Minderhoud, A.L.C. (Ben); Wind, Jelte D.D.; Leenen, Luke P.H.; Hoepelman, Andy I.M.; Ellerbroek, Pauline M.

2016-01-01

The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital’s preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery. PMID:26812146

Interprofessional student clinics: an economic evaluation of collaborative clinical placement education.

PubMed

Haines, Terry P; Kent, Fiona; Keating, Jennifer L

2014-07-01

Interprofessional student clinics can be used to create clinical education placements for health professional students in addition to traditional hospital-based placements and present an opportunity to provide interprofessional learning experiences in a clinical context. To date, little consideration has been given in research literature as to whether such clinics are economically viable for a university to run. We conducted an economic evaluation based upon data generated during a pilot of an interprofessional student clinic based in Australia. Cost-minimization analyses of the student clinic as opposed to traditional profession-specific clinical education in hospitals were conducted from university, Commonwealth Government, state government and societal perspectives. Cost data gathered during the pilot study and market prices were used where available, while $AUD currency at 2011 values were used. Per student day of clinical education, the student clinic cost an additional $289, whereas the state government saved $49 and the Commonwealth Government saved $66. Overall, society paid an additional $175 per student day of clinical education using the student clinic as opposed to conventional hospital-based placements, indicating that traditional hospital-based placements are a cost-minimizing approach overall for providing clinical education. Although interprofessional student clinics have reported positive patient and student learning outcomes, further research is required to determine if these benefits can justify the additional cost of this model of education. Considerations for clinic sustainability are proposed.

[What is the impact of education and training on flexible nursing management? Experiences from a tertiary care hospital].

PubMed

Lux, V

2013-08-01

Healthcare reforms and new legislations have a significant impact on patient care. New and more complex treatment designs and technologies are a great challenge for allied healthcare professionals. There is a growing demand for qualified allied healthcare professionals to increase productivity and to perform complex therapeutic regimens. Since recruitment of specialized healthcare workers is difficult, the University Hospital of Cologne arranges various training programs for allied healthcare staff. We provide more than 500 apprenticeship positions, 225 for nurses. Currently, 216 nursing students have been enrolled; thus, we have reached a 96 % capacity and could again improve last year's results. Some of our graduates continue their career in an academic course of study at university or a university of applied science. In this way nursing management loses qualified and dedicated employees at the bedside. In order to offer attractive alternatives to an academic course, it is important to complement basic education with advanced training and specialization. Traditional in-house education, basic as well as advanced training, is still the primary means to recruit qualified healthcare workers. Nursing management, therefore, still relies on this important strategic instrument for the recruitment and retention of staff.

Factors influencing nurses' attitudes toward simulation-based education.

PubMed

Decarlo, Deborah; Collingridge, Dave S; Grant, Carrie; Ventre, Kathleen M

2008-01-01

To identify barriers to nurses' participation in simulation, and to determine whether prior simulation exposure, professional experience, and practice location influence their tendency to perceive specific issues as barriers. We also sought to identify nurses' educational priorities, and to determine whether these were influenced by years of experience or practice location. We surveyed full-time and part-time nurses in a university-affiliated children's hospital to gather data on professional demographics, simulation exposure, perceived barriers to participation in simulation, and training priorities. A total of 523 of 936 (56%) eligible nurses completed the survey. Binary logistic regression analysis revealed that "simulation is 'not the real thing'" was selected as a barrier more often by nurses with prior simulation experience (P = 0.02), fewer years in practice (P = 0.02), and employment in non-acute care areas of the hospital (P = 0.03). "Unfamiliarity with equipment" was reported more often by nurses with less experience (P = 0.01). "Stressful or intimidating environment" was selected more often by those who work in non-acute care areas (P < 0.01). "Providing opportunities to manage rare events" was suggested as a training priority by nurses with less experience (P = 0.08) and by those practicing in acute care areas (P = 0.03). We identified several barriers to nurses' participation in simulation training. Nurses' tendency to name specific issues as barriers is related to prior simulation exposure, years of experience, and area of hospital practice. Rehearsing rare event management is a priority for less-experienced nurses and those in acute care areas.

Staff rotation: implications for occupational therapy.

PubMed

Taylor, A; Andriuk, M L; Langlois, P; Provost, E

1995-10-01

Occupational therapy departments of tertiary care hospitals can provide staff with opportunities to gain diverse clinical experience if they rotate through the various services such as surgery, medicine, geriatrics, plastic surgery and orthopaedics. The system of rotation offers both advantages and disadvantages for the staff and the institution. The Royal Victoria Hospital in Montreal, a large university teaching hospital, had traditionally offered staff the opportunity to rotate. Changes in staffing and their needs however, resulted in rotation becoming an important issue within the department. This article presents the pros and the cons of rotation and non-rotation systems as identified by therapists and administrators across Canada. Staff rotation was found to have an effect on job satisfaction and a therapist's career orientation. Given these findings, administrators may want to reconsider the role of the generalist and specialist in their facilities.

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease.

PubMed

Gutierrez, Ana Luiza; Binda, Márcia Luisa Montalvão Appel; Ramos, José Geraldo Lopes

2016-09-01

Objectives  To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil. Methods  A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected. Results  The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI ( r  = 0.670; p  = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI ( r  = 0.468; p  = 0.037). A learning curve was observed during docking and undocking times. Conclusion  Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Determining the agent factors related with time management of responsible doctors and nurses in clinics at Ankara University hospitals.

PubMed

Acuner, Ahmet Munir; Nilgun, Sarp; Cifteli, F Gulay

2006-01-01

This research has been planned and conducted as a descriptive scanning model field study in order to determine the agent factors related with time management of doctors and nurses in positions of responsibility at Ankara University hospitals. As data collection instruments; the "Personal Information Form" which has been developed to determine the socio-demographical characteristics of the research group, the questionnaire of "Determining the Time Management Attitudes and Behaviour of Managers, Time Management Opportunities of the Managers, Prodcutive Working Times of the Managers and the Factors Causing Them to Lose Time", developed by Erdem has been used. It has been determined that the time management attitudes and behaviour of doctors, nurses and nurse assistants responsible for clinics are all different. It was found that nurse assistants graduated from pre-undergraduate or high schools are the least conscious of time management. In particular, nurse assistants of 36 years old and over with 21 years of work experience and 11 years of management experience show little awareness of time management. The time losing factors of the research group were found to be unnecessary visitors, lack of materials and the excessive amount of time spent on obtaining the necessary equipment.

Dental anxiety in patients seeking care at the University Dental Hospital in Sri Lanka.

PubMed

Ekanayake, L; Dharmawardena, D

2003-06-01

The purpose of the study was to determine the prevalence and factors affecting dental anxiety in patients seeking dental care. A cross sectional study. 503 first visit patients attending the University Dental Hospital in Peradeniya, Sri Lanka. Corah's dental anxiety scale was used to assess the dental anxiety in these patients. The prevalence of dental anxiety was 32% (DAS score > or = 12) while 12% were considered to be extremely anxious (DAS score > or = 15). Females were found to be more dentally anxious than males. Level of education was associated with dental anxiety. Problem oriented attenders had a significantly higher mean DAS score than regular attenders. Those who had an extraction at the last dental visit were significantly more dentally anxious than those who had a restoration/scaling. Negative dental experience was not associated with dental anxiety. The logistic regression model revealed that gender, level of education and 'fear' which was cited as the reason for the delay in seeking care for the presenting complaint were significant predictors of dental anxiety. However, only 4% of the variation in dental anxiety could be explained by these independent variables. Socio-demographic factors and variables related to past dental experiences had a limited influence in explaining dental anxiety in this sample of dental patients.

Pioneering efforts for minority appointments and academic surgery. A narrative.

PubMed

Southwick, W O

1999-05-01

The author gives a narrative chronologic explanation for the early inclusion of African Americans and other minorities into the Yale University Orthopaedic Surgical Residency Training Program. The author's early isolation from racial problems living in rural Nebraska and the paucity of racial friction at the University of Nebraska gave him a more neutral or positive view of other cultures. Sudden exposure to the racial tension and police brutality toward African Americans in Boston followed by the well defined racial bias in the Southern city of Baltimore showed the plight of minorities. At that same time the author encountered many gentle and extremely intelligent African Americans who performed outstanding medical tasks for the Johns Hopkins Hospital hospital with little educational background. The author's experience with Shirley Moore and Augustus White at Yale made it possible to recruit a diverse group of gifted and loyal resident staff. The high number of academic appointments in minority and majority residents has evolved from the Academic Training and Research Program and a special selection process for choosing residents.

[Introduction of computerized anesthesia-recording systems and construction of comprehensive medical information network for patients undergoing surgery in the University of Tokyo Hospital].

PubMed

Kitamura, Takayuki; Hoshimoto, Hiroyuki; Yamada, Yoshitsugu

2009-10-01

The computerized anesthesia-recording systems are expensive and the introduction of the systems takes time and requires huge effort. Generally speaking, the efficacy of the computerized anesthesia-recording systems on the anesthetic managements is focused on the ability to automatically input data from the monitors to the anesthetic records, and tends to be underestimated. However, once the computerized anesthesia-recording systems are integrated into the medical information network, several features, which definitely contribute to improve the quality of the anesthetic management, can be developed; for example, to prevent misidentification of patients, to prevent mistakes related to blood transfusion, and to protect patients' personal information. Here we describe our experiences of the introduction of the computerized anesthesia-recording systems and the construction of the comprehensive medical information network for patients undergoing surgery in The University of Tokyo Hospital. We also discuss possible efficacy of the comprehensive medical information network for patients during surgery under anesthetic managements.

Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital's intercultural consultation.

PubMed

Sturm, Gesine; Guerraoui, Zohra; Bonnet, Sylvie; Gouzvinski, Françoise; Raynaud, Jean-Philippe

2017-08-01

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

[Litigation in obstetrics and gynaecology: experience of a university hospital in France].

PubMed

Shojai, R; Bretelle, F; D'Ercole, C; Boubli, L; Piercecchi, M-D

2013-02-01

To analyse the nature of medico-legal claims in a high-risk speciality. Retrospective review of the causes of medico-legal disputes at the department of Obstetrics and Gynaecology of the North University Hospital of Marseilles between November 1997 and December 2010. Disputes were defined by complaints, judicial or conciliatory claims and intentional declaration of potential medico-legal case by physicians. Fifty-nine controversial medico-legal cases were identified within this 13-year period. Ninety percent (n=53) of cases concerned obstetrics and 10% (n=6) gynaecology. The rate of litigations tripled in a decade. Half of the litigations led to judicial or conciliatory expertise. The average rate of malpractice litigations was 2.4 per physician. Uterine rupture was the most common cause of complaints. Increased awareness of the nature of litigations may help elaborate risk reduction management programs in order to reduce professional liability on the long run. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Burnout among physicians and nursing staff working in the emergency hospital of Tanta University, Egypt.

PubMed

Abdo, S A M; El-Sallamy, R M; El-Sherbiny, A A M; Kabbash, I A

2016-03-15

Little is known about professional burnout among health-care workers in Egypt. The current study aimed to reveal the extent of burnout among physicians and nursing staff working in the emergency hospital of Tanta University and to identify some of its determinants. A cross-sectional study was carried out on all physicians (n = 266) and a systematic random sample of nurses (n = 284). Burnout was assessed using the Maslach Burnout Inventory and its subscales. Most of the participants (66.0%)had a moderate level of burnout and 24.9% of them had high burnout. Multivariate analysis of variables affecting burnout showed that age, sex, frequency of exposure to work-related violence, years of experience, work burden, supervision and work activities were significant predictors of burnout among the respondents. The authors recommend health education interventions during pre-employment training programmes for prevention of burnout syndrome and periodic screening for early detection and management of burnout.

Clean, fast and preserving normal anatomy: "the Helsinki revolution" in microneurosurgery.

PubMed

Velasquez, Joham C; Lau, Jane; Kozyrev, Danil; Sharafeddin, Fransua; Colasanti, Roberto; Luostarinen, Teemu; Hernesniemi, Juha

2016-03-01

After the senior author took chairmanship in Helsinki University Hospital in, he led the department into making neurosurgical operations much faster, safer and workflow more efficient, and at the same time maintaining high surgical quality and results. The aim was to describe the philosophies and style of Helsinki Microneurosurgery. The philosophies of Helsinki Neurosurgery are categorized into two concepts: The operation room TEAM concept and the main principle "Simple, clean, fast and respecting the normal anatomy". The way to be efficient is to find good methods based on logic, reason and experience. Specific and systematic procedures before the microneurosurgery followed by high quality skills under the microscope are of utmost importance. Moreover, intraoperatively, neuroanesthesia has to provide good surgical conditions. Today, Helsinki University Central hospital Department of Neurosurgery has an annual workflow 3500 neurosurgical operations. We believe that microneurosurgical treatment remains to be important for years ahead, and neurosurgeons of great hearts, minds and skills are welcomed all over the world.

A MedlinePlus® Kiosk Promoting Health Literacy

PubMed Central

TEOLIS, MARILYN G.

2010-01-01

As an ongoing community outreach project, a pictorial touch-screen kiosk and Web site was developed for 48 MedlinePlus® tutorials. This learning experience serves Davidson County, Tennessee’s uninsured patients at the University of Tennessee/Baptist Hospital’s Internal Medicine Clinic. The availability of a health information kiosk at the University of Tennessee/Baptist Hospital primary care clinic significantly increases health literacy for patients by providing reliable, physician-recommended information in an appropriate format—information these patients did not previously find readily available. Participants report they have a greater understanding of their health issues, and the project is introducing hundreds of patients to MedlinePlus. PMID:20808715

Developing academic surgery in a socialized health care system: a 35-year experience.

PubMed

Duranceau, Andre; Martin, Jocelyne; Liberman, Moishe; Ferraro, Pasquale

2012-07-01

The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.

[The impact of preoperative stoma siting and stoma care education on patient's quality of life].

PubMed

Gulbiniene, Jurgita; Markelis, Rytis; Tamelis, Algimantas; Saladzinskas, Zilvinas

2004-01-01

The aim of study was to assess if preoperative stoma selection and adequate patient's teaching can affect the postoperative patient's quality of life. The study was performed in two university hospitals of Lithuania: Kaunas University of Medicine Hospital and Kaunas Oncology Hospital. Patients were divided into three groups. Patients were asked to answer the questionnaire the day before the stoma creation operation and two months after the operation. Questionnaires EORTC QLQ-C30, EORTC QLQ-CR38 and 10 supplementary questions were used. The results of the study show that following the stoma operation, when compared with preoperative results, general quality of life did not change significantly in groups I and II. Patients who received adequate education and preoperative stoma siting had better emotional functioning and less gastrointestinal problems. The financial problems of the patients in group I were significantly less than in the control group. Patients who received the adequate teaching without preoperative stoma selection experience better sexual satisfaction compared with control group. Stoma related problems were less in group I and II when comparing with the control group. The quality of the patients' teaching, adequacy and comfort of stoma site and satisfaction with the medical staff were significantly better in the group I and group II when compared to control group. Moreover, these results were significantly higher in the group I than in group II. CONCLUSIONS. The teaching the patients preoperatively and postoperative proceeding helps them to gain better experience in self stoma care hence reducing the psychological, physical, emotional, social and sexual problems.

Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia

PubMed Central

2014-01-01

Background Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital. Methods A facility based cross-sectional study was conducted using quantitative data collection technique in Jimma University Specialized Teaching Hospital from February 13 to April 13, 2012 on 239 patients scheduled for surgery. The data were collected by five trained diploma nurses using structured interviewer administered questionnaires that were prepared based on state trait anxiety inventory measurement scale. The quantitative data were entered into SPSS for windows version 16. 0 and descriptive, simple and multiple linear regression analyses were performed. Results A total of 239 patients were enrolled in the study with a response rate of 93.0%. Their mean age was 42.7 ± 1.8 years (range 16 to 85 years). Nearly over half 53.6% were females, while 48.1% illiterate, 72.4% Oromo and 56.5% were Muslim followers. Significant preoperative anxiety was seen in 70.3% patients. The most common factors that lead to anxiety were fear of death 38.1% and fear of unknown origin 24.3% and the most common strategy mentioned by patient in reducing anxiety were talking to other patient 79.8% and religious belief. Conclusions In the present study, two third 70.3% of preoperative patients had anxiety. Factors which were positively correlated with anxiety were trait anxiety, single and divorced, time of operation and income. Factors which were shown to reduce anxiety were preoperative anxiety related information provision and afternoon operation. Health professionals working in the hospital should provide anxiety related information for patients. PMID:25189274

Patient attitudes towards medical students at Damascus University teaching hospitals.

PubMed

Sayed-Hassan, Rima M; Bashour, Hyam N; Koudsi, Abir Y

2012-03-22

The cooperation of patients and their consent to involve medical students in their care is vital to clinical education, but large numbers of students and lack of experience as well as loss of privacy may evoke negative attitudes of patients, which may sometimes adversely affect the clinical teaching environment. This study aimed to explore the attitudes of patients towards medical students at Damascus University hospitals, and to explore the determinants of those attitudes thus discussing possible implications applicable to clinical teaching. This cross-sectional study was conducted at three teaching hospitals affiliated to the Faculty of Medicine at Damascus University. Four hundred patients were interviewed between March and April 2011 by a trained sociologist using a structured questionnaire. Of the patients interviewed, 67.8% approved the presence of medical students during the medical consultation and 58.2% of them felt comfortable with the presence of students, especially among patients with better socio-economic characteristics. 81.5% of the patients agreed to be examined by students in the presence of the supervisor, while 40.2% gave agreement even in the absence of the supervisor. Privacy was the most important factor in the patients' reticence towards examination by the students, whilst the relative safety and comfort if a supervisor was available determined patients' agreement. The study concluded overall positive attitudes to the medical students' involvement in medical education. However, it is essential that students and clinical supervisors understand and adhere to professional and ethical conduct when involving patients in medical education.

Case series of child sexual abuse: Abia State University Teaching Hospital experience.

PubMed

Okoronkwo, N C; Ejike, O

2014-01-01

Child sexual abuse remains a serious infringement on the rights of the child. Though it appears to be viewed less seriously among adolescents, the consequences may be more severe and less obvious for the younger child. Age of the child appears notto be a deterrent. There is paucity of local data in the sub-region on this important social problem. The circumstance surrounding child sexual abuse in our environment needs to be reviewed. This study sets out to evaluate the characteristics of victims of child sexual abuse and to proffer solutions on how to stem the tide of the crime. To examine the characteristics of sexually abused children presenting to the paediatrics department of Abia State UniversityTeaching hospital, Aba. The case records of 10 consecutive cases of sexually abused children that presented to the Children Outpatient Department of Abia State University Teaching Hospital (ABSUTH) Aba, from January to June 2006 were prospectively reviewed and the parents/child/abuser interviewed where possible. All the victims were females aged 3-11 yrs, while all the abusers were males 14-29 yrs. Both parties were of low socio-economic class. 50% of the victims reported the incident. Mental and psychological state of the perpetrators appears to be a factor. Physical injuries to the vulva-vaginal areas were common. This study shows that child sexual abuse may not be uncommon in our environment. The exact prevalence remains unknown.The perpetrators of child sexual abuse should be prosecuted as a deterrent and rehabilitated whenever possible.

[Epidemiological, clinical, cytologic and immunophenotypic aspects of acute leukemia in children: the experience at the hematology laboratory of IBN SINA University Hospital Center].

PubMed

Doumbia, Mariam; Uwingabiye, Jean; Bissan, Aboubacar; Rachid, Razine; Benkirane, Souad; Masrar, Azlarab

2016-01-01

The aim of this study was to describe epidemiological, cytologic and immunophenotypic aspects of acute leukemias (AL) in children diagnosed at IBN SINA University Hospital Center and to determine the concordance between cytology and immunophenotyping results. This is a cross-sectional study conducted in the hematology laboratory of IBN SINA University Hospital Center between June 2012 and May 2014. Among the 104 cases with diagnosed AL, 52% were boys with a sex-ratio H/F= 1.32, the average age was 5.7 years. The distribution of different types of AL was: lymphoid AL (LAL) (74%), myeloid (AML) (20.2%), biphenotypic AL (BAL) (65.8%). Among the LALs, 78% were classified as B LAL and 22% as T LAL. Clinical signs were mainly presented with tumor syndrome (73.1%), fever (61%) and hemorrhagic syndrome (50%). The most common blood count abnormalities were: thrombopenia (89.4%), anemia (86.5%), hyperleukocytosis (79.8%). The rate of peripheral and bone marrow blasts was statistically higher for LAL than for AML and BAL (p <0.001). The rate of relapse and mortality was 21.2% and 16. 3% respectively. Concordance rate between the results of cytology and of immunophenotyping was 92.7% for LAL and 82.6% for AML. Diagnosis of AL is always based primarily on cytology. Immunophenotyping allowed us to make a better distinction between acute leukemias. The management of paediatric AL is a major health problem which requires specialized care centers.

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

PubMed

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

2017-05-01

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

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital.

PubMed

Ali, Safaa; El Sisi, Amel

2016-04-01

To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8-3.5 mm), median weight 8 kg (IQR, 7-10 kg), and median age 10 months (IQR, 8-17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

[Diagnosing gender identity].

PubMed

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

2015-01-01

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

Comparison of Canadian and Swiss Surgical Training Curricula: Moving on Toward Competency-Based Surgical Education.

PubMed

Hoffmann, Henry; Oertli, Daniel; Mechera, Robert; Dell-Kuster, Salome; Rosenthal, Rachel; Reznick, Richard; MacDonald, Hugh

Quality of surgical training in the era of resident duty-hour restrictions (RDHR) is part of an ongoing debate. Most training elements are provided during surgical service. As exposure to surgical procedures is important but time-consuming, RDHR may affect quality of surgical training. Providing structured training elements may help to compensate for this shortcoming. This binational anonymous questionnaire-based study evaluates frequency, time, and structure of surgical training programs at 2 typical academic teaching hospitals with different RDHR. Departments of Surgery of University of Basel (Basel, Switzerland) and the Queen's University (Kingston, Ontario, Canada). Surgical consultants and residents of the Queen's University Hospital (Kingston, Ontario, Canada) and the University Hospital Basel (Basel, Switzerland) were eligible for this study. Questionnaire response rate was 37% (105/284). Queen's residents work 80 hours per week, receiving 7 hours of formal training (8.8% of workweek). Basel residents work 60 hours per week, including 1 hour of formal training (1.7% of working time). Queen's faculty and residents rated their program as "structured" or "rather structured" in contrast to Basel faculty and residents who rated their programs as "neutral" in structure or "unstructured." Respondents identified specific structured training elements more frequently at Queen's than in Basel. Two-thirds of residents responded that they seek out additional surgical experiences through voluntary extra work. Basel participants articulated a stronger need for improvement of current surgical training. Although Basel residents and consultants in both institutions fear negative influence of RDHR on the training program, this was not the case in Queen's residents. Providing more structured surgical training elements may be advantageous in providing optimal-quality surgical education in an era of work-hour restrictions. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evaluating the impact of the reconfiguration of gynaecology services at a University Hospital NHS trust in the United Kingdom.

PubMed

Choo, Teck; Deb, Shilpa; Wilkins, Joanne; Atiomo, William

2014-09-24

The project aim was to investigate the impact of reconfiguring gynaecology services on the key performance indicators of a University Hospital NHS Trust in the UK. The reconfiguration involved the centralisation of elective gynaecology on one hospital site and emergency gynaecology on the other. Data measuring outcomes of the Trust's performance indicators (clinical outcomes, patient experience, staff satisfaction, teaching/training, research/development and value for money) were collected. Two time periods, 12 months before and after the reconfiguration in March 2011, were compared for all outcome measures except patient experience. Retrospective data from the hospitals audit department on clinical activity/outcomes and emergency gynaecology patient's feedback questionnaires were analysed. Staff satisfaction, teaching/training and research/development were measured through an online survey of gynaecology consultants. Post reconfiguration, the total number of admissions reduced by 6% (6,867 vs 6,446). There was a 14% increase in elective theatre sessions available (902.29 vs 1030.57) and an 84% increase in elective theatre sessions cancelled (44.43 vs 81.71). However, the average number of elective operations performed during each theatre session remained similar (2.63 vs 2.5). There was a significant increase in medical devices related clinical incidents (2 vs 11). With patient experience, there was a significant reduction in patient's overall length of stay on the emergency gynaecology ward and waiting times for investigations. For staff satisfaction, Consultants were significantly more dissatisfied with workload (3.45 vs 2.85) and standards of care (3.75 vs 2.93). With research and development, consultants remained dissatisfied with time/funding/opportunities for research. No significant impact on undergraduate/postgraduate teaching was found. No financial data on gynaecology was provided for the assessment of value for money. Reconfiguration of gynaecology services at this Trust may have resulted in a reduction in gynaecological activity and increased cancellation of elective operations but did not significantly reduce the number of elective operations performed. Although consultants expressed increased dissatisfaction with standards of clinical care, clinical incident reports did not significantly increase apart from medical devices incidents. Patient experience of emergency gynaecology services was improved. This manuscript provides a framework for similar exercises evaluating the impact of service redesign in the NHS.

Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

PubMed

Longo, Maria Cristina

2015-01-01

The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Radio advertising increases hospital call center volume by 48%.

PubMed

2006-01-01

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

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

PubMed

2006-01-01

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

Literacy promotion at the Montreal Children’s Hospital

PubMed Central

Erdos, Caroline; Ferdinand, Jae-Marie

2017-01-01

Abstract The foundations for language and literacy are set in utero when babies hear the tone of their mother’s voice (1). There is strong evidence of a positive relationship between early literacy experiences and language and academic outcomes (2). Unfortunately, many parents do not know about the benefits of reading to and with young children, and many children enter school without the basic skills needed to learn to read and succeed. Physicians who have contact with young families are in a distinctive position to promote reading, though despite its evidence base, it has not yet become a universal intervention. A short description of the projects at the Montreal Children’s Hospital is provided. PMID:29479189

Auditing health insurance reimbursement by constructing association rules

NASA Astrophysics Data System (ADS)

Chiang, I.-Jen

2000-04-01

Two months of reimbursement claim data of the admission patients from National Taiwan University Hospital have been used to be the training set (200 MB or so), a quick method has been used to find out the association rules among the illness, the examinations and treatments, the drugs, and the equipment. The filtered rules by setting the minimum support and the minimum confidence are used to screen out a month claimed data from the other hospital. Some unproper orders to the patients are able to checked out. In this paper, we will discuss the algorithm for generalizing association rule and the experiments of using the association rules to screen out the unproper orders in the health reimbursement claims.

The liberal arts and nursing programme at the University of Maine, 1939-1956. A study of leadership behaviours and organisational structure.

PubMed

Hart, V

2001-01-01

The trend for nursing programmes affiliated with universities in the US began in 1909 but did not gain momentum until the 1960s with the demise of hospital schools of nursing. During the period of time covered in this study, beginning in the 1930s, a hybrid of the present day university-based nursing programme began to appear. These 'cooperative' programmes often sandwiched traditional hospital experience between years of university course work and involved a five-year commitment on the part of students. In 1939 a liberal arts and nursing programme was established at the University of Maine. It continued to operate until 1956 and then ceased to exist. In this descriptive historical study the author investigates why this particular programme was initiated, of what it consisted, and why it had failed. Primary sources accessed included original correspondence, curriculum descriptions, faculty and students reports, and administrative policies. Leadership and organisational behaviour theory was utilised as well as identification of the historical nursing backdrop. Oral history was also utilised for the purpose of verification of written data. Analysis of the data suggests implications for nursing educators and administrators, as well as telling a story of the power of nursing when viewed in the context of constituency groups in a sociopolitical model of organisations. This paper was first presented at the History of Nursing Millennium Conference in Edinburgh in July 2000.

[University clinics in the competitive hospital market].

PubMed

Schmidt, C E; Möller, J; Hesslau, U; Bauer, M; Gabbert, T; Kremer, B

2005-07-01

In recent years Germany has faced a growing economization and competition among hospitals. To protect their interests hospitals have to operate similarly to other commercial businesses. Academic hospitals face difficult circumstances in this competition. They have to facilitate research and education activities which require additional financial and personnel resources but also provide maximum acute care treatment at all times. This causes additional disadvantages in terms of financial resources, compared to private hospital chains. Such examples of financial shortcomings have led to the privatization of academic research centres in Germany. An alternative strategy to privatization of academic acute care hospitals is the change of their legal status into a capital company or into a foundation, according to US experiences. Public private partnerships (PPPs) may also represent a potential alternative, as they have already produced a growing number of successful examples in the public sector in Germany. Academic acute care hospitals can also choose a strategic reorganization of their targets, similar to their privately held competitors in the market. Potential economies in scale may be achieved in areas such as medical treatment, research and personnel planning.However, it is vital that academic acute care hospitals start to act productively and also individually. This article provides a number of managerial pathways and options to maintain and strengthen operational competitiveness.

Validation of the Child HCAHPS survey to measure pediatric inpatient experience of care in Flanders.

PubMed

Bruyneel, Luk; Coeckelberghs, Ellen; Buyse, Gunnar; Casteels, Kristina; Lommers, Barbara; Vandersmissen, Jo; Van Eldere, Johan; Van Geet, Chris; Vanhaecht, Kris

2017-07-01

The recently developed Child HCAHPS provides a standard to measure US hospitals' performance on pediatric inpatient experiences of care. We field-tested Child HCAHPS in Belgium to instigate international comparison. In the development stage, forward/backward translation was conducted and patients assessed content validity index as excellent. The draft Flemish Child HCAHPS included 63 items: 38 items for five topics hypothesized to be similar to those proposed in the US (communication with parent, communication with child, attention to safety and comfort, hospital environment, and global rating), 10 screeners, a 14-item demographic and descriptive section, and one open-ended item. A 6-week pilot test was subsequently performed in three pediatric wards (general ward, hematology and oncology ward, infant and toddler ward) at a JCI-accredited university hospital. An overall response rate of 90.99% (303/333) was achieved and was consistent across wards. Confirmatory factor analysis largely confirmed the configuration of the proposed composites. Composite and single-item measures related well to patients' global rating of the hospital. Interpretation of different patient experiences across types of wards merits further investigation. Child HCAHPS provides an opportunity for systematic and cross-national assessment of pediatric inpatient experiences. Sharing and implementing international best practices are the next logical step. What is Known: • Patient experience surveys are increasingly used to reflect on the quality, safety, and centeredness of patient care. • While adult inpatient experience surveys are routinely used across countries around the world, the measurement of pediatric inpatient experiences is a young field of research that is essential to reflect on family-centered care. What is New: • We demonstrate that the US-developed Child HCAHPS provides an opportunity for international benchmarking of pediatric inpatient experiences with care through parents and guardians. • Our study findings show considerable variation in experiences for types of pediatric services. Support to share good practices and launch quality improvement initiatives can be obtained by organizing regular two-way feedback sessions with clinicians to place the findings in context.

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

PubMed

Lewicki, G

1999-01-01

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

Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals.

PubMed

Hayden, Melanie G; Hughes, Samuel; Hahn, Edward J; Aryan, Henry E; Levy, Michael L; Jandial, Rahul

2011-01-01

A myriad of geopolitical and financial obstacles have kept modern neurosurgery from effectively reaching the citizens of the developing world. Targeted neurosurgical outreach by academic neurosurgeons to equip neurosurgical operating theaters and train local neurosurgeons is one method to efficiently and cost effectively improve sustainable care provided by international charity hospitals. The International Neurosurgical Children's Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training. Neurosurgical equipment and training were provided for the local neurosurgeons by a mission team from the University of California at San Diego. At the end of 3 years, with one intensive week trip per year, the host neurosurgeons were proficiently and independently applying microsurgical techniques to previously performed operations, and performing newly learned operations such as neuroendoscopy and minimally invasive neurosurgery. Our experiences may serve as a successful template for the execution of other small scale, sustainable neurosurgery missions worldwide.

Duodenal ulcer perforation: a district hospital experience.

PubMed

Durai, R; Razvi, A; Uzkalnis, A; Ng, Ph C H

2011-01-01

Duodenal ulcer perforation still occurs frequently in the 21st century inspite of the wide availability of proton pump inhibitors. During 2005-2008, 34 patients underwent treatment of duodenal ulcer perforation at the University Hospital Lewisham, London. Laparoscopic or open repair of the perforation was used. In this study, we analysed the outcome of treatment in terms of complications, mortality and hospital stay with relevant to laparoscopy and open approach. Ten patients underwent laparoscopic closure and the remaining 24 patients underwent laparotomy. The mean hospital stay for the laparoscopic group was 6.6 days and for open repair group was 12.8 days. There were two wound infection related to open approach and four patients died during the post operative period however the cause of death was not related to the procedure. Laparoscopy has the advantage of avoiding a big incision and will enable the patient to get discharged home early. However, the only limiting factor is availability of expertise and competency of the surgeon.

[Management accounting in hospital setting].

PubMed

Brzović, Z; Richter, D; Simunić, S; Bozić, R; Hadjina, N; Piacun, D; Harcet, B

1998-12-01

The periodic income and expenditure accounts produced at the hospital and departmental level enable successful short term management, but, in the long run do not help remove tensions between health care demand and limited resources, nor do they enable optimal medical planning within the limited financial resources. We are trying to estabilish disease category costs based on case mixing according to diagnostic categories (diagnosis related groups, DRG, or health care resource groups, HRG) and calculation of hospital standard product costs, e.g., radiology cost, preoperative nursing cost etc. The average DRG cost is composed of standard product costs plus any costs specific to a diagnostic category. As an example, current costing procedure for hip artheroplasty in the University Hospital Center Zagreb is compared to the management accounting approach based on British Health Care Resource experience. The knowledge of disease category costs based on management accounting requirements facilitates the implementation of medical programs within the given financial resources and devolves managerial responsibility closer to the clinical level where medical decisions take place.

A community hospital acute pain service.

PubMed

Musclow, Shirley L

2005-11-01

This article provides readers with a guide to developing and implementing an acute pain service in a community hospital. Kanter's theory of innovative diffusion is used to frame the author's experiences as a lead nurse in two community hospital acute pain services. Health-care providers recognize the importance of quality pain assessment and management. One initiative for improving pain management has been the implementation of an acute pain service (APS). In Canada, most university-affiliated teaching hospitals have now developed an APS to improve pain management. Community hospitals, however, have only recently begun to adopt the concept. Improving pain management through an APS provides an excellent opportunity for nursing leadership at all levels. Nursing administration may take the lead in proposing the idea and benefits of acquiring an APS. An advanced practice nurse can provide leadership through the coordination and provision of enhanced pain management as a lead nurse in an APS. Staff nurses can provide leadership in improving pain management on a daily basis and ensuring that quality pain care reaches the bedside, Nursing practice is at the core of making a difference in pain management.

Simulating cloud environment for HIS backup using secret sharing.

PubMed

Kuroda, Tomohiro; Kimura, Eizen; Matsumura, Yasushi; Yamashita, Yoshinori; Hiramatsu, Haruhiko; Kume, Naoto

2013-01-01

In the face of a disaster hospitals are expected to be able to continue providing efficient and high-quality care to patients. It is therefore crucial for hospitals to develop business continuity plans (BCPs) that identify their vulnerabilities, and prepare procedures to overcome them. A key aspect of most hospitals' BCPs is creating the backup of the hospital information system (HIS) data at multiple remote sites. However, the need to keep the data confidential dramatically increases the costs of making such backups. Secret sharing is a method to split an original secret message so that individual pieces are meaningless, but putting sufficient number of pieces together reveals the original message. It allows creation of pseudo-redundant arrays of independent disks for privacy-sensitive data over the Internet. We developed a secret sharing environment for StarBED, a large-scale network experiment environment, and evaluated its potential and performance during disaster recovery. Simulation results showed that the entire main HIS database of Kyoto University Hospital could be retrieved within three days even if one of the distributed storage systems crashed during a disaster.

Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement.

PubMed

Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B

2018-06-01

Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Adverse Events in Affiliated Hospitals of Mazandaran University of Medical Sciences

PubMed Central

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

2014-01-01

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

[Required Framework for the Collection of Real-life Data: An Example from University Eye Hospital Munich].

PubMed

Kortüm, Karsten; Kern, Christoph; Meyer, Gerhard; Priglinger, Siegfried; Hirneiß, Christoph

2017-12-01

Background The importance of evaluating real-life data is constantly increasing. Currently available computer systems better allow for analyses of data, as more and more data is available in a digital form. Before a project for real-life data analyses is started, technical considerations and staff, legal, and data protection procedures need to be addressed. In this manuscript, experiences made at the University Eye Hospital in Munich will be shared. Materials and Methods Legal requirements, as found in laws and guidelines governing documentation and data privacy, are highlighted. Technical requirements for information technology infrastructure and software are defined. A survey conducted by the German Ophthalmological Society, among German eye hospitals investigating the current state of digitalization, was conducted. Also, staff requirements are outlined. Results A database comprising results of 330,801 patients was set up. It includes all diagnoses, procedures, clinical findings and results from diagnostic devices. This database was approved by the local data protection officer. In less than half of German eye hospitals (n = 21) that participated in the survey (n = 54), a complete electronic documentation is done. Fourteen institutions are completely paper-based, and the remainder of the hospitals used a mixed system. Conclusion In this work, we examined the framework that is required to develop a comprehensive database containing real-life data from clinics. In future, these databases will become increasingly important as more and more innovation are made in decision support systems. The base for this is comprehensive and well-curated databases. Georg Thieme Verlag KG Stuttgart · New York.

Enema reduction of intussusception: the success rate of hydrostatic and pneumatic reduction.

PubMed

Khorana, Jiraporn; Singhavejsakul, Jesda; Ukarapol, Nuthapong; Laohapensang, Mongkol; Wakhanrittee, Junsujee; Patumanond, Jayanton

2015-01-01

Intussusception is a common surgical emergency in infants and children. The incidence of intussusception is from one to four per 2,000 infants and children. If there is no peritonitis, perforation sign on abdominal radiographic studies, and nonresponsive shock, nonoperative reduction by pneumatic or hydrostatic enema can be performed. The purpose of this study was to compare the success rates of both the methods. Two institutional retrospective cohort studies were performed. All intussusception patients (ICD-10 code K56.1) who had visited Chiang Mai University Hospital and Siriraj Hospital from January 2006 to December 2012 were included in the study. The data were obtained by chart reviews and electronic databases, which included demographic data, symptoms, signs, and investigations. The patients were grouped according to the method of reduction followed into pneumatic reduction and hydrostatic reduction groups with the outcome being the success of the reduction technique. One hundred and seventy episodes of intussusception occurring in the patients of Chiang Mai University Hospital and Siriraj Hospital were included in this study. The success rate of pneumatic reduction was 61% and that of hydrostatic reduction was 44% (P=0.036). Multivariable analysis and adjusting of the factors by propensity scores were performed; the success rate of pneumatic reduction was 1.48 times more than that of hydrostatic reduction (P=0.036, 95% confidence interval [CI] =1.03-2.13). Both pneumatic and hydrostatic reduction can be performed safely according to the experience of the radiologist or pediatric surgeon and hospital setting. This study showed that pneumatic reduction had a higher success rate than hydrostatic reduction.

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

PubMed

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

2012-11-01

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

Ethics consultation on demand: concepts, practical experiences and a case study.

PubMed

Reiter-Theil, S

2000-06-01

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study.

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

PubMed

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

2012-11-01

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

The Faculties of Pharmacy Schools Should Make an Effort to Network with Community Pharmacies.

PubMed

Matsushita, Ryo

2016-01-01

By law, medical faculties are mandated to have a designated partner hospital for the purposes of student practical training. In contrast, pharmacy faculties do not have such a legal requirement for student training in a community pharmacy setting. Nevertheless, there are several public and private universities that do have community pharmacies. However, there is no national university that has established both an educational hospital and a community pharmacy. When Kanazawa University (KU) established a graduate school with a clinical pharmacy course, the faculty of KU deemed it necessary to set up an independent community pharmacy for the purpose of practical training. Thus, in 2003, the Acanthus Pharmacy was set up as the first educational community pharmacy in Japan, managed by a nonprofit organization, with the permission of the Ishikawa Pharmaceutical Association and local community pharmacists. Since that time, Acanthus has managed a clinical pharmacy practice for students from both the undergraduate and graduate schools of KU. From 2006, the undergraduate pharmacy program was changed to a 6-year program, and the Acanthus Pharmacy has continued its roles in educating undergraduate pharmaceutical students, medical students, and as a site of early exposure for KU freshmen. From our experience, it is important to have a real clinical environment available to university pharmacy faculty and students, especially in training for community pharmacy practices.

The prevalence of, and factors related to, compliance with glove utilization among nurses in Hospital Universiti Sains Malaysia.

PubMed

Naing, L; Nordin, R; Musa, R

2001-09-01

Increasing risk of HIV infections among health care workers has been a continuing concern. The study was designed to identify the compliance of glove utilization, and factors related to non-compliance. A sample of 150 staff nurses were recruited from the study population of 550 nurses in Hospital Universiti Sains Malaysia. Data were collected by using a structured self-administered questionnaires. The response rate was 98.4%. The study revealed a low compliance (13.5%) of glove utilization (for all 9 procedures), which varied among different procedures (27-97%). Younger nurses and those with shorter duration of working experience had better knowledge of Universal Precautions. Nurses in intensive care unit and operation theatre were better in both knowledge and compliance of glove utilization. The three commonest misconceptions were identified as "selective use of gloves for high risk groups and suspected cases", and "tendency to depend on HIV prevalence". Nurses reported practical problems including administrative and personal related such as "stock irregularity" (46%), "glove not available at the emergency sites" (44%), and "reduction of tactile sensation" (39%). It was concluded that poor knowledge and practical problems were possible responsible factors for the low compliance. A good training for nurses comprising principle and practice of Universal Precautions, updated knowledge of blood and body fluid borne infections and risk and its management, will probably improve the compliance.

Assessing Governance Alternatives for University-Owned Public Teaching Hospitals.

ERIC Educational Resources Information Center

Whitley, Evangeline L.

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

Historical development of the renal histopathology services in Malaysia.

PubMed

Looi, Lai-Meng; Cheah, Phaik-Leng

2009-06-01

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

Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare

PubMed Central

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

2010-01-01

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

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

ERIC Educational Resources Information Center

Ruitenberg, Claudia

2014-01-01

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

The influence of learning environment on trainee pharmacy technicians' education and training experiences.

PubMed

Schafheutle, Ellen I; Jee, Samuel D; Willis, Sarah C

2017-12-16

In Great Britain (GB), pharmacy technicians (PTs) are registered professionals, with their education and training regulated; little is known about this or the learning environment in which it takes place. This study aimed to profile recently registered pre-registration trainee pharmacy technicians (PTPTs) in GB and capture views on PTPTs' training experiences, focussing on differences in community and hospital settings. A mixed methods study was conducted in 2013-14, following university ethics approval. One-to-one, semi-structured telephone interviews with face-to-face and distance education providers, and hospital and community pharmacy employers of PTPTs explored views on education delivery, work-based learning, and assessment. Interviews were transcribed verbatim, analysed thematically and findings informed design of a census survey of all 1457 recently registered PTs, investigating satisfaction with various aspects of their training. Quantitative data were analysed using SPSS v20, employing comparative statistics (Mann-Whitney U, Chi-Square). Six-hundred and forty-six questionnaires were returned (response rate 44.3%), 632 were usable. Three-quarters (75.9%) of respondents had trained in community; the majority (88.0%) were female, the average age was 35.26 ± 10.22. Those based in hospitals were more satisfied with their training: hospital trainees worked in larger teams and tended to be better supported, they had more study time, and were more likely to complete their training in the intended two-year period. Interviews with staff in 17 Further Education colleges, 6 distance providers, 16 community pharmacies and 15 NHS organisations confirmed survey findings and offered explanations into why differences in training experiences may exist. This study has identified differences between PTPTs' work-based experiences in hospital and community pharmacy. Perceiving PTPTs as 'apprentices' vs. 'employees' may define how their training is managed by employers. Clarity in PTs' roles, responsibilities, and expected competencies upon registration can ensure training is structured and delivered in a suitable and equitable manner across sectors. Copyright © 2017 Elsevier Inc. All rights reserved.

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

PubMed

Carroll, Tracy; Tonges, Mary; Ray, Joel

2017-11-01

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

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

PubMed

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

2011-11-01

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

Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.

PubMed

Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R

2016-06-01

The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. © The Author(s) 2015.

Quality in practice: integrating routine collection of patient language data into hospital practice.

PubMed

Hudelson, Patricia; Dominicé Dao, Melissa; Durieux-Paillard, Sophie

2013-09-01

Timely identification of patients' language needs can facilitate the provision of language-appropriate services and contribute to quality of care, clinical outcomes and patient satisfaction. At the University Hospitals of Geneva, Switzerland, timely organization of interpreter services was hindered by the lack of systematic patient language data collection. We explored the feasibility and acceptability of a procedure for collecting patient language data at the first point of contact, prior to its hospital-wide implementation. During a one-week period, receptionists and triage nurses in eight clinical services tested a new procedure for collecting patient language data. Patients were asked to identify their primary language and other languages they would be comfortable speaking with their doctor. Staff noted patients' answers on a paper form and provided informal feedback on their experience with the procedure. Registration staff encountered few difficulties collecting patient language data and thought that the two questions could easily be incorporated into existing administrative routines. Following the pilot test, two language fields with scroll-down language menus were added to the electronic patient file, and the subsequent filling-in of these fields has been rapid and hospital wide. Our experience suggests that routine collection of patient language data at first point of contact is both feasible and acceptable and that involving staff in a pilot project may facilitate hospital-wide implementation. Future efforts should focus on exploring the sensitivity and specificity of the proposed questions, as well as the impact of data collection on interpreter use.

Interference of postoperative pain on women's daily life after early discharge from cardiac surgery.

PubMed

Leegaard, Marit; Rustøen, Tone; Fagermoen, May Solveig

2010-06-01

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory-Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important. (c) 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Telestroke in Northern Alberta: a two year experience with remote hospitals.

PubMed

Khan, Khurshid; Shuaib, Ashfaq; Whittaker, Tammy; Saqqur, Maher; Jeerakathil, Thomas; Butcher, Ken; Crumley, Patrick

2010-11-01

Thrombolysis in acute ischemic stroke is usually performed in comprehensive stroke centres. Lack of stroke expertise in remote small hospitals may preclude thrombolysis. Telemedicine allows such management opportunities in distant hospitals. We report our experience in managing acute stroke over a two-year time period with telestroke. The University of Alberta Hospital acted as the 'hub' and seven remote hospitals as 'spoke'. The neurologist at the 'hub' provided stroke expertise to the local physician using either a two-way video link or telephone. Cranial CT scans were transmitted to 'hub'. Education sessions were held before the initiation of the program. Of 210 patients 44 (21%) received thrombolysis at the 'spoke' sites. In 34/44 (77%) two-way video link was available while in 10/44 (23%) telephone was used. Five (11.4%) patients experienced intracranial hemorrhage after thrombolysis, 2 (4.5%) were symptomatic. Favorable (mRS=0-1) outcome at three months was 16/40 (40%) and mortality was 9/40 (22.5%). Four patients were lost to follow-up. There was no significant three months outcome difference between two-way video link and telephone consultation (P = 0.689). Over two years the number of acute stroke transfers decreased from 144 to 15 at one of the 'spoke' sites, a 92.5% decline. It is possible to successfully treat patients with acute ischemic stroke at remote sites through videoconferencing or telephone consultation. Telestroke can also lead to a significant reduction in the number of patients requiring transfer to a tertiary care centre.

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

PubMed

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

2017-12-01

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

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

NASA Astrophysics Data System (ADS)

Vogl, Raimund

2001-08-01

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

The Status of Hospital Information Systems in Iranian Hospitals

PubMed Central

Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

2014-01-01

Background: The area of e-Health is broad and has an excellent growth potential. An increasing number of experts believe that e-Health will fuel the next breakthroughs in health system improvements throughout the world, but there is frequent evidence of unsustainable use of e-Health systems in medical centres, particularly hospitals, for different reasons in different countries. Iran is also a developing country which is presently adopting this promising technology for its traditional healthcare delivery but there is not much information about the use of e-Health systems in its hospitals, and the weakness and opportunities of utilization of such Hospital Information Systems (HIS). Methods: For this research, a number of Hospitals from Isfahan, Iran, are selected using convenient sampling. E-health research professionals went there to observe their HIS and collect required data as a qualitative survey. The design of interview questions was based on the researchers’ experiences and knowledge in this area along with elementary interviews with experts on HIS utilization in hospitals. Results: Efficient administration of e-health implementation improves the quality of healthcare, reduces costs and medical errors, makes healthcare resources available to rural areas, etc. However, there are numerous issues affecting the successful utilization of e-health in Hospitals, such as a lack of a perfect HIS implementation plan and well-defined strategy, inadequate IT-security for the protection of e-health-related data, improper training and educational issues, legal challenges, privacy concerns, improper documentation of lessons learned, resistance to the application of new technologies, and finally a lack of recovery plan and disaster management. These results along with some informative stories are extracted from interview sessions to uncover associated challenges of HIS utilization in Iranian hospitals. Conclusion: The utilization of e-health in Iranian hospitals, particularly those in Isfahan, is subject to several challenges and there is no proper long-term strategy plans for HIS initiation, development, and improvement in Iranian hospitals. In order to address these problems, six recommendations are provided. Hence, human resource and e-health professionals from third party consultancy companies along with medical university scholars have to assist such hospitals to undertake the proposed solutions in order to provide proper plans to overcome future challenges and have a mature HIS in accordance with expected HIS utilization from hospitals and medical universities. PMID:25395731

Hospital nurses' wellbeing at work: a theoretical model.

PubMed

Utriainen, Kati; Ala-Mursula, Leena; Kyngäs, Helvi

2015-09-01

To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was used. The main concepts were: patients' experience of high-quality care; assistance and support among nurses; nurses' togetherness and cooperation; fluent practical organisation of work; challenging and meaningful work; freedom to express diverse feelings in the work community; well-conducted everyday nursing; status related to the work itself; fair and supportive leadership; opportunities for professional development; fluent communication with other professionals; and being together with other nurses in an informal way. Themes included: collegial relationships; enhancing high-quality patient care; supportive and fair leadership; challenging, meaningful and well organised work; and opportunities for professional development. Object-dependent wellbeing was supported. Managers should focus on strengthening the positive aspect of wellbeing at work, focusing on providing fluently organised work practices, fair and supportive leadership and togetherness while allowing nurses to implement their own ideas and promote the experience of meaningfulness. © 2014 John Wiley & Sons Ltd.

The benefits of otoplasty for children: further evidence to satisfy the modern NHS.

PubMed

Cooper-Hobson, G; Jaffe, W

2009-02-01

To take standards from, and revalidate an existing study which addressed the psychological and social outcomes following otoplasty in children [Bradbury E, Hewison J, Timmons M. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100]. The psychosocial experiences of children undergoing otoplasty at the University Hospital of North Staffordshire were retrospectively examined and compared to the cohort in the existing study. Retrospective questionnaires were sent to all children aged 5-16 (n=101) who were on the hospital records having undergone otoplasty between 1999 and 2003, investigating social experiences, and experience of surgery. This study found: 97% reported an increase in happiness; 92% reported an increase in self-confidence; 79% noted improved social experience; 100% reported bullying reduced or stopped. The Wilcoxon Rank Sum Test confirmed the statistical validity of these findings (P<0.001). The existing study found: 63% of children reported increase in happiness and confidence; 13% noted improved social experiences; 53% noted bullying had stopped entirely. Otoplasty is an effective procedure in alleviating psychosocial distress in the vast majority of children that undergo the operation, and hence this study supports the continued availability of otoplasty on the NHS for children with prominent ears.

(Dis)-Trust in transitioning ventilator-dependent children from hospital to homecare.

PubMed

Manhas, Kiran Pohar; Mitchell, Ian

2015-12-01

Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear. To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children. We followed methods described by Franco Carnevale. We used a sociologically grounded theoretical orientation-trust-to re-interpret qualitative data for an ethical inquiry into a specific facet of that data. The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government. The Conjoint Health Research Ethics Board at the University of Calgary approved this study. First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities' allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural-urban, medical-family, and professional-personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition. The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their implications. A climate of trust could bridge divides between mothers and professionals; rural and urban professionals; and professionals with differing relationships with the family. © The Author(s) 2014.

Family presence during CPR: a study of the experiences and opinions of Turkish critical care nurses.

PubMed

Badir, A; Sepit, D

2007-01-01

The concern over family witnessed cardiopulmonary resuscitation has been a frequent topic of debate in many countries. The aim of this descriptive study is determine the experiences and opinions of Turkish critical care nurses about family presence during cardiopulmonary resuscitation and to bring this topic into the critical care and the public limelight in Turkey. Study population consisted of critical care nursing staff at four hospitals affiliated with the Ministry of Health, three hospitals affiliated with universities and three hospitals affiliated with Social Security Agency Hospitals. A total of 409 eligible critical care nurses were surveyed using a questionnaire which is consisted of 43 items under 3 areas of inquiry. None of the hospitals that participated in this study had a protocol or policy regarding family witnessed resuscitation. More than half of the sample population had no experience of family presence during cardiopulmonary resuscitation and none of the respondents had ever invited family members to the resuscitation room. A majority of the nurses did not agree that it was necessary for family members to be with their patient and did not want family members in resuscitation room. In addition, most of the nurses were concerned about the violation of patient confidentiality, had concerns that untrained family members would not understand CPR treatments, would consider them offensive and thereby argue with the resuscitation team. The nurses expressed their concern that witnessing resuscitation would cause long lasting adverse emotional effects on the family members. This study reveals that critical care nurses in Turkey are not familiar with the concept of family presence during cardiopulmonary resuscitation. In view of the increasing evidence from international studies about the value of family presence during cardiopulmonary resuscitation we recommend educational program about this issue and policy changes are required within the hospitals to enhance critical care in Turkey.

Strategy of health information seeking among physicians, medical residents, and students after introducing digital library and information technology in teaching hospitals of Iran.

PubMed

kahouei, Mehdi; Alaei, Safollah; Shariat Panahi, Sohaila Sadat Ghazavi; Zadeh, Jamileh Mahdi

2015-05-01

It is important for physicians, medical students and health care organizations of developing countries to use reliable clinical information in order to deliver the best practice. Therefore, health sector of Iran endeavored to encourage physicians and medical students to integrate research findings into practice since 2005. Several educational interventions in the areas of information technology and databases were performed. Digital library was introduced in the teaching hospitals. The purpose of this study was to investigate whether these interventions increased the use of evidence-based health information resources among physicians, medical residents and students. This descriptive study involved 315 physicians, assistants and medical students in affiliated hospitals of Semnan University of medical sciences in 2013. A total 52.9% of physicians and 79.5% of medical residents and students always used patient data. 81.3% of physicians and 67.1% of medical residents and students reported using their own experiences, 26.5% of physicians and 16.9% of medical residents and students always used databases such as PubMed and MEDLINE for patient care. Our results revealed that in spite of providing educational and technical infrastructures for accomplishment of research utilization in medical education, the study subjects often identified and used what they regarded as reliable and relevant information from sources that do not truly represent the best evidence that is available. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Not feeling ready to go home: a qualitative analysis of chronically ill patients' perceptions on care transitions.

PubMed

Verhaegh, Kim J; Jepma, Patricia; Geerlings, Suzanne E; de Rooij, Sophia E; Buurman, Bianca M

2018-06-25

Unplanned hospital readmissions frequently occur and have profound implications for patients. This study explores chronically ill patients' experiences and perceptions of being discharged to home and then acutely readmitted to the hospital to identify the potential impact on future care transition interventions. Twenty-three semistructured interviews were conducted with chronically ill patients who had an unplanned 30-day hospital readmission at a university teaching hospital in the Netherlands. A constructive grounded theory approach was used for data analysis. The core category identified was 'readiness for hospital discharge,' and the categories related to the core category are 'experiencing acute care settings' and 'outlook on the recovery period after hospital discharge.' Patients' readiness for hospital discharge was influenced by the organization of hospital care, patients' involvement in decision-making and preparation for discharge. The experienced difficulties during care transitions might have influenced patients' ability to cope with challenges of recovery and dependency on others. The results demonstrated the importance of assessing patients' readiness for hospital discharge. Health care professionals are recommended to recognize patients and guide them through transitions of care. In addition, employing specifically designated strategies that encourage patient-centered communication and shared decision-making can be vital in improving care transitions and reduce hospital readmissions. We suggest that health care professionals pay attention to the role and capacity of informal caregivers during care transitions and the recovery period after hospital discharge to prevent possible postdischarge problems.

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2016-11-01

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

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

PubMed

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

2007-01-01

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

Effects of patient safety auditing in hospital care: results of a mixed-method evaluation (part 1).

PubMed

Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Westert, Gert P; Boeijen, Wilma; Teerenstra, Steven; van Gurp, Petra J; Wollersheim, Hub

2018-06-15

To evaluate the effectiveness of internal auditing in hospital care focussed on improving patient safety. A before-and-after mixed-method evaluation study was carried out in eight departments of a university medical center in the Netherlands. Internal auditing and feedback focussed on improving patient safety. The effect of internal auditing was assessed 15 months after the audit, using linear mixed models, on the patient, professional, team and departmental levels. The measurement methods were patient record review on adverse events (AEs), surveys regarding patient experiences, safety culture and team climate, analysis of administrative hospital data (standardized mortality rate, SMR) and safety walk rounds (SWRs) to observe frontline care processes on safety. The AE rate decreased from 36.1% to 31.3% and the preventable AE rate from 5.5% to 3.6%; however, the differences before and after auditing were not statistically significant. The patient-reported experience measures regarding patient safety improved slightly over time (P < 0.001). The SMR, patient safety culture and team climate remained unchanged after the internal audit. The SWRs showed that medication safety and information security were improved (P < 0.05). Internal auditing was associated with improved patient experiences and observed safety on wards. No effects were found on adverse outcomes, safety culture and team climate 15 months after the internal audit.

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

PubMed

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

2015-08-01

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

[Designing and Operating a Comprehensive Mental Health Management System to Support Faculty at a University That Contains a Medical School and University Hospital].

PubMed

Kawanishi, Chiaki

2016-01-01

In Japan, healthcare professionals and healthcare workers typically practice a culture of self-assessment when it comes to managing their own health. Even where this background leads to instances of mental health disorders or other serious problems within a given organization, such cases are customarily addressed by the psychiatrists or psychiatric departments of the facilities affected. Organized occupational mental health initiatives for professionals and workers within the healthcare system are extremely rare across Japan, and there is little recognition of the need for such initiatives even among those most directly affected. The author has some experience designing and operating a comprehensive health management system to support students and faculty at a university in the Tokyo Metropolitan Area that contains a medical school and university hospital. At this university, various mental health-related problems were routinely being allowed to develop into serious cases, while the fundamental reforms required by the health management center and the mental health management scheme organized through the center had come to represent a challenge for the entire university. From this initial situation, we undertook several successive initiatives, including raising the number of staff in the health management center and its affiliated organizations, revising and drafting new health management rules and regulations, launching an employment support and management system, implementing screenings to identify people with mental ill-health, revamping and expanding a counselling response system, instituting regular collaboration meetings with academic affairs staff, and launching educational and awareness-raising activities. This resulted in the possibility of intervention in all cases of mental health crisis, such as suicidal ideation. We counted more than 2,400 consultations (cumulative total number; more than half of consultations was from the medical school, postgraduate medical course, or hospitals) on a campus comprising 8,700 people, in which our problem-solving approach was able to achieve a certain degree of success in a majority of cases. Amid the increasing prevalence of mental ill-health and signs of worsening mental health problems in all areas of society, I look forward to the establishment of occupational mental health systems that are suited to medical institutions.

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

PubMed

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

2007-12-01

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

Restoration of medical oncology services at LSU Interim Public Hospital in New Orleans after Hurricane Katrina: a two-year experience of LSUHSC.

PubMed

Harmon, Rachael E; Boulmay, Brian C

2011-01-01

Oncology services at Charity Hospital were discontinued following Hurricane Katrina in August 2005. Medical oncology and chemotherapy services resumed at the Louisiana State University Interim Public Hospital in 2007. Demographic, clinical, and displacement data of the re-established patient cohort were reviewed. Patients evaluated in the Louisiana State University Health Sciences Center (LSUHSC) Oncology Clinics from September 1, 2007, to August 31, 2009, were identified and data collected included time from diagnosis of malignancy to initial oncology evaluation, insurance status, percentage displaced for six months or more due to Hurricane Katrina, ethnicity, referrals for radiation oncology, and the number of outpatient clinical encounters (OCE). 464 patients were evaluated in the study time period. Sixty-five percent of the patients had new cancer diagnoses and 35% re-established cancer care in the Charity System and a substantial proportion were either unfunded or had Medicaid coverage. Thirty-four percent were confirmed to be displaced from New Orleans for greater than six months and the majority of patients were black. The majority of new cancer diagnoses were breast, lung, and colon cancer. Human immunodeficiency virus (HIV) positive patients made up 7.5% of the patient cohort. There was a 70% decline in patient volumes following Hurricane Katrina. Oncology services for a minority-based, underinsured patient population were severely impacted by Hurricane Katrina. Following the storm, persistent systemwide resource limitations led to suboptimal timeliness of medical oncology evaluations. Health care systems serving underinsured patients require a disaster plan to minimize interruption of oncology care. Our experience illustrates the need for resources to ensure rapid re-establishment of care for economically disadvantaged patients following natural disasters.

Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases.

PubMed

Al-Koudmani, Ibrahim; Darwish, Bassam; Al-Kateb, Kamal; Taifour, Yahia

2012-04-19

Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.

Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study.

PubMed

Magalhães, Mauricio; Rodrigues, Francisco Paulo Martins; Chopard, Maria Renata Tollio; Melo, Victoria Catarina de Albuquerque; Melhado, Amanda; Oliveira, Inez; Gallacci, Clery Bernardi; Pachi, Paulo Roberto; Lima Neto, Tabajara Barbosa

2015-01-01

Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that therapeutic hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns. Retrospective study, conducted in a university hospital. Thirty-five patients with perinatal asphyxia undergoing body cooling between May 2009 and November 2012 were evaluated. Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The main complication was infection, diagnosed in seven mothers (20%) and 14 newborns (40%). Convulsions occurred in 15 infants (43%). Thirty-one patients (88.6%) required mechanical ventilation and 14 of them (45%) were extubated within 24 hours. The duration of mechanical ventilation among the others was 7.7 days. The cooling protocol was started 1.8 hours after birth. All patients showed elevated levels of creatine phosphokinase, creatine phosphokinase- MB and lactate dehydrogenase. There was no severe arrhythmia; one newborn (2.9%) presented controlled coagulopathy. Four patients (11.4%) presented controlled hypotension. Twenty-nine patients (82.9%) underwent cerebral ultrasonography and 10 of them (34.5%) presented white matter hyper-echogenicity. Brain magnetic resonance imaging was performed on 33 infants (94.3%) and 11 of them (33.3%) presented hypoxic-ischemic changes. The hospital stay was 23 days. All newborns were discharged. Two patients (5.8%) needed gastrostomy. Hypothermia as therapy for asphyxiated newborns was shown to be safe.

Patient attitudes towards medical students at Damascus University teaching hospitals

PubMed Central

2012-01-01

Background The cooperation of patients and their consent to involve medical students in their care is vital to clinical education, but large numbers of students and lack of experience as well as loss of privacy may evoke negative attitudes of patients, which may sometimes adversely affect the clinical teaching environment. This study aimed to explore the attitudes of patients towards medical students at Damascus University hospitals, and to explore the determinants of those attitudes thus discussing possible implications applicable to clinical teaching. Methods This cross-sectional study was conducted at three teaching hospitals affiliated to the Faculty of Medicine at Damascus University. Four hundred patients were interviewed between March and April 2011 by a trained sociologist using a structured questionnaire. Results Of the patients interviewed, 67.8% approved the presence of medical students during the medical consultation and 58.2% of them felt comfortable with the presence of students, especially among patients with better socio-economic characteristics. 81.5% of the patients agreed to be examined by students in the presence of the supervisor, while 40.2% gave agreement even in the absence of the supervisor. Privacy was the most important factor in the patients' reticence towards examination by the students, whilst the relative safety and comfort if a supervisor was available determined patients' agreement. Conclusions The study concluded overall positive attitudes to the medical students' involvement in medical education. However, it is essential that students and clinical supervisors understand and adhere to professional and ethical conduct when involving patients in medical education. PMID:22439893

Hearing threshold assessment in young children with electrocochleography (EcochG) and auditory brainstem responses (ABR): experience at the University Hospital of Ferrara.

PubMed

Aimoni, C; Ciorba, A; Bovo, R; Trevisi, P; Busi, M; Martini, A

2010-10-01

Electrophysiological evaluation is a fundamental procedure for the diagnostic assessment of hearing loss during infancy; in these cases, information concerning threshold level and auditory perception is particularly useful to establish a correct hearing rehabilitation program (hearing aids and cochlear implants). Purpose of this study is to underline the role of auditory brainstem responses (ABR) and electrocochleography (EcochG) in the definition of hearing loss in a selected group of children, referred to the Audiology Department of the University Hospital of Ferrara, for a tertiary level audiological assessment. A retrospective study of the paediatric patient database at the Audiology Department of the University Hospital of Ferrara has been performed. In a period between January 2000 and December 2007, a total of 272 paediatric cases have been identified (544 ears). An EM 12 Mercury apparatus has been used for the electrophysiological threshold identification (ABR and EcochG). Recordings were carried out under general anaesthesia, in a protected enviroment. In 19 of the 272 paediatric cases selected--38 ears (7%), the results of threshold evaluation through ABR were uncertain. The Ecochg recording resulted crucial for the final diagnosis in terms of definition of the hearing threshold level, and it was then possible to ensure the better hearing rehabilitation strategy. ABR has to be considered the first choice in hearing assessment strategy, either for screening or for diagnosis in newborns as well as in non-collaborating children; ECochG still may be considered a reliable diagnostic tool. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2009-01-01

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

Information technology in health care--what the future holds.

PubMed

Bulgiba, A M

2004-01-01

In 1998, Malaysia opened its first hospital based on the "paperless and filmless" concept. Two are now in operation, with more to follow. Telemedicine is now being used in some hospitals and is slated to be the technology to watch. Future use of technology in health care will centre on the use of centralised patient databases and more effective use of artificial intelligence. Stumbling blocks include the enormous capital costs involved and difficulty in getting sufficient bandwidth to support applications on a national scale. Problems with the use of information technology in developing countries still remain; mainly inadequate skilled resources to operate and maintain the technology, lack of home-grown technology, insufficient experience in the use of information technology in health care and the attitudes of some health staff. The challenge for those involved in this field will not be in building new "paperless and filmless" institutions but in transforming current "paper and film-based" institutions to "paperless and filmless" ones and changing the mindset of health staff. Universities and medical schools must be prepared to respond to this new wave by incorporating elements of medical/health informatics in their curriculum and assisting governments in the planning and implementation of these projects. The experience of the UMMC is highlighted as an example of the difficulty of transforming a paper-based hospital to a "paperless and filmless" hospital.

[Clinical characteristics of pediatric victims in the Lushan and Wenchuan earthquakes and experience of medical rescue].

PubMed

Jiang, Xin; Xiang, Bo; Liu, Li-Jun; Liu, Min; Tang, Xue-Yang; Huang, Lu-Gang; Li, Yuan; Peng, Ming-Xing; Xin, Wen-Qiong

2013-06-01

To get a more comprehensive understanding of the clinical characteristics of pediatric victims in earthquake and to summarize the experience of medical rescue. The clinical information was collected from the pediatric victims who were admitted to West China Hospital, Sichuan University following the Lushan earthquake in 2013 and Wenchuan earthquake in 2008. The clinical data were compared between the pediatric victims in the two earthquakes. Thirty-four children under 14 years of age, who were injured in the Lushan earthquake, were admitted to the West China Hospital before April 30, 2013. Compared with the data in the Wenchuan earthquake, the mean age of the pediatric victims in the Lushan earthquake was significantly lower (P<0.01), and the mean time from earthquake to hospitalization was significantly shorter (P<0.01). In the Lushan earthquake, 67.6% of the injured children had variable limb fractures; traumatic brain injury was found in 29.4% of hospitalized children, versus 9.5% in the Wenchuan earthquake (P<0.05). Among the 34 children, no amputation and death occurred, and all the 13 severe cases started to recover. There were higher proportions of severely injured children and children with traumatic brain injury in the Lushan earthquake than in the Wenchuan earthquake. But these cases recovered well, which was possibly due to timely on-site rescue and transfer and multi-sector, multi-institution, and multidisciplinary cooperation.

[Health care in Western Europe in the late 18th century, as reported in Sámuel Cseh-Szombaty's travel journal].

PubMed

Rab, Irén

2015-07-19

Medical doctors working in Hungary and Transylvania were all trained abroad before the medical faculty of the University of Nagyszombat was founded in 1769. Most Roman Catholic medical students were trained in Vienna and Italy, whereas Protestants in Germany, The Netherlands, and Switzerland. In the 18th century a total of 500 Hungarian medical students studied at universities in Western Europe. Medical students' peregrination did not involve academic training only: whenever they had the possibility, students visited renowned hospitals, university clinics and famous doctors in order to gain experience and medical practice to complete their education. Sámuel Cseh-Szombaty studied in Pest and Göttingen, obtained his medical doctor's diploma in Vienna in 1790, and then spent a year and a half at various medical institutions in Germany, The Netherlands, and England. Cseh-Szombaty's so far unpublished travel journal and alba amicorum provide a wealth of information about the practical knowledge that could be learned during peregrination, characteristics of medical training, patients' treatment, quality of German hospitals of the late 18th century, where the most famous doctors worked. It is an exciting description, how a doctor from Hungary spent his time studying in Western Europe.

Long-term health effects of Vietnam-era military service: A quasi-experiment using Australian conscription lotteries.

PubMed

Johnston, David W; Shields, Michael A; Siminski, Peter

2016-01-01

This paper estimates the long-term health effects of Vietnam-era military service using Australia's National conscription lotteries for identification. Our primary contribution is the quality and breadth of our health outcomes. We use several administrative sources, containing a near-universe of records on mortality (1994-2011), cancer diagnoses (1982-2008), and emergency hospital presentations (2005-2010). We also analyse a range of self-reported morbidity indicators (2006-2009). We find no significant long-term effects on mortality, cancer or emergency hospital visits. In contrast, we find significant detrimental effects on a number of morbidity measures. Hearing and mental health appear to be particularly affected. Copyright © 2015 Elsevier B.V. All rights reserved.

Prostate Cancer Genetics in African Americans

DTIC Science & Technology

2013-09-01

tions the ~search is trying to answer, the sWdY is important to .the comn;unity .<Uld. )llC~n State’s Institutional Review Boards ~cailse. men with...for providing a balanced educational experience, the University offers a rigorous academic agenda with a broad range of disciplines, providing... Wii new hospital rehab tool • CU alum. 107. still true blue • Uke http://www.omaha.com/article/20110823/LIVEWELLOinOS239936/1165 Share 8/24

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

PubMed

Yereli, Ayşe Necef

2009-03-01

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

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital

PubMed Central

Ali, Safaa; El Sisi, Amel

2015-01-01

Aim To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Methods Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Results Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8–3.5 mm), median weight 8 kg (IQR, 7–10 kg), and median age 10 months (IQR, 8–17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. Conclusion With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory. PMID:27053899

Polycystic kidney disease at Howard University Hospital.

PubMed

Hosten, A O; Cummings, Y

1977-08-01

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

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

DTIC Science & Technology

1991-07-01

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

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

PubMed

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

2014-01-01

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

STS-29 crewmembers are briefed on Student Experiment (SE) 82-8

NASA Image and Video Library

1988-08-13

S88-44661 (13 Aug 1988) --- Tom Kestler, with Orthopaedic Hospital, USC, one of the sponsor representatives for student experimenter Andrew Fras explains components of Fras' experiment. It will be carried onboard theDiscovery for NASA's STS-29 mission next year. His primary audience is made up of members of the STS-29 crew who will monitor in-space operation of the experiment, titled "Effects of Weightlessness on Bone Healing." Crewmembers, clockwise around the table from the left, are Astronauts Robert C. Springer, James F. Buchli, Michael L. Coats, John E. Blaha and James P. Bagian. Seated in far right background is Dr. June Marshall of the University of Southern California School of Medicine, the student's sponsoring organization.

Reflections of a former vice president on long-time cardiac experiences

PubMed Central

Cheney, Richard B. (“Dick”)

2009-01-01

Editor's Note: Mr. Cheney, 46th vice president of the United States, was the featured guest speaker at the third annual Baylor Health Care System Foundation Heart and Vascular Dinner on April 7, 2009, at the home of Kathy and Harlan Crow (Figures 1 and 2). Previous speakers were former Senator Bob Dole and Denton Cooley, MD. Cheney spoke about his experiences with cardiovascular disease, his 40-year career in public service, and the challenges facing health care. Mr. Cheney has had four heart attacks and numerous other cardiovascular episodes, beginning with his first heart attack when he was 37 years old. The Foundation's Heart and Vascular Campaign, which has raised more than $11.2 million toward its $20 million fundraising goal, supports eight cardiology fellows and four residents in vascular surgery, as well as cardiovascular research at Baylor University Medical Center at Dallas, Baylor Hamilton Heart and Vascular Hospital, and The Heart Hospital Baylor Plano. PMID:21240297

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-09-01

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

Laparoscopic versus open repair of para-umbilical hernia. Is it a good alternative?

PubMed

Malik, Arshad Mehmood

2015-08-01

To compare the experience of laparoscopic repair of para-umbilical hernia with conventional open repair in terms of operative time, pre- and post-operative complications, total hospital stay, post-operative pain, morbidity, mortality and cosmesis. The prospective, randomized study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, and two private hospitals from June 2011 to June 2013, and comprised patients who were admitted with para-umbilical hernias of different sizes during the study period. The patients were divided into two groups. Group A underwent laparoscopic surgery, while Group B had conventional mesh repair. Variables studied included duration of surgery, operative and post-operative complications, morbidity and mortality. SPSS 20 was used for statistical analysis. Of the 337 patients in the study, 200(59.34%) were at the Liaquat University Hospital, while remaining 137(40.65%) patients were operated in two private hospitals. The overall mean age of the study sample was 42.18±9.789 years (range: 23-73). There were 68(20.18%) males and 269(79.82%) females. There were 166(49.26%) patients in Group A and 171(50.74%) Group B. The operative time was comparatively longer in Group A (p<0.001) especially in the first 30 operations. The laparoscopic approach was associated with a comparatively low incidence of operative and post-operative complications, reduced duration of hospital stay and cosmetically better results (p<0.05). There was no mortality in this series. Laparoscopic para-umbilical hernia repair, though a new technique, gave promising results compared to open conventional technique. However, there is a long way to go before coming to a consensus.

Review of thromboembolic prophylaxis in patients attending Cork University Hospital.

PubMed

Byrne, Stephen; Weaver, Daniel Timothy

2013-06-01

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

The role of labor pain and overall birth experience in the development of posttraumatic stress symptoms: a longitudinal cohort study.

PubMed

Garthus-Niegel, Susan; Knoph, Cecilie; von Soest, Tilmann; Nielsen, Christopher S; Eberhard-Gran, Malin

2014-03-01

The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework. The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested. Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience. Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care. © 2014, Copyright the Authors Journal compilation © 2014, Wiley Periodicals, Inc.

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

PubMed

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

2017-12-01

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

[E-learning in ENT: Usage in University Medical Centers in Germany].

PubMed

Freiherr von Saß, Peter; Klenzner, Thomas; Scheckenbach, Kathrin; Chaker, Adam

2017-03-01

E-learning is an essential part of innovative medical teaching concepts. The challenging anatomy and physiology in ENT is considered particularly suitable for self-assessed and adaptive e-learning. Usage and data on daily experience with e-learning in German ENT-university hospitals are currently unavailable and the degree of implementation of blended learning including feed-back from medical students are currently not known. We investigated the current need and usage of e-learning in academic ENT medical centers in Germany. We surveyed students and chairs for Otorhinolaryngology electronically and paperbased during the summer semester 2015. Our investigation revealed an overall heterogenous picture on quality and quantity of offered e-learning applications. While the overall amount of e-learning in academic ENT in Germany is rather low, at least half of the ENT-hospitals in medical faculties reported that e-learning had improved their own teaching activities. More collaboration among medical faculties and academic ENT-centers may help to explore new potentials, overcome technical difficulties and help to realize more ambitious projects. © Georg Thieme Verlag KG Stuttgart · New York.

Income Analysis of University-Owned Teaching Hospitals.

ERIC Educational Resources Information Center

Isaacs, Joseph C.

1979-01-01

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

A pragmatic observational feasibility study on integrated treatment for musculoskeletal disorders: Design and protocol.

PubMed

Hu, Xiao-yang; Hughes, John; Fisher, Peter; Lorenc, Ava; Purtell, Rachel; Park, A-La; Robinson, Nicola

2016-02-01

Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting. To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments. This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment. We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.

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

PubMed

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

2012-12-01

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

Treatment of eyelid injuries during period 2008-2010 at eye clinic of clinical center University of Prishtina.

PubMed

Shoshi, Mire; Shoshi, Avdyl; Xhafa, Agim; Kastrati, Fetije; Shoshi, Fitore; Shoshi, Fjolla

2012-01-01

In the Eye Clinic during 2008-2010 we have treated 446 patients, where 252 were hospitalized patients while 184 weren't. Treated patients were 1-85 years old. AIM OF THIS STUDY is to present our experience in treatment of patients with eye lids injuries and their reconstruction. In patients that were treated in the Eye Clinic, we have applied surgical methods, anti-tetanic protection and local and general medical therapy. 252 hospitalized patients also had other injuries of eye such as: rupture of bulbus, traumatic cataract, prolapsus iris, hyphaema in CA, prolapsus CV, VLC perforanc cornea et corpus alieni in CA, hyphaema totalis, VLC sclera, corpus alieni intrabulbares. Patients that weren't hospitalized were 5-10 years old, 25-35 years old and 20-25 years old. Hospitalized patients were 5-10 years old, 20-25 years old and 30-35 years old. By this we can conclude that there wasn't any significant difference based on the patients' age. In the hospitalized cases with eye-lid injuries, most injuries of the eye were: VLC perforanc cornea cum prolapsus iridea, Corpus alieni in CA et hyphaema.

Experience in the management of the mass casualty from the January 2010 Jos Crisis.

PubMed

Ozoilo, K N; Amupitan, I; Peter, S D; Ojo, E O; Ismaila, B O; Ode, M; Adoga, A A; Adoga, A S

2016-01-01

On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

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

PubMed

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

2002-12-01

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

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

PubMed

Shahi, Mehraban; Sadoughi, Farahnaz; Ahmadi, Maryam

2014-11-30

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

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

PubMed

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

2016-07-02

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

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

PubMed

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

2010-09-01

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

An educational intervention to change planned behavior concerning midwife-assisted out-of-hospital childbirth.

PubMed

Hans, Jason D; Kimberly, Claire

2011-01-01

'The Business of Being Born' is a documentary film that reviews the history, economics, and culture of birth in the United States, with an emphasis on viewing low-risk birth as a natural and reasonably safe experience that does not require medical intervention. A nonequivalent control group design with 468 American university students was used to examine the potential of 'The Business of Being Born' for changing attitudes toward, and planned behavior concerning, midwife-assisted out-of-hospital childbirth. Viewing the film had a large positive effect on planned behavior concerning midwife-assisted out-of-hospital childbirth. Rationales for planned behaviors indicated that trust and safety concerns accounted for the appeal of physician-assisted hospital childbirth over midwife-assisted out-of-hospital childbirth, but that viewing the film substantially tempered these concerns vis-à-vis midwife-assisted out-of-hospital childbirth among a large portion of participants. The results indicate that 'The Business of Being Born' can increase awareness of and support for the midwifery profession, and that these changes may result in increased demand for midwifery services. However, proactive efforts must be taken to ensure that the film reaches its target audience. © 2011 by the American College of Nurse-Midwives.

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

PubMed Central

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

2017-01-01

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

Extracorporeal cardiopulmonary resuscitation after out-of-hospital cardiac arrest in a Danish health region.

PubMed

Fjølner, J; Greisen, J; Jørgensen, M R S; Terkelsen, C J; Ilkjaer, L B; Hansen, T M; Eiskjaer, H; Christensen, S; Gjedsted, J

2017-02-01

Extracorporeal Cardiopulmonary Resuscitation (ECPR) has emerged as a feasible rescue therapy for refractory, normothermic out-of-hospital cardiac arrest (OHCA). Reported survival rates vary and comparison between studies is hampered by heterogeneous study populations, differences in bystander intervention and in pre-hospital emergency service organisation. We aimed to describe the first experiences, treatment details, complications and outcome with ECPR for OHCA in a Danish health region. Retrospective study of adult patients admitted at Aarhus University Hospital, Denmark between 1 January 2011 and 1 July 2015 with witnessed, refractory, normothermic OHCA treated with ECPR. OHCA was managed with pre-hospital advanced airway management and mechanical chest compression during transport. Relevant pre-hospital and in-hospital data were collected with special focus on low-flow time and ECPR duration. Survival to hospital discharge with Cerebral Performance Category (CPC) of 1 and 2 at hospital discharge was the primary endpoint. Twenty-one patients were included. Median pre-hospital low-flow time was 54 min [range 5-100] and median total low-flow time was 121 min [range 55-192]. Seven patients survived (33%). Survivors had a CPC score of 1 or 2 at hospital discharge. Five survivors had a shockable initial rhythm. In all survivors coronary occlusion was the presumed cause of cardiac arrest. Extracorporeal cardiopulmonary resuscitation is feasible as a rescue therapy in normothermic refractory OHCA in highly selected patients. Low-flow time was longer than previously reported. Survival with favourable neurological outcome is possible despite prolonged low-flow duration. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Hadron Cancer Therapy - relative merits of X-ray, proton and carbon beams

NASA Astrophysics Data System (ADS)

Jakel, Oliver

2014-03-01

-Heidelberg University has a long experience in radiotherapy with carbon ions, starting with a pilot project at GSI in 1997. This project was jointly run by the Dep. for Radiation Oncology of Heidelberg University, GSI and the German Cancer Research Center (DKFZ). A hospital based heavy ion center at Heidelberg University, the Heidelberg Ion Beam Therapy Center (HIT) was proposed by the same group in 1998 and started clinical operation in late 2009. Since then nearly 2000 patients were treated with beams of carbon ions and protons. Just recently the operation of the world's first and only gantry for heavy ions also started at HIT. Patient treatments are performed in three rooms. Besides that, a lot of research projects are run in the field of Medical Physics and Radiobiology using a dedicated experimental area and the possibility to use beams of protons, carbon, helium and oxygen ions being delivered with the raster scanning technique.

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

ERIC Educational Resources Information Center

Farley, Eugene S.; Piemme, Thomas E.

1975-01-01

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

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

PubMed

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

2016-10-01

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

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

PubMed

Botvin, Judith D

2003-01-01

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

Institutional responses to communicable diseases at Victoria College, University of Toronto, 1900-1940.

PubMed

Gidney, Catherine

2007-01-01

Between 1900 and 1940 students and staff risked their lives to attend, and teach at, Victoria College. Not only did Victoria experience three major epidemics--diphtheria in 1911, influenza from 1918 to 1920, and smallpox in 1927--but almost yearly one or two students contracted diseases such as scarlet fever, measles, and mumps. Yet at a time when there was no health insurance and few hospital facilities, how did the university cope with the problem? This paper examines the care provided to Victoria's residential students. In the process the paper illustrates not only the upheaval endured by individual students but also the enormous financial and emotional toll paid by the institution, especially by members of its female staff.

The University of Oklahoma College of Medicine summer medical program for high school students.

PubMed

Larson, Jerome; Atkins, R Matthew; Tucker, Phebe; Monson, Angela; Corpening, Brian; Baker, Sherri

2011-06-01

To enhance diversity of applicants to University of Oklahoma College of Medicine, a Summer Medical Program for High School Students was started in 2009. This comprehensive pipeline program included sessions on applying to medical school, interaction with a panel of minority physicians and health care professionals role models, clinically oriented didactics taught by physician faculty, shadowing experiences in clinics and hospitals, and presentation of student research reports. Students' assessments in 2009 showed increased understanding of the medical school application process, the medical curriculum and the medical field, and an increase in students'likeliness to choose a medical career. Importance of long-term mentoring and follow-up with students to sustain their medical interests is discussed.

Communication difficulties and the experience of loneliness in patients with cancer dealing with fertility issues: a qualitative study.

PubMed

Goossens, Joline; Delbaere, Ilse; Beeckman, Dimitri; Verhaeghe, Sofie; Van Hecke, Ann

2015-01-01

To explore communication difficulties and the experience of loneliness among patients with cancer dealing with fertility issues. Qualitative study based on grounded theory principles. One university hospital and two general hospitals in Flanders, Belgium. 21 female and 7 male patients with cancer with potential fertility problems as a result of treatment. Grounded theory approach using the constant comparison method; data collection (semistructured face-to-face interviews) and analysis occurred simultaneously. Loneliness was a central theme in the experience of potential fertility loss among patients with cancer. Feelings of loneliness resulted from communication difficulties between the patient and members of his or her social environment or healthcare professionals because of several underlying processes and influencing factors. Loneliness was a strong and common feeling among patients with cancer. Patients, members of their social environment, and healthcare professionals experienced difficulties in communicating about fertility in the context of cancer, leading to patients' feelings of loneliness. Healthcare professionals must be attentive to signs indicating loneliness regarding fertility concerns, and they should provide adequate information and appropriate guidance to support patients. Professionals need further training to improve knowledge and skills.

[Health Promotion and care of immigrant population in the eighth Municipality of Rome: the experience of the Medicine Service of Solidarity and the University Hospital of Tor Vergata].

PubMed

Palombi, Leonardo; Ercoli, Lucia; Buonomo, Ersilia; Mancinelli, Sandro; De Luca, Simona; Laurenti, Serena; Visconti, Giuseppe; Bollero, Patrizio

2013-01-01

The VIII Municipality of Rome is characterized by a high poverty rate, by the presence of many immigrant communities and by the lack of health services available to vulnerable social groups. In 2005 , the " Servizio di Medicina Solidale" of the University Hospital of "Tor Vergata", for the first time intervened in this Municipality regarding Immigrant Health. The paper describes the activities and organization of this service from January 2005 to December 2007. It demonstrates a complex epidemiological picture of 2,374 immigrants, characterized by a young population, mostly women with reproductive health issues, followed by children with infectious and nutritional problems and, ultimately, adults who accessed the service, firstly for gastroenterological problems, secondly for cardiovascular problems and finally for dysmetabolic disorders. The paper describes the culture-centered actions of Health Promotion and Health Education in order to improve health awareness and promote integration of immigrants. The study indicates that the limited number of hospital admissions ( n.20) with respect to the number of outpatient visits (n.70.000) in the first seven years of the service " Medicina Solidale" has significantly reduced the number of unnecessary admissions to emergency wards. In conclusion it is notable that the cost of such intervention results eight times inferior to emergency admissions and further confirms that a Community medicine approach is sustainable.

Building research capacity: through a hospital-based clinical school of nursing.

PubMed

Lee, Geraldine; Metcalf, Suzanne

2009-04-01

For clinical nurses and nursing academics wishing to participate in research, there are several logistical issues such as high workloads, lack of time and poor research skills and knowledge that can impede research being undertaken. To address these issues, La Trobe University in partnership with one of Melbourne's acute care hospitals developed a clinical school with the aim of delivering postgraduate courses and undertaking collaborative clinically focused nursing research. Clinical issues were identified jointly between university academics and clinical nursing staff. Research questions were developed to examine these issues with the clinical school staff facilitating the research process. Research has been undertaken in many specialty areas including emergency, cardiac and intensive care nursing and diabetes. The success of this collaboration is evident with many studies being undertaken and consequently dissemination of research findings published (with clinicians being the primary author on many papers), presentations at national and international conferences by clinical staff as well as an increased enrollment into masters and doctoral programmes. The presence of the clinical school at the hospital has been beneficial both to clinicians and nurse academics and resulted in developing a positive research environment. More importantly, the research has led to changes in patient care and enabled clinicians to gain research experience and further academic qualifications. The other benefit is that nurse academics have strengthened their working relationship with clinicians and ensured visible research outputs were achieved.

Hygiene trained nursing staff at wards – What can this additional educated nurses achieve?

PubMed

Tebest, Ralf; Honervogt, Fiona Yoon Mee; Westermann, Kristina; Samel, Christina; Redaèlli, Marcus; Stock, Stephanie

2017-01-01

Background: Hygiene deficits can cause hospital-acquired infections. To meet this public health problem the Robert Koch-Institute advocates the employment of infection control link nurses (ICLN). Aim: This study aimed to evaluate the experiences of ICLNs working in the University Hospital of Cologne. Method: A cross-sectional survey of all ICLNs (n = 64) working at the University Hospital of Cologne was carried out by a self developed questionaire. The data were assessed descriptively. Results: The return rate was 45.3 % (n = 29). The ICLNs were very satisfied with the ICLN training and felt well prepared for their task. The collaboration with other nursing staff, their head nurse and the Department of Hygiene was also positively evaluated. However, only one third of the respondents was satisfied with their working conditions and only half of them indicated feeling that the efforts they made so far were successful. This study also found that, many of the legal intended services were rarely performed. The study identified two barriers to implementation of ICLNs. On the one hand, the release from other routine nursing duties and on the other hand a lack of acceptance of the role by physicians. Conclusions: The task ahead is to find ways to exempt ICLNs from other duties and to involve the physicians more intensely in the implementation of ICLNs.

The injury severity score or the new injury severity score for predicting mortality, intensive care unit admission and length of hospital stay: experience from a university hospital in a developing country.

PubMed

Tamim, Hala; Al Hazzouri, Adina Zeki; Mahfoud, Ziad; Atoui, Maria; El-Chemaly, Souheil

2008-01-01

Limited research has been performed to compare the predictive abilities of the injury severity score (ISS) and the new ISS (NISS) in the developing world. From January 2001 until January 2003 all trauma patients admitted to the American University of Beirut Medical Centre were enrolled. The statistical performance of the ISS/NISS in predicting mortality, admission to the intensive care unit (ICU) and length of hospital stay (LOS dichotomised as <10 or > or =10 days) was evaluated using receiver operating characteristic and the Hosmer-Lemeshow calibration statistic. A total of 891 consecutive patients were enrolled. The ISS and NISS were equivalent in predicting survival, and both performed better in patients younger than 65 years of age. However, the ISS predicted ICU admission and LOS better than the NISS. However, these predictive abilities were lower for the geriatric trauma patients aged 65 years and above compared to the other age groups. There are conflicting results in the literature about the abilities of ISS and NISS to predict mortality. However, this is the first study to report that ISS has a superior ability in predicting both LOS and ICU admission. The scoring of trauma severity may need to be individualised to different countries and trauma systems.

Factors affecting parental satisfaction following pediatric procedural sedation.

PubMed

Lew, Vincent K; Lalwani, Kirk; Palermo, Tonya M

2010-02-01

To investigate factors affecting parental satisfaction with a pediatric sedation service in a university hospital setting. Prospective, observational study with interviews using a survey instrument. Academic university hospital. Parents (or legal guardians; hereafter "parents") of 220 children scheduled for sedation with the hospital's pediatric sedation service. Caregivers of children scheduled for sedation were interviewed using a validated survey instrument. The instrument was designed to investigate the quality of communication, environment, care provided, and the overall experience. We followed patients by telephone the day after discharge. Chi-square or linear-by-linear association tests were used to evaluate associations between satisfaction scores and demographic variables; the Mann-Whitney test was used for mean levels of satisfaction in anxious versus non-anxious children. Of 222 parents approached, 220 agreed to participate (response rate = 99.1%). Significant associations between each area of satisfaction and parents' overall satisfaction existed (P < 0.001). Previous sedations, types of sedation, age of child, or any individual provider were not significantly associated with overall satisfaction. Caregivers of anxious children reported less satisfaction than caregivers of non-anxious children. Parents of children who underwent magnetic resonance imaging reported the lowest mean satisfaction scores. Overall satisfaction was high, and care provided by anesthesiologists was significantly associated with overall satisfaction. A site in our institution was associated with significantly lower satisfaction as a result of inadequate space and privacy.

[Gender-inclusive care of victims of violence : The model project "Gender Gewaltkonzept" at the University Hospital Aachen].

PubMed

Evler, A; Scheller, M; Wagels, L; Bergs, R; Clemens, B; Kohn, N; Pütz, A; Voss, B; Schneider, F; Habel, U

2016-07-01

Violence is a topic of great social relevance, frequently causing tremendous health consequences for those affected and high consequential costs for health care and the national economy. The established consulting and assistance services are usually restricted to offers for ambulant supply, mainly from private agencies or societies. As a result, there is no identification and care for patients who have experienced violence and who are treated in hospital. Another deficiency is the identification and care of male victims of violence. Despite wide-ranging offers of assistance, only very few gender-specific consulting and support services have been available to date.Therefore, the model project "Gender Gewaltkonzept" was initiated at Aachen University Hospital to assess the prevalence of violence and the potential consequences of the violence experienced on the patients' health. In addition, we investigated whether males and females are in need of different supply requirements.Based on the results of the project "Gender Gewaltkonzept" so far, and on prevalence estimates proving that there is a high rate of violent experiences in both males and females, this overview is aimed at presenting the aid and protection concepts available for victims of violence, in addition to the existing deficiencies of the care system. We present approaches to resolving these deficiencies to be able to establish all-encompassing gender-appropriate support for victims of violence.

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

PubMed

Kawano, Seiji

2014-12-01

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

Posttraumatic growth in Iranian cancer patients.

PubMed

Rahmani, A; Mohammadian, R; Ferguson, C; Golizadeh, L; Zirak, M; Chavoshi, H

2012-01-01

To investigate the level and determinants of posttraumatic growth in Iranian cancer patients. This descriptive-correlational design study was conducted within a university-affiliated oncology hospital in Iran. A convenience sample of 450 patients with a definitive diagnosis of cancer of any type completed a demographic questionnaire and a posttraumatic growth inventory. Some disease-related information was obtained from patients' medical records. The mean of posttraumatic growth reported by participants was 76.1. There was a statistically significant association between experience of posttraumatic growth and age (r = - 0.21, P=0.001), education at university level (F = 8.9, P=0.001) and history of treatment by radiotherapy (t = 2.1, P=0.03). The findings of this study suggest that Iranian cancer patients experience a moderate to high level of posttraumatic growth and confirm the hypothesis that the level of posttraumatic growth in non-Western cancer patients is more than that of Western cancer patients. Although, assessing the reasons for this difference needs more investigations.

Care and cultural context of Lebanese Muslim immigrants: using Leininger's theory.

PubMed

Luna, L

1994-01-01

The purpose of this ethnonursing study was to describe and analyze the meanings and experiences of care for Lebanese Muslims as influenced by cultural context in selected natural and community settings. Leininger's theory of Cultural Care Diversity and Universality served as the conceptualizing frame-work for the study. Research questions focused on discovering the meanings and experiences of care as influenced by world view, social structure, and cultural context in the hospital, clinic, and home. Ethno-nursing research methods were used with key and general informants in an urban US community. The majority of informants were new immigrants living less than 10 years in the US. Universal themes of care that were similar in the three contexts reflected care as a religious obligation in Islam, care as equal but different gender role responsibilities, and care as individual and collective meanings of honor. This article also presents findings related to gender role responsibilities. Nursing decisions and actions using Leininger's three modes were identified to achieve culturally congruent nursing care.

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

NASA Astrophysics Data System (ADS)

Shimazaki, Yoichi

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

Sexual harassment and its consequences: a study within Turkish hospitals.

PubMed

Kisa, Adnan; Dziegielewski, Sophia F; Ates, Metin

2002-01-01

Sexual harassment remains a universal factor that can affect nursing performance and worker productivity in any type of health care facility. There are few studies in this area that have been conducted in developing countries. To measure the occurrence of sexual harassment, a questionnaire was given to 353 nurses in two different hospitals yielding a response rate of 61%. Overall, the majority of the respondents (n = 157 out of 251) reported that they had been subjected to sexual harassment in the workplace, and the harassment experience was strong enough to affect worker productivity. In addition, many nurses reported the belief that sexual harassment remains a disturbing problem in this developing country that should not be ignored. Based on these findings, implications for policy and further study are suggested.

Principles of blood transfusion service audit.

PubMed

Dosunmu, A O; Dada, M O

2005-12-01

Blood transfusion is still an important procedure in modern medical practice despite efforts to avoid it. This is due to it's association with infections especially HIV. It is therefore necessary to have proper quality control of its production, storage and usage [1]. A way of controlling usage is to do regular clinical audit. To effect this, there has to be an agreed standard for appropriate use of blood. The aim of this paper is to briefly highlight the importance of audit, audit procedures and tools i.e. required records, development of audit criteria and audit parameters. Every hospital/blood transfusion center is expected to develop a system of audit that is appropriate to its needs. The suggestions are mainly based on the experience at the Lagos University Teaching Hospital and the Lagos State Blood Transfusion Service.

[Cyclic vomiting with ketosis as a cause of acute kidney dysfunction: own clinical experience].

PubMed

Ostrowska-Nawarycz, L; Rapacka, E; Baszczyński, J; Górski, P; Czajka, J; Makowski, M; Kudzin, A

2000-04-01

The aim of the study was to evaluate renal activity during cyclic vomiting with ketosis. The clinical material was obtained from 50 cases of children hospitalized in Department of Pediatrics Military Medical University within 1993-1999 what makes about 1% of all patients. The examined group consisted of 26 boys (52%) and 24 girls (48%). Three of the children were repeatedly hospitalized (3 to 8 times) because of acetonemic vomiting. The special attention during the laboratory studies was paid to evaluation of renal activity. Vomiting with ketosis were associated with temporary kidneys acute dysfunction in 46% of cases. In 98% of cases the parenteral hydration was necessary. Ketonemic vomiting with kidneys dysfunction was observed mainly with the children in pre-school age.

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

PubMed

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

2013-12-01

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

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

PubMed Central

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

2010-01-01

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

Relationship between leadership styles of nurse managers and nurses' job satisfaction in Jimma University Specialized Hospital.

PubMed

Negussie, Nebiat; Demissie, Asresash

2013-03-01

Leadership style of nurse managers plays a significant role in nurses' job satisfaction. However, there is limited literature in areas related to nurses' manager leadership style. The objective of this research was thus to investigate the relationship between leadership style of nurse managers and nurses' job satisfaction in Jimma University Specialized Hospital. The study was conducted at Jimma University Specialized Hospital from January to June 2012 and used a non-experimental correlation design. All full time, non-supervisory nurses with an experience of more than one year in nursing profession were participated in the study. The Multifactor Leadership Questionnaire and Minnesota Satisfaction Questionnaire were used to collect data. Data were entered and analyzed using SPSS version16.0 statistical software. The results were analyzed through descriptive statistics followed by the application of inferential statistics on the variables. Significance level was considered when p<0.05. A total of 175 copies of the questionnaires were returned out of 186 copies distributed to respondents. The result indicated that nurses can prefer transformational leadership style over transactional leadership style and had moderate-level intrinsic (M=2.72, SD=0.71) but low level of extrinsic job satisfaction (M=1.83, SD=0.68). Furthermore, from transactional leadership, only contingent reward was found to be statically significant and correlated with extrinsic (B=0.45, p<0.01) and intrinsic job satisfaction (B=0.32, p<0.05) while all five dimension of transformational leadership style were statistically significant and correlated with both intrinsic and extrinsic job satisfaction. Nurses tended to be more satisfied with the transformational leadership than transactional leadership style. Therefore, nurses' managers should use transformational leadership style in order to increase nurses' job satisfaction.

A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances

PubMed Central

Mangnall, Louise A R; Dietrich, Thomas; Scholey, John M

2013-01-01

Objective: To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience. Design: Multicentre randomized controlled trial. Setting: Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire. Materials and methods: Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced. Results: Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001). Conclusions: Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond. PMID:24009318

[Out-of-hospital pediatric emergencies. Perception and assessment by emergency physicians].

PubMed

Eich, C; Roessler, M; Timmermann, A; Heuer, J F; Gentkow, U; Albrecht, B; Russo, S G

2009-09-01

Out-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them. All active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies. The 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children's age (p<0.03) and with their own experience (p<0.01). The EPs felt particular deficits in the fields of cardiopulmonary resuscitation (n=18) and trauma management (n=8). The preferred educational strategies included simulator-based training (n=24) as well as more exposure to pediatric intensive care and pediatric anesthesia (n=12). Despite their own limited experience EPs can realistically assess the incidence and severity of pediatric emergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators.

[Leisure for mothers of high-risk babies: analysis of the experience in these women's perspective].

PubMed

Scochi, Carmen Gracinda Silvan; Brunherotti, Mariana Ribeiro; Fonseca, Luciana Mara Monti; Nogueira, Fernanda dos Santos; Vasconcelos, Maria Gorete Lucena de; Leite, Adriana Moraes

2004-01-01

In view of the implementation of new care strategies for mothers of high-risk babies attended at neonatal units through a program involving play, recreation and educational activities, this study aims to analyze this experience according to these women's perspectives. A qualitative and descriptive study was conducted at the University Hospital of Ribeirão Preto, Brazil. Seven mothers were interviewed who had attended at least three activity sessions in the program and signed an informed consent document. The interviews were taped and were guided by the following question: "Tell us about your experience in these group meetings". It was observed that the mothers described the activities as "...they are nice and help to establish ties" and "...they are good because we get some distraction", thus revitalizing them to cope with the stress from long hospitalization. They pointed out the opportunity to learn about some types of care for their children through games and educational films -- "They solve many of our doubts, especially for those who have pre-term babies", as well as the opportunity to do manual work -- "We learned how to embroider, which was something no one knew how to do". This activity resulted in the production of clothing for the child. It was concluded that the program contributed to the process of constructing a more integral and humanized care by focusing on the family and broadening the perspective on hospitals as places that also offer leisure.

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

PubMed

Amann, I; Heyder, R; Strehl, R

2009-08-01

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

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

PubMed

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

2014-06-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

[Introduction of hospital information system and anesthesia information management system into the perianesthetic practice at Osaka City University Hospital].

PubMed

Shimizu, Motoko; Tanaka, Katsuaki; Hagiwara, Chie; Ikenaga, Kazutake; Yoshioka, Miwako; Asada, Akira

2011-06-01

Recently, the hospital information systems (HIS) and anesthesia information management systems (AIMS) have been rapidly improved and have been introduced into the clinical practice in Japan drastically; however, few reports have detailed their influences on clinical practice. We here report our experience. We introduced HIS (EGMAIN-EX, Fujitsu Co., Ltd.) in our preoperative evaluation clinic and in the postoperative care unit. AIMS (ORSYS, Philips Electronics Japan) was introduced almost only to the intraoperative management. It became easy for us to acquire patient's information and to share it with the medical staffs in the other departments. However, we had to invest large human resources for the introduction and maintenance of the HIS and the AIMS. Though AIMS is more useful in anesthetic management than HIS, it seems to be more suitable for coordination with the medical staffs in the other departments to use HIS for perioperative management than to use AIMS.

Structure of "Ventilation and Warming" in Notes on Nursing Written by Florence Nightingale in 19th Century: Introduction of Basic Physics to Nursing Students

NASA Astrophysics Data System (ADS)

Ogoh, Kazutoshi

"Basic Natural Science" for freshmen at Miyazaki Prefectural Nursing University has a component including physics. Here students learn three principles of thermal transfer; conduction, radiation, and convection through a series of experiments. The purpose of these experiments is to understand the structure of a method for the caring of breathing and temperature of patients as written in "Ventilation and Warming", the first chapter of F. Nightingale's Notes on Nursing. Students can then apply this structure to retain fresh air in today's hospital rooms, and can then appreciate studying real physics incorporated into fundamental knowledge for nursing practice.

Nonoperative management for patients with grade IV blunt hepatic trauma.

PubMed

Zago, Thiago Messias; Tavares Pereira, Bruno Monteiro; Araujo Calderan, Thiago Rodrigues; Godinho, Mauricio; Nascimento, Bartolomeu; Fraga, Gustavo Pereira

2012-08-22

The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: a single medical school experience.

PubMed

Park, Seung Won; Jang, Hye Won; Choe, Yon Ho; Lee, Kyung Soo; Ahn, Yong Chan; Chung, Myung Jin; Lee, Kyu-Sung; Lee, Kyunghoon; Han, Taehee

2016-06-01

In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM's experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges. Through a process of reflection-on-action, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease. The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students. Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology.

[Results of Training for Personnel Involved in Blood-Transfusion Testing Outside of Regular Work Hours at Saga University Hospital].

PubMed

Yamada, Marie; Yamada, Naotomo; Higashitani, Takanori; Ohta, Shoichiro; Sueoka, Eisaburo

2015-11-01

Laboratory testing prior to blood transfusion outside of regular hours in many hospitals and clinics is frequently conducted by technicians without sufficient experience in such testing work. To obtain consistent test results regardless of the degree of laboratory experience with blood transfusion testing, the number of facilities introducing automated equipment for testing prior to blood transfusion is increasing. Our hospital's blood transfusion department introduced fully automated test equipment in October of 2010 for use when blood transfusions are conducted outside of regular hours. However, excessive dependence on automated testing can lead to an inability to do manual blood typing or cross-match testing when necessitated by breakdowns in the automated test equipment, in the case of abnormal specimen reactions, or other such case. In addition, even outside of normal working hours there are more than a few instances in which transfusion must take place based on urgent communications from clinical staff, with the need for prompt and flexible timing of blood transfusion test and delivery of blood products. To address this situation, in 2010 we began training after-hours laboratory personnel in blood transfusion testing to provide practice using test tubes manually and to achieve greater understanding of blood transfusion test work (especially in cases of critical blood loss). Results of the training and difficulties in its implementation for such after-hours laboratory personnel at our hospital are presented and discussed in this paper. [Original

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

PubMed

Istl, Alexandra C; McAlister, Vivian C

2016-12-01

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

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

PubMed

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

2001-09-01

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

Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: a qualitative study.

PubMed

Caswell, Glenys; Pollock, Kristian; Harwood, Rowan; Porock, Davina

2015-08-01

This paper focuses on communication between hospital staff and family carers of patients dying on acute hospital wards, with an emphasis on the family carers' perspective. The age at which people in the UK die is increasing and many continue to die in the acute hospital setting. Concerns have been expressed about poor quality end of life care in hospitals, in particular regarding communication between staff and relatives. This research aimed to understand the factors and processes which affect the quality of care provided to frail older people who are dying in hospital and their family carers. The study used mixed qualitative methods, involving non-participant observation, semi-structured interviews and a review of case notes. Four acute wards in an English University teaching hospital formed the setting: an admissions unit, two health care of older people wards and a specialist medical and mental health unit for older people. Thirty-two members of staff took part in interviews, five members of the palliative care team participated in a focus group and 13 bereaved family carers were interviewed. In all, 245 hours of observation were carried out including all days of the week and all hours of the day. Forty-two individual patient cases were constructed where the patient had died on the wards during the course of the study. Thirty three cases included direct observations of patient care. Interviews were completed with 12 bereaved family carers of ten patient cases. Carers' experience of the end of life care of their relative was enhanced when mutual understanding was achieved with healthcare professionals. However, some carers reported communication to be ineffective. They felt unsure about what was happening with their relative and were distressed by the experience of their relative's end of life care. Establishing a concordant relationship, based on negotiated understanding of shared perspectives, can help to improve communication between healthcare professionals and family carers of their patients.

A Prospective Screening of HLA-B*57.01 Allelic Variant for Preventing the Hypersensivity Reaction to Abacavir: Experience from the Laboratory of Molecular Biology of the Infectious Diseases Division at the University Hospital of Salerno.

PubMed

Senatore, C; Charlier, B; Truono, A; Punzi, R; D'Aniello, F; Boffa, N; Izzo, V; Conti, V; Russomanno, G; Manzo, V; Filippelli, A; Mazzeo, M

2015-01-01

Abacavir is a nucleoside reverse transcriptase inhibitor largely used as part of the antiretroviral therapy in Human Immunodeficiency Virus (HIV)-infected patients. Some individuals (2-9%) who start an abacavir treatment show an immunologic reaction indicated as hypersensitivity reaction syndrome (HSR) that is often responsible for therapy discontinuation and could represent a life-threatening event. Some studies demonstrated a correlation between this adverse reaction and the class I of the major histocompatibility complex (MHC) allele, HLA-B*57.01, in several populations, including Caucasians. Nowadays, International HIV treatment guidelines recommend the HLA-B*57.01 genotyping before abacavir administration to reduce the incidence of HSR. Both male and female HIV-infected patients were enrolled at the Infectious Diseases Division at the University Hospital of Salerno, and admitted to a prospective HLAB*57.01 screening. Genetic analysis was carried out through two sequential Real-Time PCR reactions in which Sybr-Green was used. Out of 248 patients, 215 were Italians from Southern Italy and 33 were coming from several non-EU members countries. All were genotyped: 6 Italians (2.8%) and 1 of the non-EU group (3%) were identified as HLAB*57.01 carriers. In this paper we present our experience in the field of abacavir pharmacogenetic and confirm the importance of Real Time PCR as a valid and cost-effective HLA-B*57.01 typing methodology.

Experience with head and neck missile injuries at the yalgado university teaching hospital, ouagadougou, burkina faso.

PubMed

Ouedraogo, Rwl; Konsem, T; Gyebre, Ymc; Ouedraogo, Bp; Sereme, M; Bambara, Cl; Ouattara, M; Ouoba, K

2012-10-01

To report the diagnostic and therapeutic options of missile head and neck injuries. To present our experience in the management of head and neck missile injuries as seen in our centre. All the patients with head and neck missile injuries who were managed in the ENT and Dental services of Yalgado University Teaching Hospital, in Ouagadougou, the capital of Burkina Faso between January 2003 and December 2012 were reviewed. The data obtained from medical records included demographic data, history, physical findings, and site of injury, diagnosis, type of treatment/surgery, complications and outcome. Out of a total of 32 patients in this study, there were 26 males and 6 females with a sex ratio of 4.3:1. Their ages ranged from 18 to 63 years with a mean of 32 years ± 5.2. The age range of 20-40 accounted for 68.7% of the patients. The injury was accidental in 37.5%, assault in 56.3 and self inflicted/suicide in 6.3%. Most (59.4%) of the patients had multiple injuries while in 50 % of the cases, the injuries affected the face. Surgical intervention was done in 59.4% of the patients and conservative treatment in 40.6 % of the patients. Complications were noted in 52% of the patients. Seven patients died given a mortality rate of 21.9%. The head and neck missile injuries are not uncommon in our environment with a high mortality and morbidity rates.

Exploring deliberate practice in medicine: how do physicians learn in the workplace?

PubMed

van de Wiel, Margje W J; Van den Bossche, Piet; Janssen, Sandra; Jossberger, Helen

2011-03-01

Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians' learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians engage in during their work that might further their professional development. As deliberate practice requires a focused effort to improve performance, the study also examined the goals underlying this behaviour. Semi-structured interviews were conducted with 50 internal medicine physicians: 19 residents, 18 internists working at a university hospital, and 13 working at a non-university hospital. The results showed that learning in medical practice was very much embedded in clinical work. Most relevant learning activities were directly related to patient care rather than motivated by competence improvement goals. Advice and feedback were sought when necessary to provide this care. Performance standards were tied to patients' conditions. The patients encountered and the discussions with colleagues about patients were valued most for professional development, while teaching and updating activities were also valued in this respect. In conclusion, physicians' learning is largely guided by practical experience rather than deliberately sought. When professionals interact in diagnosing and treating patients to achieve high-quality care, their experiences contribute to expertise development. However, much could be gained from managing learning opportunities more explicitly. We offer suggestions for increasing the focus on learning in medical practice and further research.

Interview with a quality leader: Kent Bottles, MD, president of ICSI, on transforming care for the future. Interview by Susan V. White.

PubMed

Bottles, Kent

2010-01-01

Kent Bottles, MD, President of the Institute for Clinical Systems Improvement (ICSI). Dr. Bottles is a board-certified pathologist who specialized in surgical and cyto-pathology. He earned a medical degree from Case Western Reserve University in Ohio. He has extensive experience in integrated healthcare delivery systems, research, academia, commercial laboratories, genomics, proteomics, and management of biotech start-up companies. Dr. Bottles was vice president and chief medical officer of the Iowa Health System. Before that, he served as president and CEO of Grand Rapids Medical Education and Research Center for Health Professions, a multi-institutional consortium of healthcare organizations, and as president of Genomics Repository and chief knowledge officer, Genomics Collaborative Inc. Dr. Bottles has extensive academic experience, serving as Professor and Acting Head, Department of Pathology and Laboratory Medicine at the University of Iowa. He was also the founding medical director of managed care plans for University of Iowa employees. Dr. Bottles has addressed topics ranging from quality and patient safety and disruptive technology to patient-physician relationships and the future of medicine. He has received numerous honors, including the Rodney T. West Literary Achievement Award for the most important article on medical management presented by the American College of Physician Executives. He has broad clinical experience with the University of Iowa and the San Francisco General Hospital, and has been a national leader in changing the practice of pathology and laboratory medicine to meet the challenges of managed care.

Identifying congenital hearing impairment. Personal experience based on selective hearing screening.

PubMed

Molini, E; Ricci, G; Baroni, S; Ciorba, A; Bellocci, A; Simoncelli, C

2004-06-01

If all degrees of permanent uni- or bilateral hypoacusis are taken into consideration, hearing impairment is the most common congenital disease. Early detection of permanent infantile hearing impairment has become extremely important in preventive medicine, since steps can be taken with hearing aids and rehabilitation to ensure better development of language and higher cognitive functions. Aim of this study is to provide a critical review of the time of diagnosis of hypoacusis at our audiology laboratory, where two methods were used to screen hearing of children with/without risk indicators. Results of approximately 10 years' work were re-examined during which time outpatient screening was conducted on children referred by colleagues in neonatology and paediatrics. All were carriers of congenital risk indicators associated with sensorineural and/or conductive hearing loss, based on the Joint Committee on Infant Hearing findings, or were suspected of being hypoacusic even if they had no known congenital risk factors. Hearing screening was conducted in hospital on newborns with no risk factors, within the first few days of birth. Results of the present study showed that when selective hearing screening was performed, the mean age of high-risk patients diagnosed with hypoacusis was slightly higher than that in international guidelines. Moreover, these patients represent approximately half the hypoacusic population identified in the study period. The other half of congenital hypoacusic subjects identified had no risk indicators and there was a significant delay in diagnosis due to later manifestation of symptoms indicating hypoacusis, and thus, in turn, delayed referral for hearing tests. In contrast, subjects without risk indicators who underwent in-hospital hearing screening and proved to be hypoacusic, were diagnosed early. In our experience, however, universal screening has considerable disadvantages, such as difficulty in covering the entire population, difficulty in follow-up after discharge from hospital, and last, but by no means least, significant organisational and professional commitments, making it impossible to perform in all hospitals. In order to ensure effective hearing screening for congenital hearing loss and, thus permit prompt identification of hypoacusic children, use of hearing aids and rehabilitation screening should incorporate two aspects. First, selection should be compulsory, thereby reducing waiting time between collecting case histories and performing outpatient tests; second, hospital screening of children without risk factors should be performed whenever possible. Integrating these two aspects would make it possible to approach the "utopia" of universal hearing screening.

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

PubMed Central

Shahi, Mehraban; Sadoughi, Farahnaz; Ahmadi, Maryam

2015-01-01

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

Hospitals Known for Nursing Excellence Associated with Better Hospital Experience for Patients.

PubMed

Stimpfel, Amy Witkoski; Sloane, Douglas M; McHugh, Matthew D; Aiken, Linda H

2016-06-01

To examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This secondary analysis includes cross-sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center. We conducted a retrospective observational study. Using common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non-Magnet hospitals. Patients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication. Magnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals. © Health Research and Educational Trust.

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

ERIC Educational Resources Information Center

Young, Philip E.

1976-01-01

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

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

PubMed

Brinkworth, Simon; Kenny, Alice; Knights, Christina

2018-04-01

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

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

ERIC Educational Resources Information Center

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

2017-01-01

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

Strategies for Effective Psychiatric Hospitalization of College and University Students

ERIC Educational Resources Information Center

Rockland-Miller, Harry; Eells, Gregory

2008-01-01

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

Impacts of Campus Involvement on Hospitality Student Achievement and Satisfaction

ERIC Educational Resources Information Center

Yin, Dean; Lei, Simon A.

2007-01-01

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

Implementing Medical Teaching Policy in University Hospitals

ERIC Educational Resources Information Center

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

2017-01-01

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

Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital

PubMed Central

2012-01-01

Background The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD). Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG)-reimbursement. Method Cost data of 20 LVAD implantations (VentrAssist™) from 2005-2009 (period 1) were analyzed together with costs from nine patients using another LVAD (HeartWare™) from 2009-June 2011 (period 2). For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. Results The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299), and the corresponding DRG- reimbursement (2009) was $ 143, 192 . The mean LOS was 54 days (range 12- 127). For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664) and the corresponding DRG- reimbursement (2010) was $ 136, 963. The mean LOS was 49 days (range 31- 93). The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14, 096 US$ (CI -3, 842 to -24, 349, p < 0.01). Conclusion There were significant reductions in total hospital costs per patient as the numbers of patients were increasing. This can possibly be explained by a learning effect including better logistics, selection and management of patients. PMID:22925716

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

PubMed

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

2016-07-04

To describe the constitution and operation of a voluntary interruption of pregnancy team of a university hospital, from the outlook of the mental health team. In this case study, the following aspects were analyzed: 1) historical background; 2) implementation of Law 18,897 of October 22, 2012; and 3) functioning of the program at the Hospital de Clínicas of the Facultad de Medicina (Universidad de la República, Uruguay), taking into account three dimensions: structure, process, and results. Between December 2012 and November 2013, a total of 6,676 voluntary interruptions of pregnancy were reported in Uruguay; out of these, 80 were conducted at the Hospital de Clínicas. The patients' demographic data agreed with those reported at the national level: Of the total patients, 81.0% were aged over 19 years; 6.2% decided to continue with the pregnancy; and only 70.0% attended the subsequent control and received advice on contraception. In its implementation year in Uruguay, we can assess the experience as positive from the point of view of women's health. Our experience as a mental health team at the Hospital de Clínicas, inserted into the multidisciplinary voluntary interruption of pregnancy team, is in the process of assessment and reformulation of practices. Describir la conformación y funcionamiento de un equipo de interrupción voluntaria del embarazo de un hospital universitario, desde la mirada del equipo de salud mental. En este estudio de caso, se analizan los siguientes aspectos: 1) antecedentes históricos; 2) implementación de la Ley 18.897 de 22 de octubre de 2012; y 3) funcionamiento del programa en el Hospital de Clínicas de la Facultad de Medicina (Universidad de la República, Uruguay), teniendo en cuenta tres dimensiones (estructura, proceso y resultados). Entre diciembre de 2012 y noviembre de 2013, se reportaron en Uruguay un total de 6.676 interrupciones voluntarias del embarazo; de ellas, 80 se llevaron a cabo en el Hospital de Clínicas. Los datos sociodemográficos de las pacientes concordaron con los reportados a nivel nacional: 81,0% de las pacientes que consultaron era mayores de 19 años; 6,2% decidieron continuar con el embarazo; solo 70,0% concurrieron al control posterior y recibieron asesoramiento sobre anticoncepción. Al año de su implementación, en Uruguay, podemos evaluar la experiencia como positiva desde el punto de vista de la salud de las mujeres. Nuestra experiencia como equipo de salud mental en el Hospital de Clínicas, inserto dentro del equipo multidisciplinario de interrupción voluntaria del embarazo, se encuentra en pleno proceso de evaluación y reformulación de prácticas.

Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals.

PubMed

Trzeciak, Stephen; Gaughan, John P; Bosire, Joshua; Mazzarelli, Anthony J

2016-03-01

In 2015, the Centers for Medicare and Medicaid Services (CMS) released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

E-simulation: preregistration nursing students' evaluation of an online patient deterioration program.

PubMed

Cant, Robyn; Young, Susan; Cooper, Simon J; Porter, Joanne

2015-03-01

This study explores preregistration nursing students' views of a Web-based simulation program: FIRST ACTWeb (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends-Web). The multimedia program incorporating three videoed scenarios portrayed by a standardized patient (human actor) aims to improve students' recognition and management of hospital patient deterioration. Participants were 367 final-year nursing students from three universities who completed an online evaluation survey and 19 students from two universities who attended one of five focus groups. Two researchers conducted a thematic analysis of the transcribed narratives. Three core themes identified were as follows: "ease of program use," "experience of e-Simulation," and "satisfaction with the learning experience." The Web-based clinical learning environment was endorsed as functional, feasible, and easy to use and was reported to have high fidelity and realism. Feedback in both focus groups and surveys showed high satisfaction with the learning experience. Overall, evaluation suggested that the Web-based simulation program successfully integrated elements essential for blended learning. Although Web-based educational applications are resource intensive to develop, positive appraisal of program quality, plus program accessibility and repeatability, appears to provide important educational benefits. Further research is needed to determine the transferability of these learning experiences into real-world practice.

Developing marketing strategies for university teaching hospitals.

PubMed

Fink, D J

1980-07-01

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

Across US Hospitals, Black Patients Report Comparable Or Better Experiences Than White Patients.

PubMed

Figueroa, José F; Zheng, Jie; Orav, E John; Jha, Ashish K

2016-08-01

Patient-reported experience is a critical part of measuring health care quality. There are limited data on racial differences in patient experience. Using patient-level data for 2009-10 from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), we compared blacks' and whites' responses on measures of overall hospital rating, communication, clinical processes, and hospital environment. In unadjusted results, there were no substantive differences between blacks' and whites' ratings of hospitals. Blacks were less likely to recommend hospitals but reported more positive experiences, compared to whites. Higher educational attainment and self-reported worse health status were associated with more negative evaluations in both races. Additionally, blacks rated minority-serving hospitals worse than other hospitals on all HCAHPS measures. Taken together, there were surprisingly few meaningful differences in patient experience between blacks and whites across US hospitals. Although blacks tend to receive care at worse-performing hospitals, compared to whites, within any given hospital black patients tend to report better experience than whites do. Project HOPE—The People-to-People Health Foundation, Inc.

Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia.

PubMed

Luxford, Karen; Axam, Anne; Hasnip, Fiona; Dobrohotoff, John; Strudwick, Maureen; Reeve, Rebecca; Hou, Changhao; Viney, Rosalie

2015-06-01

To examine the impact of implementing a clinician-carer communication tool for hospitalized patients with dementia. Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-psychotics and one-to-one nursing. Twenty-one hospitals in Australia. Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation. Implementation of a communication tool over 12 months. The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs. Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = -6.85, P < 0.05). Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents 'good practice' with a low risk of harm for patients. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire

PubMed Central

Zendjidjian, Xavier Y; Auquier, Pascal; Lançon, Christophe; Loundou, Anderson; Parola, Nathalie; Faugère, Melanie; Boyer, Laurent

2014-01-01

Background The aim of our study was to identify patient- and care-related factors that are associated with patients’ satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient’s point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22). Methods This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels. Results Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (β=0.15). Clinical improvement was moderately associated with higher global satisfaction (β=−0.15), higher satisfaction with quality of care (β=−0.19), and higher satisfaction with food (β=−0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (β, 0.20–0.43) except food, and for seclusion with global satisfaction (β=−0.33) and personal experience (β=−0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (β=−0.15). Conclusion This study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient’s satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients’ management, and health outcomes in psychiatric hospitals. PMID:25368515

Transitions From Hospitals to Skilled Nursing Facilities for Persons With Dementia: A Challenging Convergence of Patient and System-Level Needs.

PubMed

Gilmore-Bykovskyi, Andrea L; Roberts, Tonya J; King, Barbara J; Kennelty, Korey A; Kind, Amy J H

2017-10-01

To describe skilled nursing facility (SNF) nurses' perspectives on the experiences and needs of persons with dementia (PwD) during hospital-to-SNF transitions and to identify factors related to the quality of these transitions. Grounded dimensional analysis study using individual and focus group interviews with nurses (N = 40) from 11 SNFs. Hospital-to-SNF transitions were largely described as distressing for PwD and their caregivers and dominated by dementia-related behavioral symptoms that were perceived as being purposely under-communicated by hospital personnel in discharge communications. SNF nurses described PwD as having unique transitional care needs, which primarily involved needing additional discharge preplanning to enable preparation of a tailored behavioral/social care plan and physical environment prior to transfer. SNF nurses identified inaccurate/limited hospital discharge communication regarding behavioral symptoms, short discharge timeframes, and limited nursing control over SNF admission decisions as factors that contributed to poorer-quality transitions producing increased risk for resident harm, rehospitalization, and negative resident/caregiver experiences. Engaged caregivers throughout the transition and the presence of high-quality discharge communication were identified as factors that improved the quality of transitions for PwD. Findings from this study provide important insight into factors that may influence transitional care quality during this highly vulnerable transition. Additional research is needed to explore the association between these factors and transitional care outcomes such as rehospitalization and caregiver stress. Future work should also explore strategies to improve inter-setting communication and care coordination for PwD exhibiting challenging behavioral symptoms. Published by Oxford University Press on behalf of the Gerontological Society of America 2016.

Unmet home healthcare needs and quality of life in cancer patients: a hospital-based Turkish sample.

PubMed

Ataman, Gülsen; Erbaydar, Tugrul

2017-07-01

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37-item, study-specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease-related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital-integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital-based healthcare services. © 2017 John Wiley & Sons Ltd.

Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis.

PubMed

Grob, Silvia; Bläuer, Cornelia; Frei, Irena Anna

2017-12-01

Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members. © 2017 Nordic College of Caring Science.

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

PubMed

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

2017-06-13

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

Colorectal cancer in Crohn's disease--review of a 56-year experience in Karolinska Institute University Hospital.

PubMed

Rubio, Carlos A; Befrits, Ragnar

2008-01-01

We previously reported that the frequency of colorectal carcinomas (CRC) in Crohn's disease (CD) had increased at this hospital between 1951 and May 1996. The aim was to compare the frequency of CRC in CD between June 1996 and September 2007 to that found between 1951 and May 1996. For that purpose colectomy specimens with an IBD-CRC diagnosis filed during the last 11 years were reviewed. It was found that 29 patients with IBD developed a CRC at this hospital: 21 had CD (or 1.91 cases/year) and the remaining eight, ulcerative colitis (or 0.72 cases/year). At this hospital, the number of cases of CRC in Crohn's colitis increased from 0.28/year between 1951 and the end of 1989, to 1.69 patients/year between 1990 and May 1996, and to 1.91 patients/year between June 1996 and September 2007 (present report). The marginal increase number of patients with CRC in Crohn's colitis/year during the last 11 years at this hospital might be only apparent, considering that the incidence of Crohn's disease in the county has dramatically increased, and that the localization of Crohn's disease has changed in later years, with a predilection for the colon and rectum.

Simulating the physician as healthcare manager: An innovative course to train for the manager role.

PubMed

Gradel, Maximilian; Moder, Stefan; Nicolai, Leo; Pander, Tanja; Hoppe, Boj; Pinilla, Severin; Von der Borch, Philip; Fischer, Martin R; Dimitriadis, Konstantinos

2016-01-01

During their formal studies medical students acquire extensive medical expertise. However, the medical profession demands additional competencies, such as those involved in efficient resource allocation, business administration, development, organization, and process management in the healthcare system. At present students are not sufficiently prepared for the physician's role as manager. In response, we designed the seminar course, MeCuM-SiGma, to impart basic knowledge about healthcare policy and management to students of medicine. This project report describes our teaching strategies and the initial evaluation of this educational project. In this semester-long, seminar course introduced in 2010, medical students gather experience with the competencies mentioned above as well as learn basic management skills. The course is offered each winter semester, and students sign up to attend voluntarily; course coordination and organization is done on a voluntary basis by physicians and employees of the Mentoring Office (MeCuM-Mentor) at the Medical School of the Ludwig Maximilian University (LMU) in Munich, Germany. The course is open to all students enrolled at the two medical schools in Munich. During the first part of this elective, students learn about the basic principles of the German political and healthcare systems in case-based, problem-based tutorials led by trained tutors and in lectures held by experts. In the second part of the course students take on the roles of the University Hospital's executive board of directors and supervisory board to work on an existing hospital project as a group within the scope of a simulation. This phase of the course is accompanied by workshops conducted in cooperation with university-based and off-campus partners that address the procedural learning objectives (teamwork, project management, negotiation strategies, etc.). A suitable, authentic issue currently facing the hospital is selected in advance by the course organizers in coordination with the hospital's executive board. Students then work on this issue in the third and final phase of the course under the supervision of tutors and with assistance from hospital employees. At the end of the course the students formally present the results of their work to the hospital's executive and supervisory boards. The course undergoes written student evaluation, a round of oral feedback, evaluation of the final projects, and feedback from the hospital's executive and supervisory boards. All attendees to date have reported a substantial gain in general knowledge and increased knowledge about the healthcare system, and rate the relevance of the course as being high. The majority felt the content was important for their future practice of medicine. Overall, students evaluated the course very positively [overall rating on a six-point grading scale (1=excellent; 6=unsatisfactory): 1.28 (mean)±0.45 (standard deviation)]. The importance of the physician's role as manager in medical organizations and as a guiding force in the healthcare system is neglected in medical degree programs. Our seminar course attempts to address this shortcoming, is the object of great interest and receives positive evaluations from seminar participants, our cooperative partners and the executive and supervisory boards of the University Hospital in Munich.

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

PubMed

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

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

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

PubMed Central

2014-01-01

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

Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals.

PubMed

Chaves, N J; Cheng, A C; Runnegar, N; Kirschner, J; Lee, T; Buising, K

2014-06-01

Antimicrobial stewardship programmes aim to optimise use of antibiotics and are now mandatory in all Australian hospitals. We aimed to identify barriers to and enablers of appropriate antimicrobial prescribing among hospital doctors. Two paper-based and one web-based surveys were administered at three Australian university teaching hospitals from March 2010 to May 2011. The 18-item questionnaire recorded doctors’ level of experience, their knowledge regarding the use of common antimicrobials and their attitudes regarding antimicrobial prescribing. Local survey modifications allowed inclusion of specific questions on: infections in intensive care unit patients, clinical microbiology and use of local guidelines. The respondents (n = 272) were comprised of 96 (35%) registrars, 67 (25%)residents, 57 (21%) interns and 47 (17%) consultant hospital doctors. Forty-one per cent were working in a medical specialty. Identified barriers included: gaps in antimicrobial prescribing knowledge (especially among interns), a lack of awareness about which antimicrobials were restricted and a reliance on senior colleagues to make antimicrobial prescribing decisions. Enablers of optimal prescribing included: an acknowledgement of the need for assistance in prescribing and reported readiness to consult national prescribing guidelines. These results were used to help guide and prioritise interventions to improve prescribing practices. A transferable knowledge and attitudes survey tool can be used to highlight barriers and facilitators to optimal hospital antimicrobial prescribing in order to inform tailored antimicrobial stewardship interventions.

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-12-01

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

Clinical initiatives linking Japanese and Swedish healthcare resources on cancer studies utilizing Biobank Repositories.

PubMed

Nishimura, Toshihide; Kawamura, Takeshi; Sugihara, Yutaka; Bando, Yasuhiko; Sakamoto, Shigeru; Nomura, Masaharu; Ikeda, Norihiko; Ohira, Tatsuo; Fujimoto, Junichiro; Tojo, Hiromasa; Hamakubo, Takao; Kodama, Tatsuhiko; Andersson, Roland; Fehniger, Thomas E; Kato, Harubumi; Marko-Varga, György

2014-12-01

The Tokyo Medical University Hospital in Japan and the Lund University hospital in Sweden have recently initiated a research program with the objective to impact on patient treatment by clinical disease stage characterization (phenotyping), utilizing proteomics sequencing platforms. By sharing clinical experiences, patient treatment principles, and biobank strategies, our respective clinical teams in Japan and Sweden will aid in the development of predictive and drug related protein biomarkers. Data from joint lung cancer studies are presented where protein expression from Neuro- Endocrine lung cancer (LCNEC) phenotype patients can be separated from Small cell- (SCLC) and Large Cell lung cancer (LCC) patients by deep sequencing and spectral counting analysis. LCNEC, a subtype of large cell carcinoma (LCC), is characterized by neuroendocrine differentiation that small cell lung carcinoma (SCLC) shares. Pre-therapeutic histological distinction between LCNEC and SCLC has so far been problematic, leading to adverse clinical outcome. An establishment of protein targets characteristic of LCNEC is quite helpful for decision of optimal therapeutic strategy by diagnosing individual patients. Proteoform annotation and clinical biobanking is part of the HUPO initiative (http://www.hupo.org) within chromosome 10 and chromosome 19 consortia.

Virtual microscopy beyond the pyramids, applications of WSI in Cairo University for E-education & telepathology.

PubMed

Ayad, Essam; Yagi, Yukako

2012-01-01

Telepathology, the practice of pathology at a long distance, has advanced continuously since 1986. The progress of telepathology passed through four stages: Static, Dynamic, Hybrid & Whole Slide Imaging. A pilot project between the Italian Hospital in Cairo & the Civico Hospital in Palermo was completed successfully, applying the static & dynamic techniques of telepathology. This project began in 2003 and continued till now. In 2004, centers in Venice, London and Pittsburgh participated actively in our project. Over eight years we consulted on many problematic pathological cases with specialized pathological centers in Italy, U.K. & U.S.A. In addition to the highly specialized scientific value, we saved a lot of time and money. We concluded from our experience that telepathology is a very useful and applicable tool for additional consulting on difficult pathological cases especially for emerging countries. In view of this success we have already established our Digital Telepathology Unit in Cairo University, using the WSI technique in teaching which was greatly successful and encouraged us to build a huge digital pathology library which will expand our telepathology & E-learning programs to cover staff and students in Egypt and Eastern Mediterranean.

Virtual Microscopy Beyond the Pyramids, Applications of WSI in Cairo University for E-Education & Telepathology

PubMed Central

Ayad, Essam; Yagi, Yukako

2012-01-01

Background: Telepathology, the practice of pathology at a long distance, has advanced continuously since 1986. The progress of telepathology passed through four stages: Static, Dynamic, Hybrid & Whole Slide Imaging. Materials and Methods: A pilot project between the Italian Hospital in Cairo & the Civico Hospital in Palermo was completed successfully, applying the static & dynamic techniques of telepathology. This project began in 2003 and continued till now. In 2004, centers in Venice, London and Pittsburgh participated actively in our project. Results: Over eight years we consulted on many problematic pathological cases with specialized pathological centers in Italy, UK & USA. In addition to the highly specialized scientific value, we saved a lot of time and money. Conclusion: We concluded from our experience that telepathology is a very useful and applicable tool for additional consulting on difficult pathological cases especially for emerging countries. In view of this success we have already established our Digital Telepathology Unit in Cairo University, using the WSI technique in teaching which was greatly successful and encouraged us to build a huge digital pathology library which will expand our telepathology & E-learning programs to cover staff and students in Egypt and Eastern Mediterranean. PMID:22297472

[Acceptance and feasibility of medical telemonitoring plus individual teleconsultation -A two years research and development project at the University Hospital Zurich].

PubMed

Schmidt-Weitmann, Sabine; Buser, Jacqueline; Baumann, Doris; Schmidt, Christian; Brettenhofer, Marlene; Tarnutzer, Silvan; Meienberger, Beda; Otto, Ulrich; Brockes, Christiane

2015-09-01

The research and development project "Long Independent Living Assistant (LILA)'; which is financially supported by the Commission for Technology and lnnoyation (KTI}, is based on the results and experiences of many years of the Medical Online Consultation Service at the University Hospital Zurich.The focus is on development and provision of a comprehensive, telemedicine service. Citizens and patients should be provided more safety at home and the family doctor should be supported by the service. Core elements of the project include the telemonitoring of vital signs combined with an individual teleconsultation via telephone, email and video. Technically, the. service is supported by a web-based documentation and communication platform with an integrated patient record. In a one-year planning phase, individual interviews and group discussions were conducted with the participants of the study. The results are continuously incorporated into the concept. The subsequent pilot phase analyzed the developed tetemedical approach and leads to further improvements. The aim of the study is the evaluation of the needs, feasibility and acceptance of telemedicine services from the perspective of the user, taking into account their social environment~

Breast cancer risk factors in African-American women: the Howard University Tumor Registry experience.

PubMed

Laing, A E; Demenais, F M; Williams, R; Kissling, G; Chen, V W; Bonney, G E

1993-12-01

This retrospective case-control study examines risk factors for breast cancer in African-American women, who recently have shown an increase in the incidence of this malignancy, especially in younger women. Our study involves 503 cases from the Howard University Hospital and 539 controls from the same hospital, seen from 1978 to 1987. Using information culled from medical charts, an analysis of various factors for their effect on breast cancer risk was made. The source of data necessarily meant that some known risk factors were missing. Increases in risk were found for known risk factors such as decreased age at menarche and a family history of breast cancer. No change in risk was observed with single marital status, nulliparity, premenopausal status, or lactation. An increased odds ratio was found for induced abortions, which was significant in women diagnosed after 50 years of age. Spontaneous abortions had a small but significant protective effect in the same subgroup of women. Birth control pill usage conferred a significantly increased risk. It is of note that abortions and oral contraceptive usage, not yet studied in African Americans, have been suggested as possibly contributing to the recent increase in breast cancer in young African-American women.

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

PubMed

Zlatkov, V

2014-01-01

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

Launching a permanent out-of-hour interventional radiology service: single-center experience from a German University Hospital.

PubMed

Goltz, J P; Janssen, H; Petritsch, B; Kickuth, R

2014-02-01

To evaluate the feasibility, frequency of use, types of intervention and labor costs of a formal round-the-clock interventional radiology on-call service. In 11/2011 a formal and permanent out-of-hour interventional radiology rota in addition to the general radiology out-of-hour rota (OOHR) was established. We retrospectively screened the interventional radiology database for procedures completed outside regular working hours, reviewed all interventions and manually selected cases in which the on-call interventionist was called in from home. We determined the type, frequency of use and costs (€/year and procedure) of this service between 1/2012 and 12/2012. The referring physicians' (sub-) specialties were evaluated. During the 12-month period, the on-call interventionists (n = 3) performed 92 procedures OOH. The procedures included angiography and hemorrhage control (n = 36, 39.1 %), angiography and intervention for acute limb ischemia (n = 25, 27.2 %), percutaneous biliary drainage (PTCD) (n = 10, 10.9 %), angiography for non-occlusive ischemia (n = 7, 7.6 %), and other (n = 14, 15.3 %). The total labor costs for the OOHR were € 42,312.21 (€ 32,982.60 lump sum for stand-by, €  9,329.61 for hours spent on procedures). The labor costs per procedure totaled € 459.92. The referring physicians' specialties were general/visceral (n = 25), vascular surgery (n = 24), internal medicine (n = 21), cardiac/thoracic vascular (n = 9), trauma surgery (n = 5), urology (n = 5), and anesthesiology (n = 3). A formal interventional OOHR is practicable in a university hospital setting. Most procedures were requested by general, vascular, and thoracic surgery as well as internal medicine with a focus on hemorrhage control, treatment of acute limb ischemia, and PTCD. The overall labor costs for the OOHR appear moderate. • In a university setting an OOHR for IR is feasible.• Labor costs per procedure appear moderate.• Hemorrhage control and treatment of limb ischemia were the most frequent procedures. Citation Format: • Goltz JP, Janssen H, Petritsch B et al. Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital. Fortschr Röntgenstr 2014; 186: 136 - 141. © Georg Thieme Verlag KG Stuttgart · New York.

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

PubMed

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

2012-01-01

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

Histopathological diagnosis of eyelid tumors in Chiang Mai University Hospital.

PubMed

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

2014-10-01

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

University Hospitals for Sale.

ERIC Educational Resources Information Center

Culliton, Barbara J.

1984-01-01

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

Rotavirus genotypes in Malaysia and Universal rotavirus vaccination

PubMed Central

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

2012-01-01

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

Pediatric trauma at an adult trauma center.

PubMed

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

2010-08-01

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

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

PubMed

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

2017-04-01

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

Patient experience with outpatient encounters at public hospitals in Shanghai: Examining different aspects of physician services and implications of overcrowding.

PubMed

Bao, Yuhua; Fan, Guanrong; Zou, Dongdong; Wang, Tong; Xue, Di

2017-01-01

Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. Retrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals. 7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014. Patient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014. Overall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only. Inadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.

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

PubMed

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

2013-02-01

Since September 2005, Charity Hospital of New Orleans has been closed due to Hurricane Katrina. A debate following the closing arose about whether this public hospital should be renovated or a new medical center affiliated with the Louisiana State University should be built. Using academic literature, government statistics, and popular press reports, we describe the economic implications that support the view that Charity Hospital should have been renovated. We also address why this policy was not pursued by demonstrating the influence politics and individual stakeholders (specifically, Louisiana State University) had on the eventual policy pursued. In this commentary we also note the political identity movement away from public-sector provision of services to private-sector interests.

The Hospital Microbiome Project: Meeting Report for the 1st Hospital Microbiome Project Workshop on sampling design and building science measurements, Chicago, USA, June 7th-8th 2012

PubMed Central

Smith, Daniel; Alverdy, John; An, Gary; Coleman, Maureen; Garcia-Houchins, Sylvia; Green, Jessica; Keegan, Kevin; Kelley, Scott T.; Kirkup, Benjamin C.; Kociolek, Larry; Levin, Hal; Landon, Emily; Olsiewski, Paula; Knight, Rob; Siegel, Jeffrey; Weber, Stephen; Gilbert, Jack

2013-01-01

This report details the outcome of the 1st Hospital Microbiome Project workshop held on June 7th-8th, 2012 at the University of Chicago, USA. The workshop was arranged to determine the most appropriate sampling strategy and approach to building science measurement to characterize the development of a microbial community within a new hospital pavilion being built at the University of Chicago Medical Center. The workshop made several recommendations and led to the development of a full proposal to the Alfred P. Sloan Foundation as well as to the creation of the Hospital Microbiome Consortium. PMID:23961316

Experience with carbon ion radiotherapy at GSI

NASA Astrophysics Data System (ADS)

Jäkel, O.; Schulz-Ertner, D.; Karger, C. P.; Heeg, P.; Debus, J.

2005-12-01

At GSI, a radiotherapy facility was established using beam scanning and active energy variation. Between December 1997 and April 2004, 220 patients have been treated at this facility with carbon ions. Most patients are treated for chordoma and chondrosarcoma of the base of skull, using a dose of 60 Gye (Gray equivalent) in 20 fractions. Carbon ion therapy is also offered in a combination with conventional radiotherapy for a number of other tumors (adenoidcystic carcinoma, chordoma of the cervical spine and sacrum, atypical menningeoma). The patients treated for skull base tumors showed an overall local control rate after two years of 90%. The overall treatment toxicity was mild. This shows that carbon ion radiotherapy can safely be applied using a scanned beam and encouraged the Heidelberg university hospital to build a hospital based facility for ion therapy.

[Analysis of HIV antibody positive cases in Peking University Hospital of Stomatology during 9 years].

PubMed

Ding, Jian-fen; Qiu, Juan; Shen, Shu-ming

2016-02-01

To investigate the prevalence and characteristics of HIV patients found in Peking University Hospital of Stomatology during 9 years, and provide management strategy for early diagnosis and control of HIV in Stomatology Hospital. A retrospective study of the HIV positive patients diagnosed by HIV antibody screening was carried out. The related information about these patients found in Peking University School of Stomatology during 2005-2013 was obtained from China Disease Control Information System. 68,562 patients accepted HIV antibody screening in Peking University Hospital of Stomatology during 2005-2013. Thirty one patients were found HIV antibody positive. The ratio of HIV antibody positive was about 0.045%, which was composed of 25 males and 6 females. 61.29% patients aged between 20-40 years, and their career was mainly commercial service with a education level of junior high school. The proportion of sexual route of transmission was about 74.91%, and 34.78% of them were male homosexuality. Most of the patients with HIV antibody positive were found in the out-patient clinic, especially in the department of oral mucosal diseases, accounting for 70.97%. HIV antibody positive rate in Peking University School of Stomatology was slightly lower than that in general hospitals. Medical staff should increase their awareness of AIDS prevention and control, for higher HIV risk departments, such as oral mucosal diseases and periodontal disease, efforts should be made to increase HIV screening, expand the scope of screening, and promote provider-initiated HIV testing and counseling.

Transitions in the communication experiences of tracheostomised patients in intensive care: a qualitative descriptive study.

PubMed

Flinterud, Stine Irene; Andershed, Birgitta

2015-08-01

To describe how tracheostomised patients in intensive care experience acts of communication and to better understand their experiences in the context of the transitions theory. Waking up in an intensive care unit unable to speak because of mechanical ventilation can be challenging. Communication aids are available, but patients still report difficulties communicating. Investigating how mechanically ventilated patients experience communication in the context of the transitions theory might elucidate new ways of supporting them during their transitions while being ventilated. A qualitative, descriptive design. Eleven patients who had previously been tracheostomised in an intensive care unit were included in this quality improvement project conducted in a university hospital in Norway. Participants were tracheostomised from 3-27 days. Semistructured interviews were conducted from June 2013-August 2013, 3-18 months after hospital discharge. Transcripts were analysed using inductive content analysis. Participants reported a great diversity of emotions and experiences attempting to communicate while being tracheostomised. One overarching theme emerging from the analysis was the 'Experience of caring and understanding despite having uncomfortable feelings due to troublesome communication.' The theme consists of three categories. The category 'Emotionally challenging' shows that patients struggled initially. With time, their coping improved, as revealed in the category 'The experience changes with time.' Despite difficulties, participants described positive experiences, as shown in the category 'Successful communication.' The importance of patients experiencing caring and understanding despite their difficult situation constitutes the core finding. The findings suggest that participants went through different transitions. Some reached the end of their transition, experiencing increased stability. Despite challenges with communication, participants reported that caring and safety provided by health care professionals were significant experiences. They viewed nonverbal communication as being very important. © 2015 John Wiley & Sons Ltd.

[Information from the invoicing sector as support for decision-making: a case study at the University Hospital of the Federal University of Grande Dourados (UFGD)].

PubMed

Cintra, Renato Fabiano; Vieira, Saulo Fabiano Amâncio; Hall, Rosemar José; Fernandes, Cristiano Rodrigues

2013-10-01

The public sector is the main financing agent of hospital admissions and the information generated constitutes the input for the hospital information network of the Unified Health System (SUS). This paper seeks to design a report template to be used for decision-making in both public and university hospitals. The theoretical approach sought inspiration in discussions about the SUS, hospital institutions, hospital information systems and decision-making. The methodological procedures used are characterized as qualitative-descriptive methods and were conducted in a single case study and action research. The primary data analysis was carried out in two stages from January through December 2007 and from January through December 2008. Based on these periods, the findings were described and the elaboration of new reports was presented, with the importance and need for each being duly emphasized. Lastly, a structured report template was created for the case study that includes information discussed in the article. The conclusion reached is that the hospital information system can become a potential support tool, as the necessary adjustments are made and the report is structured to furnish the institution with an objective communication tool for decision-making.

Health services utilization of people having and not having a regular doctor in Canada.

PubMed

Thanh, Nguyen Xuan; Rapoport, John

2017-04-01

Canada having a universal health insurance plan that provides hospital and physician benefits offers a natural experiment of whether continuity of care actually provides lower or higher utilization of services. The question we are evaluating is whether Canadians, who have a regular physician, use more health resources than those who do not have one? Using two statistical methods, including propensity score matching and zero-inflated negative binomial regression, we analyzed data from the 2010 and 2007/2008 Canadian Community Health Surveys separately to document differences between people self-reportedly having and not having a regular doctor in the utilization of general practitioner, specialist, and hospital services. The results showed, consistently for all two statistical methods and two datasets used, that people reportedly having a regular doctor used more healthcare services than a matched group of people who was self-reportedly not having a regular doctor. For specialist and hospital utilization, the statistically significant differences were in the likelihood if the service was used but not in the number of specialist visits or hospital nights among users. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Long-term effects of hospital water network disinfection on Legionella and other waterborne bacteria in an Italian university hospital.

PubMed

Casini, Beatrice; Buzzigoli, Andrea; Cristina, Maria Luisa; Spagnolo, Anna Maria; Del Giudice, Pietro; Brusaferro, Silvio; Poscia, Andrea; Moscato, Umberto; Valentini, Paola; Baggiani, Angelo; Privitera, Gaetano

2014-03-01

Legionella control still remains a critical issue in healthcare settings where the preferred approach to health risk assessment and management is to develop a water safety plan. We report the experience of a university hospital, where a water safety plan has been applied since 2002, and the results obtained with the application of different methods for disinfecting hot water distribution systems in order to provide guidance for the management of water risk. The disinfection procedures included continuous chlorination with chlorine dioxide (0.4-0.6 mg/L in recirculation loops) reinforced by endpoint filtration in critical areas and a water treatment based on monochloramine (2-3 mg/L). Real-time polymerase chain reaction and a new immunoseparation and adenosine triphosphate bioluminescence analysis were applied in environmental monitoring. After 9 years, the integrated disinfection-filtration strategy significantly reduced positive sites by 55% and the mean count by 78% (P < .05); however, the high costs and the occurrence of a chlorine-tolerant clone belonging to Legionella pneumophila ST269 prompted us to test a new disinfectant. The shift to monochloramine allowed us to eliminate planktonic Legionella and did not require additional endpoint filtration; however, nontuberculous mycobacteria were isolated more frequently as long as the monochloramine concentration was 2 mg/L; their cultivability was never regained by increasing the concentration up to 3 mg/L. Any disinfection method needs to be adjusted/fine-tuned in individual hospitals in order to maintain satisfactory results over time, and only a locally adapted evidence-based approach allows assessment of the efficacy and disadvantages of the control measures.

[Clinical ethics in psychiatry: the experience at Douglas Hospital].

PubMed

Zacchia, Camillo; Tremblay, Jacques

2006-01-01

The authors present a brief overview of the clinical ethics committee within their mental health university institute as well as its evolving mandates over the past few decades. The main functions include case consultation, input on elaboration of institutional policy, and staff education as well as public information on issues of ethics and mental illness. With examples and questions brought to the committee's attention, the authors demonstrate how these functions are intertwined. The authors conclude that ethical questioning helps examine clinical practices and serves ultimately in guiding towards best practices in mental health.

The Dual Rounding Model: Forging Therapeutic Alliances 
in Oncology and Palliative Care.

PubMed

Baxley, Carey E

2016-04-01

Inpatients with solid tumors at Duke University Hospital in Durham, NC, are cared for in a dynamic integrated care model that incorporates medical oncology and palliative care. This has profound implications for patients, their loved ones, medical and surgical staff, and oncology nurses. As a nurse with less than three years of experience, my participation in a setting that uses the Dual Rounding Model has accelerated my professional and personal development. During a typical shift, I am an oncology nurse, a palliative care nurse, and a hospice nurse.
.

Technical efficiency and resources allocation in university hospitals in Tehran, 2009-2012.

PubMed

Rezapour, Aziz; Ebadifard Azar, Farbod; Yousef Zadeh, Negar; Roumiani, YarAllah; Bagheri Faradonbeh, Saeed

2015-01-01

Assessment of hospitals' performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran. This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier 4,1 software. According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389. This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved.

Web-based training in German university eye hospitals - Education 2.0?

PubMed

Handzel, Daniel M; Hesse, L

2011-01-01

To analyse web-based training in ophthalmology offered by German university eye hospitals. In January 2010 the websites of all 36 German university hospitals were searched for information provided for visitors, students and doctors alike. We evaluated the offer in terms of quantity and quality. All websites could be accessed at the time of the study. 28 pages provided information for students and doctors, one page only for students, three exclusively for doctors. Four pages didn't offer any information for these target groups. The websites offered information on events like congresses or students curricular education, there were also material for download for these events or for other purposes. We found complex e-learning-platforms on 9 pages. These dealt with special ophthalmological topics in a didactic arrangement. In spite of the extensive possibilities offered by the technology of Web 2.0, many conceivable tools were only rarely made available. It was not always possible to determine if the information provided was up-to-date, very often the last actualization of the content was long ago. On one page the date for the last change was stated as 2004. Currently there are 9 functional e-learning-applications offered by German university eye hospitals. Two additional hospitals present links to a project of the German Ophthalmological Society. There was a considerable variation in quantity and quality. No website made use of crediting successful studying, e.g. with CME-points or OSCE-credits. All German university eye hospitals present themselves in the World Wide Web. However, the lack of modern, technical as well as didactical state-of-the-art learning applications is alarming as it leaves an essential medium of today's communication unused.

National Medical Care System May Impede Fostering of True Specialization of Radiation Oncologists: Study Based on Structure Survey in Japan

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

Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi

2012-01-01

Purpose: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. Methods and Materials: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient onmore » the basis of Japanese Blue Book guidelines (200 patients per RO). Results: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). Conclusions: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.« less

National medical care system may impede fostering of true specialization of radiation oncologists: study based on structure survey in Japan.

PubMed

Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi; Ikeda, Hiroshi; Sekiguchi, Kenji; Kamikonya, Norihiko; Koizumi, Masahiko; Tago, Masao; Ando, Yutaka; Tsukamoto, Nobuhiro; Terahara, Atsuro; Nakamura, Katsumasa; Mitsumori, Michihide; Nishimura, Tetsuo; Hareyama, Masato; Teshima, Teruki

2012-01-01

To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists. Copyright © 2012 Elsevier Inc. All rights reserved.

Robotics applied in laparoscopic kidney surgery: the Yonsei University experience of 127 cases.

PubMed

Lorenzo, Enrique Ian S; Jeong, Wooju; Oh, Cheol Kyu; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho

2011-01-01

We report our experience on 127 kidney surgeries with the da Vinci surgical system and show the feasibility of a robotics application in a variety of kidney surgeries by both a laparoscopically-trained and a laparoscopically-naïve surgeon. Clinical data of patients who underwent kidney surgery with the da Vinci surgical system from September 2006 to April 2009 were reviewed. Data acquired from medical records included patient demographics, operative time, estimated blood loss (EBL), incidence of intraoperative complication, duration of hospital stay, blood transfusion rate, oncological outcomes, and follow-up results. One-hundred twenty-seven kidney surgeries have been conducted with the da Vinci surgical system at our institution. Three urologists--1 with formal endourology training, 1 with laparoscopic experience, and 1 laparoscopically naïve--have used it for a variety of procedures involving the kidney. The cases include 65 partial nephrectomies (RPN), 38 radical nephrectomies (RRN), and 24 nephroureterectomies with bladder cuff (RNU). Results on operative time, EBL, incidence of intraoperative injury, duration of hospital stay, and blood transfusion rate are comparable with contemporary studies. Robotics application in kidney surgery is a viable option for various procedures. Our experience shows it can be safely and effectively conducted by both laparoscopically-trained and laparoscopically-naïve surgeons once they are accustomed to the robotics system. Copyright © 2011 Elsevier Inc. All rights reserved.

The Child and Family Hospital Experience

PubMed Central

Ferguson, Deron; Fryda, Sarah; Rubin, Nicole

2015-01-01

Patient and family experiences are important indicators of quality of care and little is known about how family accommodation affects hospital experience. We added questions about accommodation to standardized inpatient pediatric and neonatal intensive care unit family experience surveys at 10 U.S. hospitals to determine the accommodation types used by families, compare characteristics across accommodation types and explore accommodation-type influences on overall hospital experience outcomes. Parents of inpatient children (n = 5,105; 93.4%) most often stayed in the child’s room (76.8%). Parents of neonatal intensive care unit infants (n = 362; 6.6%) most often stayed overnight in their own home or with relatives/friends (47.2%). Accommodation varied based on hospital, parent, and child factors. Accommodation type was a significant predictor for most hospital experience outcomes, with families who stayed at a Ronald McDonald House reporting more positive overall hospital experiences (odds ratios: ranging from 1.83 to 4.86 for contrasted accommodation types and three experience outcomes). PMID:25854957

The art of improvisation: the working process of administrators at a Federal University Hospital.

PubMed

Littike, Denilda; Sodré, Francis

2015-10-01

The scope of this article is to analyze the working process of administrators at a Federal University Hospital (HUF). It includes research with a qualitative approach conducted through interviews with twelve administrators. The work process, the work tools and the human activity per se are understood to be under scrutiny. Work is acknowledged as a category that analyzes the management methods used by professional health workers. The HUFs are responsible for two social policies, namely education and health. The aim of the administrators' work is an organizational issue, and the administration tools used are bureaucratic and out-of-date for the current political context of hospital management. The most significant feature of this hospital administration is improvisation, which reduces the potential of the administrators in such a way that, instead of introducing innovative changes into their work process, they prefer to leave their jobs. Improvisation is caused by the production of sequential obstacles in management decision-making at this teaching hospital. In short, the transfer of administration at the HUF, from direct government administration by the University to the Brazilian Company of Hospital Services (EBSERH), was analyzed on the grounds that this would establish a "new" management model.

Training rotations at hospitals as a recruitment tool for Certified Registered Nurse Anesthetists.

PubMed

Wachtel, Ruth E; Dexter, Franklin

2012-08-01

Recruiting newly graduating Certified Registered Nurse Anesthetists (CRNAs) is expensive. Recruitment into rural areas is especially challenging. We analyzed the first jobs of all 95 graduates of the University of Iowa's CRNA training program, from the initial graduating class of 1997 through the class of 2009. We compared the location of the student's first job to where the student lived at the time of application to the program. Hospitals enhanced recruitment of CRNAs by having student rotations (P = .001). Most students who joined a practice offering an outside rotation were not from the county or contiguous counties of the hospital they joined (P < .001). In years that hospitals with rotations hired more than the median number of students, significantly more students had rotated through the hospital (P = .02). Offering a CRNA training program did not facilitate the university's retention of nurses already living in its county or contiguous counties (P = 0.58). Consequently, rural hospitals can view sponsoring rotations as a recruitment tool for graduating CRNAs. The university sponsoring the training program did not retain an advantage, however, in hiring its own graduates. Because this case study provided valuable insights, other programs should consider performing similar analyses.

Hazardous medical waste generation rates of different categories of health-care facilities.

PubMed

Komilis, Dimitrios; Fouki, Anastassia; Papadopoulos, Dimitrios

2012-07-01

Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed(-1)d(-1), using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed(-1)d(-1), for the public psychiatric hospitals, to up to 0.72 kg bed(-1)d(-1), for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed(-1)d(-1), for the psychiatric clinics, to up to 0.49 kg bed(-1)d(-1), for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Evaluation of the Oran university hospital information system].

PubMed

Chougrani, Saada; Ouhadj, Salah; Agag, Fouzia

2013-01-01

Oran university hospital has been operating since 2010. It is a public institution that must assess the resources required to achieve institutional goals integrated into the strategic objectives defined in the hospital development project. Implementation of this project could be supported, among other things, by a strong and efficient hospital information system. Three investigations were conducted: 1- evaluation of the hospital information system, 2- assessment of the quality of the hospital discharge summary reports, 3- assessment of the quality of medical records. The six components of the hospital information system (resources, indicators, sources, management, quality and dissemination and use of data) were clearly present but not satisfactory with a score ranging from 25 to 50% of the total score. The scores by component were as follows: 36% for resources, 37% for indicators, 42% for patient records, 19% for data management and 27% for the dissemination of information. The overall completeness of medical records was 85.2%. Completeness by group of variables gave the following results: 66% for medical information, 54% for the patient's stay and 38% for information relating to the patient's discharge. Hospital discharge summary reports were available in 59.8% of cases, but were blank in 4% of cases. The critical variable, the principal diagnosis was found in 51% of cases. The correct principal diagnosis rate was 33.3%. The deficiencies observed for content and data management raise real questions concerning data management at Oran university hospital as part of a real managerial approach.

Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases

PubMed Central

2012-01-01

Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). Conclusions New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis. PMID:22515842

[Screening for malnutrition among hospitalized patients in a Colombian University Hospital].

PubMed

Cruz, Viviana; Bernal, Laura; Buitrago, Giancarlo; Ruiz, Álvaro J

2017-04-01

On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Teleconferencing using multimedia messaging service (MMS) for long-range consultation of patients with neurosurgical problems in an acute situation.

PubMed

Waran, Vicknes; Selladurai, Benedict M; Bahuri, Nor Faizal Ahmad; George, George John K Thomas; Lim, Grace P S; Khine, Myo

2008-02-01

: We present our initial experience using a simple and relatively cost effective system using existing mobile phone network services and conventional handphones with built in cameras to capture carefully selected images from hard copies of scan images and transferring these images from a hospital without neurosurgical services to a university hospital with tertiary neurosurgical service for consultation and management plan. : A total of 14 patients with acute neurosurgical problems admitted to a general hospital in a 6 months period had their images photographed and transferred in JPEG format to a university neurosurgical unit. This was accompanied by a phone conference to discuss the scan and the patients' condition between the neurosurgeon and the referring physician. All images were also reviewed by a second independent neurosurgeon on a separate occasion to asses the agreement on the diagnosis and the management plan. : There were nine patients with acute head injury and five patients with acute nontraumatic neurosurgical problems. In all cases both neurosurgeons were in agreement that a diagnosis could be made on the basis of the images that were transferred. With respect to the management advice there were differences in opinion on three of the patients but these were considered to be minor. : Accurate diagnosis can be made on images of acute neurosurgical problems transferred using a conventional camera phone and meaningful decisions can be made on these images. This method of consultation also proved to be highly convenient and cost effective.

Collision course: the privatization of graduate medical education at one university.

PubMed

Klasko, Stephen K; Ekarius, John C

2007-03-01

On December 18, 2003, Tenet Healthcare Corporation, an investor-owned hospital corporation, announced the closure of Medical College of Pennsylvania Hospital, a historic institution that was home to many of Drexel University College of Medicine's (DUCOM's) faculty, residents, and medical students. The authors summarize the steps that were taken and lessons learned to avoid a disruption in the education of over 200 residents. The authors highlight the response by the medical school; the concerns of the Accreditation Council for Graduate Medical Education (ACGME); the interaction between the Center for Medicare and Medicaid Services (CMS) and the ACGME; the importance of the designated institutional official (DIO) in a crisis situation; and the role of residents as students versus employees when their employer wishes to move or "trade" them to another institution. Through the lens of the DUCOM experience, the authors explore the legal, political, and educational conflicts that occur when an investor-owned company or private hospital employs residents but another entity holds moral and academic accountability for their future. Finally, the authors outline five lessons learned: (1) the important role the ACGME plays as the educational conscience of graduate medical education (GME), (2) the dramatically different roles that the ACGME and the CMS play in regulating and funding the national GME system, (3) the need for constant communication with the affected residents, (4) the important role that the DIO plays in GME, and (5) the need for medical school leaders to remain focused on their educational mission and responsibilities to young physicians.

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design

PubMed Central

Hahnenkamp, Klaus; Buhre, Wolfgang F.F.A; de Korte-de Boer, Dianne; Hamaekers, Ankie E.W; Metelmann, Bibiana; Metelmann, Camila; Bortul, Marina; Palmisano, Silvia; Mellin-Olsen, Jannicke; Macas, Andrius; Andres, Janusz; Prokop-Dorner, Anna; Vymazal, Tomáš; Hinkelmann, Juergen; Rodde, Sibyll; Pfleiderer, Bettina

2017-01-01

Background All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe. Objectives The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts. Methods We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women’s academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on “personal construct theory” through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management. Results A discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service. Conclusions The main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals. PMID:28768613

Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

PubMed

Bynum, Debra L; Wilson, Lindsay A; Ong, Thuan; Callahan, Kathryn E; Dalton, Thomas; Ohuabunwa, Ugochi

2015-09-01

In order to determine how often internal medicine and family medicine residents performed specific actions related to the geriatric competencies established by the American Geriatrics Society (AGS) when caring for older hospitalized adults, a cross-sectional anonymous survey of residents at the University of North Carolina, University of Washington, Wake Forest University, Duke University, and Emory University was undertaken. Data on frequency of self-reported behaviors were analyzed, with comparisons made for different levels of training, institution, and program. A total of 375 residents responded for an overall response rate of 48%. Residents reported that they often do not demonstrate all of the AGS recommended core competencies when caring for older adults in the hospital setting. Residents report more frequently performing activities that are routinely integrated into hospital systems such as reviewing medication lists, working with an interdisciplinary team, evaluating for inappropriate bladder catheters, and evaluating for pressure ulcers. There were no consistent differences between institutions and only minor differences noted between Family Medicine and Internal Medicine residents. Operationalizing core competencies by integrating them into hospital systems' quality process indicators may prompt more consistent high-quality care and ensure systems support residents' competence. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Attitudes and experiences of nurses toward death and caring for dying patients in Turkey.

PubMed

Cevik, Banu; Kav, Sultan

2013-01-01

Caring of the dying patients and facing the death can be a stressful and difficult experience for nurses. Besides personal and professional experiences, nurses' own attitudes toward death may affect the care given to dying individuals. The aim of this study was to examine Turkish nurses' attitudes toward and experiences with death and caring for dying patients. A descriptive, cross-sectional study was conducted at 2 university hospitals and 1 state hospital located in Ankara, Turkey. Data were collected via sociodemographics form, the Death Attitude Profile-Revised, and Frommelt's Attitude Toward Caring for Dying Patients. The attitudes of Turkish nurses toward death and caring for dying patients are less positive than the reported attitudes of nurses in other studies. Significant relationships were found among level of education, willingness to care for dying patients, and scores on Frommelt's Attitude Toward Caring for Dying Patients and on Death Attitude Profile-Revised subscales (P < .05). Although the majority of nurses (85%) stated that they had received education on end of life, most of them (82%) were not comfortable talking about death. A lack of education and experience may contribute to the negative attitudes. Providing a reflective narrative environment in which nurses can express their personal feelings about death and dying could be a potentially effective approach. This study highlights the need for further educational research and development of better educational programs to help nurses to explore and understand their attitudes toward death, overcome fears, increase communication skills, and enhance coping strategies.

Implementation of an advanced clinical and administrative hospital information system.

PubMed

Vegoda, P R; Dyro, J F

1986-01-01

Over the last six years since University Hospital opened, the University Hospital Information System (UHIS) has continued to evolve to what is today an advanced administrative and clinical information system. At University Hospital UHIS is the way of conducting business. A wide range of patient care applications are operational including Patient Registration, ADT for Inpatient/Outpatient/Emergency Room visits, Advanced Order Entry/Result Reporting, Medical Records, Lab Automated Data Acquisition/Quality Control, Pharmacy, Radiology, Dietary, Respiratory Therapy, ECG, EEG, Cardiology, Physical/Occupational Therapy and Nursing. These systems and numerous financial systems have been installed in a highly tuned, efficient computer system. All applications are real-time, on-line, and data base oriented. Each system is provided with multiple data security levels, forward file recovery, and dynamic transaction backout of in-flight tasks. Sensitive medical information is safeguarded by job function passwords, identification codes, need-to-know master screens and terminal keylocks. University Hospital has an IBM 3083 CPU with five 3380 disk drives, four dual density tape drives, and a 3705 network controller. The network of 300 terminals and 100 printers is connected to the computer center by an RF broadband cable. The software is configured around the IBM/MVS operating system using CICS as the telecommunication monitor, IMS as the data base management system and PCS/ADS as the application enabling tool. The most extensive clinical system added to UHIS is the Physiological Monitoring/Patient Data Management System with serves 92 critical care beds. In keeping with the Hospital's philosophy of integrated computing, the PMS/PDMS with its network of minicomputers was linked to the UHIS system. In a pilot program, remote access to UHIS through the IBM personal computer has been implemented in several physician offices in the local community, further extending the communications horizons of University Hospital's Information System. The implications of remote access to PDMS through the IBM PC emulating a Siemens Model 420 Patient Data Management Terminal are being examined.

Universal Health Coverage and Primary Healthcare: Lessons From Japan Comment on "Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries".

PubMed

Bloom, Gerald

2016-08-28

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan's experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.

PubMed

Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

2016-02-01

At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

Early experience with high-flow nasal oxygen therapy (HFNOT) in pediatric endoscopic airway surgery.

PubMed

Riva, Thomas; Theiler, Lorenz; Jaquet, Yves; Giger, Roland; Nisa, Lluís

2018-05-01

Reporting our institutional experience with high-flow nasal oxygen therapy (HFNOT), a recently-introduced technique, for endoscopic airway approaches. Prospective collection of data of children (<16 years) undergoing endoscopic between January 2016 and August 2017 at a tertiary referral university hospital. HFNOT was used in 6 children who underwent 14 procedures for different forms and causes of upper airway obstruction of various origins. No intraoperative complications; related to oxygenation were observed, and the surgical procedures could be carried out as; initially planned. We found that HFNOT is an effective and safe technique with a variety of potential applications in the field of endoscopic pediatric airway surgery. Copyright © 2018 Elsevier B.V. All rights reserved.

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

PubMed

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

2004-11-13

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

Incidence of Nosocomial Infections in a Big University Affiliated Hospital in Shiraz, Iran: A Six-month Experience.

PubMed

Askarian, Mehrdad; Mahmoudi, Hilda; Assadian, Ojan

2013-03-01

Nosocomial infections (NIs) are one of the most important health issues, particularly in developing countries, because these infections cause high mortality and morbidity, and economic and human resource loss as a consequence. To date, most surveillance studies have been conducted in developed countries, and only a few have been performed in Iran. All of the few Iranian studies have been performed using paper-based collection forms, and none was conducted with the aid of an electronic patient data retrieving and collecting tool. The aim of this study is to determine the incidence of NIs in a big university hospital of Shiraz, with the help of specifically programmed surveillance software merging electronically the available patient data and the infection results input manually. The study was conducted prospectively through 6 months from 21(st) March up to 22(nd) September 2006, in a 374-bedded educational hospital. All patients admitted during this period were included in the study and examined everyday for detecting four types of NIs: surgical site infection (SSI), urinary tract infection (UTI), pneumonia (PNEU), and blood stream infection (BSI). Centres for Disease Control and Prevention National Nosocomial Infection Surveillance system criteria were applied. 4013 patients were admitted in the hospital. The overall infection rate was 4.14, and UTI, SSI, BSI, and PNEU rates were 1.82, 1.22, 0.5, and 0.5, respectively, per 1000 patient days of admission. The results of this study showed that the frequency of NI in the investigated hospital was not higher than in many other reported surveillance results from other countries. This, however, might be a bias as the administration of antibiotics was very high in this study and the quality of microbiological investigation might have influenced significantly, resulting in more false-negative results than expected. Overall, the use of the Iranian National Nosocomial Infection Surveillance System Software proved to be useful and allowed both rapid data collection and detailed data analysis.

Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey.

PubMed

Hahn, Sabine; Hantikainen, Virpi; Needham, Ian; Kok, Gerjo; Dassen, Theo; Halfens, Ruud J G

2012-12-01

AIM.: This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated. There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses' experiences and single interactive factors between staff and patients/visitors involved. A cross-sectional survey. The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised. Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion. To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence. © 2012 Blackwell Publishing Ltd.

Prevalence of Diabetes Mellitus in the Surgical Population of the University of Puerto Rico Affiliated Hospitals: A Study using the Surgery Database.

PubMed

Cruz, Norma I; Santiago, Elvis; Abdul-Hadi, Anwar

2016-09-01

To evaluate the prevalence of diabetes mellitus in the surgical population of the University of Puerto Rico (UPR)-affiliated hospitals. We examined all the surgical cases that were entered into the Surgical Database from April 1, 2014 through September 30, 2014. This database collects patient and procedural information from different surgical services of various UPR-affiliated hospitals (the University District Hospital, the University Pediatric Hospital, the UPR Carolina Hospital, the Dr. Isaac Gonzalez Oncologic Hospital, the PR Cardiovascular Center [thoracic service], the Pavia Hospital [colorectal service], and the Auxilio Mutuo Hospital [colorectal and oncological services]). The prevalence of diabetes mellitus (types 1 and 2 combined) was estimated, and the nondiabetic and diabetic groups were compared. The difference between groups was evaluated using a Chi2 test, Student's t-test, or ANOVA, whichever was appropriate, with a p-value of less than 0.05 being considered significant. Information from 2,603 surgical patients was available. The mean age of the group was 49 (±23) years. The gender distribution indicated that 56% were women and 44% were men. Diabetes was present in 21% of the surgical population, increasing to 40% in patients aged 65 and over. The surgical procedures most frequently required by diabetic patients were in the categories of general surgery (36%), colorectal surgery (22%), vascular surgery (16%) and oncologic surgery (14%). Complications (5%, diabetic group vs. 2%, nondiabetic group; p < 0.05) and postoperative mortality (2%, diabetic group vs. 0.2%, nondiabetic group; p < 0.05) were significantly higher in the diabetic group than in the nondiabetic group. Our surgical population has a high prevalence of diabetes, and these diabetic patients showed higher complication and mortality rates from surgery than did the non-diabetic patients. Surgeons must consider the specific needs of these diabetic patients in order to provide optimal care.

Healthcare Providers' Formative Experiences with Race and Black Male Patients in Urban Hospital Environments.

PubMed

Plaisime, Marie V; Malebranche, David J; Davis, Andrea L; Taylor, Jennifer A

2017-12-01

We explored health providers' formative personal and professional experiences with race and Black men as a way to assess their potential influence on interactions with Black male patients. Utilizing convenience sampling with snowballing techniques, we identified healthcare providers in two urban university hospitals. We compared Black and White providers' experiences based on race and level of training. We used the Gardener's Tale to conceptualize how racism may lead to racial health disparities. A semi-structured interview guide was used to conduct in-person interviews (n = 16). Using the grounded theory approach, we conducted three types of coding to examine data patterns. We found two themes reflective of personally mediated racism: (1) perception of Black males accompanied by two subthemes (a) biased care and (b) fear and discomfort and (2) cognitive dissonance. While this latter theme is more reflective of Jones's internalized racism level, we present its results because its novelty is compelling. Perception of Black males and cognitive dissonance appear to influence providers' approaches with Black male patients. This study suggests the need to develop initiatives and curricula in health professional schools that address provider racial bias. Understanding the dynamics operating in the patient-provider encounter enhances the ability to address and reduce health disparities.

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

PubMed Central

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

2009-01-01

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

Screening and Brief Intervention for Alcohol Problems among College Students Treated in a University Hospital Emergency Department

ERIC Educational Resources Information Center

Helmkamp, James C.; Hungerford, Daniel W.; Williams, Janet M.; Manley, William G.; Furbee, Paul M.; Horn, Kimberly A.; Pollock, Daniel A.

2003-01-01

The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score [less…

Evaluation of the efficiency of hospital antibiotic policy applied Dr Jan Biziel University Hospital No 2 in Bydgoszcz in 2009-2013.

PubMed

Kuziemski, Arkadiusz; Frankowska, Krystyna; Gonia, Ewa; Czerniak, Beata; Bakhurynska, Olena; Sobociński, Zbigniew

2015-01-01

The Hospital Infection Control Team (HICT) of Dr Jan Biziel University Hospital No 2 in Bydgoszcz developed and implemented the principles of a rational antibiotic therapy in 2008. A behavior algorithm has worked since 01.10.2008. Implementation of the principles of a rational antibiotic therapy was part of the hospital antibiotic policy. is to evaluate either introductory principles of the rational antibiotic therapy, after five-year experience lived up to expectations in the range specified by the authors. Hospital microbiological maps, comparisons of antibiotic cost, specification of microbiological tests made before and after introduction of the principles of a rational antibiotic therapy have been analyzed. Annual antibiotic consumption has been counted according to the defined daily dose (DDD) index created by the WHO. After 6 years of implementation of the rational antibiotic therapy principles, the decrease in number of isolated strains which are resistant to Klebsiella pneumoniae ESBL and Acinetobacter baumanii (resistant to carbapenems) has been indicated. The number of the Pseudomonas aeruginosa isolates has increased approximately three times, and the number of resistant isolates to carbapenem has grown six times. The cost of antibiotics has been gradually decreased in 2012 in order to represent 9,66% of all drug budget (without drug programs). Detailed analysis of antibiotic consumption has showed that after the implementation of rational antibiotic therapy principles the consumption of meropenem has increased twice in comparison to the all drugs. The number of microbiological tests grew from 0,20 to 0,29 per one patient, which means material to microbiological tests has been taken from every third patient. Annual DDD index calculated on 100 person-days has been reduced from 59,552 in 2007 to 39,90 in 2009, and it is 47,88 in 2013. The principles of rational antibiotic therapy in comparison with the other elements of antibiotic policy in hospital have caused positive changes in antibiotic ordinance. 1. It is required to adhere to the principles of a rational antibiotic therapy by medical staff mainly on the administrative restriction of access to antibiotics. 2. Monitoring changes in drug resistance of hospital flora is an essential element of the principles of a rational antibiotic therapy modification.

Educational standards for training paramedics in ultrasound: a scoping review.

PubMed

Meadley, Ben; Olaussen, Alexander; Delorenzo, Ashleigh; Roder, Nick; Martin, Caroline; St Clair, Toby; Burns, Andrew; Stam, Emma; Williams, Brett

2017-06-17

Paramedic-performed out-of-hospital ultrasound is a novel skill that has gained popularity in some services in recent years. In this setting point-of care ultrasound (POCUS) can provide additional information that can assist with management and guide transport to the most appropriate facility. We sought to explore the different educational approaches used for training paramedics in ultrasound in the out-of-hospital setting. Ovid MEDLINE, EMBASE, EBM Reviews, The Cochrane Library, CINAHL plus, The Monash University Research Repository and the British Thesis Library were searched from the 1 st of January 1990 to the 6 th of April 2016. Google Scholar was searched and reference lists of relevant papers were examined to identify additional studies. Articles were included if they reported on out-of-hospital and POCUS educational approaches for paramedics. A total of 2002 unique articles were identified of which 18 articles met the inclusion criteria. Most articles reported combined cohorts of emergency providers with varying years of experience though most operators were POCUS naïve. The most common clinical assessment for which paramedic POCUS curricula was described was the focused assessment sonography for trauma (FAST) examination. Education programs varied from two-minutes to two-days with all studies including both didactic and practical training. Education programs for POCUS for paramedics vary considerably, and do not appear to align with qualification level or clinical experience. Further research investigating education and subsequent clinical application of POCUS by paramedics is required, as well as prospective, outcome based studies in order to measure the clinical utility of out-of-hospital POCUS.

Nonoperative management for patients with grade IV blunt hepatic trauma

PubMed Central

2012-01-01

Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications. PMID:23531162

Survey of Communicable Diseases Surveillance System in Hospitals of Iran: A Qualitative Approach

PubMed Central

Dehcheshmeh, Nayeb Fadaei; Arab, Mohammad; Foroushani, Abbas Rahimi; Farzianpour, Fereshteh

2016-01-01

Background: Communicable Disease Surveillance and reporting is one of the key elements to combat against diseases and their control. Fast and timely recognition of communicable diseases can be helpful in controlling of epidemics. One of the main sources of management of communicable diseases reporting is hospitals that collect communicable diseases’ reports and send them to health authorities. One of the focal problems and challenges in this regard is incomplete and imprecise reports from hospitals. In this study, while examining the implementation processes of the communicable diseases surveillance in hospitals, non-medical people who were related to the program have been studied by a qualitative approach. Methods: This study was conducted using qualitative content analysis method. Participants in the study included 36 informants, managers, experts associated with health and surveillance of communicable diseases that were selected using targeted sampling and with diverse backgrounds and work experience (different experiences in primary health surveillance and treatment, Ministry levels, university staff and operations (hospitals and health centers) and sampling was continued until arrive to data saturation. Results: Interviews were analyzed after the elimination of duplicate codes and integration of them. Finally, 73 codes were acquired and categorized in 6 major themes and 21 levels. The main themes included: policy making and planning, development of resources, organizing, collaboration and participation, surveillance process, and monitoring and evaluation of the surveillance system. In point of interviewees, attention to these themes is necessary to develop effective and efficient surveillance system for communicable diseases. Conclusion: Surveillance system in hospitals is important in developing proper macro - policies in health sector, adoption of health related decisions and preventive plans appropriate to the existing situation. Compilation, changing, improving, monitoring and continuous updating of surveillance systems can play a significant role in its efficiency and effectiveness. In the meantime, policy makers’ and senior managers’ support in development and implementation of communicable disease surveillance’ plans and their reporting plays a key and core role. PMID:27157154

Nurses’ knowledge of care of chest drain: A survey in a Nigerian semiurban university hospital

PubMed Central

Kesieme, Emeka Blessius; Essu, Ifeanyichukwu Stanley; Arekhandia, Bruno Jeneru; Welcker, Katrin; Prisadov, Georgi

2016-01-01

Background/Objective: Inefficient nursing care of chest drains may associated with unacceptable and sometimes life-threatening complications. This report aims to ascertain the level of knowledge of care of chest drains among nurses working in wards in a teaching hospital in Nigeria. Methods: A cross-sectional study among nurses at teaching hospital using pretested self-administered questionnaires. Results: The majority were respondents aged between 31 and 40 years (45.4%) and those who have nursing experience between 6 and 10 years. Only 37 respondents (26.2%) had a good knowledge of nursing care of chest drains. Knowledge was relatively higher among nurses who cared for chest drains daily, nurses who have a work experience of <10 years, low-rank nurses and those working in the female medical ward; however, the relationship cant (P > 0.05). Performance was poor on the questions on position of drainage system were not statistically significant with relationship to waist level while mobilizing the patient, application of suction to chest drains, daily changing of dressing over chest drain insertion site, milking of tubes and drainage system with dependent loop. Conclusion: The knowledge of care of chest drains among nurses is poor, especially in the key post procedural care. There is an urgent need to train them so as to improve the nursing care of patients managed with chest drains. PMID:26857934

Effect of NICU Department Orientation Program on Mother’s Anxiety: a Randomized Clinical Trial

PubMed Central

Valizadeh, Leila; Hosseini, Mohammad Bager; Heydarpoor Damanabad, Zhilla; Rahkar Farshi, Mahni; Asgari Jafarabadi, Mohammad; Ranjbar Kochaksaraie, Fatemeh

2016-01-01

Introduction: Neonatal intensive care unit induces the high level of anxiety for mothers. The aim of this study was to evaluate the effectiveness of NICU orientation program on the anxiety of mothers who had preterm newborns hospitalized in NICU. Methods: This study was a randomized clinical trial (three parallel groups). Participants included 99 mothers with preterm newborns hospitalized in NICU of Al- Zahra hospital, affiliated to Tabriz University of Medical Sciences in 2015. Mothers were randomly assigned to one of three groups (film, booklet, and control). Mothers completed the State- Trait Anxiety Inventory before entering to the NICU, and then mothers in the experiment groups became familiar with the NICU environment through watching a film or reading booklet. After the first NICU visit, all mothers completed the STAI and Cattell's Anxiety Questionnaires. Data were analyzed using SPSS ver. 13 software. Results: There was no significant difference between three groups regarding state- trait anxiety before the intervention. After the first NICU visit, a significant reduction in maternal state anxiety was seen in the both experiment groups. There was no statistical significant difference regarding trait anxiety. Data obtained from Cattell's anxiety questionnaire after intervention, showed significant difference in state anxiety between groups. Conclusion: Employing film and booklet orientation strategy after preterm delivery can reduce the mother’s anxiety and beneficent for the mother, baby, family and health care system. PMID:27752486

Technical efficiency and resources allocation in university hospitals in Tehran, 2009-2012

PubMed Central

Rezapour, Aziz; Ebadifard Azar, Farbod; Yousef Zadeh, Negar; Roumiani, YarAllah; Bagheri Faradonbeh, Saeed

2015-01-01

Background: Assessment of hospitals’ performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran. Methods: This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier 4,1 software. Results: According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389. Conclusion: This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved. PMID:26793657

Evaluating Maternal and Child Health and Leadership Competencies of Emerging MCH Leaders: The MCHC/RISE-UP Experience.

PubMed

Belcher, Harolyn M E; Stone, Jacqueline D; McFadden, Jenese A; Hemmingson, Tyler A; Kreutzer, Cary; Harris, Lisa G; Wheeler, Barbara Y; Van Osdel, Joanne; Avila, Margaret; Yorker, Beatrice; Hoffman, Beth R; Turner-Musa, Jocelyn O

2015-12-01

This study examines maternal and child health core competencies and leadership characteristics of undergraduate students following participation in the Maternal and Child Health Careers/Research Initiatives for Student Enhancement-Undergraduate Program (MCHC/RISE-UP). MCHC/RISE-UP is a 10-week public health leadership program designed to promote diversity in public health workforce through mentored research, community engagement and advocacy, and clinical experiences for undergraduate students. The MCHC/RISE-UP is a national consortium of University Centers for Excellence in Developmental Disabilities including, (1) Kennedy Krieger Institute (Kennedy Krieger, lead institution) partnering with Morgan State University, a Historically Black University, (2) the University of South Dakota partnering with Tribal Serving Institutions; and (3) the University of Southern California Children's Hospital-Los Angeles and their partner institution, California State University Los Angeles, a Hispanic Serving Institution. Eighty-four junior and senior undergraduates and recent baccalaureate degree students who participated in the MCHC/RISE-UP worked on 48 maternal and child health projects. Following the MCHC/RISE-UP, students demonstrated statistically significant improvements in all maternal and child health core competencies. Transformational leadership characteristics also increased (mean increase 9.4, 95% CI 7.2-11.8; p < 0.001). At closing interview, over twice as many students endorsed a public health career goal compared to program admission (17.9 vs. 57.7%; p = 0.022). Multi-institutional collaborative public health leadership programs may extend the reach and recruitment of diverse students into the maternal and child health field. Experiential, didactic, and mentored learning opportunities may enhance student integration of maternal and child health competencies and transformational leadership characteristics.

Organisation of diagnosis and treatment of idiopathic pulmonary fibrosis and other interstitial lung diseases in the Nordic countries

PubMed Central

Bendstrup, Elisabeth; Hyldgaard, Charlotte; Altraja, Alan; Sjåheim, Tone; Myllärniemi, Marjukka; Gudmundsson, Gunnar; Sköld, Magnus; Hilberg, Ole

2015-01-01

Introduction Differences in the organisation of idiopathic pulmonary fibrosis (IPF) and interstitial lung diseases (ILDs) in the Nordic countries are not well described. Diagnostic setups, treatment modalities and follow-up plans may vary due to national, cultural and epidemiological features. The aim of the present study was to describe the different organisation of diagnostics and treatment of IPF and ILD in the Nordic countries. Methods All university and regional hospitals with respiratory physicians were invited to respond to a questionnaire collecting data on the number of physicians, nurses, patients with ILD/IPF, the presence of and adherence to disease-specific national and international guidelines, diagnosis and treatment including ILD-specific palliation and rehabilitation programmes. Results Twenty-four university and 22 regional hospitals returned the questionnaire. ILD and IPF incidence varied between 1.4 and 20/100,000 and 0.4 and 10/100,000, respectively. Denmark and Estonia have official national plans for the organisation of ILD. The majority of patients are managed at the university hospitals. The regional hospitals each manage 46 (5–200) patients with ILD and 10 (0–20) patients with IPF. There are from one to four ILD centres in each country with a median of two ILD specialists employed. Specialised ILD nurses are present in nine hospitals. None of the Nordic countries have national guidelines made by health authorities. The respiratory societies in Sweden, Norway and Denmark have developed national guidelines. All hospitals except two use the ATS/ERS/JRS/ALAT IPF guidelines from 2011. The limited number of ILD specialists, ILD-specialised radiologists and pathologists and the low volume of ILD centres were perceived as bottlenecks for implementation of guidelines. Twenty of the 24 university hospitals have multidisciplinary conferences (MDCs). Pulmonologists and radiologists take part in all MDCs while pathologists only participate at 17 hospitals. Prescription of pirfenidone is performed by all university hospitals except in Estonia. Triple therapy with steroid, azathioprine and N-acetylcysteine is not used. No hospitals have specific palliation programmes for patients with ILD/IPF, but 36 hospitals have the possibility of referring patients for palliative care, mostly based on existing oncology palliative care teams; seven hospitals have rehabilitation programmes for ILD. Conclusion There are obvious differences between the organisations of ILD patients in the Nordic countries. We call for national plans that consider the challenge of cultural and geographical differences and suggest the establishment of national reference centres and satellite collaborative hospitals to enable development of common guidelines for diagnostics, therapy and palliation in this patient group. PMID:26557259

Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

PubMed

Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

2016-06-01

Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital-based health technology assessment has been developed to support decisions. However, little is known about the different perceptions of innovative medical devices among practitioners and how different perceptions may affect decision making. What does this paper add? This paper compares and understands the perceptions of two groups of health professionals concerning innovative devices in the university hospital environment. What are the implications for practitioners? Such a comparison of viewpoints could facilitate improvements in current practices and decision-making processes in local health technology assessment for these medical products.

The awareness of experience innovation and an application in private hospitals.

PubMed

Luleci, Nimet Emel; Gemlik, Hatice Nilay; Bektas, Gulfer; Manioglu, Yagmur

2015-10-01

To evaluate the perspective of private hospitals regarding experience innovation. The qualification-type study was conducted in Istanbul, Turkey, in February 2015, and comprised 17 hospitals where patients and employees were interviewed using a semi-structured consultation guide. The employees were examined regarding the meaning of innovation, awareness of experience innovation and its measurement. The patients were asked about the reason for choosing a hospital, the actual reason for arrival at the hospital and the impressions while leaving the hospital. Based on the obtained answers, experience innovation was examined. Of the 87 subjects interviewed, 51(59%) were patients and 36(41%) were hospital employees. Overall, there were 61(70%) women and 26(30%) men in the age range of 21-75 years. It was observed that the tendencies of hospitals for innovation activities were high, but they confused it with novelty. Investments made without taking experience innovation into account do not convert into targeted results.

[Proposal for graduate school education in the future: from the viewpoint of the Department of clinical Laboratory in a university hospital].

PubMed

Ishii, Junichi

2009-08-01

Fujita Health University Hospital, located in Toyoake, is a large teaching hospital with 1,505 beds. The Department of Clinical Laboratory in our hospital, in which 136 medical technologists work, is one of the largest clinical laboratories in Japan. Medical technologists in our hospital are required not only to perform accurate laboratory examinations, but also to contribute to the medical care team. In addition, they must educate students and trainee medical technologists. Furthermore, they conduct research to develop and evaluate new laboratory methods. Thus, we hope that education in graduate schools of medical technology (Master's course), along with promoting the specialty of laboratory techniques, will develop students' clinical skills to examine patients and research skills to conduct studies.

[Accidents with biological material at West Paraná University Hospital].

PubMed

Murofuse, Neide Tiemi; Marziale, Maria Helena Palucci; Gemelli, Lorena Moraes Goetem

2005-08-01

It is a descriptive and retrospective study with the purpose of investigating labor accidents with biological material involving workers and trainees occurred in 2003 and 2004 in a University Hospital of Parana. For data collection, the electronic form of the Net of Occupational Accidents Prevention - REPAT has been utilized. Out of the 586 hospital workers, there was a register of 20 (3,4%) injured workers in 2003 and 23 (3,8%) in 2004, representing an increase of 15% in the notifications from one year to the other.

LISA, the next generation: from a web-based application to a fat client.

PubMed

Pierlet, Noëlla; Aerts, Werner; Vanautgaerden, Mark; Van den Bosch, Bart; De Deurwaerder, André; Schils, Erik; Noppe, Thomas

2008-01-01

The LISA application, developed by the University Hospitals Leuven, permits referring physicians to consult the electronic medical records of their patients over the internet in a highly secure way. We decided to completely change the way we secured the application, discard the existing web application and build a completely new application, based on the in-house developed hospital information system, used in the University Hospitals Leuven. The result is a fat Java client, running on a Windows Terminal Server, secured by a commercial SSL-VPN solution.

Highlighting 2004 award-winning initiatives.

PubMed

2005-02-01

This issue takes a closer look at how five award-winning healthcare organizations are finding--and continually refining--innovative ways to provide high-quality healthcare. One of those organizations is Robert Wood Johnson University Hospital Hamilton, which recently was named the fourth healthcare winner of the annual Malcolm Baldrige National Quality Award. The Joint Commission on Accreditation of Healthcare Organizations recently selected two facilities in the hospital category--Stamford Hospital and Staten Island University Hospital--as recipients of the eighth annual Codman Award for their work in using outcomes measurement to promote quality care. The Reading Hospital and Medical Center received a Cheers Award from the Institute for Safe Medication Practices for its toolkit promoting patient safety. Sentara Healthcare System, top winner of the American Hospital Association's Quest for Quality Award, has been cited for its efforts to align its quality and safety goals with its organizational goals.

Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations.

PubMed

Johnson, Timothy V; Schoenberg, Evan D; Abbasi, Ammara; Ehrlich, Samantha S; Kleris, Renee; Owen-Smith, Ashli; Gunderson, Kristin; Master, Viraj A

2009-01-01

Recent research suggests that low education and illiteracy may drive misunderstanding of the American Urological Association Symptom Score, a key tool in the American Urological Association benign prostatic hyperplasia guidelines. It is unclear whether misunderstanding is confined to patients of low socioeconomic status. Therefore, we reevaluated the prevalence and impact of this misunderstanding in a county vs university hospital population. This prospective study involved 407 patients from a county hospital and a university hospital who completed the American Urological Association Symptom Score as self-administered and then as interviewer administered. Responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association Symptom Score. Multivariate logistic regression analyses were used to examine the association between patient characteristics and poor understanding of the American Urological Association Symptom Score. Of the patients 72% understood all 7 American Urological Association Symptom Score questions. Of the measured demographic variables only education level significantly affected this understanding. Compared to patients with more than 12 years of education county hospital patients with less than 9 years of education were 57.06 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 14.32-329.34) while university hospital patients with less than 9 years of education were 38.27 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 1.69-867.83). Of county hospital patients 31% and of university hospital patients 21% significantly misrepresented their symptom severity according to current guidelines. Patients with low education regardless of location are more likely to misunderstand the American Urological Association Symptom Score, misrepresent their symptoms and, therefore, receive inappropriate treatment.

Factors affecting the technical efficiency of general hospitals in Iran: data envelopment analysis.

PubMed

Kalhor, Rohollah; Amini, Saeed; Sokhanvar, Mobin; Lotfi, Farhad; Sharifi, Marziye; Kakemam, Edris

2016-03-01

Restrictions on resource accessibility and its optimal application is the main challenge in organizations nowadays. The aim of this research was to study the technical efficiency and its related factors in Tehran general hospitals. This descriptive analytical study was conducted retrospectively in 2014. Fifty-four hospitals with private, university, and social security ownerships from the total 110 general hospitals were randomly selected for inclusion into this study on the basis of the share of ownership. Data were collected using a checklist with three sections, including background variables, inputs, and outputs. Seventeen (31.48%) hospitals had an efficiency score of 1 (highest efficiency score). The highest average efficiency score was in social security hospitals (84.32). Private and university hospitals ranked next with an average of 84.29 and 79.64, respectively. Analytical results showed that there was a significant relationship between hospital ownership, hospital type in terms of duty and specialization, educational field of the chief executive officer, and technical efficiency. There was no significant relationship between education level of hospital manager and technical efficiency. Most of the studied hospitals were operating at low efficiency. Therefore, policymakers should plan to improve the hospital operations and promote hospitals to an optimal level of efficiency.

[Current status of tuberculosis education in universities and future tasks].

PubMed

2000-02-01

Symposium Topics and Presenters: 1. Education of tuberculosis in medial school: Kaoru SHIMOKATA (Department of Clinical Preventive Medicine, Nagoya University Daiko Medical Center) 2. From Medical University holding Tuberculous ward: Shosaku ABE (Third Department of Internal Medicine, Sapporo Medical University School of Medicine), et al. 3. Necessity and Significance of Sanatorium ward associated with University Hospital: Saburo SONE, et al. (Third Department of Internal Medicine, The University of Tokushima School of Medicine) 4. A proposal on education and training for tuberculosis in medical school from aspect of sanitariums: Takeshi OGURA (Toneyama National Hospital) 5. How to avoid infecting TB and to prevent contracting TB while medical and nursing practices: Keiichi NAGAO (Health Sciences, Center, Chiba University), et al. 6. Special speech: A review of the year since TB patient rooms were included in a common ward as a part of ministry of welfare's model project: Shuji KURANE (Fourth Department of Internal Medicine, Nippon Medical School) Tuberculosis began to rank first in mortality rate in Japan in the Meiji Era, and especially since it did not conform to the "national wealth and military strength" that was the national policy of the time due to the high mortality rates in the early decades of life, it was referred to as the "disease that was destroying the country" and the "pandemic disease." Even after entering the Showa Era, tuberculosis long occupied first place as the cause of death in Japan, and it raged unchecked for a period after World War II. However, the prognosis of tuberculosis as a whole improved considerably as a result of the development of antituberculosis agents, such as streptomycin, and the advent of rifampicin made it a curable disease. Its rank as a cause of death subsequently fell precipitously, and many of the TB wards that had been established in university hospitals were closed as the numbers of patients rapidly declined. At the present time, only 22 of the 80 university hospitals in the country have TB wards or TB beds, and 18 of the hospitals that had TB wards have closed them. Two of them closed them prior to 1964, 6 between 1965 and 1974, 4 between 1975 and 1984, 4 between 1985 and 1994, and 2 since 1995. Thus, it would be no exaggeration to say that there has been a steady decline in the TB wards of university hospitals. It is fairly easy to surmise that the result has been a decrease in the opportunities and time available for educating medical students about tuberculosis. Today, university hospitals not only accept medical students, but 80% of clinical residents as well, and they too have lost opportunities for education concerning tuberculosis. We would hope that the concern of Japanese physicians regarding tuberculosis has not diminished in proportion to the decrease in TB wards in our university hospitals. However, as is truly revealed by the expression "doctor's delay" in the diagnosis and treatment of tuberculosis, it is a fact that physicians no longer bear pulmonary tuberculosis in mind when diagnosing and treating patients with respiratory disease, and that as a result diagnosis is delayed, treatment is drawn out, and in the worst-case scenario, we see scattered instances of a tragic outcome. When we consider the recent conditions in society, as reported in recent newspapers, tuberculosis is not a disease that is on the decline at all in Japan today. However, as stated above, but if the concern of ordinary physicians has drifted away from tuberculosis, it is fair to say that it is not only a major problem medically, but socially as well. Consideration of the tuberculosis education in university medical schools seems to be opportune at this time. Professor Shimokata of Nagoya University, who is chairperson of the Japan Tuberculosis Education Committee, outlined the problems of tuberculosis education in his speech at this symposium. (ABSTRACT TRUNCATED)

Sleep practices among medical students in Pediatrics Department of University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.

PubMed

Chinawa, J M; Chukwu, B F; Obu, H A

2014-01-01

Medical students are a population who are at great risk of having bad sleep practice and hygiene due to demanding clinical and academic activities. Poor sleep practices are a disturbing and destabilizing phenomenon. It affects many people and can affect the quality of work, performance and education of medical students. Determining the sleep practices and behaviors could be useful to establish a systematic mental health curriculum in medical schools. The objectives of this study is to describe sleep practices among undergraduate medical students in a Nigerian University. Sleep practices were investigated using a convenience sample of medical students from the University of Nigeria Teaching Hospital Ituku Ozalla, Enugu from October 2012 to February 2013. A total number of participants enrolled were 241 consisting of 150 male and 90 female medical students. However, 222 (response rate: 92.1%) completed and returned the questionnaire. The median number of hours of night sleep on a weekday and weekend were 6 and 7 h respectively. There was a significant correlation between the number of hours of sleep and use of caffeine (Spearman r = -0.148, P < 0.0321). Ninety two (45.3%) had a sleep latency of 10-30 min while 157 (70.7%) woke up 1-2 times/night. Twenty five (11.3%) experience unusual sleep practices such as sleep walking, talking or night terrors. Medical students in our institution have varying degrees of sleeping practice and behavior and this may affect academic performance.

The USC-OSA Student Chapter: goals and benefits for the optics community

NASA Astrophysics Data System (ADS)

Gómez-Varela, A. I.; Gargallo, Ana; González Núñez, Héctor; Delgado-García, Tamara; Almaguer-Gómez, Citlalli; Cambronero-López, F.; Flores-Arias, M. T.

2014-07-01

The USC-OSA Student Chapter has been constituted in March 2013 by members of the University of Santiago de Compostela (USC) in Spain and sponsored by The Optical Society of America (OSA). It is formed by five graduate and one undergraduate students with the common interest in Optics and Photonics research and a professor of the USC is also involved as a faculty advisor. We decided to start this group with the aim of involving kids, precollege and undergraduate students in the world of Optics and Photonics. The activities that the USC-OSA Student Chapter members intend to realize are mainly educational tasks for the spreading of knowledge in Photonics by means of basic experiments, demonstrations and lectures by leading researchers and teachers. Most of the needed resources to accomplish these activities are provided by the OSA, such as educational posters and a portable kit for demonstrating Optics to students. At this moment the USC-OSA Student Chapter is carrying out several activities, as educational journeys at the Santiago de Compostela University Hospital Complex (CHUS), where hospitalized children can approach to Optics through some simple experiments and games. A teaching program is also being organized in collaboration with Galician secondary schools in order to show students the importance and uses of Optics and Photonics and to arouse their interest in this field, as well as encouraging them to develop their scientific thinking. Another activity will take place in November during the Science Week, which includes a program of lectures targeted to undergraduate students and an exposition of several demonstrations

Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

PubMed

Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

2016-10-01

The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods. Copyright © 2016 Elsevier Inc. All rights reserved.

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…