Blood Type 0 is not associated with increased blood loss in extensive spine surgery✩

PubMed Central

Komatsu, Ryu; Dalton, Jarrod E.; Ghobrial, Michael; Fu, Alexander Y.; Lee, Jae H.; Egan, Cameron; Sessler, Daniel I.; Kasuya, Yusuke; Turan, Alparslan

2016-01-01

Study Objective To investigate whether Type O blood group status is associated with increased intraoperative blood loss and requirement of blood transfusion in extensive spine surgery. Design Retrospective comparative study. Setting University-affiliated, non-profit teaching hospital. Measurements Data from 1,050 ASA physical status 1, 2, 3, 4, and 5 patients who underwent spine surgeries involving 4 or more vertebral levels were analyzed. Patients with Type O blood were matched to similar patients with other blood types using propensity scores, which were estimated via demographic and morphometric data, medical history variables, and extent of surgery. Intraoperative estimated blood loss (EBL) was compared among matched patients using a linear regression model; intraoperative transfusion requirement in volume of red blood cells, fresh frozen plasma, platelet, cryoprecipitate, cell salvaged blood, volume of intraoperative infusion of hetastarch, 5% albumin, crystalloids, and hospital length of hospital (LOS) were compared using Wilcoxon rank-sum tests. Main Results Intraoperative EBL and requirement of blood product transfusion were similar in patients with Type O blood group and those with other blood groups. Conclusion There was no association between Type O blood and increased intraoperative blood loss or blood transfusion requirement during extensive spine surgery, with similar hospital LOS in Type O and non-O patients. PMID:25172503

Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation.

PubMed

Mungroop, Timothy H; van Rijssen, L Bengt; van Klaveren, David; Smits, F Jasmijn; van Woerden, Victor; Linnemann, Ralph J; de Pastena, Matteo; Klompmaker, Sjors; Marchegiani, Giovanni; Ecker, Brett L; van Dieren, Susan; Bonsing, Bert; Busch, Olivier R; van Dam, Ronald M; Erdmann, Joris; van Eijck, Casper H; Gerhards, Michael F; van Goor, Harry; van der Harst, Erwin; de Hingh, Ignace H; de Jong, Koert P; Kazemier, Geert; Luyer, Misha; Shamali, Awad; Barbaro, Salvatore; Armstrong, Thomas; Takhar, Arjun; Hamady, Zaed; Klaase, Joost; Lips, Daan J; Molenaar, I Quintus; Nieuwenhuijs, Vincent B; Rupert, Coen; van Santvoort, Hjalmar C; Scheepers, Joris J; van der Schelling, George P; Bassi, Claudio; Vollmer, Charles M; Steyerberg, Ewout W; Abu Hilal, Mohammed; Groot Koerkamp, Bas; Besselink, Marc G

2017-12-12

The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition.

Admission blood glucose predicted haemorrhagic shock in multiple trauma patients.

PubMed

Kreutziger, Janett; Rafetseder, Andreas; Mathis, Simon; Wenzel, Volker; El Attal, René; Schmid, Stefan

2015-01-01

Admission blood glucose is known to be a predictor for outcome in several disease patterns, especially in critically ill trauma patients. The underlying mechanisms for the association of hyperglycaemia and poor outcome are still not proven. It was hypothesised that hyperglycaemia upon hospital admission is associated with haemorrhagic shock and in-hospital mortality. Data was extracted from an observational trauma database of the level 1 trauma centre at Innsbruck Medical University hospital. Trauma patients (≥18 years) with multiple injuries and an Injury Severity Score ≥17 were included and analysed. In total, 279 patients were analysed, of which 42 patients (15.1%) died. With increasing blood glucose upon hospital admission, the rate of patients with haemorrhagic shock rose significantly [from 4.4% (glucose 4.1-5.5mmol/L) to 87.5% (glucose >15mmol/L), p<0.0001]. Mortality was also associated with initial blood glucose [≤5.50mmol/L 8.3%; 5.51-7.50mmol/L 10.9%, 7.51-10mmol/L 12.4%; 10.01-15mmol/L 32.0%; ≥15.01mmol/L 12.5%, p=0.008]. Admission blood glucose was a better indicator for haemorrhagic shock (cut-off 9.4mmol/L, sensitivity 67.1%, specificity 83.9%) than haemoglobin, base excess, bicarbonate, pH, lactate, or vital parameters. Regarding haemorrhagic shock, admission blood glucose is more valuable during initial patient assessment than the second best predictive parameter, which was admission haemoglobin (cut-off value 6.5mmol/L (10.4g/dL): sensitivity 61.3%, specificity 83.9%). In multiple trauma, non-diabetic patients, admission blood glucose predicted the incidence of haemorrhagic shock. Admission blood glucose is an inexpensive, rapidly and easily available laboratory value that might help to identify patients at risk for haemorrhagic shock during initial evaluation upon hospital admission. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patient blood management knowledge and practice among clinicians from seven European university hospitals: a multicentre survey.

PubMed

Manzini, P M; Dall'Omo, A M; D'Antico, S; Valfrè, A; Pendry, K; Wikman, A; Fischer, D; Borg-Aquilina, D; Laspina, S; van Pampus, E C M; van Kraaij, M; Bruun, M T; Georgsen, J; Grant-Casey, J; Babra, P S; Murphy, M F; Folléa, G; Aranko, K

2018-01-01

The aim of this survey was to evaluate the knowledge about Patient Blood Management (PBM) principles and practices amongst clinicians working in seven European hospitals participating in a European Blood Alliance (EBA) project. A web-based questionnaire was sent to 4952 clinicians working in medical, surgery and anaesthesiology disciplines. The responses were analysed, and the overall results as well as a comparison between hospitals are presented. A total of 788 responses (16%) were obtained. About 24% of respondents were not aware of a correlation between preoperative anaemia (POA) and perioperative morbidity and mortality. For 22%, treatment of POA was unlikely to favourably influence morbidity and mortality even before surgery with expected blood loss. More than half of clinicians did not routinely treat POA. 29%, when asked which is the best way to treat deficiency anaemia preoperatively, answered that they did not have sufficient knowledge and 5% chose to 'do nothing'. Amongst those who treated POA, 38% proposed red cell transfusion prior to surgery as treatment. Restrictive haemoglobin triggers for red blood cell transfusion, single unit policy and reduction of number and volumes of blood samples for diagnostic purposes were only marginally implemented. Overall, the responses indicated poor knowledge about PBM. Processes to diagnose and treat POA were not generally and homogeneously implemented. This survey should provide further impetus to implement programmes to improve knowledge and practice of PBM. © 2017 International Society of Blood Transfusion.

Institutional practices and policies in acid-base testing: a self reported Croatian survey study on behalf of the Croatian society of medical biochemistry and laboratory medicine Working Group for acid-base balance.

PubMed

Dukić, Lora; Simundić, Ana-Maria

2014-01-01

The aim of this survey study was to assess the current practices and policies in use related to the various steps in the blood gas testing process, across hospital laboratories in Croatia. First questionnaire was sent by email to all medical biochemistry laboratories (N = 104) within general, specialized and clinical hospitals and university hospital centres to identify laboratories which perform blood gas analysis. Second questionnaire with detailed questions about sample collection, analysis and quality control procedures, was sent only to 47 laboratories identified by the first survey. Questionnaire was designed as combination of questions and statements with Likert scale. Third questionnaire was sent to all participating laboratories (N=47) for additional clarification for either indeterminate or unclear answers. Blood gas analysis is performed in 47/104 hospital laboratories in Croatia. In 25/41 (0.61) of the laboratories capillary blood gas sampling is the preferred sample type for adult patient population, whereas arterial blood sample is preferentially used in only 5/44 laboratories (0.11). Blood sampling and sample processing for capillary samples is done almost always by laboratory technicians (36/41 and 37/44, respectively), whereas arterial blood sampling is almost always done by the physician (24/29) and only rarely by a nurse (5/28). Sample acceptance criteria and sample analysis are in accordance with international recommendations for majority of laboratories. 43/44 laboratories participate in the national EQA program. POCT analyzers are installed outside of the laboratory in 20/47 (0.43) institutions. Laboratory staff is responsible for education and training of ward personnel, quality control and instrument maintenance in only 12/22, 11/20 and 9/20 institutions, respectively. Practices related to collection and analysis for blood gases in Croatia are not standardised and vary substantially between laboratories. POCT analyzers are not under the direct supervision by laboratory personnel in a large proportion of surveyed institutions. Collective efforts should be made to harmonize and improve policies and procedures related to blood gas testing in Croatian laboratories.

Distribution of yeast-like fungi at a university hospital in Turkey.

PubMed

Ece, Gulfem

2014-12-01

The increased life span has led to application of more invasive procedures for diagnosis and treatment of particularly immunosuppressed individuals. This situation drew more attention to fungal infections due to existence of yeast-like fungi. Candida infections have increased due to transplant in patients, prolonged intensive care unit (ICU) stays, and invasive procedures. Recently, identification of yeast-like fungi as well as antifungal susceptibility test has been gaining more importance. In our study, we aimed to evaluate the distribution of yeast-like fungi strains isolated from blood, urine, wound and respiratory specimens, which were sent from various departments of Izmir University School of Medicine University Hospital. The 262 yeast strains (of 13860 clinical specimens), isolated during 30.05.2012-20.05.2013, which were sent from various departments of Izmir University School of Medicine to Medical Microbiology Laboratory, were included in this study. Blood, wound, respiratory (sputum, tracheal secretion), and urine specimens were cultivated on blood agar and Sabouraud dextrose agar and incubated for 24-48 hours at 37°C. The isolates were cultivated on CHROMagar Candida and Cornmeal Tween 80 medium for identification. Besides, the automatized Vitek version 2.0 system was used for identification of the yeast strains as well as the antifungal susceptibility of blood culture strains. A total of 262 strains, isolated from the Anesthesiology and Reanimation Unit, as well as from the departments of Hematology, Urology, Infectious Diseases, Gynecology and Obstetrics, and Ear Nose and Throat, were included in this study. The most common isolated yeast-like species was Candida albicans. C. parapsilosis was the most common yeast-like fungus isolated from blood cultures. All the blood culture strains were susceptible to amphotericin B, flucytosine, fluconazole and voriconazole. Candida strains isolated from newborns, elderly patients, and intensive care patients, identified and isolates from blood cultures, should be studied for antifungal susceptibility for management of the treatment. Our University Hospital is a recently opened center and these are the first data of our center. Gradually, as the number of patients increases, this data will be evaluated further.

Distribution of Yeast-Like Fungi at a University Hospital in Turkey

PubMed Central

Ece, Gulfem

2014-01-01

Background: The increased life span has led to application of more invasive procedures for diagnosis and treatment of particularly immunosuppressed individuals. This situation drew more attention to fungal infections due to existence of yeast-like fungi. Candida infections have increased due to transplant in patients, prolonged intensive care unit (ICU) stays, and invasive procedures. Recently, identification of yeast-like fungi as well as antifungal susceptibility test has been gaining more importance. Objectives: In our study, we aimed to evaluate the distribution of yeast-like fungi strains isolated from blood, urine, wound and respiratory specimens, which were sent from various departments of Izmir University School of Medicine University Hospital. Materials and Methods: The 262 yeast strains (of 13860 clinical specimens), isolated during 30.05.2012-20.05.2013, which were sent from various departments of Izmir University School of Medicine to Medical Microbiology Laboratory, were included in this study. Blood, wound, respiratory (sputum, tracheal secretion), and urine specimens were cultivated on blood agar and Sabouraud dextrose agar and incubated for 24-48 hours at 37°C. The isolates were cultivated on CHROMagar Candida and Cornmeal Tween 80 medium for identification. Besides, the automatized Vitek version 2.0 system was used for identification of the yeast strains as well as the antifungal susceptibility of blood culture strains. Results: A total of 262 strains, isolated from the Anesthesiology and Reanimation Unit, as well as from the departments of Hematology, Urology, Infectious Diseases, Gynecology and Obstetrics, and Ear Nose and Throat, were included in this study. The most common isolated yeast-like species was Candida albicans. C. parapsilosis was the most common yeast-like fungus isolated from blood cultures. All the blood culture strains were susceptible to amphotericin B, flucytosine, fluconazole and voriconazole. Conclusions: Candida strains isolated from newborns, elderly patients, and intensive care patients, identified and isolates from blood cultures, should be studied for antifungal susceptibility for management of the treatment. Our University Hospital is a recently opened center and these are the first data of our center. Gradually, as the number of patients increases, this data will be evaluated further. PMID:25741432

Integration of DPC and clinical microbiological data in Japan reveals importance of confirming a negative follow-up blood culture in patients with MRSA bacteremia.

PubMed

Miyamoto, Naoki; Yahara, Koji; Horita, Rie; Yano, Tomomi; Tashiro, Naotaka; Morii, Daiichi; Tsutsui, Atsuko; Yaita, Kenichiro; Shibayama, Keigo; Watanabe, Hiroshi

2017-10-01

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is one of the commonest and most life-threatening of all infectious diseases. The morbidity and mortality rates associated with MRSA bacteremia are higher than those associated with bacteremia caused by other pathogens. A common guideline in MRSA bacteremia treatment is to confirm bacteremia clearance through additional blood cultures 2-4 days after initial positive cultures and as needed thereafter. However, no study has presented statistical evidence of how and to what extent confirming a negative follow-up blood culture impacts clinical outcome. We present this evidence for the first time, by combining clinical microbiological data of blood cultures and the DPC administrative claims database; both had been systematically accumulated through routine medical care in hospitals. We used electronic medical records to investigate the clinical background and infection source in detail. By analyzing data from a university hospital, we revealed how survival curves change when a negative follow-up blood culture is confirmed. We also demonstrated confirmation of a negative culture is significantly associated with clinical outcomes: there was a more than three-fold increase in mortality risk (after adjusting for clinical background) if a negative blood culture was not confirmed within 14 days of the initial positive blood culture. Although we used data from only one university hospital, our novel approach and results will be a basis for future studies in several hospitals in Japan to provide statistical evidence of the clinical importance of confirming a negative follow-up blood culture in bacteremia patients, including those with MRSA infections. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Seroprevalence of transfusion-transmissible infections (HBV, HCV, syphilis and HIV) among prospective blood donors in a tertiary health care facility in Calabar, Nigeria; an eleven years evaluation.

PubMed

Okoroiwu, Henshaw Uchechi; Okafor, Ifeyinwa Maryann; Asemota, Enosakhare Aiyudubie; Okpokam, Dorathy Chioma

2018-05-22

Provision of constant and safe blood has been a public health challenge in Sub-Saharan Africa with high prevalence of transfusion-transmissible infections (TTIs). This study was aimed at determining the trend and seroprevalence of HBV, HCV, syphilis and HIV across the years within study among prospective blood donors at blood bank in University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. A retrospective analysis of blood donor data from January 2005 to December 2016 was conducted in Blood Bank/Donor Clinic of University of Calabar Teaching Hospital, Calabar, Nigeria. Sera samples were screened for hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 and 2 and Treponema pallidum using commercially available immunochromatic based kits. Out of the 24,979 screened prospective donors in the 2005-2016 study period, 3739 (14.96%) were infected with at least one infective agent. The overall prevalence of HBV, HCV, syphilis and HIV were 4.1, 3.6, 3.1 and 4.2%, respectively. During the period of study, the percentage of all transfusion-transmissible infections declined significantly with remarkable decline in HIV. The study showed male dominated donor pool (98.7%) with higher prevalence (4.2%) of transfusion-transmissible infections than in female donors (0.0%). Commercial donors constituted majority (62.0%) of the donors and as well had the highest prevalence of transfusion-transmissible infections. Majority (62.9%) of the donors were repeat donors. HBV, HCV, syphilis and HIV have remained a big threat to safe blood transfusion in Nigeria and Sub-Saharan Africa at large. Strict adherence to selection criteria and algorithm of donor screening are recommended.

Effect of infection control strategy on knowledge, attitude and practice towards hepatitis B transmission and prevention in vulnerable populations.

PubMed

Al-Tawil, M M; El-Gohary, E E; El-Sayed, M H

2013-01-01

Health care workers (HCWs) and hematological patients needing blood/ blood product transfusion are particularly vulnerable to blood born infections (BBI) including viral hepatitis. To evaluate knowledge, attitude and practice (KAP) of these target groups regarding viral hepatitis B (HBV) transmission and its change with implementing infection control policy and procedures. An anonymous questionnaire with closed questions was used to evaluate KAP including vaccination status in 2 target groups, in Children Hospital, Ain Shams University, Cairo, Egypt: 184 nurses and 210 children and adolescents with blood diseases. One year after instituting infection control as a part of hospital procedures, the same questionnaire was reused to evaluate KAP towards HBV. Baseline knowledge regarding HBV transmission, sequelae and preventive measures, was poor in both groups. Among nurses, only 62% wore gloves on withdrawing or giving blood to patients, 43.5% routinely washed hands between patients and 37.5% reported exposure after sharp injury. Only 38% of patients and 40% of nurses received HBV vaccination. Targeted infection control policy and procedures significantly improved KAP regarding HBV in both groups. Vaccination coverage significantly increased and reached 88.7% for nurses and 72% for patients. Hospital based infection control units with established policy and procedures against BBI significantly improved KAP towards HBV including a significant increase in vaccination intake.

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

PubMed

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

2007-01-01

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

Blood transfusion reactions; evaluation of 462 transfusions at a tertiary hospital in Nigeria.

PubMed

Arewa, O P; Akinola, N O; Salawu, L

2009-06-01

The immuno-haematological safety of blood remains an important and recurring issue in blood transfusion practice. Data concerning morbidity and mortality from blood transfusion is sparse in Nigeria however and while the current efforts at reduction in the incidence of adverse consequence of blood transfusion is encapsulated in the concept of Haemovigilance, the Nigerian blood transfusion service is yet to institute the practice. A prospective study of 462 transfusions at the Obafemi Awolowo University Teaching Hospital was done to evaluate the incidence and pattern of transfusion reactions in the hospital. The overall incidence of transfusion reactions is 8.7% (40 cases), with febrile nonhaemolytic transfusion reactions (FNHTR) constituting 65% of these. The incidence of adverse reaction is significantly related to a positive history of previous transfusion (p = 0.0039). Efforts must be sustained at evolving a system to minimize the incidence and consequences. The development of a haemovigilance system in which data regarding all transfusions carried out in Nigerian hospitals is collated and analyzed is necessary. The advent of the National Blood Transfusion Service (N.B.T.S) in Nigeria with Zonal centres in the six geopolitical zones of the country offers an opportunity for setting up a national haemovigilance programme.

Intravenous sulprostone infusion in the treatment of retained placenta.

PubMed

Stefanovic, Vedran; Paavonen, Jorma; Loukovaara, Mikko; Halmesmäki, Erja; Ahonen, Jouni; Tikkanen, Minna

2013-04-01

To analyze the effectiveness of intravenous sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period. Retrospective observational study. University teaching hospital. 126 consecutive women with placental retention and intravenous sulprostone infusion as primary treatment performed from October 2007 up to December 2011. Hospital records of women who received sulprostone infusion to attempt placental expulsion were reviewed. Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery. The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity. Intravenous sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Occupational exposure of interns to blood in an area of high HIV seroprevalence.

PubMed

Karstaedt, A S; Pantanowitz, L

2001-01-01

To determine the epidemiology of work-related exposure to blood among interns. Interns were invited to complete anonymously a questionnaire concerning their past percutaneous and mucocutaneous exposures to blood. Chris Hani Baragwanath Hospital, Soweto, and Johannesburg Hospital, Gauteng, where HIV infection is common among patients. Ninety-eight interns (96%) were surveyed. Sixty-nine per cent of interns reported one or more percutaneous exposures to blood during the intern year, and 33% of interns recalled accidental percutaneous exposure to HIV-infected blood. Forty-five per cent recalled a mucocutaneous exposure to HIV-positive blood. Only 28 (64%) of 44 percutaneous injuries from HIV-infected patients were reported. During their student clinical training, 56% of interns had suffered a penetrating injury, and 18% recollected needlestick injuries involving HIV-infected patients. The most common mechanisms of injury included unexpected patient movement (23%), needle recapping (17%), and withdrawal of the needle (17%). Half of the injuries occurred during the first 4 months of internship. Only 22% of intern percutaneous exposures could have been avoided by following universal precautions. Intern and medical student exposure to blood is extremely common, but is markedly underreported. Strict compliance with universal precautions will not prevent the majority of exposures. Priorities should be the introduction of safer techniques and equipment, skills training and methods of reporting blood exposures.

Inpatient Management of Diabetes Mellitus among Noncritically Ill Patients at University Hospital of Puerto Rico.

PubMed

Allende-Vigo, Myriam Zaydee; González-Rosario, Rafael A; González, Loida; Sánchez, Viviana; Vega, Mónica A; Alvarado, Milliette; Ramón, Raul O

2014-05-01

To describe the state of glycemic control in noncritically ill diabetic patients admitted to the Puerto Rico University Hospital and adherence to current standard of care guidelines for the treatment of diabetes. This was a retrospective study of patients admitted to a general medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data for the first 5 days and the last 24 hours of hospitalization were analyzed. A total of 147 noncritically ill diabetic patients were evaluated. The rates of hyperglycemia (blood glucose ≥180 mg/dL) and hypoglycemia (blood glucose <70 mg/dL) were 56.7 and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hours of hospitalization (mean random blood glucose, 226.5 mg/dL), and 54.2% were hyperglycemic during the last 24 hours of hospitalization (mean random blood glucose, 196.51 mg/dL). The mean random last glucose value before discharge was 189.6 mg/dL. Most patients were treated with subcutaneous insulin, with basal insulin alone (60%) used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60% on day 5, with 40% continuing to receive only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%); however, a substantial proportion had no change (23.7%) or even a decrease (6.2%) in their insulin dose. The management of hospitalized diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients.

Review of data of the patients receiving total parenteral nutrition at the intensive care unit of a university hospital.

PubMed Central

Ovayolu, Nimet; Torun, Seda; Ucan, Ozlem; Ozdemir, Perihan; Buyukhatipoglu, Hakan; Pehlivan, Yavuz; Geyik, Ramazan

2006-01-01

Parenteral nutrition is commonly administered to patients in intensive care units who cannot be fed gastrointestinally. Several problems might be encountered during parenteral nutrition. We designed this study to evaluate two years' data of the patients who received parenteral nutrition at the intensive care unit of the university hospital. Forty-five patients who were treated at this hospital between January 1, 2004 and December 31, 2005 were included in this study. Patient data were collected via questionnaires designed based on the information in the literature. Blood, urinary, oropharyngeal and catheter entry site cultures were obtained and analyzed on the third and seventh days of the treatment. We found the following results: 31.1% of the patients received parenteral nutrition due to renal insufficiency; ready-made amino acid/lipid solutions were used in 86.7% of the patients; 77.8% of the solutions were administered through a peripheral vein; 88.6% of total parenteral nutrition solutions given thorough the peripheral vein had higher osmolarities than 800 mOsmol/L; routine Fe and Fe binding capacity, prothrombin time, cholesterol and triglyceride level assessments were not performed before the initiation of treatment; and the culture tests most commonly revealed Staphylococcus epidermidis in the blood, Candido species in urine, Streptococcus in throat, and Staphylococcus aureus at catheter entry sites. Based on these results, we suggest that organizing a nutrition support team would be useful in order to improve the quality of the nursery and to provide close and rational management and follow-up of the patients receiving total parenteral nutrition. PMID:17225841

Transfusion safety: is this the business of blood centers?

PubMed

Slapak, Colleen; Fredrich, Nanci; Wagner, Jeffrey

2011-12-01

ATSO is in a unique position to break down organizational silos between hospitals and blood centers through the development of a collaborative relationship between the two entities. Use of the TSO as blood center staff centralizes the role into a consultative position thereby retaining the independence of the hospitals. The TSO position then becomes a value-added service offered by the blood center designed to supplement processes within the hospital.Whether the TSO is based in the hospital or the blood center, improvements are gained through appropriate utilization of blood components, reductions in hospital costs, ongoing education of hospital staff involved in transfusion practice, and increased availability of blood products within the community. Implementation and standardization of best practice processes for ordering and administration of blood products developed by TSOs leads to improved patient outcomes. As a liaison between hospitals and blood centers, the TSO integrates the mutual goal of transfusion safety: the provision of the safest blood product to the right patient at the right time for the right reason.

UV Exposure, Vitamin D, and Prostate Cancer Risk in African Americans

DTIC Science & Technology

2006-08-01

positive DRE. They were recruited through Howard University Hospital. Nine age- and ethnicity-matched controls have been recruited through the free...screenings program at Howard University Cancer Center. For patients and controls, the authors have collected medical histories and blood samples for gene

Assessment of clinical significance of positive blood cultures of relatively low-virulence isolates.

PubMed

Hirakata, Y; Furuya, N; Iwata, M; Kashitani, F; Ishikawa, M; Yumoto, S; Yasui, K; Endoh, H; Marui, A; Kaku, M; Tateda, K; Yamaguchi, K

1996-03-01

In Omori Hospital, Toho University School of Medicine, relatively low-virulence blood isolates, including coagulase-negative staphylococci (CNS), enterococci and nonfermentative gram-negative rods other than Pseudomonas aeruginosa comprised c. 60% of total blood isolates. A retrospective study was conducted to assess their clinical significance by reviewing a total of 91 hospital charts. The physicians' assessments of these positive blood cultures as recorded in the charts were classified into four categories--sepsis, possible sepsis, contamination and no comment. The episodes classified as sepsis accounted for 5.0-19.6%. These episodes were also evaluated by a graded clinical significance score based on multiple factors, including number of positive cultures and clinical signs. The scores for the 91 episodes covered a wide range from 1 to 9, indicating that both contaminants and causative organisms may have been involved. The episodes judged as sepsis or possible sepsis tended to have higher scores. The scores for the episodes associated with enterococci were also higher than those involving CNS or non-fermentative gram-negative rods. The scores for episodes associated with intravenous hyperalimentation catheters were higher than those not associated with the catheters.

Design of a model to predict surge capacity bottlenecks for burn mass casualties at a large academic medical center.

PubMed

Abir, Mahshid; Davis, Matthew M; Sankar, Pratap; Wong, Andrew C; Wang, Stewart C

2013-02-01

To design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims. Using the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability-number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources-anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability. Given base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type AB packed red blood cells (76 h), silver dressing/Acticoat (100 h), bismuth tribromophenate/Xeroform (102 h), and gauze bandage rolls/Kerlix (168 h). The following items do not precipitate a bottleneck: ventilators, topical epinephrine, staplers, foams, antimicrobial non-adherent dressing/Telfa types A, B, or O blood. Nurse, respiratory therapist, and physician staffing does not induce bottlenecks. This model, and similar models for non-burn-related MCIs, can serve as a real-time estimation and management tool for hospital capacity in the setting of MCIs, and can inform supply decision support for disaster management.

Factors affecting red blood cell storage age at the time of transfusion.

PubMed

Dzik, Walter H; Beckman, Neil; Murphy, Michael F; Delaney, Meghan; Flanagan, Peter; Fung, Mark; Germain, Marc; Haspel, Richard L; Lozano, Miguel; Sacher, Ronald; Szczepiorkowski, Zbigniew; Wendel, Silvano

2013-12-01

Clinical trials are investigating the potential benefit resulting from a reduced maximum storage interval for red blood cells (RBCs). The key drivers that determine RBC age at the time of issue vary among individual hospitals. Although progressive reduction in the maximum storage period of RBCs would be expected to result in smaller hospital inventories and reduced blood availability, the magnitude of the effect is unknown. Data on current hospital blood inventories were collected from 11 hospitals and three blood centers in five nations. A general predictive model for the age of RBCs at the time of issue was developed based on considerations of demand for RBCs in the hospital. Age of RBCs at issue is sensitive to the following factors: ABO group, storage age at the time of receipt by the hospital, the restock interval, inventory reserve, mean demand, and variation in demand. A simple model, based on hospital demand, may serve as the basis for examining factors affecting the storage age of RBCs in hospital inventories. The model suggests that the age of RBCs at the time of their issue to the patient depends on factors external to the hospital transfusion service. Any substantial change in the expiration date of stored RBCs will need to address the broad variation in demand for RBCs while attempting to balance considerations of availability and blood wastage. © 2013 American Association of Blood Banks.

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

PubMed Central

Devrajani, Bikha Ram; Shah, Syed Zulfiquar Ali; Soomro, Aftab Ahmed; Devrajani, Tarachand

2010-01-01

Objective: To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups. Study Design: Case control. Place and Duration: Department of Medicine, Liaquat University Hospital from October 2007 to March 2008. Materials and Methods: This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of ≥ 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis. Results: Majority of the patients were male with mean age ± SD, 52.86 ± 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication. Conclusion: Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection. PMID:20431802

Adequacy and pattern of blood donations in north-eastern Nigeria: the implications for blood safety.

PubMed

Ahmed, S G; Ibrahim, U A; Hassan, A W

2007-12-01

In a retrospective analysis, the quantities, patterns and adequacy of blood donations made, between 1984 and 2006, at the University of Maiduguri Teaching Hospital in north-eastern Nigeria were explored and related to blood safety in the study area. The types of blood donor were reviewed and the annual increments in the number of donations made were estimated and compared with the annual increments in the numbers of in-patients managed at the study hospital. The mean annual increment in the number of blood donations (4%) fell well below the mean annual increment in in-patient numbers (11%). The blood donations received at the hospital fell into four types: voluntary, family-replacement, commercial and pre-deposit autologous donations. Over the study period, the percentage of donations falling into the voluntary and family-replacement categories fell from 31% to 5% and from 49% to 23%, respectively. These falls were matched by increases in the percentages of donations categorised as commercial and autologous, which rose from 20% to 63%, and from 1% to 9%, respectively. By the end of the study period, the quantity of blood being donated at the hospital was grossly inadequate and predominantly derived from family and commercial donors, who were found to be generally inferior, in terms of blood safety, to voluntary donors. There is an urgent need to rectify this situation by setting up a functional and national blood-transfusion service in Nigeria.

Recruitment Strategies and Costs Associated With Enrolling People With Insomnia and High Blood Pressure Into an Online Behavioral Sleep Intervention: A Single-Site Pilot Study.

PubMed

Routledge, Faye S; Davis, Tara D; Dunbar, Sandra B

Recruitment in clinical research is a common challenge and source of study failure. The reporting of recruitment methods and costs in hypertension trials is limited especially for smaller, single-site trials, online intervention trials, and trials using newer online recruitment strategies. The aims of this study are to describe and examine the feasibility of newer online-e-mail recruitment strategies and traditional recruitment strategies used to enroll participants with insomnia and high blood pressure into an online behavioral sleep intervention study (Sleeping for Heart Health). The 16 online-e-mail-based and traditional recruitment strategies used are described. Recruitment strategy feasibility was examined by study interest and enrollee yields, conversion rates, and costs (direct, remuneration, labor, and cost per enrollee). From August 2014 to October 2015, 183 people were screened and 58 (31.7%) enrolled in the study (51.1 ± 12.9 years, 63.8% female, 72.4% African American, 136 ± 12/88 ± 7 mm Hg, 87.9% self-reported hypertension, 67.2% self-reported antihypertensive medication use). The recruitment strategies yielding the highest enrollees were the university hospital phone waiting message system (25.4%), Craigslist (22.4%), and flyers (20.3%) at a per enrollee cost of $42.84, $98.90, and $128.27, respectively. The university hospital phone waiting message system (55.6%) and flyers (54.5%) had the highest interested participant to enrolled participant conversion rate of all recruitment strategies. Approximately 70% of all enrolled participants were recruited from the university hospital phone waiting message system, Craigslist, or flyers. Given the recruitment challenges that most researchers face, we encourage the documenting, assessing, and reporting of detailed recruitment strategies and associated recruitment costs so that other researchers may benefit.

Factors affecting the labor efficiency of hospital-based blood bank laboratories.

PubMed

Lam, H C; Kominski, G F; Petz, L D; Sofaer, S

1994-09-01

A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories. This study measured labor efficiency in 40 hospital-based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency. With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers. Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.

Development of a database and processing method for detecting hematotoxicity adverse drug events.

PubMed

Shimai, Yoshie; Takeda, Toshihiro; Manabe, Shirou; Teramoto, Kei; Mihara, Naoki; Matsumura, Yasushi

2015-01-01

Adverse events are detected by monitoring the patient's status, including blood test results. However, it is difficult to identify all adverse events based on recognition by individual doctors. We developed a system that can be used to detect hematotoxicity adverse events according to blood test results recorded in an electronic medical record system. The blood test results were graded based on Common Terminology Criteria for Adverse Events (CTCAE) and changes in the blood test results (Up, Down, Flat) were assessed according to the variation in the grade. The changes in the blood test and injection data were stored in a database. By comparing the date of injection and start and end dates of the change in the blood test results, adverse events related to a designated drug were detected. Using this method, we searched for the occurrence of serious adverse events (CTCAE Grades 3 or 4) concerning WBC, ALT and creatinine related to paclitaxel at Osaka University Hospital. The rate of occurrence of a decreased WBC count, increased ALT level and increased creatinine level was 36.0%, 0.6% and 0.4%, respectively. This method is useful for detecting and estimating the rate of occurrence of hematotoxicity adverse drug events.

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

PubMed

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

2006-01-01

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

Blood culture contamination in Tanzania, Malawi, and the United States: a microbiological tale of three cities.

PubMed

Archibald, Lennox K; Pallangyo, Kisali; Kazembe, Peter; Reller, L Barth

2006-12-01

We conducted retrospective, comparative analyses of contamination rates for cultures of blood obtained in the emergency rooms of Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania; Lilongwe Central Hospital (LCH) in central Malawi; and the Duke University Medical Center (DUMC) in the United States. None of the emergency room patients had indwelling intravascular devices at the time that the blood samples for cultures were obtained. In addition, we reviewed the contamination rates for a cohort of patients already hospitalized in the DUMC inpatient medical service, most of whom had indwelling intravascular devices. The bloodstream infection rates among the patients at MNH (n=513) and LCH (n=486) were similar (approximately 28%); the contamination rates at the two hospitals were 1.3% (7/513) and 0.8% (4/486), respectively. Of 54 microorganisms isolated from cultures of blood collected in the DUMC emergency room, 26 (48%) were identified as skin contaminants. Cultures of blood collected in the DUMC emergency room were significantly more likely to yield growth of contaminants than the cultures of blood collected in the emergency rooms at MNH and LCH combined (26/332 versus 11/1,003; P<0.0001) or collected in the DUMC inpatient medical service (26/332 versus 7/283; P<0.01). For the MNH and LCH blood cultures, lower contamination rates were observed when skin was disinfected with isopropyl alcohol plus tincture of iodine rather than isopropyl alcohol plus povidone-iodine. In conclusion, blood culture contamination was minimized in sub-Saharan African hospitals with substantially limited resources through scrupulous attention to aseptic skin cleansing and improved venipuncture techniques. Application of these principles when blood samples for culture are obtained in U.S. hospital emergency rooms should help mitigate blood culture contamination rates and the unnecessary microbiology workup of skin contaminants.

NHS Blood Tracking Pilot: City University Evaluation Project

NASA Astrophysics Data System (ADS)

Goddard, Kate; Shabestari, Omid; Adriano, Juan; Kay, Jonathan; Roudsari, Abdul

Automation of healthcare processes is an emergent theme in the drive to increase patient safety. The Mayday Hospital has been chosen as the pilot site for the implementation of the Electronic Clinical Transfusion Management System to track blood from the point of ordering to the final transfusion. The Centre for Health Informatics at City University is carrying out an independent evaluation of the system implementation using a variety of methodologies to both formatively inform the implementation process and summatively provide an account of the lessons learned for future implementations.

Transfusion Patterns in All Patients Admitted to the Intensive Care Unit and in Those Who Die in Hospital: A Descriptive Analysis.

PubMed

Shehata, Nadine; Forster, Alan J; Lawrence, Nadine; Ducharme, Robin; Fergusson, Dean A; Chassé, Michaël; Rothwell, Deanna M; Hébert, Paul C; Tinmouth, Alan T; Wilson, Kumanan

2015-01-01

While it is known that the use of health care resources increases at the end of life in patients admitted to the Intensive Care Unit (ICU), the allocation of blood products at the end of life has not been described. The objective of this study was to describe overall transfusion patterns in the ICU, and specifically in patients who die in hospital. We conducted a retrospective cohort study of adult patients admitted to the ICU of a university-affiliated hospital, who were discharged or died between November 1, 2006 and June 30, 2012. During the study period, 10,642 patients were admitted at least once to the ICU. Of these patients, 4079 (38.3%) received red blood cells (RBCs), plasma or platelets in the ICU. The ICU mortality rate was 28.1% and in-hospital mortality rate was 32.3%. Among 39,591 blood product units transfused over the course of the study in the ICU (18,144 RBC units, 16,920 plasma units and 4527 platelet units), 46.2% were administered to patients who later died within the same hospitalization (41.2% of RBCs, 50.4% of plasma and 50.8% of platelets). Of all blood product units (RBCs, plasma and platelets) administered in the ICU over the study period, 11% were given within the last 24 hours before death. A large proportion of blood products used in the ICU are administered to patients who ultimately succumb to their illness in hospital, and many of these blood units are given in close proximity to death.

Prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures in Mali.

PubMed

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

2016-10-31

The increasing frequency of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is becoming a serious public health concern. This study sought to determine ESBL frequency in Enterobacteriaceae isolated from patients' blood cultures in two university teaching hospitals of Bamako, Mali. During a three-month period, the presence of Enterobacteriaceae from blood cultures of patients admitted to the university teaching hospitals of Bamako was evaluated. The microbial identifications were initially performed with an API 20E gallery and VITEK2 locally in Mali, and then confirmation in France was performed with a mass spectrometry MALDI-TOF in the bacteriology laboratory of the university teaching hospital of Bichat. Antibiotic susceptibility profiles were determined by the diffusion method as recommended by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The isolated species were K. pneumoniae (14/40; 35.0%), E. coli (11/40; 27.5%), and E. cloacae (9/40; 22.5%). Of the strains isolated, 21/34 (61.8%) had an ESBL phenotype, including 10/14 (71.4%) K. pneumoniae, 8/11 (72.7%) E. coli, and 3/9 (33.3%) E. cloacae. Resistances associated with ESBL strains of K. pneumoniae, E. coli, and E. cloacae were as follows: gentamicin (10/10, 100%; 6/8, 75%; 2/3, 67%, respectively), amikacin (2/10, 20%; 0/8, 0%; 0/3, 0%, respectively), ofloxacin (8/10, 80%; 7/8, 87%; 3/3, 100%, respectively), and cotrimoxazole (10/10, 100%; 6/8, 75%; 3/3, 100%, respectively). Almost two-thirds (61.8%) of Enterobacteriaceae isolated from our blood cultures were ESBL producers. Only susceptibilities to carbapenems and to amikacin were fully conserved within the strains.

Is there a relationship between genetic factors and the incidence and severity of H1N1 in Kosova?: A preliminary investigation and pointers for further research.

PubMed

Dreshaj, Shemsedin; Alija, Avdulla J; Schlagenhauf, Patricia; Doda, Teuta; Geca, Njomeza; Bajraktari, Ismet; Bresgen, Nikolaus; Eckl, Peter M

Host genetic factors may impact susceptibility to infection. A small number of studies have investigated the association between factors such as ABO blood groups and selected phenotypes on the incidence and severity of H1N1 infections with inconclusive results. Using data from the Clinic of Infectious Diseases - University Clinical Centre Prishtina and based on the examination of 125 patients hospitalized with H1N1 in the period 2009-2014, the frequency of blood groups from ABO and Rhesus (Rh) systems as phenotypical markers were evaluated. In addition, other phenotypes such as ear lobe free/ear lobe attached, normal chin/cleft chin, tongue roller/non roller, hand clasping right thumb over/hand clasping left thumb over, right-handed/left-handed, dark eyes/light eyes were also analyzed. The data obtained from the 125 hospitalized patients were compared with the data from the Kosovar population (n = 2000) as a reference group. A total of 303 patients with H1N1 were hospitalized in the period 2009-2015. Blood group and phenotype data available from 125 hospitalized H1N1 patients showed significant differences in the frequencies of the blood groups from Rh system as well as in two (out of six) phenotypes of the selected morphological traits compared to reference groups. The findings from this preliminary study indicate that these Rh system and phenotype differences may be linked to H1N1 susceptibility and may guide identification of risk groups and populations. Copyright © 2017 Elsevier Ltd. All rights reserved.

RFID in the blood supply chain--increasing productivity, quality and patient safety.

PubMed

Briggs, Lynne; Davis, Rodeina; Gutierrez, Alfonso; Kopetsky, Matthew; Young, Kassandra; Veeramani, Raj

2009-01-01

As part of an overall design of a new, standardized RFID-enabled blood transfusion medicine supply chain, an assessment was conducted for two hospitals: the University of Iowa Hospital and Clinics (UIHC) and Mississippi Baptist Health System (MBHS). The main objectives of the study were to assess RFID technological and economic feasibility, along with possible impacts to productivity, quality and patient safety. A step-by-step process analysis focused on the factors contributing to process "pain points" (errors, inefficiency, product losses). A process re-engineering exercise produced blueprints of RFID-enabled processes to alleviate or eliminate those pain-points. In addition, an innovative model quantifying the potential reduction in adverse patient effects as a result of RFID implementation was created, allowing improvement initiatives to focus on process areas with the greatest potential impact to patient safety. The study concluded that it is feasible to implement RFID-enabled processes, with tangible improvements to productivity and safety expected. Based on a comprehensive cost/benefit model, it is estimated for a large hospital (UIHC) to recover investment from implementation within two to three years, while smaller hospitals may need longer to realize ROI. More importantly, the study estimated that RFID technology could reduce morbidity and mortality effects substantially among patients receiving transfusions.

Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure.

PubMed

Berry, C; Brett, M; Stevenson, K; McMurray, J J V; Norrie, J

2008-03-01

To investigate the nature and importance of blood glucose abnormalities in an unselected heart failure (HF) population. Cohort study. Urban University hospital. All index emergency HF admissions to one University hospital during the year 2000 were studied. 454 consecutive index admissions had blood chemistry, diabetic status and follow-up information recorded. 390 (86%) patients had an echocardiogram, of whom 117 (30%) had preserved left ventricular systolic function and 110 (24%) had diabetes. Sixty (13%) patients had abnormal glucose tolerance (8.0-10.99 mmol/l), and 284 (63%) patients had a normal admission blood glucose (<8 mmol/l). 51 (11.2%) patients died in hospital. After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality. During follow-up (median 812 (range 632-978) days), 104 (36.6%), 30 (50.0%) and 55 (50%) patients with a normal admission blood glucose concentration, abnormal glucose tolerance and diabetes, respectively, died (log rank test p = 0.0037, adjusted p = 0.075). Compared with patients with normal admission blood glucose, abnormal glucose tolerance (adjusted HR: 1.41 (0.92 to 2.16); p = 0.12) and diabetes (adjusted HR: 2.02 (1.41 to 2.88); p = 0.0001) predicted mortality. Considering glucose on admission as a continuous covariate, a 2 mmol/l increase was associated with a HR of 1.08 (1.03 to 1.13), p = 0.0010, which after adjustment for the above covariates became 1.08 (1.03 to 1.13), p = 0.0023. Admission blood glucose concentration and diabetes are prognostically important in HF and could help target some patients for more intensive therapy.

Patient safety with blood products administration using wireless and bar-code technology.

PubMed

Porcella, Aleta; Walker, Kristy

2005-01-01

Supported by a grant from the Agency for Healthcare Research and Quality, a University of Iowa Hospitals and Clinics interdisciplinary research team created an online data-capture-response tool utilizing wireless mobile devices and bar code technology to track and improve blood products administration process. The tool captures 1) sample collection, 2) sample arrival in the blood bank, 3) blood product dispense from blood bank, and 4) administration. At each step, the scanned patient wristband ID bar code is automatically compared to scanned identification barcode on requisition, sample, and/or product, and the system presents either a confirmation or an error message to the user. Following an eight-month, 5 unit, staged pilot, a 'big bang,' hospital-wide implementation occurred on February 7, 2005. Preliminary results from pilot data indicate that the new barcode process captures errors 3 to 10 times better than the old manual process.

Establishment of new complete blood count reference values for healthy Thai adults.

PubMed

Wongkrajang, P; Chinswangwatanakul, W; Mokkhamakkun, C; Chuangsuwanich, N; Wesarachkitti, B; Thaowto, B; Laiwejpithaya, S; Komkhum, O

2018-04-28

Laboratory reference ranges are essential for diagnostic orientation and treatment decision. As complete blood count parameters are influenced by various factors, including gender, geographic origin, and ethnic origin, it is important to establish specific hematologic reference values for specific populations. This study was conducted at the Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Blood samples were taken from healthy adults aged 18-60 years that attended a health check-up program at our hospital during February 2015 to July 2015. Hematologic and routine chemistry analysis were performed. Participants were determined to be healthy based on medical history and routine medical examinations. Serum vitamin B12, folate, ferritin, and hemoglobin typing were also analyzed to exclude the possible presence of anemia. A statistically significant difference was observed between males and females for Hb level, hematocrit level, red blood cell count, mean corpuscular hemoglobin concentration, percentage neutrophils, monocytes and eosinophils, and absolute neutrophil, lymphocyte, basophil, and platelet counts. Accordingly, gender-specific reference intervals were established for all complete blood count parameters in healthy Thai adult population. The reference value ranges established in this study reflect significant differences between genders. It is possible that these reference ranges may be generalizable to adults living in Thailand. The findings of this study emphasize the importance of establishing specific hematologic reference values for specific populations. © 2018 John Wiley & Sons Ltd.

Early Detection of Increased Intracranial Pressure Episodes in Traumatic Brain Injury: External Validation in an Adult and in a Pediatric Cohort.

PubMed

Güiza, Fabian; Depreitere, Bart; Piper, Ian; Citerio, Giuseppe; Jorens, Philippe G; Maas, Andrew; Schuhmann, Martin U; Lo, Tsz-Yan Milly; Donald, Rob; Jones, Patricia; Maier, Gottlieb; Van den Berghe, Greet; Meyfroidt, Geert

2017-03-01

A model for early detection of episodes of increased intracranial pressure in traumatic brain injury patients has been previously developed and validated based on retrospective adult patient data from the multicenter Brain-IT database. The purpose of the present study is to validate this early detection model in different cohorts of recently treated adult and pediatric traumatic brain injury patients. Prognostic modeling. Noninterventional, observational, retrospective study. The adult validation cohort comprised recent traumatic brain injury patients from San Gerardo Hospital in Monza (n = 50), Leuven University Hospital (n = 26), Antwerp University Hospital (n = 19), Tübingen University Hospital (n = 18), and Southern General Hospital in Glasgow (n = 8). The pediatric validation cohort comprised patients from neurosurgical and intensive care centers in Edinburgh and Newcastle (n = 79). None. The model's performance was evaluated with respect to discrimination, calibration, overall performance, and clinical usefulness. In the recent adult validation cohort, the model retained excellent performance as in the original study. In the pediatric validation cohort, the model retained good discrimination and a positive net benefit, albeit with a performance drop in the remaining criteria. The obtained external validation results confirm the robustness of the model to predict future increased intracranial pressure events 30 minutes in advance, in adult and pediatric traumatic brain injury patients. These results are a large step toward an early warning system for increased intracranial pressure that can be generally applied. Furthermore, the sparseness of this model that uses only two routinely monitored signals as inputs (intracranial pressure and mean arterial blood pressure) is an additional asset.

Seroprevalence and trends in transfusion transmitted infections among blood donors in a university hospital blood bank: a 5 year study.

PubMed

Pallavi, P; Ganesh, C K; Jayashree, K; Manjunath, G V

2011-03-01

Blood is life. Transfusion of blood and blood components, as a specialized modality of patient management saves millions of lives worldwide each year and reduce morbidity. It is well known that blood transfusion is associated with a large number of complications, some are only trivial and others are potentially life threatening, demanding for meticulous pretransfusion testing and screening particularly for transfusion transmissible infections (TTI). These TTI are a threat to blood safety. The priority objective of BTS is thus to ensure safety, adequacy, accessibility and efficiency of blood supply at all levels. The objective of the present study was to assess the prevalence and trend of transfusion transmitted infections (TTI) among voluntary and replacement donors in the Department of Blood bank and transfusion Medicine of JSS College Hospital, a teaching hospital of Mysore during the period from 2004 to 2008. A retrospective review of donors record covering the period between 2004 and 2008 at the blood bank, JSS Hospital, Mysore was carried out. All samples were screened for HIV, HBsAg, HCV, syphilis and malaria. Of the 39,060, 25,303 (64.78%) were voluntary donors and the remaining 13,757 (35.22%) were replacement donors. The overall prevalence of HIV, HbsAg, HCV and syphilis were 0.44, 1.27, 0.23 and 0.28%, respectively. No blood donor tested showed positivity for malarial parasite. Majority were voluntary donors with male preponderance. In all the markers tested there was increased prevalence of TTI among the replacement donors as compared to voluntary donors. With the implementation of strict donor criteria and use of sensitive screening tests, it may be possible to reduce the incidence of TTI in the Indian scenario.

Blood donor screening for West Nile virus (WNV) revealed acute Usutu virus (USUV) infection, Germany, September 2016.

PubMed

Cadar, Daniel; Maier, Philipp; Müller, Susanne; Kress, Julia; Chudy, Michael; Bialonski, Alexandra; Schlaphof, Alexander; Jansen, Stephanie; Jöst, Hanna; Tannich, Egbert; Runkel, Stefan; Hitzler, Walter E; Hutschenreuter, Gabriele; Wessiepe, Martina; Schmidt-Chanasit, Jonas

2017-04-06

Between 1 June and 31 December 2016, 13,023 blood donations from the University Hospital Aachen in Germany were routinely screened for West Nile virus (WNV) RNA using the cobas TaqScreen WNV Test. On 28 September 2016, one blood donor was tested positive. Subsequent analysis revealed an acute Usutu virus (USUV) infection. During the ongoing USUV epizootics in Germany, blood transfusion services, public health authorities and clinicians should be aware of increased human USUV infections. This article is copyright of The Authors, 2017.

Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach.

PubMed

Xie, Anping; Woods-Hill, Charlotte Z; King, Anne F; Enos-Graves, Heather; Ascenzi, Judy; Gurses, Ayse P; Klaus, Sybil A; Fackler, James C; Milstone, Aaron M

2017-11-20

Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. Blood culture-ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture-ordering practices, (2) ensuring that prescribing clinicians review the patient's condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture-ordering guidelines. The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Transfusion of red blood cells: no impact on length of hospital stay in moderately anaemic parturients.

PubMed

Palo, R; Ahonen, J; Salo, H; Salmenperä, M; Krusius, T; Mäki, T

2007-05-01

In a search for information to improve decision making on red blood cell (RBC) transfusion, we examined the impact of RBC transfusion on the length of hospital stay for delivery in moderately anaemic women (haemoglobin, 7-10 g/dl). This was a retrospective, observational study covering 2 years (2002 and 2003), and included major blood-transfusing hospitals from four university and five central hospital districts managing 67.5% of Finnish in-hospital deliveries. The impact of the transfusion of 1-2 RBC units vs. no transfusion on the length of hospital stay was evaluated for three different haemoglobin levels: 7-7.9, 8-8.9 and 9-10 g/dl. Of the 1954 moderately anaemic mothers in hospital for delivery, 13.3% were transfused with RBC. The mean length of hospital stay was 5.2 days vs. the average Finnish hospital delivery stay of 3.5 days. No differences in stay were found between patients with comparable anaemia transfused with 1-2 RBC units or none (at the three haemoglobin levels: P= 0.50, P= 0.07 and P= 0.54, respectively). The final haemoglobin value was higher (P < 0.001) in transfused patients. The duration of admission for delivery in moderately anaemic parturients was longer than the average length of hospital stay in Finnish parturients. However, 1-2 RBC units had no impact on the length of stay, suggesting that unnecessary RBCs are transfused after delivery. Thus, transfusion practices in obstetrics are not always optimal.

The development of a national surveillance system for monitoring blood use and inventory levels at sentinel hospitals in South Korea.

PubMed

Lim, Y A; Kim, H H; Joung, U S; Kim, C Y; Shin, Y H; Lee, S W; Kim, H J

2010-04-01

We developed a web-based program for a national surveillance system to determine baseline data regarding the supply and demand of blood products at sentinel hospitals in South Korea. Sentinel hospitals were invited to participate in a 1-month pilot-test. The data for receipts and exports of blood from each hospital information system were converted into comma-separated value files according to a specific conversion rule. The daily data from the sites could be transferred to the web-based program server using a semi-automated submission procedure: pressing a key allowed the program to automatically compute the blood inventory level as well as other indices including the minimal inventory ratio (MIR), ideal inventory ratio (IIR), supply index (SI) and utilisation index (UI). The national surveillance system was referred to as the Korean Blood Inventory Monitoring System (KBIMS) and the web-based program for KBIMS was referred to as the Blood Inventory Monitoring System (BMS). A total of 30 256 red blood cell (RBC) units were submitted as receipt data, however, only 83% of the receipt data were submitted to the BMS server as export data (25 093 RBC units). Median values were 2.67 for MIR, 1.08 for IIR, 1.00 for SI, 0.88 for UI and 5.33 for the ideal inventory day. The BMS program was easy to use and is expected to provide a useful tool for monitoring hospital inventory levels. This information will provide baseline data regarding the supply and demand of blood products in South Korea.

Incidence of isolation of Mycobacterium tuberculosis from blood samples in tuberculosis patients in Imam Khomeini Hospital, Tehran, Iran.

PubMed

Foroughi, Maryam; Montazeri, Saman Mohaghegh; SeyedAlinaghi, SeyedAhmad; Badie, Banafshe Moradmand; Heiydarpour, Pourya; Roosta, Neda; Rasoolinejad, Mehrnaz; Cochak, Hamid Emadi

2011-01-01

It is estimated that one third of the world's population is latently infected with tuberculosis (TB). The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS (Systemic Inflammatory Response Syndrome) status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB.

Activity-based costs of blood transfusions in surgical patients at four hospitals.

PubMed

Shander, Aryeh; Hofmann, Axel; Ozawa, Sherri; Theusinger, Oliver M; Gombotz, Hans; Spahn, Donat R

2010-04-01

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse. To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.

A diagnostic protocol designed for determining allergic causes in patients with blood eosinophilia.

PubMed

Magnaval, Jean-François; Laurent, Guy; Gaudré, Noémie; Fillaux, Judith; Berry, Antoine

2017-01-01

Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematologists, often must investigate patients who present with blood eosinophilia that often, but not always, occurs because of allergic causes. Both the Departments of Hematology and Parasitology at Toulouse University Hospitals established a collaboration to rule out allergic causes of eosinophilia, particularly helminthiases, prior to initiating more sophisticated investigations. Since 2004, the authors employed the same protocol to investigate eosinophilic outpatients who attended the clinic of Parasitology at Toulouse University Hospitals, and they reported the performance of this diagnostic procedure that was designed to be rapid (no hospitalization required) and only moderately expensive. A total of 406 patients who presented with blood eosinophilia greater than 0.5 (×10 9 , giga cells per litter, G/L) had an allergic etiology in 350 (86.2%) cases. Among the remaining 56 subjects, 17 did not undergo a follow-up and 39 were referred to another specialized department, mostly Hematology. However, only 21 patients attended then were subsequently investigated. Non-allergic causes of eosinophilia, including 3 cases of the lymphoid variant of hypereosinophilic syndrome and 2 cases of myeloproliferative disorder, were identified in 14 patients, whereas 7 remained diagnosed as having idiopathic eosinophilia. This study underlines the need to investigate patients presenting with even moderate blood eosinophilia. The work-up that was employed appears to be efficient and versatile and may be used by any medical specialist, such as in hematology, infectious disease, or internal medicine departments, who needs to investigate eosinophilic patients and should initially rule out any etiology of allergic eosinophilia.

Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department.

PubMed

Bakke, Eirin; Bogstrand, Stig Tore; Normann, Per Trygve; Ekeberg, Øivind; Bachs, Liliana

2016-06-08

The presence of alcohol or other substances of abuse in blood or urine from injured patients is often used as a proxy for substance influence at the time of injury. The aim of this study was to obtain an estimate of substance influence at the time of injury based on blood concentrations of alcohol and other substances of abuse, and to explore the relationship between the substance prevalence at the time of admittance to the hospital and the actual influence at the time of the injury. The study included all adult patients admitted to the emergency department of a university hospital during 1 year (n = 996). Quantification in blood was done by an enzymatic method for alcohol, and by liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry for 28 other substances of abuse. Concentrations of alcohol and other substances in blood at the time of injury were calculated. The degree of influence was assessed on the basis of the calculated blood concentrations, with a threshold of influence set at a blood alcohol concentration (BAC) of 0.05 %, or a substance concentration leading to an influence similar to that of a BAC of 0.05 %. A total of 324 patients (32.5 %) were determined to be under the influence at the time of injury. In comparison, 394 patients (39.6 %) had one or more substances above the cut-off limit in blood at the time of admittance to the hospital. Alcohol was the most prevalent substance causing influence at 25.9 %. Among patients with violence-related injuries, almost 75 % were under the influence of alcohol and/or substances. Patients under the influence were younger, and men were more often under the influence than women. More patients were under the influence at nighttime and during weekends than at daytime and on weekdays. About one third of the injured patients were determined to be under the influence at the time of injury, with alcohol being the most prevalent substance causing influence. Approximately 98 % of the patients with alcohol detected in blood at the time of admittance to the hospital were under the influence of alcohol at the time of injury.

Diabetes Management and Self-Care Education for Hospitalized Patients With Cancer

PubMed Central

Leak, Ashley; Davis, Ellen D.; Houchin, Laura B.; Mabrey, Melanie

2009-01-01

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older “compliance” model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical. PMID:19349267

Handheld Universal Diagnostic Sensor

NASA Technical Reports Server (NTRS)

Chan, Eugene

2012-01-01

The rHEALTH technology is designed to shrink an entire hospital testing laboratory onto a handheld device. A physician or healthcare provider performs the test by collecting a fingerstick of blood from a patient. The tiny volume of blood is inserted into the rHEALTH device. Inside the device is a microfluidic chip that contains small channels about the width of a human hair. These channels help move the blood and analyze the blood sample. The rHEALTH sensor uses proprietary reagents called nanostrips, which are nanoscale test strips that enable the clinical assays. The readout is performed by laser-induced fluorescence. Overall, the time from blood collection through analysis is less than a minute.

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.

Lead poisoning in dogs at the University of Pennsylvania Veterinary Hospital

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

Kowalczyk, D.F.

1976-03-01

Twenty-seven dogs with lead poisoning were admitted to the University of Pennsylvania Veterinary Hospital from July, 1963, to April, 1975. The major source of the lead was paint. A common history was ingestion of plaster or paint scrapings during room renovation. Most of the dogs were less than 1 year old and had clinical signs referable to the gastrointestinal or the nervous system, or both. The gastrointestinal signs, in order of frequency, were vomiting, anorexia, tender abdomen, diarrhea, and constipation. The neurologic signs, in order of frequency, were hysteria, convulsions, ataxia, blindness, and mydriasis. The finding of many nucleated erythrocytesmore » without severe anemia was nearly pathognomonic for lead poisoning. Of 14 affected dogs subjected to abdominal radiography, 9 had evidence of ingested radiopaque material. A mean blood lead concentration of 18.8 ..mu..g/100 ml, with a range of 0 to 50 ..mu..g/100 ml, was found for 26 dogs that were hospitalized for problems unrelated to lead poisoning. Of the 27 dogs with lead poisoning, 22 had their blood analyzed for lead. This group had blood lead values ranging from 40 to 530 ..mu..g/100 ml. Seven of the affected dogs were monitored throughout their period of treatment with calcium ethylene-diaminetetraacetate. The concentration of lead in the blood decreased quickly after the initiation and treatment but leveled off after 2 or 3 days. The initial rapid phase probably corresponded to the removal of weakly bound or extracellular lead, whereas the slow phase probably corresponded to strongly bound or intracellular lead. 22 references.« less

Educational intervention together with an on-line quality control program achieve recommended analytical goals for bedside blood glucose monitoring in a 1200-bed university hospital.

PubMed

Sánchez-Margalet, Víctor; Rodriguez-Oliva, Manuel; Sánchez-Pozo, Cristina; Fernández-Gallardo, María Francisca; Goberna, Raimundo

2005-01-01

Portable meters for blood glucose concentrations are used at the patients bedside, as well as by patients for self-monitoring of blood glucose. Even though most devices have important technological advances that decrease operator error, the analytical goals proposed for the performance of glucose meters have been recently changed by the American Diabetes Association (ADA) to reach <5% analytical error and <7.9% total error. We studied 80 meters throughout the Virgen Macarena Hospital and we found most devices with performance error higher than 10%. The aim of the present study was to establish a new system to control portable glucose meters together with an educational program for nurses in a 1200-bed University Hospital to achieve recommended analytical goals, so that we could improve the quality of diabetes care. We used portable glucose meters connected on-line to the laboratory after an educational program for nurses with responsibilities in point-of-care testing. We evaluated the system by assessing total error of the glucometers using high- and low-level glucose control solutions. In a period of 6 months, we collected data from 5642 control samples obtained by 14 devices (Precision PCx) directly from the control program (QC manager). The average total error for the low-level glucose control (2.77 mmol/l) was 6.3% (range 5.5-7.6%), and even lower for the high-level glucose control (16.66 mmol/l), at 4.8% (range 4.1-6.5%). In conclusion, the performance of glucose meters used in our University Hospital with more than 1000 beds not only improved after the intervention, but the meters achieved the analytical goals of the suggested ADA/National Academy of Clinical Biochemistry criteria for total error (<7.9% in the range 2.77-16.66 mmol/l glucose) and optimal total error for high glucose concentrations of <5%, which will improve the quality of care of our patients.

Feasibility of hospital-based blood banking: a Tanzanian case study.

PubMed

Jacobs, B; Mercer, A

1999-12-01

The demand for blood transfusion is high in sub-Saharan Africa because of the high prevalence of anaemia and pregnancy related complications, but the practice is estimated to account for 10% of HIV infections in some regions. The main response to this problem by the international donor community is to establish vertically implemented blood transfusion services producing suitable (safe) blood at a cost of US$25-40 per unit. However, the economic sustainability of such interventions is questionable and it is argued here that hospital-based blood transfusion services operating at a basic adequate level are sufficient for low-income African countries. The results of a project aimed at improving such services in Tanzania are presented. The main findings are: (1) the cost per suitable blood unit produced was US$12.4; (2) at an HIV test sensitivity of 93.5% during the study period, discounted financial benefits of the interventions exceeded costs by a factor of between 17.2 and 37.1; (3) the cost per undiscounted year of life saved by use of these interventions was US$2.7-2.8; and (4) safe blood transfusion practices can be assured at an annual cost of US$0.07 per capita. Recommendations are made to ensure safe blood transfusion practices at hospital-based blood banks in Tanzania.

[Cost analysis of patient blood management].

PubMed

Kleinerüschkamp, A G; Zacharowski, K; Ettwein, C; Müller, M M; Geisen, C; Weber, C F; Meybohm, P

2016-06-01

Patient blood management (PBM) is a multidisciplinary approach focusing on the diagnosis and treatment of preoperative anaemia, the minimisation of blood loss, and the optimisation of the patient-specific anaemia reserve to improve clinical outcomes. Economic aspects of PBM have not yet been sufficiently analysed. The aim of this study is to analyse the costs associated with the clinical principles of PBM and the project costs associated with the implementation of a PBM program from an institutional perspective. Patient-related costs of materials and services were analysed at the University Hospital Frankfurt for 2013. Personnel costs of all major processes were quantified based on the time required to perform each step. Furthermore, general project costs of the implementation phase were determined. Direct costs of transfusing a single unit of red blood cells can be calculated to a minimum of €147.43. PBM-associated costs varied depending on individual patient requirements. The following costs per patient were calculated: diagnosis of preoperative anaemia €48.69-123.88; treatment of preoperative anaemia (including iron-deficiency anaemia and megaloblastic anaemia) €12.61-127.99; minimising perioperative blood loss (including point-of-care diagnostics, coagulation management and cell salvage) €3.39-1,901.81; and costs associated with the optimisation of the tolerance to anaemia (including patient monitoring and volume therapy) €28.62. General project costs associated with the implementation of PBM were €24,998.24. PBM combines various alternatives to the transfusion of red blood cells and improves clinical outcome. Costs of PBM vary from institution to institution and depend on the extent to which different aspects of PBM have been implemented. The quantification of costs associated with PBM is essential in order to assess the economic impact of PBM, and thereby, to efficiently re-allocate health care resources. Costs were determined at a single university hospital. Thus, further analyses of both the costs of transfusion and the costs of PBM-principles will be necessary to evaluate the cost-effectiveness of PBM.

Reexamining free flap breast reconstruction in the community and university setting: is there a difference?

PubMed

Nelson, Jonas A; Stransky, Carrie A; Fischer, John P; Fosnot, Joshua; Serletti, Joseph M; Wu, Liza C

2014-12-01

This study aimed to compare free flap breast reconstruction outcomes in community and university settings to determine whether the latter is necessary for successful performance of this complex procedure. Free tissue transfer procedures for breast reconstruction from 1 university and 1 community hospital performed between 2005 and 2011 were included. Procedures were performed by the same 2 surgeons at both institutions. Demographics and outcome measures were evaluated. Of the 1293 free tissue breast reconstructions performed, 99 (7.7%) were performed in a community hospital and 1194 (92.3%) were performed in a university center. No differences were noted in demographics, comorbidities, or type of free flap reconstruction. However, a number of perioperative characteristics differed. In the community setting, operative time was less (7.3 vs 8.3 hours, P < 0.0001), estimated blood loss was higher (330 vs 248 mL, P < 0.0001), and blood transfusions were more prevalent (24.6% vs 8.3%, P < 0.0001). Furthermore, no significant differences were noted in overall postoperative complications, although a higher rate of abdominal wound infections was noted in the community setting (7.2% vs 2.6%, P = 0.03). The mean number of hospital days was similar between the community and the university (should include value P = 0.44). Although slight differences were noted in a number of perioperative variables and wound complications, we conclude that the key to a successful free tissue transfer reconstruction is in the expertise of the surgeon and not the setting in which it is performed. Despite its complexity, free flap breast reconstruction can be safely and successfully performed in the community setting.

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.

Characteristics and Outcomes of Blood Product Transfusion During Critical Care Transport.

PubMed

Mena-Munoz, Jorge; Srivastava, Udayan; Martin-Gill, Christian; Suffoletto, Brian; Callaway, Clifton W; Guyette, Francis X

2016-01-01

Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport. We studied patients transported by a regional critical care air-medical service who received blood products during transport. This service carries two units of uncrossmatched packed Red Blood Cells (pRBCs) on every transport in addition to blood obtained from referring facilities. The pRBC are administered according to a protocol for the treatment of hemorrhagic shock or based on medical command physician order. Transfusion amount was categorized into three groups based on the volume transfused (<350 mL, 350-700 mL, >700 mL). The association between prehospital transfusion and in-hospital outcomes (mortality, subsequent blood transfusion and emergent surgery) was estimated using logistic regression models, controlling for age, first systolic blood pressure, first heart rate, Glasgow Coma Score, time of transfer, and length of hospital admission. Among the 1,440 critical care transports with transfusions examined, 81% were for medical patients, being gastrointestinal hemorrhage the most common indication (26%, CI 24-28%). pRBC transfusions were associated with emergent surgery (OR = 1.81, 95% CI = 1.31-2.52) and in-hospital transfusions (OR = 2.00, 95% CI = 1.46-2.76). Those with transfusions >700 mL were associated with emergent surgery (OR = 1.79, 95% CI = 1.10-2.92) and mortality (OR = 2.11; 95% CI = 1.21-3.69). In this sample, the majority of patients receiving blood products during air-medical transport were transfused for medic conditions; gastrointestinal hemorrhage was the most common chief complaint. The pRBC transfusions were associated with emergent surgery and in-hospital transfusion. Transfusions of >700 mL were associated with mortality.

Correlation of Blood Gas Parameters with Central Venous Pressure in Patients with Septic Shock; a Pilot Study

PubMed Central

Baratloo, Alireza; Rahmati, Farhad; Rouhipour, Alaleh; Motamedi, Maryam; Gheytanchi, Elmira; Amini, Fariba; Safari, Saeed

2014-01-01

Objective: To determine the correlation between blood gas parameters and central venous pressure (CVP) in patients suffering from septic shock. Methods: Forty adult patients with diagnosis of septic shock who were admitted to the emergency department (ED) of Shohadaye Tajrish Hospital affiliated with Shahid Beheshti University of Medical Sciences, and met inclusion and exclusion criteria were enrolled. For all patients, sampling was done for venous blood gas analysis, serum sodium and chlorine levels. At the time of sampling; blood pressure, pulse rate and CVP were recorded. Correlation between blood gas parameters and hemodynamic indices were. Results: A significant direct correlation between CVP with anion gap (AG) and inversely with base deficit (BD) and bicarbonate. CVP also showed a relative correlation with pH, whereas it was not correlated with BD/ AG ratio and serum chlorine level. There was no significant association between CVP and clinical parameters including shock index (SI) and mean arterial pressure (MAP). Conclusion: It seems that some of non invasive blood gas parameters could be served as alternative to invasive measures such as CVP in treatment planning of patients referred to an ED with septic shock. PMID:27162870

Emotional reactivity and blood pressure elevations: anxiety as a mediator.

PubMed

Ifeagwazi, Chuka Mike; Egberi, Helen Eleh; Chukwuorji, JohnBosco Chika

2018-06-01

There is a strong link between emotional reactivity and hypertension, yet little research to date has examined mediators of this relationship. Ourstudy  investigated the mediating roleof anxiety on the relationship between emotional reactivity and blood pressure elevations. Participants were226 hypertensive patients (93 men and 133 women, Mean age = 53.09, SD = 13.88 years), purposivelydrawn from the General Outpatient Department in University of Calabar Teaching Hospital, Calabar, , Nigeria. .  Measures for data collection were Emotional Reactivity Scale, State Trait Anxiety Inventory, and the Mercury Sphygmomanometer. Hayes PROCESS macro for SPSS which uses a regression-based, path-analytical framework, was employed in analysing the data. Results showed that emotional reactivity was positively associated with blood pressure elevations. Anxiety was positively associated with blood pressure elevations. Anxiety also fully mediated the relationship between emotional reactivity and blood pressure elevations, even after adjusting for the control variables (e.g., age, family history of hypertension, and educational status). The finding suggests that being less emotionally reactive is associated with a decrease in disabling influences of anxiety, thereby contributing to lower levels of mean arterial blood pressure. The findings may be helpful  in improving prevention, control and management of hypertension in healthcare.

The Blood Stocks Management Scheme, a partnership venture between the National Blood Service of England and North Wales and participating hospitals for maximizing blood supply chain management.

PubMed

Chapman, J F; Cook, R

2002-10-01

The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.

Effects of N-Acetylcysteine Addition to University of Wisconsin Solution on the Rate of Ischemia-Reperfusion Injury in Adult Orthotopic Liver Transplant.

PubMed

Aliakbarian, Mohsen; Nikeghbalian, Saman; Ghaffaripour, Sina; Bahreini, Amin; Shafiee, Mohammad; Rashidi, Mohammad; Rajabnejad, Yaser

2017-08-01

One of the main concerns in liver transplant is the prolonged ischemia time, which may lead to primary graft nonfunction or delayed function. N-acetylcysteine is known as a hepato-protective agent in different studies, which may improve human hepatocyte viability in steatotic donor livers. This study investigated whether N-acetylcysteine can decrease the rate of ischemia-reperfusion syndrome and improve short-term outcome in liver transplant recipients. This was a double-blind, randomized, control clinical trial of 115 patients. Between April 2012 and January 2013, patients with orthotopic liver transplant were randomly divided into 2 groups; in 49 cases N-acetylcysteine was added to University of Wisconsin solution as the preservative liquid (experimental group), and in 66 cases standard University of Wisconsin solution was used (control group). We compared postreperfusion hypotension, inotrope requirement before and after portal reperfusion, intermittent arterial blood gas analysis and potassium measurement, pathological review of transplanted liver, in-hospital complications, morbidity, and mortality. There was no significant difference between the groups regarding time to hepatic artery reperfusion, hospital stay, vascular complications, inotrope requirement before and after portal declamping, and blood gas analysis. Hypotension after portal reperfusion was significantly more common in experimental group compared with control group (P = .005). Retransplant and in-hospital mortality were comparable between the groups. Preservation of the liver inside Univer-sity of Wisconsin solution plus N-acetylcysteine did not change the rate of ischemia reperfusion injury and short-term outcome in liver transplant recipients.

Bacillus cereus bacteremia outbreak due to contaminated hospital linens.

PubMed

Sasahara, T; Hayashi, S; Morisawa, Y; Sakihama, T; Yoshimura, A; Hirai, Y

2011-02-01

We describe an outbreak of Bacillus cereus bacteremia that occurred at Jichi Medical University Hospital in 2006. This study aimed to identify the source of this outbreak and to implement appropriate control measures. We reviewed the charts of patients with blood cultures positive for B. cereus, and investigated B. cereus contamination within the hospital environment. Genetic relationships among B. cereus isolates were analyzed. Eleven patients developed B. cereus bacteremia between January and August 2006. The hospital linens and the washing machine were highly contaminated with B. cereus, which was also isolated from the intravenous fluid. All of the contaminated linens were autoclaved, the washing machine was cleaned with a detergent, and hand hygiene was promoted among the hospital staff. The number of patients per month that developed new B. cereus bacteremia rapidly decreased after implementing these measures. The source of this outbreak was B. cereus contamination of hospital linens, and B. cereus was transmitted from the linens to patients via catheter infection. Our findings demonstrated that bacterial contamination of hospital linens can cause nosocomial bacteremia. Thus, blood cultures that are positive for B. cereus should not be regarded as false positives in the clinical setting.

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…

[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.

Incentive spirometry does not enhance recovery after thoracic surgery.

PubMed

Gosselink, R; Schrever, K; Cops, P; Witvrouwen, H; De Leyn, P; Troosters, T; Lerut, A; Deneffe, G; Decramer, M

2000-03-01

To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections. Randomized controlled trial. University hospital, intensive care unit, and surgical department. Sixty-seven patients (age, 59 +/- 13 yrs; forced expiratory volume in 1 sec, 93% +/- 22% predicted) undergoing elective thoracic surgery for lung (n = 40) or esophagus (n = 27) resection. Physiotherapy (breathing exercises, huffing, and coughing) (PT) plus incentive spirometry (IS) was compared with PT alone. Lung function, body temperature, chest radiograph, white blood cell count, and number of hospital and intensive care unit days were all measured. Pulmonary function was significantly reduced after surgery (55% of the initial value) and improved significantly in the postoperative period in both groups. However, no differences were observed in the recovery of pulmonary function between the groups. The overall score of the chest radiograph, based on the presence of atelectasis, was similar in both treatment groups. Eight patients (12%) (three patients with lobectomy and five with esophagus resection) developed a pulmonary complication (abnormal chest radiograph, elevated body temperature and white blood cell count), four in each treatment group. Adding IS to regular PT did not reduce hospital or intensive care unit stay. Pulmonary complications after lung and esophagus surgery were relatively low. The addition of IS to PT did not further reduce pulmonary complications or hospital stay. Although we cannot rule out beneficial effects in a subgroup of high-risk patients, routine use of IS after thoracic surgery seems to be ineffective.

Neisseria meningitidis and Streptococcus pneumoniae as leading causes of pediatric bacterial meningitis in nine Mexican hospitals following 3 years of active surveillance.

PubMed

Chacon-Cruz, Enrique; Martinez-Longoria, Cesar Adrian; Llausas-Magana, Eduardo; Luevanos-Velazquez, Antonio; Vazquez-Narvaez, Jorge Alejandro; Beltran, Sandra; Limon-Rojas, Ana Elena; Urtiz-Jeronimo, Fernando; Castaneda-Narvaez, Jose Luis; Otero-Mendoza, Francisco; Aguilar-Del Real, Fernando; Rodriguez-Chagoyan, Jesus; Rivas-Landeros, Rosa Maria; Volker-Soberanes, Maria Luisa; Hinojosa-Robles, Rosa Maria; Arzate-Barbosa, Patricia; Aviles-Benitez, Laura Karina; Elenes-Zamora, Fernando Ivan; Becka, Chandra M; Ruttimann, Ricardo

2016-01-01

Meningococcal meningitis is reported as a rare condition in Mexico. There are no internationally published studies on bacterial causes of meningitis in the country based on active surveillance. This study focuses on finding the etiology of bacterial meningitis in children from nine Mexican Hospitals. From January 2010 to February 2013, we conducted a three years of active surveillance for meningitis in nine hospitals throughout Mexico. Active surveillance started at the emergency department for every suspected case, and microbiological studies confirmed/ruled out all potentially bacterial pathogens. We diagnosed based on routine cultures from blood and cerebrospinal fluid (not polymerase chain reaction or other molecular diagnostic tests), and both pneumococcal serotyping and meningococcal serogrouping by using standard methods. Neisseria meningitidis was the leading cause, although 75% of cases occurred in the northwest of the country in Tijuana on the US border. Serogroup C was predominant. Streptococcus pneumoniae followed Neisseria meningitides, but was uniformly distributed throughout the country. Serotype 19A was the most incident but before universal implementation of the 13-valent pneumococcal conjugate vaccine. Other bacteria were much less common, including Enterobacteriaceae and Streptococcus agalactiae (these two affecting mostly young infants). Meningococcal meningitis is endemic in Tijuana, Mexico, and vaccination should be seriously considered in that region. Continuous universal vaccination with the 13-valent pneumococcal conjugate vaccine should be nationally performed, and polymerase chain reaction should be included for bacterial detection in all cultures - negative but presumably bacterial meningitis cases.

Occupational exposures to blood and body fluids among health care workers at university hospitals.

PubMed

Marković-Denić, Ljiljana; Branković, Milos; Maksimović, Natasa; Jovanović, Bojan; Petrović, Ivana; Simić, Marko; Lesić, Aleksandar

2013-01-01

Occupational exposure to blood and body fluids is a serious concern of health care workers and presents a major risk of transmission of infections such as human immuno-deficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The aim of this study was to determine the frequency and circumstances of occupational blood and body fluid exposures among health care workers. Cross-sectional study was conducted in three university hospitals in Belgrade. Anonymous questionnaire was used containing data about demographic characteristics, self-reported blood and body fluid exposures and circumstances of percutaneous injuries. Questionnaire was filled in and returned by 216 health care workers (78.2% of nurses and 21.8% of doctors). 60.6% of participants-health care workers had sustained at least one needlestick injury during their professional practice; 25.9% of them in the last 12 months. Of occupational groups, nurses had higher risk to experience needlestick injuries than doctors (p = 0.05). The majority of the exposures occurred in the operating theatre (p = 0.001). Among factors contributing to the occurrence of needlestick injuries, recapping needles (p = 0.003) and decontamination/cleaning instruments after surgery (p = 0.001) were more frequent among nurses, while use of a needle before intervention was common among doctors (p = 0.004). Only 41.2% of health care workers had reported their injuries to a supervisor in order to obtain medical attention. 50.2% of health care workers were vaccinated with three doses of hepatitis B vaccine. There is a high rate of needlestick injuries in the daily hospital routine. Implementation of safety devices would lead to improvement in health and safety of medical staff.

[Assessment of a rapid diagnostic test and portable fluorescent microscopy for malaria diagnosis in Cotonou (Bénin)].

PubMed

Ogouyèmi-Hounto, A; Kinde-Gazard, D; Keke, C; Gonçalves, E; Alapini, N; Adjovi, F; Adisso, L; Bossou, C; Denon, Y V; Massougbodji, A

2013-02-01

The aim of the study was to determine the accuracy of a rapid diagnostic test (SD Bioline Malaria Ag P.f/ Pan®) and fluorescent microscopy (CyScope®) in confirming presumptive malaria diagnosis in Cotonou. Thick blood smear was used as the reference technique for comparison. Testing was conducted on persons between the ages of 6 months and 70 years at two hospitals from June to October 2010. If malaria was suspected in the sample by the nurse based on clinical findings and sent to laboratory for confirmation, one thick smear, one rapid diagnostic test and one slide for the fluorescent microscopy were performed. All tests were read in hospital laboratories involved with the quality control of thick blood smear in the parasitology laboratory of National University Hospital of Cotonou. A total of 354 patients with clinical diagnosis of malaria were included. Malaria prevalence determined by thick smear, rapid diagnostic test and fluorescent microscopy was 22.8%, 25.4%, and 25.1% respectively. The sensitivity, specificity, positive and negative predictive values compared to the thick smears were 96.3, 95.6, 86.7, and 98.9% for rapid diagnostic test; and 97.5, 96.7, 89.8, and 99.27% for fluorescent microscopy. With these performances, these tests meet acceptability standards recommended by WHO for rapid tests (sensitivity > 95%). These two methods have advantages for the confirmation of malaria diagnosis in peripheral health structures that lack the resources to conduct diagnosis confirmation by the thick blood smear.

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

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…

Investigation of the status quo of massive blood transfusion in China and a synopsis of the proposed guidelines for massive blood transfusion

PubMed Central

Yang, Jiang-Cun; Wang, Qiu-Shi; Dang, Qian-Li; Sun, Yang; Xu, Cui-Xiang; Jin, Zhan-Kui; Ma, Ting; Liu, Jing

2017-01-01

Abstract The aim of this study was to provide an overview of massive transfusion in Chinese hospitals, identify the important indications for massive transfusion and corrective therapies based on clinical evidence and supporting experimental studies, and propose guidelines for the management of massive transfusion. This multiregion, multicenter retrospective study involved a Massive Blood Transfusion Coordination Group composed of 50 clinical experts specializing in blood transfusion, cardiac surgery, anesthesiology, obstetrics, general surgery, and medical statistics from 20 tertiary general hospitals across 5 regions in China. Data were collected for all patients who received ≥10 U red blood cell transfusion within 24 hours in the participating hospitals from January 1 2009 to December 31 2010, including patient demographics, pre-, peri-, and post-operative clinical characteristics, laboratory test results before, during, and after transfusion, and patient mortality at post-transfusion and discharge. We also designed an in vitro hemodilution model to investigate the changes of blood coagulation indices during massive transfusion and the correction of coagulopathy through supplement blood components under different hemodilutions. The experimental data in combination with the clinical evidence were used to determine the optimal proportion and timing for blood component supplementation during massive transfusion. Based on the findings from the present study, together with an extensive review of domestic and international transfusion-related literature and consensus feedback from the 50 experts, we drafted the guidelines on massive blood transfusion that will help Chinese hospitals to develop standardized protocols for massive blood transfusion. PMID:28767599

Frequency of ABO/Rhesus Blood Groups in Patients with Diabetes Mellitus.

PubMed

Oner, Can; Dogan, Burcu; Telatar, Berrin; Celik Yagan, Canan Fidan; Oguz, Aytekin

2016-01-01

The correlation between ABO/Rh blood groups and diabetes mellitus is still controversial. The aim of this study was to determine the relationship between ABO/Rhesus blood groups and diabetes in Turkish population. This cross-sectional study was conducted in Istanbul Medeniyet University Göztepe Education and Training Hospital's Diabetes Units. The study group was composed of 421 patients with type-1 diabetes, 484 patients with type-2 diabetes and 432 controls. Blood samples were collected and tested for ABO/Rhesus blood groups. Data was analyzed by SPSS version 17.0. A significant association was found between blood groups and diabetes mellitus. The frequency of AB blood group was significantly higher in type-1 diabetics; and A blood group was significantly higher in type-2 diabetics. Furthermore, Rh negativity were significantly more frequent in type-2 diabetics.

A benchmarking program to reduce red blood cell outdating: implementation, evaluation, and a conceptual framework.

PubMed

Barty, Rebecca L; Gagliardi, Kathleen; Owens, Wendy; Lauzon, Deborah; Scheuermann, Sheena; Liu, Yang; Wang, Grace; Pai, Menaka; Heddle, Nancy M

2015-07-01

Benchmarking is a quality improvement tool that compares an organization's performance to that of its peers for selected indicators, to improve practice. Processes to develop evidence-based benchmarks for red blood cell (RBC) outdating in Ontario hospitals, based on RBC hospital disposition data from Canadian Blood Services, have been previously reported. These benchmarks were implemented in 160 hospitals provincewide with a multifaceted approach, which included hospital education, inventory management tools and resources, summaries of best practice recommendations, recognition of high-performing sites, and audit tools on the Transfusion Ontario website (http://transfusionontario.org). In this study we describe the implementation process and the impact of the benchmarking program on RBC outdating. A conceptual framework for continuous quality improvement of a benchmarking program was also developed. The RBC outdating rate for all hospitals trended downward continuously from April 2006 to February 2012, irrespective of hospitals' transfusion rates or their distance from the blood supplier. The highest annual outdating rate was 2.82%, at the beginning of the observation period. Each year brought further reductions, with a nadir outdating rate of 1.02% achieved in 2011. The key elements of the successful benchmarking strategy included dynamic targets, a comprehensive and evidence-based implementation strategy, ongoing information sharing, and a robust data system to track information. The Ontario benchmarking program for RBC outdating resulted in continuous and sustained quality improvement. Our conceptual iterative framework for benchmarking provides a guide for institutions implementing a benchmarking program. © 2015 AABB.

Management of blood shortages in a tertiary care academic medical center: the Yale-New Haven Hospital frozen blood reserve.

PubMed

Erickson, Michelle L; Champion, Melanie H; Klein, Roger; Ross, Rebecca L; Neal, Zena M; Snyder, Edward L

2008-10-01

Threats to national and local blood supplies in America mandate development of an effective blood management system for emergency preparedness and efficient blood inventory management. Seasonal or acute blood shortages could be compounded by the unavoidable distribution inefficiencies of the blood pipeline during an emergency. The Yale-New Haven Hospital (YNHH) Blood Bank has developed a comprehensive emergency blood management plan, which includes maintenance of a tactical, limited frozen blood supply. A computer spreadsheet-based disaster prediction model has been designed to guide the use of the frozen reserve by testing various emergency scenarios. The frozen blood reserve can likely support normal hospital red blood cell (RBC) demands during typical (3-4 days) seasonal shortages, provide a reduced supply for up to 10 days, or meet an unexpected transient increased RBC demand without requiring intensive support from the regional blood center. However, the frozen blood supply is not designed to meet the massive transfusion demand associated with extreme or sustained disasters. Rather, it serves as a short-term bridge-over supply until blood center support can be reestablished. We review the reasons for initiating a blood management plan and describe how YNHH has implemented and sustains a frozen blood reserve as part of a comprehensive disaster management plan. Despite the operational complexity, the benefits of self-sufficiency, the ability to support routine hospital requirements, and the security of having a backup supply justify the expense and difficulty of maintaining a frozen blood reserve.

Knowledge, attitude and practice of aspects of laboratory safety in Pathology Laboratories at the University of Port Harcourt Teaching Hospital, Nigeria.

PubMed

Ejilemele, A A; Ojule, A C

2005-12-01

To assess current knowledge, attitudes and practice of aspects of laboratory safety in pathology laboratories at the University of Port Harcourt Teaching Hospital in view of perceived inadequacies in safety practices in clinical laboratories in developing countries. Sixty (60) self- administered questionnaires were distributed to all cadres of staff in four (4) different laboratories (Chemical Pathology, Haematology, Blood bank and Medical Microbiology) at the Hospital. Gross deficiencies were found in the knowledge, attitudes and practice of laboratory safety by laboratory staff in areas of use of personal protective equipment, specimen collection and processing, centrifuge--related hazards, infective hazards waste disposal and provision and use of First Aid Kits. Issues pertaining to laboratory safety are not yet given adequate attention by both employers and employees in developing countries in this ear of resurgence of diseases such as HIV/AIDS and Hepatitis Band C, is emphasized.

Estimation of the Hematological Change of Red Blood Cell and Platelet Count of Healthy Pregnant Women in Saudi Arabia

NASA Astrophysics Data System (ADS)

Hana, M. M.; Ramzun, M. R.; Nabela, Z.; Zahirah, N. A. N.; Razak, Nik Noor Ashikin Nik Abdul; Azhar, A. R.; Iskandar, S. M.; Nursakinah, S.

2018-04-01

Tremendous changes in hematological values were noticed throughout trimesters of pregnancy. This study is aimed to provide a reference for hematological values based on trimesters, focused on the parameter of red blood cell (RBCs) and platelets (PLTs). There were 4075 local Saudi pregnant women were involved, attending the Maternity and Children Hospital in Dammam and King Fahad University Hospital in Al-Khobar, between 2013 to 2015. The statistical analysis, such as frequency and descriptive were performed. Overall, this study revealed a decline in RBCs and PLTs throughout pregnancy. The RBC, HCT, MPV and MCH mean values were found decreases in the 2nd trimester but increased in the 3rd trimester. On the contrary, the MCV, MCHC, and RDW showed increases in the 2nd trimester and decreased in the 3rd trimester. The changes of the RBCs parameters in 3rd trimester compared to 1st trimester shows increased for MCV while the RBC, HCT, MCH and MCHC decreased. Besides that, most of the respondent suffering from anemia. The hematological values after delivery show decreased for RBC, HCT, MCV, MCH and MPV but an increase in the MCHC, RDW and PLT. Thus, it is highly recommended to request for a complete blood cell screening during pregnancy to provide a better healthcare of the maternal and fetus.

The characteristics and impact of source of infection on sepsis-related ICU outcomes.

PubMed

Jeganathan, Niranjan; Yau, Stephen; Ahuja, Neha; Otu, Dara; Stein, Brian; Fogg, Louis; Balk, Robert

2017-10-01

Source of infection is an independent predictor of sepsis-related mortality. To date, studies have failed to evaluate differences in septic patients based on the source of infection. Retrospective study of all patients with sepsis admitted to the ICU of a university hospital within a 12month time period. Sepsis due to intravascular device and multiple sources had the highest number of positive blood cultures and microbiology whereas lung and abdominal sepsis had the least. The observed hospital mortality was highest for sepsis due to multiple sources and unknown cause, and was lowest when due to abdominal, genitourinary (GU) or skin/soft tissue. Patients with sepsis due to lungs, unknown and multiple sources had the highest rates of multi-organ failure, whereas those with sepsis due to GU and skin/soft tissue had the lowest rates. Those with multisource sepsis had a significantly higher median ICU length of stay and hospital cost. There are significant differences in patient characteristics, microbiology positivity, organs affected, mortality, length of stay and cost based on the source of sepsis. These differences should be considered in future studies to be able to deliver personalized care. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Effect of vigorous physical activity on blood lipid and glucose.

PubMed

Kwon, Hyoung-Jeong; Lee, Han-Joon

2017-12-01

The aim of the study is to investigate how the participation of vigorous physical activities in the health examination contributes to blood lipid and blood glucose. A total of 56,810 workers from the Ulsan University Hospital in Ulsan, Subjects were tested for health checkups from February to November in 2016. The subject is those who does not have medical history, current ailments, and medication histories, and selected those who conducted the study of subjects tested to research. And this study did not consider their drinking and smoking. The final selected population was 11,557 and categorized as a vigorous physical activity of the health survey items. In this study, the group participated by the vigorous physical activity activities, group 1 (n= 70) had more than 6 days of vigorous physical activity, group 2 (n= 2,960) is 3 to 5 days of vigorous physical activity, the group 3 (n= 7,389) is 1 to 2 days of vigorous physical activity. The group 4 (n= 1,138) were classified as those who did not perform vigorous physical activity. To achieve the purpose of the study, the questionnaire examined blood lipid and blood glucose, using questions related to physical activity related to health examination in the Ulsan University Hospital. We obtained the mean and standard deviation for each group and conducted the one-way analysis of variance as an independent variable. Post hoc is least significant difference test and significant level is 0.05. Vigorous physical activity more than 3 days of participation had a positive affect high-density lipoprotein cholesterol and triglyceride. But participation in vigorous physical activity did not affect blood glucose.

Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams.

PubMed

Self, Wesley H; Talbot, Thomas R; Paul, Barbara R; Collins, Sean P; Ward, Michael J

2014-08-01

Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase up-front costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with 3 collection strategies: usual care, sterile kits, and phlebotomy teams. Cost analysis. This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually. Total hospital costs associated with 3 strategies were compared: (1) usual care, with nurses collecting cultures without a standardized protocol; (2) sterile kits, with nurses using a dedicated sterile collection kit; and (3) phlebotomy teams, with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results (negative, true positive, and contaminated). Compared with usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses. EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.

Screening for G6PD Deficiency Among Neonates with Neonatal Jaundice Admitted to Tertiary Care Center: A Need in Disguise.

PubMed

Kumar, Kishwer; Sohaila, Arjumand; Tikmani, Shiyam Sunder; Khan, Iqtidar Ahmed; Zafar, Anila

2015-08-01

This study was conducted to determine the association of Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency among neonates admitted with jaundice at the neonatal intensive care unit, well baby nursery and neonatal step down nursery of the Aga Khan University Hospital, Karachi, Pakistan, from January to June 2010. A total of 205 neonates following the selection criteria were included. All selected neonates have their venous blood drawn, saved in EDTA bottle and sent to laboratory of The Aga Khan University Hospital (AKUH). The laboratory results of whether G-6-PD deficiency was present or not was recorded in the proforma. G-6-PD was deficient in 19 neonates (9.3%). All neonates were male.

Comparison of a New Cobinamide-Based Method to a Standard Laboratory Method for Measuring Cyanide in Human Blood

PubMed Central

Swezey, Robert; Shinn, Walter; Green, Carol; Drover, David R.; Hammer, Gregory B.; Schulman, Scott R.; Zajicek, Anne; Jett, David A.; Boss, Gerry R.

2013-01-01

Most hospital laboratories do not measure blood cyanide concentrations, and samples must be sent to reference laboratories. A simple method is needed for measuring cyanide in hospitals. The authors previously developed a method to quantify cyanide based on the high binding affinity of the vitamin B12 analog, cobinamide, for cyanide and a major spectral change observed for cyanide-bound cobinamide. This method is now validated in human blood, and the findings include a mean inter-assay accuracy of 99.1%, precision of 8.75% and a lower limit of quantification of 3.27 µM cyanide. The method was applied to blood samples from children treated with sodium nitroprusside and it yielded measurable results in 88 of 172 samples (51%), whereas the reference laboratory yielded results in only 19 samples (11%). In all 19 samples, the cobinamide-based method also yielded measurable results. The two methods showed reasonable agreement when analyzed by linear regression, but not when analyzed by a standard error of the estimate or paired t-test. Differences in results between the two methods may be because samples were assayed at different times on different sample types. The cobinamide-based method is applicable to human blood, and can be used in hospital laboratories and emergency rooms. PMID:23653045

Therapeutic potential of umbilical cord blood cells for type 1 diabetes mellitus.

PubMed

He, Binbin; Li, Xia; Yu, Haibo; Zhou, Zhiguang

2015-11-01

Type 1 diabetes mellitus (T1DM) is a chronic disorder that results from autoimmune-mediated destruction of pancreatic islet β-cells. However, to date, no conventional intervention has successfully treated the disease. The optimal therapeutic method for T1DM should effectively control the autoimmunity, restore immune homeostasis, preserve residual β-cells, reverse β-cell destruction, and protect the regenerated insulin-producing cells against re-attack. Umbilical cord blood is rich in regulatory T (T(reg)) cells and multiple types of stem cells that exhibit immunomodulating potential and hold promise in their ability to restore peripheral tolerance towards pancreatic islet β-cells through remodeling of immune responses and suppression of autoreactive T cells. Recently, reinfusion of autologous umbilical cord blood or immune cells from cord blood has been proposed as a novel therapy for T1DM, with the advantages of no risk to the donors, minimal ethical concerns, a low incidence of graft-versus-host disease and easy accessibility. In this review, we revisit the role of autologous umbilical cord blood or immune cells from cord blood-based applications for the treatment of T1DM. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

SU-F-R-51: Radiomics in CT Perfusion Maps of Head and Neck Cancer

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

Nesteruk, M; Riesterer, O; Veit-Haibach, P

2016-06-15

Purpose: The aim of this study was to test the predictive value of radiomics features of CT perfusion (CTP) for tumor control, based on a preselection of radiomics features in a robustness study. Methods: 11 patients with head and neck cancer (HNC) and 11 patients with lung cancer were included in the robustness study to preselect stable radiomics parameters. Data from 36 HNC patients treated with definitive radiochemotherapy (median follow-up 30 months) was used to build a predictive model based on these parameters. All patients underwent pre-treatment CTP. 315 texture parameters were computed for three perfusion maps: blood volume, bloodmore » flow and mean transit time. The variability of texture parameters was tested with respect to non-standardizable perfusion computation factors (noise level and artery contouring) using intraclass correlation coefficients (ICC). The parameter with the highest ICC in the correlated group of parameters (inter-parameter Spearman correlations) was tested for its predictive value. The final model to predict tumor control was built using multivariate Cox regression analysis with backward selection of the variables. For comparison, a predictive model based on tumor volume was created. Results: Ten parameters were found to be stable in both HNC and lung cancer regarding potentially non-standardizable factors after the correction for inter-parameter correlations. In the multivariate backward selection of the variables, blood flow entropy showed a highly significant impact on tumor control (p=0.03) with concordance index (CI) of 0.76. Blood flow entropy was significantly lower in the patient group with controlled tumors at 18 months (p<0.1). The new model showed a higher concordance index compared to the tumor volume model (CI=0.68). Conclusion: The preselection of variables in the robustness study allowed building a predictive radiomics-based model of tumor control in HNC despite a small patient cohort. This model was found to be superior to the volume-based model. The project was supported by the KFSP Tumor Oxygenation of the University of Zurich, by a grant of the Center for Clinical Research, University and University Hospital Zurich and by a research grant from Merck (Schweiz) AG.« less

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 purpose of clinical laboratory accreditation in transplantation medicine].

PubMed

Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Siftar, Zoran; Ozvald, Ivan; Vidas, Zeljko

2011-09-01

Although transplantation of solid organs has become a more standardized method of treatment, liver transplantation represents an exceptional multidisciplinary clinical procedure requiring understanding of specific pathophysiological changes that occur in the end stage of liver disease. Liver transplantation has been performed at Merkur University Hospital since 1998, with 360 transplantations performed to date. The most common indications are alcohol liver disease, cirrhosis caused by hepatitis B and C virus, hepatocellular carcinoma and cryptogenetic liver cirrhosis. Laboratory tests required for liver transplantation are performed at Department of Clinical Chemistry, Merkur University Hospital, accredited according to ISO 15189 in 2007 for the areas of clinical chemistry, laboratory hematology and coagulation, laboratory immunology-cell immunophenotyping, and molecular diagnosis. The complexity of liver transplant patients requires constant interaction between the anesthesiologist team and clinical laboratory, which has to ensure fast and efficient intraoperative monitoring of biochemical and liver profile: electrolytes and acid-base status, complete blood count, coagulation profile and monitoring of graft function according to the individual patient's health status. Dynamics of intraoperative changes is measured in whole arterial blood samples on a Nova Biomedical Stat Profile Critical Care Xpress mobile acid-base analyzer. Frequent monitoring of ionized calcium and magnesium levels is very important because of citrated blood transfusion and for appropriate therapeutic procedure. During anhepatic stage, there is a progressive increase in lactate level concentration. After reperfusion, a rapid increase in lactate clearance is an excellent indicator of stable graft initial function and its adequate size. During the transplantation procedure, there is usually a biphasic acid-base disturbance characterized by metabolic acidosis and then by metabolic alkalosis. The loss of base equivalents starts during the dissection stage and accelerates during the anhepatic stage. Fast and efficient intraoperative monitoring of hematological tests and coagulation status is of great help in detecting the cause of possible hemorrhage and consequential complications during transplantation procedure. The possibility of organ and tissue transplantation mostly depends on well regulated international cooperation in the areas of donating, transplanting and exchange of required organs and tissues, while laboratory test results must be comparable regardless of their geographical area, methodology employed or analytical equipment used, which is mainly warranted through accreditation according to the international ISO 15189 standard.

[Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital].

PubMed

Christaras, A; Schaper, J; Strelow, H; Laws, H-J; Göbel, U

2006-01-01

Reimbursement of inpatient treatment by daily constant charges is replaced by diagnosis- and procedure-related group system (G-DRG) in German acute care hospitals excerpt for psychiatry since 2004. Re-designs of G-DRG system were undertaken in 2005 and 2006. Parallel to implementation requirement- and resource-based self-adjustment of this new reimbursement system has been established by law. Adjustments performed in 2005 and 2006 are examined with respect to their effect on reimbursements in treatments of children with oncological, hematological, and immunological diseases. An unchanged population of 349 patients associated with 1,731 inpatient stays of a Clinic of Pediatric Oncology, Hematology, and Immunology in 2004 was analyzed by methods and means of G-DRG systems 2004, 2005, and 2006. DRGs and additional payments for drugs and procedures eligible for all and/or individual hospitals were calculated. G-DRG system 2005 resulted in overall reimbursement loss of 3.77 % compared to G-DRG 2004. G-DRG 2006 leads to slightly improved overall reimbursements compared to G-DRG 2005 by increasing DRG-based revenues. G-DRG 2006 effects 2.40 % reduction in overall reimbursement compared to G-DRG 2004. This loss includes ameliorating effects of additional payments for drugs and blood products already. Despite introduction of additional payments especially designed for children and teenagers in 2006, additional payment volume is decreased by 21.71 % from 2005 to 2006. G-DRG 2006 yields over-all reimbursement losses of 1.45 % in comparison to G-DRG 2004. Overall reimbursements include introduced additional payments for drugs and blood products. (Reimbursements resulting out of DRG payment alone drop by 14.73 % from 2004 to 2005, and increase by 3.26 % from 2005 to 2006 (2004 vs. 2006 11.95 %). Introduction of additional payments for drugs and blood products on a Germany-wide basis introduced in 2005 dampens DRG-based reimbursement losses. Despite introduction of dosage intervals specifically designed for children and adolescents in 2006, reimbursement of additional payments for drugs and blood products decrease by 21.71 % from 2005 to 2006. An important revenue-balancing function is attributed to additional charges individual for each hospital according to Par. 6 Section 2 (New diagnostic and therapeutic methods) and Section 2 a KHEntgG (German Hospital Reimbursement Law) with respect to financing tertiary care focusses. If possible to attain, those charges may partially equalize losses. Including these additional charges per individual hospital balance of summarized additional charges is -3.89 % from 2005 to 2006. However, fraction of additional payments on total reimbursements increases from 0.64 % in 2004 to 11.98 % in 2005, and 11.24 % in 2006, respectively. The G-DRG system in its versions 2005 and 2006 results in lowering overall reimbursements of a pediatric hematology, oncology, and immunology department compared to initial status in 2004. The growing chargeability of additional payments ameliorate this effect.

Clinical Assessment of Nursing Care Regarding Hemovigilance in Neonatal Wards and Neonatal Intensive Care Units in Selected Hospitals Affiliated to Shahid Beheshti University of Medical Sciences (2013 - 2014)

PubMed Central

Tajalli, Saleheh; Nourian, Manijeh; Rassouli, Maryam; Baghestani, Ahmad Reza

2015-01-01

Background: Hemovigilance is a series of surveillance procedures encompassing the entire transfusion chain from the collection of blood and its components to the follow-up of its recipients. It is intended to collect and access information on unanticipated or adverse effects stemming from the therapeutic use of labile blood products. Blood transfusion, particularly in neonates, requires meticulous clinical assessment to ensure safety before, during, and after the procedure. Therefore, it is essential to investigate how nurses and other health care providers implement hemovigilance with a view to elevating the standards of care. Objectives: The aim of this study, conducted between 2013 and 2014, was to assess nursing care regarding hemovigilance in the neonatal wards and neonatal intensive care units (NICUs) of selected hospitals affiliated to Shahid Beheshti University of Medical Sciences. Materials and Methods: This descriptive study assessed nursing care concerning hemovigilance in 144 neonates. Data were collected using a checklist at the neonatal wards and NICUs of Mahdiyeh, Mofid, and Imam Hussain hospitals affiliated to Shahid Beheshti University of Medical Sciences. The checklist contained information on the standard of care in relation to neonatal hemovigilance in three components of request, transfusion, and documentation. Descriptive statistics with the Statistical Package for the Social Sciences (version 21) were used to analyze the collected data. Results: The rates of compliance with the hemovigilance guidelines in terms of request, transfusion, and documentation were 47%, 63.2%, and 68%, correspondingly, with a total score of 59.6% in all areas of research. Accordingly, compliance with hemovigilance guidelines was highest in documentation (68%), followed by transfusion (63.2%) and request (47%). Conclusions: The overall score of nursing care as regards adherence to the neonatal hemovigilance guidelines was 59.6% in the present study, indicating a lack of care and failure in training in this regard. PMID:26421167

Antimicrobial activity of ceftaroline against methicillin-resistant Staphylococcus aureus (MRSA) isolates collected in 2013-2014 at the Geneva University Hospitals.

PubMed

Andrey, D O; François, P; Manzano, C; Bonetti, E J; Harbarth, S; Schrenzel, J; Kelley, W L; Renzoni, A

2017-02-01

Ceftaroline is a broad-spectrum antibiotic with activity against methicillin-resistant Staphylococcus aureus (MRSA) strains. Ceftaroline susceptibility of an MRSA set archived between 1994 and 2003 in the Geneva University Hospitals detected a high percentage (66 %) of ceftaroline resistance in clonotypes ST228 and ST247 and correlated with mutations in PBP2a. The ceftaroline mechanism of action is based on the inhibition of PBP2a; thus, the identification of PBP2a mutations of recently circulating clonotypes in our institution was investigated. We analyzed ceftaroline susceptibility in MRSA isolates (2013 and 2014) and established that resistant strains correlated with PBP2a mutations and specific clonotypes. Ninety-six MRSA strains were analyzed from independent patients and were isolated from blood cultures (23 %), deep infections (38.5 %), and superficial (skin or wound) infections (38.5 %). This sample showed a ceftaroline minimum inhibitory concentration (MIC) range between 0.25 and 2 μg/ml and disk diameters ranging from 10 to 30 mm, with a majority of strains showing diameters ≥20 mm. Based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints, 76 % (73/96) of isolates showed susceptibility to ceftaroline. Nevertheless, we still observed 24 % (23/96) of resistant isolates (MIC = 2 μg/ml). All resistant isolates were assigned to clonotype ST228 and carried the N146K mutation in PBP2a. Only two ST228 isolates showed ceftaroline susceptibility. The decreasing percentage of ceftaroline-resistant isolates in our hospital can be explained by the decline of ST228 clonotype circulating in our hospital since 2008. We present evidence that ceftaroline is active against recent MRSA strains from our hospital; however, the presence of PBP2a variants in particular clonotypes may affect ceftaroline efficacy.

Neisseria meningitidis and Streptococcus pneumoniae as leading causes of pediatric bacterial meningitis in nine Mexican hospitals following 3 years of active surveillance

PubMed Central

Chacon-Cruz, Enrique; Martinez-Longoria, Cesar Adrian; Llausas-Magana, Eduardo; Luevanos-Velazquez, Antonio; Vazquez-Narvaez, Jorge Alejandro; Beltran, Sandra; Limon-Rojas, Ana Elena; Urtiz-Jeronimo, Fernando; Castaneda-Narvaez, Jose Luis; Otero-Mendoza, Francisco; Aguilar-Del Real, Fernando; Rodriguez-Chagoyan, Jesus; Rivas-Landeros, Rosa Maria; Volker-Soberanes, Maria Luisa; Hinojosa-Robles, Rosa Maria; Arzate-Barbosa, Patricia; Aviles-Benitez, Laura Karina; Elenes-Zamora, Fernando Ivan; Becka, Chandra M.; Ruttimann, Ricardo

2016-01-01

Objectives: Meningococcal meningitis is reported as a rare condition in Mexico. There are no internationally published studies on bacterial causes of meningitis in the country based on active surveillance. This study focuses on finding the etiology of bacterial meningitis in children from nine Mexican Hospitals. Methods: From January 2010 to February 2013, we conducted a three years of active surveillance for meningitis in nine hospitals throughout Mexico. Active surveillance started at the emergency department for every suspected case, and microbiological studies confirmed/ruled out all potentially bacterial pathogens. We diagnosed based on routine cultures from blood and cerebrospinal fluid (not polymerase chain reaction or other molecular diagnostic tests), and both pneumococcal serotyping and meningococcal serogrouping by using standard methods. Results: Neisseria meningitidis was the leading cause, although 75% of cases occurred in the northwest of the country in Tijuana on the US border. Serogroup C was predominant. Streptococcus pneumoniae followed Neisseria meningitides, but was uniformly distributed throughout the country. Serotype 19A was the most incident but before universal implementation of the 13-valent pneumococcal conjugate vaccine. Other bacteria were much less common, including Enterobacteriaceae and Streptococcus agalactiae (these two affecting mostly young infants). Conclusions: Meningococcal meningitis is endemic in Tijuana, Mexico, and vaccination should be seriously considered in that region. Continuous universal vaccination with the 13-valent pneumococcal conjugate vaccine should be nationally performed, and polymerase chain reaction should be included for bacterial detection in all cultures – negative but presumably bacterial meningitis cases. PMID:27551428

Investigation of mutation distribution in DNA gyrase and topoisomerase IV genes in ciprofloxacin-non-susceptible Enterobacteriaceae isolated from blood cultures in a tertiary care university hospital in South Korea, 2005-2010.

PubMed

Nam, You Sun; Cho, Sun Young; Yang, Hee Young; Park, Kyung Sun; Jang, Ji-Hyun; Kim, Yun-Tae; Jeong, Joo-Won; Suh, Jin-Tae; Lee, Hee Joo

2013-02-01

This study investigated the distribution of mutations in DNA gyrase (gyrA and gyrB) and topoisomerase IV (parC and parE) genes and compared the distribution of these mutations with the distribution of plasmid-mediated quinolone resistance (PMQR) genes and extended-spectrum β-lactamase (ESBL) production in 101 ciprofloxacin-non-susceptible Enterobacteriaceae from blood culture isolates (80 Escherichia coli and 21 Klebsiella pneumoniae) isolated in Kyung Hee University Hospital, a tertiary care university hospital in Seoul, South Korea. Among the 101 isolates, 80 (79.2%) contained PMQR genes and 28 (27.7%) produced ESBL. Mutations in the gyrA and parC genes were observed more frequently than in the gyrB and parE genes as well as more frequently in E. coli than in K. pneumoniae isolates, even in the same ciprofloxacin minimum inhibitory concentration (MIC) range of the two species. In E. coli isolates, the distribution of the codon 529 mutation (Ile→Leu) in parE was increased with an increase in the ciprofloxacin MIC. An increase in high-level resistance to quinolones may occur with double mutations compared with a single mutation in gyrA as well as with additional mutations in parC. However, this finding could not be applied to ciprofloxacin-resistant K. pneumoniae. A higher level of quinolone resistance may be correlated with an additional mutation in parE, especially Ile529→Leu. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014.

PubMed

Dasch, Burkhard; Kalies, Helen; Feddersen, Berend; Ruderer, Caecilie; Hiddemann, Wolfgang; Bausewein, Claudia

2017-01-01

Cancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care. To describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital. Retrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life. Overall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient's life. Overambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of specialist palliative care.

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

PubMed Central

Dasch, Burkhard; Kalies, Helen; Feddersen, Berend; Ruderer, Caecilie; Hiddemann, Wolfgang; Bausewein, Claudia

2017-01-01

Background Cancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care. Aim To describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital. Methods Retrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life. Results Overall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient’s life. Conclusions Overambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of specialist palliative care. PMID:28384214

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.

The acceptability to women in Mombasa, Kenya, of the donation and transfusion of umbilical cord blood for severe anaemia in young children

PubMed Central

Hassall, O; Ngina, L; Kongo, W; Othigo, J; Mandaliya, K; Maitland, K; Bates, I

2008-01-01

Background and Objectives Severe anaemia, for which a blood transfusion can be life saving, is common in hospitalized children in sub-Saharan Africa but blood for transfusion is often in short supply. Umbilical cord blood is usually thrown away but could be a useful source of red cells for small volume transfusions in young children in this setting. The objective of this study was to evaluate the attitudes of women using the maternity services of the provincial hospital in Mombasa, Kenya, towards cord blood donation and transfusion, and essential aspects of this process including informed consent and the acceptability of screening for human immunodeficiency virus (HIV) infection. Materials and Methods A structured questionnaire was developed based on data provided by focus group discussions with women attending the hospital's maternity unit and administered to women who had recently delivered at the hospital. Results Of the 180 women who completed a questionnaire, the donation and transfusion of cord blood were acceptable to 81% and 78%, respectively. Ninety per cent of women who supported cord blood donation were willing to undergo further HIV testing at the time of delivery. Seventy-seven per cent of women wanted informed consent to be sought for cord blood donation and 66% of these felt they could make this decision alone. Conclusion The donation of umbilical cord blood and its transfusion are acceptable to the majority of women delivering at Coast Provincial General Hospital, Mombasa. Findings from the study will benefit the planned cord blood donation programme at this facility. PMID:18067489

Fifty-five years (1955-2010) of the Coagulation Section at Laboratory of Hematology, Sestre milosrdnice University Hospital, and its founder, hematologist Ljubomir Popović.

PubMed

Stancić, Vladimir; Stancić, Nevenka; Vucelić, Vesna; Lang, Nada; Grbac, Ljiljana

2011-09-01

The Coagulation Section at Laboratory of Hematology, Sestre milosrdnice University Hospital, Zagreb, was founded in 1955 by Ljubomir Popović, hematologist and assistant at School of Medicine, University of Zagreb, in cooperation with hard-working laboratory technicians. Apart from papers on hematologic neoplasms, plasmacytoma and lymphoma, Ljubomir Popović published a number of papers in the field of anticoagulant therapy with heparin and oral anticoagulants, some of which are also in use today. After Ljubomir Popović left the Hospital in 1964, the Laboratory was run by Professor Nedjeljko Milić, head of the newly founded Division of Hematology. In 1968, the management of the Laboratory of Hematology was taken over by Biserka Raić, MS, medical biochemist, until her retirement in 2007. Great development in morphological and cytometric studies of blood and blood cells has been paralleled by continuous progress and almost dominating activities in the diagnosis of hemostasis disorders. In the 1970s, Marko Koprcina, hematologist, and Biserka Raić introduced the then latest tests in practice at all Hospital departments. In that golden age of the Coagulation Section, M. Koprcina, B. Raić and their associates transferred their knowledge to all colleagues in the Hospital. Through that collaboration, high standards in the diagnosis of hemostasis disorders were achieved, from which the currently high level of clinical knowledge about coagulation disorders and their treatment has derived, making Sestre milosrdnice University Hospital one of the leading hospitals in this field in the country. By describing development of the Coagulation Section and the life of its founder Ljubomir Popović, the authors tried to provide an answer to the following question: can today's clinicians still have a deciding role in laboratory development, considering that assessments of different phenomena are always initiated by an interested clinician who is trying to interpret and understand the nature of the disorder? This means that the clinician's place may still be in the laboratory, or else, it will become clear that the laboratory, as well as knowledge in general, has undergone such an expansion that the clinician is no longer able to run it by himself. It is our belief that the answer will assert itself through the survey of the history of the Coagulation Section at Laboratory of Hematology, Division of Hematology, and the lives of its founders and beneficiaries.

Why do some apheresis donors donate blood just once?

PubMed

Ringwald, J; Lange, N; Rabe, C; Zimmermann, R; Strasser, E; Hendelmeier, M; Strobel, J; Eckstein, R

2007-11-01

More knowledge about the reasons for non-return of blood donors (BD) would enable blood donation services (BDS) to improve the efficacy of recruitment and retention programmes. We interviewed returning (RBD) and non-returning apheresis BDs (NRBD) of our university hospital-based BDS. A questionnaire was sent to 1218 individuals who passed the initial health check with no more than one subsequent blood donation. A similar questionnaire was answered by 235 randomly incoming RBDs. We asked for age, sex, profession, education level, motives to donate blood and, if applicable, reasons for non-return. These data were compared between NRBDs and RBDs and were analysed in relationship to the reasons for non-return. We received 267 answered questionnaires (21.9%). As 32 individuals indicated that they had been permanently deferred and 47 BDs had donated blood elsewhere, 188 NRBDs remained for further analysis. We found more women than men among NRBDs. Medical professions were less likely to return than students and trainees. Individuals motivated by personal experience, remuneration or a free health check were more likely to return than others. Whereas logistic reasons were of highest relevance for non-return in general, women indicated anxiety of blood donation as reason for non-return more often than men. Reducing women's anxiety of blood donation, reminding medical professions more intensively on blood donation and appealing to personal experience or a free health check may be the most promising approaches to increase BDs' return rates.

Evaluation of the non-compliance with grouping guidelines which may lead to "wrong blood in tube", an observational study and risk factor analysis.

PubMed

Daurat, A; Boudet, E; Daurat, G; Roger, C; Gris, J-C; Tunez, V; Gaste, M-C; Lefrant, J-Y

2017-06-01

In France, blood group determination requires the completion of two samples collected at two different times to detect identity mistake and "wrong blood in tube". The aims of the present study were: (1) to evaluate the compliance with guidelines and (2) to identify risk factors of non-compliance. Samples for ABO group determination collected between January 1st and December 15th, 2013 in the University hospital of Nîmes, France were analyzed. An ABO group determination demand was considered non-compliant if more than one tube arrived in the laboratory within ten minutes apart. Between May 1st and June 30th 2014, a self-administered questionnaire was offered to the nurses of the hospital on a random day for each service during this period. The aim was to validate the non-compliance criterion and the identification of risk factors using logistic regression. Among the 16,450 analyzed blood samples, the overall compliance rate was 65.1%. Lower compliance rates were found in the surgical services. Independent risk factors for wrong practice were work overload, surgical service and individual intermediate transfusion frequency. More than one third of ABO group determinations did not follow national recommendations, which induces a substantial risk of "wrong blood in tube" and group error. The study revealed major variations among hospital services. Identification of risk factors allows targeted corrective actions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

[Transfusion and Jehovah's witnesses. A review of medicosurgical attitudes in a University hospital in 1995].

PubMed

Gouëzec, H; Ballay, J L; Le Couls, H; Mallédant, Y

1996-01-01

The aim of this study was to evaluate the attitudes of physicians (anaesthetists + other doctors + surgeons) towards Jehovah's witness patients refusing blood transfusion. Such a situation is not uncommon: 79% of respondents uncountered it. For scheduled surgery in adults, 75% of these physicians (54% of anaesthetists) would accept to lake care of these patients. In case of emergency or unforeseen indication for transfusion, 54% of these physicians (72% of anaesthetists) would administer blood, despite a written transfusion refusal. These figures would be 95 and 97% respectively in children.

Integration of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in blood culture diagnostics: a fast and effective approach.

PubMed

Klein, Sabrina; Zimmermann, Stefan; Köhler, Christine; Mischnik, Alexander; Alle, Werner; Bode, Konrad A

2012-03-01

Sepsis is a major cause of mortality in hospitalized patients worldwide, with lethality rates ranging from 30 to 70 %. Sepsis is caused by a variety of different pathogens, and rapid diagnosis is of outstanding importance, as early and adequate antimicrobial therapy correlates with positive clinical outcome. In recent years, matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) fingerprinting has become a powerful tool in microbiological diagnostics. The direct identification of micro-organisms in a positive blood culture by MALDI-TOF MS can shorten the diagnostic procedure significantly. Therefore, the aim of the present study was to evaluate whether identification rates could be improved by using the new Sepsityper kit from Bruker Daltonics for direct isolation and identification of bacteria from positive blood cultures by MALDI-TOF MS compared with the use of conventional separator gel columns, and to integrate the MALDI-TOF MS-based identification method into the routine course of blood culture diagnostics in the setting of a microbiological laboratory at a university hospital in Germany. The identification of Gram-negative bacteria by MALDI-TOF MS was significantly better using the Sepsityper kit compared with a separator gel tube-based method (99 and 68 % correct identification, respectively). For Gram-positive bacteria, only 73 % were correctly identified by MALDI-TOF with the Sepsityper kit and 59 % with the separator gel tube assay. A major problem of both methods was the poor identification of Gram-positive grape-like clustered cocci. As differentiation of Staphylococcus aureus from coagulase-negative staphylococci is of clinical importance, a PCR was additionally established that was capable of identifying S. aureus directly from positive blood cultures, thus closing this diagnostic gap. Another benefit of the PCR approach is the possibility of directly detecting the genes responsible for meticillin resistance in staphylococci and for vancomycin resistance in enterococci, which is of high importance for early adequate treatment. Both of the described methods were finally integrated into a protocol for fast and effective identification of bacteria from positive blood cultures.

A procedure for rapid issue of red cells for emergency use.

PubMed

Weiskopf, Richard B; Webb, Mary; Stangle, Deena; Klinbergs, Gunter; Toy, Pearl

2005-04-01

A College of American Pathologists Q-Probe revealed that the median turnaround times for emergency requests for red blood cells from the operating room were 30 minutes to release of cells from the blood bank and 34 minutes to delivery to the operating room. These times may not be adequate to permit the red cells to provide sufficiently rapid delivery of oxygen in massively bleeding patients. To improve the time from emergency request for red cells to delivery to the operating room. A new emergency issue program was implemented for only the operating rooms; emergency issue to all other hospital locations remained unchanged. Six units of group O Rh-negative red blood cells (RBCs) are maintained in the blood bank in a separate basket with transfusion forms containing the unit numbers and expiration dates and a bag with one blood tubing segment from each unit. The times to issue and to delivery to the operating room suite were compared with time to issue of 2 group O Rh-negative RBCs for other hospital locations using the older system during the same time period and with the time to issue of 2 units to all other hospital locations during the preceding 2 years. A university hospital. Time between emergency request for red cells and delivery to the operating room. The time between blood bank notification and arrival in the operating room of the 6 units of RBCs was significantly shorter than the time required to just issue (not including delivery time) 2 units of RBCs to other hospital locations. With the new procedure, 82% of units issued reached the operating room within 2 minutes of request, 91% arrived within 3 minutes, and 100% arrived within 4 minutes. These percentages are significantly higher than those for only issue of blood (without delivery) using the older issuing procedure for all hospital locations during the previous 2 years (37%, 49%, and 66%, respectively; P = .007, .009, and .02, respectively) and for other locations during the same 7-month period (29%, 46%, and 73%, respectively; P = .004, .01, and .09, respectively). Time (mean [95% confidence interval]) from blood bank notification to delivery of RBCs to the operating room suite (2.1 [1.6-2.6] minutes, of which approximately 50-60 seconds is attributable to delivery time) was less than issue times (not including delivery times) using the older issuing procedure for other hospital locations during the same period (4.1 [3.1-5.0] minutes; P = .007). An emergency issue procedure can be used to issue several units of RBCs within 1 minute and have them delivered to the operating room within 2 minutes while maintaining sufficient controls and providing required information to satisfy patient and blood bank requirements.

Sustainability in a Hospital-Based Biobank and University-Based DNA Biorepository: Strategic Roadmaps.

PubMed

Seiler, Catherine Y; Eschbacher, Jennifer; Bowser, Robert; LaBaer, Joshua

2015-12-01

Sustainability in the biobanking community has recently become an important and oft-discussed issue as biorepositories struggle to balance limited external funding and complex cost recovery models with high operating costs and the desire to provide the highest quality materials and services to the research community. A multi-faceted view of biobanking sustainability requires consideration of operational and social sustainability in addition to the historical focus exclusively on financial sustainability. Planning and implementing this three pillar model creates a well-rounded biorepository that meets the needs of all the major stakeholders: the funders, the patients/depositors, and the researcher recipients. Often the creation of a detailed business plan is the first step to develop goals and objectives that lead down a path towards sustainability. The definition of sustainability and the complexity of a sustainable business plan may differ for each biorepository. The DNASU Plasmid Repository at Arizona State University stores and distributes DNA plasmids to researchers worldwide, and the Biobank Core Facility at St. Joseph's Hospital and Barrow Neurological Institute consents patients and collects, stores, and distributes human tissue and blood samples. We will discuss these two biorepositories, their similar and different approaches to sustainability and business planning, their challenges in creating and implementing their sustainability plan, and their responses to some of these challenges. From these experiences, the biobanks share lessons learned about planning for sustainability that are applicable to all biorepositories.

Implications of demographics on future blood supply: a population-based cross-sectional study.

PubMed

Greinacher, Andreas; Fendrich, Konstanze; Brzenska, Ralf; Kiefel, Volker; Hoffmann, Wolfgang

2011-04-01

Data on blood recipients are sparse and unconnected to data on blood donors. The objective was to analyze the impact of the demographic change on future blood demand and supply in a German federal state. A population-based cross-sectional study was conducted. For all in-hospital transfused red blood cells (RBCs; n = 95,477), in the German federal state Mecklenburg-Pomerania in 2005, characteristics of the patient and the blood donor (118,406 blood donations) were obtained. Population data were used to predict blood demand and supply until 2020. By 2020 the population increase of those aged 65 years or more (+26.4%) in Mecklenburg-Pomerania will be paralleled by a decrease of the potential donor population (18-68 years; -16.1%). Assuming stable rates per age group until 2020, the demand for in-hospital blood transfusions will increase by approximately 25% (24,000 RBC units) while blood donations will decrease by approximately 27% (32,000 RBC units). The resulting, predicted shortfall is 47% of demand for in-hospital patients (56,000 RBC units). Validation using historical data (1997-2007) showed that the model predicted the RBC demand with a deviation of only 1.2%. Demographic changes are particularly pronounced in former East Germany, but by 2030 most European countries will face a similar situation. The decrease of younger age groups requires an increase of blood donation rates and interdisciplinary approaches to reduce the need for transfusion to maintain sufficient blood supply. Demography is a major determinant of future transfusion demand. All efforts should be made by Western societies to systematically obtain data on blood donors and recipients to develop strategies to meet future blood demand. © 2010 American Association of Blood Banks.

An examination of hospital satisfaction with blood suppliers.

PubMed

Carden, Robert; DelliFraine, Jami L

2004-11-01

The purpose of this study was to identify factors that predict overall hospital satisfaction with blood suppliers. The data for this study came from a 2001 satisfaction survey of hospital blood bank managers conducted by the National Blood Data Resource Center. A total of 1325 blood-utilizing hospitals were included in the final study database. The measurement of hospital satisfaction with its blood supplier encompasses the five composites of the SERVQUAL model. The five composites are 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. Linear regression was performed with overall hospital satisfaction as the dependent variable and the five composites of the SERVQUAL model and control variables as predictors of overall hospital satisfaction with blood suppliers. Significant predictors of hospital satisfaction with blood suppliers are satisfaction with medical and clinical support provided by the blood center, satisfaction with the routine delivery schedule, and price (service fee) of red cells. Prior studies have demonstrated the importance of customer satisfaction to organizations. As organizations, blood centers can benefit from improved satisfaction from their hospital customers. Blood center strategies that focus on improving these three predictors of overall hospital satisfaction with primary blood suppliers will be the most likely to improve and/or maintain hospital customer satisfaction with primary blood suppliers.

[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.

Fragmented red blood cells automated measurement is a useful parameter to exclude schistocytes on the blood film.

PubMed

Lesesve, J-F; Asnafi, V; Braun, F; Zini, G

2012-12-01

  The diagnosis of thrombotic microangiopathies (TMA) or disorders that may mimic their features remains difficult. Mechanical hemolytic anemia with the detection of shistocytes on the blood smear is a cornerstone finding to assess the diagnosis, but microscopic evaluation of shistocytes is still problematic with wide interobserver variations. Some of the latest generation automated blood cell counters (ABCC) propose an original quantitative approach of fragmented red cells (FRC), aiming to be equivalent to the microscopic count. This parameter has been poorly evaluated.   To assess the predictive value (PV) of this test, we conducted studies comparing automated and microscopic counts of FRC/schistocytes, based on the analysis of thousands samples in four university hospitals and using the 2 ABCC currently available (Siemens ADVIA series, Sysmex XE-2100). Reference range for FRC was <0.3% for the ADVIA and <0.5% for the XE-2100. The presence of FRC below a threshold determined at 1% (ADVIA and XE-2100) had a negative PV close to 100% to exclude the presence of schistocyte on the blood smear, but in relationship with a poor PV value. Our study validated the utility of the immediately available FRC parameter on ABCC to exclude schistocytes and the diagnosis of TMA. © 2012 Blackwell Publishing Ltd.

[Renal denervation for treating hypertension: experience at the University Hospital in Lyon].

PubMed

Courand, P-Y; Dauphin, R; Rouvière, O; Paget, V; Khettab, F; Bergerot, C; Harbaoui, B; Bricca, G; Fauvel, J-P; Lantelme, P

2014-06-01

We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension. Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5±11.5 years, BMI 33±5kg/m(2) and ambulatory blood pressure 157±16/87±13mmHg with 4.2±1.5 anti-hypertensive treatment. We did not observe intra-operative or early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20±15 (P<0.001) and 10±13mmHg (P=0.014) (n=17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5±14.9mmHg (P=0.027) for SBP and of 10.5±9.6mmHg (P=0.029) for DBP (n=6). Among these patients, five of them were controlled (ABPM inferior to 130/80mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4±3mm (P=0.031), Sokolow index of 3±3mm (P=0.205), Cornell voltage criterion of 9±7mm (P=0.027) and Cornell product of 1310±1104 (P=0.027). Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe. Copyright © 2014. Published by Elsevier SAS.

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

PubMed

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

2004-12-01

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

A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital

PubMed Central

Nakajima, K; Kurata, Y; Takeda, H

2005-01-01



Problem: When patient safety programs were mandated for Japanese health care institutions, a safety culture, a tool for collecting incident reports, an organizational arrangement for multidisciplinary collaboration, and interventional methods for improvement had to be established. Design: Observational study of effects of new patient safety programs. Setting: Osaka University Hospital, a large government-run teaching hospital. Strategy for change: A voluntary and anonymous web-based incident reporting system was introduced. For the new organizational structure a clinical risk management committee, a department of clinical quality management, and area clinical risk managers were established with their respective roles clearly defined to advance the plan-do-study-act cycle and to integrate efforts. For preventive action, alert procedures, staff education, ward rounds by peers, a system oriented approach for reducing errors, and various feedback channels were introduced. Effects of change: Continuous incident reporting by all hospital staff has been observed since the introduction of the new system. Several error inducing situations have been improved: wrong choice of drug in computer prescribing, maladministration of drugs due to a look-alike appearance or confusion about the manipulation of a medical device, and poor after hours service of the blood transfusion unit. Staff participation in educational seminars has been dramatically improved. Ward rounds have detected problematic procedures which needed to be dealt with. Lessons learnt: Patient safety programs based on a web-based incident reporting system, responsible persons, staff education, and a variety of feedback procedures can help promote a safety culture, multidisciplinary collaboration, and strong managerial leadership resulting in system oriented improvement. PMID:15805458

Evaluation of Mindray BC-3600 hematology analyzer in a university hospital.

PubMed

Shu, G; Lu, H; Du, H; Shi, J; Wu, G

2013-02-01

The BC-3600 Auto Hematology Analyzer (hereinafter call BC-3600) is a quantitative, automated hematology analyzer and leukocyte differential counter for In Vitro Diagnostic Use in clinical laboratories. The analyzer was evaluated and compared with the Mindray BC-3200 3-part differential (BC-3200) and Sysmex XE-2100 5-part differential (XE-2100) Hematology Analyzer in the hematology laboratory of a university hospital. The BC-3600 was evaluated according to guidelines published by Clinical and Laboratory Standards Institute (CLSI), the International Committee for Standardization in Hematology (ICSH), and Department of Food and Drug Administration (FDA). There were no background, minimal carryover (<0.5%), and excellent linearity for white blood cell (WBC), hemoglobin (Hb) level, red blood cell (RBC), and platelet (PLT) counts (r > 0.999). Precision was good at all levels for the routine cell blood count (CBC) parameters: CV% being ≤2.0, except for platelet count (PLT) at the low level with CV% of ≤5.0% and WBC at the low level with CV% of <3.0%. Correlation between the BC-3600 and BC-3200, XE-2100 were excellent (r > 0.99) for all major CBC parameters. It is concluded that the overall performance of the BC-3600 is excellent and compares well with that of BC-3200 and XE-2100. © 2012 Blackwell Publishing Ltd.

Health and Prevention Enhancement (H-PEACE): a retrospective, population-based cohort study conducted at the Seoul National University Hospital Gangnam Center, Korea.

PubMed

Lee, Changhyun; Choe, Eun Kyung; Choi, Ji Min; Hwang, Yunji; Lee, Young; Park, Boram; Chung, Su Jin; Kwak, Min-Sun; Lee, Jong-Eun; Kim, Joo Sung; Park, Sue Kyung; Cho, Sang-Heon

2018-04-19

The Health and Prevention Enhancement (H-PEACE) study was designed to investigate the association of diagnostic imaging results, biomarkers and the predisease stage of non-communicable diseases (NCDs), such as malignancies and metabolic diseases, in an average-risk population in Korea. This study enrolled a large-scale retrospective cohort at the Healthcare System Gangnam Center, Seoul National University Hospital, from October 2003 to December 2014. The baseline and follow-up information collected in the predisease stage of NCDs allows for evaluation of an individual's potential NCD risk, which is necessary for establishing personalised prevention strategies. A total of 91 336 health examinees were included in the cohort, and we repeatedly measured and collected information for 50.9% (n=46 484) of the cohort members. All participants completed structured questionnaires (lifestyle, medical history, mini-dietary assessment index, sex-specific variables and psychiatric assessment), doctors' physical examinations, laboratory blood and urine tests and digital chest X-ray imaging. For participants with available data, we also obtained information on specific diagnostic variables using advanced diagnostic tests, including coronary CT for coronary calcium scores, colonoscopy and brain MRI. Furthermore, 17 455 of the participants who provided informed consent and donated blood samples were enrolled into the Gene-environmental interaction and phenotype study, a subcohort of the H-PEACE, from October 2013, and we analysed genome-wide single-nucleotide polymorphism array data for 6579 of these blood samples. The data obtained from this cohort will be used to facilitate advanced and accurate diagnostic techniques related to NCDs while considering various phenotypes. Potential collaborators can access the dataset after receiving approval from our institutional review board. Applications can be submitted on the study homepage (http://en-healthcare.snuh.org/HPEACEstudy). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluating large-scale blood transfusion therapy for the current Ebola epidemic in Liberia.

PubMed

Gutfraind, Alexander; Meyers, Lauren Ancel

2015-04-15

To combat the 2014-2015 Ebola virus disease (EVD) epidemic in West Africa, the World Health Organization urged the rapid evaluation of convalescent whole blood (CWB) and plasma (CP) transfusion therapy. However, the feasibility and likely impacts of broad implementation of transfusions are yet unknown. We extended an Ebola virus transmission model published by the Centers for Disease Control and Prevention to include hospital-based convalescent donations and transfusions. Using recent epidemiological estimates for EVD in Liberia and assuming that convalescent transfusions reduce the case-fatality rate to 12.5% (range, 7.5%-17.5%), we projected the impacts of a countrywide ramp-up of transfusion therapy. Under the 10% case-hospitalization rate estimated for Liberia in September 2014, large-scale CP therapy is expected to save 3586 lives by October 2015 (3.1% mortality reduction; 95% confidence interval [CI], .52%-4.5%). Under a higher 30% hospitalization rate, CP transfusions are expected to save 151 lives (0.9% of the total; 95% CI, .21%-11%). Transfusion therapy for EVD is a low-cost measure that can potentially save many lives in West Africa but will not measurably influence the prevalence. Under all scenarios considered, CP transfusions are predicted to achieve greater reductions in mortality than CWB. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Typhoid fever in a Tertiary Hospital in Nigeria: Another look at the Widal agglutination test as a preferred option for diagnosis.

PubMed

Enabulele, Osahon; Awunor, Simeon Nyemike

2016-01-01

Single Widal agglutination test rather than blood culture, is commonly employed to diagnose typhoid fever in Nigeria. We took another look at the Widal agglutination test as a preferred option for diagnosis of typhoid fever by determining the specificity and sensitivity of Widal agglutination test in febrile adult patients. Two hundred and seventy-one blood samples from consecutive adults (>18 years) with febrile illness attending the General Practice Clinic of the University of Benin Teaching Hospital were tested using the Widal agglutination test, blood culture, and malaria parasite test on each sample to establish the diagnosis of typhoid fever. Of the 271 blood samples 124 (45.76%) were positive following a Widal agglutination test, 60 (22.10%) blood samples grew Salmonella organisms on blood culture while 55 (20.29%) blood samples showed a co-infection of typhoid fever and malaria. A sensitivity of 35%, specificity of 51%, positive predictive value of 17%, and a negative predictive value of 73% were observed for Widal agglutination test as a diagnostic modality for typhoid fever infection. A single Widal agglutination test is not a valid diagnostic option for typhoid fever while co-infection with malaria parasite is the preponderant microbiological finding in typhoid fever infections. The severity of malaria parasitemia is associated with positive titers on Widal test.

Typhoid fever in a Tertiary Hospital in Nigeria: Another look at the Widal agglutination test as a preferred option for diagnosis

PubMed Central

Enabulele, Osahon; Awunor, Simeon Nyemike

2016-01-01

Background: Single Widal agglutination test rather than blood culture, is commonly employed to diagnose typhoid fever in Nigeria. We took another look at the Widal agglutination test as a preferred option for diagnosis of typhoid fever by determining the specificity and sensitivity of Widal agglutination test in febrile adult patients. Materials and Methods: Two hundred and seventy-one blood samples from consecutive adults (>18 years) with febrile illness attending the General Practice Clinic of the University of Benin Teaching Hospital were tested using the Widal agglutination test, blood culture, and malaria parasite test on each sample to establish the diagnosis of typhoid fever. Results: Of the 271 blood samples 124 (45.76%) were positive following a Widal agglutination test, 60 (22.10%) blood samples grew Salmonella organisms on blood culture while 55 (20.29%) blood samples showed a co-infection of typhoid fever and malaria. A sensitivity of 35%, specificity of 51%, positive predictive value of 17%, and a negative predictive value of 73% were observed for Widal agglutination test as a diagnostic modality for typhoid fever infection. Conclusion: A single Widal agglutination test is not a valid diagnostic option for typhoid fever while co-infection with malaria parasite is the preponderant microbiological finding in typhoid fever infections. The severity of malaria parasitemia is associated with positive titers on Widal test. PMID:27397952

Emergency Blood Transfusion in Children in a Tertiary Hospital in Nigeria: Indications, Frequency and Outcome.

PubMed

Abhulimhen-Iyoha, B I; Israel-Aina, Y T

2018-01-01

Blood transfusion is a life-saving procedure in paediatric practice. It is important in replacing blood volume in cases of haemorrhage or providing specific blood components as required. However, the procedure carries some risks and complications. The decision to transfuse, frequency of transfusion and the availability of safe blood and blood products are essential determinants of the success of the procedure. Hence, knowledge of the indications and rate of transfusion is important to ensure that blood for transfusion is safe and made available as at when due. To determine the common indications for blood transfusion, the frequency of transfusion and outcome of transfused patients. Transfusion records of children admitted into the Children Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria from January 2010 to December 2011 were retrieved. Information on the patients' biodata, indications for transfusion, type of blood product and outcome were documented. Within the 24 months under review, a total of 4133 patients were admitted, out of which 655 (15.8%) were transfused. The age of the children ranged between one month and 17 years (median and modal age was 2 years). Commonest indications for transfusion were severe malaria (55.4%), sepsis (11.5%) and sickle cell anaemia [SCA] (4.0%). Whole blood constituted the highest type of blood product utilized (99.7%). Of the 655 patients transfused, 226 (34.5%) had multiple transfusions. The frequency of blood transfusion was 1.2 transfusions per day. Ninety two percent (605) of the patients were discharged from CHER while nine (1.4%) discharged against medical advice. Mortality amongst them was 6.2% (41 patients). The ages of the patients (p = 0.56, C.I. = 0.99, 1.01) and the number of blood transfusions (p = 0.66, C.I.= 0.48, 1.60) were not significant predictors of mortality. Majority of the patients were transfused following preventable disease conditions. Reduction of the burden of these conditions by good environmental hygiene, use of insecticide treated nets (ITN), indoor residual spraying (IRS), prompt hospital presentation and genetic counselling may greatly reduce the need for blood transfusion in the region.

Tonic-Clonic Activity at Subarachnoid Hemorrhage Onset: Impact on Complications and Outcome

PubMed Central

De Marchis, Gian Marco; Pugin, Deborah; Lantigua, Hector; Zammit, Christopher; Tadi, Prasanna; Schmidt, J. Michael; Falo, M. Cristina; Agarwal, Sachin; Mayer, Stephan A.; Claassen, Jan

2013-01-01

Objective Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months. Methods Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses. Results TCA at onset was described in 170 patients (11%). Patients with onset TCA were younger (P = 0.002), presented more often with poor clinical grade (55% vs. 26%, P<0.001) and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001). After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43–5.96, P<0.001), in-hospital pneumonia (OR 1.56, 95%-CI: 1.06–2.31, p = 0.02), and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21–2.58, P = 0.003). At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume. Conclusions Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months. PMID:23951155

Integrated cluster- and case-based surveillance for detecting stage III zoonotic pathogens: an example of Nipah virus surveillance in Bangladesh.

PubMed

Naser, A M; Hossain, M J; Sazzad, H M S; Homaira, N; Gurley, E S; Podder, G; Afroj, S; Banu, S; Rollin, P E; Daszak, P; Ahmed, B-N; Rahman, M; Luby, S P

2015-07-01

This paper explores the utility of cluster- and case-based surveillance established in government hospitals in Bangladesh to detect Nipah virus, a stage III zoonotic pathogen. Physicians listed meningo-encephalitis cases in the 10 surveillance hospitals and identified a cluster when ⩾2 cases who lived within 30 min walking distance of one another developed symptoms within 3 weeks of each other. Physicians collected blood samples from the clustered cases. As part of case-based surveillance, blood was collected from all listed meningo-encephalitis cases in three hospitals during the Nipah season (January-March). An investigation team visited clustered cases' communities to collect epidemiological information and blood from the living cases. We tested serum using Nipah-specific IgM ELISA. Up to September 2011, in 5887 listed cases, we identified 62 clusters comprising 176 encephalitis cases. We collected blood from 127 of these cases. In 10 clusters, we identified a total of 62 Nipah cases: 18 laboratory-confirmed and 34 probable. We identified person-to-person transmission of Nipah virus in four clusters. From case-based surveillance, we identified 23 (4%) Nipah cases. Faced with thousands of encephalitis cases, integrated cluster surveillance allows targeted deployment of investigative resources to detect outbreaks by stage III zoonotic pathogens in resource-limited settings.

Blood Culture Testing via a Mobile App That Uses a Mobile Phone Camera: A Feasibility Study

PubMed Central

Chong, Yong Pil; Jang, Seongsoo; Kim, Mi Na; Kim, Jeong Hoon; Kim, Woo Sung

2016-01-01

Background To evaluate patients with fever of unknown origin or those with suspected bacteremia, the precision of blood culture tests is critical. An inappropriate step in the test process or error in a parameter could lead to a false-positive result, which could then affect the direction of treatment in critical conditions. Mobile health apps can be used to resolve problems with blood culture tests, and such apps can hence ensure that point-of-care guidelines are followed and processes are monitored for blood culture tests. Objective In this pilot project, we aimed to investigate the feasibility of using a mobile blood culture app to manage blood culture test quality. We implemented the app at a university hospital in South Korea to assess the potential for its utilization in a clinical environment by reviewing the usage data among a small group of users and by assessing their feedback and the data related to blood culture sampling. Methods We used an iOS-based blood culture app that uses an embedded camera to scan the patient identification and sample number bar codes. A total of 4 medical interns working at 2 medical intensive care units (MICUs) participated in this project, which spanned 3 weeks. App usage and blood culture sampling parameters (including sampler, sampling site, sampling time, and sample volume) were analyzed. The compliance of sampling parameter entry was also measured. In addition, the participants’ opinions regarding patient safety, timeliness, efficiency, and usability were recorded. Results In total, 356/644 (55.3%) of all blood culture samples obtained at the MICUs were examined using the app, including 254/356 (71.3%) with blood collection volumes of 5-7 mL and 256/356 (71.9%) with blood collection from the peripheral veins. The sampling volume differed among the participants. Sampling parameters were completely entered in 354/356 cases (99.4%). All the participants agreed that the app ensured good patient safety, disagreed on its timeliness, and did not believe that it was efficient. Although the bar code scanning speed was acceptable, the Wi-Fi environment required improvement. Moreover, the participants requested feedback regarding their sampling quality. Conclusions Although this app could be used in the clinical setting, improvements in the app functions, environment network, and internal policy of blood culture testing are needed to ensure hospital-wide use. PMID:27784649

Blood Culture Testing via a Mobile App That Uses a Mobile Phone Camera: A Feasibility Study.

PubMed

Lee, Guna; Lee, Yura; Chong, Yong Pil; Jang, Seongsoo; Kim, Mi Na; Kim, Jeong Hoon; Kim, Woo Sung; Lee, Jae-Ho

2016-10-26

To evaluate patients with fever of unknown origin or those with suspected bacteremia, the precision of blood culture tests is critical. An inappropriate step in the test process or error in a parameter could lead to a false-positive result, which could then affect the direction of treatment in critical conditions. Mobile health apps can be used to resolve problems with blood culture tests, and such apps can hence ensure that point-of-care guidelines are followed and processes are monitored for blood culture tests. In this pilot project, we aimed to investigate the feasibility of using a mobile blood culture app to manage blood culture test quality. We implemented the app at a university hospital in South Korea to assess the potential for its utilization in a clinical environment by reviewing the usage data among a small group of users and by assessing their feedback and the data related to blood culture sampling. We used an iOS-based blood culture app that uses an embedded camera to scan the patient identification and sample number bar codes. A total of 4 medical interns working at 2 medical intensive care units (MICUs) participated in this project, which spanned 3 weeks. App usage and blood culture sampling parameters (including sampler, sampling site, sampling time, and sample volume) were analyzed. The compliance of sampling parameter entry was also measured. In addition, the participants' opinions regarding patient safety, timeliness, efficiency, and usability were recorded. In total, 356/644 (55.3%) of all blood culture samples obtained at the MICUs were examined using the app, including 254/356 (71.3%) with blood collection volumes of 5-7 mL and 256/356 (71.9%) with blood collection from the peripheral veins. The sampling volume differed among the participants. Sampling parameters were completely entered in 354/356 cases (99.4%). All the participants agreed that the app ensured good patient safety, disagreed on its timeliness, and did not believe that it was efficient. Although the bar code scanning speed was acceptable, the Wi-Fi environment required improvement. Moreover, the participants requested feedback regarding their sampling quality. Although this app could be used in the clinical setting, improvements in the app functions, environment network, and internal policy of blood culture testing are needed to ensure hospital-wide use.

Utility of blood cultures in children admitted to hospital with community-acquired pneumonia.

PubMed

Davis, Tessa R; Evans, Hannah R; Murtas, Jennifer; Weisman, Aimee; Francis, J Lynn; Khan, Ahmed

2017-03-01

The aim of the study was to assess the utility of blood cultures in children admitted to hospital with community-acquired pneumonia. The primary outcome was the number of positive blood culture results, and secondary outcomes included the effect of positive blood culture results on management, and the identification of other clinical/biochemical variables that could predict blood culture results or the course of illness. A retrospective data analysis was carried out on all children admitted to Gosford Hospital during the 2-year period from July 2013 to June 2015. Included were patients under 16 years old who had a diagnosis-related group code of pneumonia. A review of blood culture results, chest X-ray, serology, C-reactive protein and white cell count and clinical outcomes were analysed. There were 215 paediatric admissions with a diagnosis of pneumonia during the 2-year study period. A blood culture was collected in 82.3% (177/215). Although seven had a positive blood culture, only two of these were finally reported as true positives and both were Streptococcus pneumoniae. Both patients were treated with a cephalosporin and demonstrated clinical improvement. No changes were made to their treatment based on the blood culture results. Blood cultures have a low yield and do not appear to be helpful when collected in all patients admitted to hospital with community-acquired pneumonia. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Effect of postmortem sampling technique on the clinical significance of autopsy blood cultures.

PubMed

Hove, M; Pencil, S D

1998-02-01

Our objective was to investigate the value of postmortem autopsy blood cultures performed with an iodine-subclavian technique relative to the classical method of atrial heat searing and antemortem blood cultures. The study consisted of a prospective autopsy series with each case serving as its own control relative to subsequent testing, and a retrospective survey of patients coming to autopsy who had both autopsy blood cultures and premortem blood cultures. A busy academic autopsy service (600 cases per year) at University of Texas Medical Branch Hospitals, Galveston, Texas, served as the setting for this work. The incidence of non-clinically relevant (false-positive) culture results were compared using different methods for collecting blood samples in a prospective series of 38 adult autopsy specimens. One hundred eleven adult autopsy specimens in which both postmortem and antemortem blood cultures were obtained were studied retrospectively. For both studies, positive culture results were scored as either clinically relevant or false positives based on analysis of the autopsy findings and the clinical summary. The rate of false-positive culture results obtained by an iodine-subclavian technique from blood drawn soon after death were statistically significantly lower (13%) than using the classical method of obtaining blood through the atrium after heat searing at the time of the autopsy (34%) in the same set of autopsy subjects. When autopsy results were compared with subjects' antemortem blood culture results, there was no significant difference in the rate of non-clinically relevant culture results in a paired retrospective series of antemortem blood cultures and postmortem blood cultures using the iodine-subclavian postmortem method (11.7% v 13.5%). The results indicate that autopsy blood cultures obtained using the iodine-subclavian technique have reliability equivalent to that of antemortem blood cultures.

Single site laparoscopy for fertility preservation: a cohort study.

PubMed

Núñez Valera, María José; Padilla Iserte, Pablo; Higueras García, Gema; Herraiz, Sonia; Rubio, José María; Romeu Villarroya, Mónica; Pellicer, Antonio; Díaz-García, César

2015-02-01

To compare operative and postoperative results of ovarian cortex retrieval by conventional laparoscopy (1cm umbilical site and 3 accessory 5-mm-reusable working ports) (HASS) versus single site laparoscopy (SSL). Prospective cohort study. Fertility Preservation Programme at La Fe University Hospital-University of Valencia, Valencia, Spain, 2011 to 2012. Fertility Preservation Programme at La Fe University Hospital of Valencia, Valencia, Spain. Twenty-one patients with cancer (breast cancer: n = 17; Hodgkin's lymphoma: n = 3; and non-Hodgkin's lymphoma: n = 1). Ovarian cortex retrieval either by conventional laparoscopy using an umbilical Hasson port and 3 accessory ports (HASS group: n = 11) or by SSL (SSL group: n = 10). Operative length, blood loss, postoperative pain (visual analog scale for pain at 6, 24, and 48 hours), need of additional analgesia, quality of life (European Quality of Life-5 Dimensions), cosmesis of the scar, and patient's self-perception were assessed at 24 and 48 hours and 3 months after surgery. Baseline characteristics were similar between groups. Estimated blood loss, operative length, and postoperative pain did not differ between groups. The start of chemotherapy was not delayed in either group, and cosmesis and image self-perception were also similar. The SSL approach can be considered a safe option compared with the classic multisite approach. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data.

PubMed

Prasad, Priya A; Shea, Erica R; Shiboski, Stephen; Sullivan, Mary C; Gonzales, Ralph; Shimabukuro, David

2017-08-01

Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS). Sepsis intervention bundle elements included measurement of blood lactate; drawing of blood cultures before starting antibiotics; initiation of broad spectrum antibiotics within 3 hours of sepsis presentation in the emergency department or 1 hour of presentation on an inpatient unit; administration of intravenous fluid bolus if the patient was hypotensive or had a lactate level >4 mmol/L; and starting intravenous vasopressors if the patient remained hypotensive after fluid bolus administration. Poisson regression for a binary outcome variable was used to estimate an adjusted incidence-rate ratio (IRR) comparing mortality in groups defined by bundle compliance measured as a binary predictor, and to estimate an adjusted number needed to treat (NNT). Complete bundle compliance was associated with a 31% lower risk of mortality (adjusted IRR, 0.69, 95% confidence interval [CI], 0.53-0.91), adjusting for SS/SS presentation in the emergency department, SS/SS present on admission (POA), age, admission severity of illness and risk of mortality, Medicaid/Medicare payor status, immunocompromised host status, and congestive heart failure POA. The adjusted NNT to save one life was 15 (CI, 8-69). Other factors independently associated with mortality included SS/SS POA (adjusted IRR, 0.55; CI, 0.32-0.92) and increased age (adjusted IRR, 1.13 per 10-year increase in age; CI, 1.03-1.24). The University of California, San Francisco, sepsis bundle was associated with a decreased risk of in-hospital mortality across hospital units after robust control for confounders and risk adjustment. The adjusted NNT provides a reasonable and achievable goal to observe measureable improvements in outcomes for patients diagnosed with SS/SS.

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.

[From the medieval hospitals hospices to modern National public Health Institutes].

PubMed

de Micheli, Alfredo

2016-01-01

Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the xvii century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

[Acute ethanol intoxication among children and adolescents. A retrospective analysis of 173 patients admitted to a university children hospital].

PubMed

Schöberl, S; Nickel, P; Schmutzer, G; Siekmeyer, W; Kiess, W

2008-01-01

In the last time the alcohol consumption among children and adolescents is a big theme in all kind of media. The ethanol consumption among children and adolescents has risen during the last years, but also new hazardous drinking patterns like "binge-drinking" are increasing. These drinking episodes are responsible for many hospital presentations of children and adolescents with acute ethanol intoxication. This study is a retrospective analysis of 173 patients admitted to the university children hospital of Leipzig due to acute ethanol intoxication during the period 1998-2004. Investigated parameters were: socio-demographic factors, clinical presentation and management as well as quantity and type of alcohol. During the years 1998-2004 the rate of alcohol intoxicated patients in this study increased, from 1998-2003 at about 171.4%. Totally 173 patients with an average age of 14.5 years were admitted to the university children hospital. There were significantly more boys than girls. The mean blood alcohol concentration of these patients was 1.77%. Some of the patients had severe symptoms. 62 were unconscious, 2 were in coma and at least 3 patients had to be ventilated. A difference between socioeconomic groups could be observed by comparing the different school types. 44.8% of the patients went to the middle school. Furthermore 17 patients of this study had mental disorders or psychosocial problems and were therefore in psychological or psychiatric treatment. In this study a significant influence of social classes or psychosocial problems on alcohol consumption such as binge-drinking leading to acute ethanol intoxication could not be found. Alarming is the increasing number of ethanol intoxicated patients, the young age, the high measured blood ethanol concentrations and the severe symptoms of these patients. This is the reason why early and intensive prevention strategies are required.

[Present status of critical hemorrhage and its management in the operating room].

PubMed

Irita, Kazuo

2014-12-01

Hemorrhage is a major cause of cardiac arrest in the operating room. Many human factors, including surgical procedures, transfusion practices, blood supply, and anesthetic management, are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital-based regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations with simulated drills. If intraoperative hemorrhage may become critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether or not a hospital can establish a procedure to deal with it depends on the overall capability of critical and crisis management of the hospital. (Review).

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.

The use of CellaVision competency software for external quality assessment and continuing professional development.

PubMed

Horiuchi, Yuki; Tabe, Yoko; Idei, Mayumi; Bengtsson, Hans-Inge; Ishii, Kiyoshi; Horii, Takashi; Miyake, Kazunori; Satoh, Naotake; Miida, Takashi; Ohsaka, Akimichi

2011-07-01

Quality assessment of blood cell morphological testing, such as white blood cell (WBC) differential and its interpretation, is one of the most important and difficult assignments in haematology laboratories. A monthly survey was performed to assess the possible role of the proficiency testing program produced by CellaVision competency software (CCS) in external quality assessment (EQA) of the clinical laboratories of affiliated university hospitals and the effective utilisation of this program in continuing professional development (CPD). Four monthly proficiency surveys were conducted in collaboration with four clinical laboratories affiliated with the teaching hospitals of Juntendo University of Medicine in Japan. EQA results by the CCS proficiency testing program revealed a difference of performance levels of WBC differential and morphological interpretation and a discrepancy in the WBC differential criteria among laboratories. With regard to the utilisation of this proficiency program as a tool for CPD, this program successfully improved the performance of the low-scoring laboratories and less experienced individuals. The CCS proficiency testing program was useful for the quality assessment of laboratory performance, for education, and for the storage and distribution of cell images to be utilised for further standardisation and education.

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.

Cord blood collection for banking and the risk of maternal hemorrhage.

PubMed

Amat, Lluís; Sabrià, Joan; Martínez, Eva; Rodríguez, Núria L; Querol, Sergio; Lailla, Josep M

2011-09-01

We determined the effect of cord blood collection before placental expulsion on postpartum maternal blood loss in a retrospective study between a group of cord blood donors and a group of non-donors. The study was conducted in a university hospital blood bank and obstetric services and included Spanish women entered in a European study project (EUPHRATES) and who had consented to donate cord blood for public banking purposes. We measured blood volume lost during delivery by a bag collection method, as well as the need for transfusion and postpartum anemia symptoms. Deliveries at which cord blood was collected presented a significant increase in blood loss (321 ± 273 vs. 255 ± 237 ml, p=0.02). Instrumental deliveries were associated with higher postpartum blood loss than spontaneous deliveries. Cord blood collection can increase intrapartum blood loss, especially at instrumental deliveries. Additional staff who handle the collection are required to allow the leading clinician to focus on maternal care. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

PubMed

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

The effect of storage on ammonia, cytokine, and chemokine concentrations in feline whole blood.

PubMed

Cummings, Katherine A; Abelson, Amanda L; Rozanski, Elizabeth A; Sharp, Claire R

2016-09-01

To determine if the concentrations of ammonia and inflammatory mediators in feline stored whole blood (SWB) increase with duration of storage. Prospective ex vivo study. University Teaching Hospital. Thirteen cats, recruited from the hospital feline donor pool, deemed healthy based on the predonation donor screening process. One unit (30 mL) of whole blood was collected from 13 unique blood donor cats, anticoagulated with citrate-phosphate-dextrose, and stored at 4°C. Concentrations of ammonia, interleukin (IL) 6, and IL-10 were measured in 5 units weekly for 4 weeks. Presence of chemokine ligand (CXCL) 8 was measured weekly in 8 other units in the same manner. The ammonia concentration increased nonlinearly with duration of storage, from a median of 48 μmol/L (range 25-74 μmol/L) on day 0 and 417 μmol/L (324-457 μmol/L) on day 28. IL-6 and IL-10 concentrations were below the lower limits of detection of the assay used (IL-6 < 31.2 pg/mL and IL-10 < 125 pg/mL). CXCL-8 was detected in 4 of 8 SWB units at all time points. Ammonia concentration increases with storage time in feline SWB. The clinical significance of this finding is yet to be determined. The presence of the proinflammatory chemokine CXCL-8 in feline SWB warrants further research to determine whether it can incite an inflammatory response in the recipient. Further research evaluating the epidemiology of transfusion reactions in cats should evaluate the effect of unit age, and should include the possible impact of the presence of CXCL-8. © Veterinary Emergency and Critical Care Society 2016.

Invasive Bacterial Pathogens and their Antibiotic Susceptibility Patterns in Jimma University Specialized Hospital, Jimma, Southwest Ethiopia.

PubMed

Zenebe, Tizazu; Kannan, Subbaram; Yilma, Daniel; Beyene, Getenet

2011-03-01

Presence of microorganisms in the circulating blood whether continuously or intermittently is a threat to every organ in the body. Approximately 200,000 cases of bacteraemia occur annually with mortality rates ranging from 20-50%. Early diagnosis and appropriate treatment of these infections can make the difference between life and death. The aim of the present study was to determine the bacterial flora of the blood stream infections and their antibiotic susceptibility pattern. A cross sectional study was conducted on 260 adult febrile patients in Jimma University Specialized Hospital from 27 October 2009 to 26 March 2010. The positive blood cultures were examined and the organisms were identified as per standard procedures. Antimicrobial testing was performed for all isolates by disk diffusion techniques, according to Clinical Laboratory Standards Institute guide lines. The data was analyzed using SPSS for windows version 16 and Microsoft Office Excel. From the total of two hundred sixty blood specimens only 23(8.8%) were positive to seven different types of bacteria. The isolated bacteria were: Coagulase negative staphylococci 6(26.1%), S. aureus 5 (21.7%), S. pyogens 3 (13.0%), E. coli 4(17.4%), K. pneumoniae 3(13.0%), Salmonella spp. 1(4.3%), and Citrobacter spp. 1(4.3%). The isolates showed high rates of resistance to most antibiotics tested. The range of resistance for gram positive bacteria were 0% to 85.7%, and for gram negative from 0% to 100%. None of the isolates were resistance to ciprofloxacin and ceftriaxone. Our study result showed the presence of invasive bacterial pathogens with high rate of resistance to most commonly used antibiotics used to treat bacterial infections. Therefore, timely investigation of bacterial flora of the blood stream infections and monitoring of their antibiotic resistance pattern plays an important role in reduction of the incidence of blood stream infections.

Effect of modifying the information and training structure on the occupational safety of health care workers in exposure to blood and body fluids: A quasi-experimental study.

PubMed

Sarbaz, Masoumeh; Kimiafar, Khalil; Taherzadeh, Zhila; Naderi, HamidReza; Eslami, Saeid

2017-01-01

This study was a quasi-experimental design to assess the effect of a Web-based information system on the occupational exposure to blood and body fluids (BBFs) among health care workers (HCWs). The outcome was the number of exposure incidents with BBFs among HCWs in both hospital A (intervention) and hospital B (control). The findings showed that the implementation of the Web-based information system about infection prevention and control in hospital A decreased exposure incidents with BBFs among the HCWs (P < .001). Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Prevalence of glucose-6-phosphate dehydrogenase deficiency in neonates in Egypt.

PubMed

Elella, Soheir Abo; Tawfik, Mahaa; Barseem, Naglaa; Moustafa, Wafaa

2017-01-01

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disorder which causes neonatal jaundice in most cases, and under certain conditions, can cause a spectrum of hemolytic manifestations. To determine the local prevalence of G6PD deficiency in newborns. Cross-sectional. University hospital. Infants born during 2015 were prospectively screened for G6PD deficiency. Dried blood spot samples on filter paper were collected in collaboration with the central laboratories of the Ministry of Health. Quantitative measurement of G6PD enzyme activity was measured from the blood samples using fluorometric analysis. A value.

"I go I die, I stay I die, better to stay and die in my house": understanding the barriers to accessing health care in Timor-Leste.

PubMed

Price, Jennifer A; Soares, Ana I F Sousa; Asante, Augustine D; Martins, Joao S; Williams, Kate; Wiseman, Virginia L

2016-09-30

Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres. Communication was in the local language, Tetum, using a pre-tested interview schedule. Approval was obtained from community and national stakeholders, with written consent from participants. Lack of patient transport is the critical cross-cutting issue preventing access to hospital care. Without it, many communities resort to carrying patients by porters or on horseback, walking or paying for (unaffordable) private arrangements to reach hospital, or opt for home-based care. Other significant out-of-pocket expenses for hospital visits were blood supplies from private suppliers; accommodation and food for the patient and family members; and repatriation of the deceased. Entrenched nepotism and hospital staff denigrating patients' hygiene and personal circumstances were also widely reported. Consequently, some respondents asserted they would never return to hospital, others delayed seeking treatment or interrupted their treatment to return home. Most considered traditional medicine provided an affordable, accessible and acceptable substitute to hospital care. Obtaining a referral for higher level care was not a significant barrier to gaining access to hospital care. Onerous physical, financial and socio-cultural barriers are preventing or discouraging people from accessing hospital care in Timor-Leste. Improving access to quality primary health care at the frontline is a key strategy for ensuring universal access to health care, pursued alongside initiatives to overcome the multi-faceted barriers to hospital care experienced by the vulnerable. Improving the availability and functioning of patient transport services, provision of travel subsidies to patients and their families and training hospital staff in standards of professional care are some options available to government and donors seeking faster progress towards universal health coverage in Timor-Leste.

Using in situ simulation to evaluate operational readiness of a children's hospital-based obstetrics unit.

PubMed

Ventre, Kathleen M; Barry, James S; Davis, Deborah; Baiamonte, Veronica L; Wentworth, Allen C; Pietras, Michele; Coughlin, Liza; Barley, Gwyn

2014-04-01

Relocating obstetric (OB) services to a children's hospital imposes demands on facility operations, which must be met to ensure quality care and a satisfactory patient experience. We used in situ simulations to prospectively and iteratively evaluate operational readiness of a children's hospital-based OB unit before it opened for patient care. This project took place at a 314-bed, university-affiliated children's hospital. We developed 3 full-scale simulation scenarios depicting a concurrent maternal and neonatal emergency. One scenario began with a standardized patient experiencing admission; the mannequin portrayed a mother during delivery. We ran all 3 scenarios on 2 dates scheduled several weeks apart. We ran 2 of the scenarios on a third day to verify the reliability of key processes. During the simulations, content experts completed equipment checklists, and participants identified latent safety hazards. Each simulation involved a unique combination of scheduled participants who were supplemented by providers from responding ancillary services. The simulations involved 133 scheduled participants representing OB, neonatology, and anesthesiology. We exposed and addressed operational deficiencies involving equipment availability, staffing, interprofessional communication, and systems issues such as transfusion protocol failures and electronic order entry challenges. Process changes between simulation days 1 to 3 decreased the elapsed time between transfusion protocol activation and blood arrival to the operating room and labor/delivery/recovery/postpartum setting. In situ simulations identified multiple operational deficiencies on the OB unit, allowing us to take corrective action before its opening. This project may guide other children's hospitals regarding care processes likely to require significant focus and possible modification to accommodate an OB service.

Nurses' readiness for evidence-based practice at Finnish university hospitals: a national survey.

PubMed

Saunders, Hannele; Stevens, Kathleen R; Vehviläinen-Julkunen, Katri

2016-08-01

The aim of this study was to determine nurses' readiness for evidence-based practice at Finnish university hospitals. Although systematic implementation of evidence-based practice is essential to effectively improving patient outcomes and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' individual and organizational readiness for evidence-based practice. Although nurses' evidence-based practice competencies have been widely studied in countries leading the evidence-based practice movement, less is known about nurses' readiness for evidence-based practice in the non-English-speaking world. A cross-sectional descriptive survey design. The study was conducted in November-December 2014 in every university hospital in Finland with a convenience sample (n = 943) of practicing nurses. The electronic survey data were collected using the Stevens' Evidence-Based Practice Readiness Inventory, which was translated into Finnish according to standardized guidelines for translation of research instruments. The data were analysed using descriptive and inferential statistics. Nurses reported low to moderate levels of self-efficacy and low levels of evidence-based practice knowledge. A statistically significant, direct correlation was found between nurses' self-efficacy in employing evidence-based practice and their actual evidence-based practice knowledge level. Several statistically significant differences were found between nurses' socio-demographic variables and nurses' self-efficacy in employing evidence-based practice, and actual and perceived evidence-based practice knowledge. Finnish nurses at university hospitals are not ready for evidence-based practice. Although nurses are familiar with the concept of evidence-based practice, they lack the evidence-based practice knowledge and self-efficacy in employing evidence-based practice required for integrating best evidence into clinical care delivery. © 2016 John Wiley & Sons Ltd.

Knowledge and behavior towards voluntary blood donation among students of a tertiary institution in Nigeria.

PubMed

Salaudeen, A G; Odeh, E

2011-01-01

Blood donation is the only way of acquiring blood to meet emergency requirements in cases of road traffic accidents, complications of pregnancy and childbirth, various anemic disorders and surgical emergencies among others. Globally, 80 million units of blood are donated each year, but only two million units are donated in sub-Saharan Africa where the need is enormous. The objective of this study was to determine the behavior of the students of a tertiary institution in Nigeria towards voluntary blood donation. This is a descriptive cross-sectional study, which involved students of a tertiary institution in Nigeria. A multistage sampling technique was employed in selecting the participants for this study. A semi-structured self-administered questionnaire was used to collect information on socio-demographic characteristics, knowledge, attitude and factors affecting voluntary blood donation. The data obtained were analyzed using EPI-INFO 2005 software Version 3.3.2. Less than two-thirds (61%) of total respondents had good knowledge of blood donation. More than three quarters (85%) of the respondents had never donated blood. Of the 15% that had donated, only 3% donated voluntarily. Among those that had ever donated, males (57%) were more than females. Many of the donors donated for relatives (57%). The majority of the respondents were compelled to donate because of emergency situations (75%). The reasons why many did not donate were lack of opportunity (45%) due to tight lecture schedule and inadequate knowledge (24%). Gift items such as hematinics, T-shirts and wrist bands (29%) would motivate respondents to donate. The Students' Union body and other Organizations in the University should include a blood donation drive in their monthly/annual activities. The University authorities, the University health service centre and the Hematology Department of the Teaching hospital should collaborate in promoting voluntary blood donation among the students.

Knowing blood donation surroundings: Implications for nurse service in hemotherapy.

PubMed

Silva, Gilce Erbe de Miranda; Valadares, Glaucia Valente

2015-01-01

The study aims at discussing the significations apprehended by the non-blood donators, considering the context and the consequences of the acting of the nurse in hemotherapy. It is a qualitative approach, with theoretical frame of Symbolic Interactionism and Grounded Theory method. The data production was carried out by intensive interview with subjects of three sample groups of a University Hospital of Rio de Janeiro City. The phenomenon originated two analysis categories: "Perceiving the blood matter" and "Reflecting about the blood donation campaigns". It was observed that the environment of the donor is not composed by contact with the other and the information that it can achieve, including the media. These were the main basis for the knowledge of blood donation according to their beliefs, culture and values. Therefore, all these aspects must be considered by the nurse acting on donors capture.

Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial.

PubMed

Shamim, Muhammad

2009-08-01

This prospective, double-blind, randomized, controlled trial was designed to compare the outcome of diathermy incisions versus scalpel incisions in general surgery. A total of 369 patients who underwent diathermy incision (group A: 185 patients) or scalpel incision (group B: 184 patients) were analyzed. Variables analyzed were: surgical wound classification, length and depth of incision, incision time, duration of operation, incisional blood loss, postoperative pain, duration of hospital stay, duration of healing, and postoperative complications. The inclusion criteria were all patients who underwent elective or emergency general surgery. The exclusion criteria were only cases with incomplete patients' data and patients who were lost to follow-up. This study was conducted at Fatima Hospital-Baqai Medical University and Shamsi Hospital (Karachi), from January 2006 to December 2007. Incision time was significantly longer for patients in group B (p = 0.001). Incisional blood loss also was more for patients in group B (p = 0.000). Pain perception was found to be markedly reduced during the first 48 h in group A (p = 0.000). Total period of hospital stay (p = 0.129) and time for complete wound healing (p = 0.683) were almost the same for both groups. Postoperative complication rate by wound classification did not differ markedly between the two groups (p = 0.002 vs. p = 0.000). Diathermy incision has significant advantages compared with the scalpel because of reduced incision time, less blood loss, & reduced early postoperative pain.

The current state of genetic counseling and newborn screening: an interview with Megan Tucker

PubMed Central

Tucker, Megan

2017-01-01

Megan Tucker talks to Francesca Lake, Managing Editor: A certified genetic counselor for over 10 years, Megan is currently the director of the Indiana State University Genetic Counseling Graduate Program and the Genetic Counseling Clinic at Union Hospital (Terre Haute, IN, USA). She began her career split between the Center for Prenatal Diagnosis and the Medical Genetics and Neurodevelopmental Center at St Vincent Hospital (Indianapolis, IN, USA). During this time she was instrumental in both the development of the statewide Perinatal Loss Evaluation Program and a hospital protocol to ensure collection of cord blood to allow time to effectively genetically evaluate babies. Her current clinical focus is in cancer and psychiatric genetic counseling. PMID:28883988

[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.

Measuring job stress among hospital nurses: an attempt to identify biological markers.

PubMed

Kawaguchi, Yoshichika; Toyomasu, Kouji; Yoshida, Noriko; Baba, Kaori; Uemoto, Masaharu; Minota, Shoichi

2007-02-01

The purpose of this study was to identify biological markers corresponding to job stress among hospital nurses. The subjects of this study were 128 nurses working at a university hospital. The NIOSH job stress questionnaire and the Miki Nurse Stressor 35-item Scale measured their job stress levels. The GHQ28 was also used to measure the subjects' general mental health status. Blood analyses for neuroendocrine function and immunity reaction were performed in order to identify biological markers of job stress. Stress is related to the plasma levels of catecholamine, cortisol, adrenocorticotrophic hormone, and natural killer cell activity, therefore these factors were measured accordingly. In consideration to circadian rhythms, blood was collected from the subjects prior to the start of the day shift. The nurses filled out the questionnaires on the day of the blood tests. In order to investigate the correlation between job stress reactions indicated by the questionnaires and the results of the blood tests, we utilized Pearson's correlation coefficient and partial correlation coefficient for which other affected items were controlled. In this study, significant correlations were found between job stress and biological factors; however, the correlations were not strong. Thus, it can be said that the biological markers associated with a specific kind of job stress remain unclear. In the future, rather than implementing a simple cross-sectional study, a longitudinal study including follow-up research will be more effective in establishing biological markers for job stress.

Hepatitis B vaccination status among healthcare workers in a tertiary care hospital in Tripoli, Libya.

PubMed

Ziglam, Hisham; El-Hattab, Mabrouk; Shingheer, Noura; Zorgani, Abdulaziz; Elahmer, Omar

2013-08-01

The prevalence of hepatitis B virus (HBV) among healthcare workers (HCWs) in hospitals in developing countries is high. However, the vaccination status of these workers and its relationship with occupational factors are not well documented. The aim of this study was to evaluate the susceptibility of HCWs to HBV infection in the representative Tripoli Central Hospital in Libya and prepare a practical guideline to protect HCWs from occupational exposure. In this cross-sectional study, a questionnaire survey was administered to 2705 healthcare workers of a university hospital in Tripoli. The questionnaire included vaccination status. Compliance with preventive practices against HBV infection was also assessed. The overall vaccination coverage (anti-HBs) was 78.1%. Furthermore, 82.6% of HCWs had received at least one dose of vaccine, but only 72% reported that they were fully vaccinated. The prevalence of hepatitis B surface antigen was 1.1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 17.3%. HCWs at hospitals are frequently exposed to blood-borne infections. Vaccines should be more readily available for Libyan HCWs, and current vaccination programs should be enforced. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

An echo to Choosing Wisely® in Switzerland

PubMed Central

Chok, Lionel; Debrunner, Johann; Jaeggli, Sandra; Kusic, Karmen; Bachli, Esther B

2018-01-01

Background Inspired by the US Choosing Wisely®, in 2016 the Swiss Society of General Internal Medicine released a list of five treatments or diagnostic tests used in the hospital and considered unnecessary based on not improving patient care and adding to health care costs. These “Smarter Medicine” recommendations were implemented in the Department of Internal Medicine, Uster Hospital, in August 2016. They were supported by lectures and weekly email communications. We analyzed the number of blood draws before and after implementation of the recommendation aimed at reducing blood tests. Methods This retrospective analysis was conducted in the Department of Internal Medicine, Uster Hospital, Canton of Zurich, Switzerland. Patients hospitalized in the 3 months before and after implementation were analyzed. Results A total of 2023 hospitalizations were analyzed. There was a significant decrease in the number of blood draws after introduction of the recommendation: before implementation, the median number of blood draws per patient was 4 (interquartile range [IQR], 2–7); after implementation, the median was 4 (IQR, 2–6; P = 0.002). Indeed, since 46% of the patients in the first group had more than four blood tests, this ratio decreased to 39% after implementation. Discussion Inappropriate blood draws may lead to anemia, patient discomfort and false-positive results. The simple and low-cost interventions used to implement “Smarter Medicine” have changed physician behavior by reducing the number of blood orders. These results are promising. Whether such recommendations will impact patient and clinical outcomes remains unknown; hence, further studies are needed to clarify this issue. PMID:29765244

Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network.

PubMed

Cumming, Melissa; Osinski, Anthony; O'Hearn, Lynne; Waksmonski, Pamela; Herman, Michele; Gordon, Deborah; Griffiths, Elzbieta; Knox, Kim; McHale, Eileen; Quillen, Karen; Rios, Jorge; Pisciotto, Patricia; Uhl, Lynne; DeMaria, Alfred; Andrzejewski, Chester

2017-02-01

A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements. Users of the NHSN Hemovigilance Module adhere to specified data entry guidelines, resulting in data that are comparable and standardized. Keys to successful statewide adoption of this reporting method include the fostering of strong partnerships with local hemovigilance champions and experts, engagement of regulatory and epidemiology divisions at the state health department, the leveraging of existing relationships with hospital NHSN administrators, and the existence of a regulatory deadline for implementation. Although limitations exist, successful implementation of statewide use of the NHSN Hemovigilance Module for hospital blood bank reporting is possible. The result is standardized, actionable data at both the hospital and state level that can facilitate interfacility comparisons, benchmarking, and opportunities for practice improvement. © 2016 AABB.

A Hospital Local Area Communication Network—The First Year's Experience

PubMed Central

Simborg, D. W.; Chadwick, M.; Whiting-O'Keefe, Q. E.; Tolchin, S. G.; Stewart, R. L.; Kahn, S. A.; Bergan, E. S.; Gafke, G. P.

1982-01-01

A local area communications network has been implemented at the University of California, San Francisco Hospital to integrate major components of the hospital's information system. This microprocessor-based network technology was developed by The Applied Physics Laboratory of the Johns Hopkins University. The first year's experience has demonstrated the basic feasibility of this technology in simplifying the integration of diverse hardware and software systems. Four minicomputer-based UCSF systems now use the network to synchronize key patient identification and registration information among the systems. Clinical uses of the network will begin during the second year of the project.

An academic-based hospital donor site: do physicians donate blood?

PubMed

Kanner, William A; Jeffus, Susanne; Wehrli, Gay

2009-01-01

The objectives of this prospective, cross-sectional study were to characterize blood donors in an academic-based hospital donor center, to determine whether physicians donate, and to elucidate the donation impetus. A confidential survey was issued to presenting, potential donors over 200 weekdays. Three questions were asked: their role at the institution, if and when they had previously donated blood, and what prompted the current donation. The majority of the 687 respondents were institution-affiliated (73.5%) and 79.3% had previously donated, with a median of 3 mo since the prior donation. Only 21 (3.1%) respondents were physicians. The predominant reasons for donor presentation were an appointment, knowing it had been 8 wk since the last donation, and contact by the blood center to donate. This study shows the dearth of physician blood donors and a strong cohort of institution-affiliated repeat donors. Physicians represent a potential, stable, and sustainable donor pool; further studies are needed to establish physician recruitment programs.

The costs of heparin-induced thrombocytopenia: a patient-based cost of illness analysis.

PubMed

Wilke, T; Tesch, S; Scholz, A; Kohlmann, T; Greinacher, A

2009-05-01

SUMMARY BACKGROUND AND OBJECTIVES: Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. Patients diagnosed with HIT (1995-2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. One hundred and thirty HIT cases with a 4T-score >or=4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 euro. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies.

Study on incidence of needle stick injury and factors associated with this problem among medical students.

PubMed

Norsayani, Mohamad Yaakob; Noor Hassim, Ismail

2003-05-01

Medical students face the threat of needle stick injury with the consequent risk of acquiring blood-borne infection by pathogens such as HIV, Hepatitis B and Hepatitis C while performing their clinical activities in the hospitals. A cross-sectional study was conducted among 417 final year medical students from Universiti Kebangsaan Malaysia (UKM), University Malaya (UM) and Universiti Putra Malaysia (UPM). The aims of the study were to determine the incidence of cases and episodes of needle stick injury among them in the past year. This study was also done to find out the factors that might be associated with the occurrence of this problem. The factors were sociodemographic factors, duration of exposure, level of knowledge of blood-borne diseases and Universal Precaution, perception of risk of blood-borne diseases and level of practice of Universal Precaution. The incidence of needle stick injury among medical students was 14.1% (59 cases). The total number of episodes of needle stick injury was 87 and the incidence of episodes among respondents was high i.e. 20.9%. The highest incidence of episodes of needle stick injury occurred in Obstetric & Gynaecology postings, followed by Medicine and Surgery. For clinical procedures, venepuncture had the highest incidence followed by setting up drips and giving parenteral injections. The results showed the students who had needle stick injury (cases) had lower scores in the practice of Universal Precautions than non-cases (p<0.05). There was a significant association between the level of practice of Universal Precautions and the number of episodes of needle stick injury, i.e. the higher the score for the practice of Universal Precautions, the lower the number of episodes (beta=-2.03 x 10(-2), p<0.05). This study showed that medical students are at risk of needle stick injury and blood-borne infections during their clinical activities while performing procedures on patients especially for those who were poor at practising Universal Precautions. Therefore some preventive measures should be taken by the management of the universities and medical students to avoid the occurrence of these problems.

The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals.

PubMed

Willems, Elise; Smismans, Annick; Cartuyvels, Reinoud; Coppens, Guy; Van Vaerenbergh, Kristien; Van den Abeele, Anne-Marie; Frans, Johan

2012-05-01

Bloodstream infections remain a major challenge in medicine. Optimal detection of pathogens is only possible if the quality of preanalytical factors is thoroughly controlled. Since the laboratory is responsible for this preanalytical phase, the quality control of critical factors should be integrated in its quality control program. The numerous recommendations regarding blood culture collection contain controversies. Only an unambiguous guideline permits standardization and interlaboratory quality control. We present an evidence-based concise guideline of critical preanalytical determinants for blood culture collection and summarize key performance indicators with their concomitant target values. In an attempt to benchmark, we compared the true-positive rate, contamination rate, and collected blood volume of blood culture bottles in 5 Belgian hospital laboratories. The true-positive blood culture rate fell within previously defined acceptation criteria by Baron et al. (2005) in all 5 hospitals, whereas the contamination rate exceeded the target value in 4 locations. Most unexpected, in each of the 5 laboratories, more than one third of the blood culture bottles were incorrectly filled, irrespective of the manufacturer of the blood culture vials. As a consequence of this shortcoming, one manufacturer recently developed an automatic blood volume monitoring system. In conclusion, clear recommendations for standardized blood culture collection combined with quality control of critical factors of the preanalytical phase are essential for diagnostic blood culture improvement. Copyright © 2012 Elsevier Inc. All rights reserved.

Sustainability in a Hospital-Based Biobank and University-Based DNA Biorepository: Strategic Roadmaps

PubMed Central

Eschbacher, Jennifer; Bowser, Robert; LaBaer, Joshua

2015-01-01

Sustainability in the biobanking community has recently become an important and oft-discussed issue as biorepositories struggle to balance limited external funding and complex cost recovery models with high operating costs and the desire to provide the highest quality materials and services to the research community. A multi-faceted view of biobanking sustainability requires consideration of operational and social sustainability in addition to the historical focus exclusively on financial sustainability. Planning and implementing this three pillar model creates a well-rounded biorepository that meets the needs of all the major stakeholders: the funders, the patients/depositors, and the researcher recipients. Often the creation of a detailed business plan is the first step to develop goals and objectives that lead down a path towards sustainability. The definition of sustainability and the complexity of a sustainable business plan may differ for each biorepository. The DNASU Plasmid Repository at Arizona State University stores and distributes DNA plasmids to researchers worldwide, and the Biobank Core Facility at St. Joseph's Hospital and Barrow Neurological Institute consents patients and collects, stores, and distributes human tissue and blood samples. We will discuss these two biorepositories, their similar and different approaches to sustainability and business planning, their challenges in creating and implementing their sustainability plan, and their responses to some of these challenges. From these experiences, the biobanks share lessons learned about planning for sustainability that are applicable to all biorepositories. PMID:26697909

Blood transfusion practice: a survey in Sichuan, China.

PubMed

Liu, Yu; Lin, Jia; Zhong, Ling; He, Yi; Yang, Jia; Wu, Yanhong; Yang, Jing; Li, Qian; Wang, Jingxing; Rao, Shaoqin

2015-02-01

To get full knowledge of current conditions and development in the past seven years of clinical transfusion practice in Sichuan, China. This survey was performed by means of a questionnaire which consisted of three parts of questions including basic conditions of blood banks in the hospitals, procedures for clinical blood transfusion and the utilization of different types of blood products. Thirty-five representative hospitals from different geographic locations in Sichuan province participated in this survey. All of the 35 hospitals returned the questionnaires and 33 hospitals (94.3%) answered the questions completely. The blood bank information system began to be used by more hospitals from 2006 (21.21%, 7/33) to 2012 (48.48%, 16/33). Automated grouping and cross-matching systems have not been used in level 2 hospitals and only 3 level 3 hospitals used automated systems in 2012. Still less common were procedures for evaluation of blood order forms for appropriateness (2/33, 6.06%) and evaluation of appropriateness and effect of blood component transfusion (8/33, 24.2%), and all the hospitals having these procedures are level 3 hospitals. The percentage of whole blood usage in the volume of all types of blood products used decreased a lot from 7.45% in 2006 to 0.16% in 2010. Technological instruments for bedside checking are not used by any of the hospitals. The transfusion service degree of the hospitals in Sichuan, China, has developed a lot in the past seven years; however, there are still some problems including whole blood still being used, albeit decreasing; lack of independent blood banks within the hospitals; lack of dedicated personnel for the transfusion services; lack of education; lack of blood bank information systems and automation; lack of screening for appropriateness for blood orders. Thus, the quality control center of clinical blood transfusion (QCCCBT) of Sichuan province should help the transfusion departments to attract more investment in staffing, equipment and information system from the hospitals, enhance the training of transfusion department staffs, and emphasize the supervision of transfusion department's work on directing clinical blood utilization and evaluating clinical transfusion appropriateness. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Relevance of the hemovigilance regional database for the shared medical file identity server].

PubMed

Doly, A; Fressy, P; Garraud, O

2008-11-01

The French Health Products Safety Agency coordinates the national initiative of computerization of blood products traceability within regional blood banks and public and private hospitals. The Auvergne-Loire Regional French Blood Service, based in Saint-Etienne, together with a number of public hospitals set up a transfusion data network named EDITAL. After four years of progressive implementation and experimentation, a software enabling standardized data exchange has built up a regional nominative database, endorsed by the Traceability Computerization National Committee in 2004. This database now provides secured web access to a regional transfusion history enabling biologists and all hospital and family practitioners to take in charge the patient follow-up. By running independently from the softwares of its partners, EDITAL database provides reference for the regional identity server.

Attitude to blood donation in Saudi Arabia

PubMed Central

Abdel Gader, Abdel Galil M.; Osman, Abdel Moniem A.; Al Gahtani, Furgah H.; Farghali, Mohamed N.; Ramadan, Ali H.; Al-Momen, Abdel Kareem M.

2011-01-01

Background and Objectives: The blood donor system in the Kingdom of Saudi Arabia depends on a combination of voluntary and involuntary donors. The aim of this study is to explore the attitudes, beliefs and motivations of Saudis toward blood donation. Materials and Methods: The study was conducted at the Donor Centers at King Khalid University Hospital (KKUH) Blood Bank and King Saud University Students Health Center, Riyadh. A self-administered questionnaire was distributed to donors (n = 517) and nondonors (n = 316), between February and June 2008. All were males. Results: Ninety-nine percent of the respondents showed positive attitude toward blood donations and its importance for patients care, and object the importation of blood from abroad. Blood donors: Ninety-one percent agree that that blood donation is a religious obligation, 91% think no compensation should be given, 63% will accept a token gift, 34% do not object to donating six times/year and 67% did not mind coming themselves to the donor center to give blood. Nondonors: Forty-six percent were not asked to give blood and those who were asked mentioned fear (5%) and lack of time (16%) as their main deterrents. Reasons for rejection as donors include underweight and age (71%) and health reasons (19%). Seventy-five percent objected to money compensation but 69% will accept token gifts and 92% will donate if a relative/friend needs blood. Conclusion: These results reflect an encouraging strong positive attitude toward blood donation. Further future planning with emphasis on educational/publicity programs and careful organization of donor recruitment campaigns could see the dream of total voluntary nonremunerated blood donations should not take long to be true. PMID:21897588

High blood levels of lead in children aged 6-36 months in Kathmandu Valley, Nepal: A cross-sectional study of associated factors

PubMed Central

Karki, Khem Bahadur; Aryal, Krishna Kumar; Dhimal, Bimala; Joshi, Hari Datt; Puri, Sajan; Pandey, Achyut Raj; Dhakal, Purushotam; Sharma, Arun Kumar; Raya, Ganendra Bhakta; Ansari, Imran; Groneberg, David A.; Müller, Ruth; Kuch, Ulrich

2017-01-01

Young children are at greatest risk of exposure to lead and its effects. Although lead is one of the most widely used elements with known health hazard, there is little data on the blood lead level (BLL) of children in the Kathmandu Valley. Thus, this study aimed to assess factors associated with high BLL in children who were 6–36 months of age and resided in the Kathmandu Valley. In this hospital-based cross-sectional study 6–36 month-old children visiting the Paediatrics Outpatient Department of Tribhuvan University Teaching Hospital, Patan Hospital, and Siddhi Memorial Hospital were enrolled. All three hospitals are located in different areas inside the Kathmandu Valley. Written informed consent was obtained from the parents, and exposure data were collected using a structured questionnaire. Portable Anodic Stripping Voltammetry (ASV) was used to determine BLLs in children. Data were analyzed using SPSS version 16. Of 312 children enrolled in the study, 64.4% had BLLs ≥5μg/dl. A significant association was found between BLL and exposure to enamel paints in the household in the form of painting materials used in different parts of the house like walls, windows and doors (p = 0.001). Furthermore, multivariate analyses showed that BLLs were 4.5 times higher in children playing with dirt and dust (p = 0.006) and that children belonging to the community of lower caste/ethnicity groups had significantly higher BLLs compared to those from the upper caste groups (p = 0.02). Our study demonstrated that children living in households that have used enamel paints, children belonging to lower caste/ethnic groups, and children frequently playing with dirt and dust had significantly higher BLLs. The results of this study highlight the importance of policy decisions to limit environmental lead contamination, and to roll out awareness building measures designed to limit lead exposure and break the poverty cycle associated with chronic lead poisoning. PMID:28604801

Results after laparoscopic Heller-Dor operation for esophageal achalasia in 100 consecutive patients.

PubMed

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2009-01-01

The laparoscopic Heller-Dor operation has been the procedure of choice for the treatment of achalasia. However, because the incidence of achalasia is low, reports on the outcome of surgical treatment for achalasia are limited. In this study, the therapeutic results after laparoscopic Heller-Dor operation for achalasia at a single university hospital were evaluated. Between August 1994 and July 2006, 100 consecutive patients underwent laparoscopic Heller-Dor operation. The therapeutic results after laparoscopic Heller-Dor operation were assessed based on complications, operation time, blood loss, postoperative hospital stay, and the standardized questionnaire for satisfaction by telephone or outpatient clinic interview. With respect to perioperative complications, lower esophageal mucosal perforation occurred in 14 patients, but all of them could be suture-obliterated laparoscopically. One patient was converted to laparotomy because of uncontrolled bleeding from the short gastric artery. The mean operative time was 169 minutes, and the mean perioperative blood loss was 22 mL. The median postoperative hospital stay was 7 days. Reflux esophagitis, which was seen in five patients, was treated successfully with a proton pump inhibitor. According to the standardized questionnaire for satisfaction, 77 patients rated their recovery as 'excellent', 17 as 'good', 4 as 'fair', and 2 as 'poor'; thus, the overall success rate was 94%. There were no significant differences in surgical outcomes by morphologic type and severity of esophageal dilatation; however, the success rate deteriorated significantly with progression of the morphologic type. Laparoscopic Heller-Dor operation is a safe and effective surgical treatment for achalasia.

Comparison of five automated hematology analyzers in a university hospital setting: Abbott Cell-Dyn Sapphire, Beckman Coulter DxH 800, Siemens Advia 2120i, Sysmex XE-5000, and Sysmex XN-2000.

PubMed

Bruegel, Mathias; Nagel, Dorothea; Funk, Manuela; Fuhrmann, Petra; Zander, Johannes; Teupser, Daniel

2015-06-01

Various types of automated hematology analyzers are used in clinical laboratories. Here, we performed a side-by-side comparison of five current top of the range routine hematology analyzers in the setting of a university hospital central laboratory. Complete blood counts (CBC), differentials, reticulocyte and nucleated red blood cell (NRBC) counts of 349 patient samples, randomly taken out of routine diagnostics, were analyzed with Cell-Dyn Sapphire (Abbott), DxH 800 (Beckman Coulter), Advia 2120i (Siemens), XE-5000 and XN-2000 (Sysmex). Inter-instrument comparison of CBCs including reticulocyte and NRBC counts and investigation of flagging quality in relation to microscopy were performed with the complete set of samples. Inter-instrument comparison of five-part differential was performed using samples without atypical cells in blood smear (n=292). Automated five-part differentials and NRBCs were additionally compared with microscopy. The five analyzers showed a good concordance for basic blood count parameters. Correlations between instruments were less well for reticulocyte counts, NRBCs, and differentials. The poorest concordance for NRBCs with microscopy was observed for Advia 2120i (Kendall's τb=0.37). The highest flagging sensitivity for blasts was observed for XN-2000 (97% compared to 65%-76% for other analyzers), whereas overall specificity was comparable between different instruments. To the best of our knowledge, this is the most comprehensive side-by-side comparison of five current top of the range routine hematology analyzers. Variable analyzer quality and parameter specific limitations must be considered in defining laboratory algorithms in clinical practice.

The Bloodgen Project of the European Union, 2003–2009

PubMed Central

Avent, Neil D.; Martinez, Antonio; Flegel, Willy A.; Olsson, Martin L.; Scott, Marion L.; Nogués, Núria; Písăcka, Martin; Daniels, Geoff L.; Muñiz-Diaz, Eduardo; Madgett, Tracey E.; Storry, Jill R.; Beiboer, Sigrid; Maaskant-van Wijk, Petra M.; von Zabern, Inge; Jiménez, Elisa; Tejedor, Diego; López, Monica; Camacho, Emma; Cheroutre, Goedele; Hacker, Anita; Jinoch, Pavel; Svobodova, Irena; van der Schoot, Ellen; de Haas, Masja

2009-01-01

Summary The Bloodgen project was funded by the European Commission between 2003 and 2006, and involved academic blood centres, universities, and Progenika Biopharma S.A., a commercial supplier of genotyping platforms that incorporate glass arrays. The project has led to the development of a commercially available product, BLOODchip, that can be used to comprehensively genotype an individual for all clinically significant blood groups. The intention of making this system available is that blood services and perhaps even hospital blood banks would be able to obtain extended information concerning the blood group of routine blood donors and vulnerable patient groups. This may be of significant use in the current management of multi-transfused patients who become alloimmunised due to incomplete matching of blood groups. In the future it can be envisaged that better matching of donor-patient blood could be achieved by comprehensive genotyping of every blood donor, especially regular ones. This situation could even be extended to genotyping every individual at birth, which may prove to have significant long-term health economic benefits as it may be coupled with detection of inborn errors of metabolism. PMID:21113258

ABO blood groups and risk of deep venous thromboembolism in Chinese Han population from Chaoshan region in South China.

PubMed

Yu, Min; Wang, Cantian; Chen, Tingting; Hu, Shuang; Yi, Kaihong; Tan, Xuerui

2017-04-01

 Objectives: To demonstrate the prevalence of ABO blood groups with deep venous thromboembolism in Chinese Han population. A retrospective study was conducted between January 2010 and March 2015 in The First Affiliated Hospital of Shantou University Medical College in Chaoshan District of Guangdong Province in South China. Eighty nine patients with confirmed diagnosis of deep venous thromboembolism were included. Frequency of blood groups was determined. Results: Of 89 patients with deep venous thromboembolism, 28 patients had blood group A (31.5%), 28 patients had blood group B (31.5%), 13 patients had blood group AB (14.6%), and 20 patients had blood group O (22.5%). Compared with O blood type, the odds ratios of deep venous thromboembolism for A, B and AB were 2.23 (95% CI, 1.27-3.91), 2.34 (95% CI, 1.34-4.09) and  4.43 (95% CI, 2.24-8.76). Conclusion: There is a higher risk of venous thromboembolism in non-O blood groups than O group.

27 CFR 22.105 - Hospitals, blood banks, and sanitariums.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Hospitals, blood banks... Tax-Free Alcohol § 22.105 Hospitals, blood banks, and sanitariums. (a) Tax-free alcohol withdrawn for use by hospitals, blood banks, and sanitariums shall be used exclusively for medicinal, mechanical...

27 CFR 22.105 - Hospitals, blood banks, and sanitariums.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Hospitals, blood banks... Tax-Free Alcohol § 22.105 Hospitals, blood banks, and sanitariums. (a) Tax-free alcohol withdrawn for use by hospitals, blood banks, and sanitariums shall be used exclusively for medicinal, mechanical...

27 CFR 22.105 - Hospitals, blood banks, and sanitariums.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Hospitals, blood banks... Tax-Free Alcohol § 22.105 Hospitals, blood banks, and sanitariums. (a) Tax-free alcohol withdrawn for use by hospitals, blood banks, and sanitariums shall be used exclusively for medicinal, mechanical...

27 CFR 22.105 - Hospitals, blood banks, and sanitariums.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Hospitals, blood banks... Tax-Free Alcohol § 22.105 Hospitals, blood banks, and sanitariums. (a) Tax-free alcohol withdrawn for use by hospitals, blood banks, and sanitariums shall be used exclusively for medicinal, mechanical...

27 CFR 22.105 - Hospitals, blood banks, and sanitariums.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Hospitals, blood banks... Tax-Free Alcohol § 22.105 Hospitals, blood banks, and sanitariums. (a) Tax-free alcohol withdrawn for use by hospitals, blood banks, and sanitariums shall be used exclusively for medicinal, mechanical...

Triggers and appropriateness of red blood cell transfusions in the postpartum patient--a retrospective audit.

PubMed

So-Osman, C; Cicilia, J; Brand, A; Schipperus, M; Berning, B; Scherjon, S

2010-01-01

Despite published guidelines, a proportion of red blood cell (RBC) transfusions seem unnecessary. To evaluate the indications for and the appropriateness of RBC transfusions in the postpartum patient, we performed a retrospective audit over a 1-year period in two Dutch hospitals. Observational study of transfused obstetric patients, admitted in 2006 to the Departments of Obstetrics of a university and a general hospital, was carried out. Relevant clinical and laboratory data were recorded. The appropriateness of RBC transfusions was assessed using the national and age-based transfusion guidelines for the general population; for the studied group the transfusion threshold haemoglobin (Hb) value was 6.4 g/dl for non-massive and 8.1 g/dl for massive blood loss. From these we derived target Hb levels. Ninety patients received one or more RBC units within 48 h of delivery. Mean pretransfusion Hb level was 6.9 [SD 1.2] g/dl. Median number of transfusions was 2. Mean Hb level at discharge was 9.7 [SD 1.1] g/dl. Taking threshold Hb and the derived target Hb level into account, 68% (n = 61) of the patients may have received one or more RBC units inappropriately. Of 311 RBC units transfused, 143 units (46%) were possibly inappropriate, partly due to over-transfusion. A significant proportion of postpartum RBC transfusions are possibly inappropriate, partly due to over-transfusion. If current guidelines would be more specific, in particular, with respect to the target Hb levels, the total amount of RBC transfusions may be considerably decreased.

Safety of falciparum malaria diagnostic strategy based on rapid diagnostic tests in returning travellers and migrants: a retrospective study

PubMed Central

2012-01-01

Background Rapid diagnostic tests for malaria (RDTs) allow accurate diagnosis and prompt treatment. Validation of their usefulness in travellers with fever was needed. The safety of a strategy to diagnose falciparum malaria based on RDT followed by immediate or delayed microscopy reading at first attendance was evaluated in one referral hospital in Switzerland. Methods A retrospective study was conducted in the outpatient clinic and emergency ward of University Hospital, covering a period of eight years (1999–2007). The study was conducted in the outpatient clinic and emergency ward of University Hospital. All adults suspected of malaria with a diagnostic test performed were included. RDT and microscopy as immediate tests were performed during working hours, and RDT as immediate test and delayed microscopy reading out of laboratory working hours. The main outcome measure was occurrence of specific complications in RDT negative and RDT positive adults. Results 2,139 patients were recruited. 1987 had both initial RDT and blood smear (BS) result negative. Among those, 2/1987 (0.1%) developed uncomplicated malaria with both RDT and BS positive on day 1 and day 6 respectively. Among the 152 patients initially malaria positive, 137 had both RDT and BS positive, four only BS positive and five only RDT positive (PCR confirmed) (six had only one test performed). None of the four initially RDT negative/BS positive and none of the five initially BS negative/RDT positive developed severe malaria while 6/137 of both RDT and BS positive did so. The use of RDT allowed a reduction of a median of 2.1 hours to get a first malaria test result. Conclusions A malaria diagnostic strategy based on RDTs and a delayed BS is safe in non-immune populations, and shortens the time to first malaria test result. PMID:23158019

Diagnostic accuracy of blood centers in the screening of blood donors for viral markers

PubMed Central

Dogbe, Elliot Eli; Arthur, Fareed

2015-01-01

Introduction Blood transfusion still remains a life saving intervention in almost all healthcare facilities worldwide. Screening of blood donors/blood units is done in almost every blood bank facility before the blood units/blood components are transfused to prevent transfusion-transmissible infections. The kind of testing kits or the methods used by a facility and the technical expertise of the personnel greatly affects the screening results of a facility. This study was aimed at evaluating the diagnostic accuracy of five hospital-based blood bank testing facilities (Komfo Anokye Teaching Hospital KNUST, Kwame Nkrumah University of Science and Technology, Agogo, Bekwai and Sunyani) that used rapid immunochromatograhic assays (RIA) in screening blood donors/blood units in Ghana. Methods Blood samples (300) from the five testing facilities and their screening results for hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (HCV) and human immunodeficiency virus (HIV) using RIAs were obtained. All the samples were then analysed for the three viral markers using 3rd generational enzyme linked immunosorbent assay (ELISA) kit as the gold standard. Results The mean false positive for HBsAg was 2.2% with Bekwai testing facility having the highest of 4.4%. For HCV, the mean false positive was 2.8% with Agogo and Bekwai testing facilities having the highest of 8.7% respectively. For HIV screening, the mean false positive was 11.1% with Bekwai testing facility having the highest of 28.0%. The mean false negative for the facilities were 3.0% for HBV, 75.0% for HCV and 0.0% for HIV with KATH having the highest of 6.3% for HBV, Bekwai having the highest of 100% for HCV and no facility showing false negative for HIV. Mean sensitivity of the screening procedure for the facilities was 97.0%, 25.0% and 100.0% whilst the mean specificity was 97.8%, 97.2% and 88.9% for HBV, HCV and HIV respectively. Statistical comparison among the testing facilities showed no significant differences among the various testing centres for HBV screening; however, significant differences were obtained for HCV and HIV screening. Conclusion This study has shown that there is no standardised screening procedure for blood bank testing facilities in the country. There is therefore an urgent need for an internal and external control body to oversee screening procedures in blood banks across the country. PMID:26090067

Preliminary experience with a hospital blood pressure follow up clinic with nurse practitioner assessment and microprocessor based data retrieval.

PubMed Central

Rubin, P C; Curzio, J L; Kelman, A; Elliott, H L; Reid, J L

1984-01-01

Experience over two years with 376 hypertensive patients managed at a clinic where the primary observations are made by a trained nurse, clinical information is held on a microprocessor, and treatment follows a standard stepped care approach has been assessed. Blood pressure control after both one and two years was appreciably improved, with over 70% of patients having diastolic pressure below 90 mm Hg compared with 22% of patients when they first attended the new clinic. The non-attendance rate was half that of the conventional hospital outpatient clinic. A computer based record system with a nurse run hypertension clinic is acceptable to patients and offers the possibility of more effective long term control of blood pressure in large numbers of patients. PMID:6432180

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.

ABO and rhesus antigens in a cosmopolitan Nigeria population.

PubMed

Nwauche, C A; Ejele, O A

2004-01-01

Port Harcourt is a cosmopolitan city consisting of several ethnic groupings such as Ikwerre, Ijaw, Igbo, Ogonis, Efik-Ibibio, Edo, Yoruba, Hausa and foreign nationals. ABO and Rhesus D antigens were screened in this cross-sectional study with the aim of generating data that would assist in the running of an efficient blood transfusion service for a cosmopolitan city as Port Harcourt. Blood donors were sampled and screened for ABO and Rhesus D antigens at three Health facilities within Port Harcourt: University of Port Harcourt Teaching Hospital, Braithwaite Memorial Hospital and Orogbum Health centre. A total of 936 blood donors were tested in this study. The results of the ABO screening shows that blood group O was the highest with 527 (56.30%) followed by blood group A, B and lastly AB with 212 (22.65%), 178 (19.02%) and 18(2.10%) respectively. The highest contribution to blood group O was from the Ibos with 220 (23.50%) while the Ijaws gave the highest contribution of Rhesus "D" antigen with 370 (39.53%), closely followed by the Igbos with 334 (0.43%). Rhesus negativity values in this study was 7.26% of which the highest contributors were also the Ijaws with 33 (3.53%) and Igbos with 27(2.89%). The increased demand for safe blood calls for an efficient Blood, Transfusion Service at the local, state and national levels. It is hoped that the data generated in this study would assist in the planning and establishment of a functional Blood service that would not only meet the ever increasing demand for blood products, but also play a vital role in the control of HIV/AIDS and . Hepatitis B global scourge.

Prognostic value of low blood glucose at the presentation of E. coli bacteremia.

PubMed

Alamgir, Shamsuddin; Volkova, Natalia B; Peterson, Michael W

2006-11-01

Septicemia is the tenth leading cause of death in the United States, and Escherichia coli is the most common isolate in blood cultures. Low blood glucose is a known complication of sepsis. The prognostic role of low blood glucose in E. coli bacteremia is unknown. The study's objective was to identify the incidence of low blood glucose at the presentation of E. coli bacteremia and determine its influence on prognosis and outcome. A retrospective cohort study was conducted in university-affiliated community hospitals. Subjects were consecutive patients diagnosed with E. coli bacteremia between 1997 and 2003. We identified 1060 patients with documented E. coli bacteremia. We excluded 105 patients who were younger than 18 years old or pregnant. We recorded demographic characteristics, discharge diagnosis, and outcome. Among the 955 patients with E. coli bacteremia, the average age was 64+/-19.4 years. Overall, 4.6% had documented low blood glucose (blood glucose <70 mg/dL) at presentation. The incidence of low blood glucose was the same in diabetic and nondiabetic patients. Patients with low blood glucose had a 4.7 times higher risk of death compared to patients with non-low blood glucose. Race, age, sex, and diabetes had no influence on survival. Gastrointestinal and genitourinary sources for E. coli bacteremia were more commonly associated with low blood glucose (P <.001). The study was limited to E. coli-positive blood cultures and to the one hospital system. Low blood glucose is present at the onset of E. coli bacteremia in 4.6% of patients. This represents a potentially large number of patients because E. coli is the most common blood culture isolate. Low blood glucose predicts poor outcome, especially in patients with abnormal hepatic and renal function. Low blood glucose should be considered an early clinical sign of E. coli bacteremia and aggressive therapy should be instituted to potentially save lives.

Clinical effect of a multidisciplinary team approach to the initial treatment of patients with hospital-acquired bloodstream infections at a Japanese university hospital.

PubMed

Tsukamoto, Hitoshi; Higashi, Takashi; Nakamura, Toshiaki; Yano, Ryoichi; Hida, Yukio; Muroi, Yoko; Ikegaya, Satoshi; Iwasaki, Hiromichi; Masada, Mikio

2014-09-01

Hospital-acquired bloodstream infections (BSIs) are significant causes of mortality, and strategies to improve outcomes are needed. We aimed to evaluate the clinical efficacy of a multidisciplinary infection control team (ICT) approach to the initial treatment of patients with hospital-acquired BSI. A before-after quasiexperimental study of patients with hospital-acquired BSI was performed in a Japanese university hospital. The ICT provided immediate recommendations to the attending physician about appropriate antimicrobial therapy and management after reviewing blood cultures, Gram's stain, final organism, and antimicrobial susceptibility results. The sample included 469 patients with hospital-acquired BSI (n = 210, preintervention group; n = 259, postintervention group). There were no significant differences between the groups in background or microbiologic characteristics. The 30-day mortality was significantly lower and significantly more patients received appropriate antimicrobial therapy in the postintervention group (22.9% vs 14.3%; P = .02 and 86.5% vs 69.0%; P < .001, respectively). Multivariate analysis confirmed that the ICT intervention was significantly associated with appropriate antimicrobial therapy (odds ratio, 2.22; 95% confidence interval, 1.27-3.89) and 30-day mortality (odds ratio, 0.49; 95% confidence interval, 0.25-0.95). A timely multidisciplinary team approach decreases the delay of appropriate antimicrobial treatment and may improve HABSI patient outcomes. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Quality indicators for the hospital transfusion chain: a national survey conducted in 100 dutch hospitals.

PubMed

Zijlker-Jansen, P Y; Janssen, M P; van Tilborgh-de Jong, A J W; Schipperus, M R; Wiersum-Osselton, J C

2015-10-01

The 2011 Dutch Blood Transfusion Guideline for hospitals incorporates seven internal quality indicators for evaluation of the hospital transfusion chain. The indicators aim to measure guideline compliance as shown by the instatement of a hospital transfusion committee and transfusion safety officer (structural indicators), observance of transfusion triggers and mandatory traceability of labile blood components (process indicators). Two voluntary online surveys were sent to all Dutch hospitals for operational years 2011 and 2012 to assess compliance with the guideline recommendations. Most hospitals had a hospital transfusion committee and had appointed a transfusion safety officer (TSO). In 2012, only 23% of hospitals complied with the recommended minimum of four annual transfusion committee meetings and 8 h/week for the TSO. Compliance with the recommended pretransfusion haemoglobin threshold for RBC transfusion was achieved by 90% of hospitals in over 80% of transfusions; 58% of hospitals measured the pretransfusion platelet count in over 80% of platelet transfusions and 87% of hospitals complied with the legally mandatory traceability of blood components in over 95% of transfusions. With the current blood transfusion indicators, it is feasible to monitor aspects of the quality of the hospital transfusion chain and blood transfusion practice and to assess guideline compliance. The results from this study suggest that there are opportunities for significant improvement in blood transfusion practice in the Netherlands. These indicators could potentially be used for national and international benchmarking of blood transfusion practice. © 2015 International Society of Blood Transfusion.

An examination of blood center structure and hospital customer satisfaction: what can centralized and decentralized blood centers learn from each other?

PubMed

Carden, Robert; DelliFraine, Jami L

2005-01-01

The cost of blood and blood products has increased rapidly over the last several years while the supply of available blood donors has simultaneously decreased. Higher blood costs and donor shortages have put a strain on the relationship between blood suppliers and their hospital customers. This study examines the association between blood center centralization or decentralization and several aspects of hospital satisfaction. Centralized and decentralized blood centers have significant differences in various aspects of hospital customer satisfaction. Advantages and disadvantages of the two structures are discussed, as well as areas for future research.

Clinical varieties of Toxocariasis canis in Children's Hospital, Mansoura University: is it an underestimated problem?

PubMed

Elshazly, Atef M; Attia, Gehan; El-Ghareeb, Azza S A; Belal, Usama S

2011-08-01

Human toxocariasis is a worldwide parasitic disease. Children are more frequently infected because of the closer contact with contaminated soil and relatively frequent geophagia. Toxocariasis in children has variable modes of presentation but clinical diagnosis is difficult. Various clinical phenotypes of toxocariasis in symptomatic children attending Children's Hospital Mansoura University were studied. A total of 480 children were included in the study with mean age 7.24 +/- 4.22 years, 61.9% were boys and 200 age-sex-matched healthy controls. Patients were examined clinically, and the anti-Toxocara antibodies in the blood of children were performed by ELISA using T. canis larval excretory-secretory products as antigen. Eosinophils level in peripheral blood was measured. Sero-positive cases were 12 % of patients and only 3.5% of controls. Statistical analysis showed a significant association between infection and male sex (P <0.001). Sero-positive children were older than the sero-negative (P <0.001). Eosinophilia was detected in 86.2% of sero-positive children. Sero-positivity and degree of eosinophilia were more frequently detected among patients with allergy (bronchial asthma and urticaria). Degree of eosinophilia was found to be positively correlated to the optical density (OD) ELISA of anti-Toxocara IgG.

Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden.

PubMed

Carlsson, Stefan; Nilsson, Andreas E; Schumacher, Martin C; Jonsson, Martin N; Volz, Daniela S; Steineck, Gunnar; Wiklund, Peter N

2010-05-01

To quantify complications to surgery in patients treated with robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) at our institution. Radical prostatectomy is associated with specific complications that can affect outcome results in patients. Between January 2002 and August 2007, a series of 1738 consecutive patients underwent RARP (n = 1253) or RRP (n = 485) for clinically localized prostate cancer. Surgery-related complications were assessed using a prospective hospital-based complication registry. The baseline characteristics of all patients were documented preoperatively. Overall, 170 patients required blood transfusions (9.7%), 112 patients (23%) in the RRP group compared with 58 patients (4.8%) in the RARP group. Infectious complications occurred in 44 RRP patients (9%) compared with 18 (1%) in the RARP group. Bladder neck contracture was treated in 22 (4.5%) patients who had undergone RRP compared with 3 (0.2%) in the RARP group. Clavien grade IIIb-V complications were more common in RRP patients (n = 63; 12.9%) than in RARP patients (n = 46; 3.7%). The introduction of RARP at our institution has resulted in decreased number of patients with Clavien grade IIIb-V complications, such as bladder neck contractures, a decrease in the number of patients who require blood transfusions, and decreased numbers of patients with postoperative wound infections. Copyright 2010 Elsevier Inc. All rights reserved.

Successful implementation of a P&T-approved therapeutic interchange program of angiotensin II receptor blockers in a medical center in Taiwan.

PubMed

Lee, Yen-Ying; Hsiao, Paul; Lin, You-Meei; Yen, Yu-Hsuan; Chen, Hsiang-Yin

2012-01-01

Therapeutic interchange is not a common practice in the medical society in Asia. We used clinic blood pressure readings, patients' tolerance, and cost saving as measures to evaluate the impact of a therapeutic interchange program implemented at a medical center in Taiwan. Taipei Medical University-Wan Fang Hospital initiated a therapeutic interchange program involving angiotensin II receptor blockers (ARBs). Data were retrospectively collected for 444 outpatients who were converted from other ARBs to candesartan. Evaluation of therapeutic efficacy, adverse effects associated with therapy, and drug costs was conducted before and after the program implementation. Patients whose treatment was converted to candesartan experienced no statistically significant differences in blood pressure, and the average number of antihypertensive agents used per patient remained unchanged. A direct cost savings of US$62,237 was estimated for the 444 patients studied. Only 3.15% of the patients developed adverse drug reactions potentially related to candesartan, and none required hospitalization. Based on the results of this retrospective chart review, the present ARB therapeutic interchange program was successfully developed and implemented. This is the first study to establish the positive impact of a well-run ARB therapeutic interchange program in Taiwan. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines

PubMed Central

Vieira Machado, Alessandra A.; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-01-01

Background Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. Methods and Results To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). Conclusion The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care. PMID:25188295

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.

Candidaemia and antifungal susceptibility testing in a teaching hospital.

PubMed

Tzar, M N; Shamim, A S

2009-03-01

We reviewed cases of candidaemia at Universiti Kebangsaan Malaysia Medical Centre from 1st January 2005 to 30th June 2006. All blood cultures positive for Candida species or its teleomorphs within the study period were identified and antifungal susceptibility testing was performed. Out of 50 blood isolates, 20 (40%) were identified as Candida albicans, 16 (32%) C. tropicalis, five (10%) C. parapsilosis, three (6%) C. famata, two (4%) C. glabrata, two (4%) Pichia ohmeri, one (2%) C. krusei and one (2%) P. etchell/carsonii. Susceptibility to amphotericin B was 100%, fluconazole 90%, itraconazole 40%, ketoconazole 88%, 5-flucytosine 98% and voriconazole 98%.

Cord blood banking activities at a university hospital in northeast Mexico: an 8-year experience.

PubMed

Jaime-Perez, Jose C; Monreal-Robles, Roberto; Colunga-Pedraza, Julia; Mancías-Guerra, Consuelo; Rodríguez-Romo, Laura; Gómez-Almaguer, David

2012-12-01

Umbilical cord blood (UCB) represents an alternative source of stem cells for transplantation for the treatment of hematologic malignancies and genetic disorders. There is scarce information detailing cord blood bank (CBB) collection and transplantation activities from developing countries. We documented our experience at a public university hospital in northeast Mexico. We carried out a retrospective and descriptive analysis of our CBB activity during an 8-year period from May 2002 to September 2010. Collection, processing, and cryopreservation of CB were carried out following standard operating procedures. The minimum volume and total nucleated cell (TNC) content for cryopreservation were 80 mL and 8.0 × 10(8) , respectively. A total of 1256 UCB units were collected; 428 (34%) were banked and 828 (66%) were discarded. The main reason for exclusion was biologic: low volume and/or low number of TNC accounted for 84% of the total discarded units. Cryopreserved cord blood units (CBUs) had a median volume of 113.8 mL (range, 80-213.2 mL) and 13.0 × 10(8) (range, 8 × 10(8) -36.6 × 10(8) ) TNCs. Cell viability was 99.3% (88-100%). The median CD34+ cell content was 4.0 × 10(6) (0.46 × 10(6) -19.38 × 10(6) ). Sixteen units have been released for transplantation, leading to a utilization rate of 3.7%. CBB demands considerable human and financial resources; it is then essential for centers at developing countries to share their experience, results, and databases to increase the probability of finding matching units for their patients. Efforts to create and maintain CBBs allow to offer this therapeutic option at an affordable cost. © 2012 American Association of Blood Banks.

Analysis of variability of concentrations of valproic acid (VPA) and its selected metabolites in the blood serum of patients treated with VPA and patients hospitalized because of VPA poisoning.

PubMed

Wilimowska, J; Kłys, M; Jawień, W

2014-01-01

To compare the metabolic profile of valproic acid (VPA) in the studied groups of cases through an analysis of variability of concentrations of VPA with its selected metabolites (2-ene-VPA, 4-ene-VPA, 3-keto-VPA). Blood serum samples collected from 27 patients treated with VPA drugs in the Psychiatry Unit and in the Neurology and Cerebral Strokes Unit at the Ludwik Rydygier Provincial Specialist Hospital in Krakow, and blood serum samples collected from 26 patients hospitalized because of suspected acute VPA poisoning at the Toxicology Department, Chair of Toxicology and Environmental Diseases, Jagiellonian University Medical College in Krakow. The analysis of concentrations of VPA and its selected metabolites has shown that the metabolic profile of VPA determined in cases of acute poisoning is different from cases of VPA therapy. One of VPA's metabolic pathways - the process of desaturation - is unchanged in acute poisoning and prevails over the process of β-oxidation. The ingestion of toxic VPA doses results in an increased formation of 4-ene-VPA, proportional to an increase in VPA concentration. Acute VPA poisoning involves the saturation of VPA's metabolic transformations at the stage of β-oxidation. The process of oxidation of 2-ene-VPA to 3-keto-VPA is slowed down after the ingestion of toxic doses.

The Experience of Human Milk Banking for 8 Years: Korean Perspective.

PubMed

Jang, Hye Lim; Cho, Jung Yoon; Kim, Mi Jin; Kim, Eun Jeong; Park, Eun Young; Park, Sung Ae; Kim, In Young; Choi, Yong Sung; Bae, Chong Woo; Chung, Sung Hoon

2016-11-01

Human milk banks are a solution for mothers who cannot supply their own breast milk to their sick or hospitalized infants; premature infants, in particular, are unable to receive a full volume of breast milk for numerous reasons. As of December 2015, there was only one milk bank in a university hospital in Korea. We reviewed the basic characteristics of donors and recipients, and the amounts and contamination of breast milk donated at the Human Milk Bank in Kyung Hee University Hospital at Gangdong in Korea from 2008 to 2015. The donor pool consisted of 463 first-time donors and 452 repeat donors who made 1,724 donations. A total of 10,820 L of breast milk was collected, and 9,541.6 L were processed. Detectable bacteria grew in 12.6% after pasteurization and 52.5% had cytomegalovirus DNA before pasteurization in donated milk. There were 836 infant and 25 adult recipients; among new infant recipients, 48.5% were preterm; the groups received 8,009 and 165.7 L of donor milk, respectively. There was an increase in the percentage of preterm infants among new infant recipients in 2015 (93.1%) compared to 2008 (8.5%). Based on the number of premature infants in Korea, the number of potential recipients is not likely to diminish anytime soon, despite efforts to improve the breastfeeding rate. Sustainability and quality improvement of the milk bank need long-term financial support by health authorities and a nationwide network similar to blood banking will further contribute to the progress of milk banking.

The Experience of Human Milk Banking for 8 Years: Korean Perspective

PubMed Central

2016-01-01

Human milk banks are a solution for mothers who cannot supply their own breast milk to their sick or hospitalized infants; premature infants, in particular, are unable to receive a full volume of breast milk for numerous reasons. As of December 2015, there was only one milk bank in a university hospital in Korea. We reviewed the basic characteristics of donors and recipients, and the amounts and contamination of breast milk donated at the Human Milk Bank in Kyung Hee University Hospital at Gangdong in Korea from 2008 to 2015. The donor pool consisted of 463 first-time donors and 452 repeat donors who made 1,724 donations. A total of 10,820 L of breast milk was collected, and 9,541.6 L were processed. Detectable bacteria grew in 12.6% after pasteurization and 52.5% had cytomegalovirus DNA before pasteurization in donated milk. There were 836 infant and 25 adult recipients; among new infant recipients, 48.5% were preterm; the groups received 8,009 and 165.7 L of donor milk, respectively. There was an increase in the percentage of preterm infants among new infant recipients in 2015 (93.1%) compared to 2008 (8.5%). Based on the number of premature infants in Korea, the number of potential recipients is not likely to diminish anytime soon, despite efforts to improve the breastfeeding rate. Sustainability and quality improvement of the milk bank need long-term financial support by health authorities and a nationwide network similar to blood banking will further contribute to the progress of milk banking. PMID:27709856

Blood donation practice and its associated factors among health professionals of University of Gondar Hospital, Northwest Ethiopia: a cross sectional study.

PubMed

Arage, Getachew; Ibrahim, Seada; Adimasu, Endeshaw

2017-07-19

Blood donation has remained a challenge in developing countries, like Ethiopia. In Ethiopia there is a high reliance on family surrogate and waged blood donors which carries an attendant increased risk of transfusion transmissible infection. Health workers are expected to practice blood donation so as to create a good image to the public. A study on blood donation behavior may improve successful implementation of the blood donation programs. An institution based cross-sectional study was deployed from January to June 2015. An aggregate of 427 health workers were included in the study by using simple random sampling technique. Data were collected by using pre tested and structured questionnaire via self-administrated method. Descriptive and summary statistics were employed. Bivariate and multiple logistic regressions were computed. Odds ratios and their 95% confidence intervals were calculated to determine the level of significance. A total of 427 participants were included in the final analysis (response rate = 100%). Among these participants, 33.2% of them practice blood donation. Age above 25 years [AOR = 1.8 (95% CI 1.1, 3.0)], health professionals' knowledge of blood donation [AOR = 1.9 (95% CI 1.1, 3.1)], health professionals' attitude towards blood donation [AOR = 3.0, 95% CI 1. 8, 4.9)], and the presence of family members or relatives who received blood [AOR = 5.4, 95% CI 3.7, 8.7)] were significantly and independently associated with blood donation behavior of health professionals. Blood donation practice of health professionals in this study was found to be low as compared to other studies conducted in developing countries. Health professionals' knowledge, attitude, age and the presence of family members or relatives who received blood before were independently associated with blood donation practice. Thus, awareness has to be created for health professionals to improve blood donation practices.

The hospital library online--a point of service for consumers and hospital staff: a case study.

PubMed Central

Cain, N J; Fuller, H J

1999-01-01

The Health Library at Stanford University is described in the context of electronic information services provided to Stanford University Medical Center, the local community, and Internet users in general. The evolution from CD-ROM-based services to Web-based services and in-library services to networked resources are described. Electronic services have expanded the mission of The Health Library to include national and international users and the provision of unique services and collections. PMID:10427424

Bloodstream infections at a tertiary referral hospital in Yangon, Myanmar.

PubMed

Myat, Tin Ohn; Prasad, Namrata; Thinn, Kyi Kyi; Win, Kyu Kyu; Htike, Wah Win; Zin, Khwar Nyo; Murdoch, David R; Crump, John A

2014-11-01

Data regarding characteristics of bloodstream infections in Myanmar are limited. Blood culture results from all outpatients and inpatients were extracted from records of the Clinical Microbiology Laboratory, Yangon General Hospital, for the period 2005 through 2013. Of 3865 blood cultures performed, 449 (11.6%) were positive for a pathogenic organism. Gram-negative bacteria was the most common organism group, accounting for 246 (55.5%) of 449 isolations. Staphylococcus aureus was the most common isolate, detected in 171 (38.1%) of 449 blood cultures. From 2005-2008 to 2009-2013 the proportion of all pathogenic isolates that were Gram-positive declined from 52.8% (167/316) to 20.3% (27/133) (p<0.001), whereas the proportion of Gram-negative bacteria rose from 45.6% (144/316) to 78.9% (105/133) (p<0.001), with non-fermentative bacilli accounting for much of this increase. Antimicrobial susceptibility testing demonstrated a high prevalence resistance of S. aureus to first-line antimicrobials such as erythromycin, penicillin and oxacillin. More than half of tested Escherichia coli and Citrobacter species showed resistance to amoxicillin-clavulanic acid, ceftriaxone or gentamicin. Bloodstream infections are common among patients receiving blood culture at a tertiary hospital in Yangon, Myanmar. Our findings suggest that antimicrobial resistance among invasive bacteria is common, similar to patterns described elsewhere in the region, and highlight the need for locally adapted antimicrobial guidelines for sepsis management. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Association of brain metabolites with blood lactate and glucose levels with respect to neurological outcomes after out-of-hospital cardiac arrest: A preliminary microdialysis study.

PubMed

Hifumi, Toru; Kawakita, Kenya; Yoda, Takeshi; Okazaki, Tomoya; Kuroda, Yasuhiro

2017-01-01

Out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Cerebral microdialysis (CMD) is an efficient sampling technique to detect neurochemical changes in brain interstitial tissue. In this retrospective study, we hypothesised that there are different CMD levels between patients with favourable and unfavourable neurological outcomes. Data of patients with OHCA admitted to Kagawa University Hospital and administered therapeutic hypothermia (TH) were collected. Using a CMD probe, extracellular glucose, lactate and pyruvate levels were measured hourly along with intracranial perfusion pressure (ICP) and cerebral perfusion pressure (CPP) for the initial 72h during TH. The lactate/pyruvate (LP) ratio was calculated. Patients were divided into favourable [Glasgow-Pittsburgh cerebral performance category 1-2 at 30days after cardiac arrest] or unfavourable neurological outcome groups. CMD biochemical markers and blood lactate and glucose levels were compared between two groups. Ten patients were included. ICP was significantly higher in the unfavourable than in the favourable neurological outcome group; there were no significant differences with respect to CPP. The CMD LP ratio in the unfavourable outcome group progressively increased; significant differences were observed on days 2, 3 and 4 (p<0.01). Significant differences in blood lactate levels were observed between the groups only on day 3.5. CMD and blood glucose levels were higher in the unfavourable than in the favourable outcome group during TH. The association of CMD levels with long-term outcomes would be better defined in a large randomised prospective study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

State-wide hospital clinical laboratory plan for measuring cholinesterase activity for individuals suspected of exposure to nerve agent chemical weapons.

PubMed

Wu, Alan H B; Smith, Andrew; McComb, Robert; Bowers, George N; Makowski, Gregory S; McKay, Charles A; Vena, Jason; McDonagh, John; Hopfer, Sidney; Sena, Salvatore F; Malkus, Herbert; Forte, Elaine; Kelly, Katherine

2008-02-01

Hospital laboratories currently lack the capacity to provide emergency determination of cholinesterase activity. We have developed a hospital-based 3-tiered system to test plasma for butyrylcholinesterase (BChE) activity and whole blood for red cell acetylcholinesterase (AChE) activity using available technology and personnel. Interagency communications, toxidrome definition, and patient triage will be coordinated by the Connecticut Department of Public Health and the Poison Control Center. Initial BChE data documents good precision between institutions (coefficient of variation < 8%). Laboratory testing of plasma or blood for cholinesterase activity is important in the management of nerve agent exposure and in ruling out disease in those with non-specific symptoms in the setting of a terrorist attack or accidental exposure. Rapid availability of strong hospital-based analytic support in a smoothly functioning network of clinical, public health, and laboratory services will facilitate overall regional response to chemical terrorism or large scale HazMat events.

Effect of peripheral IV based blood collection on catheter dwell time, blood collection, and patient response.

PubMed

Mulloy, Deborah F; Lee, Susan M; Gregas, Matthew; Hoffman, Kate E; Ashley, Stanley W

2018-04-01

To evaluate the effect of daily PIV-based phlebotomy using the PIVO device on PIVC dwell times and replacement rates, as well as the reliability of blood sample collection, and patient response to this method of blood collection. Blood draws which are also known as phlebotomy for laboratory analyses are one of the most common experiences for hospitalized patients. When performed by venipuncture, they are often associated with pain and anxiety for patients. Most hospitals avoid phlebotomy from peripheral IV catheters due to sample hemolysis, sample dilution by fluids in PIVC line or infused medications, PIVC dislodgement or infiltration, and increased rates of phlebitis. A prospective, randomized- controlled study of 160 GI surgery patients was enrolled. Patients were randomized to either control evaluation of PIVC dwell or to receive daily PIVO blood collections in addition to evaluation of PIVC dwell. Daily PIVO blood collections did not negatively affect PIVC dwell or replacement rates. Overall 81% of blood collection attempts were successful and the likelihood of success was strongly associated with PIVC condition. Patients reported 0.7/10 pain for PIVO blood collection on a 0-10 pain scale and a 9.1/10 preference for PIVO on a 0 (strongly prefer needle) to 10 (strongly prefer PIVO) preference scale. Results suggest that use of a PIV based blood collection was a reliable and valid approach and was superior to routine phlebotomy in self-reported responses from patients. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

The efficacy of a neonatal screening programme in decreasing the hospitalization rate of patients with G6PD deficiency in southern Iran.

PubMed

Cohan, Nader; Karimi, Mehran; Khalili, Amir Hossein; Falahzadeh, Mohammad Hossein; Samadi, Behrang; Mahdavi, Mohammad Reza

2010-01-01

To investigate whether a neonatal screening programme for G6PD deficiency has decreased hospitalization for acute haemolytic attack in the Fars province of southern Iran. A total of 850 patients registered with G6PD deficiency were included in the study. Variables including age, sex, time and cause of hospitalization, cause of haemolytic crisis, positive history of blood transfusion, G6PD enzyme deficiency, blood urea nitrogen (BUN) and creatinine were recorded based on a standard questionnaire. All patients were analysed for G6PD enzyme level based on a quantitative test. Five hundred and fifty-three patients were hospitalized before the introduction of the neonatal screening programme (2001-2004) and 297 afterwards (2005-2008). Of those patients hospitalized after the introduction of the screening programme, 237 were wrongly classified as normal and 60 were recorded as having G6PD enzyme deficiency by the neonatal screening programme. The main causes of haemolytic crisis in G6PD-deficient patients were fava bean consumption (88.2%), underlying infection (10.9%) and drugs (0.8%). Our study showed the effectiveness of the neonatal screening programme in decreasing the hospitalization rate.

Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital.

PubMed

Ryan, L; O'Mahony, E; Wrenn, C; FitzGerald, S; Fox, U; Boyle, B; Schaffer, K; Werner, G; Klare, I

2015-10-01

Ireland has the highest rate of vancomycin-resistant Enterococcus faecium (VREfm) isolated from blood of nosocomial patients in Europe, which rose from 33% (110/330) in 2007 to 45% (178/392) in 2012. No other European country had a VREfm rate from blood cultures of >25%. Our aim was to elucidate the reasons for this significantly higher rate in Ireland. The epidemiology and molecular typing of VRE from bloodstream infections (BSIs) was examined in a tertiary care referral hospital and isolates were compared with those from other tertiary care referral centres in the region. The most common source of VRE BSIs was intra-abdominal sepsis, followed by line-related infection and febrile neutropenia. Most of the isolates were positive for vanA; 52% (43/83) possessed the esp gene and 12% (10/83) possessed the hyl gene. Genotyping by SmaI macrorestriction analysis (PFGE) of isolates revealed clonal relatedness between bloodstream isolates and environmental isolates. VRE BSI isolates from two other tertiary care hospitals in the Dublin region showed relatedness by PFGE analysis. MLST revealed four STs (ST17, ST18, ST78 and ST203), all belonging to the clonal complex of hospital-associated strains. Irish VRE BSI isolates have virulence factor profiles as previously reported from Europe. Typing analysis shows the spread of individual clones within the hospital and between regional tertiary care hospitals. Apart from transmission of VRE within the hospital and transfer of colonized patients between Irish hospitals, no other explanation for the persistently high VREfm BSI rate in Ireland has been found. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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.

Development of a mobile emergency patient information and imaging communication system based on CDMA-1X EVDO

NASA Astrophysics Data System (ADS)

Yang, Keon Ho; Jung, Haijo; Kang, Won-Suk; Jang, Bong Mun; Kim, Joong Il; Han, Dong Hoon; Yoo, Sun-Kook; Yoo, Hyung-Sik; Kim, Hee-Joung

2006-03-01

The wireless mobile service with a high bit rate using CDMA-1X EVDO is now widely used in Korea. Mobile devices are also increasingly being used as the conventional communication mechanism. We have developed a web-based mobile system that communicates patient information and images, using CDMA-1X EVDO for emergency diagnosis. It is composed of a Mobile web application system using the Microsoft Windows 2003 server and an internet information service. Also, a mobile web PACS used for a database managing patient information and images was developed by using Microsoft access 2003. A wireless mobile emergency patient information and imaging communication system is developed by using Microsoft Visual Studio.NET, and JPEG 2000 ActiveX control for PDA phone was developed by using the Microsoft Embedded Visual C++. Also, the CDMA-1X EVDO is used for connections between mobile web servers and the PDA phone. This system allows fast access to the patient information database, storing both medical images and patient information anytime and anywhere. Especially, images were compressed into a JPEG2000 format and transmitted from a mobile web PACS inside the hospital to the radiologist using a PDA phone located outside the hospital. Also, this system shows radiological images as well as physiological signal data, including blood pressure, vital signs and so on, in the web browser of the PDA phone so radiologists can diagnose more effectively. Also, we acquired good results using an RW-6100 PDA phone used in the university hospital system of the Sinchon Severance Hospital in Korea.

Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia.

PubMed

McCulloh, Russell J; Koster, Michael P; Yin, Dwight E; Milner, Tiffany L; Ralston, Shawn L; Hill, Vanessa L; Alverson, Brian K; Biondi, Eric A

2015-01-01

Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children. To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS). We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS. Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95% CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89), hospital admission from the ED (OR 1.65, 95% CI 1.05-2.60), and having health insurance (OR 0.42, 95% CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures had median 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97) or death (P = .25). Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.

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.

Acute air pollution exposure and blood pressure at delivery among women with and without hypertension.

PubMed

Männistö, Tuija; Mendola, Pauline; Liu, Danping; Leishear, Kira; Sherman, Seth; Laughon, S Katherine

2015-01-01

Chronic air pollution exposure increases risk for hypertensive disorders of pregnancy, but the effect of acute air pollution exposure on blood pressure during pregnancy is less well known. We studied 151,276 singleton term deliveries from the Consortium on Safe Labor (2002-2008) with clinical blood pressure measured at admission to labor/delivery and diagnoses of hypertensive disorders collected from electronic medical records and hospital discharge summaries. Air pollution exposures were estimated for the admission hour and the 4 hours preceding admission using a modified version of the Community Multiscale Air Quality models and observed air monitoring data. Blood pressure was categorized as normal; high normal; and mild, moderate, or severe hypertension based on pregnancy cut points. Adjusted ordinal logistic regression estimated the odds of women having a higher admission blood pressure category as a function of air pollutant, hypertensive disorders, and their interaction effect. Odds of high blood pressure at admission to labor/delivery were increased in normotensive women after exposure to nitrogen oxides (by 0.2%/5 units), sulfur dioxide (by 0.3%/1 unit), carbon monoxide and several air toxics (by 3%-4%/high exposure). The effects were often similar or stronger among women with gestational hypertension and preeclampsia. Exposure to particulate matter <10 μm increased odds of high blood pressure in women with preeclampsia by 3%/5 units. Air pollution can influence admission blood pressure in term deliveries and may increase likelihood of preeclampsia screening at delivery admission. © Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2014. This work is written by (a) US Government employees(s) and is in the public domain in the US.

[Team approaches to critical bleeding (massive bleeding and transfusion) - chairmen's introductory remarks. Questionnaire survey on current status of hospital clinical laboratories evaluating critical hemorrhage].

PubMed

Kino, Shuichi; Suwabe, Akira

2014-12-01

In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).

Robotic assisted gastrectomy compared with open resection: a case-matched study.

PubMed

Caruso, Riccardo; Vicente, Emilio; Quijano, Yolanda; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Ferri, Valentina

2018-05-04

In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic gastrectomy, however, is adopted in only a few selected centers. The goals of this study were to examine the adoption of robotic gastrectomy and to compare outcomes between open and robotic gastric resections. This is a case-matched analysis of patients who underwent robotic and open gastric resection performed at Sanchinarro University Hospital, Madrid from November 2011 to February 2017. Patient data were obtained retrospectively. Clinicopathologic characteristics and perioperative and postoperative outcomes were recorded and analyzed. Two groups of demographically similar patients were analyzed: the robotic group (n = 20) and the open surgery group (n = 19). The patient characteristics of the two groups have been compared. Robotic resection resulted in less blood loss, shorter postoperative hospital stay, and a longer operating time. The two groups had similar complication rates. Pathological data were similar for both procedures. Robotic gastrectomy for locally advanced gastric carcinoma is safe, and long-term outcomes are comparable to those patients who underwent open resection. Robotic gastrectomy resulted in a shorter hospital stay, less blood loss and morbidity comparable with the outcomes of open gastrectomy.

Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing.

PubMed

Fazal, M Ali; Bagley, Caroline; Garg, Parag

2018-02-01

The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71.8% of the long nails (p < 0.05), 65.8% patients above the age of 80 (p < 0.05), 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 (p < 0.05). 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion (p > 0.05). Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p < 0.05). 55.1% operated within 36 h and 47.6% operated after 36 h of admission needed transfusion (p > 0.05). Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% (p > 0.05). Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

A second-generation blood substitute (perfluorodichlorooctane emulsion) does not activate complement during an ex vivo circulation model of bypass.

PubMed

Rosoff, J D; Soltow, L O; Vocelka, C R; Schmer, G; Chandler, W L; Cochran, R P; Kunzelman, K S; Spiess, B D

1998-08-01

To examine whether a second-generation perfluorocarbon (PFC) blood substitute added to the cardiopulmonary bypass (CPB) prime influences complement production. A prospective, randomized, single-blinded, ex vivo model. A university hospital, laboratory, and clinics. Ten healthy adult consented volunteer blood donors (five men, five women). Ex vivo closed-loop extracorporeal circuit including membrane oxygenator, tubing, and filter primed with crystalloid or crystalloid plus PFC was circulated for 1 hour with the addition of 500 mL of heparinized fresh human whole blood. Laboratory specimens were drawn from the circuit at 10-minute intervals for 1 hour and measured for complement (C3a, Bb fragment) concentrations, blood gases, fibrinogen concentration, platelet count, and hematocrit. In the PFC group, C3a and Bb fragments were equal to or less than those in the group that received crystalloid alone. The second-generation PFC added to the prime of a CPB circuit does not independently increase complement production.

Severe Childhood Anaemia and Blood Transfusion in a Nigerian Secondary Level Facility.

PubMed

Ogunlesi, Tinuade; Fetuga, Bolanle; Olowonyo, Michael; Adekoya, Adesola; Adetola, Oluseyi; Ajetunmobi, Adebimpe

2016-04-01

This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume <20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Severe Lead Toxicosis in a Lionhead Rabbit.

PubMed

Walter, Kristen M; Bischoff, Karyn; de Matos, Ricardo

2017-03-01

Lead toxicosis occurs in veterinary patients, with few reports involving rabbits, and no previous reports using oral calcium disodium EDTA. A 7-year-old male castrated Lionhead rabbit presented to the Cornell University Hospital for Animals (CUHA) for evaluation after a 2-day history of lethargy and a 2-week history of hyporexia. The patient had been observed pulling paint from the walls of the home, a house built circa 1900, in the months prior to presentation. The patient was moderately anemic with a hematocrit of 21% with red blood cell morphological changes consistent with lead toxicosis, including basophilic stippling, nucleated red blood cells, and polychromasia. Radiographic images of the abdomen revealed excessive accumulation of gas in the gastrointestinal tract in a pattern consistent with gastric stasis and numerous small mineral to metallic opacities in the cecum. The blood lead concentration was 792 μg/dL, confirming the diagnosis of lead toxicosis with secondary gastrointestinal stasis. The rabbit was hospitalized for treatment with oral and subcutaneous calcium disodium EDTA for 4 days and then discharged home to the care of the owners. Severe lead toxicosis in a rabbit can be treated successfully with oral and subcutaneous calcium disodium EDTA and aggressive supportive treatment.

Routine admission laboratory testing for general medical patients.

PubMed

Hubbell, F A; Frye, E B; Akin, B V; Rucker, L

1988-06-01

We evaluated the usefulness of commonly ordered routine admission laboratory tests in 301 patients admitted consecutively to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of the test results on patient care. The evaluated tests were the urinalysis, hematocrit, white blood cell count, platelet count, six-factor automated multiple analysis (serum sodium, potassium, chloride, bicarbonate, glucose, and blood urea nitrogen), prothrombin time, partial thromboplastin time, chest x-ray, and electrocardiogram. Forty-five percent of the 3,684 tests were ordered for patients without recognizable medical indications. Twelve percent of these routine tests were abnormal, 5% led to additional laboratory testing, but only 0.5% led to change in the treatment of patients. We conclude that the impact of routine admission laboratory testing on patient care is very small and that there is little justification for ordering tests solely because of hospital admission.

A new model in teaching undergraduate research: A collaborative approach and learning cooperatives.

PubMed

O'Neal, Pamela V; McClellan, Lynx Carlton; Jarosinski, Judith M

2016-05-01

Forming new, innovative collaborative approaches and cooperative learning methods between universities and hospitals maximize learning for undergraduate nursing students in a research course and provide professional development for nurses on the unit. The purpose of this Collaborative Approach and Learning Cooperatives (CALC) Model is to foster working relations between faculty and hospital administrators, maximize small group learning of undergraduate nursing students, and promote onsite knowledge of evidence based care for unit nurses. A quality improvement study using the CALC Model was implemented in an undergraduate nursing research course at a southern university. Hospital administrators provided a list of clinical concerns based on national performance outcome measures. Undergraduate junior nursing student teams chose a clinical question, gathered evidence from the literature, synthesized results, demonstrated practice application, and developed practice recommendations. The student teams developed posters, which were evaluated by hospital administrators. The administrators selected several posters to display on hospital units for continuing education opportunity. This CALC Model is a systematic, calculated approach and an economically feasible plan to maximize personnel and financial resources to optimize collaboration and cooperative learning. Universities and hospital administrators, nurses, and students benefit from working together and learning from each other. Copyright © 2016 Elsevier Ltd. All rights reserved.

Preanesthetic Assessment of the Jehovah's Witness Patient

PubMed Central

Lin, Eric S.; Kaye, Alan D.; Baluch, Amir R.

2012-01-01

The Jehovah's Witnesses, a religious group of 7 million people in more than 200 countries, teaches its followers to not accept blood, resulting in potentially challenging and ethical dilemmas for anesthesiologists. In recent years, Jehovah's Witnesses changed certain elements of their approach to blood transfusion practice, including accepting autologous transfusions in certain circumstances. We examine mechanisms to resolve ethical conflicts, such as additional medical consultations with other involved physicians, surgeons, and anesthesiologists; short-term counseling or psychiatric consultation for patient and family; case management conferences; consultation with individuals trained in clinical ethics or a hospital-based ethics committee; and discussions with hospital administration. We also discuss treatment options, including certain blood products, anesthetic techniques, and pharmacological interventions. PMID:22438784

77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

... Donald Howard, (410) 786-6764, Hospital Value-Based Purchasing (VBP) Program Issues. SUPPLEMENTARY... analyses performed by Brandeis University and Mathematica Policy Research together despite their slightly...

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.

Relationship between preoperative radial artery and postoperative arteriovenous fistula blood flow in hemodialysis patients.

PubMed

Sato, Michiko; Io, Hiroaki; Tanimoto, Mitsuo; Shimizu, Yoshio; Fukui, Mitsumine; Hamada, Chieko; Horikoshi, Satoshi; Tomino, Yasuhiko

2012-01-01

It is recommended that arteriovenous fistula (AVF) blood flow should be more than 425 ml/min before cannulation. However, the relationship between preoperative radial artery flow (RAF) and postoperative AVF blood flow has still not been examined. Sixty-one patients with end-stage kidney disease (ESKD) were examined. They had an AVF prepared at Juntendo University Hospital from July 2006 through August 2007. Preoperative RAF and postoperative AVF blood flows were measured by ultrasonography. AVF blood flow gradually increased after the operation. AVF blood flow was significantly correlated with preoperative RAF. When preoperative RAF exceeded 21.4 ml/min, AVF blood flow rose to more than 425 ml/min. The postoperative AVF blood flow in the group with RAF of more than 20 ml/min was significantly higher than that in those with less than 20 ml/min. Preoperative RAF of less than 20 ml/min had a significantly high risk of primary AVF failure within 8 months compared with that of more than 20 ml/min. It appears that measurement of RAF by ultrasonography is useful for estimating AVF blood flow postoperatively and can predict the risk of complications in ESKD patients.

Study of helminthiasis in pregnancy and its correlation with haemoglobin level.

PubMed

K, Shrinivas; Radhika; R, Sreelatha; K, Kavitha

2014-10-01

To study types of worm infestation in pregnancy and to correlate helminthiasis with haemoglobin level in antenatal women presenting in 2nd and 3rd trimester. This prospective cross sectional hospital based study conducted at Vanivilas hospital attached to Bangalore medical college, over a period of sixmonths. Study included 500 pregnant women attending antenatal opd in 2nd and 3rd trimester, selected by systematic random sampling method. Parasitic examination and haemoglobin estimation done respectively with Stool and blood samples collected from study group. Presence of parasites was correlated with haemoglobin percentage. Helminthiasis was found in 62 women (12.4%). All infected women had single type helminth infection. Ascariasis was more commonly found than hookworm (10% Vs 2.4%). Anaemia of various degrees was found in 88.7% of women with helminthiasis as compared to 56.4% women without worm infestation (p-value <0.05). Helminthiasis is a significant burden in pregnancy and it is associated with anaemia. Hence, the policy of universal administration of anthelminthic drug in pregnancy after first trimester, as recommended by WHO should be practically enforced besides health education.

Dynamic composition of medical support services in the ICU: Platform and algorithm design details.

PubMed

Hristoskova, Anna; Moeyersoon, Dieter; Van Hoecke, Sofie; Verstichel, Stijn; Decruyenaere, Johan; De Turck, Filip

2010-12-01

The Intensive Care Unit (ICU) is an extremely data-intensive environment where each patient needs to be monitored 24/7. Bedside monitors continuously register vital patient values (such as serum creatinine, systolic blood pressure) which are recorded frequently in the hospital database (e.g. every 2 min in the ICU of the Ghent University Hospital), laboratories generate hundreds of results of blood and urine samples, and nurses measure blood pressure and temperature up to 4 times an hour. The processing of such large amount of data requires an automated system to support the physicians' daily work. The Intensive Care Service Platform (ICSP) offers the needed support through the development of medical support services for processing and monitoring patients' data. With an increased deployment of these medical support services, reusing existing services as building blocks to create new services offers flexibility to the developer and accelerates the design process. This paper presents a new addition to the ICSP, the Dynamic Composer for Web services. Based on a semantic description of the medical support services, this Composer enables a service to be executed by creating a composition of medical services that provide the needed calculations. The composition is achieved using various algorithms satisfying certain quality of service (QoS) constraints and requirements. In addition to the automatic composition the paper also proposes a recovery mechanism in case of unavailable services. When executing the composition of medical services, unavailable services are dynamically replaced by equivalent services or a new composition achieving the same result. The presented platform and QoS algorithms are put through extensive performance and scalability tests for typical ICU scenarios, in which basic medical services are composed to a complex patient monitoring service. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

[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.

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.

Propranolol reduces the anxiety associated with day case surgery.

PubMed

Mealy, K; Ngeh, N; Gillen, P; Fitzpatrick, G; Keane, F B; Tanner, A

1996-01-01

To find out if propranolol, a non-cardioselective beta-blocker, can reduce the anxiety associated with day case surgery. Prospective randomized double blind trial. University hospital, Ireland. An unselected group of 53 patients undergoing day case surgery. Subjects randomised to receive either propranolol (10 mg) or placebo on the morning of operation. Blood pressure; pulse, anxiety, pain score and patient satisfaction. Mean (SD) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group (2.5 (0.7) compared with 4.6 (0.7), p < 0.0001) before discharge. A low dose of propranolol given on the morning of day case surgery significantly reduced patients' anxiety.

Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism

PubMed Central

Gedikli, Ömer; Ekşi, Alay; Avcıoğlu, Yonca; Soylu, Ayşegül İdil; Yüksel, Serkan; Aksan, Gökhan; Gülel, Okan; Yılmaz, Özcan

2016-01-01

Introduction Neutrophil-to-lymphocyte ratio (NLR), which is an essential marker of inflammation, has been shown to be associated with adverse outcomes in various cardiovascular diseases in the literature. In this study we sought to evaluate the association between NLR and prognosis of acute pulmonary embolism (APE). Material and methods We retrospectively evaluated blood counts and clinical data of 142 patients with the diagnosis of pulmonary embolism (PE) from Ondokuz Mayis University Hospital between January 2006 and December 2012. The patients were divided into two groups according to NLR: NLR < 4.4 (low NLR group, n = 71) and NLR ≥ 4.4 (high NLR group, n = 71). Results Massive embolism (66.2% vs. 36.6%, p < 0.001) and in-hospital mortality (21.1%, 1.4%, p < 0.001) were higher in the high NLR group. In multivariate regression analysis NLR ≥ 5.7, systolic blood pressure (BP) < 90 mm Hg, serum glucose > 126 mg/dl, heart rate > 110 beats/min, and PCO2 < 35 or > 50 mm Hg were predictors of in-hospital mortality. The optimal NLR cutoff value was 5.7 for mortality in receiver operating characteristic (ROC) analysis. Having an NLR value above 5.7 was found to be associated with a 10.8 times higher mortality rate than an NLR value below 5.7. Conclusions In patients presenting with APE, NLR value is an independent predictor of in-hospital mortality and may be used for clinical risk classification. PMID:26925123

Safety of the use of group A plasma in trauma: the STAT study.

PubMed

Dunbar, Nancy M; Yazer, Mark H

2017-08-01

Use of universally ABO-compatible group AB plasma for trauma resuscitation can be challenging due to supply limitations. Many centers are now using group A plasma during the initial resuscitation of traumatically injured patients. This study was undertaken to evaluate the impact of this practice on mortality and hospital length of stay (LOS). Seventeen trauma centers using group A plasma in trauma patients of unknown ABO group participated in this study. Eligible patients were group A, B, and AB trauma patients who received at least 1 unit of group A plasma. Data collected included patient sex, age, mechanism of injury, Trauma Injury Severity Score (TRISS) probability of survival, and number of blood products transfused. The main outcome of this study was in-hospital mortality differences between group B and AB patients compared to group A patients. Data on early mortality (≤24 hr) and hospital LOS were also collected. There were 354 B and AB patients and 809 A patients. The two study groups were comparable in terms of age, sex, TRISS probability of survival, and total number of blood products transfused. The use of group A plasma during the initial resuscitation of traumatically injured patients of unknown ABO group was not associated with increased in-hospital mortality, early mortality, or hospital LOS for group B and AB patients compared to group A patients. These results support the practice of issuing thawed group A plasma for the initial resuscitation of trauma patients of unknown ABO group. © 2017 AABB.

Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone.

PubMed

Yecies, Derek; Tawfik, Daniel; Damman, Jennifer; Thorson, Chad; Hong, David S; Grant, Gerald A; Bensen, Rachel; Damian, Mihaela

2017-07-07

A four-year-old female was admitted to a university-based children's hospital with a newly-diagnosed posterior fossa tumor. She was started on famotidine and high-dose dexamethasone and underwent gross total resection of a medulloblastoma. She was continued on dexamethasone and famotidine. She exhibited postoperative posterior fossa syndrome and was started on enteral feeds via the nasoduodenal tube. She had small gastrointestinal bleeds on postoperative days eight, 11, and 18, and was found to have a well-circumscribed posterior duodenal ulcer. On postoperative day 19, she suffered a massive life-threatening gastrointestinal bleed requiring aggressive resuscitation with blood products. She required an emergent laparotomy due to ongoing blood loss and she was found to have posterior duodenal wall erosion into her gastroduodenal artery. She recovered and subsequently began delayed chemotherapy. This case demonstrates a rare and life-threatening complication of high-dose dexamethasone therapy in the setting of posterior fossa pathology despite stress ulcer prophylaxis. We present a historical perspective with the review of the association between duodenal and intracranial pathology and the usage of high-dose dexamethasone in such cases.

Nosocomial bloodstream infections in a Turkish university hospital: study of Gram-negative bacilli and their sensitivity patterns.

PubMed

Köseoğlu , O; Kocagöz, S; Gür, D; Akova, M

2001-06-01

Treatment of nosocomial bacteraemia is usually governed by the surveillance results of the particular unit. Such results are especially important when antimicrobial resistance rates are high. Multiresistant isolates including Gram-negatives producing extended-spectrum beta-lactamases have been frequently reported in tertiary care units in Turkey. In this study, antimicrobial susceptibilities of Gram-negative blood isolates (n=348) were determined by microbroth dilution tests. The results showed carbapenems (meropenem and imipenem) to be uniformly more potent in vitro than any other drug against the Enterobacteriaceae. Quinolone antibiotics were more active in vitro than aminoglycosides against a range of bacteria. Gram-negative bloodstream isolates were highly resistant to many antimicrobial agents in the hospital. In order to prevent hospital infection and antimicrobial resistance, surveillance of aetiological agents must be performed regularly.

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.

Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

PubMed Central

Sadek, Abdelrahim Abdrabou; Mohamed, Montaser Mohamed; Sharaf, El-Zahraa El-Said Ahmed; Magdy, Rofaida Mohamed; Allam, Ahmed Ahmed

2016-01-01

Introduction Breath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital. Methods An observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG). Results During the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children. Conclusion BHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country. PMID:27279996

The Management Development Program: A Competency-Based Model for Preparing Hospitality Leaders.

ERIC Educational Resources Information Center

Brownell, Judi; Chung, Beth G.

2001-01-01

The master of management program at Cornell University focused on competency-based development of skills for the hospitality industry through core courses, minicourses, skill benchmarking, and continuous improvement. Benefits include a shift in the teacher role to advocate/coach, increased information sharing, student satisfaction, and clear…

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.

Scores of nutritional risk and parameters of nutritional status assessment as predictors of in-hospital mortality and readmissions in the general hospital population.

PubMed

Budzyński, Jacek; Tojek, Krzysztof; Czerniak, Beata; Banaszkiewicz, Zbigniew

2016-12-01

We have no "gold standard" for the diagnosis of malnutrition. The aim of this study was to determine the importance of many of the parameters used in nutritional status screening and assessment among inpatients for the prediction of in-hospital mortality, readmission and length of hospitalization. On the base of the medical documentation a retrospective analysis was performed of nutritional status screening and assessment parameters for all 20,237 non-selected, consecutive hospitalizations in 15,013 patients over 18 years of age treated in one hospital during the course of one year. The risk of malnutrition expressed as a Nutritional Risk Screening (NRS)-2002 score ≥ 3 concerned 6.4% hospitalizations. The greater risk of in-hospital death, as well as readmission within 14 days and 30 days, was related to an NRS-2002 score ≥3, age >65 years, male gender, urgent admission, body mass deficit calculated as the difference between actual body mass and ideal weight determined according to the Lorentz formula, higher degree of Instant Nutritional Assessment (INA), greater value of a C-reactive protein (CRP)/albumin ratio, and plasma glucose concentration. Whereas, greater blood concentration of albumin, hemoglobin, cholesterol and triglycerides, as well as a greater blood lymphocyte count, were associated with reduced risk of the measured outcomes. NRS-2002 score, blood albumin, CRP/albumin ratio, and INA seem to be good predictors of in-hospital mortality, readmission rate and length of hospital stay. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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.

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.

Antimicrobial susceptibility pattern of Klebsiella species from Ebonyi State University Teaching Hospital Abakaliki, Nigeria.

PubMed

Akujobi, C N

2005-12-01

Klesiella specie isolated from clinical specimens from Ebonyi State University Teaching Hospital (EBSUTH). Abakakliki were studied to determine the antimicrobial susceptibility pattern. Between January, 2003 and September 2004 a total of 3.600 specimens processed in the routine Medical Microbiology laboratory of EBSUTH, of which 245(6.8%) yielded Klebsiella species, with 84 from out - patients and 161 from in - patients. The number of isolates from various samples were: Urine 126, Sputum 37 Endocervical swab 13, Aspirates 8, High Vaginal Swab 7, Blood 3, Eye Swab, Ear Swab and Cerebrospinal fluid were 2 samples each. Organisms were identified by conventional methods. Antimicrobial susceptibility was done by the disk diffusion methods. The antimicrobial disk used include: Ceftazidime, Cefuroxime, Cefotaxine, Augmentin, Pefloxacin (30ug), Doxycyline (25ug) Genticin (10 ug) Ciprofloacin and Ofloxacin (5ug) each and Erythromycin (15ug). All were Oxoid products. Results were interpreted according to NCCLS criteria. Klebsilla species were isolated mostly from urine specimens (51.4%) followed by wound swabs (18.4%). Antimicrobial susceptibility to various groups drugs used was generally poor. The most sensitive antimicrobial was Ciprofloxacin with 121(49.4%) isolates susceptible to it, followed by Gentamicin with 95 (38.8%) and Ceftazidime with 90(36.7%). Seventeen isolates were multiresistant to all the antimicrobial agents used. The result of this study will help in the empiric therapy of infection caused by Klebsiella species in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria but continuous surverillance of antimicrobial resistance of the organnisn is very necessary in the formulation of a sound antibiotic policy in the hospital.

Correlation between the neutrophil-lymphocyte count ratio and bacterial infection in patient with human immunodeficiency virus

NASA Astrophysics Data System (ADS)

Kusnadi, D.; Liwang, M. N. I.; Katu, S.; Mubin, A. H.; Halim, R.

2018-03-01

Parameters for starting antibiotic therapy such as CRP andleukocytosis are considered non-specific. Previous studies have shown the Neutrophil-Lymphocyte Count Ratio (NLCR) can serve as the basis of bacterial infection, the level of infection, and the basis of antibiotic therapy. Compared with the Procalcitonin parameter, this NLCR is rapid, an inexpensive and requires no additional sampling. To determine the correlation between The Neutrophil-LymphocyteCount Ratio to bacterial infection in HIV patients. This study was a cross-sectional observational approach to HIV subject at Wahidin Sudirohusodo and Hasanuddin University Hospital. The subjects performed routine blood, microbiology test,and blood Procalcitonin levels tests. Then performed NLCR calculations based on routine blood results. The subjects then grouped the presence or absence of bacterial infection.In 146 study subjects, there were 78 (53.4%) with bacterial infections and 68 (46.6%) without bacterial infection as controls. Subjects with bacterial infections had higher total neutrophils (84.83) compared with non-bacterial infections. Subjects with bacterial infections had total lymphocytes with an average of 8.51 lower than non-bacterial infections. Subjects with bacterial infections had higher NLCR values with an average of 12.80. The Neutrophil-Lymphocyte Count Ratio can become a marker of bacterial infection in HIV patients.

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice – the Frankfurt Experience

PubMed Central

Fischer, Dania P.; Zacharowski, Kai D.; Müller, Markus M.; Geisen, Christof; Seifried, Erhard; Müller, Heiko; Meybohm, Patrick

2015-01-01

Introduction A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program. PMID:26019704

The Effect of Mother's Voice on Arterial Blood Sampling Induced Pain in Neonates Hospitalized in Neonate Intensive Care Unit.

PubMed

Azarmnejad, Elham; Sarhangi, Forogh; Javadi, Mahrooz; Rejeh, Nahid

2015-04-19

Due to devastating effects of pain in neonates, it is very important to ease it though safe and feasible methods. This study was to determine the effect of familiar auditory stimuli on the arterial blood sampling (ABS) induced pain in term neonates. This study was done on 30 newborns hospitalized in neonate intensive care unit (NICU) of a hospital in Tehran. Research samples were selected by using convenience sampling and randomly divided into two groups of control and test. In the test group, the recorded mothers' voices were played for the newborns before and after blood sampling procedure. Then, pain measures were recorded 10 minutes before, during and 10 minutes after blood collection based on Neonatal Infant Pain Scale (NIPS); then the pain level changes were reviewed and studied. The findings showed significant differences between the control and test groups that indicating the effect of mother's voice on reducing the pain of neonates during the ABS (p<0.005). Research findings demonstrate that mother's voice reduces ABS induced pain in the term neonates.

Evaluation of gingival blood as a minimally invasive screening tool for diabetes mellitus among 40-59-year-old adults in dental clinics: A cross-sectional study.

PubMed

Partheeban, Indumathi K; Chaly, Preetha; Priyadarshni, Indra; Junaid, Mohammed; Nijesh, J E; Vaishnavi, S

2017-01-01

To evaluate a quick, safe, and minimally invasive method to screen for diabetes using gingival blood with the help of self-monitoring glucometer during periodontal examination. A hospital-based, cross-sectional comparative study was conducted among 40-59-year-old diabetic and nondiabetic population who had come for their master health examination to a private tertiary care hospital (Global Hospital and Health City) in Chennai. Among them, those who fulfilled the inclusion criteria were selected for the study. Thirty diabetic and thirty nondiabetic patients with moderate to severe gingivitis were enrolled and subjected to routine clinical periodontal examination. Blood samples of two sites were analyzed using a glucose self-monitoring device (Accu-Check). Patients were tested for venous fasting blood sugar (VFBS), venous postprandial blood sugar (VPPS), gingival fasting blood sugar (GFBS) level, gingival postprandial blood sugar (GPPS) level, peripheral fingerstick fasting blood sugar (PFBS) level, and peripheral fingerstick postprandial sugar (PPPS) level. Data obtained were statistically analyzed using Student's t-test, ANOVA, and Pearson's correlation test. A significant positive correlation was found between GFBS and VFBS, GFBS and PFBS, GPPS and VPPS, and GPPS and PPPS (P < 0.01) in both diabetic and nondiabetic patients correlation. Using venous blood glucose level as a gold standard, the sensitivity and specificity of GFBS was 93% and 100%, respectively, whereas in GPPS, the sensitivity and specificity was 80% and 96%, respectively. Gingival blood glucometry can be used as a minimally invasive screening tool for diabetes mellitus in dental clinics.

Lower Blood Pressure-Induced Renal Hypoperfusion Promotes Cisplatin-Induced Nephrotoxicity.

PubMed

Mizuno, Tomohiro; Hayashi, Takahiro; Shimabukuro, Yuka; Murase, Maho; Hayashi, Hiroki; Ishikawa, Kazuhiro; Takahashi, Kazuo; Yuzawa, Yukio; Yamada, Shigeki; Nagamatsu, Tadashi

2016-01-01

Cisplatin-induced nephrotoxicity primarily occurs in the proximal tubules, and tubular injuries reduce glomerular filtration rates. Lower blood pressure causes renal hypoperfusion, which promotes ischemic acute kidney injury (AKI). Our study examined the relationship between lower blood pressure-induced renal hypoperfusion and cisplatin-induced nephrotoxicity. The relationship between cisplatin use and hypoalbuminemia is not clear. This study consisted of Japanese patients who received cisplatin as the first-line chemotherapy at Fujita Health University Hospital from April 2006 to December 2012. Hypoalbuminemia was defined as serum albumin levels ≤3.5 mg/dl. Patients who experienced lower blood pressure during chemotherapy were included in the lower blood pressure group (n = 229), and those who did not were included in the normal blood pressure group (n = 743). Total cisplatin dose in the normal blood pressure and lower blood pressure groups was 58.9 ± 23.8 and 55.0 ± 20.4 mg/m2, respectively. The rate of severe nephrotoxicity was higher and overall survival was shorter in the lower blood pressure group than in the normal blood pressure group. In a multivariable analysis, lower blood pressure significantly correlated with hypoalbuminemia. To prevent ischemic AKI, nutrition and cachexia controlling are important parts of cancer treatment. © 2016 S. Karger AG, Basel.

Unified Modeling Language (UML) for hospital-based cancer registration processes.

PubMed

Shiki, Naomi; Ohno, Yuko; Fujii, Ayumi; Murata, Taizo; Matsumura, Yasushi

2008-01-01

Hospital-based cancer registry involves complex processing steps that span across multiple departments. In addition, management techniques and registration procedures differ depending on each medical facility. Establishing processes for hospital-based cancer registry requires clarifying specific functions and labor needed. In recent years, the business modeling technique, in which management evaluation is done by clearly spelling out processes and functions, has been applied to business process analysis. However, there are few analytical reports describing the applications of these concepts to medical-related work. In this study, we initially sought to model hospital-based cancer registration processes using the Unified Modeling Language (UML), to clarify functions. The object of this study was the cancer registry of Osaka University Hospital. We organized the hospital-based cancer registration processes based on interview and observational surveys, and produced an As-Is model using activity, use-case, and class diagrams. After drafting every UML model, it was fed-back to practitioners to check its validity and improved. We were able to define the workflow for each department using activity diagrams. In addition, by using use-case diagrams we were able to classify each department within the hospital as a system, and thereby specify the core processes and staff that were responsible for each department. The class diagrams were effective in systematically organizing the information to be used for hospital-based cancer registries. Using UML modeling, hospital-based cancer registration processes were broadly classified into three separate processes, namely, registration tasks, quality control, and filing data. An additional 14 functions were also extracted. Many tasks take place within the hospital-based cancer registry office, but the process of providing information spans across multiple departments. Moreover, additional tasks were required in comparison to using a standardized system because the hospital-based cancer registration system was constructed with the pre-existing computer system in Osaka University Hospital. Difficulty of utilization of useful information for cancer registration processes was shown to increase the task workload. By using UML, we were able to clarify functions and extract the typical processes for a hospital-based cancer registry. Modeling can provide a basis of process analysis for establishment of efficient hospital-based cancer registration processes in each institute.

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.

Monitoring compliance with transfusion guidelines in hospital departments by electronic data capture

PubMed Central

Norgaard, Astrid; de Lichtenberg, Trine Honnens; Nielsen, Jens; Johansson, Pär I.

2014-01-01

Background The practice of transfusing red blood cells is still liberal in some centres suggesting a lack of compliance with guidelines recommending transfusion of red blood cells at haemoglobin levels of 6–8 g/dL in the non-bleeding patient. Few databases provide ongoing feedback of data on pre-transfusion haemoglobin levels at the departmental level. In a tertiary care hospital, no such data were produced before this study. Our aim was to establish a Patient Blood Management database based on electronic data capture in order to monitor compliance with transfusion guidelines at departmental and hospital levels. Materials and methods Hospital data on admissions, diagnoses and surgical procedures were used to define the populations of patients. Data on haemoglobin measurements and red blood cell transfusions were used to calculate pre-transfusion haemoglobin, percentage of transfused patients and transfusion volumes. Results The model dataset include 33,587 admissions, of which 10% had received at least one unit of red blood cells. Haemoglobin measurements preceded 96.7% of the units transfused. The median pre-transfusion haemoglobin was 8.9 g/dL (interquartile range 8.2–9.7) at the hospital level. In only 6.5% of the cases, transfusion was initiated at 7.3 g/dL or lower as recommended by the Danish national transfusion guideline. In 27% of the cases, transfusion was initiated when the haemoglobin level was 9.3 g/dL or higher, which is not recommended. A median of two units was transfused per transfusion episode and per hospital admission. Transfusion practice was more liberal in surgical and intensive care units than in medical departments. Discussion We described pre-transfusion haemoglobin levels, transfusion rates and volumes at hospital and departmental levels, and in surgical subpopulations. Initial data revealed an extensive liberal practice and low compliance with national transfusion guidelines, and identified wards in need of intervention. PMID:24960656

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

PubMed Central

2009-01-01

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

Impact of universal screening on MRSA bacteremias in a single acute NHS organisation (2006-12): interrupted time-series analysis.

PubMed

Sarma, Jayanta B; Marshall, Bryan; Cleeve, Victoria; Tate, David; Oswald, Tamsin

2013-01-14

In November 2004, a national target was set for the English hospital trusts to reduce the Meticillin-Resistant Staphylococcus aureus (MRSA) bacteremia rate by 60% by April 2008 against the number during 2003/04 (baseline year). In our organisation the number of MRSA bacteremias had risen since 2002 and peaked at 75 in 2005/06. A target was set to reduce the number and series of specific and non- specific interventions was introduced including universal MRSA screening. This study analyzes the impact of universal MRSA screening using a quasi-experimental design using routinely gathered data. This study used data gathered routinely for clinical governance, quality control, financial management and outbreak monitoring purposes. Interrupted Time Series (ITS) analysis of 15 pre- and 19 post- universal MRSA screening (and decolonisation) quarterly numbers of bacteremias was carried out where Meticillin-Sensitive Staphylococcus aureus (MSSA) numbers served as non-equivalent dependent variable (control). An immediate sharp fall in MRSA bacteremias was observed following the universal MRSA screening (and decolonisation) commenced in Q2, 2007. The number dropped sharply from 23 (Q2, 2007) to 10 (Q3, 2007) for all MRSA bacteremias, and, from 15 (Q2, 2007) to 6 (Q3, 2007) for bacteremias ≥48 hours of hospitalization. The declining trend continued reaching zero in Q2, 2009 and Q4, 2010 for those with ≥48 hours of hospitalization and all bacteremias, respectively. ITS analysis revealed significant impact of universal MRSA screening on all MRSA bacteremias (β2 -0.554, p 0.000) and those with ≥48 of hospitalization (β2 -0.577, p 0.001). Impact estimation predicted 17 and 13 bacteremias for all and those with ≥48 hours hospitalization, respectively in the 19th quarter post-intervention, if the intervention did not occur. The number of MRSA isolates from non-blood culture systemic sources as percentage of admissions also dropped significantly from 3.32% in Q2, 2007 to 1.51% in Q3, 2007 (β2 -0.506, p 0.000) which is still running low at 0.33% at the end of Q1, 2012. On the other hand, there was no statistically significant impact of universal screening on MSSA bacteremias. We conclude that of all interventions, the universal MRSA screening (and decolonisation) is the most effective intervention associated with significant and sharp drop in MRSA burden.

Impact of universal screening on MRSA bacteremias in a single acute NHS organisation (2006–12): interrupted time-series analysis

PubMed Central

2013-01-01

Background In November 2004, a national target was set for the English hospital trusts to reduce the Meticillin-Resistant Staphylococcus aureus (MRSA) bacteremia rate by 60% by April 2008 against the number during 2003/04 (baseline year). In our organisation the number of MRSA bacteremias had risen since 2002 and peaked at 75 in 2005/06. A target was set to reduce the number and series of specific and non- specific interventions was introduced including universal MRSA screening. This study analyzes the impact of universal MRSA screening using a quasi-experimental design using routinely gathered data. Methods This study used data gathered routinely for clinical governance, quality control, financial management and outbreak monitoring purposes. Interrupted Time Series (ITS) analysis of 15 pre- and 19 post- universal MRSA screening (and decolonisation) quarterly numbers of bacteremias was carried out where Meticillin-Sensitive Staphylococcus aureus (MSSA) numbers served as non-equivalent dependent variable (control). Results An immediate sharp fall in MRSA bacteremias was observed following the universal MRSA screening (and decolonisation) commenced in Q2, 2007. The number dropped sharply from 23 (Q2, 2007) to 10 (Q3, 2007) for all MRSA bacteremias, and, from 15 (Q2, 2007) to 6 (Q3, 2007) for bacteremias ≥48 hours of hospitalization. The declining trend continued reaching zero in Q2, 2009 and Q4, 2010 for those with ≥48 hours of hospitalization and all bacteremias, respectively. ITS analysis revealed significant impact of universal MRSA screening on all MRSA bacteremias (β2 -0.554, p 0.000) and those with ≥48 of hospitalization (β2 -0.577, p 0.001). Impact estimation predicted 17 and 13 bacteremias for all and those with ≥48 hours hospitalization, respectively in the 19th quarter post-intervention, if the intervention did not occur. The number of MRSA isolates from non-blood culture systemic sources as percentage of admissions also dropped significantly from 3.32% in Q2, 2007 to 1.51% in Q3, 2007 (β2 -0.506, p 0.000) which is still running low at 0.33% at the end of Q1, 2012. On the other hand, there was no statistically significant impact of universal screening on MSSA bacteremias. Conclusions We conclude that of all interventions, the universal MRSA screening (and decolonisation) is the most effective intervention associated with significant and sharp drop in MRSA burden. PMID:23316746

[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.

Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study.

PubMed

Villatte, Guillaume; Engels, Emilien; Erivan, Roger; Mulliez, Aurélien; Caumon, Nicolas; Boisgard, Stéphane; Descamps, Stéphane

2016-11-01

Total hip arthroplasty (THA) is considered a painful procedure with significant blood loss. The aim of the this study was to determine whether local infiltration analgaesia (LIA) (with long-acting local anaesthetics and epinephrine) during THA could reduce acute postoperative pain, improve early recovery and reduce per- and postoperative bleeding. One hundred and fifty patients scheduled for primary THA were randomised into two groups. The treatment group received LIA (ropivacaine with epinephrine), whereas the control group had no infiltration. Pain intensity was measured with a visual analogue scale (VAS) for the duration of hospital stay and analgaesic consumption. Length of hospital stay, time to get out of bed alone and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index at 3, 6 and 12 months were recorded to evaluate recovery. Per- and postoperative bleeding were evaluated using direct and indirect criteria (operative blood loss, haemoglobin, estimation of uncompensated blood loss and red blood cell transfusion). Patients with LIA had significantly less pain during the first 24 h (p = 0.04). No significant differences were found in terms of analgaesic consumption (p = 0.57), early and delayed recovery or bleeding between groups. Operative wound infiltration of LIA reduced acute pain after primary THA but did not improve recovery or influence per- and postoperative bleeding.

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.

The acceptability of volunteer, repeat blood donations in a hospital setting in the Adamaoua region of Cameroon.

PubMed

Rolseth, S; Stange, P; Adamou, D; Roald, B; Danki-Sillong, F; Jourdan, P

2014-12-01

The knowledge of factors that may influence blood donation in Cameroon is limited. The objectives of this study are to assess the characteristics of previous and potential blood donors by exploring the religious beliefs, and knowledge and understanding of blood donations among individuals present at a district hospital. Forty-nine in-depth, semi-structured interviews were conducted among consenting, randomly selected 18 years or older community members present at a district hospital in the Adamaoua region during October and November 2011. Ninety-eight per cent (48/49) of the individuals present at this district hospital had heard of blood transfusions. Forty-seven per cent (23/49) had not previously been asked to donate blood; however, 94% (44/47) said that they would donate if given the opportunity. Thirty-three per cent (16/49) had previously donated blood to family members or for replacement, and 81% of these said they would repeat donations. The majority of both donors and non-donors were motivated to donate blood for altruistic reasons. The findings suggest that community members present at this district hospital in Cameroon may be recruited for repeat blood donations. Although the altruistic motivation to donate blood suggests that donors could be recruited from a district hospital population, targeted information about blood donations and accessible blood transfusion services need to be put in place. The study may add to the understanding of the preconditions for blood donations and the possibility to establish sustainable blood transfusion services in the Adamaoua region in Cameroon. © 2014 British Blood Transfusion Society.

[Occurence, etiology and clinical significance of trombocytopenia in pregnancy].

PubMed

Brychtová, P; Procházka, M; Lattová, V; Lubušký, M; Procházková, J; Slavík, L; Úlehlová, J; Simetka, O

2013-12-01

The principal objective of the study is to compare results from the experimental group of pregnant women suffering from thrombocytopenia in pregnancy with results from the control group of pregnant women with normal physiologic blood platelet count. Department of Obstetrics and Gynaecology of the Tomas Bata Regional Hospital Zlín, Obstetrics and Gynaecology Clinic, Haematology and Oncology Clinic of the Palacky University Teaching Hospital and Medical School in Olomouc, Obstetrics and Gynaecology Clinic of the Ostrava Teaching Hospital. A group of 200 pregnant women suffering from thrombocytopenia underwent thorough medical tests. The level of platelets, presence of anti-platelets agents, liver function (LFT), anti-phospholipid antibodies, complete blood count with differential, specific antibodies for hepatitis B and C, Lyme borreliosis and cytomegalovirus were determined from venous blood using the EIA, ELISA methods. Medical articles and books about thrombocytopenia divide the causes for thrombocytopenia as follows: 79.5% benign gestational thrombocytopenia, 16% preeclampsia, 2.5% HELLP syndrome, 1% immune thrombocytopenia, 1% HVC. The number of women who developed physiological anaemia in pregnancy and were overweight is identical in the experimental group of pregnant women suffering from thrombocytopenia and in the control group of pregnant women with normal physiologic blood platelet count, and the proportion of the different age groups in the two groups of pregnant women is also identical. 32% of pregnancies in the experimental group ended in a caesarean section, of which 13.5% in a group of 127 pregnant women suffering from mild thrombocytopenia, 17.5% in a group of 71 pregnant women suffering from moderate thrombocytopenia and 1% in a group of 2 pregnant women suffering from severe thrombocytopenia. 20.5% pregnancies in the control group ended in caesarean section.

Influence of aggressive nutritional support on growth and development of very low birth weight infants.

PubMed

Xu, Y M; Zhu, X P; Xiao, Z; Yu, L; Zhao, X

2014-01-01

To investigate the influence of the early postnatal aggressive nutritional support on the very low birth weight infants (VLBWI) during hospitalization. Surviving premature infants without obvious deformity, with gestational age more than 28 weeks and less than 32 weeks, birth weight 1,000 g to 1,500 g, admitted in NICU in Affiliated Children's Hospital of Suzhou University during 12 hours after birth and stay for two weeks or more from January 2008 to December 2011 were selected, including 44 cases (admitted from September 2010 to December 2011) in the observation group and 36 cases in the control group (admitted from January 2008 and September 2010). The infants in the observation group were treated by aggressive nutritional management, while traditional nutritional management for infants in the control group. The variations of nutritional intake, weight gain, jaundice index, blood biochemistry, serum electrolytes indexes, and complications were compared between the two groups. Compared to the control group, the average growth rate and the albumin (ALB) and prealbumin (PA) levels two week after birth and before leaving hospital of the infants in the observation group was significantly higher (p < 0.05), and the incidence of the extrauterine growth retardation was significantly decreasing (p < 0.05). However, the days of hyperbilirubinemia, highest value of the serum bilirubin, duration ofjaundice, platelets after intravenous nutrition, liver function, blood lipid levels, blood glucose, blood PH, serum creatinine, urea nitrogen, and electrolytes of the first day and the seventh day after birth and the in- cidence of parenteral nutrition-associated cholestasis (PNAC) and necrotizing enterocolitis (NEC) between the two group had no difference (p > 0.05). The implementation of aggressive nutritional management on the with VLBWI was safe and effective.

Attitudes and Perceptions of Cancer Patients Toward Biospecimen Donation for Cancer Research: A Cross-Sectional Survey Among Chinese Cancer Patients.

PubMed

He, Na; Guo, Yan; He, Min; Qiang, Wanmin; Li, Haixin

2017-08-01

High-quality biospecimen collection from consented patients is crucial for cancer research activities. Patients' attitudes and willingness toward specimen donation influence high-quality biospecimen collection for cancer research activities. We carried out a cross-sectional study among randomly selected patients from 11 cancer departments of Tianjin Medical University Cancer Institute and Hospital between August 2014 and August 2015. A total of 784 patients were included to complete a 30-item self-administered survey. We evaluated the patients' willingness to consider providing leftover samples and additional samples for cancer research purposes. Among 784 patients, 683 (87.1%) and 653 (83.3%) were willing to donate leftover tissue and surplus blood after diagnosis, respectively. Six hundred thirty-one (80.5%) were favorably disposed to consider donating both tissue and blood samples for future cancer research. Female patients showed less willingness to donate biospecimens or related clinical data for research. First-hospitalized or older patients were less willing to provide leftover biospecimens or additional blood samples or even clinical data for research. By contrast, patients with a higher education level were more likely to donate leftover tissues after biopsy or surgery for research activities. Most Chinese cancer patients were willing to consider donating blood and tissue samples for cancer research. Several factors, including age, gender, first hospitalization, and education level, can influence their willingness to donate biospecimens. We need to provide proper education to increase understanding of patients in biobanking activities. This study provides novel empirical data on the likelihood of donating surplus and additional biospecimens and clinical health information among Chinese cancer patients.

The quality of arterial hypertension treatment in cardiology service in Kosovo--a single center study.

PubMed

Bajraktari, Gani; Sylejmani, Xhevahire; Thaçi, Kimete; Elezi, Shpend; Ndrepepa, Gjin

2009-04-01

The epidemiological data have shown that the goal blood pressure (BP) control is achieved in only a small percentage of the hypertensive patients. The aim of this study was to assess the quality of the management of arterial hypertension (AH) in patients hospitalized in Service of Cardiology, University Clinical Centre of Kosovo, in Prishtina, and to determine the predictors of uncontrolled AH. This retrospective study included 938 consecutive hypertensive patients (63.1+/- 11.3 years, 55.1% females), admitted to our institution between January 2003 and June 2006. Systolic and diastolic blood pressure, blood analyses, drug prescription and echocardiographic findings were analyzed in all study patients. Multiple regression analysis was used to identify the independent associates of poor BP control. Overall, 83%f of patients were discharged on angiotensin-converting enzyme inhibitors (A), 71% - on beta-blockers (B), 26% - on calcium channel blockers (C) and 60% - on diuretics (D). The most frequent drug combination used was ABD (30.5%), followed by AB (18%) and AD (8%). The goal systolic and diastolic BP was achieved in 50% of patients. Multivariate analysis identified diabetes, (OR=0.479, 95% confidence interval [CI] 0.339-0.677, <0.001), creatinine level (OR=0.997, 95% CI 0.996-0.999, p=0.001], and ABCD combination therapy (OR=0.445, 95% CI 0.253-0.774, p=0.046)], as independent correlates of in-hospital poor BP control. Half of hypertensive patients hospitalized in the Service of Cardiology had achieved the goal blood pressure. The diabetes, level of creatinine and a combination of 4 antihypertensive drugs were independent predictors of poor hypertension control.

Blood transfusion services in Delhi.

PubMed

Makroo, R N; Kumar, N D

1993-04-01

In 1991, approximately 40% of total blood requirement in Delhi was collected from commercial blood donors. The rest was supplied by voluntary and replacement donations in hospital-based blood banks and by voluntary blood recruiting agency (Indian Red Cross Society). This study analyses the standards of working and quality assurance in 26 blood transfusion centers in Delhi. The majority of these centers are ill-equipped and lack trained manpower. Most of these do not have adequate testing facilities and any standardized procedure for blood collection. Quality assurance scheme is not being followed and documentation and record maintenance is grossly inadequate. This reports also gives the recommendations for improvements of blood transfusion services in Delhi.

Massive blood loss in elective spinal and orthopedic surgery: Retrospective review of intraoperative transfusion strategy.

PubMed

Rankin, Demicha; Zuleta-Alarcon, Alix; Soghomonyan, Suren; Abdel-Rasoul, Mahmoud; Castellon-Larios, Karina; Bergese, Sergio D

2017-02-01

To evaluate the perioperative dynamics of hematologic changes and transfusion ratio in patients undergoing a major spinal surgery accompanied with massive bleeding defined as blood loss >5 liters. Retrospective cohort study. Operating room of a university-affiliated hospital. Adult patients who underwent elective neurosurgical, orthopedic, or combined spinal surgical procedure between 2008 and 2012. Patients who underwent a major spinal or orthopedic surgery and who experienced major bleeding (>5 L) during surgery were identified and selected for final analysis. The following information was analyzed: demographics, clinical diagnoses, hematologic parameters, estimated intraoperative blood loss, blood product transfusions, and survival 1 year after surgery. During the study period, 25 patients, who underwent 28 spinal procedures, experienced intraoperative blood loss >5 L. Mean patient age was 50.5 years and 56.4% were males. The majority of patients underwent procedures to manage spinal metastases. Median estimated intraoperative blood loss was 11.25 L (IQR 6.35-22 L) and median number of units (U) transfused was 24.5 U (IQR 14.0-32.5 U) of packed red blood cells (RBCs), 24.5 U (IQR 14.0-34.0 U) of fresh frozen plasma (FFP), and 4.5 U (IQR 3.0-11.5 U) of platelets (PLTs). The blood product transfusion ratio was 1 and 4 for RBC:FFP, and RBC:PLT, respectively. Hematocrit, hemoglobin, PLTs, partial thromboplastin, prothrombin time, INR, and, fibrinogen varied significantly throughout the procedures. However, acid-base status did not change significantly during surgery. Patients' survival at 1 year was 79.17%. Our results indicate that a 1:1 RBC:FFP and 4:1 RBC:PLT transfusion ratio was associated with significant intraoperative variations in coagulation variables but stable intraoperative acid-base parameters. This transfusion ratio helped clinicians to achieve postoperative coagulation parameters not significantly different to those at baseline. Future studies should assess if more liberal transfusion strategies or point of care monitoring might be warranted in patients undergoing spinal surgery at risk of major blood loss. Copyright © 2016 Elsevier Inc. All rights reserved.

Febrile neutropaenia in cancer patients.

PubMed

Walwyn, M; Nicholson, A; Lee, M G; Wharfe, G; Frankson, M A

2010-03-01

Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally. This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinicalfeatures. These cases were compared with non-neutropaenic cancer patients admitted with fever. A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients. Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

Blood cultures for women hospitalized with acute pelvic inflammatory disease. Are they necessary?

PubMed

Apuzzio, J J; Hessami, S; Rodriguez, P

2001-09-01

To determine the incidence of positive blood cultures and if the results affect the clinical management or the duration of hospital stay in patients with acute pelvic inflammatory disease (PID). Retrospective study of all patients hospitalized with a diagnosis of acute PID from January 1, 1996, to December 31, 1997. Of 93 patients in the study, 3 had significant bacterial growth from blood culture specimens. The results of blood culture specimens did not affect clinical management. Routine specimens for blood culture may not be needed from patients hospitalized with acute PID.

Lower blood pressure and risk of cisplatin nephrotoxicity: a retrospective cohort study.

PubMed

Komaki, Kazumi; Kusaba, Tetsuro; Tanaka, Mai; Kado, Hiroshi; Shiotsu, Yayoi; Matsui, Masahiro; Shiozaki, Atsushi; Nakano, Hiroshi; Ishikawa, Takeshi; Fujiwara, Hitoshi; Konishi, Hideyuki; Itoh, Yoshito; Matoba, Satoaki; Tamagaki, Keiichi

2017-02-20

The pathophysiological mechanisms of cisplatin nephrotoxicity include the reduction of renal blood flow, as well as tubular epithelial cell toxicity. The objective of this study was to investigate the influence of lower blood pressure and decreased food intake on the incidence of cisplatin nephrotoxicity. We conducted a retrospective cohort study at a university hospital between 2011 and 2012. We identified hospitalized adult patients with head and neck cancer, esophageal cancer, or gastric cancer, who received intravenous cisplatin administration. The primary outcome was the incidence of cisplatin nephrotoxicity defined as the increase in serum creatinine after cisplatin administration more than 1.5 times from baseline. The study participants included 182 patients, in whom we observed a total of 442 cycles of cisplatin chemotherapy. The incidence of cisplatin nephrotoxicity was observed in 41 of 182 cycles with initial administration. Multivariate logistic regression analysis showed that systolic blood pressure was independently associated with cisplatin nephrotoxicity (adjusted odds ratio 0.75, 95% confidence interval 0.57 to 0.95 for each 10 mmHg). The use of renin-angiotensin system (RAS) inhibitors was also associated with cisplatin nephrotoxicity (3.39, 1.30 to 8.93). Among quartiles of systolic blood pressure in all cycles of chemotherapy, the incidence of nephrotoxicity in the lower blood pressure group was significantly higher than that in the higher blood pressure group for patients taking non-solid food (P = 0.037), while there was no significant difference for patients taking solid food (P = 0.67). Lower blood pressure and the use of RAS inhibitors were associated with the incidence of cisplatin nephrotoxicity, and lower blood pressure had a greater influence on nephrotoxicity in patients who could not take solid food. Discontinuation of antihypertensive medication including RAS inhibitors before cisplatin chemotherapy should be considered, which may be beneficial for patients with lower blood pressure.

The Sewol Ferry Disaster: Experiences of a Community-Based Hospital in Ansan City.

PubMed

Park, Jong-Hak; Cho, Hanjin; Kim, Joo Yeong; Song, Joo-Hyun; Moon, Sungwoo; Cha, Sang Hoon; Choi, Byung-Min; Han, Chang-Su; Ko, Young-Hoon; Lee, Hongjae

2017-06-01

The Sewol ferry disaster is one of the most tragic events in Korea's modern history. Among the 476 people on board, which included Danwon High School students (324) and teachers (14), 304 passengers died in the disaster (295 recovered corpses and 9 missing) and 172 survived. Of the rescued survivors, 72 were attending Danwon High School, located in Ansan City, and residing in a residence nearby. Because the students were young, emotionally susceptible adolescents, both the government and the parents requested the students be grouped together at a single hospital capable of appropriate psychiatric care. Korea University Ansan Hospital was the logical choice, as the only third-tier university-grade hospital with the necessary faculty and facilities within the residential area of the families of the students. We report the experiences and the lessons learned from the processes of preparing for and managing the surviving young students as a community-based hospital. (Disaster Med Public Health Preparedness. 2017;11:389-393).

[A 10-year review of childhood type 1 diabetes mellitus and the clinical value of interleukin-10 in diabetic ketoacidosis].

PubMed

Dai, Yang-Li; Fu, Jun-Fen; Liang, Li; Dong, Guan-Ping

2010-11-01

To review the incident status of childhood type 1 diabetes mellitus hospitalized in the Children's Hospital of Zhejiang University School of Medicine from 1999 to 2009 and to explore the clinical value of IL-10 in diabetic ketoacidosis. The clinical data of 263 children with type 1 diabetes mellitus hospitalized in the Children's Hospital of Zhejiang University School of Medicine from January 1999 to February 2009 were retrospectively reviewed. Serum lipid levels were measured in 48 children with type 1 diabetes mellitus and in 24 healthy children. The diabetic children were classified into two subgroups, with or without ketoacidosis. Serum lipid and cytokines levels were compared. Childhood type 1 diabetes mellitus was common in females (56.3%). The peak incident age of the disease was between 6 and 11.9 years. Diabetic ketoacidosis was as the presenting symptom for the first visit in 86 cases (32.7%). The levels of serum lipid, blood glucose and HbA1c in diabetic children with ketoacidosis were significantly higher than those without ketoacidosis (P<0.05). Logistic analysis demonstrated that the increased levels of blood glucose, serum lipid and HbA1c were risk factors for diabetic ketoacidosis. The level of serum IL-10 in diabetic children with ketoacidosis was significantly higher than that in patients without ketoacidosis (P<0.01), while there were no differences in serum levels IL-2, IL4, IL-6, TNF-α and IFN-γ between them. Serum levels IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ in diabetic children were significantly higher than those in healthy children (P<0.01). Ketoacidosis is a common acute complication of type 1 diabetes mellitus. The disorders of glucose and lipid metabolism are the risk factors for ketoacidosis in diabetic children. IL-10 may be a sensitive index of diabetic ketoacidosis in children with type 1 diabetes mellitus.

Patterns of multi-drug resistant bacteria at first culture from patients admitted to a third level University hospital in Calabria from 2011 to 2014: implications for empirical therapy and infection control.

PubMed

Reale, Mariaconcetta; Strazzulla, Alessio; Quirino, Angela; Rizzo, Claudia; Marano, Vito; Postorino, Maria Concetta; Mazzitelli, Maria; Greco, Giuseppe; Pisani, Vincenzo; Costa, Chiara; Cesana, Bruno Mario; Liberto, Maria Carla; Torti, Carlo; Focà, Alfredo

2017-06-01

Surveillance of antimicrobial drug resistance is fundamental to guide empirical treatment. However, the European Antimicrobial Resistance Surveillance Network provides a general picture, which might not be applicable to clinical settings that are excluded from this survey. We evaluated resistance patterns of ESKAPE isolates over a four-year period in a third level University hospital in the province of Catanzaro (Southern Italy). In this retrospective study, we evaluated the frequency of ESKAPE isolates with different resistance patterns (group 1=low-resistant bacteria; group 2=multi-drug and extremely drug-resistant bacteria; group 3=pan-resistant bacteria), stratified by year (2011, 2012, 2013 and 2014), hospital units (intensive care units, medical and surgical units) and by sample type (urine, blood, wound swabs, respiratory samples, other samples). Chi square test was applied to find differences between isolates with different resistance patterns by hospital unit and by organs and systems. Cochran-Armitage trend test was applied to assess the trend in resistance patterns during the four years analyzed. Amongst 2385 isolates, Escherichia coli (38%) was the most frequent, followed by Pseudomonas aeruginosa (15%), Klebsiella pneumoniae (14%), Staphylococcus aureus (13%), Acinetobacter baumannii (9%), Enterococcus faecalis (8%) and Enterococcus faecium (3%). From 2011 to 2014, frequency of isolates in group 2 plus 3 decreased from 23% to 14% (chi square=55.093; p<0.0001), particularly for E. coli and K. pneumoniae, but the trend increased for S. aureus (from 5% in 2011 to 10% in 2014), and remained stable for the other species. Frequency of isolates in group 2 plus 3 was higher in intensive care units for K. pneumoniae (chi square =32.292; p<0.0001), A. baumannii (chi square =6.947; p<0.0001) and S. aureus (chi square =22.079; p<0.0001). It was also higher from blood than from different sources for most species.

[Application of the concetrations ratio of soluble receptor tyrosine kinase type 1, and placental growth factor for short-term prediction and diagnosis of preeclampsia].

PubMed

Bubeníková, Š; Cíchová, A; Roubalová, L; Durdová, V; Vlk, R

Bring a comprehensive overview of the available information about applications of the concetration ratio of soluble receptor tyrosine kinase type 1 (sFlt-1), and placental growth factor for short-term prediction and diagnosis of preeclampsia. Overview study. Department of Midwifery, Faculty of Health Sciences, Olomouc; Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, University Hospital Olomouc; Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital. Analysis of literary sources and databases Ovid, Medline (2001-2016). Preeclampsia is a multisystem disease with not fully understood etiology. This disease occurs in 2-5% of pregnant women. Preeclampsia is one of the main causes of global maternal and perinatal morbidity and mortality. It manifests itself as a newborn hypertension and proteinuria after 20 weeks of pregnancy in previously normotensive women. The only effective treatment is the delivery of the child. Diagnosis of preeclampsia comprises measuring blood pressure and proteinuria. These indicators have low diagnostic sensitivity and specificity. In preeclampsia, there is a decrease of serum levels of placental growth factor (PlGF). Soluble receptor tyrosine kinase type 1 (sFlt-1) is an antagonist of PlGF. Increased levels of sFlt-1 in proportion to the reduced level of PlGF are associated with an increased risk of preeclampsia. The sFlt-1/PlGF ratio can be a better predictive marker in the diagnosis of pre-eclampsia after 20 weeks of gestation.

The attitude of Canadian university students toward a behavior-based blood donor health assessment questionnaire.

PubMed

Go, Stephanie L; Lam, Cindy T Y; Lin, Yahui T; Wong, Deborah J; Lazo-Langner, Alejandro; Chin-Yee, Ian

2011-04-01

In Canada, all men who have sex with men (MSM) are indefinitely deferred from donating blood. The purpose of this study was to determine the acceptability of an alternative behavior-based donor health questionnaire among Canadian university students. Further we sought to determine the perception of blood safety associated with specific risk behaviors. Questions found on the Canadian Blood Services' donor health assessment questionnaire as well as from studies assessing high-risk behavior for human immunodeficiency virus infection were included. For each question participants were asked to rate the acceptability, comfort in answering, perceived effect on blood safety, and whether the question would deter them from donating blood. Data were analyzed using nonparametric tests. A total of 741 students participated in the study. Questions regarding sexual practices of the donor were rated less important for blood safety compared to those assessing for sexually transmitted infections, sex for money, and injection drug use (30%-62% vs. 69%-95% unsafe). A total of 24.4% of students rated both questions on MSM status and a behavior-based alternative as equally unacceptable. We found an inverse correlation between perception of safety and acceptability of questions. Our findings suggest that a behavior-based screening modification is unlikely to change opinions or satisfy those who object to the MSM current policy in place. Acceptability of these questions might be related to a poor understanding of the effect of sexual practices on blood supply safety. © 2010 American Association of Blood Banks.

[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.

Incidence, nature, and etiology of metabolic acidosis in dogs and cats.

PubMed

Hopper, K; Epstein, S E

2012-01-01

Metabolic acidosis is an important abnormality in ill and injured dogs and cats. To describe the incidence, nature, and etiology of metabolic acidosis in dogs and cats that had arterial or venous blood gases measured for any reason at a university teaching hospital. Dogs and cats at the Veterinary Medical Teaching Hospital. Acid base parameters and electrolyte and lactate concentrations in dogs and cats measured during a 13-month period were retrospectively retrieved from a computer database. Metabolic acidosis was defined as a standardized base excess (SBE) in dogs of <-4 mmol/L and in cats <-5 mmol/L. A total of 1,805 dogs and cats were included; of these, 887 (49%) were classified as having a metabolic acidosis (753 dogs and 134 cats). Primary metabolic acidosis was the most common disorder in dogs, whereas mixed acid base disorder of metabolic acidosis and respiratory acidosis was most common in cats. Hyperchloremic metabolic acidosis was more common than a high anion gap (AG) metabolic acidosis; 25% of dogs and 34% of cats could not be classified as having either a hyperchloremic metabolic acidosis or a high AG metabolic acidosis. Metabolic acidosis was found commonly in this patient population and was associated with a wide variety of disease processes. Mixed acid base disorders occur frequently and routine categorization of metabolic acidosis based on the presence of high AG or hyperchloremia may be misleading in a large proportion of cases. Copyright © 2012 by the American College of Veterinary Internal Medicine.

Beyond the computer-based patient record: re-engineering with a vision.

PubMed

Genn, B; Geukers, L

1995-01-01

In order to achieve real benefit from the potential offered by a Computer-Based Patient Record, the capabilities of the technology must be applied along with true re-engineering of healthcare delivery processes. University Hospital recognizes this and is using systems implementation projects, such as the catalyst, for transforming the way we care for our patients. Integration is fundamental to the success of these initiatives and this must be explicitly planned against an organized systems architecture whose standards are market-driven. University Hospital also recognizes that Community Health Information Networks will offer improved quality of patient care at a reduced overall cost to the system. All of these implementation factors are considered up front as the hospital makes its initial decisions on to how to computerize its patient records. This improves our chances for success and will provide a consistent vision to guide the hospital's development of new and better patient care.

Factors Associated With Elevated Blood Lead Levels in Children.

PubMed

Chaudhary, Sakshi; Firdaus, Uzma; Ali, Syed Manazir; Mahdi, Abbas Ali

2018-01-15

To determine the prevalence and correlates of elevated blood lead level in children (6-144 months) of Aligarh. A hospital-based cross-sectional study was conducted. Venous blood was obtained for lead estimation and a structured questionnaire was filled. A total of 260 children were enrolled. The prevalence of elevated blood lead level was 44.2%, seen mostly in children below 5 years of age. Old and deteriorating wall paints at home was found to be significantly associated with elevated levels. Lead-based house paints are potential source of lead exposure. Meticulous renovation and painting of the walls with safe paints is desirable.

Hepatitis B vaccination status and needlestick injuries among healthcare workers in syria.

PubMed

Yacoub, Rabi; Al Ali, Radwan; Moukeh, Ghamez; Lahdo, Ayham; Mouhammad, Yaser; Nasser, Mahmood

2010-01-01

Although a majority of countries in the Middle East show intermediate or high endemicity of hepatitis B virus (HBV) infection, which clearly poses a serious public health problem in the region, the situation in the Republic of Syria remains unclear. The aim of this study is to determine the hepatitis B vaccination status, to assess the number of vaccinations administered, and to estimate the annual incidence of needlestick injuries (NSIs) among healthcare workers (HCWs) in Aleppo University hospitals. A cross-sectional design with a survey questionnaire was used for exploring details of NSIs during 2008, hepatitis B vaccination status, and HBV infection among a random stratified sample of HCWs in three tertiary hospitals in Aleppo (n = 321). Two hundred and forty-six (76.6%) HCWs had sustained at least one NSI during 2008. Nine (2.8%) had HBV chronic infection and 75 HCWs (23.4%) were never vaccinated. Anesthesiology technicians had the greatest exposure risk when compared to office workers [OR = 16,95% CI (2.55-100), P < 0.01], doctors [OR = 10,95% CI (2.1 47.57), P < 0.01], and nurses [OR = 6.75,95% CI (1.56-29.03), P = 0.01]. HCWs under 25 and between the age of 25 and 35 years were at increased risk for NSI when compared to HCWs older than 45 years [OR = 3.12,95% CI (1.19-8.19), P = 0.02] and [OR = 3.05,95% CI (1.42-6.57), P < 0.01], respectively. HCWs at Aleppo University hospitals are frequently exposed to blood-borne infections. Precautions and protection from NSIs are important in preventing infection of HCWs. Education about the transmission of blood-borne infections, vaccination, and post-exposure prophylaxis must be implemented and strictly monitored.

Hepatitis B Vaccination Status and Needlestick Injuries Among Healthcare Workers in Syria

PubMed Central

Yacoub, Rabi; Al Ali, Radwan; Moukeh, Ghamez; Lahdo, Ayham; Mouhammad, Yaser; Nasser, Mahmood

2010-01-01

Background: Although a majority of countries in the Middle East show intermediate or high endemicity of hepatitis B virus (HBV) infection, which clearly poses a serious public health problem in the region, the situation in the Republic of Syria remains unclear. The aim of this study is to determine the hepatitis B vaccination status, to assess the number of vaccinations administered, and to estimate the annual incidence of needlestick injuries (NSIs) among healthcare workers (HCWs) in Aleppo University hospitals. Materials and Methods: A cross-sectional design with a survey questionnaire was used for exploring details of NSIs during 2008, hepatitis B vaccination status, and HBV infection among a random stratified sample of HCWs in three tertiary hospitals in Aleppo (n = 321). Results: Two hundred and forty-six (76.6%) HCWs had sustained at least one NSI during 2008. Nine (2.8%) had HBV chronic infection and 75 HCWs (23.4%) were never vaccinated. Anesthesiology technicians had the greatest exposure risk when compared to office workers [OR = 16,95% CI (2.55-100), P < 0.01], doctors [OR = 10,95% CI (2.1 47.57), P < 0.01], and nurses [OR = 6.75,95% CI (1.56-29.03), P = 0.01]. HCWs under 25 and between the age of 25 and 35 years were at increased risk for NSI when compared to HCWs older than 45 years [OR = 3.12,95% CI (1.19-8.19), P = 0.02] and [OR = 3.05,95% CI (1.42-6.57), P < 0.01], respectively. Conclusion: HCWs at Aleppo University hospitals are frequently exposed to blood-borne infections. Precautions and protection from NSIs are important in preventing infection of HCWs. Education about the transmission of blood-borne infections, vaccination, and post-exposure prophylaxis must be implemented and strictly monitored. PMID:20300414

Seasonal Outbreak of Bacillus Bacteremia Associated With Contaminated Linen in Hong Kong.

PubMed

Cheng, Vincent C C; Chen, Jonathan H K; Leung, Sally S M; So, Simon Y C; Wong, Shuk-Ching; Wong, Sally C Y; Tse, Herman; Yuen, Kwok-Yung

2017-05-15

A high seasonal incidence of Bacillus bacteremia was associated with the use of contaminated hospital linens. An outbreak investigation was conducted to study the incidence and source of Bacillus bacteremia during the baseline, outbreak, and postoutbreak period from 1 January 2012 through 31 July 2016 at a university-affiliated teaching hospital in Hong Kong. Replicate organism detection and counting plates were used for microbial screening of linen samples. The Bacillus species isolated from patient and linen samples were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and were phylogenetically analyzed. During the study period, a total of 113 207 blood cultures were collected from 43 271 patients, of which 978 (0.86%) specimens from 744 (1.72%) patients were identified as Bacillus species. The incidence of Bacillus bacteremia per 10 000 patient admissions and per 10 000 patient-days was significantly higher during the summer outbreak as compared with baseline and 1 year postoutbreak after cessation of the linen supply from the designated laundry and change of laundry protocol (39.97 vs 18.21 vs 2.27; 13.36 vs 5.61 vs 0.73; P < .001). The mean total aerobic bacterial count per 100 cm2 was significantly higher among the 99 linen samples screened during the outbreak period compared to the 100 screened in the postoutbreak period (916.0 ± 641.6 vs 0.6 ± 1.6; P < .001). Blood culture isolates of Bacillus cereus group in 14 of 87 (16.1%) patients were phylogenetically associated with 9 linen sample isolates. Suboptimal conditions of hospital laundry contributed to the seasonal outbreak of Bacillus bacteremia. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Anemia, nutritional status, and inflammation in hospitalized elderly.

PubMed

Ramel, Alfons; Jonsson, Palmi V; Bjornsson, Sigurbjorn; Thorsdottir, Inga

2008-01-01

Anemia (hemoglobin <120 g/L) in elderly patients is a health problem. The aim of this study was to investigate the prevalence of anemia and associations of anemia with nutritional status and inflammation in hospitalized elderly. Sixty patients from the Department of Geriatrics were randomly assigned to participate. Blood samples were drawn and analyzed at the laboratory of the University Hospital in Reykjavik. Nutritional status was assessed using anthropometric and hematologic parameters. The prevalence of anemia was 36.7%. Female participants were more frequently anemic than male participants (47.4% versus 18.2%, P = 0.024). Anemic patients had a lower albumin level (31.3 versus 33.4 g/L, P = 0.019) and a higher erythrocyte sedimentation rate (29.6 versus 16.0 mm/h, P = 0.005) and were more often malnourished (81.8% versus 44.7%, P = 0.005) than non-anemic patients. Hemoglobin correlated with prealbumin (rho = 0.338, P = 0.008) and albumin (rho = 0.250, P = 0.054) levels, but negatively with age (rho = -0.310, P = 0.016) and erythrocyte sedimentation rate (rho = -0.412, P < 0.001). In the multivariate analysis, erythrocyte sedimentation rate and nutritional status were significant predictors of hemoglobin (R(2) = 34.0%). This cross-sectional analysis provides evidence of anemia in 36.7% of patients hospitalized at the Landspitali-University Hospital in Reykjavik and shows an association among anemia, deteriorated nutritional status, and inflammation. Future prospective studies are needed to assess the efficacy of adjuvant nutritional support to stabilize or improve nutritional status including anemia in hospitalized elderly.

Organizing integrated care in a university hospital: application of a conceptual framework.

PubMed

Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

2014-04-01

As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: Outcome analysis and prognostic factors.

PubMed

Kimura, Norihisa; Young, Alastair L; Toyoki, Yoshikazu; Wyatt, Judith I; Toogood, Giles J; Hidalgo, Ernest; Prasad, K Rajendra; Kudo, Daisuke; Ishido, Keinosuke; Hakamada, Kenichi; Lodge, J Peter A

2017-09-01

Extensive resection for hilar cholangiocarcinoma is the most effective treatment, but high morbidity and poor prognosis remain concerns. Previous data have shown marked differences in outcomes between comparable Eastern and Western centers. We compared the outcomes of the management for hilar cholangiocarcinoma at one Japanese and one British institution with comparable experience. Of 298 consecutive patients with hilar cholangiocarcinoma evaluated at Hirosaki University Hospital, Japan and St. James's University Hospital, Leeds, UK, 183 underwent radical resection. Clinicopathologic variables and postoperative outcomes were compared. Significant differences were not observed between the Hirosaki and Leeds cohorts in overall outcomes despite several differences in the patient characteristics. Although there was a difference in 90-day mortality (2.5% vs 13.6%, respectively), disease-specific 5-year survival rates were 32.8% and 31.9%, respectively (P = .767). Multivariate analysis identified trisectionectomy (odds ratio = 2.32; P = .010), combined pancreatoduodenectomy (odds ratio = 7.88; P = .010), and perioperative blood transfusion (odds ratio = 1.88; P = .045) were associated with postoperative major complications, while preoperative biliary drainage associated with postoperative major complications, while preoperative biliary drainage (risk ratio = 2.21; P = .018), perioperative blood transfusion (risk ratio = 1.58; P = .029), lymph node metastasis (risk ratio = 2.00; P = .002), moderate/poorly differentiated tumor (risk ratio = 1.72; P = .029), microvascular invasion (risk ratio = 1.63; P = .046), and R1 resection (risk ratio = 1.90; P = .005) were risk factors for poor survival. Disease-specific survival and prognostic factors were similar in both centers. Meticulous operative technique to avoid perioperative blood transfusion may improve long-term survival. Copyright © 2017 Elsevier Inc. All rights reserved.

Thromboelastometry versus standard coagulation tests versus restrictive protocol to guide blood transfusion prior to central venous catheterization in cirrhosis: study protocol for a randomized controlled trial.

PubMed

Rocha, Leonardo Lima; Pessoa, Camila Menezes Souza; Neto, Ary Serpa; do Prado, Rogerio Ruscitto; Silva, Eliezer; de Almeida, Marcio Dias; Correa, Thiago Domingos

2017-02-27

Liver failure patients have traditionally been empirically transfused prior to invasive procedures. Blood transfusion is associated with immunologic and nonimmunologic reactions, increased risk of adverse outcomes and high costs. Scientific evidence supporting empirical transfusion is lacking, and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far. The aim of this study is to compare three transfusion strategies (routine coagulation test-guided - ordinary or restrictive, or thromboelastometry-guided) prior to central venous catheterization in critically ill patients with cirrhosis. Design and setting: a double-blinded, parallel-group, single-center, randomized controlled clinical trial in a tertiary private hospital in São Paulo, Brazil. adults (aged 18 years or older) admitted to the intensive care unit with cirrhosis and an indication for central venous line insertion. Patients will be randomly assigned to three groups for blood transfusion strategy prior to central venous catheterization: standard coagulation tests-based, thromboelastometry-based, or restrictive. The primary efficacy endpoint will be the proportion of patients transfused with any blood product prior to central venous catheterization. The primary safety endpoint will be the incidence of major bleeding. Secondary endpoints will be the proportion of transfusion of fresh frozen plasma, platelets and cryoprecipitate; infused volume of blood products; hemoglobin and hematocrit before and after the procedure; intensive care unit and hospital length of stay; 28-day and hospital mortality; incidence of minor bleeding; transfusion-related adverse reactions; and cost analysis. This study will evaluate three strategies to guide blood transfusion prior to central venous line placement in severely ill patients with cirrhosis. We hypothesized that thromboelastometry-based and/or restrictive protocols are safe and would significantly reduce transfusion of blood products in this population, leading to a reduction in costs and transfusion-related adverse reactions. In this manner, this trial will add evidence in favor of reducing empirical transfusion in severely ill patients with coagulopathy. ClinicalTrials.gov, identifier: NCT02311985 . Retrospectively registered on 3 December 2014.

Outbreak of late-onset group B streptococcal infections in healthy newborn infants after discharge from a maternity hospital: a case report.

PubMed

Kim, Hyung Jin; Kim, Soo Young; Seo, Won Hee; Choi, Byung Min; Yoo, Young; Lee, Kee Hyoung; Eun, Baik Lin; Kim, Hai Joong

2006-04-01

During a four-week period, four healthy term newborn infants born at a regional maternity hospital in Korea developed late-onset neonatal group B Streptococcus (GBS) infections, after being discharged from the same nursery. More than 10 days after their discharge, all of the infants developed fever, lethargy, and poor feeding behavior, and were subsequently admitted to the Korea University Medical Center, Ansan Hospital. GBS was isolated from the blood cultures of three babies; furthermore, GBS was isolated from 2 cerebral spinal fluid cultures. Three babies had meningitis, and GBS was isolated from their cerebral spinal fluid cultures. This outbreak was believed to reflect delayed infection after early colonization, originating from nosocomial sources within the hospital environment. This report underlines the necessity for Korean obstetricians and pediatricians to be aware of the risk of nosocomial transmissions of GBS infection in the delivery room and/or the nursery.

Impact of music therapy interventions (listening, composition, Orff-based) on the physiological and psychosocial behaviors of hospitalized children: a feasibility study.

PubMed

Colwell, Cynthia M; Edwards, Robin; Hernandez, Emily; Brees, Kristine

2013-01-01

The purpose of this study was to compare three music therapy strategies (music listening, music composition, and Orff-based active engagement) on physiological (heart rate, blood pressure, oxygen saturation, and pain) and psychosocial (anxiety) behaviors of hospitalized children (N=32, 17 females,15 males, ranging in age from 6 to 17). This study was designed and facilitated cooperatively by pediatric nurses and music therapists. Results indicated no clinically significant changes in heart rate, blood pressure, or oxygen saturation (p>.05). Pain and anxiety both decreased significantly (p=.01) but not differentiated among conditions. Videotape analysis determined level of engagement in coping-related behaviors. Copyright © 2013 Elsevier Inc. All rights reserved.

Experiences of the Dresdner Cord Blood Bank, supported by the Deutsche Knochenmarkspenderdatei.

PubMed

Ordemann, R; Petzold, K; Hölig, K; Schaffer, B; Mauersberger, S; Ehninger, G; Ehminger, G

1999-01-01

Allogeneic bone marrow and peripheral blood stem cell transplantation is the treatment of choice for some malignant hematologic diseases, marrow failure syndromes, and severe congenital immunodeficiency states. Since Gluckman et al reported in 1988 the first successful human leukocyte antigen (HLA)-matched sibling umbilical cord blood stem cell transplantation, it has been known that cord blood is a valuable source of hematopoietic stem cells. The Cord Blood Bank at the University Hospital of Dresden was founded in 1997 and started collecting, processing, and cryoconserving umbilical cord blood in August 1997. The cord blood bank is supported by the largest German donor registry: Deutsche Knochenmarkspenderdatei (DKMS) in Tubingen, Germany. With the informed consent of the mothers, the collection is performed in collaboration with six hospitals in Dresden, Berlin, and Bautzen. We routinely perform a volume reduction by centrifuging the blood bag and expressing the leukocyte-rich supernatant. Routinely, sterility, total nucleated cells (TNC), CD34+ cell count, HLA class I and II, ABO/Rh blood group, and colony-forming units are evaluated. The maternal blood is screened for anti-immunodeficiency virus (anti-HIV), anti-hepatitis C virus (anti-HCV), anti-hepatitis B surface antigen (HBsAg), anti-hepatitis B surface (anti-HBs), anti-hepatitis B core (anti-HBc), anticytomegalovirus (anti-CMV), and toxoplasmosis and with Treponema pallidum hemagglutination assay (TPHA). More than 1,000 cord blood units could be collected. Because of the required volume and cell count and because of sterility, 50% of the collected units had to be discharged. Our results are comparable with data of other cord blood banks: mean volume 79 mL; cell count after volume reduction-TNC, 7.16 x 10(8); mononucleated cells (MNC), 3.75 x 10(8); CD34+ cells, 1.95 x 10(6); colony-forming units (CFU), 67.1 x 10(4). To increase the pool of potential umbilical cord blood units and in order to evaluate the possibility for unrelated transplants, cryopreservation and banking of large numbers of cord bloods are necessary.

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.

20 years of trauma documentation in Germany--actual trends and developments.

PubMed

2014-10-01

The TraumaRegister DGU(®) has been founded 20 years ago. Although initially supported by larger hospitals and universities, it has recently become a representative registry for the care of severely injured patients in Germany. Based on the registry data some important trends and developments of the recent decades are presented. German trauma patients with an Injury Severity Score (ISS)≥ 16 were eligible if primary admitted from the scene. All cases documented between 1993 and 2012 (20 years) were eligible. For selected variables, an average change per years was calculated using linear regression analysis. A total of 49,801 patients was analysed. The mean age was 46.3 years, and 72% were males. The following relevant trends could be observed: The average age increased dramatically from 38 to 50 years. Pre-hospital intubation rate was halfed in patients with Glasgow Coma Scale (GCS)>8 but remained constant in unconscious patients (GCS ≤ 8; 90% intubation rate). Pre-hospital volume administration decreased as well, which led to less blood transfusions (from 45% to 16%). The use of helicopters for transportation into a trauma centre decreased as well but today still 27% of all cases are transported by air. Whole-body CT was performed in about 80% of patients; this value is stable in the last four years. Hospital mortality could be reduced and was 2-3% lower than expected in recent years. The Revised Injury Severity Classification (RISC) score used as a reference here was based on TR-DGU data from the 1990s. Standardised prospective registration of severely injured patients over 20years allows to empirically monitor trends and developments in acute trauma care. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed

Istl, Alexandra C; McAlister, Vivian C

2016-12-01

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

HIV seroprevalence among hospital workers in Kinshasa, Zaire: lack of association with occupational exposure

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

Mann, J.M.; Francis, H.; Quinn, T.C.

1986-12-12

A study of seroprevalence of the human immunodeficiency virus involving 2384 (96%) of Mama Yemo Hospital's (Kinshasa, Zaire) 2492 personnel found 152 (6.4%) to be seropositive. Prevalence was higher among women than among men (8.1% vs 5.2%); in women peak seroprevalence (13.9%) occurred in 20 to 29-year-olds. Workers most likely to be seropositive were those who were relatively young, those who were unmarried, those reporting a blood transfusion or hospitalization during the previous ten years, and those receiving medical injections during the previous three years. Medical, administrative, and manual workers had similar seroprevalence (6.5%, 6.4%, and 6.0%, respectively), and seropositivitymore » was not associated with any measure of patient, blood, or needle contact. These findings are consistent with other hospital-based studies indicating low risks for occupational transmission of human immunodeficiency virus.« less

Very poor agreement between routine outpatient clinic office and ambulatory blood pressure: time to improve an old hospital outpatient clinic routine?

PubMed

Reinhard, Mark; Poulsen, Per L; Christensen, Kent L

2016-12-01

We investigated the agreement between elevated outpatient clinic office blood pressure (OC-OBP) as measured in the daily routine in our University Hospital Cardiology Outpatient Clinic and subsequent awake ambulatory blood pressure (AABP). In all patients referred for ambulatory blood pressure monitoring from our Cardiology Outpatient Clinic, we identified OC-OBP and changes in medication in the period from 1 January 2014 to 15 September 2015. The AABP was used as a reference measurement for the OC-OBP. A total of 183 patients were included in the study. Their mean age was 62.1±14.0 years and 49% were women. The mean systolic OC-OBP was 166.8±17.9 mmHg and the difference between the mean systolic OC-OBP and AABP was 28.0±19.5 mmHg (P<0.001) with 95% limits of agreement from -10.2 to +66.3 mmHg. The difference in mean systolic OC-OBP and AABP was 18.6±14.7 mmHg in patients less than 45 years (n=21), 24.8±18.2 mmHg in patients 45-74 years (n=121) and 42.3±18.5 mmHg in patients more than or equal to 75 years (n=41). In 32 (17%) of the patients, the antihypertensive treatment was intensified before the AABP, but in nine (28%) of these patients, the antihypertensive treatment was reduced again after the AABP because of low blood pressure. Routine OC-OBP in a busy cardiology clinic agrees poorly with AABP and may lead to unnecessary treatment and pharmacologically induced symptomatic hypotension, particularly in elderly patients. The results of this study urgently call for alternative solutions to routine OC-OBP in hospital outpatient clinics.

Analysis of potential factors affecting microbiological cultures in tissue donors during procurement.

PubMed

Lannau, B; Van Geyt, C; Van Maele, G; Beele, H

2015-03-01

During the procurement of musculoskeletal grafts contamination may occur. As this might be detrimental for the acceptor, it is important to know which variables influence this occurrence and to alter procurement protocols accordingly. From 2004 to 2012 we gathered information on 6,428 allografts obtained from 291 donors. Using a multiple regression model we attempted to determine the factors that influence the contamination risk during procurement. We used the following variables: cause of death, type of hospital (i.e. university hospital vs. general hospital), previous blood vessel donation, previous organ donation, donor age, time between death and the start of the procurement, duration of the procurement, number of people attending the procurement and the number of procured grafts. The multiple regression model was only able to explain 5 % of the variability of the used outcome variable. None of the variables examined appear to have an important influence on the contamination risk.

Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study.

PubMed

Irfan, Furqan B; Consunji, Rafael; El-Menyar, Ayman; George, Pooja; Peralta, Ruben; Al-Thani, Hassan; Thomas, Stephen Hodges; Alinier, Guillaume; Shuaib, Ashfaq; Al-Suwaidi, Jassim; Singh, Rajvir; Castren, Maaret; Cameron, Peter A; Djarv, Therese

2017-08-01

Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival. Copyright © 2017 Elsevier B.V. All rights reserved.

Review of thromboembolic prophylaxis in patients attending Cork University Hospital.

PubMed

Byrne, Stephen; Weaver, Daniel Timothy

2013-06-01

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

Stroke Thrombolysis in a Centralized and a Decentralized System (Helsinki and Telemedical Project for Integrative Stroke Care Network).

PubMed

Hubert, Gordian J; Meretoja, Atte; Audebert, Heinrich J; Tatlisumak, Turgut; Zeman, Florian; Boy, Sandra; Haberl, Roman L; Kaste, Markku; Müller-Barna, Peter

2016-12-01

Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1.56 million inhabitants, 9096 km 2 ) and the decentralized TeleStroke Unit network in a predominantly rural area (Telemedical Project for Integrative Stroke Care [TEMPiS], South-East Bavaria, Germany, 1.94 million inhabitants, 14 992 km 2 ). All consecutive tPA treatments were prospectively registered. We compared tPA rates per total ischemic stroke admissions in the Helsinki and TEMPiS catchment areas. For delay comparisons, we excluded patients with basilar artery occlusions, in-hospital strokes, and those being treated after 270 minutes. From January 1, 2011, to December 31, 2013, 912 patients received tPA in Helsinki University Central Hospital and 1779 in TEMPiS hospitals. Area-based tPA rates were equal (13.0% of 7017 ischemic strokes in the Helsinki University Central Hospital area versus 13.3% of 14 637 ischemic strokes in the TEMPiS area; P=0.078). Median prehospital delays were longer (88; interquartile range, 60-135 versus 65; 48-101 minutes; P<0.001) but in-hospital delays were shorter (18; interquartile range, 13-30 versus 39; 26-56 minutes; P<0.001) in Helsinki University Central Hospital compared with TEMPiS with no difference in overall delays (117; interquartile range, 81-168 versus 115; 87-155 minutes; P=0.45). A decentralized telestroke thrombolysis service can achieve similar treatment rates and time delays for a rural population as a centralized system can achieve for an urban population. © 2016 American Heart Association, Inc.

[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.

Effective Prototype Costing Policies in Research Universities: Are They Possible?

ERIC Educational Resources Information Center

McClure, Maureen W.; Abu-Duhou, Ibtisam

Policy problems of prototype costing at research universities are discussed, based on a case study of a clinical treatment prototype program at a research university hospital. Prototypes programs generate reproducible knowledge with useful applications and are primarily developed in professional schools. The potential of using costing prototypes…

Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals.

PubMed

Heiwe, Susanne; Kajermo, Kerstin Nilsson; Tyni-Lenné, Raija; Guidetti, Susanne; Samuelsson, Monika; Andersson, Inga-Lena; Wengström, Yvonne

2011-04-01

To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Cross-sectional survey. University hospital. All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients.

[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.

Placenta previa

PubMed Central

Abduljabbar, Hassan S.; Bahkali, Nedaa M.; Al-Basri, Samera F.; Hachim, Estabrq Al; Shoudary, Ibrahim H.; Dause, Wesam R.; Mira, Mohammed Y.; Khojah, Mohammed

2016-01-01

Objectives: To review cases of placenta previa in the last 13 years in a tertiary teaching hospital to identify risk factors for maternal morbidity. Methods: A retrospective analysis of all cases of placenta previa managed at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia from January 2001 to December 2013. Results: The total number of deliveries was 55,862 deliveries, and 11,412 (20.3%) delivered by cesarean section (C/S). The charts of 230 cases diagnosed with placenta previa was reviewed, and different variables were collected and analyzed. Diagnoses were achieved in 94% of them using ultrasound. The prevalence rate of placenta previa was 4.1 per 1000 births. Cesarean section was carried out as an emergency procedure in 130 (56.5%) women and as elective in 100 (43.5%) women. Of them, 26 patients were admitted to the intensive care unit (ICU) (11.3%), all of which received blood transfusion >6 units and 22 patients had a hysterectomy for uncontrollable bleeding. Conclusion: Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of <36 weeks, and estimated blood loss >2000 ml. PMID:27381536

Haemoglobin Fontainebleau (HBA2: c. 64G>C) in Oman: molecular and haematological characteristics and interaction with various haemoglobinopathies.

PubMed

Daar, Shahina; Al Zadjali, Shoaib; Alkindi, Salam; Wali, Yasser; Al-Rawas, Abdulhakeem; Al-Haddabi, Humood; Al-Riyami, Arwa Z

2018-04-01

To describe the laboratory features of haemoglobin Fontainebleau (Hb FB) and its interactions with various α and β globin gene mutations in the Omani population. Over a period of 10 years, a total of 94 blood samples were suspected to have an α variant on HPLC at the Sultan Qaboos University Hospital, Muscat, Oman. Molecular testing was performed using PCR based techniques to define the variant and to analyse other interacting mutations in either α or β globin genes. Of 94 subjects, molecular analysis confirmed the Hb FB variant in 55 samples (38 non-cord and 17 cord blood). A total of 36/38 non-cord samples were heterozygous for the variant, while all 17 cord blood samples were heterozygotes. A total of 43/55 individuals had a concomitant α and/or β globin gene mutation. Hb FB is the the most common α variant in the Omani population. We report the different HPLC profiles of this variant that we observed, with and without other haemoglobinopathies in non-cord and cord blood samples. This is the first report describing the HPLC profiles of this α globin chain variant on 1 year follow-up testing of cord blood samples. With careful analysis by HPLC, it is possible not only to identify Hb FB but also to predict any concomitant α and/or β globin gene mutations. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Predicting bacteremia based on nurse-assessed food consumption at the time of blood culture.

PubMed

Komatsu, Takayuki; Onda, Toshihito; Murayama, Go; Yamanouchi, Masashi; Inukai, Minori; Sakai, Ai; Kikuta, Masumi; Branch, Joel; Aoki, Makoto; Tierney, Lawrence M; Inoue, Kenji

2012-01-01

Bacteremia and its complications are important causes of morbidity and mortality in hospitalized patients. However, the yield of blood cultures is relatively low, with many false-positive results from bacterial contamination. We investigated the relationship between patient food consumption and the presence of bacteremia. This was an observational analysis of a cohort of 1179 patients who underwent blood culture analysis between January 2005 and December 2009. Patients with anorexia-inducing conditions, such as gastrointestinal illness and malignant disease treated with chemotherapy, were excluded. Food consumption was rated by nurses as the percentage of food consumed during the meal preceding the blood culture. Groupings were as follows: low consumption (<50%), moderate (>50% to <80%), and high (>80%). Low consumption was observed in 39.8% of patients, moderate in 17.8%, and high in 41.6%. The average body temperature was 38.1 ± 1.1°C. Bacteremia was present in 18.5%, 3.9%, and 1.4% of patients in the low, moderate, and high food consumption groups, respectively. The negative predictive value was 98.3%, suggesting that bacteremia is very unlikely in the setting of good food intake. Bacteremia is an unlikely occurrence in hospitalized patients who maintain adequate food consumption at the time of blood culture. Copyright © 2012 Society of Hospital Medicine.

[Development and practice evaluation of blood acid-base imbalance analysis software].

PubMed

Chen, Bo; Huang, Haiying; Zhou, Qiang; Peng, Shan; Jia, Hongyu; Ji, Tianxing

2014-11-01

To develop a blood gas, acid-base imbalance analysis computer software to diagnose systematically, rapidly, accurately and automatically determine acid-base imbalance type, and evaluate the clinical application. Using VBA programming language, a computer aided diagnostic software for the judgment of acid-base balance was developed. The clinical data of 220 patients admitted to the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. The arterial blood gas [pH value, HCO(3)(-), arterial partial pressure of carbon dioxide (PaCO₂)] and electrolytes included data (Na⁺ and Cl⁻) were collected. Data were entered into the software for acid-base imbalances judgment. At the same time the data generation was calculated manually by H-H compensation formula for determining the type of acid-base imbalance. The consistency of judgment results from software and manual calculation was evaluated, and the judgment time of two methods was compared. The clinical diagnosis of the types of acid-base imbalance for the 220 patients: 65 cases were normal, 90 cases with simple type, mixed type in 41 cases, and triplex type in 24 cases. The accuracy of the judgment results of the normal and triplex types from computer software compared with which were calculated manually was 100%, the accuracy of the simple type judgment was 98.9% and 78.0% for the mixed type, and the total accuracy was 95.5%. The Kappa value of judgment result from software and manual judgment was 0.935, P=0.000. It was demonstrated that the consistency was very good. The time for software to determine acid-base imbalances was significantly shorter than the manual judgment (seconds:18.14 ± 3.80 vs. 43.79 ± 23.86, t=7.466, P=0.000), so the method of software was much faster than the manual method. Software judgment can replace manual judgment with the characteristics of rapid, accurate and convenient, can improve work efficiency and quality of clinical doctors and has great clinical application promotion value.

[Classification and Risk-factor Analysis of Postoperative Cardio-pulmonary 
Complications after Lobectomy in Patients with Stage I Non-small Cell Lung Cancer].

PubMed

Lai, Yutian; Su, Jianhua; Wang, Mingming; Zhou, Kun; Du, Heng; Huang, Jian; Che, Guowei

2016-05-20

There are incresing lung cancer patients detected and diagnosed at the intermediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health consciousness. The aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary complications in stage I non-small cell lung cancer (NSCLC) patients, based on routine laboratory tests, basic characteristics, and intraoperative variables in hospital. The 421 patients after lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratified into complication group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications after lobectomy in 30 days. Of them, 64 (15.2%) patients were finally identified and selected into the complication group, compared with 357 (84.8%) in non-complication group: pneumonia (8.8%, 37/421) was the primary complication, and other main complications included atelectasis (5.9%, 25/421), pleural effusion (≥middle) (5.0%, 21/421), persistent air leak (3.6%, 15/421); The operation time (P=0.007), amount of blood loss (P=0.034), preoperative chronic obstructive pulmonary disease (COPD) (P=0.027), white blood cell (WBC) count (P<0.001), neutrophil-lymphocyte ratio (NLR) (P<0.001) were significantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078, P<0.001) and WBC count (OR=1.451, 95%CI: 1.212-1.736, P<0.001) were independent risk factors for postoperative cardio-pulmonary complications. Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD, may be the independent risk factors of the occurrence of postoperative cardio-pulmonary complications.

Simultaneous or Early Sequential Rupture of Multiple Intracranial Aneurysms: A Rare and Insufficiently Understood Entity.

PubMed

Hou, Kun; Zhao, Jinchuan; Zhang, Yang; Zhu, Xiaobo; Zhao, Yan; Li, Guichen

2016-05-01

Simultaneous or early sequential rupture of multiple intracranial aneurysms (MIAs) is encountered rarely, with no more than 10 cases having been reported. As a result of its rarity, there are a lot of questions concerning this entity need to be answered. A 67-year-old woman was admitted to the First Hospital of Jilin University (Eastern Division) from a local hospital after a sudden onset of severe headache, nausea, and vomiting. Head computed tomography (CT) at the local hospital revealed diffuse subarachnoid hemorrhage (SAH) that was concentrated predominately in the suprasellar cistern and interhemispheric fissure. During her transfer to our hospital, she experienced another episode of sudden headache. CT on admission to our hospital revealed that the SAH was increased with 2 isolated hematomas both in the interhemispheric fissure and the left paramedian frontal lobe. Further CT angiography and intraoperative findings were in favor of early sequential rupture of 2 intracranial aneurysms. To further elucidate the characteristics, mechanism, management, and prognosis of this specific entity, we conducted a comprehensive review of the literature. The mechanism of simultaneous or early sequential rupture of MIAs is still obscure. Transient elevation of blood pressure might play a role in the process, and preventing the sudden elevation of blood pressure might be beneficial for patients with aneurysmal SAH and MIAs. The management of simultaneously or early sequentially ruptured aneurysms is more complex for its difficulty in responsible aneurysm determination, urgency in treatment, toughness in intraoperative manipulation and poorness in prognosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Opportunistic pathology-based screening for diabetes

PubMed Central

Simpson, Aaron J; Krowka, Renata; Kerrigan, Jennifer L; Southcott, Emma K; Wilson, J Dennis; Potter, Julia M; Nolan, Christopher J; Hickman, Peter E

2013-01-01

Objective To determine the potential of opportunistic glycated haemoglobin (HbA1c) testing of pathology samples to detect previously unknown diabetes. Design Pathology samples from participants collected for other reasons and suitable for HbA1c testing were utilised for opportunistic diabetes screening. HbA1c was measured with a Biorad Variant II turbo analyser and HbA1c levels of ≥6.5% (48 mmol/mol) were considered diagnostic for diabetes. Confirmation of previously unknown diabetes status was obtained by a review of hospital medical records and phone calls to general practitioners. Setting Hospital pathology laboratory receiving samples from hospital-based and community-based (CB) settings. Participants Participants were identified based on the blood sample collection location in the CB, emergency department (ED) and inpatient (IP) groups. Exclusions pretesting were made based on the electronic patient history of: age <18 years, previous diabetes diagnosis, query for diabetes status in the past 12 months, evidence of pregnancy and sample collected postsurgery or transfusion. Only one sample per individual participant was tested. Results Of the 22 396 blood samples collected, 4505 (1142 CB, 1113 ED, 2250 IP) were tested of which 327 (7.3%) had HbA1c levels ≥6.5% (48 mmol/mol). Of these 120 (2.7%) were determined to have previously unknown diabetes (11 (1%) CB, 21 (1.9%) ED, 88 (3.9%) IP). The prevalence of previously unknown diabetes was substantially higher (5.4%) in hospital-based (ED and IP) participants aged over 54 years. Conclusions Opportunistic testing of referred pathology samples can be an effective method of screening for diabetes, especially in hospital-based and older persons. PMID:24065696

Blood gas analysis and cooximetry in retired racing Greyhounds

PubMed Central

Zaldivar-Lopez, Sara; Chisnell, Hope K.; Guillermo Couto, C.; Westendorf-Stingle, Nicole; Marin, Liliana M.; Iazbik, Maria C.; Cooper, Edward S.; Wellman, Maxey L.; Muir, William W.

2013-01-01

Objective The purposes of this study were to evaluate the oxygen affinity of hemoglobin (Hb) in healthy retired racing Greyhounds via cooximetry, and to establish reference intervals for blood gases and cooximetry in this breed. Design Prospective clinical study. Setting University Teaching Hospital. Animals Fifty-seven Greyhounds and 30 non-Greyhound dogs. Interventions Venous blood samples were collected from the jugular vein and placed into heparinized tubes. The samples were analyzed within 30 minutes of collection using a blood gas analyzer equipped with a cooximeter. Measurements and Main Results Greyhounds had significantly higher pH, PO2, oxygen saturation, oxyhemoglobin, total Hb, oxygen content, and oxygen capacity and significantly lower deoxyhemoglobin and P50 when compared with non-Greyhound dogs. Conclusion These findings support the fact that this breed is able to carry a higher concentration of total oxygen in the blood. As reported previously, this breed also has lower P50 and, therefore, high oxygen affinity. In light of recent findings suggesting that in certain tissues a high affinity for oxygen is beneficial, this adaptation may be of benefit during strenuous exercise. PMID:21288290

[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.

Reducing blood testing in pediatric patients after heart surgery: a quality improvement project.

PubMed

Delgado-Corcoran, Claudia; Bodily, Stephanie; Frank, Deborah U; Witte, Madolin K; Castillo, Ramon; Bratton, Susan L

2014-10-01

To safely optimize blood testing and costs for pediatric cardiac surgical patients without adversely impacting patient outcomes. This is a quality improvement cohort project with pre- and postintervention groups. University-affiliated pediatric cardiac ICU in a tertiary care children's hospital. All patients were surgical patients for whom Risk Adjustment for Congenital Heart Surgery categories allowed for stratification by complexity. The preintervention group was treated in 2010 and the postintervention group in 2011. Laboratory ordering processes were analyzed, and practice changed to limit standing blood test orders and requires individualized ordering. Three hundred nineteen patients were studied in 2010 and 345 in 2011. Groups were similar in median age, weight, length of stay (ICU length of stay), and Risk Adjustment for Congenital Heart Surgery category. There was a reduction in the total blood tests per patient (24 vs 38; p < 0.0001) and length of stay adjusted tests per patient-day (10.4 vs 14.4; p = 0.0001) in the postintervention group. The largest test reductions were blood gases and single electrolytes. Adverse outcomes, such as extubation failure (6.4% vs 5.6%), central catheter-associated bloodstream infection (2.2 vs 1.5), and hospital mortality (0.6% vs 0.6%), were not significantly different between the groups. Cost analysis demonstrated an overall laboratory cost savings of 32%. In addition, the volume of packed RBC transfusions was also significantly decreased in the postintervention group among the most complex patients (Risk Adjustment for Congenital Heart Surgery, 6). Blood testing rates were safely decreased in postoperative pediatric cardiac patients by changing laboratory ordering practices. In addition, packed RBC transfusion was decreased among the most complex patients.

How good is the obesity associated with blood groups in a cohort of female university going students?

PubMed

Jawed, Shireen; Atta, Komal; Tariq, Saba; Amir, Farah

2018-01-01

To find out frequency of obesity in female University students in Faisalabad and to investigate its association with blood groups of ABO system. A cross sectional study was conducted with a sample size of 200 female University students, recruited from the Faisalabad based institutes from May 2017 to July 2017. Relevant information was taken by administering questionnaire. Height in meters and weight in kg were taken by stadiometer. BMI was calculated using formula BMI=weight in kg/height m 2 . Blood groups were determined by classic (antigen-antibody agglutination test). The data was analyzed through SPSS 20. Descriptive were presented as mean± SD and association of BMI with blood groups was assessed by regression analysis. P value ≤0.05 deemed statistically significant. Out of students, 192 attempted the questionnaire and participated in study (96% response rate), 30% of the 192 females were obese, distribution of ABO blood group showed 43%, followed by O, A and AB. 90% were Rh positive and 10% were Rh negative. Blood group O showed a trend towards obesity and blood group AB showed a trend towards lean body. The blood group O showed the significant positive association with obesity. Population with blood group O showed greatest susceptibility to be overweight and obese.

[Effects of Aromatherapy on Stress Responses, Autonomic Nervous System Activity and Blood Pressure in the Patients Undergoing Coronary Angiography: A Non-Randomized Controlled Trial].

PubMed

Song, Eun Jeong; Lee, Mi Young

2018-02-01

The purpose of this study was to examine the effects of aromatherapy on stress responses, autonomic nervous system (ANS) activity, and blood pressure in patients hospitalized to receive coronary angiography (CAG). A non-equivalent control group with a pretest-posttest design was used. The subjects were patients admitted to the day angiography room to receive CAG at E University Hospital (34 in the experimental group and 30 in the control group). The experimental group treatment was inhalation of the aroma oil blended with lavender, ylang-ylang, and neroli at a ratio of 4:2:1 twice before and after CAG. The measurements of stress index, ANS activity, and blood pressure were performed 5 times as follows: at admission, at pre-CAG after treatment I, at post-CAG, 2 hours after treatment II, and 4 hours after treatment II. The data were analyzed using the Mann-Whitney U Test and repeated-measures analysis of variance. Significant interactions in the high frequency of ANS (F=5.58, p=.005) were observed between group and time. Stress index (z=2.14, p=.016), systolic blood pressure (z=4.14, p<.005), and diastolic blood pressure (z=3.28, p=.001) were significantly different between the experimental and control groups after 4 hours of treatment II. The findings showed that aromatherapy was not effective before CAG, but was effective after CAG. Therefore, aromatherapy can be used as a nursing intervention for patients receiving CAG. © 2018 Korean Society of Nursing Science.

Integration of red cell genotyping into the blood supply chain: a population-based study.

PubMed

Flegel, Willy A; Gottschall, Jerome L; Denomme, Gregory A

2015-07-01

When problems with compatibility arise, transfusion services often use time-consuming serological tests to identify antigen-negative red cell units for safe transfusion. New methods have made red cell genotyping possible for all clinically relevant blood group antigens. We did mass-scale genotyping of donor blood and provided hospitals with access to a large red cell database to meet the demand for antigen-negative red cell units beyond ABO and Rh blood typing. We established a red cell genotype database at the BloodCenter of Wisconsin on July 17, 2010. All self-declared African American, Asian, Hispanic, and Native American blood donors were eligible irrespective of their ABO and Rh type or history of donation. Additionally, blood donors who were groups O, A, and B, irrespective of their Rh phenotype, were eligible for inclusion only if they had a history of at least three donations in the previous 3 years, with one donation in the previous 12 months at the BloodCenter of Wisconsin. We did red cell genotyping with a nanofluidic microarray system, using 32 single nucleotide polymorphisms to predict 42 blood group antigens. An additional 14 antigens were identified via serological phenotype. We monitored the ability of the red cell genotype database to meet demand for compatible blood during 3 years. In addition to the central database at the BloodCenter of Wisconsin, we gave seven hospitals online access to a web-based antigen query portal on May 1, 2013, to help them to locate antigen-negative red cell units in their own inventories. We analysed genotype data for 43,066 blood donors. Requests were filled for 5661 (99.8%) of 5672 patient encounters in which antigen-negative red cell units were needed. Red cell genotyping met the demand for antigen-negative blood in 5339 (94.1%) of 5672 patient encounters, and the remaining 333 (5.9%) requests were filled by use of serological data. Using the 42 antigens represented in our red cell genotype database, we were able to fill 14,357 (94.8%) of 15,140 requests for antigen-negative red cell units from hospitals served by the BloodCenter of Wisconsin. In the pilot phase, the seven hospitals identified 71 units from 52 antigen-negative red cell unit requests. Red cell genotyping has the potential to transform the way antigen-negative red cell units are provided. An antigen query portal could reduce the need for transportation of blood and serological screening. If this wealth of genotype data can be made easily accessible online, it will help with the supply of affordable antigen-negative red cell units to ensure patient safety. BloodCenter of Wisconsin Diagnostic Laboratories Strategic Initiative and the NIH Clinical Center Intramural Research Program. Copyright © 2015 Elsevier Ltd. All rights reserved.

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District.

PubMed

Kubio, Chrysantus; Tierney, Geraldine; Quaye, Theophilus; Nabilisi, James Wewoli; Ziemah, Callistus; Zagbeeb, Sr Mary; Shaw, Sandra; Murphy, William G

2012-10-01

Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed. © 2012 American Association of Blood Banks.

Evaluation of Blood Glucose Monitoring System in Screening for Neonatal Hypoglycemia: Tighter Accuracy Standard.

PubMed

Tsao, Mei-Fen; Chang, Hui-Wen; Chang, Chien-Hsi; Cheng, Chi-Hsuan; Lin, Hsiu-Chen

2017-05-01

Neonatal hypoglycemia may cause severe neurological damages; therefore, tight glycemic control is crucial to identify neonate at risk. Previous blood glucose monitoring system (BGMS) failed to perform well in neonates; there are calls for the tightening of accuracy requirements. It remains a need for accurate BGMS for effective bedside diabetes management in neonatal care within a hospital population. A total of 300 neonates were recruited from local hospitals. Accuracy performance of a commercially available BGMS was evaluated against reference instrument in screening for neonatal hypoglycemia, and assessment was made based on the ISO15197:2013 and a tighter standard. At blood glucose level < 47 mg/dl, BGMS assessed met the minimal accuracy requirement of ISO 15197:2013 and tighter standard at 100% and 97.2%, respectively.

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.

Prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Teaching Hospital in 2014, northwest Ethiopia.

PubMed

Asrie, Fikir; Enawgaw, Bamlaku; Getaneh, Zegeye

2017-01-01

Thrombocytopenia is a common hematologic abnormality during pregnancy. Pregnant women with thrombocytopenia have a higher risk of bleeding excessively during or after childbirth, particularly if they need to have a cesarean section or other surgical intervention during pregnancy, labor or in the puerperium. The main aim of this study was to determine the prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Hospital, northwest Ethiopia. A cross-sectional study was used to assess the prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Hospital from January to April 2015. A total of 217 pregnant women were included in the study and a structured pretested questionnaire was used to obtain sociodemographic information, nutritional factors, obstetrics and gynecological factors, history and clinical condition. Blood samples were collected for platelet count and other platelet parameters, which were determined by using SysmexKX 21 automation. The data were entered to Epi info version 6 software and analyzed using SPSS version 20 software. Bivariable and multivariable statistical analyses were used to evaluate the effect of independent variable over the dependent variable. A p -value of <0.05 was considered as statistically significant. A total of 217 women receiving antenatal care service at Gondar University Hospital participated in the study. Thrombocytopenia among 19 pregnant women showed a prevalence of 8.8%. The mean ± standard deviation platelet count was 238.85×10 9 /L (±74.57). Thrombocytopenia was significantly associated with patients who lived rurally (crude odds ratio =4.3, 95% confidence interval 1.48-12.76). The prevalence of thrombocytopenia was 8.8% predominantly with mild type of thrombocytopenia. Thrombocytopenia was higher among pregnant women who lived rurally. Therefore, health care providers should screen routinely for thrombocytopenia to avoid excessive bleeding during pregnancy, especially in women who live rurally.

Changing patterns in sensitivity of causative organisms of septicaemia in children: the need for quinolones.

PubMed

Orogade, A A; Akuse, R M

2004-03-01

A review of the pattern, and antibiotic sensitivities of blood culture isolates over a 3 year period in children presenting to the Paediatric Unit of Ahmadu Bello University Teaching Hospital, Kaduna is reported. Positive blood culture isolates were obtained in 26.9% of 1,982 children. The most prevalent isolates were Staphylococcus aureus (59.9%), Escherichia coli (16.9%) and Klebsiella (16.3%). There was a striking paucity of isolation of Salmonella typhi (1.3%) and Streptococcus. Sensitivity to commonly used drugs like ampicillin/cloxacillin, genticin, ceftazidime and chloramphenicol was low (8.0-50.0%), with a corresponding delayed fever resolution and prolonged hospital stay. 31.0-83.3% of the isolates were highly sensitive to pefloxacin, norfloxacin and ofloxacin, which were not generally recommended for use in paediatric patients. In two patients with no response to commonly used antibiotics, use of quinolones lysed their fever within 48 hours. This change of antibiotic sensitivity patterns calls for a thorough investigation into the potential role of these quinolones in paediatric chemotherapeutics either singly or in appropriate combinations with existing antibiotics.

Factors Relating to Acceptance of Hepatitis B Virus Vaccination by Nursing Students in a Tertiary Hospital, Pakistan

PubMed Central

Mengal, Hafeez-ur-Rehman; Howteerakul, Nopporn; Suwannapong, Nawarat; Rajatanun, Thitipat

2008-01-01

This cross-sectional study aimed at assessing the prevalence of, and factors relating to, the acceptance of hepatitis B virus (HBV) vaccination by nursing students in a tertiary hospital in Pakistan. In total, 210 nursing students of Year 2 to Year 4 were invited to participate in the study; of them, 196 (93.3%) returned completed questionnaires. Overall, the prevalence of acceptance of HBV vaccination among them was 75.0%. Of these, 37.2% (73/196) were completely vaccinated, and 25.0% (49/196) had not been vaccinated at all. More than half (27/49, 55.1%) of the unvaccinated nursing students stated that they would accept vaccination if offered. Multiple logistic regression analysis indicated three variables significantly related to acceptance of HBV vaccination: history of accidental exposure to blood or blood products, acceptable knowledge about HBV infection, and adequate budget for HBV vaccination. Health institutions should allocate adequate budgets to vaccinate their nursing students. Effective intervention programmes designed to increase knowledge about HBV infection and adhering to universally-accepted precautions are needed. PMID:18637527

Measuring pleural fluid pH: high correlation of a handheld unit to a traditional tabletop blood gas analyzer.

PubMed

Kohn, G L; Hardie, W D

2000-12-01

STUDY PURPOSES: To survey hospital laboratories in the United States to determine methods used for measuring pleural fluid pH, and to compare pleural fluid pH values obtained with a traditional tabletop blood gas analyzer (BGA) to those obtained with a handheld analyzer. Hospital laboratories nationwide were contacted by telephone to survey the methods used to measure pleural fluid pH. In a second phase, pleural fluid was prospectively collected from 19 pediatric and adult patients with pleural effusions, and pleural fluid pH was measured simultaneously with a traditional tabletop BGA and with a handheld unit. A total of 220 hospital laboratories were contacted by telephone, and 166 responded (75%). The methods for determining pleural fluid pH for all hospital laboratories were pH meter (35%; n = 59), BGA (32%; n = 53), and litmus paper (31%: n = 51); 2% (n = 3) did not perform the test. University hospitals were more likely to use a BGA, compared to community hospitals (p < 0.014) or children's hospitals (p < 0.001). In the comparison of pleural fluid measurements, the mean pH for the traditional BGA was 7.358 +/- 0.189, and the mean pH for the handheld unit was 7.382 +/- 0.203. The absolute difference between the two machines was 0.024 U, and the two methods were correlated (p < 0.01; r = 0.993; degrees of freedom = 36). Most hospital laboratories in the United States do not measure pleural fluid pH using a traditional BGA and use alternative methods that have previously been shown to be inaccurate. Pleural fluid pH obtained by a handheld unit has a high degree of correlation to that of a traditional tabletop BGA, and it offers a satisfactory alternative for laboratories reluctant to measure pleural fluid pH with a BGA.

A double-blind, randomized clinical trial comparing soybean oil–based versus olive oil–based lipid emulsions in adult medical–surgical intensive care unit patients requiring parenteral nutrition

PubMed Central

Spiegelman, Ronnie; Zhao, Vivian; Smiley, Dawn D.; Pinzon, Ingrid; Griffith, Daniel P.; Peng, Limin; Morris, Timothy; Luo, Menghua; Garcia, Hermes; Thomas, Christopher; Newton, Christopher A.; Ziegler, Thomas R.

2013-01-01

Objective Parenteral nutrition has been associated with metabolic and infectious complications in intensive care unit patients. The underlying mechanism for the high risk of complications is not known but may relate to the proinflammatory effects of soybean oil–based lipid emulsions, the only Food and Drug Administration–approved lipid formulation for clinical use. Design Prospective, double-blind, randomized, controlled trial. Setting Medical–surgical intensive care units from a major urban teaching hospital and a tertiary referral university hospital. Patients Adult medical–surgical intensive care unit patients. Intervention Parenteral nutrition containing soybean oil–based (Intralipid) or olive oil–based (ClinOleic) lipid emulsions. Measurements Differences in hospital clinical outcomes (nosocomial infections and noninfectious complications), hospital length of stay, glycemic control, inflammatory and oxidative stress markers, and granulocyte and monocyte functions between study groups. Results A total of 100 patients were randomized to either soybean oil–based parenteral nutrition or olive oil–based parenteral nutrition for up to 28 days. A total of 49 patients received soybean oil–based parenteral nutrition (age 51 ± 15 yrs, body mass index 27 ± 6 kg/m2, and Acute Physiology and Chronic Health Evaluation II score 15.5 ± 7 [±SD]), and a total of 51 patients received olive oil–based lipid emulsion in parenteral nutrition (age 46 ± 19 yrs, body mass index 27 ± 8 kg/m2, and Acute Physiology and Chronic Health Evaluation II score 15.1 ± 6 [±SD]) for a mean duration of 12.9 ± 8 days. The mean hospital blood glucose concentration during parenteral nutrition was 129 ± 14 mg/dL, without differences between groups. Patients treated with soybean oil–based and olive oil–based parenteral nutrition had a similar length of stay (47 ± 47 days and 41 ± 36 days, p = .49), mortality (16.3% and 9.8%, p = .38), nosocomial infections (43% vs. 57%, p = .16), and acute renal failure (26% vs. 18%, p = .34). In addition, there were no differences in inflammatory and oxidative stress markers or in granulocyte and monocyte functions between groups. Conclusion The administration of parenteral nutrition containing soybean oil–based and olive oil–based lipid emulsion resulted in similar rates of infectious and noninfectious complications and no differences in glycemic control, inflammatory and oxidative stress markers, and immune function in critically ill adults. PMID:22488002

Impact of Educational Activities in Reducing Pre-Analytical Laboratory Errors

PubMed Central

Al-Ghaithi, Hamed; Pathare, Anil; Al-Mamari, Sahimah; Villacrucis, Rodrigo; Fawaz, Naglaa; Alkindi, Salam

2017-01-01

Objectives Pre-analytic errors during diagnostic laboratory investigations can lead to increased patient morbidity and mortality. This study aimed to ascertain the effect of educational nursing activities on the incidence of pre-analytical errors resulting in non-conforming blood samples. Methods This study was conducted between January 2008 and December 2015. All specimens received at the Haematology Laboratory of the Sultan Qaboos University Hospital, Muscat, Oman, during this period were prospectively collected and analysed. Similar data from 2007 were collected retrospectively and used as a baseline for comparison. Non-conforming samples were defined as either clotted samples, haemolysed samples, use of the wrong anticoagulant, insufficient quantities of blood collected, incorrect/lack of labelling on a sample or lack of delivery of a sample in spite of a sample request. From 2008 onwards, multiple educational training activities directed at the hospital nursing staff and nursing students primarily responsible for blood collection were implemented on a regular basis. Results After initiating corrective measures in 2008, a progressive reduction in the percentage of non-conforming samples was observed from 2009 onwards. Despite a 127.84% increase in the total number of specimens received, there was a significant reduction in non-conforming samples from 0.29% in 2007 to 0.07% in 2015, resulting in an improvement of 75.86% (P <0.050). In particular, specimen identification errors decreased by 0.056%, with a 96.55% improvement. Conclusion Targeted educational activities directed primarily towards hospital nursing staff had a positive impact on the quality of laboratory specimens by significantly reducing pre-analytical errors. PMID:29062553

Impact of Educational Activities in Reducing Pre-Analytical Laboratory Errors: A quality initiative.

PubMed

Al-Ghaithi, Hamed; Pathare, Anil; Al-Mamari, Sahimah; Villacrucis, Rodrigo; Fawaz, Naglaa; Alkindi, Salam

2017-08-01

Pre-analytic errors during diagnostic laboratory investigations can lead to increased patient morbidity and mortality. This study aimed to ascertain the effect of educational nursing activities on the incidence of pre-analytical errors resulting in non-conforming blood samples. This study was conducted between January 2008 and December 2015. All specimens received at the Haematology Laboratory of the Sultan Qaboos University Hospital, Muscat, Oman, during this period were prospectively collected and analysed. Similar data from 2007 were collected retrospectively and used as a baseline for comparison. Non-conforming samples were defined as either clotted samples, haemolysed samples, use of the wrong anticoagulant, insufficient quantities of blood collected, incorrect/lack of labelling on a sample or lack of delivery of a sample in spite of a sample request. From 2008 onwards, multiple educational training activities directed at the hospital nursing staff and nursing students primarily responsible for blood collection were implemented on a regular basis. After initiating corrective measures in 2008, a progressive reduction in the percentage of non-conforming samples was observed from 2009 onwards. Despite a 127.84% increase in the total number of specimens received, there was a significant reduction in non-conforming samples from 0.29% in 2007 to 0.07% in 2015, resulting in an improvement of 75.86% ( P <0.050). In particular, specimen identification errors decreased by 0.056%, with a 96.55% improvement. Targeted educational activities directed primarily towards hospital nursing staff had a positive impact on the quality of laboratory specimens by significantly reducing pre-analytical errors.

Organizing integrated care in a university hospital: application of a conceptual framework

PubMed Central

Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

2014-01-01

Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care. PMID:24966806

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

Trust-based or performance-based management: a study of employment contracting in hospitals.

PubMed

Pettersen, Inger Johanne

2011-01-01

Hospitals are frequently changing managerial practices due to numerous public sector reforms taking place. In general, these reforms include the making and monitoring of contracts that regulate relations between the hospitals and their professional staffs. The aim of this paper is to discuss some main characteristics of the contracts that regulate the perceived relations between physicians as employees and the public hospital as employer. The theoretical framework is based on a contract theory approach. The empirical data is based on survey data from full-time employed physicians in the medical and surgical divisions in one of the largest university hospitals in Norway. This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio-cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems. Copyright © 2009 John Wiley & Sons, Ltd.

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.

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.

Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient's Outcome: A Prospective, Multicenter Cohort Study With a Noninferiority Design.

PubMed

Meybohm, Patrick; Herrmann, Eva; Steinbicker, Andrea U; Wittmann, Maria; Gruenewald, Matthias; Fischer, Dania; Baumgarten, Georg; Renner, Jochen; Van Aken, Hugo K; Weber, Christian F; Mueller, Markus M; Geisen, Christof; Rey, Julia; Bon, Dimitra; Hintereder, Gudrun; Choorapoikayil, Suma; Oldenburg, Johannes; Brockmann, Christian; Geissler, Raoul G; Seifried, Erhard; Zacharowski, Kai

2016-08-01

To determine whether the implementation of patient blood management (PBM) is effective to decrease the use of red blood cell without impairment of patient's safety. The World Health Organization encouraged all member states to implement PBM programs employing multiple combined strategies to increase and preserve autologous erythrocyte volume to minimize red blood cell transfusions. Data regarding safety issues are not sufficiently available. In this prospective, multicenter study, surgical inpatients from four German University Hospitals were analyzed before (pre-PBM) and after the implementation of PBM. PBM program included multiple measures (ie, preoperative optimization of hemoglobin levels, blood-sparing techniques, and standardization of transfusion practice). Primary aim was to show noninferiority of the PBM cohort with a margin of 0.5%. Secondary endpoints included red blood cell utilization. A total of 129,719 patients discharged between July 2012 and June 2015 with different inclusion periods for pre-PBM (54,513 patients) and PBM (75,206 patients) were analyzed. The primary endpoint was 6.53% in the pre-PBM versus 6.34% in the PBM cohort. The noninferiority aim was achieved (P < 0.001). Incidence of acute renal failure decreased in the PBM cohort (2.39% vs 1.67%; P < 0.001, regression model). The mean number of red blood cell transfused per patient was reduced from 1.21 ± 0.05 to 1.00 ± 0.05 (relative change by 17%, P < 0.001). The data presented show that implementation of PBM with a more conscious handling of transfusion practice can be achieved even in large hospitals without impairment of patient's safety. Further studies should elucidate which PBM measures are most clinically and cost effective. PBM-Study ClinicalTrials.gov, NCT01820949.

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

PubMed

Leahy, Michael F; Hofmann, Axel; Towler, Simon; Trentino, Kevin M; Burrows, Sally A; Swain, Stuart G; Hamdorf, Jeffrey; Gallagher, Trudi; Koay, Audrey; Geelhoed, Gary C; Farmer, Shannon L

2017-06-01

Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001). Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Knowledge, beliefs, and decisions of pregnant Australian women concerning donation and storage of umbilical cord blood: a population-based survey.

PubMed

Jordens, Christopher F C; Kerridge, Ian H; Stewart, Cameron L; O'Brien, Tracey A; Samuel, Gabrielle; Porter, Maree; O'Connor, Michelle A C; Nassar, Natasha

2014-12-01

Many women giving birth in Australian hospitals can choose to donate their child's umbilical cord blood to a public cord blood bank or pay to store it privately. We conducted a survey to determine the proportion and characteristics of pregnant women who are aware of umbilical cord blood (UCB) banking and who have considered and decided about this option. The survey also sought to ascertain information sources, knowledge, and beliefs about UCB banking, and the effect of basic information about UCB on decisions. Researchers and hospital maternity staff distributed a survey with basic information about UCB banking to 1,873 women of at least 24 weeks' gestation who were attending antenatal classes and hospital clinics in 14 public and private maternity hospitals in New South Wales. Most respondents (70.7%) were aware of UCB banking. Their main information sources were leaflets from hospital clinics, print media, antenatal classes, TV, radio, friends, and relatives. Knowledge about UCB banking was patchy, and respondents overestimated the likelihood their child would need or benefit from UCB. Women who were undecided about UCB banking were younger, less educated, or from ethnic or rural backgrounds. After providing basic information about UCB banking, the proportion of respondents who indicated they had decided whether or not to donate or store UCB more than doubled from 30.0 to 67.7 percent. Basic information for parents about UCB banking can affect planned decisions about UCB banking. Information should be accurate and balanced, should counter misconceptions, and should target specific groups. © 2014 Wiley Periodicals, Inc.

An Integrated Intervention for Increasing Clinical Nurses' Knowledge of HIV/AIDS-Related Occupational Safety.

PubMed

He, Liping; Lu, Zhiyan; Huang, Jing; Zhou, Yiping; Huang, Jian; Bi, Yongyi; Li, Jun

2016-11-07

Background : Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives : To assess the effectiveness of integrated interventions on nurses' knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods : We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results : Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly ( χ ² = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) ( χ ² = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre-test knowledge scores on universal precautions were relatively high. Correct answers about universal precautions improved significantly from pre-test (83.71%) to post-test (89.58%; χ ² = 25.00, p = 0.00). After the intervention, nurses' attitude scores improved significantly from pre-test (3.80 ± 0.79) to post-test (4.06 ± 0.75; t = 3.74, p = 0.00). Conclusions : Integrated educational interventions enhance nurses' knowledge of risk reduction for occupationally acquired HIV infections and improve the observance of universal precautionary procedures. This enhancement allows nurses to assume a teaching role for prevention and management of HIV/AIDS.

Association Between Inpatient Sleep Loss and Hyperglycemia of Hospitalization

PubMed Central

DePietro, Regina H.; Knutson, Kristen L.; Spampinato, Lisa; Anderson, Samantha L.; Meltzer, David O.; Van Cauter, Eve

2017-01-01

OBJECTIVE To determine whether inpatient sleep duration and efficiency are associated with a greater risk of hyperglycemia in hospitalized patients with and without diabetes. RESEARCH DESIGN AND METHODS In this retrospective analysis of a prospective cohort study, medical inpatients ≥50 years of age were interviewed, and their charts were reviewed to obtain demographic data and diagnosis. Using World Health Organization criteria, patients were categorized as having normal blood glucose, impaired fasting blood glucose, or hyperglycemia based on morning glucose from the electronic health record. Wrist actigraphy measured sleep. Multivariable ordinal logistic regression models, controlling for subject random effects, tested the association between inpatient sleep duration and proportional odds of hyperglycemia versus impaired fasting blood glucose or impaired fasting blood glucose versus normal blood glucose in hospitalized adults. RESULTS A total of 212 patients (60% female and 74% African American) were enrolled. Roughly one-third (73, 34%) had diabetes. Objective inpatient sleep measures did not differ between patients with or without diabetes. In ordinal logistic regression models, each additional hour of in-hospital sleep was associated with an 11% (odds ratio 0.89 [95% CI 0.80, 0.99]; P = 0.043) lower proportional odds of a higher glucose category the next morning (hyperglycemia vs. elevated and elevated vs. normal). Every 10% increase in sleep efficiency was associated with an 18% lower proportional odds of a higher glucose category (odds ratio 0.82 [95% CI 0.74, 0.89]; P < 0.001). CONCLUSIONS Among medical inpatients, both shorter sleep duration and worse sleep efficiency were independently associated with greater proportional odds of hyperglycemia and impaired fasting glucose. PMID:27903614

Quality of anaesthesia for Caesarean sections: a cross-sectional study of a university hospital in a low-income country.

PubMed

Eriksson, Jesper; Baker, Tim; Jörnvall, Henrik; Irestedt, Lars; Mulungu, Moses; Larsson, Emma

2015-10-01

To evaluate the quality of anaesthesia for Caesarean sections at Muhimbili National Hospital, Dar es Salaam, Tanzania. We developed an instrument consisting of 40 quality indicators using an expert group process based on the existing literature. Using the instrument, we observed 50 Caesarean sections. Twenty-eight of the indicators were structural indicators, such as essential drugs, oxygen supply and anaesthetic equipment. Twelve were process indicators such as evaluation of airway, blood pressure assessment or insertion of an intravenous line. The median patient age was 28.5 years. A total of 75% (range 61-82%) of the structural indicators were present in the operating theatres, and 55% (range 33-83%) of the process indicators were performed. The neonates' median Apgar score was 9 (range 3-10). Seven babies required ventilation, four babies were stillborn, and all others were alive at follow-up 2 days after partus. All mothers were alive 2 days post-surgery. The low process score suggests that quality improvement initiatives should focus on the processes of anaesthesia for Caesarean sections rather than new drugs and equipment. © 2015 John Wiley & Sons Ltd.

Performance of time-series methods in forecasting the demand for red blood cell transfusion.

PubMed

Pereira, Arturo

2004-05-01

Planning the future blood collection efforts must be based on adequate forecasts of transfusion demand. In this study, univariate time-series methods were investigated for their performance in forecasting the monthly demand for RBCs at one tertiary-care, university hospital. Three time-series methods were investigated: autoregressive integrated moving average (ARIMA), the Holt-Winters family of exponential smoothing models, and one neural-network-based method. The time series consisted of the monthly demand for RBCs from January 1988 to December 2002 and was divided into two segments: the older one was used to fit or train the models, and the younger to test for the accuracy of predictions. Performance was compared across forecasting methods by calculating goodness-of-fit statistics, the percentage of months in which forecast-based supply would have met the RBC demand (coverage rate), and the outdate rate. The RBC transfusion series was best fitted by a seasonal ARIMA(0,1,1)(0,1,1)(12) model. Over 1-year time horizons, forecasts generated by ARIMA or exponential smoothing laid within the +/- 10 percent interval of the real RBC demand in 79 percent of months (62% in the case of neural networks). The coverage rate for the three methods was 89, 91, and 86 percent, respectively. Over 2-year time horizons, exponential smoothing largely outperformed the other methods. Predictions by exponential smoothing laid within the +/- 10 percent interval of real values in 75 percent of the 24 forecasted months, and the coverage rate was 87 percent. Over 1-year time horizons, predictions of RBC demand generated by ARIMA or exponential smoothing are accurate enough to be of help in the planning of blood collection efforts. For longer time horizons, exponential smoothing outperforms the other forecasting methods.

Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

PubMed

Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

2018-04-01

Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination.

PubMed

Little, J R; Murray, P R; Traynor, P S; Spitznagel, E

1999-08-01

Contamination of blood cultures creates problems in their interpretation and unneeded resource utilization. Because skin flora comprise the major group of contaminant species, more effective skin disinfection at the venipuncture site could reduce contamination. We performed a randomized trial in adult inpatients at a tertiary care teaching hospital. Antecubital venipuncture sites were randomly disinfected with povidone-iodine or iodine tincture, and blood cultures (two bottles, 10 mL of blood) were drawn by professional phlebotomists. Scoring of contaminant species was restricted to skin flora. Hospital resource utilization was compared among patients with contaminated blood cultures and those with sterile blood cultures. Of the 3,851 blood cultures collected during the study, 120 (3.1%) were contaminated with skin flora. The contamination rate for blood cultures collected after povidone-iodine was 3.8% (74 of 1,947), compared with a rate of 2.4% (46 of 1,904, P = 0.01) after iodine tincture. The difference in mean total hospital costs for patients with contaminated blood cultures and those with sterile blood cultures was $4,100 (95% confidence interval: $740 to $7,400, P = 0.02). Iodine tincture is superior to povidone-iodine for venipuncture site antisepsis before blood culture sampling. Because of the high costs associated with contaminated blood cultures, hospitals should consider switching from povidone-iodine to iodine tincture. Reduction of the contamination rate may improve the quality of patient care and reduce hospital costs.

[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.

Hypertension in patients admitted to clinical units at university hospital: post-discharge evaluation rated by telephone

PubMed Central

de Campos, Cássia Lima; Pierin, Angela Maria Geraldo; de Pinho, Natalia Alencar

2017-01-01

ABSTRACT Objective To characterize hypertensive patients after admission to hospital considering the current status, compliance to treatment, habits and lifestyle, and knowledge and beliefs about the disease. Methods This was an exploratory study with 265 hypertensive patients admitted to a medical inpatients unit of a university hospital. Data were collected in an interview over the telephone. The level of significance was set as p<0.05. Results It was found that 32% of hypertensive patients had died. One hundred patients were interviewed, mean age of 64.15 (13.2) years, 51% were women, 56% non-white, 51% with primary education, 52% were retired, 13% were smokers, 38% used alcohol, 80% did not perform physical exercise, and the mean body mass index was 35.9 (15.5) kg/m2. The comorbidities were heart problem (52%), diabetes (49%) and stroke (25%). As to antihypertensive treatment, 75% were on use, 17.3% stopped taking them and 21.3% missed visits. The treatment sites were the primary care unit (49%) and hospital (36%). As for knowledge and beliefs, 25% believed hypertension is curable, 77% that treatment should last for the rest of their lives, and hypertension brings complications (84%). A total of 46.7% were controlled. The lack of control was associated (p<0.05) with non-white ethnicity and absence of heart problems. Conclusion There were significant deaths occurred after hospitalization and poor control of blood pressure, probably due to inadequate habits and lifestyles and non-compliance to antihypertensive treatment. PMID:28444088

Spreading of blood drops over dry porous substrate: complete wetting case.

PubMed

Chao, Tzu Chieh; Arjmandi-Tash, Omid; Das, Diganta B; Starov, Victor M

2015-05-15

The process of dried blood spot sampling involves simultaneous spreading and penetration of blood into a porous filter paper with subsequent evaporation and drying. Spreading of small drops of blood, which is a non-Newtonian liquid, over a dry porous layer is investigated from both theoretical and experimental points of view. A system of two differential equations is derived, which describes the time evolution of radii of both the drop base and the wetted region inside the porous medium. The system of equations does not include any fitting parameters. The predicted time evolutions of both radii are compared with experimental data published earlier. For a given power law dependency of viscosity of blood with different hematocrit level, radii of both drop base and wetted region, and contact angle fell on three universal curves if appropriate scales are used with a plot of the dimensionless radii of the drop base and the wetted region inside the porous layer and dynamic contact angle on dimensionless time. The predicted theoretical relationships are three universal curves accounting satisfactorily for the experimental data. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Midwifery in Iceland: From vocational training to university education.

PubMed

Olafsdottir, Olof A; Kristjansdottir, Hildur; Halfdansdottir, Berglind; Gottfredsdottir, Helga

2018-07-01

Midwifery education is a foundation for health professionals' competence in providing quality healthcare for the benefit of women, their families and society. This paper describes midwifery and the development of midwifery education in Iceland. It examines policy and extensive reforms, from hospital-based vocational training in midwifery to an academic university education, and the impact on the scope of midwifery practice in Iceland. The university-based programme, with its emphasis on autonomy of the midwife, seems to have affected the context of home birth and strengthened midwives' role in primary healthcare. Education reform with a focus on evidence-based practice and midwife-led continuity of care has had limited influence within the hospital system, where the structure of care is fragmented and childbirth is under threat of increasing interventions. Research is needed on the role of education in supporting evidence-based practice, normal childbirth and reproductive health in the Icelandic context. Copyright © 2018 Elsevier Ltd. All rights reserved.

Intraoperative transfusion practices in Europe.

PubMed

Meier, J; Filipescu, D; Kozek-Langenecker, S; Llau Pitarch, J; Mallett, S; Martus, P; Matot, I

2016-02-01

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. NCT 01604083. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

Metabolic syndrome and its characteristics among obese patients attending an obesity clinic.

PubMed

Termizy, H M; Mafauzy, M

2009-04-01

The increased prevalence of metabolic syndrome worldwide is closely related to the rising obesity epidemic. The objectives of the study were to determine the prevalence and identify the associated and prognostic factors that influence the risk of metabolic syndrome among obese patients attending the Obesity Clinic at Hospital Universiti Sains Malaysia. A study was conducted involving 102 obese persons who attended the Obesity Clinic from January 1 to December 31, 2005. Metabolic syndrome was defined according to the International Diabetes Federation criteria. The overall prevalence of metabolic syndrome among obese patients was 40.2 percent. The prevalence was higher in females (43.7 percent) than in males (32.3 percent). The prevalence of metabolic syndrome was noted to increase with increasing body mass index class, from class 1 to class 2. However, the prevalence was lower in obesity class 3. The prevalence of metabolic comorbidities of raised blood pressure, reduced high density lipoprotein, high triglyceride and raised fasting blood glucose was 42, 40, 36 and 17 percent, respectively. A quarter of obese patients in this study had no other comorbidity. Based on logistic regression multivariable analysis, age was the only significant associated factor that influenced the risk of having metabolic syndrome. The prevalence of metabolic syndrome was high and the highest comorbidity was high blood pressure. Age was the only significant risk factor of having this syndrome.

Current challenges and future achievements of blood transfusion service in Afghanistan.

PubMed

Cheraghali, A M; Sanei Moghaddam, E; Masoud, A; Faisal, H

2012-10-01

Afghanistan is a country with population of over 28 million. The long term conflicts have devastated country's qualified resources including human resources. ANBSTS was established by MoPH as the country national blood service. Currently in addition to central and regional blood centers of ANBSTS many other hospitals have their own transfusion services. Blood donation in Afghanistan mainly depends on replacement donors. Donor selection and donor interview are not very efficient. Most of the blood in Afghanistan is administered as fresh whole blood. Although blood transfusion services in Afghanistan require more efforts to be fully efficient, based on recent improvements in working procedures of ANBSTS a promising future for blood transfusion services in Afghanistan is predicted. Copyright © 2012 Elsevier Ltd. All rights reserved.

A national common massive transfusion protocol (MTP) is a feasible and advantageous option for centralized blood services and hospitals.

PubMed

Chay, J; Koh, M; Tan, H H; Ng, J; Ng, H J; Chia, N; Kuperan, P; Tan, J; Lew, E; Tan, L K; Koh, P L; Desouza, K A; Bin Mohd Fathil, S; Kyaw, P M; Ang, A L

2016-01-01

A common national MTP was jointly implemented in 2011 by the national blood service (Blood Services Group) and seven participating acute hospitals to provide rapid access to transfusion support for massively haemorrhaging patients treated in all acute care hospitals. Through a systematic clinical workflow, blood components are transfused in a ratio of 1:1:1 (pRBC: whole blood-derived platelets: FFP), together with cryoprecipitate for fibrinogen replacement. The composition of components for the MTP is fixed, although operational aspects of the MTP can be adapted by individual hospitals to suit local hospital workflow. The MTP could be activated in support of any patient with critical bleeding and at risk of massive transfusion, including trauma and non-trauma general medical, surgical and obstetric patients. There were 434 activations of the MTP from October 2011 to October 2013. Thirty-nine per cent were for trauma patients, and 30% were for surgical patients with heavy intra-operative bleeding, with 25% and 6% for patients with gastrointestinal bleeding and peri-partum haemorrhage, respectively. Several hospitals reported reduction in mean time between request and arrival of blood. Mean transfusion ratio achieved was one red cell unit: 0·8 FFP units: 0·8 whole blood-derived platelet units: 0·4 units of cryoprecipitate. Although cryoprecipitate usage more than doubled after introduction of MTP, there was no significant rise in overall red cells, platelet and FFP usage following implementation. This successful collaboration shows that shared transfusion protocols are feasible and potentially advantageous for hospitals sharing a central blood provider. © 2015 International Society of Blood Transfusion.

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.

The performance implications of pharmacy information system at the university teaching hospitals of Shiraz, Iran: Cluster approach

PubMed Central

Bayati, Saeede; Bastani, Peivand; Sagheb, Zahra Mahmoodzade; Jamalabadi, Sara; Samadbeik, Mahnaz

2017-01-01

Pharmacy information system (PIS) is becoming vital in assisting pharmacists to do their responsibilities. The aim of this study was to identify the current PIS implications in teaching hospitals affiliated with Shiraz University of Medical Science. This cross-sectional study was conducted in teaching hospitals affiliated with Shiraz University of Medical Science over the year 2016. Data were collected by observing the PIS as well as interviewing its users based on the researcher-made checklist. The checklist was prepared based on reviewing the Persian and English literature and its content validity was approved by the experts. To determine the reliability of the checklist, inter-rater reliability was used. Data were analyzed using SPSS16, and hospitals were clustered using SK-means method. In this study, the least conformity to the standards was shown in smart clinical features (4.54%), pharmaceutical companies' relationship (32.6%), and optimization of drug therapy (34.6%). In contrast, the highest conformity to the standards was shown in reporting capabilities (77.3%) and entry information and input (70.4%). Medication stock checking and optimization of drug therapy were effective features that have made a distinction between hospitals and lead to 95% variance between clusters. Based on the results, the current PIS design pays less attention to clinical features. Besides, clinical information for pharmacists and outside organization relationship were not provided by the current system. Thus, emphasis should be placed on the implementation of corrective actions to eliminate the current system's deficiencies. PMID:29184843

Incidence and species distribution of candidaemia in Asia: a laboratory-based surveillance study.

PubMed

Tan, B H; Chakrabarti, A; Li, R Y; Patel, A K; Watcharananan, S P; Liu, Z; Chindamporn, A; Tan, A L; Sun, P-L; Wu, U-I; Chen, Y-C

2015-10-01

The epidemiology of candidaemia varies between hospitals and geographic regions. Although there are many studies from Asia, a large-scale cross-sectional study across Asia has not been performed. We conducted a 12-month, laboratory-based surveillance of candidaemia at 25 hospitals from China, Hong Kong, India, Singapore, Taiwan and Thailand. The incidence and species distribution of candidaemia were determined. There were 1601 episodes of candidaemia among 1.2 million discharges. The overall incidence was 1.22 episodes per 1000 discharges and varied among the hospitals (range 0.16-4.53 per 1000 discharges) and countries (range 0.25-2.93 per 1000 discharges). The number of Candida blood isolates and the total number of fungal isolates were highly correlated among the six countries (R² = 0.87) and 25 hospitals (R² = 0.77). There was a moderate correlation between incidence of candidaemia and the intensive care unit (ICU)/total bed ratio (R² = 0.47), although ICUs contributed to only 23% of candidaemia cases. Of 1910 blood isolates evaluated, Candida albicans was most frequently isolated (41.3%), followed by Candida tropicalis (25.4%), Candida glabrata (13.9%) and Candida parapsilosis (12.1%). The proportion of C. tropicalis among blood isolates was higher in haemato-oncology wards than others wards (33.7% versus 24.5%, p 0.0058) and was more likely to be isolated from tropical countries than other Asian countries (46.2% versus 18.9%, p 0.04). In conclusion, the ICU settings contribute, at least in part, to the incidence variation among hospitals. The species distribution is different from Western countries. Both geographic and healthcare factors contribute to the variation of species distribution. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Multicenter validation of the clinical dehydration scale for children].

PubMed

Gravel, J; Manzano, S; Guimont, C; Lacroix, L; Gervaix, A; Bailey, B

2010-12-01

Dehydration is an important complication for sick children. The Clinical Dehydration Scale for children (CDS) measures dehydration based on 4 clinical signs: general appearance, eyes, saliva, and tears. To validate the association between the CDS and markers of dehydration in children aged 1 month to 5 years visiting emergency departments (EDs) for vomiting and/or diarrhea. An international prospective cohort study conducted in 3 university-affiliated EDs in 2009. Participants were a convenience sample of children aged 1-60 months presenting to the ED for acute vomiting and/or diarrhea. Following triage, a research nurse obtained informed consent and evaluated dehydration using the CDS. A few days after recovery, another research assistant weighed participants at home. The primary outcome was the percentage of dehydration calculated by the difference in weight at first evaluation and after recovery. Secondary outcomes included proportion of blood test measurements, intravenous use, hospitalization, and inter-rater agreement. During the study period, 264 children were recruited and data regarding weight and dehydration scores were complete for 219 (83%). According to the CDS, 88 had no dehydration, 159 some dehydration, and 15 moderate or severe dehydration. A Chi-square test showed a statistical association between CDS and weight gain, the occurrence of blood tests, intravenous rehydration, hospitalization, and abnormal plasmatic bicarbonate. Good inter-rater correlation was found among participants (linear weighted Kappa score of 0.65; (95% CI, 0.43-0.87). CDS categories correlate with markers of dehydration for young children complaining of vomiting and/or diarrhea in the ED. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Preparedness of Finnish Emergency Medical Services for Chemical Emergencies.

PubMed

Jama, Timo J; Kuisma, Markku J

2016-08-01

Introduction The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland. Hypothesis The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching. This cross-sectional study was conducted as a Webropol (Wuppertal, Germany) survey. All hospital districts (n=20) in continental Finland were asked about their EMS preparedness level in terms of capability of treating and transporting chemically affected patients in the field. Their capability for decontamination of affected patients in the field was also inquired. University hospital district-based EMS systems had at least 20% better absolute clinical capacity than central hospital-based EMS systems for treating chemically affected patients concerning all treatments inquired about, except the capacity for non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) treatment in the field. Overall, there was a good level of preparedness for treating chemical accident patients with supplemental oxygen, bronchodilators, and inhaled corticosteroids. Preparedness for providing antidote therapy in cases of cyanide gas exposure was, in general, low. The variation among the hospital districts was remarkable. Only nine of 15 central hospital district EMS had a mobile decontamination unit available, whereas four of five university hospital districts had one. Emergency Medical Services capacity in Finland for treating chemically affected patients in the field needs to be improved, especially in terms of antidote therapy. Mobile decontamination units should be available in all hospital districts. Jama TJ , Kuisma MJ . Preparedness of Finnish Emergency Medical Services for chemical emergencies. Prehosp Disaster Med. 2016;31(4):392-396.

Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories.

PubMed

Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine

2010-09-01

Scand J Caring Sci; 2010; 24; 581-591 
 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories   Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory.   To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories.   Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing.   The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff.   The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.

Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

PubMed Central

Hubben, Gijs; Bootsma, Martin; Luteijn, Michiel; Glynn, Diarmuid; Bishai, David

2011-01-01

Background Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings. Methodology/Principal Findings A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively. Conclusions/Significance Admission screening costs $4,100–$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving. PMID:21483492

MRSA-surveillance in Germany: data from the Antibiotic Resistance Surveillance System (ARS) and the mandatory surveillance of MRSA in blood.

PubMed

Schweickert, B; Noll, I; Feig, M; Claus, H; Krause, G; Velasco, E; Eckmanns, T

2012-08-01

Data from the German Antibiotic Resistance Surveillance system (ARS) and statutory notification of methicillin-resistant Staphylococcus aureus (MRSA) in blood cultures are presented. ARS is a voluntary laboratory-based surveillance system providing resistance data of all clinical pathogens and sample types from hospitals and ambulatory care. Statutory notification includes MRSA detected in blood and cerebrospinal fluid by microbiological laboratories. Resistance data from 2008 to 2010 and MRSA-bacteraemia incidences from 2010 are presented. From 2008 to 2010, resistance data from 70,935 Staphylococcus aureus isolates were transferred to the national health institution. MRSA proportions in hospitals and outpatient care account for 19.2% and 10.6%, respectively. In hospital care high proportions of MRSA were found in nephrological, geriatric, neurological general wards and surgical ICUs (49.4%, 45.8%, 34.2%, and 27.0%, respectively), while in community outpatient care urological practices (29.2%) account for the highest values. In both healthcare settings urinary tract samples stand out with high proportions of MRSA (hospitals, 32.9%; outpatients, 20.5%). In 2010, 3900 cases of MRSA bacteraemia were reported, accounting for an incidence of MRSA bacteraemia of 4.8/100,000 inhabitants/year. Stratification by federal states shows considerable regional differences (range, 1.0-8.3/100,000 inhabitants/year). Vulnerable areas in hospitals and outpatient care have been pointed out as subjects for further inquiries.

[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.

Comparing a Japanese and a German hospital information system.

PubMed

Jahn, F; Issler, L; Winter, A; Takabayashi, K

2009-01-01

To examine the architectural differences and similarities of a Japanese and German hospital information system (HIS) in a case study. This cross-cultural comparison, which focuses on structural quality characteristics, offers the chance to get new insights into different HIS architectures, which possibly cannot be obtained by inner-country comparisons. A reference model for the domain layer of hospital information systems containing the typical enterprise functions of a hospital provides the basis of comparison for the two different hospital information systems. 3LGM(2) models, which describe the two HISs and which are based on that reference model, are used to assess several structural quality criteria. Four of these criteria are introduced in detail. The two examined HISs are different in terms of the four structural quality criteria examined. Whereas the centralized architecture of the hospital information system at Chiba University Hospital causes only few functional redundancies and leads to a low implementation of communication standards, the hospital information system at the University Hospital of Leipzig, having a decentralized architecture, exhibits more functional redundancies and a higher use of communication standards. Using a model-based comparison, it was possible to detect remarkable differences between the observed hospital information systems of completely different cultural areas. However, the usability of 3LGM(2) models for comparisons has to be improved in order to apply key figures and to assess or benchmark the structural quality of health information systems architectures more thoroughly.

[Operational qualification of the computer-based information system and electronic data interchanges in a hospital blood bank].

PubMed

Vaquier, C; Legrand, D; Caldani, C

2009-05-01

Since 1985, a Council Resolution defines a new approach to technical harmonization and standards. The directives resulting from this new approach establish the essential safety requirements with which products put on the market must conform, and which should therefore enjoy free movement throughout the European Union, owing to a presumption of conformity. However, if the manufacturer is responsible for the conformity of its product in terms of safety, it is the end-user who must make sure that its requirements for a specific use or a considered application are satisfied and that the product meets its needs. It is the objective of the procedure of validation, which calls upon protocols of qualification intended to show the aptitude of a material, a system, a device, of an installation, to meet the requirements of specified quality and safety. This concept of qualification applies to the data-processing software of the hospital blood banks. Only the stage of operational qualification will be developed here. It involves scenarios made up of test files which make it possible to check the electronic data interchanges between the hospital blood bank and the blood establishment (transmission of the results of analysis, transmission of the data of traceability), as well as the functions of assistance to the issuing of the labile blood products.

Clinical Decision Support Reduces Overuse of Red Blood Cell Transfusions: Interrupted Time Series Analysis.

PubMed

Kassakian, Steven Z; Yackel, Thomas R; Deloughery, Thomas; Dorr, David A

2016-06-01

Red blood cell transfusion is the most common procedure in hospitalized patients in the US. Growing evidence suggests that a sizeable percentage of these transfusions are inappropriate, putting patients at significant risk and increasing costs to the health care system. We performed a retrospective quasi-experimental study from November 2008 until November 2014 in a 576-bed tertiary care hospital. The intervention consisted of an interruptive clinical decision support alert shown to a provider when a red blood cell transfusion was ordered in a patient whose most recent hematocrit was ≥21%. We used interrupted time series analysis to determine whether our primary outcome of interest, rate of red blood cell transfusion in patients with hematocrit ≥21% per 100 patient (pt) days, was reduced by the implementation of the clinical decision support tool. The rate of platelet transfusions was used as a nonequivalent dependent control variable. A total of 143,000 hospital admissions were included in our analysis. Red blood cell transfusions decreased from 9.4 to 7.8 per 100 pt days after the clinical decision support intervention was implemented. Interrupted time series analysis showed that significant decline of 0.05 (95% confidence interval [CI], 0.03-0.07; P < .001) units of red blood cells transfused per 100 pt days per month was already underway in the preintervention period. This trend accelerated to 0.1 (95% CI, 0.09-0.12; P < .001) units of red blood cells transfused per 100 pt days per month following the implementation of the clinical decision support tool. There was no statistical change in the rate of platelet transfusion resulting from the intervention. The implementation of an evidence-based clinical decision support tool was associated with a significant decline in the overuse of red blood cell transfusion. We believe this intervention could be easily replicated in other hospitals using commercial electronic health records and a similar reduction in overuse of red blood cell transfusions achieved. Copyright © 2016 Elsevier Inc. All rights reserved.

Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design.

PubMed

McLaughlin, John M; Jiang, Qin; Isturiz, Raul E; Sings, Heather L; Swerdlow, David L; Gessner, Bradford D; Carrico, Ruth M; Peyrani, Paula; Wiemken, Timothy L; Mattingly, William A; Ramirez, Julio A; Jodar, Luis

2018-05-21

Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P = .02) and overweight or obese (41.2% vs 58.6%, P = .01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%-91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%-73.3%). Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.

[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.

On the Development of a Hospital-Patient Web-Based Communication Tool: A Case Study From Norway.

PubMed

Granja, Conceição; Dyb, Kari; Bolle, Stein Roald; Hartvigsen, Gunnar

2015-01-01

Surgery cancellations are undesirable in hospital settings as they increase costs, reduce productivity and efficiency, and directly affect the patient. The problem of elective surgery cancellations in a North Norwegian University Hospital is addressed. Based on a three-step methodology conducted at the hospital, the preoperative planning process was modeled taking into consideration the narratives from different health professions. From the analysis of the generated process models, it is concluded that in order to develop a useful patient centered web-based communication tool, it is necessary to fully understand how hospitals plan and organize surgeries today. Moreover, process reengineering is required to generate a standard process that can serve as a tool for health ICT designers to define the requirements for a robust and useful system.

[Evidence based practice of nurses working in university hospitals in the French speaking part of Switzerland: a descriptive and correlational study

PubMed

Gentizon, Jenny; Borrero, Patricia; Vincent-Suter, Sonja; Ballabeni, Pierluigi; Morin, Diane; Eicher, Manuela

2016-12-01

Introduction : evidence-based practice (EBP) is too scarcely applied in nursing and is a key contemporary challenge for the discipline. Method and objective : This descriptive and correlational study invited 221 nurses working in three different clinical settings of university hospitals in Switzerland. The objective of this study was to describe their level of knowledge, beliefs and implementation of EBP. Results : of the 221 nurses in this study, only 67 were familiar EBP (30%). These demonstrate favorable beliefs and attitudes towards EBP, but indicate a lack of skills and knowledge to implement it. Compared to both internal medicine and geriatric nurses clinical nurse specialists (ISC) were significantly more familiar with EBP and its implementation. Results also indicate that positive nurses’ beliefs and attitudes toward EBP are predictive of better implementation in clinical practice. Discussion and Conclusion : as demonstrated in other studies, our results show that knowledge about EBP is not that widespread and its implementation remains a challenge even in university hospitals. Future work could include testing EBP implementation strategies to overcome the barriers identified.

[The carrier model of neurology in Hungary: a proposal for the solution until 2020].

PubMed

Bereczki, Dániel; Csiba, László; Komoly, Sámuel; Vécsei, László; Ajtay, András

2011-11-30

Based on our previous survey on the capacities of neurological services and on the predictable changes in the neurologist workforce in Hungary, we present a proposal for the organization of the structure of neurological services in the future. We discuss the diagnostic groups treated by neurologists, the neurological services and their progressive organization. Using the current capacities as baseline, we propose patient groups to be treated by neurologists in the future, and the levels of services. Based on the tendencies seen in the last years we suggest to consider to allocate acute stroke services exclusively to stroke units in neurological departments, and we identify a few other diagnostic groups where neurology should have a larger share in patient care. We define three levels for inpatient care: university departments, regional/county hospitals, city hospitals. Instead of minimum criteria we assign outpatient and inpatient standards that are functional from the economic point of view as well. University departments cover all areas of neurological services, have a function in graduate and postgraduate training, and on a regional basis they participate in professional quality assurance activities at the county and city hospital levels, and would have a more independent role in residency training. As far as patient care is concerned, the task of the regional/county hospitals would be similar to that of university departments - without the exclusively university functions. A general neurological service would be offered at the city hospital level - the representation of all subspecialties of neurology is not required. Neurorehabilitation would be organized at special units of neurological wards at the city hospital level, at independent neurorehabilitation wards in regional/county hospitals, and also as an outpatient service offered at the patients' home. The most significant organizational change would affect the outpatient neurological services. In addition to the special outpatient units associated with university departments and regional/county hospitals, the general neurological outpatient services would be organized as private practices, similarly to the current system of general practitioners, where the individual practices contract independently with the health insurance fund. Their task would be a general neurological service offered 30 hours per week, and also basic, screening neurophysiological and neurosonological examinations, with proper equipment and trained assistance. A transformation in residency training and a change in financing is needed for this plan to fulfill.

Blood glucose screening among elderly Malaysians: Who to target?

PubMed

Cheah, Yong Kang; Goh, Kim-Leng

2017-01-01

Early detection of raised blood glucose can reduce the risk of developing diabetes. Despite being a high-risk group, a significant proportion of the elderly population does not undergo blood glucose screening. The aim of the present study was to examine the factors affecting blood glucose screening among the elderly. Data from a sample of 2463 respondents in the National Health and Morbidity Survey 2011 were used. Pearson Chi-squared tests were conducted to find factors associated with screening behavior. A logit model was used to analyze the likelihood of screening. Income, age, education, ethnicity, employment status, availability of medical coverage, and smoking behavior were significantly associated with blood glucose screening. The likelihood of blood glucose screening was positively correlated with available monthly income and was higher in those aged 60-69 years, those attaining higher education, Malays, and elderly who are medically covered. The findings of the present study provide insights for health policy formulation for the elderly. As part of their efforts to reduce national health costs, governments should pay particular attention to the elderly, who are likely to be unscreened for blood glucose levels, because they face even larger risk exposure. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Alarming levels of carboxyhemoglobin in banked blood.

PubMed

Ehlers, Melissa; Labaze, Georges; Hanakova, Marcela; McCloskey, David; Wilner, George

2009-06-01

To determine the level of carboxyhemoglobin found in banked blood in the Albany, NY region. A retrospective descriptive analysis of carboxyhemoglobin (COHb) levels in a series of packed red blood cell (PRBC) units. The blood bank of a university tertiary care hospital in Albany, NY. All PRBC units considered for possible use in pediatric cardiac surgery were first analyzed for levels of COHb. Only those units with COHb levels of <1.5% were deemed acceptable for use during pediatric cardiac surgery. A sample of blood drawn from the sample side arm of each PRBC unit was analyzed on a Chiron 855 Blood Gas Analyzer (Chiron Inc, Emeryville, CA, now Siemens/Bayer RapidLab 865) to determine the level of COHb. The average COHb level was 0.78% (standard deviation +/- 1.48%), and out of the 468 units tested, 48 (10.3%) had COHb levels of 1.5% or greater. The highest recorded COHb level was 12%. The transfusion of PRBC units may artificially elevate readings of COHb and cause confusion over possible causes. Certain high-risk populations (eg, cyanotic neonates undergoing cardiopulmonary bypass) may be especially at risk. Although levels of COHb in the US blood supply are dropping, institutions may want to consider analyzing COHb levels in their PRBC units before transfusion in these high-risk populations.

Metabolic syndrome and associated factors among psychiatric patients in Jimma University Specialized Hospital, South West Ethiopia.

PubMed

Asaye, Sintayehu; Bekele, Shiferaw; Tolessa, Daniel; Cheneke, Waqtola

2018-04-24

Metabolic syndrome is a multisystem disorder which coined to describe the recognized clustering of metabolic and cardiovascular abnormalities including obesity, hypertension, dyslipidemia, and abnormalities of glucose homeostasis. To assess the prevalence and associated factors of metabolic syndrome among psychiatric patients in Jimma University Specialized Hospital. This study was conducted at Jimma University Specialized hospital psychiatric ward from May 15 to July 16, 2015. A cross-sectional study design and consecutive sampling technique were used. A single population proportion formula was used to include a total of 360 psychiatric patients. An interview administered structured questionnaire was used to collect socio-demographic and some clinical data. Anthropometric data were collected based on standard guild line for anthropometric measurement. Five milliliter of venous blood was collected from ante-cubital fossa after overnight fasting for 8 h. Semi-automated clinical chemistry analyzer (Temis Linear) was used for biochemical laboratory analysis. Data analysis was performed by using SPSS version-20 software. Binary and multiple logistic regressions were used to identify the association between dependent and independent variables. P value less than 0.05 was taken as statistically significant association. The prevalence of metabolic syndrome among psychiatric patients was 28.9%. Age greater than 30 years old (AOR: 5.2, CI: 2.3, 11.8, P. value < 0.05); being female (AOR: 7.1, CI: 3.3, 15.2, P. value < 0.05); regularly eating high protein and fat (AOR: 3.3, CI: 1.3, 8.2, P. value < 0.056) were independent determinant variables for high prevalence of metabolic syndrome among diabetic patients in the study area. The other independent variables such as family history of hypertension, chewing chat, Psychotropic drugs, duration of treatment, regularly eating fruits and vegetables had no statistically significant association with metabolic syndrome (P. value > 0.05). There was high prevalence of metabolic syndrome among the psychiatric patients. Therefore; close assessment, management and treatment of metabolic syndrome among patients with psychiatry problem is essential. Copyright © 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Data Science Priorities for a University Hospital-Based Institute of Infectious Diseases: A Viewpoint.

PubMed

Valleron, Alain-Jacques

2017-08-15

Automation of laboratory tests, bioinformatic analysis of biological sequences, and professional data management are used routinely in a modern university hospital-based infectious diseases institute. This dates back to at least the 1980s. However, the scientific methods of this 21st century are changing with the increased power and speed of computers, with the "big data" revolution having already happened in genomics and environment, and eventually arriving in medical informatics. The research will be increasingly "data driven," and the powerful machine learning methods whose efficiency is demonstrated in daily life will also revolutionize medical research. A university-based institute of infectious diseases must therefore not only gather excellent computer scientists and statisticians (as in the past, and as in any medical discipline), but also fully integrate the biologists and clinicians with these computer scientists, statisticians, and mathematical modelers having a broad culture in machine learning, knowledge representation, and knowledge discovery. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Autologous blood donation in a small general acute-care hospital.

PubMed Central

Mott, L. S.; Jones, M. J.

1995-01-01

Increased public concerns about infectious risk associated with homologous blood transfusions have led to a significant increase in autologous blood collections. In response, blood banks and large hospitals have implemented autologous blood donation programs (ABDPs). Small hospitals lack the technical resources and patient case loads to effectively institute ABDPs. A preoperative ABDP designed to increase availability and patient convenience--and, therefore, utilization--is described. The program created in a rural 90-bed general acute-care hospital processed 105 donors and collected 197 units over a 38-month period. The percentage of the collected units that were transfused was 44.7%, and only 6.1% of participating patients required homologous transfusions. Comparisons of hematological and clinical data with previously published results indicate that small-scale preoperative ABDPs are clinically effective, safe, and provide cost-efficient utilization of the safest blood supply available. PMID:7674344

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.

[Association between the use of blood components and the five-year mortality after liver transplant].

PubMed

de Morais, Bruno Salomé; Sanches, Marcelo Dias; Ribeiro, Daniel Dias; Lima, Agnaldo Soares; de Abreu Ferrari, Teresa Cristina; Duarte, Malvina Maria de Freitas; Cançado, Guilherme Henrique Gomes Moreira

2011-01-01

Liver transplant (LT) surgery is associated with significant bleeding in 20% of cases, and several authors have demonstrated the risks related to blood components. The objective of the present study was to evaluate the impact of using blood components during hospitalization in five-year survival of patients undergoing LT. One hundred and thirteen patients were evaluated retrospectively. Several variables, including the use of blood components intraoperatively and throughout hospitalization, were categorized and evaluated by univariate analysis using Fisher's test. A level of significance of 5% was adopted. Results with p < 0.2 underwent multivariate analysis using multinomial logistic regression. Parenchymal diseases, preoperative renal dysfunction, and longer stay in hospital and ICU are associated with greater five-year mortality after LT (p < 0.05). Unlike the intraoperative use of blood components, the accumulated transfusion of packed red blood cell, frozen fresh plasma, and platelets during the entire hospitalization was associated with greater five-year mortality after liver transplantation (p < 0.01). This study emphasizes the relationship between the use of blood components during hospitalization and increased mortality in five years after LT. 2011 Elsevier Editora Ltda. All rights reserved.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement.

PubMed

Abeeleh, Mahmoud Abu; Tareef, Tareq M; Hani, Amjad Bani; Albsoul, Nader; Samarah, Omar Q; ElMohtaseb, M S; Alshehabat, Musa; Ismail, Zuhair Bani; Alnoubani, Omar; Obeidat, Salameh S; Halawa, Sami Abu

2017-08-01

To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Implementation of Molecular Surveillance After a Cluster of Fatal Toxoplasmosis at 2 Neighboring Transplant Centers.

PubMed

Isa, Flonza; Saito, Kohta; Huang, Yao-Ting; Schuetz, Audrey; Babady, N Esther; Salvatore, Steven; Pessin, Melissa; van Besien, Koen; Perales, Miguel-Angel; Giralt, Sergio; Sepkowitz, Kent; Papanicolaou, Genovefa A; Soave, Rosemary; Kamboj, Mini

2016-08-15

After a cluster of fatal toxoplasmosis among stem cell transplant recipients at 2 hospitals, surveillance with polymerase chain reaction (PCR) (blood) was instituted. Rate of reactivation among seropositive recipients was 2.2 and 16%. Parasitemia was successfully managed with preemptive treatment. For seropositive recipients unable to take prophylaxis, toxoplasma PCR surveillance should be routinely performed. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

A comparison of patient characteristics and survival in two trauma centres located in different countries.

PubMed

Templeton, J; Oakley, P A; MacKenzie, G; Cook, A L; Brand, D; Mullins, R J; Trunkey, D D

2000-09-01

The aim of the study was to compare patient characteristics and mortality in severely injured patients in two trauma centres located in different countries, allowing for differences in case-mix. It represents a direct bench-marking exercise between the trauma centres at the North Staffordshire Hospital (NSH), Stoke-on-Trent, UK and the Oregon Health Sciences University (OHSU) Hospital, Portland, Oregon, USA. Patients of all ages admitted to the two hospitals during 1995 and 1996 with an Injury Severity Score >15 were included, except for those who died in the emergency departments. Twenty-three factors were studied, including the Injury Severity Score, Glasgow Coma Score, mechanism of injury and anatomical site of injury. Outcome analysis was based on mortality at discharge. The pattern of trauma differed significantly between Stoke and Portland. Patients from Stoke tended to be older, presented with a lower conscious level and a lower systolic blood pressure and were intubated less frequently before arriving at hospital. Mortality depended on similar factors in both centres, especially age, highest AIS score, systolic blood pressure and Glasgow Coma Score.The crude analysis of mortality showed a highly significant odds-ratio of 1.64 in Stoke compared with Portland. Single-factor adjustments were made for the above four factors, which had a similar influence on mortality in both centres. Adjusting for the first three factors individually did not alter the odds-ratio, which stayed in the range 1.53-1.59 and remained highly significant. Adjusting for the Glasgow Coma Score reduced the odds-ratio to 0.82 and rendered it non-significant. In a multi-factor logistic regression model incorporating all of the factors shown to influence mortality in either centre, the odds-ratio was 1.7 but was not significant. The analysis illustrates the limitations and pitfalls of making crude outcome comparisons between centres. Highly significant differences in crude mortality were rendered non-significant by case-mix adjustments, supporting the null hypothesis that the two centres were equally effective in terms of this short-term indicator of outcome. To achieve a meaningful comparison between centres, adjustments must be made for the factors which affect mortality.

The National Blood Service. Supporting better blood transfusion.

PubMed

Gerrard, Rebecca

2004-05-01

The National Blood Service (NBS) is an integral part of the National Health Service that provides blood, blood components, blood products and tissues from fifteen blood centres to England and North Wales. Each year, the NBS collects tests, processes, stores and issues approximately 2.3 million blood donations. The service also undertakes research into blood safety, provides clinical advice to hospital staff and supports hospital transfusion practitioners. Rebecca Gerrard describes some of the initiatives to improve blood transfusion practices, including monitoring of the serious hazards of transfusion, bench marking schemes and the roles of blood transfusion liaison (BTL) nurses.

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.

[Hospital mortality associated with upper gastrointestinal hemorrhage due to ruptured esophageal varices at the Lomé Campus Hospital in Togo].

PubMed

Bouglouga, O; Bagny, A; Lawson-Ananissoh, L; Djibril, M

2014-01-01

To study hospital mortality associated with upper gastrointestinal hemorrhages due to variceal bleeding in the department of hepatology and gastroenterology at the Lome Campus University Hospital. This retrospective cross-sectional and analytic study examined the 55 patients admitted for variceal bleeding on upper endoscopies during the 3-year period from January 1, 2008, through December 31, 2010. These patients accounted for 4.1% of all hospitalizations during the study period in the department. Their average age was 35 years, and their sex-ratio 4. A history of chronic liver disease was found in 65.5%. Liver cirrhosis was the principal cause of the esophageal varices, complicated by hepatocellular carcinoma in 30.9% of them. The mortality rate was 25.5% and was not related to the cause of portal hypertension. All the patients with a recurrence of bleeding died. Mortality was associated with jaundice. Blood transfusion did not significantly improve the prognosis. the mortality rate among patients with upper gastrointestinal hemorrhage linked to variceal bleeding is high in our unit. The prevention of hepatitis virus B is important because it is the main cause of chronic liver disease causing portal hypertension in our department.

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

Umbilical vein injection of misoprostol versus normal saline for the treatment of retained placenta: intrapartum placebo-controlled trial.

PubMed

Rajab, Sheelan S; Alalaf, Shahla K

2014-01-21

The third stage of labour may be complicated by retained placenta, which should be managed promptly because it may cause severe bleeding and infection, with a potentially fatal outcome. This study evaluated the effectiveness of umbilical vein injection of misoprostol for the treatment of retained placenta in a hospital setting. This hospital-based placebo-controlled trial was conducted at the Maternity Teaching Hospital, Erbil City, Kurdistan region, Northern Iraq from April 2011 to February 2012. The inclusion criteria were: gestational age of at least 28 weeks, vaginal delivery, and failure of the placenta to separate within 30 minutes after delivery of the infant despite active management of the third stage of labour. Forty-six women with retained placentas were eligible for inclusion. After informed consent was obtained, the women were alternately allocated to receive umbilical vein injection of either 800 mcg misoprostol dissolved in 20 mL of normal saline (misoprostol group) or 20 mL of normal saline only (saline group). The women were blinded to the group allocation, but the investigator who administered the injection was not. The trial was registered by the Research Ethics Committee of Hawler Medical University. After umbilical vein injection, delivery of the placenta occurred in 91.3% of women in the misoprostol group and 69.5% of women in the saline group, which was not a significant difference between the two groups. The median vaginal blood loss from the time of injection until delivery of the placenta was significantly less in the misoprostol group (100 mL) than in the saline group (210 mL) (p value < 0.001). Umbilical vein injection of misoprostol is an effective treatment for retained placenta, and reduces the volume of vaginal blood loss with few adverse effects. Current Controlled Trial HMU: N252.1.2011.

Umbilical vein injection of misoprostol versus normal saline for the treatment of retained placenta: intrapartum placebo-controlled trial

PubMed Central

2014-01-01

Background The third stage of labour may be complicated by retained placenta, which should be managed promptly because it may cause severe bleeding and infection, with a potentially fatal outcome. This study evaluated the effectiveness of umbilical vein injection of misoprostol for the treatment of retained placenta in a hospital setting. Methods This hospital-based placebo-controlled trial was conducted at the Maternity Teaching Hospital, Erbil City, Kurdistan region, Northern Iraq from April 2011 to February 2012. The inclusion criteria were: gestational age of at least 28 weeks, vaginal delivery, and failure of the placenta to separate within 30 minutes after delivery of the infant despite active management of the third stage of labour. Forty-six women with retained placentas were eligible for inclusion. After informed consent was obtained, the women were alternately allocated to receive umbilical vein injection of either 800 mcg misoprostol dissolved in 20 mL of normal saline (misoprostol group) or 20 mL of normal saline only (saline group). The women were blinded to the group allocation, but the investigator who administered the injection was not. The trial was registered by the Research Ethics Committee of Hawler Medical University. Results After umbilical vein injection, delivery of the placenta occurred in 91.3% of women in the misoprostol group and 69.5% of women in the saline group, which was not a significant difference between the two groups. The median vaginal blood loss from the time of injection until delivery of the placenta was significantly less in the misoprostol group (100 mL) than in the saline group (210 mL) (p value < 0.001). Conclusion Umbilical vein injection of misoprostol is an effective treatment for retained placenta, and reduces the volume of vaginal blood loss with few adverse effects. Clinical Trial Registration Current Controlled Trial HMU: N252.1.2011 PMID:24444360

[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.

[PROGNOSTIC SIGNIFICANCE OF CHANGES OF BLOOD GLUCOSE LEVEL IN PATIENTS WITH THORACOABDOMINAL INJURIES.

PubMed

Sorokin, E P; Ponomarev, S V; Shilyaeva, Ye V; Bel'skih, Ye A; Gritsan, A I

2016-07-01

Background Currently, one of the causes of high morbidity and mortality is injuries. Predict the outcome of injuries - it is an important task of the treating physician. Trauma is a stress factor so to predict the outcome, you can use markers of stress, the most accessible ofwhich is blood glucose. to reveal the dynamics of the relationship between blood glucose levels and the outlook for the life ofpatients with thoracoabdominal injuries. A retrospective analysis of medical records of hospitalized patients were divided into two groups, depending on the outlook for the life of (favorable or unfavorable), and each of the groups - into two subgroups according to the presence or absence of signs of intoxication at admission. The subgroups were calculated and compared the mean blood glucose levels at different hours of hospital treatment. It was found that the average blood glucose levels at various hours of hospital stay were significantly higher in patients with poor outcome. The most noticeable was the difference in the first days of hospital treatment. Signs of intoxication was associated with lower values of glucose and a tendency to hypoglycaemia. In addition, among patients with high blood glucose ( 8 mg / dL) was observed over deaths in the first day of hospital stay. High blood glucose levels ( 8,0 mmol / L) in the first day of hospital treatment is a predictor ofpoor outcome in patients with thoracoabdominal injuries.

Healthcare infrastructure capacity to respond to severe acute respiratory infection (SARI) and sepsis in Vietnam: A low-middle income country.

PubMed

Dat, Vu Quoc; Long, Nguyen Thanh; Giang, Kim Bao; Diep, Pham Bich; Giang, Ta Hoang; Diaz, Janet V

2017-12-01

This study investigated the availability of relevant structural and human resources needed for the clinical management of patients with severe acute respiratory infections and sepsis in critical care units in Vietnam. A questionnaire survey was conducted by purposive sampling of 128 hospitals (36% of total hospitals in surveyed provinces), including 25 provincial and 103 district level hospitals, from 20 provinces in Vietnam. Data on availability of hospital characteristics, structural resources and health care workers was then analyzed. Most hospitals (>80%) reported having 60% of the relevant structural resources. Significant differences were observed between provincial hospitals when compared to district hospitals in regards to availability of central oxygen piping system (78.3% vs 38.7%, p=0.001) mechanical ventilation (100.0% vs 73.6%, p=0.003), mobile x-rays (80.0% vs 29.8%, p<0.001), carbapenem antibiotic (73.9% vs 17.4%, p<0.001) and norepinephrine (95.8% vs 56.3%, p<0.001). There was a limited availability of arterial blood gas analyzers (13.7%), oseltamivir (42.2%) and N95 respirators (54.6%) across all hospitals surveyed. The limited availability of relevant structural and human resources in critical care units around Vietnam makes the implementation of quality critical care to patients with SARI and sepsis, according international guidelines, not universally possible. Copyright © 2017 Elsevier Inc. All rights reserved.

An Instantaneous Low-Cost Point-of-Care Anemia Detection Device

PubMed Central

Punter-Villagrasa, Jaime; Cid, Joan; Páez-Avilés, Cristina; Rodríguez-Villarreal, Ivón; Juanola-Feliu, Esteve; Colomer-Farrarons, Jordi; Miribel-Català, Pere Ll.

2015-01-01

We present a small, compact and portable device for point-of-care instantaneous early detection of anemia. The method used is based on direct hematocrit measurement from whole blood samples by means of impedance analysis. This device consists of a custom electronic instrumentation and a plug-and-play disposable sensor. The designed electronics rely on straightforward standards for low power consumption, resulting in a robust and low consumption device making it completely mobile with a long battery life. Another approach could be powering the system based on other solutions like indoor solar cells, or applying energy-harvesting solutions in order to remove the batteries. The sensing system is based on a disposable low-cost label-free three gold electrode commercial sensor for 50 μL blood samples. The device capability for anemia detection has been validated through 24 blood samples, obtained from four hospitalized patients at Hospital Clínic. As a result, the response, effectiveness and robustness of the portable point-of-care device to detect anemia has been proved with an accuracy error of 2.83% and a mean coefficient of variation of 2.57% without any particular case above 5%. PMID:25690552

Placenta previa. A 13 years experience at a tertiary care center in Western Saudi Arabia.

PubMed

Abduljabbar, Hassan S; Bahkali, Nedaa M; Al-Basri, Samera F; Al Hachim, Estabrq; Shoudary, Ibrahim H; Dause, Wesam R; Mira, Mohammed Y; Khojah, Mohammed

2016-07-01

To review cases of placenta previa in the last 13 years in a tertiary teaching hospital to identify risk factors for maternal morbidity.  A retrospective analysis of all cases of placenta previa managed at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia from January 2001 to December 2013.    The total number of deliveries was 55,862 deliveries, and 11,412 (20.3%) delivered by cesarean section (C/S). The charts of 230 cases diagnosed with placenta previa was reviewed, and different variables were collected and analyzed. Diagnoses were achieved in 94% of them using ultrasound. The prevalence rate of placenta previa was 4.1 per 1000 births. Cesarean section was carried out as an emergency procedure in 130 (56.5%) women and as elective in 100 (43.5%) women. Of them, 26 patients were admitted to the intensive care unit (ICU) (11.3%), all of which received blood transfusion >6 units and 22 patients had a hysterectomy for uncontrollable bleeding.   Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of less than 36 weeks, and estimated blood loss more than 2000 ml.

Metabolic acidosis as a risk factor for the development of acute kidney injury and hospital mortality.

PubMed

Hu, Jiachang; Wang, Yimei; Geng, Xuemei; Chen, Rongyi; Xu, Xialian; Zhang, Xiaoyan; Lin, Jing; Teng, Jie; Ding, Xiaoqiang

2017-05-01

Metabolic acidosis has been proved to be a risk factor for the progression of chronic kidney disease, but its relation to acute kidney injury (AKI) has not been investigated. In general, a diagnosis of metabolic acidosis is based on arterial blood gas (ABG) analysis, but the diagnostic role of carbon dioxide combining power (CO 2 CP) in the venous blood may also be valuable to non-respiratory patients. This retrospective study included all adult non-respiratory patients admitted consecutively to our hospital between October 01, 2014 and September 30, 2015. A total of 71,089 non-respiratory patients were included, and only 4,873 patients were evaluated by ABG analysis at admission. In patients with ABG, acidosis, metabolic acidosis, decreased HCO 3 - and hypocapnia at admission was associated with the development of AKI, while acidosis and hypocapnia were independent predictors of hospital mortality. Among non-respiratory patients, decreased CO 2 CP at admission was an independent risk factor for AKI and hospital mortality. ROC curves indicated that CO 2 CP was a reasonable biomarker to exclude metabolic acidosis, dual and triple acid-base disturbances. The effect sizes of decreased CO 2 CP on AKI and hospital mortality varied according to age and different underlying diseases. Metabolic acidosis is an independent risk factor for the development of AKI and hospital mortality. In non-respiratory patient, decreased CO 2 CP is also an independent contributor to AKI and mortality and can be used as an indicator of metabolic acidosis.

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

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.

Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial.

PubMed

Smith, Stephen R; Murray, David; Pockney, Peter G; Bendinelli, Cino; Draganic, Brian D; Carroll, Rosemary

2018-01-01

Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking. The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage. This was a prospective, double-blind, placebo-controlled, randomized clinical trial. The study was conducted at a tertiary referral university hospital in Australia. Consecutive patients aged >18 years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265). A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo. The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates. There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo; p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo; p = 0.661), mean transfusion volume (1.27 vs 1.93 units; p = 0.355), intervention rates (7/49 vs 13/47; p = 0.134), length of hospital stay (4.67 vs 4.74 d; p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use. A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes. Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at http://links.lww.com/DCR/A453.

Hazardous medical waste generation rates of different categories of health-care facilities

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

Komilis, Dimitrios, E-mail: dkomilis@env.duth.gr; Fouki, Anastassia; Papadopoulos, Dimitrios

Highlights: Black-Right-Pointing-Pointer We calculated hazardous medical waste generation rates (HMWGR) from 132 hospitals. Black-Right-Pointing-Pointer Based on a 22-month study period, HMWGR were highly skewed to the right. Black-Right-Pointing-Pointer The HMWGR varied from 0.00124 to 0.718 kg bed{sup -1} d{sup -1}. Black-Right-Pointing-Pointer A positive correlation existed between the HMWGR and the number of hospital beds. Black-Right-Pointing-Pointer We used non-parametric statistics to compare rates among hospital categories. - Abstract: Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed{sup -1} d{sup -1}, using data from 132 health-care facilities in Greece. The calculations were basedmore » 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{sup -1} d{sup -1}, for the public psychiatric hospitals, to up to 0.72 kg bed{sup -1} d{sup -1}, for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed{sup -1} d{sup -1}, for the psychiatric clinics, to up to 0.49 kg bed{sup -1} d{sup -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.« less

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.

Distribution of ABO and Rh Blood Groups in Patients With Keratoconus: A Case-Control Study.

PubMed

Naderan, Mohammad; Rajabi, Mohammad Taher; Shoar, Saeed; Kamaleddin, Mohammad Amin; Naderan, Morteza; Rezagholizadeh, Farzaneh; Zolfaghari, Masoome; Pahlevani, Rozhin

2015-07-01

Association of keratoconus (KC) with genetic predisposition and environmental factors has been well documented. However, no single study has investigated the possible relationship between ABO and Rh blood groups and KC. A case-control study was designed in a university hospital enrolling 214 patients with KC in the case group and equal number of age- and sex-matched healthy subjects in the control group. Primary characteristics, ABO blood group, and Rh factors were compared between the two groups. Topographic findings of KC eyes and the severity of the diseases were investigated according to the distribution of the blood groups. Blood group O and Rh(+) phenotype were most frequent in both groups. There was no significant difference between the two groups in terms of ABO blood groups or Rh factors. Mean keratometery (K), central corneal thickness, thinnest corneal thickness, flat K, steep K, sphere and cylinder, spherical equivalent, and uncorrected visual acuity were all similar between ABO blood groups and Rh(+) and Rh(-) groups. However, the best spectacle-corrected visual acuity (BCVA) had the highest value in AB blood group (0.35 ± 0.22 logMAR, P=0.005). Moreover, the blood group AB revealed the highest frequency for grade 3 KC, followed by grades 1, 2, and 4 (P=0.003). We observed no significant excess of any particular blood group among KC cases compared with healthy subjects. Except BCVA, none of the keratometric or topographic findings was significantly different between blood groups.

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.

[A survey on injuries among nurses and nursing students: a descriptive epidemiologic analysis between 2002 and 2012 at a University Hospital].

PubMed

Stefanati, Armando; Boschetto, Piera; Previato, Sara; Kuhdari, Parvanè; De Paris, Paola; Nardini, Marco; Gabutti, Giovanni

2015-05-04

Biological risk is the main occupational hazard in hospitals (40-50% of the total). More than 130,000 injuries occur every year in Italy and nurses are the most affected occupational category. This study evaluated the incidence of injuries related to biological risk in nurses and nursing students in the University Hospital of Ferrara, how they occur, the knowledge on the topic and on behaviour during the department's activity. A retrospective study involving a sample of 8 departments (selected for the occurrence of more than 30 biological injuries between 1st January 2002 and 31 December 2012) recorded injuries related to biological risk; subsequently a cross-sectional survey was carried out through a questionnaire administered to nurses and nursing students. 909 biological accidents were reported (81.18% in nurses and 18.82% in students). Blood was the main biological material involved (83.72% of cases), mostly by percutaneous exposure (84.16%). According to the questionnaire, 53% of subjects reported having had at least one injury during their career, and 5.72% did not report it; 46% reported doing risky procedures (re-capping needles) and 95.45% that they had been informed about the correct use of PPE. The lower percentage of injuries in students could be linked to good university training and to less risky procedures being performed. Re-capping needles remains one of the most dangerous manoeuvers practised. Ongoing training on the correct use of PPE is essential to train prepared and aware health professionals.

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

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…

Routine clinical heart examinations using SQUID magnetocardiography at University of Tsukuba Hospital

NASA Astrophysics Data System (ADS)

Inaba, T.; Nakazawa, Y.; Yoshida, K.; Kato, Y.; Hattori, A.; Kimura, T.; Hoshi, T.; Ishizu, T.; Seo, Y.; Sato, A.; Sekiguchi, Y.; Nogami, A.; Watanabe, S.; Horigome, H.; Kawakami, Y.; Aonuma, K.

2017-11-01

A 64-channel Nb-based DC-SQUID magnetocardiography (MCG) system was installed at the University of Tsukuba Hospital (UTH) in March 2007 after obtaining Japanese pharmaceutical approval and insurance reimbursement approval. In the period between 2008 and 2016, the total number of patients was 10 085. The heart diseases diagnosed in fetuses as well as adults are mainly atrial arrhythmia, abnormal repolarization, ventricular arrhythmia, and fetal arrhythmia. In most cases of insufficient diagnostic accuracy with electrocardiography, SQUID MCG precisely revealed these heart diseases as an abnormal electrical current distribution. Based on success in routine examinations, SQUID MCG is now an indispensable clinical instrument with diagnostic software tuned up during routine use at UTH.

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

Decongestion: Diuretics and other therapies for hospitalized heart failure

PubMed Central

Vazir, Ali; Cowie, Martin R.

2016-01-01

Acute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Often the syndrome is characterized by congestion, and is associated with long hospital admissions and high risk of readmission and further healthcare expenditure. Despite a limited evidence-base, diuretics remain the first-line treatment for congestion. Loop diuretics are typically the first-line diuretic strategy with some evidence that initial treatment with continuous infusion or boluses of high-dose loop diuretic is superior to an initial lower dose strategy. In patients who have impaired responsiveness to diuretics, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. The use of intravenous low-dose dopamine is no longer supported in heart failure patients with preserved systolic blood pressure and its use to assist diuresis in patients with low systolic blood pressures requires further study. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence-base is not robust, and its place in clinical practice is yet to be established. Several novel pharmacological agents remain under investigation. PMID:27056656

[The influence of intellectual capital in performance evaluation: a case-study in the hospital sector].

PubMed

Bonacim, Carlos Alberto Grespan; Araújo, Adriana Maria Procópio de

2010-06-01

This paper contributes to public institutions with the adaptation of a performance evaluation tool based on private companies. The objective is to demonstrate how the impact of an educational activity might be measured in the economic value added for the society of a public university hospital. The paper was divided in four parts, despite the introductory and methodological aspects and the final remarks. First, the hospital sector is explained, specifically in the context of the public university hospitals. Then, the definitions, the nature and measure of the intellectual capital are presented, followed by the disclosure of the main economic performance evaluation models. Finally, an adapted model is presented, under the approach of the value based management, considering adjustments of the return and the respective investment measures, showing the impacts of the intellectual capital management and the education activity on the economic result of those institutions. The study was developed based on a methodology supported by a bibliographical research, using a comparative method procedure in the descriptive modality. At last, it is highlighted the importance of accountability for the society regarding the use of public resources and how this study can help in this way.

Mortality in Severe Human Immunodeficiency Virus-Tuberculosis Associates With Innate Immune Activation and Dysfunction of Monocytes.

PubMed

Janssen, Saskia; Schutz, Charlotte; Ward, Amy; Nemes, Elisa; Wilkinson, Katalin A; Scriven, James; Huson, Mischa A; Aben, Nanne; Maartens, Gary; Burton, Rosie; Wilkinson, Robert J; Grobusch, Martin P; Van der Poll, Tom; Meintjes, Graeme

2017-07-01

Case fatality rates among hospitalized patients diagnosed with human immunodeficiency virus (HIV)-associated tuberculosis remain high, and tuberculosis mycobacteremia is common. Our aim was to define the nature of innate immune responses associated with 12-week mortality in this population. This prospective cohort study was conducted at Khayelitsha Hospital, Cape Town, South Africa. Hospitalized HIV-infected tuberculosis patients with CD4 counts <350 cells/µL were included; tuberculosis blood cultures were performed in all. Ambulatory HIV-infected patients without active tuberculosis were recruited as controls. Whole blood was stimulated with Escherichia coli derived lipopolysaccharide, heat-killed Streptococcus pneumoniae, and Mycobacterium tuberculosis. Biomarkers of inflammation and sepsis, intracellular (flow cytometry) and secreted cytokines (Luminex), were assessed for associations with 12-week mortality using Cox proportional hazard models. Second, we investigated associations of these immune markers with tuberculosis mycobacteremia. Sixty patients were included (median CD4 count 53 cells/µL (interquartile range [IQR], 22-132); 16 (27%) died after a median of 12 (IQR, 0-24) days. Thirty-one (52%) grew M. tuberculosis on blood culture. Mortality was associated with higher concentrations of procalcitonin, activation of the innate immune system (% CD16+CD14+ monocytes, interleukin-6, tumour necrosis factor-ɑ and colony-stimulating factor 3), and antiinflammatory markers (increased interleukin-1 receptor antagonist and lower monocyte and neutrophil responses to bacterial stimuli). Tuberculosis mycobacteremia was not associated with mortality, nor with biomarkers of sepsis. Twelve-week mortality was associated with greater pro- and antiinflammatory alterations of the innate immune system, similar to those reported in severe bacterial sepsis. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Comparison of ultrasonic shears and traditional suture ligature for vaginal hysterectomy: randomized controlled trial.

PubMed

Fitz-Gerald, Alison Louise; Tan, Jason; Chan, Kok-Weng; Polyakov, Alex; Edwards, Geoff N; Najjar, Haider; Tsaltas, Jim; Vollenhoven, Beverley

2013-01-01

To compare operating time, intraoperative blood loss, postoperative analgesia, and length of hospital stay using ultrasonic shears vs traditional suture ligature in vaginal hysterectomy. Randomized controlled trial (Canadian Task Force classification I). Gynecology units within a single health network, university hospital. Forty women requiring vaginal hysterectomy because of benign disease. Vaginal hysterectomy performed using either ultrasonically activated shears (USS) or traditional suture ligatures. Twenty-one patients were randomized to the USS arm, and 19 patients to the traditional suture ligature arm. Patient characteristics were comparable. Mean (SD) hysterectomy time and was similar in both the USS and traditional arms, 28.66 (4.0) minutes vs 32.37 (3.18) minutes (p = .47), as was total operating time, 97.38 (8.9) minutes vs 91.63 (7.69) minutes (p = .63). Operative blood loss was significantly decreased in the USS group: 62.63 (12.46) mL vs 136.05 (21.54) mL (p = .006). There was, however, no significant change in hemoglobin concentration between the 2 groups: 19.53 (1.79) g/L vs -16.72 (2.5) g/L. There was no significant difference in mean oxycodone use: 9.29 (2.66) mg vs 8.06 (3.19) mg (p = .77). Length of hospital stay was similar in both groups: 58.98 (3.27) hours vs 60.05 (6.48) hours (p = .88). There was no significant difference in overall complication rates between the groups. Although the Harmonic scalpel system, compared with the traditional suture ligation method, seems to be a safe alternative for securing the pedicles in vaginal hysterectomy, it offers no benefit insofar as operative time, reduction in clinically significant blood loss, and analgesic requirements. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Risk Factors and Outcomes in Transfusion-associated Circulatory Overload

PubMed Central

Murphy, Edward L.; Kwaan, Nicholas; Looney, Mark R.; Gajic, Ognjen; Hubmayr, Rolf D.; Gropper, Michael A.; Koenigsberg, Monique; Wilson, Greg; Matthay, Michael; Bacchetti, Peter; Toy, Pearl

2013-01-01

BACKGROUND Transfusion-associated circulatory overload is characterized by new respiratory distress and hydrostatic pulmonary edema within 6 hours after blood transfusion, but its risk factors and outcomes are poorly characterized. METHODS Using a case control design, we enrolled 83 patients with severe transfusion-associated circulatory overload identified by active surveillance for hypoxemia and 163 transfused controls at the University of California, San Francisco (UCSF) and Mayo Clinic (Rochester, Minn) hospitals. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression, and survival and length of stay were analyzed using proportional hazard models. RESULTS Transfusion-associated circulatory overload was associated with chronic renal failure (OR 27.0; 95% CI, 5.2–143), a past history of heart failure (OR 6.6; 95% CI, 2.1–21), hemorrhagic shock (OR 113; 95% CI, 14.1–903), number of blood products transfused (OR 1.11 per unit; 95% CI, 1.01–1.22), and fluid balance per hour (OR 9.4 per liter; 95% CI, 3.1–28). Patients with transfusion-associated circulatory overload had significantly increased in-hospital mortality (hazard ratio 3.20; 95% CI, 1.23–8.10) after controlling for Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, and longer hospital and intensive care unit lengths of stay. CONCLUSIONS The risk of transfusion-associated circulatory overload increases with the number of blood products administered and a positive fluid balance, and in patients with pre-existing heart failure and chronic renal failure. These data, if replicated, could be used to construct predictive algorithms for transfusion-associated circulatory overload, and subsequent modifications of transfusion practice might prevent morbidity and mortality associated with this complication. PMID:23357450

Inter-arm blood pressure differences in pregnant women.

PubMed

Poon, L C Y; Kametas, N; Strobl, I; Pachoumi, C; Nicolaides, K H

2008-08-01

To determine the prevalence of blood pressure inter-arm difference (IAD) in early pregnancy and to investigate its possible association with maternal characteristics. A cross-sectional observational study. Routine antenatal visit in a university hospital. A total of 5435 pregnant women at 11-14 weeks of gestation. Blood pressure was taken from both arms simultaneously with a validated automated device. The presence of inter-arm blood pressure difference of 10 mmHg or more. The IAD in systolic and diastolic blood pressure was 10 mmHg or more in 8.3 and 2.3% of the women, respectively. Systolic IAD was found to be significantly related to systolic blood pressure and pulse pressure, and diastolic IAD was found to be significantly related to maternal age, diastolic blood pressure and pulse pressure. The systolic and diastolic IAD were higher in the hypertensive group compared with the normotensive group and absolute IAD increased with increasing blood pressure. About 31.0 and 23.9% of cases of hypertension would have been underreported if the left arm and the right arm were used, respectively, in measuring the blood pressure. There is a blood pressure IAD in a significant proportion of the pregnant population, and its prevalence increases with increasing blood pressure. By measuring blood pressure only on one arm, there is a one in three chance of underreporting hypertension. Therefore, it would be prudent that during the booking visit blood pressure should be taken in both arms and thus provide guidance for subsequent blood pressure measurements during the course of pregnancy.

Hypertension despite dehydration during severe pediatric diabetic ketoacidosis.

PubMed

Deeter, Kristina H; Roberts, Joan S; Bradford, Heidi; Richards, Todd; Shaw, Dennis; Marro, Kenneth; Chiu, Harvey; Pihoker, Catherine; Lynn, Anne; Vavilala, Monica S

2011-06-01

Diabetic ketoacidosis (DKA) may result in both dehydration and cerebral edema but these processes may have opposing effects on blood pressure. We examined the relationship between dehydration and blood pressure in pediatric DKA. A retrospective review was performed at Seattle Children's Hospital, Seattle, WA. Participants were hospitalized children less than 18 yr. Intervention(s) or main exposure was to patients with DKA (venous pH < 7.3, glucose > 300 mg/dL, HCO(3) < 15 mEq/L, and urinary ketosis). Dehydration was calculated as percent body weight lost at admission compared to discharge. Hypertension (systolic and/or diastolic blood pressure (DBP) percentile > 95%) was defined based on National Heart, Lung, and Blood Institute (NHLBI, 2004) nomograms and hypotension was defined as systolic blood pressure (SBP) <70 + 2 [age]. Thirty-three patients (median 10.9 yr; range 10 months to 17 yr) were included. Fifty-eight percent of patients (19/33) had hypertension on admission before treatment and 82% had hypertension during the first 6 h of admission. None had admission hypotension. Hypertension 48 h after treatment and weeks after discharge was common (28 and 19%, respectively). Based on weight gained by discharge, 27% of patients had mild, 61% had moderate, and 12% presented with severe dehydration. Despite dehydration, most children admitted with severe DKA had hypertension. © 2011 John Wiley & Sons A/S.

[Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes].

PubMed

Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés

2017-02-01

To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

Rating scale for the assessment of competence in ultrasound-guided peripheral vascular access - a Delphi Consensus Study.

PubMed

Primdahl, Stine C; Todsen, Tobias; Clemmesen, Louise; Knudsen, Lars; Weile, Jesper

2016-09-21

Peripheral vascular access is vital for treatment and diagnostics of hospitalized patients. Ultrasound-guided vascular access (UGVA) is superior to the landmark technique. To ensure competence-based education, an assessment tool of UGVA competence is needed. We aimed to develop a global rating scale (RS) for assessment of UGVA competence based on opinions on the content from ultrasound experts in a modified Delphi consensus study. We included experts from anesthesiology, emergency medicine and radiology across university hospitals in Denmark. Nine elements were drafted based on existing literature and recommendations from international societies. In a multi-round survey, the experts rated the elements on a five-point Likert scale according to importance, and suggested missing elements. The final Delphi round occurred when >80% of the experts rated all elements ≥4 on the Likert scale. Sixteen experts consented to participate in the study, one withdrew consent prior to the first Delphi round, and 14 completed all three Delphi rounds. In the first Delphi round the experts excluded one element from the scale and changed the content of two elements. In the second Delphi round, the experts excluded one element from the scale. In the third Delphi round, consensus was obtained on the eight elements: preparation of utensils, ergonomics, preparation of the ultrasound device, identification of blood vessels, anatomy, hygiene, coordination of the needle, and completion of the procedure. We developed an RS for assessment of UGVA competence based on opinions of ultrasound experts through a modified Delphi consensus study.

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population - a cross-sectional analysis of medical documentation.

PubMed

Budzyński, Jacek; Anaszewicz, Marzena

2017-01-01

Atrial fibrillation (AF) and nutrition status abnormalities are two of the most significant epidemics in current health care. The aim of this study was to determine the relationship between the prevalence and outcome of AF, and the parameters of nutritional status among consecutive, real-life patients hospitalised in a university hospital. Analysis of the medical documentation of 4930 consecutive patients aged ≥ 18 years hospitalised for more than one day with diagnoses of cardiovascular disorders. Patients admitted with a diagnosis of AF (n = 512) compared to their counterparts without AF less frequently had an NRS-2002 score ≥ 3, normal range of body mass index (BMI), higher blood haemoglobin, and lower low density lipoprotein cholesterol (LDL-C) concentration. In logistic regression analysis, the risk of a hospitalisation due to AF was negatively related to BMI, NRS-2002 score, and the value of the difference between ideal and actual body mass. Urgent admission and having an NRS-2002 score ≥ 3 remained the only significant variables determining the risk of in-hospital death. Blood concentration of LDL-C and urgent admission were the only significant variables determining risk of 30-day rehospitalisation in the studied population. Inpatients with AF had a lower prevalence of normal body mass. Patients with an AF diagnosis had different risk factors for in-hospital death and 30-day rehospitalisation than their counterparts with diagnosis of cardiovascular diseases but without AF; however, the parameters of nutritional status played an important role in both patient groups. The obesity and cholesterol paradoxes were also observed.

Improvement in antenatal testing for sexually transmissible infections and blood-borne viruses in Western Australian hospitals, 2007 to 2010.

PubMed

Kwan, Kellie S H; Giele, Carolien M; Combs, Barry; Mak, Donna B

2012-09-01

Antenatal testing for specified sexually transmissible infections (STIs) and blood-borne viruses (BBVs) is recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). In 2007, the Department of Health, Western Australia (DoHWA) issued an operational directive (OD) recommending universal testing for chlamydia and additional testing for women in the STI endemic regions of Western Australia (WA). To assess adherence to these guidelines, seven WA public hospitals were audited. Demographic details and testing information of the last 200 women who gave birth immediately before 30 June 2007 (baseline audit) and 30 June 2010 (follow-up audit) were obtained from each hospital's antenatal records. Data from 2718 women who delivered at ≥36 weeks' gestation were analysed (baselinen=1353; follow-upn=1365). Testing at the first antenatal visit in accordance with the guidelines improved over time (RANZCOG: 68-74%; χ(2)-test = 13.96, d.f.=1, P<0.001; DoHWA OD: 12-40%; χ(2)-test = 279.71, d.f.=1, P<0.001). Retesting at 28-36 weeks' gestation in the STI endemic regions improved for chlamydia (3-10%; χ(2)-test = 17.40, d.f.=1, P<0.001) and gonorrhoea (3-7%; χ(2)-test=6.62, d.f.=1, P<0.05), but not for syphilis or HIV. Chlamydia prevalence was 3% and 8% among nonAboriginal and Aboriginal women, respectively. The proportion of women delivering in WA public hospitals who had antenatal STI and BBV tests improved after publication and promotion of the OD.

Development of hospital data warehouse for cost analysis of DPC based on medical costs.

PubMed

Muranaga, F; Kumamoto, I; Uto, Y

2007-01-01

To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees. We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignant tumors and whose DPC category was reevaluated in 2004. The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital. These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

A comparison of capillary and venous blood haematocrits of pregnant women in Nigeria: the impact on diagnosis and prevalence of anaemia in pregnancy.

PubMed

Dim, Cyril Chukwudi; Ugwu, Emmanuel Onyebuchi; Anyaehie, Ugochukwu Bond; Obioha, Kingsley Chukwu

2014-01-01

Volume of red cells in capillary blood varies from that of venous blood. The magnitude of this variation as well as its impact on the diagnosis of anaemia in pregnancy needs to be studied. This study demonstrates the disparity between capillary and venous PCV in pregnancy. To determine whether capillary blood PCV (cPCV) differed from venous blood PCV (vPCV) of normal pregnant women in Enugu, Nigeria, and its effect on diagnosis and prevalence of anaemia. PCV was estimated using pairs of venous and capillary blood samples from 200 consecutive pregnant women at the Antenatal Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Participants' cPCV (median = 34.0%, IQR = 31.0-35.8) was significantly lower than their vPCV (median = 34.0%, IQR = 32.0-37.0) (Z = -6.85, P < 0.001). However, women's cPCV had strong positive correlation with their vPCV (r = 0.883, P < 0.001). The prevalence of anaemia among participants using capillary and venous blood was 33.5% (67/200) and 28.0% (56/200), respectively (O.R = 1.3 (CI 95%: 0.85, 1.98),  P = 0.233). Capillary blood PCV was lower than vPCV among pregnant women in Enugu, Nigeria. Nevertheless, the prevalence of anaemia derived from cPCV did not differ significantly from that of vPCV.

Prospective studies of infectious mononucleosis in university students

PubMed Central

Grimm, Jennifer M; Schmeling, David O; Dunmire, Samantha K; Knight, Jennifer A; Mullan, Beth D; Ed, Julie A; Brundage, Richard C; Hogquist, Kristin A; Balfour, Henry H

2016-01-01

We performed an intensive prospective study designed to obtain as much data as possible on the incubation and early illness periods of primary Epstein–Barr virus (EBV) infection. Undergraduate students who lacked EBV antibody and oral EBV DNA (EBV-naive) were seen every 2 weeks during their freshman year. Clinical and behavioral data, oral washes and venous blood were obtained. EBV antibodies were quantified by enzyme immunoassay and viral loads by PCR. During a median 8 months of observation, 14/85 subjects experienced primary EBV infections (24 cases/100 person-years). The only significant risk factor for acquisition of EBV infection was deep kissing (P=0.02). Eleven subjects had infectious mononucleosis with a median duration of 21 days. Two subjects were hospitalized. Infections were initially identified in 12 subjects by finding EBV DNA in oral cells before onset of symptoms and in 2 subjects by symptom reporting. EBV DNA and viral capsid antigen (VCA) IgM and gp350 IgG antibodies were present in the blood before onset of illness. To provide a more robust evaluation of primary EBV infection in undergraduate university students, we combined data on risk factors and antibody responses from this and an earlier study that used the exact same clinical and laboratory methods. The observation that the only significant risk factor for acquisition of EBV infection was deep kissing was confirmed. Most importantly, higher amounts of gp350 antibody correlated significantly with a lower severity of infectious mononucleosis (P<0.0001), which strengthens the rationale for a gp350-based prophylactic EBV vaccine. PMID:27588199

Prospective studies of infectious mononucleosis in university students.

PubMed

Grimm, Jennifer M; Schmeling, David O; Dunmire, Samantha K; Knight, Jennifer A; Mullan, Beth D; Ed, Julie A; Brundage, Richard C; Hogquist, Kristin A; Balfour, Henry H

2016-08-01

We performed an intensive prospective study designed to obtain as much data as possible on the incubation and early illness periods of primary Epstein-Barr virus (EBV) infection. Undergraduate students who lacked EBV antibody and oral EBV DNA (EBV-naive) were seen every 2 weeks during their freshman year. Clinical and behavioral data, oral washes and venous blood were obtained. EBV antibodies were quantified by enzyme immunoassay and viral loads by PCR. During a median 8 months of observation, 14/85 subjects experienced primary EBV infections (24 cases/100 person-years). The only significant risk factor for acquisition of EBV infection was deep kissing (P=0.02). Eleven subjects had infectious mononucleosis with a median duration of 21 days. Two subjects were hospitalized. Infections were initially identified in 12 subjects by finding EBV DNA in oral cells before onset of symptoms and in 2 subjects by symptom reporting. EBV DNA and viral capsid antigen (VCA) IgM and gp350 IgG antibodies were present in the blood before onset of illness. To provide a more robust evaluation of primary EBV infection in undergraduate university students, we combined data on risk factors and antibody responses from this and an earlier study that used the exact same clinical and laboratory methods. The observation that the only significant risk factor for acquisition of EBV infection was deep kissing was confirmed. Most importantly, higher amounts of gp350 antibody correlated significantly with a lower severity of infectious mononucleosis (P<0.0001), which strengthens the rationale for a gp350-based prophylactic EBV vaccine.

Legal and ethical issues in safe blood transfusion.

PubMed

Chandrashekar, Shivaram; Kantharaj, Ambuja

2014-09-01

Legal issues play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical issues pave the way for quality. Despite licensing of all blood banks, failure to revamp the Drugs and Cosmetic Act (D and C Act) is impeding quality. Newer techniques like chemiluminescence or nucleic acid testing (NAT) find no mention in the D and C Act. Specialised products like pooled platelet concentrates or modified whole blood, therapeutic procedures like erythropheresis, plasma exchange, stem cell collection and processing technologies like leukoreduction and irradiation are not a part of the D and C Act. A highly fragmented BTS comprising of over 2500 blood banks, coupled with a slow and tedious process of dual licensing (state and centre) is a hindrance to smooth functioning of blood banks. Small size of blood banks compromises blood safety. New blood banks are opened in India by hospitals to meet requirements of insurance providers or by medical colleges as this a Medical Council of India (MCI) requirement. Hospital based blood banks opt for replacement donation as they are barred by law from holding camps. Demand for fresh blood, lack of components, and lack of guidelines for safe transfusion leads to continued abuse of blood. Differential pricing of blood components is difficult to explain scientifically or ethically. Accreditation of blood banks along with establishment of regional testing centres could pave the way to blood safety. National Aids Control Organisation (NACO) and National Blood Transfusion Council (NBTC) deserve a more proactive role in the licensing process. The Food and Drug Administration (FDA) needs to clarify that procedures or tests meant for enhancement of blood safety are not illegal.

Legal and ethical issues in safe blood transfusion

PubMed Central

Chandrashekar, Shivaram; Kantharaj, Ambuja

2014-01-01

Legal issues play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical issues pave the way for quality. Despite licensing of all blood banks, failure to revamp the Drugs and Cosmetic Act (D and C Act) is impeding quality. Newer techniques like chemiluminescence or nucleic acid testing (NAT) find no mention in the D and C Act. Specialised products like pooled platelet concentrates or modified whole blood, therapeutic procedures like erythropheresis, plasma exchange, stem cell collection and processing technologies like leukoreduction and irradiation are not a part of the D and C Act. A highly fragmented BTS comprising of over 2500 blood banks, coupled with a slow and tedious process of dual licensing (state and centre) is a hindrance to smooth functioning of blood banks. Small size of blood banks compromises blood safety. New blood banks are opened in India by hospitals to meet requirements of insurance providers or by medical colleges as this a Medical Council of India (MCI) requirement. Hospital based blood banks opt for replacement donation as they are barred by law from holding camps. Demand for fresh blood, lack of components, and lack of guidelines for safe transfusion leads to continued abuse of blood. Differential pricing of blood components is difficult to explain scientifically or ethically. Accreditation of blood banks along with establishment of regional testing centres could pave the way to blood safety. National Aids Control Organisation (NACO) and National Blood Transfusion Council (NBTC) deserve a more proactive role in the licensing process. The Food and Drug Administration (FDA) needs to clarify that procedures or tests meant for enhancement of blood safety are not illegal. PMID:25535417

Immediate effects of blood donation on physical and cognitive performance-A randomized controlled double-blinded trial.

PubMed

Eliassen, Håkon S; Hervig, Tor; Backlund, Sebastian; Sivertsen, Joar; Iversen, Vegard Vereide; Kristoffersen, Morten; Wengaard, Eivind; Gramstad, Arne; Fosse, Theodor; Bjerkvig, Christopher K; Apelseth, Torunn; Doughty, Heidi; Strandenes, Geir

2018-06-01

The success of implementing damage control resuscitation principles pre-hospital has been at the expense of several logistic burdens including the requirements for resupply, and the question of donor safety during the development of whole blood programs. Previous studies have reported effects on physical performance after blood donation; however, none have investigated the effects of blood donation on cognitive performance. We describe a prospective double-blinded, randomized, controlled study comprised of a battery of tests: three cognitive tests, and VO2max testing on a cycle ergometer. Testing was performed 7 days before blinded donation (baseline day), immediately after donation (Day 0), and 7 days (Day 7) after donation. The inclusion criteria included being active blood donors at the Haukeland University Hospital blood bank, where eligibility requirements were met on the testing days, and providing informed consent. Participants were randomized to either the experimental (n = 26) or control group (n = 31). Control group participants underwent a 'mock donation" in which a phlebotomy needle was placed but blood was not withdrawn. In the experimental group, mean ± SEM VO2max declined 6% from 41.35 ± 1.7 mLO2/(min·kg) at baseline to 39.0 ± 1.6 mLO2/(min·kg) on Day 0 and increased to 40.51 ± 1.5 mLO2/(min·kg) on Day 7. Comparable values in the control group were 42.1 ± 1.8 mLO2/(min·kg) at baseline, 41.6 ± 1.8 mLO2/(min·kg)) on Day 1 (1% decline from baseline), and 41.8 ± 1.8 mLO2/(min·kg) on Day 7.Comparing scores of all three cognitive tests on Day 0 and Day 7 showed no significant differences (p > 0.05). Our main findings are that executive cognitive and physical performances were well maintained after whole blood donation in healthy blood donors. The findings inform postdonation guidance on when donors may be required to return to duty. Randomized, controlled, double-blinded prospective trial study, level 1.

[Investigation on current situation of malaria blood examinations in township-level hospitals of Nantong City].

PubMed

Gui-Sheng, Ding; Cai-Qun, Cao; Ping, Miao; Mei-Fang, Gu; Xiao-Bin, Cao

2016-11-18

To understand the quality of malaria blood examinations in township-level hospitals, so as to provide the evidence for continuing the malaria blood examinations in the stage of post-malaria elimination. A total of 64 township hospitals were investigated and 640 negative malaria blood slides were scored individually according to 10 indicators in "Malaria Elimination Technical Scheme" in 2013 and 2014. The single and multiple indicators were calculated, and the work of blood examinations and situation of technicians were investigated. The data of malaria blood examinations and patient discovery in township hospitals of Nantong City were collected and analyzed during the period of 2011-2014. For the single indicator, 29.5% of the thick blood films did not reach the standard, and 35.8% of thin blood films did not reach the standard. For the multiple indicators, blood slides with more than 4 indicators below the standard (poor quality) accounted for 32.5%. From malaria blood examinations and malaria situation, the number of slides was 194 635 during the period of 2011-2014, and there were no local vivax malaria casesin 4 consecutive years from 2011 to 2014, and local malaria has been effectively controlled in Nantong City. For health facilities where malaria patients initially presented, the township and village level accounted for 16.3%, and county and higher level accounted for 83.7%. The quality of malaria blood examinations in township level hospitals of Nantong City is not high and the microscopic examination has a relatively low efficiency in the discovery of malaria cases. A new model for malaria blood examinations needs to be further explored.

Information-seeking behavior of cardiovascular disease patients in Isfahan University of Medical Sciences hospitals

PubMed Central

Zamani, Maryam; Soleymani, Mohammad Reza; Afshar, Mina; Shahrzadi, Leila; Zadeh, Akbar Hasan

2014-01-01

Background: Patients, as one of the most prominent groups requiring health-based information, encounter numerous problems in order to obtain these pieces of information and apply them. The aim of this study was to determine the information-seeking behavior of cardiovascular patients who were hospitalized in Isfahan University of Medical Sciences hospitals. Materials and Methods: This is a survey research. The population consisted of all patients with cardiovascular disease who were hospitalized in the hospitals of Isfahan University of Medical Sciences during 2012. According to the statistics, the number of patients was 6000. The sample size was determined based on the formula of Cochran; 400 patients were randomly selected. Data were collected by researcher-made questionnaire. Two-level descriptive statistics and inferential statistics were used for analysis. Results: The data showed that the awareness of the probability to recover and finding appropriate medical care centers were the most significant informational needs. The practitioners, television, and radio were used more than the other informational resources. Lack of familiarity to medical terminologies and unaccountability of medical staff were the major obstacles faced by the patients to obtain information. The results also showed that there was no significant relationship between the patients’ gender and information-seeking behavior, whereas there was a significant relationship between the demographic features (age, education, place of residence) and information-seeking behavior. Conclusion: Giving information about health to the patients can help them to control their disease. Appropriate methods and ways should be used based on patients’ willingness. Despite the variety of information resources, patients expressed medical staff as the best source for getting health information. Information-seeking behavior of the patients was found to be influenced by different demographic and environmental factors. PMID:25250349

Readiness of district and regional hospitals in Burkina Faso to provide caesarean section and blood transfusion services: a cross-sectional study.

PubMed

Compaoré, Georges Dayitaba; Sombié, Issiaka; Ganaba, Rasmané; Hounton, Sennen; Meda, Nicolas; Brouwere, Vincent De; Borchert, Matthias

2014-05-02

Health centres and hospitals play a crucial role in reducing maternal mortality and morbidity by offering respectively Basic Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and Newborn Care (CEmONC). The readiness of hospitals to provide CEmONC depends on the availability of qualified human resources, infrastructure like surgical theatres, and supplies like drugs and blood for transfusion. We assessed the readiness of district and regional hospitals in Burkina Faso to provide two key CEmONC functions, namely caesarean section and blood transfusion. As countries conduct EmONC needs assessments it is critical to provide national and subnational data, e.g. on the distribution of EmONC facilities as well as on facilities lacking the selected signal functions, to support the planning process for upgrading facilities so that they are ready to provide CEmONC. In a cross-sectional study we assessed the availability of relevant health workers, obstetric guidelines, caesarean section and blood transfusion services and experience with quality assurance approaches across all forty-three (43) district and nine (9) regional hospitals. The indicator corresponding to one comprehensive emergency care unit for 500,000 inhabitants was not achieved in Burkina Faso. Physicians with surgical skills, surgical assistants and anaesthesiologist assistants are sufficiently available in only 51.2%, 88.3% and 72.0% of district hospitals, respectively. Two thirds of regional and 20.9% of district hospitals had blood banks. Most district hospitals as opposed to only one third of regional hospitals had experience in maternal death reviews. Our findings suggest that only 27.8% of hospitals in Burkina Faso at the time of the study could continuously offer caesarean sections and blood transfusion services. Four years later, progress has likely been made but many challenges remain to be overcome. Information provided in this study can serve as a baseline for monitoring progress in district and regional hospitals.

Distributed medical services within the ATM-based Berlin regional test bed

NASA Astrophysics Data System (ADS)

Thiel, Andreas; Bernarding, Johannes; Krauss, Manfred; Schulz, Sandra; Tolxdorff, Thomas

1996-05-01

The ATM-based Metropolitan Area Network (MAN) of Berlin connects two university hospitals (Benjamin Franklin University Hospital and Charite) with the computer resources of the Technical University of Berlin (TUB). Distributed new medical services have been implemented and will be evaluated within the highspeed MAN of Berlin. The network with its data transmission rates of up to 155 Mbit/s renders these medical services externally available to practicing physicians. Resource and application sharing is demonstrated by the use of two software systems. The first software system is an interactive 3D reconstruction tool (3D- Medbild), based on a client-server mechanism. This structure allows the use of high- performance computers at the TUB from the low-level workstations in the hospitals. A second software system, RAMSES, utilizes a tissue database of Magnetic Resonance Images. For the remote control of the software, the developed applications use standards such as DICOM 3.0 and features of the World Wide Web. Data security concepts are being tested and integrated for the needs of the sensitive medical data. The highspeed network is the necessary prerequisite for the clinical evaluation of data in a joint teleconference. The transmission of digitized real-time sequences such as video and ultrasound and the interactive manipulation of data are made possible by Multi Media tools.

An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

PubMed

McCormick, Carol; Pickard, Alison Jane

2013-06-01

Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Comparison of umbilical cord interlukin-8 in low birth weight infants with premature rupture of membranes and intact membranes.

PubMed

Najati, N; Rafeey, M; Melekian, Taghy

2009-08-01

Some studies showed increased levels ofproinflammatory cytokines like IL-6, IL-8 and TNF-alpha in the blood samples of pregnant women with PROM (Premature rupture of membranes) and their neonates. The aim of this study was to find a relationship between increased level of IL-8 and PROM, a cost benefit method for early diagnosis and reduction of hospitalization period of neonatal sepsis. This case control study was conducted in Obstetrics and Gynecology Department of Al-Zahra Hospital at Tabriz University of Medical Sciences, Iran from 10th April 2001 to 20th June 2003. We studied 50 LBW (Low birth weight) neonates born from mothers with PROM as the case group and fifty LBW neonates born from mothers without PROM as our control group Neonates born from pregnant women with PROM underwent sepsis workup and blood samples from their umbilical cord were sent for blood culture and IL-8 level measurement. Mean levels of IL-8 in study and control groups were 128.12 and 39.2 pg mL(-1), respectively. We had no positive blood culture and no bacteria could be isolated. Significantly elevated values (p<0.0003) were showed in cases with PROM compared to cases without PROM (medians 67.5 pg mL(-1) vs. 29.5 pg mL(-1), respectively). This study showed a strong relationship between IL-8 elevation and PROM. Increased levels of IL-8 can be used as indicator for early diagnosis of neonatal sepsis.

The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial.

PubMed

Voorn, Veronique M A; Marang-van de Mheen, Perla J; van der Hout, Anja; Hofstede, Stefanie N; So-Osman, Cynthia; van den Akker-van Marle, M Elske; Kaptein, Ad A; Stijnen, Theo; Koopman-van Gemert, Ankie W M M; Dahan, Albert; Vliet Vlieland, Thea P M M; Nelissen, Rob G H H; van Bodegom-Vos, Leti

2017-05-30

Perioperative autologous blood salvage and preoperative erythropoietin are not (cost) effective to reduce allogeneic transfusion in primary hip and knee arthroplasty, but are still used. This study aimed to evaluate the effectiveness of a theoretically informed multifaceted strategy to de-implement these low-value blood management techniques. Twenty-one Dutch hospitals participated in this pragmatic cluster-randomized trial. At baseline, data were gathered for 924 patients from 10 intervention and 1040 patients from 11 control hospitals undergoing hip or knee arthroplasty. The intervention included a multifaceted de-implementation strategy which consisted of interactive education, feedback on blood management performance, and a comparison with benchmark hospitals, aimed at orthopedic surgeons and anesthesiologists. After the intervention, data were gathered for 997 patients from the intervention and 1096 patients from the control hospitals. The randomization outcome was revealed after the baseline measurement. Primary outcomes were use of blood salvage and erythropoietin. Secondary outcomes included postoperative hemoglobin, length of stay, allogeneic transfusions, and use of local infiltration analgesia (LIA) and tranexamic acid (TXA). The use of blood salvage (OR 0.08, 95% CI 0.02 to 0.30) and erythropoietin (OR 0.30, 95% CI 0.09 to 0.97) reduced significantly over time, but did not differ between intervention and control hospitals (blood salvage OR 1.74 95% CI 0.27 to 11.39, erythropoietin OR 1.33, 95% CI 0.26 to 6.84). Postoperative hemoglobin levels were significantly higher (β 0.21, 95% CI 0.08 to 0.34) and length of stay shorter (β -0.36, 95% CI -0.64 to -0.09) in hospitals receiving the multifaceted strategy, compared with control hospitals and after adjustment for baseline. Transfusions did not differ between the intervention and control hospitals (OR 1.06, 95% CI 0.63 to 1.78). Both LIA (OR 0.0, 95% CI 0.0 to 0.0) and TXA (OR 0.3, 95% CI 0.2 to 0.5) were significantly associated with the reduction in blood salvage over time. Blood salvage and erythropoietin use reduced over time, but not differently between intervention and control hospitals. The reduction in blood salvage was associated with increased use of local infiltration analgesia and tranexamic acid, suggesting that de-implementation is assisted by the substitution of techniques. The reduction in blood salvage and erythropoietin did not lead to a deterioration in patient-related secondary outcomes. www.trialregister.nl, NTR4044.

Contingency plan implementation.

PubMed

Neurath, D; Cober, N; Owens, W; Giulivi, A

2012-06-01

Although the National blood system in Canada reduces the risk of inventory shortages the possibility of a blood supply shortage still exists. The Ontario Ministry of Health and Long-Term Care developed a provincial plan to manage blood transfusion needs and inventory in the event of a National blood shortage. The Ontario plan was developed to align with the National plan as well as other provincial plans in order to ensure consistency in blood management strategies across the country. The Ontario plan was released in 2008, along with a toolkit to aid hospitals in developing their facility specific plans. In the Champlain region of Ontario, a group of 16 hospitals worked collaboratively to develop a regional blood shortage plan. A provincial blood shortage simulation exercise was held in 2010 to test out these plans. The Director of Transfusion Medicine of the largest facility in the group of 16 hospitals (The Ottawa Hospital) took the lead in the development of the regional blood shortage management plan. Working groups from all 16 sites contributed to the plan development. The proposed plan was presented to the Medical Advisory Committee for approval. The plan consists of activities relating to the severity of the supply shortage as defined by Amber, Red, Recovery and Green phases. The plan includes a communication plan for notifying stakeholders including patients whose treatment may be affected. Inventory management and triage guidelines are provided to reduce the demand for blood and to conserve inventory for those patients whose need is prioritized as highest. The regional blood shortage management plan was tested successfully during the provincial simulation exercise. Where regional hospitals work together to provide healthcare, it is beneficial to develop a standardized plan to provide guidance to hospital personnel in response to a blood supply shortage. A consistent plan will ensure patient care is provided in a consistent manner across a health region. Mock or simulation exercises can aid in testing plans and raising the awareness of stakeholders. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Transport and treatment of patients with STEMI in rural Iceland--Only a few patients receive PPCI within 120 minutes].

PubMed

Sigmundsson, Thórir S; Arnarson, Daníel; Rafnsson, Arnar; Magnússon, Viðar; Gunnarsson, Gunnar Thór; Thorgeirsson, Gestur

2016-01-01

ST-segment Elevation Myocardial Infarction (STEMI) is a life-threatening disease and good outcome depends on early restoration of coronary blood flow. Primary percutaneous coronary intervention (PPCI) is the treatment of choice if performed within 120 minutes of first medical contact (FMC) but in case of anticipated long transport or delays, pre-hospital fibrinolysis is indicated. The aim was to study transport times and adherence to clinical guidelines in patients with STEMI transported from outside of the Reykjavik area to Landspitali University Hospital in Iceland. Retrospective chart review was conducted of all patients diagnosed with STEMI outside of the Reykjavik area and transported to Landspitali University Hospital in Reykjavik in 2011-2012. Descriptive statistical analysis and hypothesis testing was applied. Eighty-six patients had signs of STEMI on electrocardiogram (ECG) at FMC. In southern Iceland nine patients (21%) underwent PPCI within 120 minutes (median 157 minutes) and no patient received fibrinolysis. In northern Iceland and The Vestman Islands, where long transport times are expected, 96% of patients eligible for fibrinolysis (n=31) received appropriate therapy in a median time of 57 minutes. Significantly fewer patients received appropriate anticoagulation treatment with clopidogrel and enoxaparin in southern Iceland compared to the northern part. Mortality rate was 7% and median length of stay in hospital was 6 days. Time from FMC to PPCI is longer than 120 minutes in the majority of cases. Pre-hospital fibrinolysis should be considered as first line treatment in all parts of Iceland outside of the Reykjavik area. Directly electronically transmitted ECGs and contact with cardiologist could hasten diagnosis and decrease risk of unnecessary interhospital transfer. A STEMI database should be established in Iceland to facilitate quality control.

Blood conservation: the CEO perspective.

PubMed

Morgan, Timothy O

2004-08-01

Hospital CEOs are concerned about more than just cost of services to their patients. The advancement of patient car along with maintaining or improving patient safety are also key elements to the CEO, to limit patient risks, hospital liability, and negative public relations. The CEO is accountable to the hospital staff, the patients, and the general public. Establishing programs such as blood management or bloodless medicine can be implemented by using a team approach. A physician champion with a clear business plan that addresses all issues and challenges is critical for successful implementation. As blood and blood product costs rise and supply decreases, alternatives such as cell saving techniques and the use of pharmacologic interventions can have a significant impact on net hospital expenditures.

Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

PubMed

Chew, K S; Mohd Hashairi, F; Jusoh, A F; Aziz, A A; Nik Hisamuddin, N A R; Siti Asma, H

2013-08-01

Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice. All healthcare staffs in emergency department, HUSM who consented to this study were given a set of selfadministered anonymous questionnaire to fill. More than half (53.1%) of the 64 participants are emergency medicine residents. Majority of them (75%) have been working in the emergency medicine, HUSM for more than 2 years. More than half of them were able to answer correctly the amount of blood volume needed for culture in adult and pediatric patients. When asked what are the factors required to improve the true yield as well as to reduce the risk of culture contamination, the four commonest answers given were observing proper aseptic technique during blood sampling, donning sterile glove, proper hand scrubbing as well as ensuring the sterility of the equipments. This study suggests that there is a lack of proper knowledge of good blood culture sampling practice among our healthcare staffs in emergency department.

Mass casualty events: blood transfusion emergency preparedness across the continuum of care.

PubMed

Doughty, Heidi; Glasgow, Simon; Kristoffersen, Einar

2016-04-01

Transfusion support is a key enabler to the response to mass casualty events (MCEs). Transfusion demand and capability planning should be an integrated part of the medical planning process for emergency system preparedness. Historical reviews have recently supported demand planning for MCEs and mass gatherings; however, computer modeling offers greater insights for resource management. The challenge remains balancing demand and supply especially the demand for universal components such as group O red blood cells. The current prehospital and hospital capability has benefited from investment in the management of massive hemorrhage. The management of massive hemorrhage should address both hemorrhage control and hemostatic support. Labile blood components cannot be stockpiled and a large surge in demand is a challenge for transfusion providers. The use of blood components may need to be triaged and demand managed. Two contrasting models of transfusion planning for MCEs are described. Both illustrate an integrated approach to preparedness where blood transfusion services work closely with health care providers and the donor community. Preparedness includes appropriate stock management and resupply from other centers. However, the introduction of alternative transfusion products, transfusion triage, and the greater use of an emergency donor panel to provide whole blood may permit greater resilience. © 2016 AABB.

Why do-Saudi Women Refrain Donating Their Blood?--a Study on the Attitude, Belief and Motivation of Saudi Female University Students Towards Blood Donation.

PubMed

Al-Johar, Al-Waleed; Al-Saud, Abdulrahman; Abalkhail, Yazeed; Jawdat, Talal; Al-Khamees, Saleh; Al-Thunayan Faisal; Abdel-Gader, Abdel G

2016-01-01

Saudi females constitute less than 5% of blood donors and as demand for blood is ever increasing there is a need to identify the factors that discourage them from donating their blood and subsequently to find approaches to enhance their share as blood donors. The aim of this study is to find out the knowledge, attitude and motivation of Saudi female university students towards blood donation. This is a questionnaire-based cross-sectional descriptive study among female students (n = 300) from six colleges: Medicine, Dentistry, Applied Medical Sciences, Science, Arts, and Business Administration at King Saud University, Riyadh. Questions covered their knowledge on blood donation and factors that discourage or motivate them to donate. The majority of participants are unaware that females constitute less than 5% of donors, but know that blood banks are in continuous need for donors to give support for needy patients particularly road traffic accidents and surgical patients. Fear from complications of the donation process prevailed widely. Most participants would donate as a religious obligation, need of a relative or friend, but not for money. The most prominent hurdle preventing them from donating is the difficulty of reaching the blood bank as they cannot drive cars or move alone in public transport. Most will donate if blood collection is done at their colleges and other places of gather- ing such as shopping malls. The attitude of Saudi female students towards blood donation is positive and few misconceptions that emerged could be corrected by health awareness campaigns. Careful organization of blood collection efforts that would observe the special status of women in the society by reaching them in their colleges and other gathering sites could enhance female donor input markedly.

A network of web multimedia medical information servers for a medical school and university hospital.

PubMed

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

1997-08-01

Modern medicine requires a rapid access to information including clinical data from medical records, bibliographic databases, knowledge bases and nomenclature databases. This is especially true for University Hospitals and Medical Schools for training as well as for fundamental and clinical research for diagnosis and therapeutic purposes. This implies the development of local, national and international cooperation which can be enhanced via the use and access to computer networks such as Internet. The development of professional cooperative networks goes with the development of the telecommunication and computer networks and our project is to make these new tools and technologies accessible to the medical students both during the teaching time in Medical School and during the training periods at the University Hospital. We have developed a local area network which communicates between the School of Medicine and the Hospital which takes advantage of the new Web client-server technology both internally (Intranet) and externally by access to the National Research Network (RENATER in France) connected to the Internet network. The address of our public web server is http:(/)/www.med.univ-rennesl.fr.

Assessment of a self-deferral form for screening blood donors, Chiang Mai University Hospital, Thailand.

PubMed

Thaikruea, Lakkana; Nantachit, Niwes; Leetrakool, Nipapan; Fongsatitkul, Ladda; Sompan, Prakai; Heaton, Andrew; Nelson, Kenrad E

2008-09-01

A self-deferral form has been used to screen Chiang Mai University Hospital blood donors and was improved in 2005. It has never been evaluated. The study aimed to assess the self-deferral form procedures in detecting infected donors. Sera from 5,083 donors, who passed the self-deferral screening form, were tested with the routine immuno-assays (serology) for HIV 1 and 2 antibodies, P24 antigen, HCV antibodies, HBV surface antigen, and syphilis. Antibody negative sera were also tested individually with the the Procleix Ultrio Assay for HIV-1 DNA, HCV RNA, and HBV DNA. The donors who had discrepant results between serology and NAT were evaluated with additional tests, including a more sensitive Alternative Nucleic Acid Test, AntiBcore IgM, AntiBcore IgG, HBsAg and Anti HBs. Among 5,083 donors, 331 (6.5%) had at least one positive marker. In multiple logistic regression analysis, the statistically significant factors (adjusted odds ratio and 95% CI) for infection were age 30 years or below [1.45 (1.03, 2.03)], male gender [2.73 (1.64, 4.56)], primary school or lower education [1.56 (1.09, 2.23)], first-time donation [1.82 (1.25, 2.67)], and frequent donation [0.80 (0.70, 0.92)]. The safest donors were females, older than 30 years, with an education more than primary school, and frequent donation. Because of missing responses to some sensitive questions, there remains a need for further improvement of the self-deferral form.

Gastrointestinal surgery in gynecologic oncology: evaluation of surgical techniques.

PubMed

Penalver, M; Averette, H; Sevin, B U; Lichtinger, M; Girtanner, R

1987-09-01

In recent years, the use of surgical staples has become popular in all subspecialties of surgery. The advantages proposed have been a decrease in operative time and morbidity. This paper reviews the University of Miami/Jackson Memorial Medical Center, Division of Gynecologic Oncology experience with the use of surgical staples in gastrointestinal surgery on patients with a diagnosis of a gynecologic malignancy. Between January 1, 1979 and July 1, 1985, a total of 152 procedures were done, 81 by stapler and 71 by suture anastomosis. Ninety-one patients had received previous radiation or chemotherapy. The average age of the patients was 52 years. The results show a decrease in operating time, blood loss, and postoperative hospital stay in those patients where the stapler anastomosis was used. The postoperative morbidity and mortality were not increased. Twenty-seven total pelvic exenterations were performed during the period of study and they were evaluated separately. The hospital stay and blood loss as well as the operative time were significantly less using staplers. This report includes a detailed evaluation of the results. From this study, we concluded that surgical staples are a safe alternative in gastrointestinal surgery in patients with a gynecologic malignancy.

Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.

PubMed

Henriksen, Hanne H; Rahbar, Elaheh; Baer, Lisa A; Holcomb, John B; Cotton, Bryan A; Steinmetz, Jacob; Ostrowski, Sisse R; Stensballe, Jakob; Johansson, Pär I; Wade, Charles E

2016-12-09

The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. 75 patients received pre-hospital plasma and/or RBCs (PH group; nearly half received both RBCs and plasma) whereas 182 patients only received in-hospital blood products (RBCs, Plasma and Platelets) within 6 hours of admission (IH group). PH patients had lower Glasgow coma scale (GCS) scores, more penetrating injuries, lower systolic blood pressures, lower hemoglobin levels, lower platelet counts and greater acidosis upon ED admission than the IH group (all p < 0.05). Despite differences in type of injury and admission vitals indicating that the PH group had more signs of bleeding than the IH group, there were no significant differences in in-hospital mortality (PH 26.7% vs. IH 20.9% p = 0.31). When comparing rTEG variables between PH patients transfused with 0, 1 or 2 units of plasma, more pre-hospital plasma transfusion was tendency towards improved rTEG variables. When adjusting for pre-hospital RBC, pre-hospital plasma was associated with significantly higher rTEG MA (p = 0.012) at hospital admission. After adjusting for pre-hospital RBCs, pre-hospital plasma transfusion was independently associated with increased rTEG MA, as well as arrival indices of shock and hemodynamic instability. Besides more severe injury and worse clinical presentation, the group that received pre-hospital transfusion had early and late mortality similar to patients not transfused pre-hospital. These data suggest that early administration of plasma can provide significant hemostatic and potential survival benefit to severely hemorrhaging trauma patients.

Thyroid, cortisol and growth hormone levels in adult Nigerians with metabolic syndrome.

PubMed

Udenze, Ifeoma Christiana; Olowoselu, Olusola Festus; Egbuagha, Ephraim Uchenna; Oshodi, Temitope Adewunmi

2017-01-01

The similarities in presentation of cortisol excess, growth hormone deficiency, hypothyroidism and metabolic syndrome suggest that subtle abnormalities of these endocrine hormones may play a causal role in the development of metabolic syndrome. The aim of this study is to determine the levels of cortisol, thyroid and growth hormones in adult Nigerians with metabolic syndrome and determine the relationship between levels of these hormones and components of the syndrome. This was a case control study conducted at the Lagos University Teaching Hospital, Lagos, Nigeria. Participants were fifty adult men and women with the metabolic syndrome, and fifty, age and sex matched males and females without the metabolic syndrome. Metabolic syndrome was defined based on the NCEP-ATPIII criteria. Written Informed consent was obtained from the participants. Socio demographic and clinical data were collected using a structured questionnaire. Venous blood was collected after an over-night fast. The Ethics committee of the Lagos University Teaching Hospital, Lagos, Nigeria, approved the study protocol. Comparison of continuous variables was done using the Student's t test. Correlation analysis was employed to determine the associations between variables. Statistical significance was set at P<0.05. Triiodotyronine (T3) was significantly decreased (p<0.001) and thyroxine (T4 ) significantly increased ( p<0.001) in metabolic syndrome compared to healthy controls. T3 correlated positively and significantly with waist circumference (p=0.004), glucose (p= 0.002), total cholesterol ( p=0.001) and LDL- cholesterol ( p<0.001 ) and negatively with body mass index ( p<0.001 )and triglyceride ( p=0.026). T4 had a negative significant correlation with waist circumference (p=0.004). Cortisol and growth hormone levels were similar in metabolic syndrome and controls. Cortisol however had a positive significant correlation with waist/hip ratio (p<0.001) while growth hormone correlated positively with HDL ( p=0.023)and negatively with diastolic blood pressure (p=0.049). Thyroid hormones T3 and T4 were associated with metabolic syndrome. The thyroid hormones, cortisol and growth hormones correlated with components of the syndrome. A therapeutic role may exit for these hormones in the management of metabolic syndrome and related disorders.

A Critical-Incident Stress Debriefing Program for Hospital-Based Health Care Personnel.

ERIC Educational Resources Information Center

Spitzer, William J.; Burke, Laurie

1993-01-01

Reviews individual and institutional effects of critical-incident stress on health care delivery and use of stress education, defusings, and debriefings as effective interventions with health care personnel. Presents successful efforts of social work department using these techniques in major university hospital system as model for replication in…

Planning for Tomorrow: Increased Productivity through Education and Training.

ERIC Educational Resources Information Center

Stein, David; Hull, Peggy K.

At The Ohio State University Hospitals Education and Training Department, a data-based strategic planning and coordinating model is being developed to ensure that the educational mission is responsive to the trends and forces affecting the hospital unit and individual productivity. This model is being implemented in order to attempt to meet the…

Evaluation of a pretest scoring system (4Ts) for the diagnosis of heparin-induced thrombocytopenia in a university hospital setting.

PubMed

Vatanparast, Rodina; Lantz, Sarah; Ward, Kristine; Crilley, Pamela Ann; Styler, Michael

2012-11-01

The initial diagnosis of heparin-induced thrombocytopenia (HIT) is made on clinical grounds because the assays with the highest sensitivity (eg, heparin-platelet factor 4 antibody enzyme-linked immunosorbent assay [ELISA]) and specificity (eg, serotonin release assay) may not be readily available. The clinical utility of the pretest scoring system, the 4Ts, was developed and validated by Lo et al in the Journal of Thrombosis and Haemostasis in 2006. The pretest scoring system looks at the degree and timing of thrombocytopenia, thrombosis, and the possibility of other etiologies. Based on the 4T score, patients can be categorized as having a high, intermediate, or low probability of having HIT. We conducted a retrospective study of 100 consecutive patients who were tested for HIT during their hospitalization at Hahnemann University Hospital (Philadelphia, PA) in 2009. Of the 100 patients analyzed, 72, 23, and 5 patients had 4T pretest probability scores of low, intermediate, and high, respectively. A positive HIT ELISA (optical density > 1.0 unit) was detected in 0 of 72 patients (0%) in the low probability group, in 5 of 23 patients (22%) in the intermediate probability group, and in 2 of 5 patients (40%) in the high probability group. The average turnaround time for the HIT ELISA was 4 to 5 days. Fourteen (19%) of the 72 patients with a low pretest probability of HIT were treated with a direct thrombin inhibitor. Ten (71%) of the 14 patients in the low probability group treated with a direct thrombin inhibitor had a major complication of bleeding requiring blood transfusion support. In this retrospective study, a low 4T score showed 100% correlation with a negative HIT antibody assay. We recommend incorporating the 4T scoring system into institutional core measures when assessing a patient with suspected HIT, selecting only patients with intermediate to high probability for therapeutic intervention, which may translate into reduced morbidity and lower health care costs.

A computer-assisted personnel data system for a hospital department of dietetics. I. Development of the data base.

PubMed

Shick, G L; Hoover, L W; Moore, A N

1979-04-01

A data base was developed for a computer-assisted personnel data system for a university hospital department of dietetics which would store data on employees' employment, personnel information, attendance records, and termination. Development of the data base required designing computer programs and files, coding directions and forms for card input, and forms and procedures for on-line transmission. A program was written to compute accrued vacation, sick leave, and holiday time, and to generate historical records.

Transfusion-Associated Circulatory Overload: Evidence-Based Strategies to Prevent, Identify, and Manage a Serious Adverse Event.

PubMed

Henneman, Elizabeth A; Andrzejewski, Chester; Gawlinski, Anna; McAfee, Kelley; Panaccione, Thomas; Dziel, Kimberly

2017-10-01

Transfusion-associated circulatory overload (TACO) is a potentially life-threatening complication of blood transfusion and is associated with increased morbidity, length of stay (hospital and intensive care unit), and hospital costs. Bedside nurses play a key role in the prevention, identification, and reporting of this complication. A common misperception is that the most frequently encountered serious adverse event during transfusion is a hemolytic reaction in a patient who receives ABO-incompatible blood. In fact, the incidence of TACO-related fatalities is higher than fatalities caused by ABO-related hemolytic reactions. Surveillance and evidence-based strategies such as clinical decision support systems have the potential to reduce the incidence of TACO and mitigate its effects. Practical suggestions for conducting bedside transfusion surveillance and future directions for improving transfusion care are presented. ©2017 American Association of Critical-Care Nurses.

Integrative Medicine Selects Best Practice from Public Health and Biomedicine

PubMed Central

Ryan, Terence J

2013-01-01

The meaning of terms Integrated and Integrative are described variously by an amalgam of latest scientific advances with ancient healing systems, of complementary medicine and biomedicine, and sexually transmitted infections and HIV/AIDS. It means seamless good quality care between hospital and primary care. They provoke approval mostly from patients and disapproval mostly from advocates of science and evidence-based medicine. The Institute of Applied Dermatology in Kasaragod, Kerala, India has championed a mix of Biomedicine, Yoga and herbals from Ayurvedic medicine, partly based on publications from the Department of Dermatology of the University of Oxford. In Oxford dermatology, acceptance of value of integrative medicine (IM) is demonstrated, especially in wound healing and the skin's blood supply. This has long featured in the university's research program. A variety of approaches to the practice of medicine are illustrated with reference to Osler, Garrod, and Doll. IM is believed to underlie contemporarily best practice. Particular emphasis is given to the control of heat, pain, redness, and swelling, all manifestations of inflammation, and the importance of emotion as a stimulus or inhibitor carried by neural pathways. These may explain some unbelievable Asian practices and one of the many roles of Yoga. The concept of Integrative is expanded to include care of the earth and nutrition, the hazards of climate change, Gardens for Health, do (k) no (w) harm as a key to good practice. PMID:23716803

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.

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital.

PubMed

Khan, Junaid H; Green, Emily A; Chang, Jimmin; Ayala, Alexandria M; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D

2017-12-01

Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management. Retrospective analysis of blood product usage pre-implementation, post-CPB changes and post-Hemostasis Management System (HMS) implementation was done to determine the effectiveness of the blood conservation strategies. Statistically significant decrease in packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelet usage over the stepped implementation of both technologies was observed. New oxygenator and centrifugal pump technologies reduced active circuitry volume and caused less damage to blood cells. Individualizing heparin and protamine dosing to a patient using the HMS led to transfusion reductions as well. Overall trends toward reductions in hospital length of stay and intensive care unit stay, and as a result, blood product cost and total hospitalization cost are positive over the period of implementation of both CPB circuit changes and HMS implementation. Although they are multifactorial in nature, these trends provide positive enforcement to the changes implemented.

Clinicians’ perceptions and the relevant computer-based information needs towards the practice of evidence based medicine

PubMed Central

Jiang, Guoqian; Ogasawara, Katsuhiko; Endoh, Akira; Sakurai, Tsunetaro

2003-01-01

We conducted a survey among 100 clinicians in a university hospital to determine the clinician’s attitudes and the relevant computer-based information needs towards the practice of evidence-based medicine in outpatient setting. PMID:14728387

Time-based analysis of the apheresis platelet supply chain in England.

PubMed

Wilding, R; Cotton, S; Dobbin, J; Chapman, J; Yates, N

2011-10-01

During 2009/2010 loss of platelets within NHS Blood and Transplant (NHSBT) due to time expiry was 9.3%. Hospitals remain reluctant to hold stocks of platelets due to the poor shelf life at issue. The purpose of this study was to identify areas for time compression in the apheresis platelet supply chain to extend the shelf life available for hospitals and reduce wastage in NHSBT. This was done within the context of NHSBT reconfiguring their supply chain and moving towards a consolidated and centralised approach. Time based process mapping was applied to identify value and non-value adding time in two manufacturing models. A large amount of the non-value adding time in the apheresis platelet supply chain is due to transportation and waiting for the next process in the manufacturing process to take place. Time based process mapping provides an effective 'lens' for supply chain professionals to identify opportunities for improvement in the platelet supply chain. © 2011 The Author(s). Vox Sanguinis © 2011 International Society of Blood Transfusion.

Assessment of cardiovascular risk and target organ damage among adult patients with primary hypertension in Thika Level 5 Hospital, Kenya: a criteria-based clinical audit.

PubMed

Mwita, Clifford Chacha; Akello, Walter; Sisenda, Gloria; Ogoti, Evans; Tivey, David; Munn, Zachary; Mbogo, David

2013-06-01

Appropriate management of hypertension reduces the risk of death from stroke and cardiac disease and includes routine assessment for target organ damage and estimation of cardiovascular risk. However, implementation of evidence-based hypertension management guidelines is unsatisfactory. We explore the use of audit and feedback as a quality improvement (QI) strategy for reducing the knowledge practice gap in hypertension care in a resource poor setting. The aim of this study is to determine the level of compliance to evidence-based guidelines on assessment of cardiovascular risk and target organ damage among patients with hypertension in Thika Level 5 Hospital in central Kenya and to implement best practice with regard to evidence utilisation among clinicians in the hospital. A retrospective clinical audit done in three phases spread over 5 months. Phase one involved identifying five audit criteria on assessment of cardiovascular risk and target organ damage in patients with hypertension and conducting a baseline audit in which compliance to audit criteria, blood pressure control and drug prescription practices were assessed. Phase two involved identifying barriers to compliance to audit criteria and strategies to overcoming these barriers. The third phase was a follow-up audit. There was no use of a cardiovascular risk assessment tool in both audits (0% vs. 0%; P = 1.00). Testing urine for haematuria and proteinuria reduced from 13% to 8% (P = 0.230) while taking a blood sample for measuring blood glucose, electrolytes and creatinine levels improved from 11% to 17% (P = 0.401). Performance of fundoscopy and electrocardiography remained unchanged at 2% and 8%, respectively (P = 0.886 and P = 0.898). High patient load was identified as the biggest barrier to implementation of best practice. Blood pressure control improved from 33% to 70% (P ≤ 0.001), whereas the proportion of patients on two or more recommended antihypertensive drugs rose from 59% to 72% (P = 0.158). In Thika Level 5 Hospital, audit and feedback has a poor impact on assessment of cardiovascular risk and target organ damage but positive impact on blood pressure control and prescription practices. Time and sample size may have affected observed results. Additional audits and alternative QI strategies are warranted. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

27 CFR 22.101 - Authorized uses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... use exclusively in scientific research; (c) For use at any hospital, blood bank, or sanitarium (including use in making any analysis or test at a hospital, blood bank, or sanitarium), or at any pathological laboratory exclusively engage in making analyses, or test, for hospitals or sanitariums; or (d...

Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan

PubMed Central

2011-01-01

Background Hepatitis B Virus (HBV) may progress to serious consequences and increase dramatically beyond endemic dimensions that transmits to or from health care workers (HCWs) during routine investigation in their work places. Basic aim of this study was to canvass the safety of HCWs and determine the prevalence of HBV and its possible association with occupational and non-occupational risk factors. Hepatitis B vaccination coverage level and main barriers to vaccination were also taken in account. Results A total of 824 health care workers were randomly selected from three major hospitals of Peshawar, Khyber Pakhtunkhwa. Blood samples were analyzed in Department of Zoology, Kohat University of Science and Technology Kohat, and relevant information was obtained by means of preset questionnaire. HCWs in the studied hospitals showed 2.18% prevalence of positive HBV. Nurses and technicians were more prone to occupational exposure and to HBV infection. There was significant difference between vaccinated and non-vaccinated HCWs as well as between the doctors and all other categories. Barriers to complete vaccination, in spite of good knowledge of subjects in this regard were work pressure (39.8%), negligence (38.8%) un-affordability (20.9%), and unavailability (0.5%). Conclusions Special preventive measures (universal precaution and vaccination), which are fundamental way to protect HCW against HBV infection should be adopted. PMID:21645287

Video-assisted mediastinoscopic resection compared with video-assisted thoracoscopic surgery in patients with esophageal cancer.

PubMed

Wang, Qian-Yun; Tan, Li-Jie; Feng, Ming-Xiang; Zhang, Xiao-Ying; Zhang, Lei; Jiang, Nan-Qing; Wang, Zhong-Lin

2014-06-01

The purpose of this study was to explore the indications of radical vedio-assisted mediastinoscopic resection for esophageal cancer. The data of 109 patients with T1 esophageal cancer who underwent video-assisted mediastinoscopic resection (VAMS group) in Third Affiliated Hospital of Soochow University Hospital from December 2005 to December 2011 were collected in the study for comparison with the 58 patients with T1 esophageal cancer who underwent video-assisted thoracoscopic surgery (VATS group) in Zhongshan Hospital, Fudan University. The perioperative safety and survival were compared between the two groups. All operations were successful in both groups. One perioperative death was noted in the VATS group. The incidences of post-operative complications were not significantly different between these two groups, whereas the VAMS group was favorable in terms of operative time (P<0.001) and blood loss (P<0.001), and a significantly larger number of chest lymph nodes were dissected in the VATS group compared with the VAMS group (P<0.001). Long-term follow-up showed that the overall survival was not significantly different between these two groups (P=0.876). T1N0M0 esophageal cancer can be as the indication of VAMS radical resection. VAMS radical resection can be considered as the preferred option for patients with poor pulmonary and cardiac function or a history of pleural disease.

Video-assisted mediastinoscopic resection compared with video-assisted thoracoscopic surgery in patients with esophageal cancer

PubMed Central

Wang, Qian-Yun; Tan, Li-Jie; Feng, Ming-Xiang; Zhang, Xiao-Ying; Zhang, Lei; Jiang, Nan-Qing

2014-01-01

Objective The purpose of this study was to explore the indications of radical vedio-assisted mediastinoscopic resection for esophageal cancer. Methods The data of 109 patients with T1 esophageal cancer who underwent video-assisted mediastinoscopic resection (VAMS group) in Third Affiliated Hospital of Soochow University Hospital from December 2005 to December 2011 were collected in the study for comparison with the 58 patients with T1 esophageal cancer who underwent video-assisted thoracoscopic surgery (VATS group) in Zhongshan Hospital, Fudan University. The perioperative safety and survival were compared between the two groups. Results All operations were successful in both groups. One perioperative death was noted in the VATS group. The incidences of post-operative complications were not significantly different between these two groups, whereas the VAMS group was favorable in terms of operative time (P<0.001) and blood loss (P<0.001), and a significantly larger number of chest lymph nodes were dissected in the VATS group compared with the VAMS group (P<0.001). Long-term follow-up showed that the overall survival was not significantly different between these two groups (P=0.876). Conclusions T1N0M0 esophageal cancer can be as the indication of VAMS radical resection. VAMS radical resection can be considered as the preferred option for patients with poor pulmonary and cardiac function or a history of pleural disease. PMID:24976988

[Tianjin characteristics of integrated traditional Chinese and Western medicine in first aid medical system].

PubMed

Li, Zhijun

2018-05-01

Tianjin, as the earliest city to open up, the exchange of Chinese and Western cultures also started earlier. Therefore, today's emergency medicine system with integrated features of Chinese and Western medicine is formed. Professor Wang Jinda, who works in Tianjin First Center Hospital, makes the theory of "treating bronchitis and treating diseases" and "three methods of three syndromes" for the treatment of severe diseases such as sepsis. The surgical aspect is the treatment of acute abdomen with the combination of Chinese and Western medicine which is proposed by Academician Wu Xianzhong who worked in Tianjin Nankai Hospital. In the aspect of acupuncture and moxibustion, Professor Guo Yi, who works in Tianjin University of Traditional Chinese Medicine, provides the twelve Jing points blood-letting therapy for cerebral diseases such as stroke. Professor Liu Xinqiao from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine also conducts in-depth studies on brain protection after cardiopulmonary resuscitation (CPR). He proposes the importance of traditional Chinese medicine in addition to mild hypothermia and neuroprotective agents. The author summarized these achievements, in light of which looked forward to the future and proposed the concept of establishing a multi-specialist collaboration and an emergency center with obvious characteristics of integrated Chinese and Western medicine, which would pave the way for the development of integrated Chinese and Western medicine first aid.

Profiles of blood and blood component transfusion recipients in Zimbabwe

PubMed Central

Mafirakureva, Nyashadzaishe; Khoza, Star; Hassall, Oliver; Faragher, Brian E.; Kajja, Isaac; Mvere, David A.; Emmanuel, Jean C.; Postma, Maarten J.; van Hulst, Marinus

2015-01-01

Background There are limited published data on the characteristics of blood transfusion recipients in sub-Saharan Africa. This study describes the demographic characteristics of blood transfusion recipients and patterns of blood and blood component use in Zimbabwe. Materials and methods Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, duration of stay in hospital), were retrospectively collected from four major hospitals for the period from January 1, 2012 to December 31, 2012. Diagnoses were grouped into broad categories according to the disease headings of the International Classification of Diseases (ICD-10). Surgical procedures were grouped into broad categories according to organ system using ICD-9. Results Most of the 1,793 transfusion recipients studied were female (63.2%) and in the reproductive age group, i.e. 15–49 years (65.3%). The median age of the recipients was 33 years (range, 0–93). The majority of these recipients (n=1,642; 91.6%) received a red blood cell transfusion. The majority of the patients were diagnosed with conditions related to pregnancy and childbirth (22.3%), and diseases of blood and blood-forming organs (17.7%). The median time spent in hospital was 8 days (range, 0–214) and in-hospital mortality was 15.4%. Discussion Our sample of blood transfusion recipients were fairly young and most of them received red blood cell transfusions. The majority of patients in the reproductive age group received blood transfusions for pregnancy and childbirth-related diagnoses. PMID:26192782

Perioperative blood ordering optimization process using information from an anesthesia information management system.

PubMed

Rinehart, Joseph B; Lee, Tiffany C; Kaneshiro, Kayleigh; Tran, Minh-Ha; Sun, Coral; Kain, Zeev N

2016-04-01

As part of ongoing perioperative surgical home implantation process, we applied a previously published algorithm for creation of a maximum surgical blood order schedule (MSBOS) to our operating rooms. We hypothesized that using the MSBOS we could show a reduction in unnecessary preoperative blood testing and associated costs. Data regarding all surgical cases done at UC Irvine Health's operating rooms from January 1, 2011, to January 1, 2014 were extracted from the anesthesia information management systems (AIMS). After the data were organized into surgical specialties and operative sites, blood order recommendations were generated based on five specific case characteristics of the group. Next, we assessed current ordering practices in comparison to actual blood utilization to identify potential areas of wastage and performed a cost analysis comparing the annual hospital costs from preoperative blood orders if the blood order schedule were to be followed to historical practices. Of the 19,138 patients who were categorized by the MSBOS as needing no blood sample, 2694 (14.0%) had a type and screen (T/S) ordered and 1116 (5.8%) had a type and crossmatch ordered. Of the 6073 procedures where MSBOS recommended only a T/S, 2355 (38.8%) had blood crossmatched. The cost analysis demonstrated an annual reduction in actual hospital costs of $57,335 with the MSBOS compared to historical blood ordering practices. We showed that the algorithm for development of a multispecialty blood order schedule is transferable and yielded reductions in preoperative blood product screening at our institution. © 2016 AABB.

[Contribution of medical technologists in team medical care of diabetics].

PubMed

Sato, Itsuko; Jikimoto, Takumi; Ooyabu, Chinami; Kusuki, Mari; Okano, Yosie; Mukai, Masahiko; Kawano, Seiji; Kumagai, Shunichi

2006-08-01

For the effective treatment of diabetic mellitus (DM), patients are encouraged to self-manage their disease according to the doctor's instructions and advice from certified diabetes educators (CDE) and other comedical staff. Therefore, the cooperation of medical staff consisting of a doctor, CDE, nurse, pharmacist, dietitian, and medical technologist is important for DM education. Medical technologists licensed for CDE (MT-CDE) have been participating in the DM education team in Kobe University Hospital since 2000. MT-CDE are in charge of classes for medical tests, guidance for self-monitoring of blood glucose and teaching how to read the fluctuation graph of the blood glucose level in the education program for hospitalized DM patients. MT-CDEs teach at the bedside how to read the results of medical tests during the first few days of hospitalization using pamphlets for medical tests. The pamphlets are made comprehensible for patients by using graphics and photographs as much as possible. It is important to create a friendly atmosphere and answer frank questions from patients, since they often feel stress when having medical tests at the early stage of hospitalization. This process of questions and answers promotes their understanding of medical tests, and seems to reduce their anxiety about having tests. We repeatedly evaluate their level of understanding during hospitalization. By showing them the fluctuation graph of the glucose level, patients can easily understand the status of their DM. When prescriptions are written on the graph, their therapeutic effects are more comprehensible for the patients. The items written on the graph are chosen to meet the level of understanding of each patient to promote their motivation. In summary, the introduction of MT-CDE has been successful in the education program for DM patients in our hospital. We plan to utilize the skills and knowledge of MT-CDE more in our program so that our DM education program will help patients cope with life with DM.

What Happens to Donated Blood?

MedlinePlus

... freezers for up to one year. Step Five Distribution Blood is available to be shipped to hospitals 24 hours a day, 7 days a week. Hospitals typically keep some blood units on their shelves, but may call for more at any time, such as in case of large scale emergencies. ...

Teaching Specialized Vocabulary by Integrating a Corpus-Based Approach: Implications for ESP Course Design at the University Level

ERIC Educational Resources Information Center

Hou, Hsiao-I

2014-01-01

The purpose of this study is to demonstrate how to integrate two in-house specialized corpora into a university-level English for Specific Purposes (ESP) course for nonnative speakers of English. The ESP course was an introductory level of wine tasting for Applied English Department students at a university specializing in hospitality in Taiwan.…

[Organization of an anaesthesia preoperative evaluation clinic - The Anaesthesia/Patient Blood Management Clinic: one Model].

PubMed

Schöpper, Christa; Venherm, Stefan; Van Aken, Hugo; Ellermann, Ines; Steinbicker, Andrea

2016-04-01

The anesthesia preoperative evaluation has been developed in recent years in a centralized clinic, that can be visited by the majority of patients, in order to evaluate and obtain patient's consent for anesthesia. In the current article, the organization and structure of such a central anesthesia preoperative evaluation clinic in the Department of Anesthesia, Intensive Care and Pain Medicine at the University Hospital of Muenster, is described. Besides the central preoperative evaluation clinic, 3 clinics are localized in separate buildings and preoperative visits have to be completed in special scenarios on the wards, too. A pharmaceutical evaluation for patient's medication and the patient blood management have been integrated into the anesthesia preoperative evaluation clinic. Processes are explained and current numbers of patients are mentioned. © Georg Thieme Verlag Stuttgart · New York.

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.

Radical prostatectomy innovation and outcomes at military and civilian institutions.

PubMed

Leow, Jeffrey J; Weissman, Joel S; Kimsey, Linda; Hoburg, Andrew; Helmchen, Lorens A; Jiang, Wei; Hevelone, Nathanael; Lipsitz, Stuart R; Nguyen, Louis L; Chang, Steven L

2017-06-01

Limited data are available regarding the impact of the type of healthcare delivery system on technology diffusion and associated clinical outcomes. We assessed the adoption of minimally invasive radical prostatectomy (MIRP), a recent clinical innovation, and whether this adoption altered surgical morbidity for prostate cancer surgery. Retrospective review of administrative data from TRICARE, the healthcare program of the United States Military Health System. Surgery occurred at military hospitals, supported by federal appropriations, or civilian hospitals, supported by hospital revenue. We evaluated TRICARE beneficiaries with prostate cancer (International Classification of Disease, 9th Revision, Clinical Modification [ICD-9-CM] code: 185) who received a radical prostatectomy (60.5) between 2005 and 2009. MIRP was identified based on minimally invasive surgery codes (54.21, 17.42). We assessed yearly MIRP utilization, 30-day postoperative complications (Clavien classification system), length of stay, blood transfusion, and long-term urinary incontinence and erectile dysfunction. A total of 3366 men underwent radical prostatectomy at military hospitals compared with 1716 at civilian hospitals, with minimal clinic-demographic differences. MIRP adoption was 30% greater at civilian hospitals. There were fewer blood transfusions (odds ratio, 0.44; P <.0001) and shorter lengths of stay (incidence risk ratio, 0.85; P <.0001) among civilian hospitals, while 30-day postoperative complications, as well as long-term urinary incontinence and erectile dysfunction rates, were comparable. Compared with military hospitals, civilian hospitals had a greater MIRP adoption during this timeframe, but had comparable surgical morbidity.

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.

27 CFR 1.60 - Use of distilled spirits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... laboratory for use exclusively in scientific research; (3) For use at any hospital, blood bank, or sanitarium (including use in making analysis or test at such hospital, blood bank, or sanitarium), or at any pathological laboratory exclusively engaged in making analyses, or tests, for hospitals or sanitariums; or (4...

Cost comparative study of autologous peripheral blood progenitor cells (PBPC) and bone marrow (ABM) transplantations for non-Hodgkin's lymphoma patients.

PubMed

Woronoff-Lemsi, M C; Arveux, P; Limat, S; Deconinck, E; Morel, P; Cahn, J Y

1997-12-01

Intensive high-dose chemotherapy with autologous stem-cell support has become a common treatment strategy for non-Hodgkin's lymphomas. A cost-identification analysis was conducted comparing 10 patients autografted with PBSC to 10 others autografted with BM. The analysis included harvest and graft until graft day +100 and was carried out from the point of view of the hospital setting. Resources used, logistic and direct medical costs per patient were identified, and sensitivity analyses performed. The cost distribution was different. Stem cell harvest was more expensive for PBPC ($9030) and BM ($4745); on the other hand, hospitalization from graft to discharge from hospital cost savings with PBSC were about $10666. After discharge from hospital, costs were similar and cheaper in both groups. For the overall study the PBPC procedure was less expensive than ABMT, $35381 and $41759 respectively, with cost savings of $6378. The number of days spent in hospital and blood bank costs were the major cost factors. This study was based on a single pathology, non-Hodgkin's lymphoma, and the actual hospital records for each patient situation as opposed to a clinical trial, and our results were consistent with different previous studies carried out in different health care systems.

Factors affecting blood sample haemolysis: a cross-sectional study.

PubMed

Barnard, Ed B G; Potter, David L; Ayling, Ruth M; Higginson, Ian; Bailey, Andrew G; Smith, Jason E

2016-04-01

To determine the effect of blood sampling through an intravenous catheter compared with a needle in Emergency Department blood sampling. We undertook a prospective, cross-sectional study in a UK university teaching hospital Emergency Department. A convenience sample of 985 patients who required blood sampling via venepuncture was collected. A total of 844 complete sets of data were analysed. The median age was 63 years, and 57% of patients were male. The primary outcome measure was the incidence of haemolysis in blood samples obtained via a needle compared with samples obtained via an intravenous catheter. Secondary outcome measures defined the effect on sample haemolysis of the side of the patient the sample was obtained from, the anatomical location of sampling, the perceived difficulty in obtaining the sample, the order of sample tubes collected, estimated tourniquet time and bench time. Data were analysed with logistic regression, and expressed as odds ratios (95% confidence intervals; P-values). Blood samples obtained through an intravenous catheter were more likely to be haemolysed than those obtained via a needle, odds ratio 5.63 (95% confidence interval 2.49-12.73; P<0.001). Blood sampling via an intravenous catheter was significantly associated with an increase in the likelihood of sample haemolysis compared with sampling with a needle. Wherever practicable, blood samples should be obtained via a needle in preference to an intravenous catheter. Future research should include both an economic evaluation, and staff and patient satisfaction of separating blood sampling and intravenous catheter placement.

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

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

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 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. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC 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 POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

A novel fiber optic sensor for the measurement of pH of blood based on colorimetry

NASA Astrophysics Data System (ADS)

Chaudhari, A. L.; Patil, D. D.; Shaligram, Arvind D.

2005-04-01

Fiber optic sensors designed to the date are largely based on monitoring the absorption change of several immobilized indicators or change in fluorescence of fluorometric indicators. The present paper reports a new type of fiber optic sensor for the measurement of blood pH based on Colorimetric principle. The sensor consists of two multimode step index fibers, mirror as reflector and blood serum with universal indicator as medium. LED is used as source and photodiode as detector. The intensity of color produced due to addition of indicator to blood serum depends upon hydrogen ion concentration. The output intensity from receiving fiber is measured as a function of pH of blood. The developed sensor is calibrated against the standard pH meter. The design, construction and calibration details are presented in paper.

Role of inflammatory mediators in patients with recurrent pregnancy loss.

PubMed

Comba, Cihan; Bastu, Ercan; Dural, Ozlem; Yasa, Cenk; Keskin, Gulsah; Ozsurmeli, Mehmet; Buyru, Faruk; Serdaroglu, Hasan

2015-12-01

To examine interleukin-12 (IL-12), IL-18, IFN-γ, intracellular adhesion molecule-1 (ICAM-1), leukemia inhibitory factor (LIF), and migration inhibitory factor (MIF) levels in precisely-timed blood and endometrial tissue samples from women with idiopathic recurrent pregnancy loss (RPL). Case-control study. University hospital. Twenty-one women with RPL and 20 women with proven fertility (controls). Primary endometrial cells and blood samples during the midsecretory phase (days 19-23). Detection of IL-12, IL-18, IFN-γ, ICAM-1, LIF, and MIF via enzyme-linked immunosorbent assay in both blood and endometrial tissue samples. The blood and tissue levels of IL-12, IL-18, and IFN-γ were statistically significantly higher, and the blood and tissue levels of LIF and MIF were statistically significantly lower in patients with RPL. Only the level of tissue ICAM-1 was higher in patients with RPL. There was a strong correlation between blood and tissue level measurements of IL-12, IL-18, LIF, and MIF. Our findings support the hypothesis that inflammatory processes may contribute to pregnancy loss, possibly through their role in implantation. We found that blood and tissue levels of IL-18, LIF, and MIF, and tissue levels of IL-12, IFN-γ, and ICAM-1 have statistically significant prognostic relevance. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Increased Cord Blood Betatrophin Levels in the Offspring of Mothers with Gestational Diabetes

PubMed Central

Wu, Shimin; Zhao, Yue; Du, Caiqi; Yuan, Guandou; Ning, Qin; McCormick, Kenneth; Luo, Xiaoping

2016-01-01

Aim Exposing a fetus to hyperglycemia can increase the risk for later-life metabolic disorders. Betatrophin has been proposed as a key regulator of pancreatic beta cell proliferation and lipid regulation. Highly responsive to nutritional signals, serum betatrophin concentrations have been found to be altered by various physiological and pathological conditions. We hypothesized that betatrophin levels are increased in the cord blood in offspring exposed to intrauterine hyperglycemia. Methods This was a cross-sectional study including 54 mothers who underwent uncomplicated Cesarean delivery in a university hospital. Maternal gestational glucose concentration was determined at 24–48 weeks gestation after a 75-g OGTT. Cord blood and placental tissue was collected immediately post delivery. Metabolic parameters were determined in the Clinical Laboratory. Cord blood betatrophin levels were assayed using a commercially available ELISA kit. Placental mitochondrial content was determined by real-time PCR. Results Cord blood betatrophin levels were increased in the gestational diabetes mellitus (GDM) group compared with the normoglycemic group. Furthermore, betatrophin levels were positively correlated with maternal gestational 2h post-OGTT glucose, cord blood insulin, HOMA-IR, and inversely correlated with placental mitochondrial content. Conclusions Cord blood betatrophin may function as a potential biomarker of maternal intrauterine hyperglycemia and fetal insulin resistance, which may presage for long-term metabolic impact of GDM on offspring. PMID:27196053

The hospital transfusion committee: a step towards improved quality assurance.

PubMed

Calder, L; Woodfield, G

1991-10-09

Quality assurance has an important contribution to make in the judicious use of scarce resources. Auckland Hospital has established a transfusion committee because there was an escalating usage of blood and blood products which are expensive prescription medicines. A pilot audit of red cell transfusions indicated that 29% of red cell transfusions may have been unnecessary. A wide range of initiatives at Auckland Hospital has reduced blood product usage. Inappropriate use of blood carries an opportunity cost and may subject patients to unnecessary risk of reactions, including potential disease transmission. Strategies which need to be employed by transfusion committees include the introduction of clinical audit, physician education, restrictions on availability, and clinical budgeting. It is recommended that transfusion committees be set up in all major hospitals.

Occupational safety among dental health-care workers.

PubMed

Shimoji, Shigehiro; Ishihama, Kohji; Yamada, Hidefumi; Okayama, Masaki; Yasuda, Kouichi; Shibutani, Tohru; Ogasawara, Tadashi; Miyazawa, Hiroo; Furusawa, Kiyofumi

2010-01-01

Compared to other health-care workers, dental health-care workers come in close contact with patients and use a variety of sharp and high-speed rotating instruments. It is important to understand the characteristics of the occupational accidents that occur. We reviewed incident reports from April 1, 2005, to March 31, 2010, at Matsumoto Dental University Hospital. In addition, questionnaires dealing with identification of occupational safety issues, especially splash exposures, were conducted for dentists, dental hygienists, and nurses. Thirty-two occupational injuries were reported during the study period, including 23 sharp instrument injuries (71.9%), 6 splash exposures (18.8%), and 3 others. Of the six splash exposures, only two cases involved potential contamination with blood or other potentially infectious patient material. Of the 66 workers who experienced sharps injuries, 20 workers (30.3%, 20/66) reported them to the hospital work safety team. The questionnaire revealed high incident of splash exposures and conjunctiva exposures: 87.9% (51/58) and 60.3% (35/58) in dentists and 88.6% (39/44) and 61.4% (27/44) in dental hygienists. The compliance rate for routine use of protective eyewear was 60.3% (35/58) for dentists and 34.1% (15/44) for hygienists. Of the presented informational items included in the questionnaire, those that strongly persuaded respondents to use protective eyewear were 'splatters from the patient's mouth contain blood' (90%, 99/110) and 'dental operations at our clinic are performed based only on a questionnaire without serious examinations for HBV, HCV, and HIV' (71.8%, 79/110). The reason of low compliance of protective eyewear among dentists might relate to fine dental procedures. Appropriate information is important for the motive of wearing personal protective equipment, and an early educational program may have a potential to increase compliance with the use of that equipment.

Clinical symptoms, laboratory, and microbial patterns of suspected neonatal sepsis cases in a children's referral hospital in northwestern Iran.

PubMed

Mahallei, Majid; Rezaee, Mohammad Ahangarzadeh; Mehramuz, Bahareh; Beheshtirooy, Shayan; Abdinia, Babak

2018-06-01

Sepsis is the systemic response to infection manifested as hyperthermia or hypothermia, tachycardia, tachypnea, and shock. This condition represents a major life-threatening factor in all age groups, particularly in neonatal period. The present study aimed to examine the results of blood, cerebrospinal fluid (CSF), and urine culture tests in suspected neonatal sepsis cases in northwestern Iran.This descriptive-analytical study was conducted on suspected neonatal sepsis cases hospitalized in Tabriz Children's Hospital. All subjects underwent complete blood count with white blood differential, C-reactive protein, blood culture and, if deemed necessary, CSF and urine culture tests and analyses. Laboratory findings in positive culture cases were scored based on the hematological scoring system (HSS) for the diagnosis of neonatal sepsis. The data were then collected, entered into SPSS v18 and analyzed.Among 838 suspected neonatal sepsis cases, 102 (12.17%) neonates with positive cultures were examined; 59.8% of whom were male with a mean age of 9.9 days, gestational age of 36.91 weeks, and mean weight of 2.966 kg. 76.47% of neonates with positive culture were term, 69.6% had normal birth weights, 68.6% were diagnoses with late-onset sepsis, 65.68% had positive blood culture, 38.23% had positive urine culture with no positive CSF culture case. Poor feeding (39.21%) and lethargy (35.29%) were the most common clinical symptoms and previous history of hospital stay (40.19%) and surgery (21.56%) the most common risk factors for neonatal sepsis development. Results revealed that 50 (49.01%) neonates achieved HSS scores equal or greater than 2 (HSS ≥2), and that the mean HSS score in deceased positive blood culture neonates was significantly higher than that of survived ones (2.21 vs 1.37). In this study, coagulase-negative staphylococcus and Staphylococcus aureus represented the most common bacteria isolated from blood with 37.31% and 12.43%, respectively. Fungi (38.5%) and Klebsiella (28.20%) were the most common microorganic urine isolates.The results suggested that only a small percentage of suspected neonatal sepsis cases had positive blood and/or urine cultures (12.17%) and that coagulase-negative staphylococcus (CoNS) and S aureus were highly prevalent in positive blood cultures, whereas fungi and Klebsiella were the most common microorganisms found in positive urine cultures.

Poor procedures and quality control among non-affiliated blood centers in Burkina Faso: an argument for expanding the reach of the national blood transfusion center

PubMed Central

Nébié, Koumpingnin; Ouattara, Siaka; Sanou, Mahamoudou; Kientega, Youssouphe; Dahourou, Honorine; Ky, Lassina; Kienou, Kisito; Diallo, Samba; Bigirimana, Françoise; Fretz, Catherine; Murphy, Edward L.; Lefrère, Jean-Jacques

2011-01-01

Introduction The World Health Organization (WHO) recommends the creation of national blood transfusion services. Burkina Faso has a CNTS (Centre national de transfusion sanguine - National Blood Transfusion Center) but it currently covers only 53% of the national blood supply versus 47% produced by independent hospital blood banks. Study design To evaluate blood collection, testing, preparation and prescription practices in the regions of Burkina Faso that are not covered by the CNTS, we conducted a cross-sectional survey. Methodology Data were collected by trained professionals from May to June 2009, at 42 autonomous blood centers not covered by the CNTS. Results Blood collection was supervised in all sites by laboratory technicians without specific training. There was no marketing of community blood donation nor mobile collection. Donation was restricted to replacement (family) donors in 21.4% of sites. Pre-donation screening of donors was performed in 63.4% of sites, but some did not use written questionnaires. Testing for HIV, hepatitis B virus and syphilis was universal, although some sites did not screen for hepatitis C virus. In 83.3% of the sites blood typing was performed without reverse ABO typing. In 97.6% of the sites, nurses acted alone or in conjunction with a physician to order blood transfusions. Conclusion Shortcomings in non-CNTS blood centers argue for the development of a truly national CNTS. Such a national center should coordinate and supervise all blood transfusion activities, and is the essential first step for improving and institutionalizing blood transfusion safety and efficacy in a developing country. PMID:21736582

Longitudinal analysis on utilization of medical document management system in a hospital with EPR implementation.

PubMed

Kuwata, Shigeki; Yamada, Hitomi; Park, Keunsik

2011-01-01

Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR.

Antimicrobial agent prescription patterns for chemotherapy-induced febrile neutropenia in patients with hematological malignancies at Sultan Qaboos University Hospital, Oman.

PubMed

Al Balushi, K A; Balkhair, A; Ali, B H; Al Rawas, N

2013-06-01

The aim of this study was to describe the antimicrobial prescription patterns of patients with hematological malignancies who developed febrile neutropenia (FN) at Sultan Qaboos University Hospital (SQUH) in Oman. This was a retrospective observational study covering a period of 3 years (January 2007-February 2010). FN episodes were studied in patients with hematological malignancies in three different wards at SQUH. A total of 176 FN episodes were analyzed. Overall, 64% of the 107 patients studied experienced at least 2 episodes during the analysis period. Approximately, 69% of the febrile neutropenia episodes had severe neutropenia. The duration of neutropenia was less than 1 week in the majority of the episodes (57%). The mean duration of treatment was approximately 7 days, with no significant difference between specialties or different types of malignancies. Only 34 (19%) episodes had positive cultures, and most of these were from blood samples (30 episodes, 88%). The majority of isolates were gram-negative organisms (63%). The initial empirical treatment included monotherapy (37%), dual therapy (60%) and triple therapy (3%). This study demonstrates that there is a large variation in the antimicrobial treatment of FN episodes in patients with hematological malignancies at SQUH. All chosen drugs were within international guideline recommendations. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Advantages of type and screen policy: Perspective from a developing country!

PubMed

Aggarwal, Geet; Tiwari, Aseem K; Arora, Dinesh; Dara, Ravi C; Acharya, Devi P; Bhardwaj, Gunjan; Sharma, Jyoti

2018-01-01

The authors' center recently changed their pretransfusion testing protocol from "conventional" type and screen (TS) with anti-human globulin (AHG) crossmatch (Policy A) to TS with immediate-spin (IS) crossmatch (Policy B). Red blood cell (RBC) units were issued after compatible IS crossmatch as and when required instead of AHG crossmatch. This study was conducted to compare the effects of change of policy from A to B over 1-year period on crossmatch-to-transfusion (C/T) ratio, RBC issue turnaround time (TAT), outdating of RBC, man-hours consumption, and monetary savings. This was a comparative, prospective study conducted by the Department of Transfusion Medicine of a tertiary hospital-based blood bank in Northern India. The Policy B was implemented in the department from January 2014. Relevant retrospective data for comparison of the previous 1 year, when Policy A was practiced, were derived from hospital information system. 23909 and 24724 RBC units transfused to patients admitted to the hospital during respective 1-year period of practice for Policy A and B. There was significant reduction in C/T ratio (1.94 vs. 1.01) and RBC issue TAT (79 vs. 65 min) with Policy B. Expiry due to outdating reduced (37 vs. zero) along with man-hours (16% reduction) and monetary (33% reduction) savings. Use of 'TS with IS crossmatch' policy provides multiple advantages to all the stakeholders; blood banker, clinician, patient, and the hospital management.

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

Hasebrook, Joachim; 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

2017-08-02

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. 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. 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. 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. 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. ©Joachim Hasebrook, Klaus Hahnenkamp, Wolfgang F.F.A. Buhre, Dianne de Korte-de Boer, Ankie E.W. Hamaekers, Bibiana Metelmann, Camila Metelmann, Marina Bortul, Silvia Palmisano, Jannicke Mellin-Olsen, Andrius Macas, Janusz Andres, Anna Prokop-Dorner, Tomáš Vymazal, Juergen Hinkelmann, Sibyll Rodde, Bettina Pfleiderer. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 02.08.2017.

Assessing the depth of isoflurane anaesthesia during cardiopulmonary bypass.

PubMed

Ng, Ka Ting; Alston, R Peter; Just, George; McKenzie, Chris

2018-03-01

Bispectral index (BIS) and monitoring of end-tidal concentration may be associated with a reduction in the incidence of awareness during volatile-based general anaesthesia. An analogue of end-tidal concentration during cardiopulmonary bypass (CPB) is measuring exhausted isoflurane concentration from the oxygenator as an estimate to blood and, so, brain concentration. The aim of this study was to determine the relationships between oxygenator exhaust and blood concentrations of isoflurane and the BIS score during CPB when administering isoflurane into the sweep gas supply to the oxygenator. Seventeen patients undergoing elective cardiac surgery using CPB and isoflurane with BIS monitoring were recruited in a single-centre university hospital. Isoflurane gas was delivered via a calibrated vaporiser at the beginning of anaesthetic induction. Radial arterial blood samples were collected after the initiation of CPB and before aortic cross-clamping, which were analysed for isoflurane by gas chromatography and mass spectrometry. The BIS score and the concentration of exhausted isoflurane from the oxygenator membrane, as measured by an anaesthetic gas analyser, were recorded at the time of blood sampling. The mean duration of anaesthetic induction to arterial blood sampling was 90 min (95%CI: 80,100). On CPB, the median BIS was 39 (range, 7-43) and the mean oxygenator exhaust isoflurane concentration was 1.24 ± 0.21%. No significant correlation was demonstrated between BIS with arterial isoflurane concentration (r=-0.19, p=0.47) or oxygenator exhaust isoflurane concentration (r=0.07, p=0.80). Mixed-venous blood temperature was moderately correlated to BIS (r=0.50, p=0.04). Oxygenator exhaust isoflurane concentration was moderately, positively correlated with its arterial concentration (r=0.64, p<0.01). In conclusion, in patients undergoing heart surgery with CPB, the findings of this study indicate that, whilst oxygenator exhaust concentrations were significantly associated with arterial concentrations of isoflurane, neither had any association with the BIS scores, whereas body temperature has moderate positive correlation.

The cost-effectiveness of predonation screening for transfusion transmissible infections using rapid test kits in a hospital-based blood transfusion centre.

PubMed

Dosunmu, Adedoyin Owolabi; Akinbami, Akinsegun Abduljaleel; Ismail, Ayobami Kamal; Olaiya, Modupe Adebimpe; Uche, Ebele Ifeyinwa; Aile, Igbinoba Kingsley

2017-01-01

Blood transfusion practice emphasises safety, efficacy and appropriate use. These require cost-effective programme management. This study focused on the cost of screening for transfusion transmissible infections (TTI). This was a 1 year (2016) analysis of screening in a hospital-based transfusion centre. The cost of screening all blood donors by ELISA was compared to the cost of serial screening starting from rapid kit, taking into account, the estimated cost of blood bags prevented from discard after ELISA screening (attributable cost). The cost of voluntary donor drive plus cost of ELISA screening was compared with the present cost of screening. A total of 5591 donors were screened for HIV, hepatitis B and C using the rapid kit, 291 donors were deferred (5.2%). A total of 5300 units were further screened by ELISA. A total of 435 blood units (8.2%) were discarded due to TTI positivity. TTI positivity rate was 12.98%. Only 2.36% were voluntary donors and among these 9.1% were TTI positive. The attributable cost of serial screening was 55,653.5 USD while that of screening by ELISA only was 55,910 USD. The attributable cost of rapid screening for only hepatitis B and then ELISA was 53,313.9 USD taking into consideration that 187 blood units would be prevented from undue discard. This analysis demonstrated that with proper donor selection, rapid screening for hepatitis B virus only before ELISA screening is more cost-effective. This will also reduce the waiting time for donors and counselling if HIV positive.

Pediatric Critical Care Telemedicine Program: A Single Institution Review.

PubMed

Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P

2016-01-01

Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

Oral mucosal diseases in children - casuistics from the Department of Dermatology - University of São Paulo - Brazil.

PubMed

Erthal, Aline; Lourenço, Silvia Vanessa; Nico, Marcello Menta Simonsen

2016-01-01

There are no studies about pediatric oral mucosal diseases performed by dermatologists in Brazil. This study presents the casuistics of oral mucosal diseases in children examined at the Oral Diseases Clinic at the Department of Dermatology - University of São Paulo - Brazil. Cases were retrospectively studied from the hospital records from 2003 to 2015. A hundredsix children have been examined. Commoner lesions examined included mucoceles and aphthae. Rare and difficult cases were also seen and have been published; this clinic is based in a tertiary hospital center that deals mostly with complex cases.

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions.

PubMed

Abbott, Tom E F; Torrance, Hew D T; Cron, Nicholas; Vaid, Nidhi; Emmanuel, Julian

2016-11-01

The utility of an early warning score may be improved when used with near patient testing. However, this has not yet been investigated for National Early Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone. This was a prospective cohort study of adult medical admissions to a single-centre over 20days. Blood gas results and physiological observations were recorded at admission. NEWS was calculated retrospectively and combined with the biomarkers in multivariable logistic regression models. The primary outcome was a composite of mortality or critical care escalation within 2days of hospital admission. The secondary outcome was hospital length of stay. After accounting for missing data, 15 patients out of 322 (4.7%) died or were escalated to the critical care unit. The median length of stay was 4 (IQR 7) days. When combined with lactate or base excess, NEWS was associated with the primary outcome (OR 1.18, p=0.01 and OR 1.13, p=0.03). However, NEWS alone was more strongly associated with the primary outcome measure (OR 1.46, p<0.01). The combination of NEWS with glucose was not associated with the primary outcome. Neither NEWS nor any combination of NEWS and a biomarker were associated with hospital length of stay. Admission NEWS is more strongly associated with death or critical care unit admission within 2days of hospital admission, compared to combinations of NEWS and blood-gas derived biomarkers. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care.

PubMed

Seow, Lee Seng Esmond; Chong, Siow Ann; Wang, Peizhi; Shafie, Saleha; Ong, Hui Lin; Subramaniam, Mythily

2017-04-01

Metabolic syndrome (MetS) and cardiovascular risk are highly prevalent among individuals with schizophrenia. This study aimed to determine the cardiometabolic profile and the associated risk factors in a group of institutionalized patients with schizophrenia or schizoaffective disorder receiving prolonged hospital care in the only tertiary psychiatric institution in Singapore. Patients residing in long stay wards who were hospitalized for a minimum period of 1year were recruited. Fasting blood sample was collected to obtain levels of blood glucose, total cholesterol, high-density lipoprotein (HDL) and triglycerides. Waist circumference, blood pressure, height and weight were also measured. The prevalence of MetS and the 10-year cardiovascular risk were determined. This inpatient group had a mean age of 56.1years and an average length of hospitalization of 8.8years. The prevalence of MetS in this group was 51.9% and 26.9% based on the AHA/NHLBI and modified NCEP ATP III criteria respectively. Those in the high risk BMI category and those who had pre-existing diabetes had higher odds of MetS. Their 10-year cardiovascular risk was estimated at 12.8%, indicating intermediate risk based on the Framingham risk function. Despite the low smoking rate in this group of inpatients, their cardiovascular risk appeared to be relatively high possibly due to old age and age-related conditions such as hypertension and low HDL. While literature has found the use of atypical antipsychotic medications to increase the risk of MetS, we did not find any significant association. Additionally, the duration of hospitalization did not affect the rate of MetS in our sample. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study.

PubMed

El Hachem, Lena; Andikyan, Vaagn; Mathews, Shyama; Friedman, Kathryn; Poeran, Jashvant; Shieh, Kenneth; Geoghegan, Michael; Gretz, Herbert F

2016-01-01

To assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. Retrospective case-control study (Canadian Task Force classification II-2). University-affiliated community hospital. Female patients undergoing RSS or CL gynecologic procedures. Comparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Patient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p < .001), and the average total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p < .001). Although RSS surgery and CL have comparable clinical outcomes in selected patients, RSS surgery remains associated with increased incremental disposable cost per case and total hospital charges. Careful case selection and judicious use of equipment are necessary to maximize cost-effectiveness in RSS gynecologic surgery. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Relation between ultra-sensitive C-reactive protein, diabetes and periodontal disease in patients with and without myocardial infarction.

PubMed

Arregoces, Francina Escobar; Uriza, Catalina Latorre; Porras, Juliana Velosa; Camargo, Maria Beatriz Ferro; Morales, Alvaro Ruiz

2014-06-01

The purpose of this study was to evaluate the impact of diabetes and periodontal disease in us-CRP, an inflammatory marker in patients with and without acute myocardial infarction (AMI). A case-control study was conducted in 401 subjects aged between 30 and 75 years, living in Bogotá D.C. (Colombia). Patients arriving at the emergency room of the San Ignacio University Hospital with AMI were included into the case group. The control group was defined as those subjects without AMI. The following blood tests were performed: complete blood count (CBC), glycemia, total cholesterol, triglycerides, cHDL, cLDL, and us-CRP. Patients with infections or antibiotic treatment within the last three months, who had received periodontal treatment within the six months prior to the study entry, had oral ulcerations, or less than seven teeth were excluded from the study. Periodontal disease was diagnosed based on the 1999 Armitage's classification. The mean us-CRP value found in diabetic patients with severe chronic periodontitis was 5.31 mg/L (SD 6.82), and 2.38 mg/L (SD 4.42) in non-diabetic patients, being statistically significant (p = 0.000). Diabetes had an impact in periodontal disease and us-CRP. In patients with AMI, DM and PD considerably increased the us-CRP.

Addressing the challenges of ECMO simulation.

PubMed

Alinier, Guillaume; Hassan, Ibrahim Fawzy; Alsalemi, Abdullah; Al Disi, Mohammed; Ait Hssain, Ali; Labib, Ahmed; Alhomsi, Yahya; Bensaali, Fayçal; Amira, Abbes; Ibrahim, Abdulsalam Saif

2018-05-01

The patient's condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants' suspension of disbelief. This is especially relevant to ECMO SBE as circuit/patient interactions are difficult to fully simulate without confusing circuit alterations. Our efforts concentrate on making ECMO simulation easier and more realistic in order to reduce the current gap there is between SBE and real ECMO patient care. Issues to be overcome include controlling the circuit pressures, system failures, patient issues, blood colour and cost factors. Key to our developments are the hospital-university collaboration and research funding. A prototype ECMO simulator has been developed that allows for realistic ECMO SBE. The system emulates the ECMO machine interface with remotely controllable pressure parameters, haemorrhaging, line chattering, air bubble noise and simulated blood colour change. The prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants. Future developments will encompass the patient cannulation aspect.

[Effects of the ISO 15189 accreditation on Nagoya University Hospital].

PubMed

Yoshiko, Kenichi

2012-07-01

The Department of Clinical Laboratory, Nagoya University Hospital acquired ISO 15189 accreditation in November, 2009. The operation of our Quality Management System (QMS) was first surveyed in October, 2010. In this paper, we reported the activity for the preparation and operation of our QMS and the effects of ISO 15189 accreditation. We investigated the changes in the number and content on nonconformities, incident reports and complaints before and after accreditation as indicators to evaluate the effect of ISO 15189 accreditation. Post accreditation, the number of nonconformities and incident reports decreased, seeming to show an improvement of quality of the laboratory activity; however, the number of complaints increased. We identified the increase of complaints at the phlebotomy station. There had been some problems with blood sampling in the past, but it seemed that staff had a high level of concern regarding these problems at the phlebotomy station and took appropriate measures to resolve the complaints. We confirmed that the ISO 15189 accreditation was instrumental in the improvements of the safety and efficiency on laboratory works. However there was a problem that increase of overtime works to operate the QMS. We deal with development of a laboratory management system using IT recourses to solve the problem.

Human polyomavirus 9 in immunocompromised patients in the University Hospital in Hradec Kralove, Czech Republic.

PubMed

Fajfr, Miroslav; Pliskova, Lenka; Kutova, Radka; Matyskova-Kubisova, Michaela; Navratil, Pavel; Radocha, Jakub; Valenta, Zbynek; Dusilova-Sulkova, Sylvie

2017-12-01

Human polyomaviruses such as JC polyomavirus and BK polyomavirus have long been well known pathogens of immunocompromised patients. Several new members of this viral family have been described during the last decade. Human polyomavirus 9 seems to be a novel pathogen of transplanted patients according to some studies. The aim of our study was to determine the presence of human polyomavirus 9 in patients after kidney or stem cell transplantation (SCT) at the University Hospital in Hradec Kralove, Czech Republic. Overall 100 patients, 65 after kidney transplantation and 35 after SCT, were included into the study. At least three follow-up samples from each patient were examined for human polyomavirus 9 DNA presentation with the two previously described in-house PCR protocols. Despite the frequent reactivation of human CMV (14.3% in kidney transplantation and 63.3% after SCT) or BK polyomavirus in our patient group, there was no positivity for human polyomavirus 9 either in blood samples or urine samples. One of the possible reasons for this discrepancy versus previous published studies could be a relatively low proportion of patients treated by induction therapy before kidney transplantation in our study cohort. © 2017 Wiley Periodicals, Inc.

Molecular detection and identification of enteroviruses in children admitted to a university hospital in Greece.

PubMed

Siafakas, Nikolaos; Attilakos, Ahilleas; Vourli, Sofia; Stefos, Efstathios; Meletiadis, Joseph; Nikolaidou, Polyxeni; Zerva, Loukia

2011-01-01

Although enteroviral infections occur frequently during childhood, the circulation of particular serotypes has never been studied in Greece. The objectives of the present report were molecular detection and identification of human enteroviruses in children admitted with nonspecific febrile illness or meningitis to a university hospital during a 22-month period. A one-step Real-Time RT-PCR protocol was used for rapid enterovirus detection in genetic material extracted directly from clinical samples, and a sensitive reverse transcription-semi-nested PCR targeting part of the VP1-coding region was used for genotypic identification of the different serotypes. Twenty-one enterovirus strains were detected and identified in 20 stool samples, one cerebrospinal fluid (CSF) sample, one whole blood sample and one throat swab from 21 out of 134 febrile patients (15.7%). Ten strains belonged to Human Enterovirus Species B (HEV-B) (six serotypes) and eleven to HEV-A (four serotypes). Most of the strains were closely associated with virulent strains circulating in Europe and elsewhere. Detection of the emerging pathogen enterovirus 71 for a first time in Greece was particularly important. Copyright © 2011 Elsevier Ltd. All rights reserved.

Audit of compliance with the British Committee for Standards in Haematology (BCSH) revised guidelines for the diagnosis and assessment of treatment response of hairy cell leukemia in University Hospital Galway.

PubMed

Velazquez-Kennedy, K; Crowe, C; Craven, B; Walsh, J; Prendergast, C; Krawczyk, J

2017-05-01

Hairy cell leukemia (HCL) is an uncommon B cell lymphoproliferative disorder. The object of the present audit was to assess whether the investigation and management of HCL in University College Hospital Galway (UCHG) complies with the British Committee for Standards in Haematology (BCSH) guidelines. Following a review of the records in our Haematology Department, 18 cases of HCL were identified between January 2006 and October 2014. Blood film examination had been performed in all cases. Flow cytometry of liquid material had been undertaken in 89 % (n = 16) of cases, of which only 31 % (n = 5) included all four hairy cell panel markers (CD11c, CD25, CD103, CD123). Although all initial trephine biopsies included CD20, none analyzed DBA44. Only 65 % (n = 11) of treated patients had a post-treatment bone marrow biopsy preformed. This audit highlights areas of improvement in the diagnosis and management of HCL in UCHG, which do not currently adhere to the BCSH recommendations.

Determinants in Adolescence of Stroke-Related Hospital Stay Duration in Men: A National Cohort Study.

PubMed

Bergh, Cecilia; Udumyan, Ruzan; Appelros, Peter; Fall, Katja; Montgomery, Scott

2016-09-01

Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke. Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first. Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45). Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors. © 2016 American Heart Association, Inc.

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.

Introduction for "Reiki at University Medical Center, Tucson, Arizona, a magnet hospital": Mega R. Mease is interviewed by William Lee Rand.

PubMed

Vitale, Anne

2011-01-01

There is a sustained interest in the use of Reiki among US consumers and health care providers and lay practitioners alike. As a result, hospitals and other health care institutions are incorporating Reiki into patient care services toward the promotion of caring-healing environments. Variations in hospital-based program structures with Reiki are possible and can enhance the use of Reiki into traditional care settings.

Hospital enterprise Architecture Framework (Study of Iranian University Hospital Organization).

PubMed

Haghighathoseini, Atefehsadat; Bobarshad, Hossein; Saghafi, Fatehmeh; Rezaei, Mohammad Sadegh; Bagherzadeh, Nader

2018-06-01

Nowadays developing smart and fast services for patients and transforming hospitals to modern hospitals is considered a necessity. Living in the world inundated with information systems, designing services based on information technology entails a suitable architecture framework. This paper aims to present a localized enterprise architecture framework for the Iranian university hospital. Using two dimensions of implementation and having appropriate characteristics, the best 17 enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts' inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was written accordingly to distinguish the necessity of those characteristics using expert's opinions and Delphi method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen regarding having appropriate characteristics and the ability to be implemented among reference formats. In the next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For determining architecture framework parts, a questionnaire with 145 questions was written based on literature review and expert's opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were chosen and certified to be used in the hospital. The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and 11 parts. This new model could be used to be performed in other Iranian hospitals. Copyright © 2018 Elsevier B.V. All rights reserved.