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Long-term hospitalization of nonorganic failure-to-thrive infants: patient characteristics and hospital course.

Hospitalization remains an available treatment option for nonorganic failure-to-thrive (NOFT) infants, even though it separates an infant from his/her caregiver and may further weaken an already impaired caregiver-infant attachment. Long-term hospitalization as an intervention for NOFT has been noted, but not documented, in previous reports in the literature. The present study describes patient characteristics, growth in hospital, and length of stay among a group of NOFT infants referred for and treated through long-term hospitalization. The study also investigated the effects of an additional family-oriented outpatient intervention program on hospital course and discharge planning for these infants. Results of the study found that NOFT infants referred for extended hospitalization were an impoverished group, with the majority showing below average development functioning. One-third presented with "interactional" failure-to-thrive, in which biological vulnerability coexisted with, but was not causative of, the infant's poor growth. Infants averaged 18 weeks in hospital, but lengths of stay differed, dependent on the presence of an outpatient treatment group and additional medical problems with both factors reliably associated with shorter lengths of stay. Infants in county welfare custody who did not receive additional outpatient intervention were also more likely to be placed outside the parental home at discharge.

Analysis of Variance↗

[Care of patients with cerebrovascular disorders in the health service area of one of Warsaw's neurological hospital departments. I. Hospital admissions].

A group of patients hospitalized in the period from Oct 1 1978 to March 31 1980 for cerebrovascular disease was analysed in a Warsaw neurological hospital department. It was estimated that in this time period the annual number of patients admitted with acute and subacute episodes of cerebral circulatory failure was 90 per 100 thousand of the population in the catchment area of the hospital. About one-fifth of all admissions were due to haemorrhagic strokes, in 40% of cases ischaemic stroke was diagnosed, in 16% the character of stroke was unrecognized, 9% had transient brain ischaemia, and 15% had other vascular syndromes. The mean duration of hospital stay of the admitted patients was about 29 days, and that of the discharged patients was 38 days. The mortality was 40%. Differences were found in the index of admissions, pattern of diagnoses and mortality between patients from the catchment area and those from a more distant area, which may suggest a bias in the admissions of cerebrovascular disease cases indicating that the availability of the services of the hospital department depends on organizational factors such as distance of the place of residence from the hospital and connections between inpatient and outpatient health services. It may be estimated that in that time period the department admitted not more than 50-60% of stroke cases from its catchment area, including 60-80% from the city district near the hospital and 30% from a more distant districts.

Adult↗

Subjecting hospitals to truth in lending disclosure requirements: Bright V. Ball Memorial Hospital.

The federal Truth in Lending Act requires creditors to comply with complex disclosure requirements whenever they engage in consumer credit transactions. In light of procedures adopted by hospitals and health care professionals which permit payment for services over time, there is some question as to whether these groups may be considered creditors within the meaning of the Act and therefore subject to the Act's disclosure requirements. In Bright v. Ball Memorial Hospital, the Court of Appeals for the Seventh Circuit concluded that a hospital can be a creditor with respect to certain hospital-patient transactions. However, the court found that the defendant had not consummated consumer credit transactions with the plaintiffs and consequently had not violated the Act by failing to make disclosures. This Case Comment contends that although the court correctly determined that a hospital, in certain circumstances, may be subject to the Act, it incorrectly held that Ball Memorial failed to consummate consumer credit transactions with the plaintiffs. This Case Comment also discusses the circumstances under which a hospital should be considered a creditor for purposes of the Truth in Lending Act and recommends that hospitals offering installment payment plans routinely comply with disclosure requirements of the Act.

Accounting↗

Hospital performance in multihospital systems: a comparative study of system and independent hospitals.

Hospital costs and productivity in multihospital systems versus those of independent hospitals are a major source of debate among health care providers and researchers. Previous studies have shown system hospitals perform better than independent hospitals. The evidence, however, has been limited to only a few nonprofit systems. To help fill this research gap, approximately 100 system hospitals from 14 systems and 4 ownership types are compared with approximately 50 independent hospitals using cost and productivity data from one year. The results show that system hospitals realize both significantly higher cost and higher productivity levels, except for county-owned facilities which have lower costs and insignificantly different productivity levels. Factors that help explain these results are discussed and directions for further research are suggested.

Bed Occupancy↗

[A problem of hospital infection: conclusions from a practice in n German hospitals].

The aim of this publication is to focus on a worldwide problem of hospital infections, that exists not only in Poland but also in other countries around the world. Authors tried to mention not only an epidemiologic and a financial aspect of hospital infections, but also the possible ways of fighting them. In Germany, problems of a sterilization, disinfection and hospital hygiene are of the same importance as are the diagnostics and medical treatment. About 4.5-12 percent of patients in Germany hospitals are treated because of hospital infections (like in the USA). Authors hope that newly established Polish Society of Hospital Infection will help not only in the exchange of experiences but will also coordinate the measures aimed at the improvement of hygiene status of Polish hospitals.

Disinfection↗

Evaluation of hospital diets in five hospitals at Dhaka city.

The study was undertaken to assess the prevalent situation of diets provide to different types of patients in five hospitals at Dhaka. Calorie content of foods supplied to the patients was about 50% of the calorie that was mentioned on diet menus for different hospitals. The patients intake of food supplied by the hospital was very low. Except BIRDEM, majority of the patients in other hospitals were not satisfied with different types of foods supplied to them by the hospitals. Calorie, carbohydrate, protein, vegetable fat, iron and calcium intake by the patients differ significantly (p = 0.03-0.001) in different hospitals. The hospital diet is imbalanced to met therapeutic need.

Bangladesh↗

[The annual incidence and mortality associated with hospital infections of the lower respiratory tract in a regional hospital].

BASIR. The incidence and the associated mortality to lower respiratory tract nosocomial infections (LRTI) were studied in a small regional hospital to evaluate if the different structural complexity of hospitals has some repercussions on the morbidity and the mortality of those infections. MATERIAL AND METHODS. The study was carried out in Calatayud hospital, a small regional hospital of 122 beds belonging to Health Area III of Aragón. All LRTI that occurred during 1992 were recorded by means of a prospective surveillance system based on a daily revision of hospital medical records. The accumulated incidence of LRTI (AI-LRTI), the accumulated incidence of infected patients (AIIP) and the associated mortality rate (AMR) were used as morbidity and mortality indicators of LRTI. The relative effect of the exposition to some variables on morbidity and mortality was estimated by means of the odds ratio (OR). RESULTS. Altogether, 64 LRTI were detected in 63 patients during the period of study, accounting for 21% of all nosocomial infections of the whole year and supposing an AI-LRTI and an AI IP of 1.5 cases per 100 patients admissions. The incidence was bigger in males (OR = 1.7), in older than 70 years (OR = 3.7) and in patients that were admitted in services of general surgery (AI-LRTI = 3.8%) and traumatology (AI-LRTI = 2.1%). The AMR to LRTI was 24%, accounting for 12% of hospital global mortality during that year. CONCLUSIONS. Results point out that LRTI could be an important cause of nosocomial morbidity and associated mortality also in small hospitals. It would be required that in this sort of centers, depending of the more frequent kind of LRTI, suitable precautions were adopted systematically to avoid as far as possible the emergence of LRTI and their negatives consequences.

Adolescent↗

Hospital stay due to various hysterectomies, caesarean section and normal delivery in Turku University Central Hospital area from 1983 to 1992.

The optimal length of hospital stay in obstetrics and gynaecology has recently been much debated, as short hospitalisation times being commonly introduced as alternatives to conventional hospitalisations. The hospital stay for major gynaecological and obstetric surgery as well as normal delivery was studied in the hospitals working in area of the Turku University Central Hospital (population approximately 750,000). In the six studied hospitals the mean hospital stay for abdominal and vaginal hysterectomy decreased during the 1980s by one fifth. In 1992, the mean hospitalisation for hysterectomy varied from 7.4 to 8.3 and from 9.0 to 9.1 days, for abdominal and vaginal hysterectomy, respectively, and that of caesarean section from 8.1 to 8.6 days. The number of days in hospital required for normal delivery was 4.4-6.2 days. These figures are similar to the corresponding national average in Finland, but they also show that the discharge in our country occurs some 2 to 3 times later than what has recently been reported, e.g. from the U.S.A. Consequently, we find that there is a need for a prospective trial to find out how rational short hospitalisation is in the field of obstetrics and gynaecology in Finland.

Adult↗

[Continuity of care during hospital and after hospitalization for the patients with stroke. Comparing the level of independence in ADL and care needs].

Thanks to the advancement of medical technology, there has been a significant decline in stroke mortality in Japan. This means that many stroke victims could gain additional years of survival with several disabilities. It is necessary that nurses assist these disabled patients upon discharge for shifting smoothly from the hospital to the home. The purpose of this study was to clarify the factors of continuity of care for the disabled patients who has had a stroke, between hospital and community. The 504 patients who were discharged from the Kanagawa Prefectural Rehabilitation hospital and were in need of visiting nursing services upon their discharge were selected in this study. The survey was conducted through discharge summaries and visiting nursing reports. The data were compared at discharge with the first nursing visit with respect to the level of independence in activities of daily living (ADL) and their care needs. The results were summarized as follows: 1. As for the functional level of ADL, most patients remained unchanged. Feeding was improved; however, grooming (including bathing), using the toilet, and dressing were worse. Hence, hospital nurses should strongly educate the patients and repeat ADL so that dressing is a rehabilitation exercise itself. Also, nurses, prior to discharge, should consider dealing with the housing problems, especially in the bathrooms and washrooms, due to the patients' physical disabilities. Nurses should pay particular attention to the aged group upon the continuity of care since their level of independence in walking changed variously among individuals. 2. Hospital nurses identified nursing problems mostly in the physical aspects, whereas public health nurses did it in terms of family-caregivers and social resources rather than physical needs. The reasons why nursing problems did not correspond between hospital nurses and public health nurses were probably owing to the differences in their practice settings, job content, and working conditions between the hospital and community. Thus, both nurses should reciprocally provide one's information and introduce other's information in order to understand and employ the other's standpoints.

Activities of Daily Living↗

Why are children hospitalized? The role of non-clinical factors in pediatric hospitalizations.

OBJECTIVE: Pediatric medical discharge rates vary widely across hospital service areas, beyond differences explained by chance or disease incidence alone. This study examines the relationship between the characteristics of local medical services and the likelihood of hospitalization. DESIGN: Small area and population-based regression analysis. SETTING: The 72 hospital service areas of Maine, New Hampshire, and Vermont. STUDY POPULATION: The 589,290 (1989) children of Maine, New Hampshire, and Vermont < 15 years of age with 120,806 discharges during 1985 through 1989. MEASUREMENT AND MAIN RESULTS: Using logistic regression and controlling for community income, we found that children residing in zip codes with high per capita bed supply (4.0/1000) had 9% more discharges (odds ratio: 1.09; 99% confidence interval: 1.07, 1.11) compared with children in areas with low per capita bed supply (1.9/1000). Children living 30 minutes from the nearest hospital had 15% fewer medical discharges (odds ratio: 0.849; confidence interval: 0.830, 0.867) than those living in a zip code with a hospital. Residence in one of the three academic medical center hospital service areas resulted in 32% fewer discharges (odds ratio: 0.68; confidence interval: 0.66, 0.70). Similar and statistically significant (P < .01) results were noted for the most common nonperinatal diagnostic categories: asthma/bronchitis (diagnostic related group = 98) and gastroenteritis (diagnostic related group = 184). No effect was noted for femur fracture, a condition for which admission rates equal disease incidence. CONCLUSIONS: The supply and character of medical care are important influences on the likelihood of hospitalization for pediatric medical conditions for which outpatient alternatives are available.

Adolescent↗

Responding to domestic violence: a coordinated response by a consortium of teaching hospitals. Domestic Violence Task Force, Conference of Boston Teaching Hospitals.

Increasingly, health care providers are recognizing their role in the struggle against domestic violence. Although individual institutions around the country have developed protocols and programs in conjunction with community providers, there has been no unified health care effort. In May 1995, the Conference of Boston Teaching Hospitals (COBTH)--a collaborative body of the 14 academic hospitals and medical centers in the Boston area--formed the COBTH Domestic Violence Task Force. This task force, chaired by the president of Children's Hospital, represents the first time that hospital administrators and clinical staff have joined forces to deal with this issue. Critical to this effort were (1) the recognition that the hospitals have a responsibility to respond to patients as well as employees who are battered, (2) that in order for this work to move forward and become integrated into hospital systems, the involvement of senior medical staff and management is necessary, (3) that training and education must be ongoing and penetrate all levels of staff, and (4) that this work must be collaborative, with hospital staff working across disciplines and with community service providers. This paper outlines the year-long work of this Committee, including specific objectives and recommendations.

Boston↗

[Program of Medical Information System and diseases of the respiratory tract (CMD, No.4). Study of 1,020 hospital stays out of the total of 18,253 hospitalizations at the Centre Hospitalier de Saint-Gaudens in the framework of the National Study of Costs].

OBJECTIVE: To analyse hospital activity, the characteristics and course of patients having been classified, by the programme of medical information system (French PMSI) in the major diagnostic category of respiratory disorders (CMD n(o) 4). STUDY: Using the files created by Saint-Gaudens Hospital (145 acute beds, 7000 annual admissions) for three years within the context of the national study of the cost of medical activity. A descriptive statistical analysis then an explanation of the variations of consumptions by stay and by patient. RESULTS: In CMD n(o) 4 there were 26 homogeneous groups of patients (GHM) representing 1020 hospital admissions (out of a total of 18,253) of whom 76 were admitted as an emergency, 63 were in the thoracic medicine group and 27 had a spell in intensive care, 73% were discharged home and 9.8% died. CMD n(o) 4 represented 9% of the hospitals synthetic activity index (ISA). Of these 822 patients had a mean age of 70, 60% of them had chronic disease and 20% were living alone. The variations of cost had been explained by GHM (P < 0.001), test of variants [ANOVA]) as well as by complementary indicators (performance status WHO) and a simplified index of severity. Men, elderly subjects and those with chronic disease consumed more. Hospital activity determined from CMD n(o) 4 has been compared to an extraction of stays based on pure diagnostic medicine (thoracic medicine) of the principal disorder: important differences were apparent, explained in large part by the method of admission, by the PMSI, respiratory tumours and ambulatory care. CONCLUSION: An analysis of activity in thoracic medicine has been able to give an over view of the hospital with the reserves linked to the system which were essentially economic and should be able to be compensated by later improvements seeking to give a more medical aspect to the description of hospital stays.

Adult↗

Allogeneic blood transfusion, hospital charges, and length of hospitalization: a study of 487 consecutive patients undergoing colorectal cancer resection.

OBJECTIVE: To investigate the independent association of allogeneic blood transfusion with longer hospital stays and higher hospital charges, after adjustment for the effects of confounding factors that are related to both these outcomes and the receipt of a perioperative transfusion. DESIGN AND METHODS: The records of 487 consecutive patients undergoing colorectal cancer resection and assigned a diagnosis-related group code between 146 and 149 were reviewed. The influence of allogeneic transfusion in explaining the variation in the observed length of stay and total hospital charges was calculated after adjustment for the effects of 20 confounding factors that related to severity of illness, difficulty of operation, and risk of postoperative infection. RESULTS: Length of stay (mean +/- SE) was 16.7 +/- 0.81 days in the transfused group, compared with 10.3 +/- 0.26 days in the untransfused group (P < .0001); hospital charges were $28101 +/- 1121 and $15978 +/- 265, respectively (P < .0001). After adjustment for the effects of 20 confounding factors, length of stay increased by 1.3% (95% confidence interval 0.5% to 2.1%) per unit of red blood cells and/or platelets transfused (P < .001), and hospital charges increased by 2.0% (95% confidence interval, 1.4% to 2.6%) per unit (P < .001). CONCLUSION: Allogeneic transfusion was independently associated with longer hospital stays and higher hospital charges. This association may be due to a relationship between allogeneic transfusion and a higher incidence of septic complications of surgery or may reflect the function of blood transfusion as a surrogate marker for severity of illness.

Aged↗

Future directions: alternative approaches to traditional hospital care-home hospital.

The acute hospital may be a difficult environment for many older patients and is an expensive site of care for payers. Home hospital is an emerging model of care that allows an older person with acute medical illness to avoid an inpatient hospital admission by bringing the critical elements of hospital care to the home. Challenges associated with the development and study of home hospitals as well as several specific home hospital models are reviewed. The need for continued study and the potential of home hospital are discussed.

Aged↗

[Treating mother and baby in conjoint hospitalization in a psychiatric hospital].

Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended.

Adult↗

Neighborhood characteristics and hospital closures. A comparison of the public private and voluntary hospital systems.

This paper analyzes the neighborhood distribution of hospital closures in New York City between 1970 and 1981. Discriminant analysis procedures are used to compare the social, economic and health status characteristics of neighborhoods in which hospitals have closed with those of neighborhoods in which facilities have remained open. The results show that overall hospital closures have had a substantial distributional impact, with facilities in low-income, high infant mortality neighborhoods having the highest rates of failure. Closures of voluntary hospitals occurred most frequently in disadvantaged neighborhoods; whereas municipal and proprietary hospital closures showed no differential neighborhood impact. Implications for the geographical accessibility to various groups to health care and for the efficiency and cost of hospital services are discussed.

Catchment Area, Health↗

Patient and hospital factors associated with disparities in acute stroke treatment in community and academic hospitals.

BACKGROUND: Systemic barriers may affect identification, emergency transportation (EMS), and care coordination for people with stroke. We assessed patient- and hospital-level factors for associations with pre-hospital and emergency department care. We compared trends for patients presenting to an academic medical center (AMC) versus community hospitals (CHs). METHODS: We conducted a retrospective cohort study at an AMC (Tufts Medical Center) with 542 patients aged &#x2265;18&#xa0;years hospitalized with acute ischemic stroke or transient ischemic attack between 1/1/2018-12/31/2020 who presented directly to AMC or presented to AMC as a transfer from initial contact CHs. Primary outcomes were EMS use, stroke code activation, door-to-CT time, and door-to-needle time. RESULTS: AMC patients identifying as non-Hispanic Asian (odds ratio (OR)&#xa0;=&#xa0;0.25; 95% confidence interval (CI)&#xa0;=&#xa0;0.13-0.47) and Hispanic (OR&#xa0;=&#xa0;0.19; 95% CI&#xa0;=&#xa0;0.05-0.72) and CH non-Hispanic Black/African-American patients (OR&#xa0;=&#xa0;0.17; 95% CI&#xa0;=&#xa0;0.05-0.62) were less likely to use EMS compared to non-Hispanic white patients. Patients with non-English primary language were less likely to use EMS (OR&#xa0;=&#xa0;0.38; 95% CI&#xa0;=&#xa0;0.23-0.63) compared to English-speaking patients in both hospital settings. CH Hispanic patients were less likely to have stroke code activation (OR&#xa0;=&#xa0;0.24; 95% CI&#xa0;=&#xa0;0.05-0.86) compared to non-Hispanic white patients. CH patients were less likely to have stroke code activation (OR&#xa0;=&#xa0;0.12; 95% CI&#xa0;=&#xa0;0.07-0.19), had 31% shorter door-to-CT time (95% CI&#xa0;=&#xa0;15-43% shorter), and had 29% longer door-to-needle time (95% CI&#xa0;=&#xa0;5-58% longer). CONCLUSION: Patient-level factors and hospital setting were associated with differences in acute care suggesting opportunities for community outreach on EMS use, interventions to alleviate language barriers, and a need to address systemic biases.

Humans↗

Handwashing practices in Polish hospitals: results of a survey conducted by Polish Society of Hospital Infection.

Handwashing is the most important and least expensive measure for preventing transmission of hospital-acquired infections. Nevertheless, healthcare workers do not seem to understand the risks associated with non-compliance. Thus, compliance is usually poor and rarely exceeds 40%. The Polish Society of Hospital Infection has made a short study of handwashing practices in Polish hospitals as observed by members of infection control teams. The study was based on questionnaires given to infection control workers attending the annual congress of the society. The workers were asked to complete the forms during the congress according to their perceived estimations. Altogether 78 complete questionnaires were analysed. The responding staff members were from hospitals of all sizes, reference levels and regions. Nearly all (95.6%) hospitals had a written protocol for handwashing procedures but according to the estimates of their infection control teams, the compliance rates varied from 20 to 80% although in most institutions was between 40% and 60%. In the vast majority of the hospitals, alcoholic rub preparations were used (70.3%), but in some both handwashing with chlorhexidine in detergents and alcohol-based antiseptics were used in different situations. According to the respondents, the mean time of hand disinfection varied from 1 to 3 min. The handwashing procedures were mostly performed in examination, operating and patients' rooms. Thus, it seems that as in other countries, Polish healthcare workers fail to understand the importance of handwashing.

Anti-Infective Agents, Local↗