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PubMedDate not supplied

Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: a prospective study.

BACKGROUND: Successful treatment of acute myocardial infarction is dependent on early presentation of the patient to the hospital. The factors that contribute to delay in seeking treatment have not been systematically evaluated in the Indian milieu. METHODS: Patients admitted with acute myocardial infarction to a 125-bed urban community hospital were evaluated prospectively. A record of admission characteristics, prior medical history, pre-hospital symptoms and treatment patterns was completed within 48 hours of each admission. Independent predictors of delayed admission were identified by logistic regression. RESULTS: Of 144 consecutive admissions with myocardial infarction, 133 had completed data as per the protocol [mean (SD) age 59 (12.7) years; 79.6% men]. The distribution of presentation times was skewed, with the mode, median and mean being 1, 3 (interquartile range 1.25-11) and 10.9 (SD 20.5) hours, respectively. Seventy-nine patients (59.4%) consulted a general practitioner prior to hospital referral and 48 patients (36.1%) delayed admission to hospital by more than 6 hours from the onset of symptoms. On multivariate analysis, individuals who were initially seen by a general practitioner (OR 5.57; 95% CI 1.84-16.8) and those over the age of 65 years (OR 3.24; 95% CI 1.06-9.89) were identified as 'delayers', while patients with severe symptoms (OR 0.32; 95% CI 0.12-0.87) or prodromal angina (OR 0.25; 95% CI 0.08-0.82) minimized delay. CONCLUSION: Though 50% of patients with acute myocardial infarction present to hospital within 3 hours, about 36% delay seeking treatment by more than 6 hours. Besides age and the pattern and severity of symptoms, visits to the general practitioner were found to be an independent correlate of delay.

Adult↗

PubMed1994

[Towards a sociology of hospitalized populations: Resorting to the hospital in Germany in the early nineteenth century].

Based on a sociological analysis of the populations which were hospitalized in the German academic hospitals during the first half of the 19th century, the purpose of this article is to put into perspective the equivalence which has often been established between penury and hospitalization. Indeed during this period the use of hospitals had not yet spread to all social classes; but numerous signs (such as the rate of activity, the age or the sex of the patients, their geographical origin, the duration of their stay and above all the development of the hospital insurances) shows that the German hospital was in no way only the refuge of indigent and marginal people but an answer to a demand springing from the popular classes as a whole.

Germany↗

PubMedDate not supplied

The influence of hospital culture on rehabilitation team functioning in VA hospitals.

A conceptual model of rehabilitation effectiveness, in which team functioning is influenced by hospital culture, has been previously suggested by several authors of this study. The current study tested the efficacy of the hospital culture portion of the model using survey data from 523 rehabilitation team members and 162 administrators from 50 participating Veterans Administration Hospitals (VAHs). We assessed four types of hospital culture (personal, dynamic, formal, and production-oriented) using an instrument developed originally for a Competing Values Model. Rehabilitation team members and administrators perceived three of the four hospital cultures differently (p < 0.0001), agreeing only on production-oriented culture. With the use of VAH dominant culture as the independent variable, statistically significant differences were found among all nine measures of team functioning (dependent variables). The major contrast was between personal versus formal hospital culture types.

Data Collection↗

PubMed2002

[Registry of heart failure patients hospitalized in 2000. Data from the National College of Cardiology and General Hospital].

The French epidemiological data on cardiac insufficiency in the hospital environment are scarce. A register collecting 1772 patients was produced by the services of the National College of General Hospital Cardiologists (C.N.C.H.G.) during two periods: autumn 1999 (November) and spring 2000 (June). It involved completing a form for each of the first 20 patients with cardiac failure hospitalized over a month. 1011 and 761 observations from 59 and 47 centres (that is 17 and 16 observations per centre) were collected during the autumn and spring periods respectively. In France, in the general hospital centres (CHG) cardiology services during the year 2000, the characteristics and the medical treatment of hospitalized patients with cardiac failure are very similar to those presented in 1998 by A. Cohen-Solal in the name of the working group "Cardiomyopathy and Cardiac Insuficiency of the French Society of Cardiology". The hospitalized patient with cardiac failure is very old, usually male, has an ischaemic cardiopathy in one in two cases, and is at stage II and III on the New York Heart Association (NYHA) scale in 83% of cases. There is practically always an electrocardiographic anomaly. Loop diuretics are prescribed nine times out of ten, digitalis one in three, anagiotensin converting enzyme inhibitors are underused being prescribed two out of three times, but an increase in the prescription of anti-aldosterone and betablockers is found. The majority of patients improve during their stay, 7.8% dying and this mortality is influenced by age, ejection fraction (FE), functional NYHA class, causal cardiopathy, and the existence of severe renal failure. The data collected by the cardiology services of the C.N.C.H.G. are representative of the profile of the population affected and are important to know in order to improve the management of these patients.

Adrenergic beta-Antagonists↗

PubMed2002

[Prevalence of psychiatric disorders by alcohol and other substances abuse in men and women hospitalized in an internal medicine service of a hospital in Santiago de Chile].

BACKGROUND: Studies done in Chile and abroad report a high frequency of substance abuse among patients hospitalized in general medical services. AIM: To report the frequency of substance abuse in a sample of patients hospitalized in a public hospital of Santiago. MATERIAL AND METHODS: A structured psychiatric interview for the Third Revised Version of The Diagnostic and Statistical Manual (DSM-III-R) was applied to 203 males, aged 58.5 years and 203 females, aged 52.9 years, hospitalized in an internal medicine Service of a public hospital. All subjects had a low educational and income level. RESULTS: The discharge diagnoses of studied patients were digestive diseases in 32%, circulatory diseases in 19%, cancer, diabetes mellitus and genitourinary diseases in 11% respectively and mental or behavioral diseases in 5%. Thirty eight percent of males and 6% of females qualified for alcohol dependency or abuse in some moment of their lives. The figures for benzodiazepine dependency were 1% among males and 6% among females. The figures for cannabis, cocaine or stimulant abuse were 1.5% for males and 1% for females. Other conditions of the axis 1 of DSM-IIIR were diagnosed in 47% of males and 65% of females with substance abuse. CONCLUSIONS: Substance abuse underlies medical conditions in a high proportion of patients admitted to medical services in general hospitals.

Adult↗

PubMed2002

Impact of a hospital palliative care service: perspective of the hospital staff.

The first New Zealand hospital palliative care support service was established in 1985. Different service models have now been adopted by various major hospitals. In 1998, a palliative care service, funded by Mary Potter Hospice, was piloted at Wellington Public Hospital. Twelve months post-implementation, the hospital staff's views of the service were evaluated. It was found that referrals to palliative care from hospital specialities outside the Cancer Centre increased. While most doctors, nurses and social workers strongly agreed or agreed that the service positively influenced patients' care and effectively addressed their symptom management needs, spiritual needs were less often met. Over 90 percent of each discipline strongly agreed or agreed that the service had assisted them in caring for patients, but, only about a half agreed that useful discharge planning advice and staff support was provided. Significant differences in responses were found between different disciplines and specialities. One fifth of the staff identified palliative care education needs. Recommendations are made concerning the development of a future hospital palliative care service.

Attitude of Health Personnel↗

PubMed1992

Relation between hospital experience and in-hospital mortality for patients with AIDS-related Pneumocystis carinii pneumonia: experience from 3,126 cases in New York City in 1987.

There is marked debate about whether outcomes of care, particularly mortality, vary as a function of hospital and physician experience with a disease. This issue is especially important with respect to AIDS because greater than 200,000 individuals have now been diagnosed with this disease. We analyzed discharge data for 3,126 persons with AIDS who had Pneumocystis carinii pneumonia and who were treated at one of 73 New York City hospitals in 1987. In-hospital mortality was 25%. Factors associated with higher chances of short-term death were older age, being black, not having private health insurance, and being severely ill. A logistic regression model indicated that after controlling for differences in patient and hospital characteristics, the chances of death decreased when care was given at hospitals with higher caseloads of patients with Pneumocystis carinii pneumonia. Our findings suggest that hospital experience may decrease mortality in this subset of patients with human immunodeficiency virus disease, although it is unknown whether this is due to differences in quality of care.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Prevalence and associated factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Ministry of Health Malaysia (MOH) Hospitals in Kelantan.

Karasek's job strain model postulates that workers chronically exposed to adverse psychosocial work environment (high strain job)--high psychological job demands and low job control, including poor social support, increased physical demand and hazardous work condition--will eventually develop both physical illnesses such as cardiovascular diseases and psychological disorders such as depression. In order to determine the prevalence and associated factors of job-related depression, a cross-sectional study was conducted among laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan between September 2001 and February 2002. One hundred and two laboratory technicians in HUSM and 79 laboratory technicians in 7 KKM Hospitals were selected; 84/102 (82.4%) in HUSM and 71/79 (89.9%) in KKM Hospitals responded. Data was collected using self-administered questionnaires of the validated Malay version of the Job Content Questionnaire (JCQ) originally developed by Robert Karasek. Results indicated that the prevalence of high job strain in laboratory technicians in HUSM and KKM hospitals was 33.3% (28/84) and 26.8% (19/71), respectively (p>0.05). Significantly higher proportion (59.5%) (50/84) of laboratory technicians in HUSM compared to those in KKM Hospitals (39.4%) (28/71) (p = 0.016) experienced job-related depression. Significant associated factors of job-related depression were low social support (HUSM: adjusted OR 4.7, 95% CI 1.2-18.8; KKM: adjusted OR 14.8, 95%CI 2.4-89.3), high psychological demand (HUSM: adjusted OR 3.0, 95%CI 1.0-8.8), and low decision authority (KKM: adjusted OR 9.7, 95%CI 1.0-91.1). We conclude that strengthening the social support network (supervisors' and coworkers' support), reducing psychological job demand, and increasing decision-making authority of laboratory technicians may go a long way towards reducing job-related depression.

Adult↗

PubMed2004

The influence of hospital integration on hospital financial performance.

A clinical and functional integration strategy has a positive influence on increasing hospital revenue, and a solely functional integration strategy has a negative influence on increasing hospital expenses. Functional integration and clinical/functional integration strategies have a positive influence on hospital profit and the overall operations of the hospital. The mechanism of influence differs, however, based on the strategy used. Clinical/functional strategy has an impact on increasing hospital revenue, while functional integration strategy has an impact on reducing hospital expenses. Overall, the study shows that a functional integration strategy is more profitable than a clinical/functional integration strategy.

Delivery of Health Care, Integrated↗

PubMed2005

Concentration and detection of SARS coronavirus in sewage from Xiao Tang Shan Hospital and the 309th Hospital of the Chinese People's Liberation Army.

A worldwide outbreak of severe acute respiratory syndrome (SARS) had been reported. Over 8439 SARS cases and 812 SARS-related deaths were reported to the World Health Organization from 32 countries around the world up to 5 July 2003. The mechanism of transmission of SARS-CoV has been limited only to close contacts with patients. Attention was focused on possible transmission by the sewage system because laboratory studies showed that patients excreted coronavirus RNA in their stools in Amoy Gardens in Hong Kong. To explore whether the stool of SARS patients or the sewage containing the stool of patients would transmit SARS-CoV or not, we used a style of electropositive filter media particle to concentrate the SARS-CoV from the sewage of two hospitals receiving SARS patients in Beijing, as well as cell culture, semi-nested RT-PCR and sequencing of genes to detect and identify the viruses from sewage. There was no live SARS-CoV detected in the sewage in these assays. The nucleic acid of SARS-CoV was found in the sewage before disinfection from both hospitals by PCR. After disinfection, SARS-CoV RNA could be detected from some samples from the 309th Hospital of the Chinese People's Liberation Army, but not from Xiao Tang Shan Hospital after disinfection. In this study, we found that the virus can survive for 14 days in sewage at 4 degrees C, 2 days at 20 degrees C, and its RNA can be detected for 8 days though the virus had been inactivated. In conclusion, this study demonstrates that the RNA of SARS-CoV could be detected from the concentrates of sewage of both hospitals receiving SARS patients before disinfection and occasionally after disinfection though there was no live SARS-CoV; thus much attention should be paid to the treatment of stools of patients and the sewage of hospitals receiving SARS patients.

Bacteriophages↗

PubMed2006

Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. In this rule, we are finalizing additional quality measures for the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures.

Forms and Records Control↗

PubMed1991

[Where is the experience of "Pilot-Hospitals" in hospital hygiene? First approach of a quality label].

The testing of "Pilot-Hospitals", which started in early 1990, is being continued and expanded: the continuous monitoring of cross infections in "Pilot-Hospitals" according to one single methodology, the one recommended by the Council of Europe, has enabled us to record and to analyse 5,389 reports of infections for the year 1990. Urinary tract infection is the most common site of nosocomial infection (36.5%), followed by broncho-pulmonary complications (22%), local complications (15%) and septicaemias (12.2%). Enterobacteria, and especially Escherichia coli, predominate and Staphylococci infections, especially coagulase-negative Staphylococci, increase. According to the wish of the "Académie Nationale de Médecine de France", which required us to establish a Quality Label which could be applied to the various hospitals, "Pilot-Hospitals" are progressively establishing the criteria of this label. At present, eleven criteria have been kept: the first three ones are inherent in the Recommendations of the Council of Europe and require the introduction of a continuous monitoring of nosocomial infections, the setting up of an Infection Control Committee--which meets at least three times a year--, as well as a pluri-disciplinary training scheme. The eight other criteria emphasize the necessity for an operational cell in hospital hygiene, according to the size of the hospital, and determination of a personnel ratio assigned to the cell according to the number of beds occupied and to the type of activity of the department.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗

PubMed1991

[A hospital in a developing country. Experiences from the Sidamo Regional Hospital in southern Ethiopia].

Hospitals can serve as an important complement to Primary Health Care. Therefore it is necessary to undertake periodic reviews of hospital function. We reviewed hospital use and pattern of referral by analyzing 4,797 admissions, at a regional hospital in southern Ethiopia. The main causes of sickness were related to childbirth, gastrointestinal disorders, infectious diseases and injuries. Acute diseases were more common in the younger age-groups. Infections were the main cause of death. Hospital use was inversely proportional to distance from the patient's home, but varied for different groups of patients. Thus, the effect of proximity was more obvious for poor patients, for women, and for children. The study demonstrates limitations in hospital function in third world countries, and recommends closer cooperation between primary and secondary levels of health care.

Developing Countries↗

PubMed1990

[Alcohol withdrawal syndrome at the internal medicine department of a general hospital; epidemiology and hospital costs].

Alcohol withdrawal syndrome (AWS) is an admission problem and can also occur in hospitalized patients. We endeavoured to ascertain the exact epidemiology and hospital cost of AWS based on a review of the charts of patients admitted during 1986, 1987, 1988 (total = 78). The statistical analysis of the differences was performed by chi-square test with a significant level = or less than of 0.05. The results were: total hospital prevalence of AWS = 2.44%, hospital prevalence by season = 3.33% (spring), 2.04% (summer), 2.28% (fall), 2.19% (winter). Outpatients presentation = 79.49%, highlighting fever syndrome of unknown origin (FSUO) (16.4%) and pneumonia (11.48%); hospital presentation = 20.51% focusing acute pancreatitis (31.25%) and pneumonia (25%) as first causes of admission. The significant association between FSUO and spring and winter (84.62%); relation male: female = 5.5: 1; mean age = 42.57 years; decade distributions = 1st decade 0%, second = 1.28%, third = 11.64%, fourth = 35.90%, fifth = 24.36%, sixth = 16.67%, seventh = 8.97%, eighth = 1.28%, ninth = 0%; mean admission time = 14.12 days; total hospital cost of out-patients presentation = 15.087.370 pesetas.

Costs and Cost Analysis↗

PubMed1989

[Trauma and poisoning in children and adolescents in Poland from 1980-1985 in the light of data on hospitalization. II. Territorial differences in hospitalization of children and adolescents in Poland for trauma and poisoning].

The differences between various provinces in the frequency of hospitalizations of children and adolescents in Poland in the years are presented. The data were obtained from the All-Polish study of General Hospital Morbidity. The provinces with the highest hospitalization rates included those of Wałbrzych, Jelenia Góra, Suwałki, and the lowest rates were in the Province of Gdańsk and Province of Rzeszów. A relationship was noted between the number of hospitalized patients and the duration of hospital stay--with longer hospitalization in the areas with low number of such cases.

Adolescent↗

PubMed1989

Recognition of endemic and epidemic prosthetic device infections: the role of surveillance, the hospital infection control practitioner, and the hospital epidemiologist.

Surveillance as a means of identifying endemic and epidemic problems is an established and useful public health practice, which increasingly has been applied to the hospital population. The current practice of hospital infection control surveillance tends to concentrate on acute, in-hospital events. It will miss most longer-term prosthetic device infections, since they will often appear at a distance both in time and place. Currently, case report information is not reliably returned to the hospital or physician responsible for the implantation of the device. Since ongoing analysis of the epidemiologic patterns involved in these cases would seem useful, it is proposed that existing infection control units create, define, and maintain a system of net-working communication to return case data to the hospital of origin. This hospital could then combine these data with its own population data, in the hopes of generating useful epidemiologic information for the future.

Cross Infection↗

PubMed1986

Partial hospitalization. An alternative to inpatient psychiatric hospitalization.

Partial hospitalization programs provide alternatives to traditional inpatient hospitalization. The initial optimism generated by the development of partial hospital programs has been moderated by the realization that it is quite difficult to make changes in mental health care, even though the effectiveness of traditional approaches has not been demonstrated. Research findings about partial hospital programs have provided information that many persons formerly treated as inpatients can be treated in partial hospital programs, probably at an economic savings. Several conceptual models are briefly reviewed for providing direction and rationale to guide thinking, planning, and decision making regarding client care. Continual effort must be given to the development and expansion of useful models and sets of interventions for care directed not only at symptom reduction but toward facilitation of health induction. Partial hospitalization programs have the potential to provide the settings and services to meet this need. Changing times offer nurses new opportunities to consider alternatives for providing psychiatric care. It is a challenge which nurses are well prepared to accept. To ignore the current situation and the needs of clients, families, and communities for these services would be to lose an opportunity for nurses to share a significant role in providing services to psychiatric clients.

Day Care, Medical↗

PubMed1978

Hospital-based patient education programs and the role of the hospital librarian.

This paper examines current advances in hospital-based patient education, and delineates the role of the hospital librarian in these programs. Recently, programs of planned patient education have been recognized by health care personnel and the public as being an integral part of health care delivery. Various key elements, including legislative action, the advent of audiovisual technology, and rising health care costs have contributed to the development of patient education programs in hospitals. As responsible members of the hospital organization, hospital librarians should contribute their expertise to patient education programs. They are uniquely trained with skills in providing information on other health education programs; in assembling, cataloging, and managing collections of patient education materials; and in providing documentation of their use. In order to demonstrate the full range of their skills and to contribute to patient care, education, and research, hospital librarians should actively participate in programs of planned patient education.

Cost-Benefit Analysis↗