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Student participation in a state licensure examination.
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[Rehabilitation of mental disorders].
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Dispatch system eases patient transports.
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Hospital employee-patient relations: a program for enhancing patient well-being.
Hospital service employees are often untrained for the human relations aspects of their jobs. Yet, workers who clean patient rooms, deliver meals, provide escort services, make room repairs, and the like can make a critical difference in the quality of patients' hospital experiences. The Patient Service Ethic Program helps such employees identify typical patient concerns during the course of hospitalization and guides them in ways to respond appropriately to those concerns. At a large teaching hospital where this program has been implemented, employees have responded positively to the caregiver role, and managers have used the program as a catalyst for constructive change.
Assessment of hospital services by consumers: a study from a psychiatric setting.
The present study revealed perception of forty-five patients and fifty nine family members selected from the outpatinet deptt. of a Psychiatric hospital. A semi-structured questionnaire was used. The issues like efficiency, punctuality, behaviour of doctors and other staff, waiting time, supply of draugs and diet and cleanliness of the hospital etc were enquired. More than ninety % of the patients and their escorts appreciated the services provided. Most of them (75-80%) was satisfied with supply of drugs, quality of diet, clinical care and cleanliness of the hospital. Measures for improvement were also suggested.
[The second report on Japanese abroad with psychiatric problems: air transportation of Japanese with mental disorders in western Europe].
This is to report on airline travel processes experienced with two Japanese psychotics (schizophrenic) abroad who were treated by the local consulates of Japan, and escorted by Japanese psychiatrists from April to May in 1989. A comparative analysis was made of the two cases from the following six points of view: psychopathology concerning travel, psychiatric evaluation at the time of travel, access to local psychiatric medical services, trust between the patient and escorting physician, method of administering drugs, and cooperation in strategy with the airline company. Results indicate that the following three points are crucial in the air transportation of Japanese psychotics: 1) Establishment of patient-escorting physician trust relationship, 2) Adequate sedation through sufficient administration of tranquilizers, 3) Establishment of communication and close cooperation with the airline company.
The patient transit assistance scheme: the clerk's perspective.
The Patient Transit Assistance Scheme (PTAS) is an important government program designed to ensure equity of access for residents in rural and remote Queensland to essential healthcare services. Where specialist services cannot be provided at recognised hospitals, PTAS ensures equity by accepting the responsibility for assisting with the transport and accommodation of patients and at times their escort, to locations where such services are available. This article presents research findings on the concerns of clerks involved in administering PTAS for patients with leukaemia and associated haematological disorders. The findings indicate that there are many problems with this scheme that need attention and can be remedied.
Where do persons with blindness caused by cataracts in rural areas of India seek treatment and why?
The utilization of eye care facilities by patients with a cataract was evaluated among 240 patients selected from eye care camps that were conducted by our center. Of the patients, 52.9% had visited previous eye care camps, while 19.2% consulted private ophthalmologists. Easy accessibility, reputation of a facility, competence of its staff, free service, and nearby facilities were the major reasons that were cited by patients for utilization of service facilities. Distance, monetary constraints, and a lack of professional trust, escorts, and the perception about the seriousness of their ocular condition were the main reasons that patients were not motivated to use such service facilities. Statistically significant differences were observed when past utilization of eye care camps was related to age, marital status, and source of income.
Physician Response Unit -- a feasibility study of an initiative to enhance the delivery of pre-hospital emergency medical care.
OBJECTIVES: To describe the rationale, development and initial results of a collaborative pre-hospital pilot project designed to enhance the emergency care needs of an inner city population. METHODS: Retrospective descriptive analysis of emergency calls attended by a rapid response car staffed by a pre-hospital care physician and ambulance service technician or paramedic. RESULTS: Seven hundred and forty-eight consecutive patients over a 13-month period are described. Six hundred and thirty-eight (82%) patients underwent clinical consultation with a physician within 8 min of emergency call. The Physician Response Unit (PRU) also provided an additional vehicle responding to emergency calls, reaching the national 8 min target response time in 638 (82%) of all cases. Two hundred and eighty-nine (39%) of the patients attended had medical therapy initiated by the PRU physician. Nearly two-thirds of this group, 189 (65%), received medical therapy outside current ambulance service protocols. A physician medical escort was provided for 142 (25%) of patients attending hospital. Of all patients seen 577 (77%) attended the emergency department via ambulance, and 136 (18%) patients were assessed, treated and prevented from attending the emergency department. CONCLUSIONS: The PRU provided clinical care beyond that delivered by the ambulance service. It also contributed positively to local ambulance service response times. The service was able to prevent unnecessary ambulance journeys and attendance at hospital. It demonstrates that traditional working practices can be altered to improve the delivery of emergency medical care.
Day-case transfer of inpatients for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography.
BACKGROUND: To use facilities flexibly and efficiently, a diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) service was offered to inpatients from referring hospitals on a day-case basis. METHODS: Patients were transferred by ambulance with a nurse escort and returned to the parent hospital after a short period of recovery. The activity of this service was audited. RESULTS: A total of 188 patients (70 men and 118 women of mean age 63.5 (range 22-94) years) were referred, 55 by physicians or geriatricians and 133 by surgeons from 19 hospitals up to 100 miles distant. Some 109 (58 per cent) had jaundice, 12 (6 per cent) cholangitis, seven (4 per cent) acute pancreatitis and 41 (22 per cent) abdominal pain. All patients arrived between 08:30 and 12:00 hours, all but 16 between 09:30 and 11:00 hours, and all but one with an escort; 129 patients travelled less than 10 miles. The mean time spent in the authors' hospital was 5.9 (range 2.2-9.5) h. The mean time spent away from the parent hospital by patient and escort was 7.0 (range 3.5-10) h. Cannulation failed in 12 patients (6 per cent), two with duodenal tumours. Sphincterotomy was performed in 70 cases, mechanical lithotripsy in seven and stents were inserted in 67. Nine patients were admitted, four for percutaneous stent insertion after failed ERCP and three for abdominal pain (one acute pancreatitis); two patients with sepsis and malignancy died after admission to this hospital. After return to the parent hospital, a further patient died following laparotomy for malignancy and five patients developed abdominal pain (three acute pancreatitis). CONCLUSION: These findings show that short-stay ERCP can be undertaken on transferred inpatients safely and efficiently without adverse effect on success or complication rates.
Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization?
BACKGROUND: It is now well documented that both black and white patients with severe mental illness are likely to use different types of treatment facilities, have different lengths of hospital stays, and receive different types and dosages of psychotropic medications. It is still uncertain, however, whether these differences exist at the early stages of treatment. METHOD: We examined treatment patterns for a countywide sample of patients with psychotic disorders recruited at their initial psychiatric hospitalization. Illness characteristics, prior treatment histories, admission conditions, and psychotropic medication use during this hospitalization were compared for both black and white patients. RESULTS: Black patients were less likely to have had out-patient treatment prior to their first hospitalization and were more likely to be hospitalized in public than in community psychiatric units than were white patients. Black patients were also more likely to be hospitalized primarily for a behavioral disturbance and escorted to the hospital by the emergency medical services or police, while white patients were more often hospitalized primarily for subjective suffering. These patterns were particularly significant for those with a non-schizophrenia diagnosis. However, there were few statistically significant differences between black and white patients on psychotropic medication use during the first hospitalization. CONCLUSIONS: Differences during the early stages of treatment between black and white patients with psychotic disorders appear to arise most prominently before, rather than during, their first hospitalization.
[Helicopter transport of patients from Croatian Adriatic Islands and coastal area in the period from 1996 to 2002].
For most of the Croatian Adriatic islands and coastal area, helicopter is the fastest, and for some remote areas the only effective way of patient transport. In Croatia, most of the aeromedical transports are performed by helicopters of 95th Air Force Base. During the post-war period, the number of civilian patients transported with those helicopters increased from 56 in 1996 to 311 in 2002, this trend continuing in 2003. The majority of these transports were performed in the third trimester of the year, the largest number of patients were transported from the Island of Hvar, and the most common medical indication for aeromedical trasport was trauma. The lack of competent medical escort may have unfavourable impact on patient health and flight safety. The increasing trend in requesting aeromedical transport would obviously justify the foundation of a specialized commercial service to provide both safe transport and competent medical escort.
Emergency department workload--a transatlantic comparison.
This paper compares the workload of the emergency department of a Level One trauma center in the United States and a large city hospital in the United Kingdom. The referral pattern and diagnostic classification of 5,000 patients presenting to both departments were compared, as were the transportation systems at the two sites. It was shown that similarities existed in many areas. Major trauma formed only a small proportion of the overall workload of both departments. The conclusion is that although the two emergency care systems have fundamental differences in terms of organization and finance, the workloads are remarkably similar. Interesting differences arose in areas such as use of helicopter transport, psychiatric and drug and alcohol related admissions, and in the number of patients brought to hospital under police escort.
Roe v. Abortion Abolition Society, 9 March 1987.
The plaintiffs, two patients, two physicians, a clinic providing abortion services, members of its staff, and an escort service, sought to bring a class action against an anti-abortion society and its members under the Ku Klux Klan Act of 1871, which prohibits private conspiracies to deprive persons or classes of persons of the equal protection of the laws or of equal privileges and immunities under the laws. They claimed that the defendants had harassed, intimidated, and assaulted them. The Court held that the plaintiffs did not constitute a class for purposes of the statute because holding similar religious views on abortion was not sufficient to meet the common characteristics requirement of a class. The Court, however, allowed class action suits based on different statutory provisions to continue against several municipalities for failure to protect the plaintiffs' rights against the society and its members.
Major trauma transfer in Western Australia.
BACKGROUND: The transfer of critically injured patients in a rural Australian setting presents a unique challenge to medical services due to the constraints of distance and time. The purpose of this study is to analyse which injuries are being transferred, how they occur, pretransfer intervention, transfer methods and transfer times. METHODS: The Trauma Registry Database collected data prospectively on all major rural trauma cases attending the Royal Perth Hospital between August 1994 and January 2000. Patients were divided into rural and metropolitan groups on the basis of trauma location, and the latter group used as a control. RESULTS: A total of 1275 major trauma patients were treated of which 566 (44%) were from rural areas. Driver road traffic trauma was the most common cause of injury throughout, although most prominent in rural areas (30%vs 18%). For rural patients, the Royal Flying Doctor Service was responsible for 440 (79%) of transfers of which 83% had a doctor and a nurse escort. The most commonly transferred injuries from rural areas were head injury (63%) and thoracic injury (55%). A total of 450 (93%) rural patients were transferred to Royal Perth Hospital within 24 h of trauma although the mean transfer time was over 9 h. CONCLUSIONS: This data produces a realistic framework of how major trauma in rural areas is treated in Western Australia. It highlights some areas of good practice, such as transfer methods and escorts, but also highlights problem areas such as transfer times and pretransfer intervention.
The impact of crime on home care services.
A telephone survey of 49 Veterans Administration Home Care Programs found 32 programs reporting dangerous areas in their territories. Twelve excluded patients based on safety of area of residence. Programs in the eastern United States and in cities with higher rates of crime were more likely to have paired visits, escorted visits, or to exclude patients. Programs providing paired or escorted visits were less likely to exclude patients, suggesting that such policies maximize access to home care.