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PubMed1983

Attitudes of potential employers toward drug abuse.

Administrators of engineering, fiscal, and personnel services were surveyed for attitudes toward drug abuse. Responses were highly correlated despite significant differences among groups in age, education, and personal acquaintance with drug abusers. They applied more stringent preemployment requirements to drug abusers than alcoholics, and consequences of these requirements in a troubled economic climate were considered. Attitudes of nontreatment administrators were correlated to a lesser degree with earlier responses by psychology administrators. Groups frequently endorsed the concept of special hospitals for abusers and seldom endorsed the use of jails and the court system unless distribution or related criminal activity was involved.

Adult↗
PubMed2001

Invasive pneumococcal infection and drug-resistant Streptococcus pneumoniae in Thai children.

Sixty-eight children with systemic Streptococcus pneumoniae infection were identified by hospital chart review between 1986-1997. The age distribution varied from 2 days to 15 years, with a mean age of 3.3 years. There were 35 boys and 33 girls. Four clinical entities included 30 cases of meningitis, 20 cases of pneumonia, 10 cases of peritonitis and 8 cases of septicemia/bacteremia. Forty patients (58.8%) had underlying diseases. Seventeen patients (25.0%) developed early complications and the mortality rate was 8.8 per cent. The percentage of susceptible isolates to penicillin, chloramphenicol, cefotaxime/ceftriaxone, ciprofloxacin, imipenem and vancomycin were 69.6, 91.3, 100.0, 87.2, 100.0 and 97.1 per cent, respectively. There were six cases of drug-resistant S. pneumoniae (DRSP) infection; 3 cases of meningitis, one case of pneumonia, one case of infective endocarditis and one case of purpura fulminans. Our data indicate that S. pneumoniae infection is relatively serious and life-threatening. There is a trend of increasing prevalence of invasive pneumococcal and DRSP infections.

Adolescent↗
PubMed2003

Using respiratory-related calls to a nurse advice line to predict pediatric upper respiratory infection-related healthcare utilization.

Using Poisson regression analysis, respiratory-related calls to a nurse advice line in Denver, Colorado were used to predict pediatric upper respiratory infection (URI) outpatient and urgent care visits. Use of electronic hospital information systems and triage software allowed for the rapid identification of respiratory-related calls and URI-related utilization. Monitoring nurse advice line call volume may help increase awareness and planning for increases in healthcare utilization.

Colorado↗
PubMed1991

The geographic spread and temporal increase of the Lyme disease epidemic.

OBJECTIVE: To describe the temporal and geographic progression of the Lyme disease epidemic in New York State from 1977 through 1989. DESIGN: Communicable disease surveillance system. SETTING: Statewide. MAIN OUTCOME MEASURES: The progression of the epidemic was examined by analyzing trends in Lyme disease cases reported to the state surveillance system, town and county Lyme disease incidence rates, Lyme disease hospital discharge rates, and the distribution of Ixodes dammini ticks obtained from surveillance efforts and submitted for identification. MAIN RESULTS: The number of confirmed Lyme disease cases in New York has increased with concurrent increases in the number of hospital discharges. The number of counties endemic for Lyme disease increased from four to eight between 1985 and 1989. The number of counties with documented I dammini ticks increased from four in 1985 to 22 in 1989. Incidence of the disease also increased within known endemic counties. CONCLUSIONS: Tick surveillance indicated that the range of I dammini has expanded annually into areas up to 384 km from the original known endemic areas of Long Island, NY, and Connecticut. Cumulative data from human surveillance resources document both temporal increases and geographic expansion of the Lyme disease epidemic in New York.

Adolescent↗
PubMedDate not supplied

Workload and environmental factors in hospital medication errors.

Nine hospital workload factors and seasonal changes in daylight and darkness were examined over a 5-year period in relation to nurse medication errors at a medical center in Anchorage, Alaska. Three workload factors, along with darkness, were found to be significant predictors of the risk of medication error. Errors increased with the number of patient days per month (OR/250 patient days = 1.61) and the number of shifts worked by temporary nursing staff (OR/10 shifts = 1.15); errors decreased with more overtime worked by permanent nursing staff members (OR/10 shifts = .85). Medication errors were 95% more likely in midwinter than in the fall, but the effect of increasing darkness was strongest; a 2-month delay was found between the level of darkness and the rate of errors. More than half of all medication errors occurred during the first 3 months of the year.

Alaska↗
PubMed1994

Systemic Haemophilus influenzae disease in Thai children.

Fifty patients with systemic Haemophilus influenzae disease were indentified by hospital chart review between 1980-1992. The age distribution varied from 8 days to 14 years; the mean age of the patients was 12.7 months. The peak incidence was between 4 and 6 months of age. There were 27 male patients and 23 female patients for a male:female ratio of 1.17:1. The relative frequencies of 79 clinical entities encountered in 50 patients are as follows: meningitis 55.7%, bacteremia 13.9%, pneumonia 25.3%, cellulitis 2.5% arthritis 1.3%, septic shock 1.3%. There were 23 patients (46%) who had more than one disease entity. Most of the patients were anemic (Hb < 10 gm%) when hospitalization. Sixty-four percent of the patients had early complications. The mortality rate was 8%. Although serotyping was not done from the isolates, at least 33 cerebrospinal fluid samples were positive for H. influenzae type b capsular antigen by counterimmunoelectrophoresis. The percentage of susceptible H. influenzae to penicillin, ampicillin, chloramphenicol, co-trimoxazole were 57.1%, 76.4%, 87.5% and 54.2%, respectively. There was no strain resistant to third generation cephalosporin. Our data indicate that H. influenzae is a serious and life threatening infection. Early diagnosis and proper treatment will reduce the morbidity and mortality rates. For prevention of infection, an appropriate strategy for vaccination is required.

Adolescent↗
PubMed1993

[A characteristic magnetic resonance image of a dissecting aneurysm in the vertebrobasilar system].

Recently several reports of dissecting aneurysm in the vertebrobasilar system have been published. We report the effectiveness of MRI for the detection of a dissecting aneurysm in the vertebrobasilar distribution system. A 47 year-old male [correction of female] was admitted to our hospital due to right occipitalgia and the right Wallenberg's syndrome. Computed tomography disclosed no abnormalities. Cerebral angiogram showed the pearl and string sign of the right vertebral artery, which suggested a dissecting aneurysm. MRI exhibited the infarct area at the right dorsolateral part of the medulla oblongata, which corresponded to right Wallenberg's syndrome. It disclosed high intensity ring-like findings circumscribing a low intensity spot of the lumen of the right vertebral artery. This high intensity was thought to be the hematoma between the intima and the media at the subacute stage. Its high intensity corresponded to the site of the dissecting aneurysm and of Wallenberg's syndrome. These findings are thought to be useful in the diagnosis of a dissecting aneurysm of the vertebral artery.

Aortic Dissection↗
PubMed1995

Digital distribution of chest radiographs to intensive care units.

This paper describes the implementation of the Medical Image Access System for Intensive Care Units (MIAS/ICU). MIAS/ICU is a distributed computer system that integrates the collection of computed radiography images with information from the Hospital Information System (HIS) to allow caregivers in two Intensive Care Units (ICUs) at University Medical Center (Tucson, AZ, USA) to view digital chest radiographs on dual-monitor workstations within minutes of the time the exposures are made. The system uses entirely "off-the-shelf" hardware components and software based on widely followed standards. MIAS/ICU is based on an innovative modular software architecture that allows simple incremental expansion of the system, along with enhanced portability among platforms.

Arizona↗
PubMed1998

[Radiotherapy: a significant treatment option in management of prostatic cancer].

In the management of patients with localized prostate cancer, both radical prostatectomy and radiotherapy are shown in the U.S. to be equally effective to control a local disease but associate with different types of toxicity. Therefore, both treatments are recommended for patients to choose freely. Recently, mainly in western countries, radiotherapy has achieved technological innovation so as to increase target tumor doses and to decrease the volume and dose of peritumoral normal tissues, by which the treatment outcome is further improved. Major innovative techniques include three-dimensional conformal radiotherapy (3D CRT) and a high dose-rate (HDR) brachytherapy system. Three-D CRT focuses radiation on the tumor through multiple portals minutely tailored to the tumor volume determined by computed tomography, in conjunction with a sophisticated treatment planning system. A HDR brachytherapy system provides high-tech interstitial radiotherapy; a remote afterloading system precludes radiation exposure of hospital workers and a computer-controlled source-scanning system enables optimization of dose distribution. In order to provide a variety of effective treatment options for Japanese patients, radiation oncologists must master these techniques in practice, in cooperation with urologists.

Aged↗
PubMed1994

[Links between risks of aspergillosis and environmental contamination. Review of the literature].

An increasing number of nosocomial invasive aspergilloses is related with the development of new therapies and to Aspergillus spores in the vicinity of the patient. The infiltration of thermophilic fungal spores in the patients' environment is linked not only with contaminated air systems but also to different other factors among which earth moving, demolition or renovation works adjacent to or inside the hospital. Potted plants and individual sachets of ground pepper distributed to patients are another source of Aspergillus spores. To limit fungal exposure, patients undergoing bone marrow transplant should be isolated under laminar flow while simple procedures such as taping windows and doors, shutting down air systems and mycological environmental control measures should be encouraged to protect immunocompromised patients.

Air Conditioning↗
PubMedDate not supplied

[Dietary-therapeutic product supply in unitary doses at a university hospital: effect on consumption and costs].

GOALS: To analyze the consumption and costs of the Enteral Nutrition products (diets and dietary supplements) dispensed from the Nutrition unit in a 735-bed general hospital during two six-month periods, before and after the implementation of a unit-dose (UD) distribution system. MATERIALS AND METHODS: The defined daily dose (DDD) methodology was used. A DDD of 1,500 Kcal/day was defined for complete diets in adults, with 1,000 Kcal/day for complete diets in children, 1,200 Kcal/day for "start-up" diets, 500 Kcal/day for normocaloric supplements and 600 Kcal/day for hypercaloric supplements and 450 Kcal for very low caloire diets. RESULTS: The total consumption in the hospital fell from 10.21 DDD per 100 stays/day (DED in its Spanish acronym), representing generated costs of 8,640,130 pesetas between November, 1997, and April, 1998, to 6.25 DED in the same period for 1998-99, with costs amounting to 6,674,775 pesetas (-23%). In the services handled using UD, the total consumption declined from 9.3 DED between November, 1997, and April, 1998, to 5.2 DED in the same period for 1998-99. The consumption of standard/special diets and dietary supplements went from 1.38/0.76/7.16 DED to 1.48/0.53/3.19 DED during the two periods under study, with an accompanying drop in costs of -1,806,598 pesetas (-30%). In percentage terms, the standard diets varied from 26% to 41% (of the total cost generated in the services with UD), special diets from 28% to 22% and dietary supplements from 54% to 37%. In those services where the UD was not applied (ICU and reanimation), the total consumption of diets remained stable with a slight drop from 25.3 DED to 24.3 DED. CONCLUSIONS: The unit dose system has improved the prescription of therapeutic dietary products in our hospital and has reduced the costs, mainly through the notable decrease in the dispensation of supplements.

Adult↗
PubMed2004

Frequency of cancer in children residing in Mexico City and treated in the hospitals of the Instituto Mexicano del Seguro Social (1996-2001).

BACKGROUND: The objective of this article is to present the frequency of cancer in Mexican children who were treated in the hospitals of the Instituto Mexicano del Seguro Social in Mexico City (IMSS-MC) in the period 1996-2001. METHODS: The Registry of Cancer in Children, started in 1996 in the IMSS-MC, is an on-going, prospective register. The data from 1996 through 2001 were analyzed and the different types of cancer were grouped according to the International Classification for Cancer in Children (ICCC). From this analysis, the general and specific frequencies by age and by sex were obtained for the different groups of neoplasms. Also, the frequency of the stage of the disease that had been diagnosed in cases of children with solid tumors was obtained. RESULTS: A total of 1,702 new cases of children with cancer were registered, with the male/female ratio at 1.1/1. Leukemias had the highest frequency with 784 cases (46.1%) and, of these, acute lymphoblastic leukemias were the most prevalent with 614 cases (78.3%). Thereafter, in descending order of frequency, were tumors of the central nervous system (CNST) with 197 cases (11.6%), lymphomas with 194 cases (11.4%), germinal cell tumors with 110 cases (6.5%), and bone tumors with 97 cases (5.7%). The highest frequency of cancer was found in the group of one to four year-olds that had 627 cases (36.8%). In all the age groups, leukemias were the most frequent. In the present work, the frequency of Hodgkin's disease (~4%) was found to be lower than that (~10%) in previous studies and the frequency of tumors of the sympathetic nervous system was low (2.3%). Of those cases of solid tumors for which the stage of the disease had been determined, 66.9% were diagnosed as being Stage III or IV. CONCLUSIONS: The principal cancers in the children treated in the IMSS-MC were leukemias, CNST, and lymphomas, consistent with those reported by developed countries. A 2.5-fold reduction in the frequency of Hodgkin's disease was found. Of the children, the stage of whose disease had been determined, two thirds were diagnosed as having advanced stages of the disease.

Adolescent↗
PubMed1987

Refining case-mix adjustment. The research evidence.

We review case-mix adjustment, which is the process of adjusting for differences in the cases treated in different hospitals so that their costs or outcomes can be compared. We examine the Medicare payment system, which rests on case-mix adjustment, and identify areas, including outlier payments, in which payment accuracy might be improved without better measurement of the severity of illness. There is no available measure of severity of illness that would produce a large improvement in the accuracy of Medicare payments if used to supplement or replace the system of diagnosis-related groups. Evidence regarding whether better measurement of severity would substantially change the distribution of payments across hospitals is mixed. Considerable evidence suggests that the intensity of medically appropriate treatment for patients in the same diagnosis-related group varies substantially for reasons other than the severity of illness. Despite great demand for measures of the quality of care, important technical problems must be solved before we can be confident that differences in case-mix-adjusted outcomes reflect differences in the quality of care.

Diagnosis-Related Groups↗
PubMed1997

Pattern of neuro-ophthalmic disorders in a tertiary eye care centre in Addis Ababa.

A neuro-ophthalmic subspeciality clinic was established in Ethiopia for the first time in September 1993. A total of 700 patients attended this clinic over a period of two years. Optic nerve lesions (22%), herpes zoster ophthalmicus (18%), ocular motor palsies (17%), facial palsy (10%) and papilloedema (7%) were the leading neuro-ophthalmic disorders observed. Myasthenia gravis and muscular dystrophies were not rare diseases as well. HIV infection manifested in a variety of neuro-ophthalmic disorders. In a significant number of the patients, precise diagnoses could not be made due to lack of diagnostic facilities. Most patients presented in advanced and irreversible state. Increased awareness on the part of patients as well as health care providers is thus of paramount importance in order to avert unnecessary death and blindness, also is underlined the need for improved diagnostic facilities like magnetic resonance imaging and computerized tomography.

Adolescent↗
PubMed2005

The café fire on New Year's Eve in Volendam, the Netherlands: description of events.

AIM OF STUDY: The café fire at Volendam occurred shortly after midnight on the first of January 2001 and resulted in one of the worst mass burn incidents in recent Dutch history. The aim of this study was to provide insight into medical and organisational requirements of a major burns incident. METHODS: Shortly after the fire, two university hospitals and a burn center in the region of the accident developed a plan for evaluation of medical care given during and after this major burn incident. A multidisciplinary research group investigated the management of victims at the scene, in the emergency departments (ED) and during admission in the hospitals. All 245 casualties were included in this study. RESULTS: A brief severe fire occurred in a crowded cafe with around 350 young visitors on a small embankment of a relatively isolated town, resulting in a unusually high number of severely injured burn victims. Four died immediately. The ensuing rescue effort was hampered by poor access and chaotic circumstances. At the scene of the incident, mobile medical teams ensured orderly transport and treatment priority for the injured. There were 245 victims with a median total body surface area burned of 12%. Inhalation injury was present in 96 patients. A total of 182 victims were admitted, with 112 to intensive care. Ten patients died in the hospital. Seventy-eight patients were secondarily transported, many to specialised centers in the Netherlands and abroad. In total, 36 hospitals in three countries participated. CONCLUSION: An incident with high numbers of burn victims poses a challenge to any health care system. The difficult circumstances at the site demonstrated the need for robust organisational structures. The primary and secondary distribution of patients required coordination, general hospitals were able to provide initial medical care to these major burn casualties.

Adolescent↗