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PubMed2001

Pediatric PACS, Astrid Lindgren Children's Hospital at Karolinska Hospital, Stockholm, technical and practical aspects.

We present a filmless pediatric radiology department for the Stockholm area (1.8 million inhabitants) producing 50000 examinations per year. Seventy percent of the examinations are non scheduled, 50% are emergency cases out of office hours. The system is designed for high reliability operating with 99.7% uptime. A large number of daily conferences are held throughout the Children's Hospital at the various specialized departments, distributed through the intranet, with one pediatric radiologist attending. Instant reading is made in the majority of examinations and reports are available with images throughout the hospital including PC's at doctors rooms. The system uses conventional hardware and software with an open systems standard based approach. The system is highly appreciated by clinicians and has improved availability of radiology information.

Hospitals, Pediatric↗
PubMed2003

[IHE (Integrating the Healthcare Enterprise): a new approach for the improvement of digital communication in healthcare].

Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information.

Computer Systems↗
PubMed2000

[Myocardial infarction hospitalization by the day of the week: retrospective study].

INTRODUCTION: There is in the literature some studies looking for cycles and a circadian rhythm associated with acute myocardial infarction. Several authors have pointed out a higher incidence of myocardial infarction on Mondays suggesting the existence of trigger mechanisms in the disease onset. The week day distribution of hospitalizations due to myocardial infarction and its associations with patient sex and category of hospitalization (social status) in the Ribeirão Preto area from 1987 to 1996, were studied. METHODS: A total of 173,982 hospitalizations due to heart and cerebral vascular diseases, including 5,804 cases of acute myocardial infarction, were evaluated using the medical records of the Hospital Data Center of the medical school of Ribeirão Preto, University of S. Paulo. The hospitalizations were classified as being on a private basis, through private insurance or the Unified Health System (SUS). The associations with sex, patient condition at discharge and category of the hospitalization were studied. RESULTS/CONCLUSIONS: The distribution of hospitalizations due to heart and vascular diseases and acute myocardial infarction showed a peak incidence on Mondays, corresponding to 19.3% and 16.9% of the cases. During the weekend there was a decrease in the number of heart and vascular disease hospitalizations (8.6%) and a smaller reduction in the number of myocardial infarction cases (12.7%) which are statistically significant. In addition, there were observed differences in the distribution patterns according to the day of the week and category of hospitalization. While the SUS patients (4,120) and private insurance patients (1,225) are more likely to be hospitalized on Mondays, private patients (459) are more likely to be hospitalized on Fridays and Saturdays. There were no associations with patient sex and patient condition at discharge.

Brazil↗
PubMed1989

[An epidemiologic study on patients with lung disease, using a data base management system and the histopathologic diagnosis].

A new pathologic data base management system was introduced in the Section of Pathology, Clinical Laboratory, of this hospital for an efficient sorting and searching past data and for the rapid epidemiological study of them. By the use of this system, the incidence and the age and sex distribution of various diseases were studied in a total of 1,264 patients received pathological examination for surgically operated specimens or biopsied materials at the Chest Disease Research Institute Hospital, Kyoto University, from January, 1986 to December, 1988. A gradual increase in the number of frozen section samples of surgically removed organs and of open lung biopsies was noted during this period. Adenocarcinoma, squamous cell carcinoma, small cell carcinoma and large cell carcinoma amounted to 42.5%, 32.9%, 12.2%, and 7.5% of primary lung cancers, respectively. The male-to-female ratio of patients with primary lung cancers was 2.9:1 but there was no significant difference in the age distribution among four types of the primary cancers in both sexes. Two hundred and ninety nine (32.6%) patients were diagnosed as non-neoplastic lung diseases: 121 infectious (13.2%), 69 granulomatous (7.5%), 62 pulmonary fibrotic (6.8%) and 47 miscellaneous non-neoplastic (5.1%) diseases.

Adult↗
PubMed1997

Completeness of reporting on prognostic factors for breast cancer: a regional survey.

BACKGROUND: Effective management of breast cancer is dependent on adequate pathological reporting of the surgical specimen. OBJECTIVE: To describe the frequency with which histopathological features of known prognostic importance are routinely recorded. STUDY POPULATION: 885 cases of invasive breast cancer diagnosed in NHS laboratories in Lancashire and Greater Manchester. METHODS: Pathology reports were reviewed for details for tumour histological type, size, and grade, the presence or absence of tumour in blood or lymphatic vascular channels, and a comment on the proximity of tumour to the lines of surgical excision. Laboratories were categorised according to their throughput of cases of breast cancer, involvement in the breast screening programme, and whether they were attached to a teaching hospital. RESULTS: Histological type, tumour size, presence or absence of tumour in vascular channels, and adequacy of excision were recorded for 843 (95%), 803 (91%), 436 (49%), and 761 (86%) cases, respectively. Non-screening and low throughput laboratories were significantly less likely to record certain histopathological features. No significant differences were observed between teaching and non-teaching hospitals. CONCLUSIONS: The substantial interlaboratory variation in the histopathological reporting of breast cancers can, in part, be related to throughput of cases and involvement in the breast screening programme.

Adult↗
PubMed1998

[DRG's and cost/efficacy indicators in nephrology and dialysis. Results at a hospital division].

The Diagnosis Related Groups (DRGs) classification system correlates hospital performance with their relative costs and encourages more efficient productive processes. We report the following parameters: a) the distribution of hospital discharges according to the Major Diagnostic Categories (MDCs) and DRGs; b) the relationship between mean length of stay and threshold values; c) economic analysis of the cost-reimbursement pay-off. The results showed that 71.3% of DRGs belonged to nephro-urological MDC 11 and 28.7% in other internal MDCs (mainly involving cardiac and respiratory system). Of the latter, 67.7% were utilized for dialysis and transplant patients and kidney donors. In MDC 11 the most common DRGs were: the surgical DRG 315, produced by the vascular accesses for hemodialysis and by insertion of Tenckoff catheter for peritoneal dialysis, DRG 316 by cases of acute and chronic renal failure, DRG 332 by biopsy-proven glomerulonephritides. The length of stay was most commonly within range of one-third of threshold value for specific DRG; there was a low percentage of one-day stays and outlier cases. The economic analysis demonstrated that mean daily reimbursement sum was 590,714 ITL. Analysis of the overall costs yielded a mean daily cost of 455,838 ITL. In conclusion, quality indicators show that, appropriately, our specialist activity is largely devoted to the diagnosis and treatment of acute and chronic nephropathies and complications following dialysis and renal transplant.

Adolescent↗
PubMed1979

Bacteriuria during closed urinary drainage: an evaluation of top-vented versus bag-vented systems.

For a 10-month period a top-vented closed urinary drainage system was evaluted and compared to a conventional bag-vented drainage system. The study involved random assignment of either system to all adult patients who required urinary catheterization. Criteria for exclusion included acute or chronic genitourinary tract infection and surgical interference with bladder function. The end point of the study was removal of any part of the system after at least 24 hours or a positive urine culture (greater than 10,000 colonies per ml. urine). The series included 236 patients. Distributions of patient age, sex and hospital service assignment (medical or surgical), antibiotic usage and duration of catheterization were similar in both study groups. Of 113 patients with the top-vented system 16 (14.2 per cent) acquired bacteriuria, whereas 13 of 123 (10.6 per cent) with the bag-drainage system acquired bacteriuria. No significant difference was noted. Antibiotics were used in 202 of 236 patients (86 per cent). Although usage delayed the appearance of bacteriuria in both groups isolates were more frequently yeasts and gram-negative organisms other than Escherichia coli.

Adolescent↗
PubMed1982

Potable water supply as the hospital reservoir for Pittsburgh pneumonia agent.

Both legionnaires' disease and pneumonia caused by Pittsburgh pneumonia agent (PPA) are endemic in the Veterans Administration Medical Center, Pittsburgh. 85% of cases of legionnaires' disease and 100% of the cases of PPA were acquired in hospital. A selective dye-containing medium which allows visual discrimination of Legionella pneumophila and PPA has been used in a large-scale environmental survey of the hospital. Samples from 53 sites, including hot-water storage tanks, showerheads, mixing valves, and taps from 19 wards, were cultured. PPA was isolated from 2 sites and L. pneumophila from 33 sites. Water from a tap in the surgical intensive-care unit yielded 6 colony-forming units (CFU) of PPA/0.1 ml and 300 CFU of L. pneumophila/0.1 ml after centrifugation. Water from the outlet valve of a hot-water storage tank yielded 10 CFU of L. pneumophila/0.1 ml and when concentrated by centrifugation also yielded 2 CFU of PPA/0.1 ml. PPA and L. pneumophila share the same environmental niche, but isolation of PPA is more difficult. It seems that the reservoir for PPA in the VA Medical Center is the hot-water distribution system. PPA and L. pneumophila were simultaneously isolated from the lung tissue of a patient in this hospital who died of hospital-acquired pneumonia; this finding supports the hypothesis of a common reservoir and mode of transmission for the two organisms.

Cross Infection↗
PubMed1999

Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days.

This article evaluates the behavior of an adaptation of the Charlson Index (CHI) applied to administrative databases to measure the relationship between chronic comorbidity and the hospital care outcomes of length of stay (LOS), in-hospital mortality, and emergency readmissions at 30 and 365 days. These outcomes were analyzed in 106,673 hospitalization episodes whose records are registered in a minimum basic data set maintained by the public health authorities of the community of Valencia, Spain. The highest comorbidity measured by the CHI was associated with greater LOS and in-hospital mortality and increased readmission at 30 and 365 days. The rate of readmissions at 1 year dropped, however, in the group with the greatest comorbidity, probably owing to an increase in mortality after hospitalization. While comorbidity does appear to increase the risk of adverse outcomes in general and mortality and readmission specifically, the second outcome is only possible if the first has not occurred. For this reason, information and selection biases derived from administrative databases, or from the CHI itself, should be taken into account when using and interpreting the index.

Adolescent↗
PubMed2002

[Accreditation knowledge acquired by personnel in the Marseille hospital].

Sensitization and educational training programmes are important pre-requisites in order to ensure the understanding of the issues at stake in the accreditation process. According to the preparatory research involved for this work, there has been no study published nor is there any documentation available on such a topic, specifically on carrying out the sensitization process to successful completion. The aims of this study are to evaluate the effectiveness of the sensitization phase and to refine general recommendations to serve as a guide for health institutions and their communications policies. A transversal randomised study was conducted through the distribution of a questionnaire to 107 health professionals from 23 clinical services in the public hospital system in Marseille. The results demonstrate that the knowledge about accreditation seems to be well integrated, with only 7 of the professionals being unaware of the accreditation programme, and 58% of them associating the accreditation process with an administrative procedure. Grouping the staff's responses according to professional category has shown to have almost no influence on the results. The level of overall knowledge is greater in more highly trained personnel (p < 0.05), but there was a poor level of knowledge regarding the internal organisational structures that existed. 75% of the health professionals thought that communication about accreditation was insufficient. The study authenticated the positive benefits of communication and identified a certain number of stumbling blocks to avoid. Several recommendations are proposed.

Accreditation↗
PubMed2002

[Data bank project for acute stroke patients].

Stroke is the second cause of death within major adult disease and the first cause of functional disability for elderly in Japan. The diffusion rate of MRI is the highest in the world. Even though, there is only few evidence for stroke management has been reported from Japan. It is necessary to make a data bank of acute stroke patients as infrastructure making evidence for standardization of stroke management. We made Japan standard stroke registry study supported by ministry of health and welfare for 3 years. We completed computerized registry system and accumulated about 8,000 acute stroke cases from 45 stroke center hospitals. This system is also functioning as a stroke database for each hospital. From the analysis of the distribution of stroke subtype, the incidence of atherothrombotic infarction and cardiogenic embolism was similar to lacunar infarction as shown in Fig. 1. Furthermore, the 38% of ischemic stroke patients admitted within 3 hours. Thrombolytic therapy was performed in 15% of the patients who admitted within 3 hours and their initial severity were NIHSS 6-29. The outcome of the patients treated with thrombolytic therapy was significantly better than those without it. These data indicate that the stroke data bank should be useful tool to make verification of the guideline and planning of clinical trial for EBM.

Acute Disease↗
PubMedDate not supplied

[Occupational exposure to inhalation anesthetics: 10 years of measurements at hospitals in Puglia].

The Authors provide the data gathered from measurements of nitrous oxide in the operating room of Puglia during the period between 1993 and 2003. They prove significant reductions of pollution according with time and they verify lower pollution levels in the operating rooms of private hospitals with respect to public facilities. The importance of the maintenance of gas distribution and evacuation systems is shown and a method of environmental and biological monitoring is provided. Finally, the Authors prove the utility of the graphic representation of the measurements, conduced utilising dedicated instrumentation.

Air Pollution, Indoor↗
PubMed1984

Users' perspectives of hospital pharmacy computer systems.

A survey was conducted to determine if user characteristics affected respondents' expectations of computer systems and to identify the most and least desirable features hospital pharmacists want in computer systems. A questionnaire was mailed to 200 hospital pharmacists selected randomly. The survey was designed to gather demographic data, general systems information, and information on system features in 10 major categories. A total of 111 surveys were returned. Of the respondents, 55% had some type of computer system. The leading type of system used by the respondents was a mainframe-shared system. The majority of respondents (87.4%) indicated that they had a "moderate" amount of experience with computer systems. The most commonly preferred hardware was the minicomputer. It appeared that user characteristics did not influence the pharmacists' expectations of computer systems. In ranking the categories, the hospital pharmacists indicated that the i.v. admixture area, inpatient drug distribution, and clinical functions were the most important for computer applications.

Attitude of Health Personnel↗