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PubMed1977

Infection by the distribution of biotypes of enterobacteriacease species in leukaemic patients treated under ward conditions and in units for protective isolation in seven hospitals in Europe.

In a cooperative study on the efficiency of isolation and decontamination in patients with acute leukaemia performed in seven hospitals in Europe, faecal samples and oral washings were collected twice weekly and shipped for culturing to a Central Bacteriological Laboratory. In this laboratory the Enterobacteriaceae species isolated from these samples were biotyped as well as those isolated from infections that occurred in these patients during treatment. Enterobacteriaceae biotypes isolated for the first time during the isolation phase of the patient indicated a leak in the isolation system. The "colonizing" (newly resident) biotypes of Enterobacteriaceae species were found to be more often involved in infections and to be more commonly distributed among the patients in the participating hospitals than the "contaminating" (transient) Enterobacteriaceae biotypes. Furthermore, a linear correlation was found between the incidence of gram-negative infections and the number of cases in which these Enterobacteriaceae biotypes colonized the gastro-intestinal tract of patients. The majority of the infections was caused by Enterobacteriaceae biotypes that had settled in the gastro-intestinal tract during treatment and consequently were of nosocomial origin.

Cross Infection↗
PubMed2006

Technologies for image distribution in hospitals.

After the establishment of web-based image distribution, three challenges for image distribution can be identified today. Firstly, PACS (picture archiving and communication system) and the distribution of radiological images and reports need to be integrated with the emerging electronic medical record. Secondly, report and image data should be available on mobile devices like PDAs (personal digital assistants) or smartphones in the future. Thirdly, future systems must be available not only to transmit sectional images, but also to allow access to three- and four-dimensional data that are produced by multidetector CT and modern MR scanners.

Computers, Handheld↗
PubMed2001

An investigation of the conus medullaris termination level during the period of fetal development to adulthood.

The spinal cord fills the length of the vertebral canal at the early period of intrauterine term. It is reported to extend to the level of the third lumbar vertebra at birth, because the vertebral column is growing more rapidly in the longitudinal direction than the spinal cord. The present investigation aimed to determine the changes in the termination level of conus medullaris (TLCM) from fetus to adulthood in a total of 285 individuals who had no defects in the central or peripheral nervous system, and were obtained from our Faculties of Medicine and Konya Maternity Hospital between 1992-1995. The age distribution was as follows: 36 fetuses, 20 prematures and 50 neonates, 51 children aged 1 to 7 years and 128 adults aged 15 to 68 years. In this study, for fetuses, prematures, neonates and children the TLCM was determined using ultrasonography. In addition, microdissection was used in fetuses to confirm the results obtained from the above technique. Also, magnetic resonance imaging was used in adults. During fetal life the end of the conus altered its levels from S5 to L3 vertebrae. The tip of the conus medullaris of the prematures and neonates ranged from L1 to L3 vertebrae. The tip of the conus medullaris in the children lay between the Th12 and L3 vertebrae, and in the adults it was between the Th12 and L2 vertebrae. There were slight differences between the prematures and neonates in terms of the TLCM. We concluded that there are differences in the TLCM between the age groups and therefore, especially in prematures and infants the determination of the tip of conus medullaris might be important for preventing postoperative neurological complications.

Adolescent↗
PubMed1986

The evacuation hospital in civilian disasters.

In a mass casualty situation the hospital nearest to the disaster scene is usually overwhelmed by the injured. We propose a solution whereby a civilian hospital in times of crisis can become an evacuation hospital (EH) to meet the immediate needs of the casualties. An EH is a hospital located as near as possible to the disaster area, whose function is to serve as a forward treating facility. All the wounded should be brought first to the EH, where they are sorted, resuscitated and stabilized for transportation, after which they are evacuated. Only the critically wounded undergo surgery at the EH; the lightly wounded remain in the EH, and all other wounded are distributed among the general hospitals for rapid definitive treatment. This principle was first applied in a civilian medical system. The Rokach (Hadassah) Hospital in Tel Aviv served as an EH in admitting 40 casualties following a nearby terrorist attack. Seventeen seriously and moderately wounded patients were resuscitated and evacuated to hospitals in the vicinity. All arrived in stable condition. Seventeen lightly wounded were detained in the EH and 4 underwent life-saving surgery there.

Disasters↗
PubMed2006

Incidence, comorbidity, case fatality and readmission of hospitalized stroke patients in Canada.

BACKGROUND: Stroke is a leading cause of death and disability, and poses a significant burden of care for those who survive. OBJECTIVES: To estimate the incidence of hospitalization for stroke and describe the impact of age, sex and comorbidity on in-hospital mortality, length of stay and readmission rates. METHODS: Health insurance numbers were used to link acute care hospitalizations across Canada in 1999/2000 for stroke patients with no discharges for a stroke within the preceding five years. Patients were followed up for one year from the date of their initial admission. RESULTS: The numbers of men (15,367) and women (16,740) in the study were similar. The incidence of all types of stroke (International Classification of Diseases, ninth revision, codes 430, 431 and 434/436) for hospitalized men and women was 14.4 per 10,000, with a 15-fold rise from 8.7 for the age group of 45 to 64 years to 131.9 per 10,000 for the age group 80 years and older. For the index episode, stroke patients spent an average of 21.0 days in the hospital, and 18.2% died in the hospital within 28 days. Of those who survived the first episode, 10.3% were readmitted to the hospital within one year with a recurrent stroke, and overall 37.1% were readmitted for any cause (including stroke). Among these stroke patients, hypertension was codiagnosed in 35%; diabetes in 17%; arrhythmia in 15%; ischemic heart disease in 13.6%; and congestive heart failure in 5%. CONCLUSIONS: Hospital records linked by patient identification can produce more accurate national estimates of patients hospitalized with stroke than any current countrywide surveillance system.

Adult↗
PubMed1990

[Prevalence of nosocomial infections in Catalonia. I. Infections and risk factors. EPINCAT study group].

Following an extensive protocol, an investigation on the prevalence of nosocomial infections was carried out in May 1988 in 33 hospitals from Catalonia. A total number of 7434 patients were included. Communitary infections were also tabulated. The prevalence for nosocomial infections was 12.1% and the incidence of communitary infections was about 17.1%. The nosocomial more frequent infections involved the urinary tract (29.2%), the surgical procedures (25.6%), the low respiratory airways (17.3%), and the blood (4.9%). The prevalence of surgical infections ranged between 5.6% and 8.9%. Logistic adjustment showed that notorious risk factors for nosocomial infections are: urinary catheterization, central vascular catheterization, mechanical ventilation and tracheostomy, and the duration of hospital stay. For some infections the age, sex, risk of the baseline illness, and intrinsic risk factors appear to be important determinants of the risk. The study provided a large information regarding the distribution of hospital infections among the clinic departments, the differences depending on the hospital size, the distribution of the location of the infection, and the importance of the risk factors. Attention is directed to the need for appropriate surveillance systems to reduce the incidence of nosocomial infections.

Cohort Studies↗
PubMed1975

A highly automated hospital medication system. Five years' experience and evaluation.

Since 1969, medications have been provided to patients at the Johns Hopkins Hospital using a computer system that controls the entire medication process from entry of physician's order to hourly drug distribution. Special envelopes containing patient and dosage information are computer generated for each dose to be administered. These envelopes, containing individually labelled ready-to-administer doses, are delivered to the nursing units hourly. The system provides daily medication profiles, drug administration histories, discharge summaries, and management and billing reports. Medication errors of commission were 4.6 times more frequent on the traditional nursing units compared to the units with the computer system. Registered nurses spend 56% less time performing medication-related activities on the units served by the computer. For 250 beds, total costs are 7% higher using the computer system. For 450 beds, total costs are 14% lower using the computer system.

Costs and Cost Analysis↗
PubMed1997

Access to the emergency psychiatry system in Japan.

Although the need for an emergency psychiatry system is increasing in Japan because of a shift to providing psychiatric care from hospitalization to community-based services, little attention is being given to what the general population expects from the health care system. To ascertain the expectations of the general population about how emergency psychiatric cases should be handled, the authors distributed a questionnaire to 1000 people containing 12 characteristic psychiatric emergency cases. The results showed that most expected psychiatric care to be rendered in a general hospital. This was different from the opinion held by most mental health professionals who felt that mental health hospitals should be the core hospitals of emergency psychiatry. Although there was a higher expectation for police officers or paramedics to provide emergent psychiatric care, the general population expected less from public health centers which now provide mental health service in the community. To connect emergency psychiatry with the community, the general hospital must play a larger role in the system through training programs for general hospital psychiatrists as well as nonpsychiatrist professionals, paramedics, and police officers.

Adolescent↗
PubMed2001

Human resource assignment and role representation mechanism with the "cascading staff-group authoring" and "relation/situation" model.

We have previously reported the access control mechanism and audit strategy of the "patient-doctor relation and clinical situation at the point-of-care" model with multi-axial access control matrix (ACM). This mechanism overcomes the deficit of ACM in the aspect of data accessibility but does not resolve the representation of the staff's affiliate and/or plural membership in the complex real world. Care groups inside a department or inter-department clinical team plays significant clinical role but also spend great amount of time and money in the hospital. Therefore the impact of human resource assignment and cost of such stakeholders to the hospital management is huge, so that they should be accurately treated in the hospital information system. However multi-axial ACM has problems with the representation of staff groups due to static parameters such as department/license because staffs belong to a group rather temporarily and/or a medical staff may belong to plural groups. As a solution, we have designed and implemented "cascading staff-group authoring" method with "relation and situation" model and multi-axial ACM. In this mechanism, (i) a system administrator certifies "group chief certifying person" according to the request and authorization by the department director, (ii) the "group chief certifying person" certifies "group chief(s)", (iii) the "group chief" recruits its members from the medical staffs, and at the same time the "group chief" decides the profit distribution policy of this group. This will enable medical staff to access EMR according to the role he/she plays whether it is as a department staff or as a group member. This solution has worked successfully over the past few years. It provides end-users with a flexible and time-to-time staff-group authoring environment using a simple human-interfaced tool without security breach and without system administration cost. In addition, profit and cost distribution is clarified among departments and inter-departments groups.

Computer Security↗
PubMed1984

Evaluating group purchasing through a prime vendor.

Use of a prime vendor by a drug-purchasing group representing 17 community hospitals is described and evaluated for cost effectiveness. The group was formed in 1981 by 15 hospitals in Minnesota and one each in Wisconsin and Iowa. The group solicited bids to select one drug wholesaler (distribution center). Drug-product manufacturers submitted bids to the group, and contracts were awarded to low bidders who agreed to use the distribution center. All 17 hospitals were evaluated for differences in inventory value and inventory turnover before (1980) and after (1982) initiation of the prime-vendor system; hospitals in the group were paired with control hospitals to eliminate environmental bias. A detailed analysis of inventory and operating costs was conducted in one of the hospitals. The hospitals in the purchasing group reduced drug inventory value by 30.1%, increased inventory turns by 55.3%, and purchased 72.8% of all their pharmaceuticals (based on dollar value) through the distribution center. The group obtained a distribution center service fee reduction of 39.2%. Hospitals in this group showed greater decreases in inventory value and increases in inventory turnover than the controls. The detailed analysis at a single hospital showed that cost savings included direct savings on inventory investment and order handling and indirect savings from elimination of inventory carrying costs and costs of processing checks and purchase orders. Operating costs were reduced by group purchasing of drug products from a prime vendor. Inventory control and purchasing practices improved.

Cost-Benefit Analysis↗
PubMed2004

Preventing airborne contamination.

The air in a hospital contains a variety of contaminants originating from outdoor air, but also significant concentrations of compounds emitted indoors. All of these are transferred and distributed via the central heating, ventilation and air conditioning (HVAC) systems unless protective measures are taken.

Air Conditioning↗
PubMed2002

Picture archiving and computing systems: the key to enterprise digital imaging.

The utopian view of the electronic medical record includes the digital transformation of all aspects of patient information. Historically, imagery from the radiology, cardiology, ophthalmology, and pathology departments, as well as the emergency room, has been a morass of paper, film, and other media, isolated within each department's system architecture. In answer to this dilemma, picture archiving and computing systems have become the focal point of efforts to create a single platform for the collection, storage, and distribution of clinical imagery throughout the health care enterprise.

Decision Making, Organizational↗
PubMed2002

Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities.

The validity and cost-effectiveness of three methods for detecting medication errors were examined. A stratified random sample of 36 hospitals and skilled-nursing facilities in Colorado and Georgia was selected. Medication administration errors were detected by registered nurses (R.N.s), licensed practical nurses (L.P.N.s), and pharmacy technicians from these facilities using three methods: incident report review, chart review, and direct observation. Each dose evaluated was compared with the prescriber's order. Deviations were considered errors. Efficiency was measured by the time spent evaluating each dose. A pharmacist performed an independent determination of errors to assess the accuracy of each data collector. Clinical significance was judged by a panel of physicians. Observers detected 300 of 457 pharmacist-confirmed errors made on 2556 doses (11.7% error rate) compared with 17 errors detected by chart reviewers (0.7% error rate), and 1 error detected by incident report review (0.04% error rate). All errors detected involved the same 2556 doses. All chart reviewers and 7 of 10 observers achieved at least good comparability with the pharmacist's results. The mean cost of error detection per dose was $4.82 for direct observation and $0.63 for chart review. The technician was the least expensive observer at $2.87 per dose evaluated. R.N.s were the least expensive chart reviewers at $0.50 per dose. Of 457 errors, 35 (8%) were deemed potentially clinically significant; 71% of these were detected by direct observation. Direct observation was more efficient and accurate than reviewing charts and incident reports in detecting medication errors. Pharmacy technicians were more efficient and accurate than R.N.s and L.P.N.s in collecting data about medication errors.

Chi-Square Distribution↗
PubMed2006

Lessons learned from clinical anthrax drills: evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments.

STUDY OBJECTIVE: Emergency department (ED) physicians and nurses are considered critical sentinels of a bioterrorist attack. We designed a special hospital drill to test EDs' response to inhalational anthrax and assess the level of preparedness for anthrax bioterrorism. We hypothesized that the occurrence of such a drill in an ED would improve the knowledge of its physicians, even those who had not actually participated in the drill. METHODS: We conducted 23 drills at all Israeli general hospitals' EDs. An actor entered the walk-in triage area, simulating a febrile patient with lower respiratory complaints. A chest radiograph with mediastinal widening, as can be seen in early anthrax disease, was planted in the hospital's imaging results system. Patients were instructed to give additional epidemiologic clues, such as having a few friends with a similar syndrome. Either before or after the drills, we distributed multiple choice tests about diagnosis and management of anthrax to the 115 senior emergency physicians at these hospitals. RESULTS: In 91% of EDs, a decision to admit the patient was made. Sixty-one percent included anthrax in the differential diagnosis and activated the appropriate protocols. Only 43% contacted all relevant officials. Average score on the anthrax tests was 58 (of 100). Physicians who were tested before the drill (in their institution) achieved a mean score of 54.5, whereas those who were tested after their ED had been exercised achieved a mean score of 59.3. CONCLUSION: A national framework of drills on bioterrorism can help estimate and potentially augment national preparedness for bioterrorist threats. It is not, on its own, an effective educational tool. More emphasis should be given to formal accredited continuing medical education programs on bioterrorism, especially for emergency physicians and ED nurses, who will be in the front line of a bioterrorist attack.

Anthrax↗
PubMed1988

Urinary tract infections in the surgical patient.

Urinary tract infection (UTI) continues to be a common nosocomial infection. From a 2-year city-county hospital experience, 212 nosocomial UTI were identified in 153 patients from 3747 admissions. Mean age was 54 years; 102 were men. Foley catheterization was an associated factor in 129 patients (84%). UTI was caused by 40 different species of bacteria. In 28 infections (13%), the UTI was polymicrobial. Only nine patients had bacteremia. The bacteriology of the UTI depended on whether the patient had received systemic antibiotics previously during the hospitalization. Prior antibiotic administration increased the probability of Pseudomonas and Serratia as pathogens. Thus, patients that have had antibiotic therapy demonstrate a distribution of pathogens that are different from patients not receiving antibiotics, and a distribution different from the community-acquired UTI. Continued emphasis on the shorter duration and more judicious use of systemic antibiotics for both prophylaxis and therapy is warranted.

Adolescent↗
PubMed1981

Developing a model for health education interventions in the hospital setting.

Health education interventions in hospitals represent a factor of major influence with regard to the effectiveness of treatment and the prevention of relapse. A purposeful health education system aimed at patients, their families and friends has therefore been developed in the USSR after due experimentation. As regards patients, focus is placed on raising their level of knowledge about adequate health behaviour during hospitalization and after discharge, in order to prevent relapses, acute states and complications. Topics covered include regimen, diet, physical exercise, developing resistance to cold, giving up harmful habits (smoking, for example), etc. This includes individual, semi individual, semi group and group activities at all stages of the patient's stay in hospital. The mass media supplements this approach through hospital radio and TV programmes and popular scientific literature from the hospital library. For patients' relatives and friends, a programme of individual talks has been developed. Another facet of health education involves correspondence with patients and their relatives, to whom special leaflets are distributed. Preliminary evaluation carried out by public health administrators and health education workers indicates that the system yields satisfactory results.

Family↗
PubMed2006

Methods for analysing recurrent events in health care data. Examples from admissions in Ebeltoft Health Promotion Project.

BACKGROUND: Evaluation of health care contacts from first events alone often misses large amounts of potentially important data and may produce different results than evaluation of all data including recurrent events. OBJECTIVE: We aim to bring the different methodological approaches for analysing longitudinal health care data to the attention of researchers in primary care. METHODS: We used hospital admission data from the Ebeltoft Health Promotion Project, a randomized trial in primary care examining the effect of preventive health checks. Comparisons included three randomized groups: an intervention group receiving health checks, a group where intervention consisted of a health check followed by a health discussion with the GP and one control group. RESULTS: Both intervention groups had approximately 20% fewer hospital admissions than the control group over a 6 year period. If dependence among recurrent events is excluded, such a reduction amounts to a highly significant effect. Use of the standard Poisson distribution for analysing recurrent events and exclusion of their dependent structure causes data interpretation to be incorrect, because the model does not account for the extra variability between persons; the resulting 95% CIs would therefore be too small. CONCLUSION: Analysis of health care contacts should embrace both first and recurrent events and it should use a model appropriate to these data. An individual rate model that includes a parameter of an unspecified individual event distribution frailty may be a natural choice when analysing longitudinal data of contacts to the health care system in broad terms.

Denmark↗
PubMed1984

National health insurance: a new imperative.

When viewed from the perspective of the policy analyst, observed inequities in the access to health services and the rising costs of physician and hospital care are among the most important issues confronting the American health delivery system. Recognizing that publicly financed health insurance programs result in a more equitable distribution of medical services, this paper focuses on the components of a national health insurance scheme that not only offers a comprehensive range of benefits but also employs prospective payment and a set of financial incentives to control the costs of care provided by physicians, hospitals, and other health facilities. The national health insurance program proposed in this paper is designed to eliminate or reduce unwarranted expenditures on plant and equipment; the responsibility for approving and funding capital acquisitions is also regarded as an integral component of the program.

Capital Expenditures↗