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At least 19 recordsLinked to original sources
PubMed1977

[Hygienic and bacteriological comparative studies in 50 hospitals. VI. The efficacy of a hospital-hygienic instruction regarding 6 hospitals].

The efficacy of hospital hygienic measures was checked in six hospitals. The programme was started by determining the effective state. Subsequently a two-day extension course for the training and instruction of the responsible personnel in charge (physicians, nurses and administrative staff) in the essential problems of hospital hygiene was held. The next measure consisted in giving advice in the preparation of hygiene plans which had to make allowance for the prevailing personal and constructional situation as well as for the hospital equipment. The hygiene plans represented the written concept of the measures to be implemented. Then enquiries, local inspections as well as hygienic-bacteriological ambient analyses were carried out to determine the hygienic situation in the hospital after adoption of the measures and the findings were compared with the situation preceding the initiation of the hygienic programme. The results show that the proposed improvements were mostly realised as far as such administrative measures as the procurement of disinfectant dispensers, throwaway towels and suitable disinfectants were concerned. The instructions given for the implementation of suitable methods of application were complied with to a lesser extent. Moreover, considerable improvements were achieved with regard to the operation and efficiency of the sterilizers. On the whole, the present study demonstrates that suitable measures largely reduce the extensive gaps in information on the part of the staff on hospital hygiene and that the resulting intensification of efforts can greatly contribute towards an improvement of the overall hygiene in hospitals.

Air Microbiology↗
PubMed2025

Hospitalization for child physical abuse before hospitalization for osteogenesis imperfecta or severe hemophilia: A nationwide cohort study in France.

BACKGROUND: Timely and accurate diagnosis of early child physical abuse (CPA) is crucial to avoid recurrence and protect victims. Ruling out differential diagnoses is also important to avoid misdiagnosis of CPA. We evaluated the risk of hospitalization for early CPA before hospitalization for its 2 main differential diagnoses: osteogenesis imperfecta (OI) and severe hemophilia (SH). METHODS: This population-based cohort study used the national administrative database covering all hospitals in France. We followed infants born from 2010 to 2019 until age 2. We identified infants with a first discharge code for early CPA, OI, and SH and calculated crude absolute and relative risks. RESULTS: Among the 6,315,216 infants included, 2088 (33/100,000 infants per year) were hospitalized for early CPA, 160 (3/100,000) for OI, and 402 (6/100,000) for SH before age 2. Among infants hospitalized for early CPA, 2085 (99.86 %) had no further hospitalization for OI or SH, 3 (0.14 %) were further hospitalized for OI with a 9-month median interval between hospitalizations, and 0 were further hospitalized for SH. The absolute risk of hospitalization for early CPA before hospitalization for OI was 1.9 % (3/160, 95 % confidence interval [CI] 0.39-5.38), and the relative risk as compared with infants without hospitalization for OI was 56.8 (95 % CI 18.5-174.3). CONCLUSIONS: The very low to null absolute risks of hospitalization for early CPA before OI or SH probably reflect excellent current clinical practices in ruling out differential diagnoses. A better implementation of existing guidelines could further shorten the time to diagnosis of OI before age 2.

Humans↗
PubMedDate not supplied

[Some problems of psychiatric care unit in a general hospital I: Concerning decision of admission to hospital (author's transl)].

Over a thousand patients a year request hospitalization at the Psychiatric Admission Unit of the Region General Hospital of Santa Maria Nuova in Florence. About five hundred are actually hospitalized, less than half. Decision to hospitalize depends on several factors: a) factors relating to the patient (the psychopathological picture, the severity of his condition, his family background etc.); b) factors relating to the doctor on duty (degree of experience, attitude toward the patients, theoretical view toward hospitalization etc.); c) practical and administrative factors (service situation, day of the week, time of the day etc.). On the other hand the doctor's attitude may be that of undertaking care of the patient's psychiatric needs or not. This behaviour is largely independent from the decision to hospitaliz or not. Hospitalization does not necessarily mean taking care of the patient from a psychiatric point of view (hospital seen as a parking place, for example) and, vice versa, treatment can be planned without hospitalizing the patient who asks for it. Thus, there are four possibilities in a Psychiatric Admission Unit: a) hospitalization and care of the patient; b) no hospitalization but care of the patient; c) hospitalization without care of the patient; d) no hospitalization and no care of the patient. These four situations discussed with appropriate examples. The emotional attitude of the psychiatrist in his relationship with the patients who request admission is viewed as the most important factor for a correct decision.

Humans↗
PubMed1978

[Hospital legislation in the Federal Republic of Germany and its effects on psychiatric hospitals (author's transl)].

The article discusses the hospital laws of several land governments enacted subsequent to the hospital financing law of the Federal Government, in respect of the influence exercised by these laws on the internal structure of the hospital. The fact that the laws apply to all kinds of hospitals, and hence also to big psychiatric hospitals, is considered a disadvantage for psychiatric care. Such care is obviously hampered, on the one hand, by the legislative demand for departmentalization of the individual fields according to specialist subjects, representing a setup which is opposed to the realization of patient care in accordance with the requirements of the communities and citizens who expect to be cared for on an individual and not on a schematic basis, whereas, on the other hand, the new structures of management stipulated by the law do not provide for the inclusion of representatives of the new groups of professions now engaged in psychiatric activities. The model of regrouping the hospital structure into sectors instead of medical specialist departments, is presented and contrasted with the proposed model. It is recommended to arrange for representation of the non-medical and non-nursing professions in the managing boards, as well as to take into account the sociotherapeutico-rehabilitative interests as forming part of the conceptual approach to care in psychiatric hospitals, via special hospital committees.

Economics, Hospital↗
PubMed2025

Duration of Hospitalization is Associated with the Gut Microbiome in Patients Undergoing Hematopoietic Stem Cell Transplantation: Early Results from a Randomized Trial of Home Versus Hospital Transplantation.

Home-based hematopoietic stem cell transplantation (HCT) is an innovative care model with growing interest, but its impact on the gut microbiome remains unexplored in a randomized setting. We present interim results from the first randomized controlled trials (RCT) evaluating the effect of HCT location-home versus hospital-on gut microbial diversity and antimicrobial resistance (AMR) gene carriage. We hypothesize that patients randomized to undergo home HCT would have higher gut taxonomic diversity and lower AMR gene abundance compared to those undergoing standard hospital HCT. We analyzed stool samples from the first 28 patients enrolled in ongoing Phase II RCTs comparing home (n = 16) and hospital (n = 12) HCT at Duke University using shotgun metagenomic sequencing to compare taxa and AMR gene composition between groups. We also performed a secondary analysis comparing patients who received transplants at outpatient infusion clinics versus inpatient standard HCT to evaluate the influence of hospitalization duration. In the primary RCT analysis, taxonomic and AMR gene α- and β-diversity were comparable between home and hospital groups, reflecting similar durations of hospitalization despite group allocation. In contrast, secondary analyses demonstrated that patients transplanted in outpatient infusion clinics who experienced significantly reduced hospitalization had higher gut taxonomic α-diversity and differential β-diversity, although AMR gene diversity remained unchanged. In summary, randomization by transplant location did not impact the gut microbiota to the same extent as the duration of hospitalization, although secondary analyses were heavily confounded. Even when taxonomic differences were observed, AMR genes were similar between groups. This RCT represents a novel investigation into how care setting influences the gut microbiome during HCT. Our findings suggest that hospital duration, rather than randomization allocation alone, is the primary driver of microbial disruption. These results underscore the potential for reducing hospital duration to mitigate microbiome injury, thereby informing future interventions to reduce infection risk and improve patient outcomes.

Microbiome↗
PubMed1977

Characteristics of hospitalizations and death cases of diabetic patients in a general hospital.

Hospital admissions of diabetic patients were analyzed in relation to total hospital admissions, during a period of 7 years in a general hospital. The prevalence of hospitalization of diabetic patients was 2.5%. The female to male ratio was 1.4:1.0. Admissions of diabetic patients to hospital are mainly in the older age groups. By the age of 40 years, 73.4% of the total hospitalizations occur but only 13.0% of these hospital admissions are diabetics. The age at time of death of admissions ending fatally is similar in both the total and the diabetic admission groups to hospital. When the percentages of hospital admissions which terminated in death are calculated for age groups, an increase is specifically demonstrated in the diabetic group compared to the total admission group. Thus, diabetes is a complicating factor which increases mortality in people over 50 years of age.

Adolescent↗
PubMed1979

Multiple hospital systems and the teaching hospital.

A substantial portion of hospital beds are in institutions that are in multiple hospital systems having varying degrees of formal linkage. Relatively few core teaching hospitals are part of such systems, but they do share strong relationships with their parent medical schools and affiliated hospitals. The missions of core teaching hospitals are patient care, education, and research. The traditional affiliation arrangement between hospitals permits the parent university to achieve these missions. The possible benefits to be gained through participation in a multiple hospital system do not appear to be of sufficient magnitude to either core teaching hospitals or their parent universities to persuade them to join or form such a system.

Economics, Hospital↗
PubMed1978

[On the importance of the geographical position of psychiatric hospitals for the admission rates and hospitalization period (author's transl)].

Rates of admission, duration of hospitalization, chances of discharge and legal basis of admissions are analyzed with reference to the distances between the patients' domiciles and the hospital, basing on the figures which apply to the district hospitals Gabersee in Upper Bavaria. More patients from nearby are admitted, and also given long-term treatment, than from the more distant zones; in the long run, chances of discharge are not more favorable for patients living nearby; there is no variation regarding the share of voluntary admissions in relation to the distances between the respective domiciles and the hospital. These results show that there must be increased cooperation between hospitals or wards for inpatients, partial inpatients, and outpatients, in view of the expected increased hospitalization frequency in future psychiatric practice located in the immediate vicinity of the individual districts. Under no circumstances should it happen that instead of the expected saving in the number of hospital beds, the overall capacity of the hospitals is increased.

Geography↗
PubMed1978

Duration of hospitalization for acute bacterial empyema at Boston City Hospital during 12 selected years from 1935 to 1972.

The duration of hospitalization for acute bacterial empyema of the pleura was determined for all cases at Boston City Hospital during 12 selected years between 1935 and 1972. Patients whose infection was acquired after admission stayed in the hospital longer than those in whom the empyema, or the infection of which the empyema was a complication, was present at the time of admission. The differences were mostly related to serious underlying disease in the hospital-acquired cases. However, the duration of hospitalization after the empyema was bacteriologically confirmed was not much different in the community-acquired and hospital-acquired cases. Hospital stay was further prolonged in patients whose empyema was superinfected with new bacterial species after the original infecting organisms were determined. Hospitalization was shorter in the 10 selected years between 1974 and 1972, when penicillin and other active antibiotics were used, than in two years before penicillin became available, 1935 and 1941.

Acute Disease↗
PubMed1976

Conservation in hospital resource use: treatment of pneumonias. An investigation of care in four hospitals over the past decade.

An investigation of patient care in four hospitals compared levels of resource use between 1964 and 1974 for patients with a primary diagnosis of pneumonia. Results showed a decreased length of stay in all hospitals. Unique patterns of increases and decreases existed in each hospital for the changing use of diagnostic and therapeutic resources. Reduction in dollar value of length of stay was larger in all cases than increases in dollar value of diagnostic and therapeutic resource use. This resulted in an overall reduction in hospital resource charges over the decade, when 1974 dollar values were used. Large increases in diagnostic or therapeutic resources (up to 217%) were reflected as only minor increases in the partial hospital bill over the decade ( less than 11%). Increased intensity of resource use has contributed to increasing per-day charges of up to 27%, in the face of recent average cost rises of more than 10 times that size for daily hospital expenses.

Costs and Cost Analysis↗
PubMed1978

Bacteremic superinfections of patients with bacteremia: occurrence, bacteriology, mortality, and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972.

During the course of hospitalization of 6,414 patients with bacteremic infections identified at Boston City Hospital (Boston, Massachusetts) during 12 selected years between 1935 and 1972, 6.0% developed verified bacteremic superinfections with organisms not isolated or identified in the primary bacteremic infection. Analysis of these cases reemphasizes the increasing occurrence of serious hospital-acquired infections despite the successive introduction and intensive use of a large number of effective antibacterial agents. The bacteremic superinfections, like the primary hospital-acquired bacteremias, increased in incidence over the years, particularly since 1961; they were more frequent and were associated with a higher mortality rate and longer duration of hospital stay in the primary hospital-acquired cases than in the patients in whom bacteremia was considered to be community-acquired. The organisms in superinfections were similar to those in primary hospital-acquired bacteremias. Superinfection was more frequent among the patients who died than among the survivors.

Bacterial Infections↗