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The influence of patient-level factors on palliative and hospice care is unclear. We conducted a retrospective review of 2321 patients aged ≥18 that died within 6 months of admission to our institution between 2012 and 2017. Patients were included for analysis if their chart was complete, their length of stay was ≥48 hours, and if based on their diagnoses, they would have benefited from palliative care consultation (PCC). Bayesian regression with a weakly informative prior was used to find the odds ratio (OR) and 99% credible interval (CrI) of receiving PCC based on race/ethnicity, education, language, insurance status, and income. 730 patients fit our inclusion criteria and 30% (n = 211) received PCC. The OR of receiving PCC was 1.26 (99% CrI, 0.73-2.12) for Blacks, 0.81 (99% CrI, 0.31-1.86) for Hispanics, and 0.69 (99% CrI, 0.19-2.46) for other minorities. Less than high school education was associated with greater odds of PCC (OR 2.28, 99% CrI, 1.09-4.93) compared to no schooling. Compared to English speakers, non-English speakers had higher odds of receiving PCC when cared for by medical services (OR 3.01 [99% CrI, 1.44-5.32]) but lower odds of PCC when cared for by surgical services (0.22 [99% CrI

Nearly 500 employee slip, trip and fall incidents were reported in just over three years on a Midwestern urban hospital campus of approximately 10,000 employees. In an attempt to reduce the fall frequency, the hospital analyzed employee incident data during this period. Specifically, management searched for facility locations where multiple incidents occurred. However, the hospital found few, if any, patterns in the data with respect to fall location. In response, the hospital hired the author to provide them assistance in their effort to reduce the employee fall rate. The author first re-analyzed the data according to fall hazard rather than fall location and found common causes of incidents that accounted for large percentages of all falls. The data analysis was followed up with a site investigation and written recommendations.

Few qualitative studies have explored the relationship between substance use and self-harm. We employed a multiple-case study research design to analyze data from 80 patients who were admitted to a hospital in South Africa following self-harm. Our analysis revealed, from the perspective of patients, a number of distinct ways in which substance use is implicated in self-harm. Some patients reported that substance intoxication resulted in poor decision making and impulsivity, which led to self-harm. Others said substance use facilitated their self-harm. Some participants detailed how in the past their chronic substance use had served an adaptive function helping them to cope with distress, but more recently, this coping mechanism had failed which precipitated their self-harm. Some participants reported that substance use by someone else triggered their self-harm. Findings suggest that there are multiple pathways and a host of variables which mediate the relationship between substance use and self-harm.

Purpose: To evaluate the effectiveness of an integrated Pharmacy Transitions of Care (PTC) pilot program on reducing hospital readmissions and improving patient satisfaction. Methods: This prospective observational cohort study compares patients who participated in the PTC program to a control of usual hospital discharged patients during January through April 2014. The PTC program provided discharge medication review, medication counseling, delivery of medications to bedside, clinic scheduling, and follow-up phone calls. The primary outcome measure was 30-day readmissions. Secondary outcomes included emergency department (ED) visits, pharmacist interventions, and patient satisfaction. Results: Seventy patients participated in the PTC program. Compared to the control (n = 725), the study group had decreased 30-day all-cause readmissions (5.7% vs 13.8%, P = .08), 30-day readmissions for the same diagnosis (2.9% vs 8.1%, P = .18), and ED visits (18.6% vs 25%, P = .82). Twenty-five interventions during discharge medication review included discontinuation of unnecessary medications and correction of medication dose or frequency. The majority of patients were satisfied with the medication education provided (94%) and the timely delivery of prescriptions to bedside (96%). Conclusion: There was no significant difference in 30-day readmission rates. However, pharmacists were able to make a positive impact on patient satisfaction and improve understanding of medications during discharge.

Objective To learn about (1) mothers' perspectives on their children's social experiences and (2) how mothers interpret social situations and provide guidance to their children in challenging situations. Design This was a qualitative study analyzing narratives. Mothers participated in a semistructured interview; mothers and their children participated in a social coaching task involving responses to hypothetical situations. Transcripts of audio recordings were used to create thematic coding categories, and transcripts were reviewed and coded. Setting Children were patients at a reconstructive plastic surgery center in an urban hospital and medical school; families were recruited from a regional support group associated with the hospital. Participants Mothers of nine children with congenital craniofacial anomalies, aged 9 to 14 years. Main Outcome Measures Thematic narrative coding categories, focusing on mothers' perspectives on children's actual social experiences (from the interview) and mothers' advice and interpretations regarding challenging hypothetical social tasks (from the coaching task). Results In the interviews, mothers reported positive and negative social experiences for their children. Multiple approaches were used by mothers to interpret social interactions experienced by children (interview) and hypothetical social situations (coaching task). These included consideration of situational factors, motivations of others, and factors within own child. Mothers' hypothetical advice was often prosocial, including concrete strategies to resolve conflict, to plan ways to avoid problems, to foster self-reliance, and to avoid hurtful situations. Conclusions Mothers showed active interest and concern in their children's peer relationships and were thoughtful in devising strategies to successfully manage potential social challenges.

OBJECTIVE: This study presents a detailed account of processes and multiple methodologies used in conducting a diagnostic post-occupancy evaluation (POE) in an urban hospital emergency department. BACKGROUND: Healthcare design POE research findings can lead to improved work environments for healthcare providers and higher levels of staff, patient, and visitor satisfaction. METHODS: This evaluation was conducted in two separate phases over 12 months, with data analysis occurring after each phase. Phase 1 involved 200 hours of observation, physical measurements, and occupancy counts. Phase 2 included surveys ( n = 315) of staff, visitors, and patients. In addition, eight distinct staff focus groups (e.g., Nursing, Housekeeping, Physician, etc.) were conducted. RESULTS: To illustrate the process, one healthcare design-related issue, privacy and confidentiality, was assessed in light of the linear design model with a central core. Phase 1 observation results indicated that most confidential conversations were contained within the linear core. However, Phase 2 focus groups revealed that many staff members had concerns regarding the level of privacy and confidentiality due to the core's open design. The use of multiple methods provided greater information and a more comprehensive picture of the emergency department environment and design. CONCLUSIONS: This study presents a comprehensive framework for diagnostic post-occupancy evaluation in healthcare design. The findings indicate that a systematic, multi-methodological approach developed around a conceptual framework can lead to higher quality evaluations. Diagnostic POEs should be grounded in extant literature and customized based on the setting, the client's guiding principles, and the design team's objectives. In diagnostic POEs, one size does not fit all.

Background. Exclusive breastfeeding is important for immunity and lack of breastfeeding during the neonatal age impedes that. Our aim was to assess the consequences of lack of breastfeeding on infants with diarrhea in the neonatal period. Methods. In this design, infants from DDSS (Diarrheal Disease Surveillance System) from 2009 to 2013 were studied. Those who did not have breastfeeding or had cessation of breastfeeding at the neonatal age constituted the cases, whereas infants who continued breastfeeding since birth or for at least 6 months since birth constituted the controls. Results. The cases more often presented at a younger age, had an illiterate mother, frequently presented with complicated diarrhea, had severe wasting, and had abnormal mental status compared with the controls. In logistic regression, after adjusting for potential confounders, infants who lacked breastfeeding at the neonatal period had an independent association with dehydrating diarrhea. Conclusions. The results of our analyses suggest that infants with diarrhea who did not have breastfeeding at the neonatal age are prone to develop some or severe dehydration.

Emergency preparedness and management has evolved exponentially from the inception of the Incident Command Structure in the 1970s to the tragic events of September 11, 2001. As a result, emergency management is essential for government agencies to private businesses, including hospitals. The events of 9-11 have drastically changed the way individuals think and operate in our health care environment. This report describes an emergency incident that occurred in the author’s medium-sized urban hospital because of loss of power from the power grid due to theft. The emergency that ensued lasted for more than 24 hours and confronted the hospital with unique challenges. This article describes the basic information about the general structure of hospital emergency preparedness and the specific aspect of preparedness that affect the intensive care unit. During the course of the emergency situation great insight into the function of the emergency preparedness plan was gained. In the end, many valuable lessons were learned that have led to improved function of emergency preparedness response and recovery.

Aconite is one of the most toxic plants. Aconite is used by herbalists for pain relief. Toxicity occurs due to misidentification, contamination, adulteration and mis-processing. Patients usually present with classical symptoms of aconite poisoning such as perioral paraesthesia, gastrointestinal upset, and generalised burning sensation. Cardiac manifestations include hypotension and ventricular tachycardia. Since aconite is a life-threatening herb commonly used in all cultures, every clinician should be aware of this poison. This report recorded three cases of aconite poisoning in a Nepalese family who were managed in a major urban hospital in Hong Kong. They all presented with variable severity of aconite poisoning after mistakenly ingesting aconite. Management was performed basing on the clinical features, as laboratory confirmation of aconite poisoning was not immediately available. All three patients survived and did not suffer from any consequences.

The sense of coherence (SOC) is a measure of one's global orientation toward the world; it is the extent to which one perceives life as comprehensible, manageable, and meaningful. The study assesses the SOC of cardiac and cancer inpatients, and examines whether age, gender, race, education, and length of illness predict SOC. Participants comprise 172 patients (84 women, 88 men) at an urban hospital in the Northeastern United States, 122 with cardiac conditions and 50 with cancer. The mean age is 59.8. Results show that the SOC of cardiac and cancer patients is slightly lower than the general population. There are no differences in SOC between cardiac and cancer patients. Multiple regression shows that age and length of illness predict SOC ( R = .26, R2 = .07, p = .002); however because of the small effect size and collinearity, their exact contributions need further study. SOC does not vary according to gender, race, or education.

Rural health care organizations struggle to attract and retain nurses, yet much of the research has focused on characteristics of the nurse work environment or empowerment in urban hospitals. The purpose of this study was to examine the nurse work environment in rural areas across settings by describing the relationship between structural empowerment and characteristics of the nurse work environment. Nurses ( N = 97) working in home care agencies and hospitals were surveyed. Significant differences were found between the groups, with home care nurses having significantly higher empowerment scores than medical/surgical nurses. A strong correlation was found between characteristics of the nurse work environment and empowerment. Policy makers are using evidence to guide development of policies, but much of the research has been conducted in urban hospital settings. This study begins to provide evidence that differences exist between urban and rural areas and between practice settings.

Heart failure (HF) affects more than one million older Americans. As the population ages, the incidence of HF will increase. The purpose of this study was to identify variables that profile elders hospitalized with HF who are at high risk for poor postdischarge outcomes. A total of 103 patients were enrolled in the study. A low serum sodium and a fair or poor self-reported health status predicted all-cause readmission. A low serum sodium predicted HF-related readmissions. Four or more HF symptoms and index admission to an urban hospital predicted physician office visits. Admission to a community hospital predicted emergency department visits, and the number of coexisting medical conditions indicated an increased risk for an emergency department visit. The findings indicate that it is possible to profile hospitalized elders with HF who are at risk for poor postdischarge outcomes.

The current study examines gender differences in victim and crime characteristics in an effort to determine the extent to which sexual assault is a similar experience for men and for women. Data from a routine structured interview was obtained from medical charts of 842 women and 128 men seen at an urban hospital-based rape treatment center. Demographic characteristics were similar, although males were more like to identify as gay or bisexual, and women were more likely to be of minority ethnicity. Men were more likely to report acute psychiatric symptoms, a history of psychiatric disorder, and a history of psychiatric hospitalization. Women were more likely to experience vaginal or anal penetration, to sustain injuries, and to make a police report. Implications for services for both men and women are discussed.

This article compared data on 200 patients at a large urban hospital on a number of demographic variables to distinguish clients who initiated an advance directive from those who declined. To better understand why some respondents refused, a telephone survey was conducted. As a result of the survey, an educational intervention was initiated in the walk-in clinic area. A social work student provided informatton and assisted with the completion of the forms. An ambulatory care setting was chosen assuming that, when patients are less ill, they may be better able to absorb the information on advance directives. As a result of the educational intervention, 66% of the respondents approached initiated an advance directive. Those that declined were called 2 weeks later, and 80% gave responses indicating they were making an informed decision. The findings clearly demonstrate that an educational intervention increases the percentage of individuals who initiate an advance directive.

Data from a survey of more than 800 nurses who care for AIDS patients revealed that the organizational form of the unit and hospital in which care was provided significantly affected the likelihood of nurses reporting that they were emotionally exhausted. Nurses who worked in dedicated or specialized AIDS units, or in “magnet” hospitals known to possess organizational characteristics attractive to nurses, exhibited lower levels of emotional exhaustion than did nurses who cared for AIDS patients in general, scattered-bed medical units. These differences persisted after nurse characteristics were statistically controlled, but they were accounted for in part by controlling for the amount of organizational support that nurses perceived was present in their workplaces.

One hundred and six women giving birth in a rural hospital in Northern India were compared with 100 women delivering in a tertiary care urban hospital located in an adjacent state. The women in the rural hospital were younger and more likely to be multiparous. Their antenatal course was characterized by fewer antenatal check-ups, significantly lower haemoglobin values, but equal weight gain during pregnancy. They were more likely to have a spontaneous vaginal delivery, and less likely to undergo caesarean section and episiotomy. Neonatal birth weights were lower in the rural group; other indices of neonatal well-being were comparable.

Results from afield study with 152 members of a large urban hospital indicate that the relationship between the quality of leader-member exchange (LMX) and subordinate performance is moderated by perceptions of task analyzability and variety. LMX and performance are found to be significantly related when task challenge is either very high or very low. Under these task conditions, data indicate that there is a positive link between LMX and performance such that a higher quality leader-member exchange correlates with higher levels of performance. On the other hand, analyses also reveal that when tasks are perceived to be moderately challenging, no significant relationship between LMX and performance is present. In other words, these data suggest that characteristics of the task act as moderating agents of the LMX/performance relationship. Results are discussed in terms of theory development, managerial implications, andfuture LMX research.

In 326 fibreoptic upper gastrointestinal (GI) endoscopies performed in Evangel Hospital (Jos, Nigeria), pathology was found in 210 patients, and of a major nature such as peptic ulcer disease or cancer in 129 of these. The three most useful features to predict the presence of major pathology were epigastric tenderness (the single most useful feature), loss of weight and epigastric pain of a burning nature. These features were selected by stepwise discriminant analysis, which also led to the conclusion that the presence of at least two of these three features is an even more powerful predictor of major pathology.

My pager buzzed one day when I was a social worker in an urban hospital and there was a message asking me to come to the intensive care unit (ICU). As the elevator door opened there was a familiar medical resident standing in front. His face could best be described as luminous with a wide-eyed stare and a soft smile. He had delivered his first baby and said, “As I delivered him, he opened his eyes and stared into mine. It was all so silent. It just struck me that I was the first human being the baby had ever seen. I was not prepared to realize that!” He was present in that moment and engrossed in that felt memory. Afterward, I continued to another floor and got off at the ICU, imagining what it must feel like to be the first person a new life sees upon delivery into the world.

The ability of 100 mothers in a suburban private pediatric practice and 100 mothers in an urban hospital-based practice to read a mercury glass thermometer accurately was assessed. Ninety-three percent of suburban practice parents could read three pre-set thermometers correctly, but only 10% of urban practice parents could perform the same task. Education level only partially explained the inability of most urban parents to read successfully. Because certain clinical situations require accurate fever assessment at home, simplified methods of fever assessment should be considered in populations with low competence in reading a thermometer by traditional methods.

This is a retrospective study that set out to determine the mortality patterns and case fatality rates of people with diabetes mellitus (DM) in a Nigerian hospital. The sources of data were the medical records, ward admissions, deaths register and death certificates. Of a total of 13,797 medical admissions made over a period of 11 years (1990-2000),1423 (10.3%) were DM related and the documented case fatality rate of DM was 22.6%.

Purpose/Background Cervical carcinoma is both the number one cancer killer of women in the developing world and the most common malignancy found in human immunodeficiency virus (HIV)-positive women. Yet many resource-poor regions, which are heavily burdened with HIV, offer little cervical cancer education or screening to their populations. Objectives To assess the need and determine the feasibility of establishing a cervical cancer screening program for HIV-positive women in a resource-constrained setting and to raise funds to support such a project. Methods Implement a multitiered fundraising effort, perform a systematic examination of screening programs in similar settings, assess established medical infrastructure on the ground in Nairobi, and design an appropriate, sustainable cervical cancer screening program for HIV-positive women. Results/Conclusions $8000 US was raised before departure and additional funds were acquired while in Nairobi. Medical infrastructure at an urban hospital-based HIV clinic was deemed an appropriate setting for the establishment of a Pap smear-based screening program. Women in need of additional diagnostics and possible treatment would be referred for further assessment at the national hospital. To address this need, a treatment subsidy and follow-up program linking the HIV clinic with the national hospital was proposed. A detailed proposal was presented to and accepted by clinic administrators.

As in previous selective exposure (avoidance) research, the purpose of this study was to determine whether individuals shy away from information which could be dissonance-arousing. However, in contrast to previous laboratory-type studies, this was carried out in a field setting in conjunction with an ongoing health education program at a large urban hospital serving low-income groups. The key dependent variables were actual attention to the health film and stated preferences for further information on two potentially dissonance-arousing topics: the risks of cigarette smoking and of untreated hypertension. The data show only negligible evidence of selective exposure on either topic for either indicator. To the very limited extent selective exposure was found to occur, the tendency was greater, in terms of actual attention among people thirty and above than among those younger, and greater, in terms of stated preferences for further information, among dogmatic than among less dogmatic individuals.

(96) Ray E. Trussell, Jack Elinson, and Morton L. Levin, "Comparison of Various Methods of Estimating the Prevalence of Chronic Disease in a Community," American Journal of Public Health, 46 (February, 1956), 173-182. (97) Urban Life Research Institute, Nursing Services in a Large Urban Hospital, New Orleans: Tulane University, 1954. (98) L. Wes Wager, "The Measurement of the Job Satisfaction of Professional Nurses," Research Studies of the State College of Washington, 20 (June, 1952), 45-55.