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OBJECTIVE: To identify patient expectations regarding chaplain visitation, characteristics of patients who want to be visited by a chaplain, and what patients deem important when a chaplain visits. PARTICIPANTS AND [...]

Shelli Cannon, MD, likes the familiarity of the free clinic where she volunteers. It has the same equipment, supplies, and procedures as her offices at Parkway Medical Group in Asheville, [...]

Under Internal Revenue Service requirements, nonprofit hospitals will begin filing new community, benefit reports in 2010. Maryland has had similar requirements since 2004. This paper, based on interviews at 20 [...]

Advocates for physician-owned hospitals specializing in cardiac, orthopedic, and surgical services claim that these facilities induce healthy competition, stimulating improved performance among acute care hospitals. This paper examines the effect [...]

The study investigates if care coordination programs reduce hospitalizations and Medicare expenditures and enhance quality of care for chronically ill Medicare beneficiaries. Findings suggest that practical care coordination programs without a strong element of transitional care may not offer net Medicare savings. However, programs with significant in-person contact with moderate to severe patients can be cost effective and partially improve care quality.

Introduction: Although specialized palliative care services in rural areas are scarce, many people who are dying, and their families, want to remain in their homes or within their own community. As such, semirural communities across Canada have developed a variety of initiatives to address this need. The purpose of our paper is to describe a semirural palliative care program located in British Columbia. Methods: We used univariate and bivariate analyses to examine all patients for whom a palliative care bed was requested in the Saanich Peninsula Hospital Palliative Care Unit (PCU) between Jan. 1, 2005, and Dec. 31, 2006. Results: Data suggest that there is provision of care for local residents in this semirural community. Throughout 2005 and 2006, SPH received a total of 411 requests for a palliative care bed with about three-quarters of admissions coming from other units within the hospital and from local residents. Conclusion: Use of services data collected from hospital charts can provide valuable information to help inform program and policy decision-makers. Yet such information is limited in relation to answering the question of whether the end-of-life needs of local residents are being met. Future studies should consider input from families and patients to enhance our understanding of the role of a PCU in a semirural environment. Introduction : Bien qu'il existe peu de services de soins palliatifs specialises dans les regions rurales, bon nombre de personnes en fin de vie, ainsi que leurs familles, souhaitent rester dans leur domicile ou dans leur propre communaute. C'est pourquoi des communautes semi-rurales dans tout le Canada ont mis en oeuvre divers projets pour repondre a ce besoin. Dans cet article, nous decrivons un programme de soins palliatifs semi-rural en Colombie-Britannique. Methodes : Nous avons effectue des analyses unidimensionnelles et bidimensionnelles de toutes les demandes de lits en soins palliatifs a l'unite des soins palliatifs (USP) de l'hopital de la peninsule de Saanich entre le 1er janvier 2005 et le 31 decembre 2006. Resultats : Les donnees indiquent que l'on a prevu des soins pour les residants locaux de cette communaute semi-rurale. En 2005 et 2006, l'hopital de la peninsule de Saanich a recu 411 demandes de lits en soins palliatifs et environ les trois quarts des patients admis provenaient d'autres unites de l'hopital ou etaient des residants locaux. Conclusion : Les donnees sur les services extraites des dossiers de l'hopital peuvent fournir des renseignements precieux pour informer les decideurs en matiere de programmes et de politiques. Pourtant, de tels renseignements ne suffisent pas pour repondre a la question de savoir si les besoins de fin de vie des residants locaux sont satisfaits. Les recherches futures devraient tenir compte des commentaires des familles et des patients pour mieux comprendre le role d'une USP dans un milieu semi-rural., INTRODUCTION It is well documented that Canada's large rural areas, characterized by sparse populations, fewer services and greater distances, present a major challenge to residents in need of health care [...]

Mike Duckett, Royal Brompton Hospital's catering manager, believes that happy patients are more receptive to treatment and feels that it is his moral responsibility to produce good hospital food. Mike Duckett's radical campaign to improve hospital food includes buying more locally produced food. Mike Duckett's other views, as well as key information on him, are presented.

CASE DESCRIPTION The primary subject matter of this case is concerning the managerial and personnel issues in a hospital pharmacy. Focus is on the implications of mismanagement leading to localized [...]

Objective Mulago and Mbarara hospitals are large tertiary hospitals in Uganda with a high HIV/AIDS burden. Until recently, HIV testing was available only upon request and payment. From November 2004, routine free HIV testing and counselling has been offered to improve testing coverage and the clinical management of patients. All patients in participating units who had not previously tested HIV-positive were offered HIV testing. Family members of patients seen at the hospitals were also offered testing. Methods Data collected at the 25 participating wards and clinics between 1 November 2004 anal 28 February 2006 were analysed to determine the uptake rate of testing and the HIV seroprevalence among patients and their family members. Findings Of the 51 642 patients offered HIV testing, 50 649 (98%) accepted. In those who had not previously tested HIV- positive, the overall HIV prevalence was 25%, with 81% being tested for the first time. The highest prevalence was found in medical inpatients (35%) and the lowest, in surgical inpatients (12%). The prevalence of HIV was 28% in the 39 037 patients who had never been tested before and 9% in those who had previously tested negative. Of the 10 439 family members offered testing, 9720 (93%) accepted. The prevalence in family members was 20%. Among 1213 couples tested, 224 (19%) had a discordant HIV status. Conclusion In two large Ugandan hospitals, routine HIV testing and counselling was highly acceptable and identified many previously undiagnosed HIV infections and HIV-discordant partnerships among patients and their family members. Objectif Les etablissements hospitaliers de Mulago et de Mbarara sont de grands hopitaux tertiaires d'Ouganda, dans lesquels la charge de VIH/sida est importante. Jusqu'a recemment, le depistage du VIH n'etait disponible que sur demande et contre paiement. Depuis novembre 2004, un depistage du VIH et des conseils sont proposes de maniere systematique et gratuite afin d'ameliorer la couverture du depistage et la prise en charge clinique des patients. Un depistage du VIH a ete propose a tous les patients des unites participantes n'ayant jamais ete testes positifs pour ce virus. Ce depistage a egalement ete propose aux membres de la famille venus a l'hopital. Methodes Les donnees recueillies dans les 25 unites et services hospitaliers participants entre le [1.sup.er] novembre 2004 et le 28 fevrier 2006 ont ete analysees pour determiner le taux d'utilisation du depistage et la seroprevalence du VIH chez les patients et les membres de leur famille. Resultats Parmi les 51 642 patients auxquels un depistage avait ete propose, 50 649 (98 %) ont accepte. Parrni les patients jamais testes positifs auparavant, la prevalence globale du VIH etait de 25 %, ce depistage etant le premier pour 81% d'entre eux. C'est parmi les patients en hospitalisation medicale qu'on a releve la plus forte prevalence du VIH (35 %) et parmi ceux hospitalises en chirurgie, que ce parametre etait le plus bas (12 %). Chez les 39 037 patients jamais depistes auparavant, la prevalence du VIH etait de 28 % et chez ceux precedemment testes negatifs, de 9 %. Parmi les 10 439 membres de la famille auxquels avait ete propose un depistage, 9720 (93 %) ont accepte. La prevalence du virus chez les membres de la famille etait de 20 %. Parmi les 1213 couples depistes, 224 (19 %) etaient serodicordants. Conclusion Dans deux grands hopitaux ougandais, le depistage systematique du VIH et les conseils au sujet du VIH/sida se sont reveles tres acceptables et ont permis d'identifier de nombreuses infections a VIH encore non diagnostiquees et des partenaires serodiscordants parmi les patients et les membres de leur famille. Objetivo Los hospitales de Mulago y de Mbarara son dos grandes hospitales terciarios de Uganda que presentan una elevada carga de infeccion por VIH/SIDA. Hasta hace poco, las pruebas de deteccion del VIH solo se realizaban a peticion de los interesados y eran de pago. Desde noviembre de 2004 se viene ofreciendo asesoramiento y pruebas de deteccion del VIH gratuitas y sistematicas a fin de mejorar la cobertura de analisis y el manejo clinico de los pacientes. Se ofrecieron las pruebas del VIH a todos los pacientes de las unidades participantes que no habian dado antes resultados positivos para el VIH, y tambien se ofrecio la posibilidad de someterse a las pruebas a los familiares de los pacientes. Metodos Se analizaron los datos reunidos en las 25 salas y consultorios participantes entre el 1 de noviembre de 2004 y el 28 de febrero de 2006 a fin de determinar la tasa de uso de las pruebas y la seroprevalencia del VIH entre los pacientes y sus familiares. Resultados De los 51 642 pacientes a los que se ofrecieron pruebas de deteccion del VIH, 50 649 (98%) aceptaron someterse a ellas. Entre los que no habian dado antes resultados positivos, la prevalencia global de infeccion por VIH fue del 25%; el porcentaje de personas analizadas por vez primera fue del 81%. La prevalencia mas alta correspondio a los pacientes ingresados clinicos (35%), y la mas baja a los enfermos ingresados quirurgicos (12%). La prevalencia de infeccion por VIH fue del 28% entre los 39 037 pacientes que no se habian sometido nunca a esos analisis, y del 9% entre los que habian obtenido resultados negativos en pruebas anteriores. De los 10 439 familiares a los que se ofrecio la posibilidad de someterse a las pruebas, 9720 (93%) aceptaron; la prevalencia entre ellos fue del 20%. Entre las 1213 parejas analizadas, 224 (19%) presentaron resultados discordantes en su serologia VIH. Conclusion En dos grandes hospitales ugandeses, el asesoramiento y las pruebas sistematicas de deteccion del VIH fueron ampliamente aceptados, y gracias a ello se identifico un gran numero de infecciones por VIH no diagnosticadas hasta el momento y de casos de discordancia serologica entre los pacientes y sus familiares., Introduction Both counselling and testing are key components of HIV prevention and care programmes. (1) Through HIV counselling and testing (HCT), uninfected individuals can take steps to avoid becoming infected, [...]

A study to record if the outcomes after a cardiac arrest in hospital differed during nights and weekends as against days or evening and weekdays is conducted. Results show lower survival rates from cardiac arrests during nights and weekends.

This paper reports the initial operational outcomes of an emergency department-based HIV testing program in a high-prevalence and resource-limited setting by describing (1) the number and percentage of patients approached, tested, and found to be HIV positive and (2) the linkage of care to the HIV clinic. A retrospective log and chart review of the initial 5 months (January 2006 to April 2006) of the HIV testing program was performed. Patients were selected for HIV testing by routine screening and by provider initiated referrals. Out of the 1371 patients who were approached for HIV testing, 1339 (97.7%) patients were tested for HIV. Three hundred twelve (22.7%) of the patients tested were HIV positive. Within a sample group of patients newly diagnosed with HIV in the department, 82% were compliant with their initial HIV clinic visit and 65% were compliant with a 1-month follow-up visit. The implementation of an emergency department-based HIV testing program in a high HIV prevalence and resource poor country is feasible with a high percentage of patients accepting HIV testing and a high percentage of positive patients presenting to follow-up care. Establishment of rapid HIV testing in emergency departments can identify significant numbers of HIV-positive patients who would otherwise remain undiagnosed and provides an education opportunity for those patients who are HIV negative.

Purpose: This study describes current stroke care within hospital acute care settings. Method: Twenty-two acute care hospital sites in Central South Ontario were mailed a survey exploring the prevalence of [...]

Studies have identified the importance of hospitals' organisational culture in clinical information system diffusion, but few have quantified its role. This study measured organisational culture in two Australian hospitals to explore whether clinicians' perceptions of culture related to their attitudes to, and satisfaction with, a computerised provider order entry system (CPOE). Data were collected using the Organisational Culture Inventory and a user-satisfaction survey administered to a population of 249 clinicians from the two hospitals. One hospital used CPOE to order clinical laboratory and radiology tests and view results, and the other used the test viewing function only, the ordering facility being planned for later implementation. We found a relationship between culture and clinicians' attitudes, with those in the constructive culture hospital more likely to express positive attitudes towards CPOE, whereas those in the agressive/defensive hospital were more likely to be negative. The relationship between culture and attitudes towards clinical information systems should be taken into account when planning for their adoption. Keywords: Australia; Organisational culture; Hospital information systems; Clinical information systems; Computerised provider order entry systems (CPOE)

An assessment of the quality of services offered by for-profit (FP) and not-for-profit (NFP) hospitals is presented. Previous studies have shown a relationship between nurse staffing and quality of services. An analysis shows that case mix-adjusted registered nurse staffing was lower in FPs compared to NFPs. It was also found that a lower level of registered nurse staffing resulted in higher levels of mortality and length of stay in hospitals.

Shared care, in which nurse clinicians lead care as 'specialist' advisers to general practitioners (GPs), is becoming more popular among health professionals working in the area of drugs and alcohol [...]

The Transition into Primary Care Psychiatry (TIPP) clinical model, a shared mental healthcare service implemented at London and Thunder Bay, Ontario, facilitates collaboration in mental health service delivery for patients [...]

The use of high-volume hospitals for certain procedures is advocated in an effort to improve the quality of surgical care in the United States and referral to high volume hospitals is recommended for operations with a demonstrated volume-outcome relationship. This method was resorted to because of numerous reports of a direct volume-outcome relationship for certain procedures with patients at high-volume hospitals consistently having better outcomes.

Historic advances in biomedical research provide both unprecedented insights into the pathogenesis of human diseases and the challenge to translate these insights efficiently into improved health. Meeting this challenge requires [...]

OBJECTIVE. The goal was to examine the influence of sociodemographic characteristics and health care system factors on the utilization of hospital resources by US children [greater than or equal to] 17 years of age with a diagnosis of traumatic brain injury. METHODS. A retrospective analysis of data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, from January 1, 2000, to December 31, 2000, was performed. National estimates of traumatic brain injury-associated hospitalization rates and resource use were calculated with Kids' Inpatient Database sample weighting methods. RESULTS. Of 2 516 833 encounters between January 1, 2000, and December 31, 2000, 25 783 cases involved patients [greater than or equal to] 17 years of age with a recorded diagnosis of traumatic brain injury. On the basis of these data, there were an estimated 50 658 traumatic brain injury-associated hospitalizations among children [greater than or equal to] 17 years of age in the United States in 2000. The traumatic brain injury-associated hospitalization rate was 70 cases per 100 000 children [greater than or equal to] 17 years of age per year; 15- to 17-year-old patients had the highest hospitalization rate (125 cases per 100 000 children per year). Pediatric inpatients accrued more than $1 billion in total charges for traumatic brain injury-associated hospitalizations in this study. In the multivariate regression models, older age, Medicaid insurance status, and admission to any type of children's hospital were associated with a longer length of stay for pediatric traumatic brain injury-associated hospitalizations. Older age, longer length of stay, and in-hospital death predicted higher total charges for traumatic brain injury-associated hospitalizations. CONCLUSION. Pediatric traumatic brain injury is a substantial contributor to the health resource burden in the United States, accounting for more than $1 billion in total hospital charges annually. Key Words traumatic brain injury pediatrics resource utilization length of stay, total charges, Kids' Inpatient Database Abbreviations CDC--Centers for Disease Control and Prevention CI--confidence interval KID---Kids' Inpatient Database LOS--length of stay OLS--ordinary least-squares TBI--traumatic brain injury, TRAUMATIC BRAIN INJURY (TBI) has been referred to as the "silent epidemic" by the Centers for Disease Control and Prevention (CDC) and others, because of its vast incidence and pressing [...]

Background: There is a lack of information from Canadian hospitals on the role of hospital characteristics such as procedure volume and teaching status on the survival of patients who undergo [...]

Ferguson Medical Group and Missouri Delta Medical Center are virtually next-door neighbors in the small town of Sikeston, MO, about 140 miles south of St. Louis. In between them stands [...]

A study aims to assess whether using a clinical pathway for on-site treatment of pneumonia and other lower respiratory tract infections in nursing homes could reduce hospital admissions, related complications, and costs. Results show that the line of treatment can result in comparable clinical outcomes, while reducing hospitalizations and health care costs.

PREPARATIONS: In New Orleans, Louisiana, we had been through the drill many times before. Annually, disaster preparation is undertaken in conjunction with our Office of Emergency Preparedness when an imaginary [...]

AUGUST 26: 3 DAYS BEFORE LANDFALL: Like most Friday afternoons, our 12-person neonatology group went through the weekend sign-out process of patients divided among the 9 area hospitals for which [...]

AUGUST 29: HURRICANE KATRINA LANDFALL: I am a neonatologist in private practice and had been at the hospital for >24 hours along with 40 other physicians. I had volunteered to [...]

Resident physicians from a pediatric academic training program developed a hospital-wide research project in an effort to enhance their residency research experience. In this model, residents themselves assumed primary responsibility for each stage of a large prospective clinical research study. The project, which was integrated successfully into the residency program, enabled a large group of residents, with mentorship from a dedicated faculty member, to benefit from a structured clinical research experience while providing the flexibility necessary to meet the demands of a busy residency curriculum. Careful topic selection with a well-defined end point, faculty involvement, resident collegiality, and institutional support were factors identified by study leaders as central to the success of this model. Key Words: research, resident education/training, residency/internship, PARTICIPATION IN RESEARCH during residency training is recognized as an important component of physician education. (1-9) Although many residents express interest in pursuing research during residency, rates of participation tend [...]

Studying the characteristics of attempted suicide is helpful in knowing the background of some completed suicides and improving prevention or intervention strategies. This current study analyzed data of 74 suicide attempters and 92 accident injured patients admitted to 6 hospital emergency rooms in an area of Northeastern China and found both similarities and differences between Chinese and Western suicide attempters. The data show that more women than men attempted suicide. Perhaps because of the unavailability of firearms to Chinese civilians, pesticide was the most lethal means of suicidal behavior. The stressful life events that account for the majority of suicidal incidents were mostly familial or marital problems. Compared with accident victims, these Chinese suicide attempters were younger, poorer, more likely to believe in a religion/superstition, more likely to perceive gender inequality, and less likely to experience support from either family or community. The traditional culture downplaying the status of women coupled with a belief in the transmigration of life may play an important role in the suicide of Chinese young women.

Objectives Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case--fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the annual incidence of all self-poisoning, and of fatal self-poisoning, in a rural developing-world setting. Methods Self-poisoning patients admitted to Anuradhapura General Hospital, Sri Lanka, were reviewed on admission from 1 July to 31 December 2002. We audited medical notes of self-poisoning patients admitted to 17 of the 34 surrounding peripheral hospitals for the same period. Findings A total of 742 patients were admitted with self-poisoning to the secondary hospital; 81 died (CFR 10.9%). 483 patients were admitted to 17 surrounding peripheral hospitals. Six patients (1.2%) died in peripheral hospitals, 249 were discharged home, and 228 were transferred to the secondary hospital. There was no effect of gender or age on likelihood of transfer; however, patients who had ingested oleander or paraquat were more likely to be transferred than were patients who had taken organophosphorus pesticides or other poisons. Estimated annual incidences of self-poisoning and fatal self-poisoning were 363 and 27 per 100 000 population, respectively, with an overall CFR of 7.4% (95% confidence interval 6.0-9.0). Conclusion Fifty per cent of patients admitted to peripheral hospitals were discharged home, showing that CFRs based on secondary hospital data are inflated. However, while incidence of self-poisoning is similar to that in England, fatal self-poisoning is three times more common in Sri Lanka than fatal self-harm by all methods in England. Population based data are essential for making international comparisons of case fatality and incidence, and for assessing public health interventions. Keywords Poisoning/epidemiology; Suicide, Attempted/trends; Referral and consultation; Sri Lanka (source: MeSH, NLM). Mots cles lntoxication/epidemiologie; Tentative suicide/orientations; Consultation pour avis expert; Sri Lanka (source: MeSH, INSERM). Palabras clave Envenenamiento/epidemiologia; Intento de suicidio/tendencias; Remision y consulta; Sri Lanka (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.] Bulletin of the World Health Organization 2006;84:276-282. Voir page 281 le resume en francais. En la pagina 281 figura un resumen en espanol., Modalites d'hospitalisation des cas d'autoempoisonnement delibere en milieu rural au Sri Lanka : ce qu'elles impliquent pour l'estimation de l'incidence des autoempoisonnements dans le monde en developpement Objectifs La plupart [...]

Impact on quality of care given to patients, when the hospitals have increased admissions, is analyzed.

Recent years have seen major changes in NHS service delivery. Changes have included the introduction of payment by results and new posts such as diabetes inpatient specialist nurses (DISNs) and [...]