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Hospital capacity

Ran Wei, N Clay Mann, Mengtao Dai, Renee Y Hsia
OBJECTIVE: Previous studies examining access to trauma care use patient residence as a proxy for location and need for services, which could result in a flawed understanding of access to trauma centers. The objective of this study is to examine the geographic access of the U.S. population to trauma centers based on - trauma incident locations. METHODS: We conducted a cross-sectional study using 911 Emergency Medical Services (EMS) activations associated with traumatic injury from the 2014 National Emergency Medical Services Information System (NEMSIS) and trauma centers participating in the 2014 American Hospital Association Annual Survey...
July 18, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Daphna Vilozni, Adi Dagan, Moran Lavie, Ifat Sarouk, Bat-El Bar-Aluma, Moshe Ashkenazi, Sarina Levy Mendelovich, Yael Betzalel, Ori Efrati
BACKGROUND: Inspiratory capacity (IC) was scarely considered an important measured index of spirometry in patients with cystic fibrosis (CF). Abnormally low IC may indicate the onset of static/dynamic hyperinflation, which may be accompanied by dyspnea and an increase in the work of breathing. This cross-sectional study sought to determine whether measuring IC during spirometry, may add clinical value to FEV1 measurements in CF subjects. METHODS: Anthropometric, clinical, spirometry, and static lung volume data were gathered retrospectively from 98 of 165 patients with CF (mean ± SD age 26...
July 17, 2018: Respiratory Care
Yasmine Yousef, Angela Lee, Frehun Ayele, Dan Poenaru
BACKGROUND: The purpose of this study was to estimate the unmet burden of surgically correctable congenital anomalies in African low- and middle-income countries (LMICs). METHODS: We conducted a chart review of children operated for cryptorchidism, isolated cleft lip, hypospadias, bladder exstrophy and anorectal malformation at an Ethiopian referral hospital between January 2012 and July 2016 and a scoping review of the literature describing the management of congenital anomalies in African LMICs...
June 27, 2018: Journal of Pediatric Surgery
Jan M Myszewski, Madhav N Sinha
Purpose Health care is an example of an organization where the needs of potential clients are much greater than the capabilities of the service delivery system. The implementation of any medical procedure, as well as the provision of any service, just like the manufacturing of any product, can be decomposed into a series of tasks. The purpose of this paper is to propose a model for measuring the effectiveness of quality assurance tasks in health-care delivery processes. Design/methodology/approach The authors analyze a system of factors that affect the implementation of tasks in a process...
July 2, 2018: Leadership in Health Services
Hossam Elamir
Purpose This paper aims to propose lean-based interventions that address the main causes of emergency department overcrowding. Emergency department overcrowding (EDOC) and increased length of stay (LOS) have been key global issues for more than 20 years, as they have serious repercussions. No measurements have been done to assess the situation nationally. Expanding emergency departments (EDs) and adding more beds have never succeeded in eliminating wastes and targeting the root causes of the problem. Design/methodology/approach This paper is a quantitative analytical applied research...
July 2, 2018: Leadership in Health Services
F Fabregues, I González-Foruria, J Peñarrubia, F Carmona
STUDY QUESTION: Is the length of the anogenital distance (AGD) a biomarker of ovarian reserve and response to controlled ovarian stimulation (COS)? SUMMARY ANSWER: Shorter AGD is associated with presence of poor ovarian response. WHAT IS KNOWN ALREADY: Organ development during prenatal life is influenced by the prevailing intrauterine environment, and it has been suggested that nutritional, environmental and toxic factors could affect ovarian reserve set prenatally...
July 16, 2018: Human Reproduction
Enoch Odame Anto, William K B A Owiredu, Samuel Asamoah Sakyi, Cornelius Archer Turpin, Richard K D Ephraim, Linda Ahenkorah Fondjo, Christian Obirikorang, Eric Adua, Emmanuel Acheampong
BACKGROUND: Advanced maternal age (AMA) has been associated with negative pregnancy outcomes. Oxidative stress (OS) and defective placental dysfunction are contributing factors. This study determined the association between AMA and adverse pregnancy outcomes, OS biomarkers and angiogenic growth mediators (AGMs) in normal pregnancies. METHODS: This prospective cohort study conducted at the Obstetrics and Gynaecology (O&G) Department of the Komfo Anokye Teaching Hospital (KATH) finally included 175 normal pregnant women comprising, 58 AMA (35-45 years), 55 (30-34 years) and 62 optimal childbearing age (20-29 years)...
2018: PloS One
Lillian Hung, Alison Phinney, Habib Chaudhury, Paddy Rodney
In this article, we discuss how video-reflexive ethnography may be useful in engaging staff to improve dementia care in a hospital medical unit. Seven patients with dementia were involved in the production of patient-story videos, and fifty members of staff (nurses, physicians, and allied health practitioners) participated in video-reflexive groups. We identified five substantial themes to describe how video-reflexive groups might contribute to enacting person-centered care for improving dementia care: (a) seeing through patients' eyes, (b) seeing normal strange and surprised, (c) seeing inside and between, (d) seeing with others inspires actions, and (e) seeing with the team builds a culture of learning...
January 2018: Global Qualitative Nursing Research
Elisabet Guiral, Maria Jesús Pons, Delfino Vubil, Marta Marí-Almirall, Betuel Sigaúque, Sara Maria Soto, Pedro Luís Alonso, Joaquim Ruiz, Jordi Vila, Inácio Mandomando
Background: The emergence and spread of extended-spectrum β-lactamases (ESBLs), especially CTX-M, is an important public health problem with serious implications for low-income countries where second-line treatment is often unavailable. Knowledge of the local prevalence of ESBL is critical to define appropriate empirical therapeutic strategies for multidrug-resistant (MDR) organisms. This study aimed to assess and characterize the presence of ESBL and especially CTX-M-producing Escherichia coli MDR isolates from patients with urinary tract infections (UTIs) and bacteremia in a rural hospital in Mozambique...
2018: Infection and Drug Resistance
Angela Durey, Susan Kaye Lee, Bola Adebayo, Linda Slack-Smith
Adult women in Australia are more likely than men to have no teeth, more missing teeth or have a dental hospital admission. Experiences of war, family and domestic violence, mental health or alcohol and other drug use problems may also negatively affect women's oral health. Yet, oral health is often excluded from primary healthcare. Little is known about what helps or inhibits primary healthcare service workers to promote oral health to women in need. Identifying the perceptions and experiences of such workers is a step towards a strategy to develop resources to support them in raising oral health issues with disadvantaged clients...
July 17, 2018: Australian Journal of Primary Health
J N Oliwa, J Maina, P Ayieko, D Gathara, I A Kathure, E Masini, A H Van't Hoog, M B van Hensbroek, M English
BACKGROUND: Globally, 40% of all tuberculosis (TB) cases, 65% paediatric cases and 75% multi-drug resistant TB (MDR-TB) cases are missed due to underreporting and/or under diagnosis. A recent Kenyan TB prevalence survey found that a significant number of TB cases are being missed here. Understanding spatial distribution and patterns of use of TB diagnostic tests as per the guidelines could potentially help improve TB case detection by identifying diagnostic gaps. METHODS: We used 2015 Kenya National TB programme data to map TB case notification rates (CNR) in different counties, linked with their capacity to perform diagnostic tests (chest x-rays, smear microscopy, Xpert MTB/RIF®, culture and line probe assay)...
July 16, 2018: BMC Infectious Diseases
Matthew Jankowich, Beth Elston, Qing Liu, Siddique Abbasi, Wen-Chih Wu, Chad Blackshear, Mark Godfrey, Gaurav Choudhary
RATIONALE: Although COPD has been related to heart failure, the relationship between the restrictive spirometry pattern (FVC<80% predicted with preserved FEV1/FVC ratio) and heart failure is poorly understood. OBJECTIVE: To determine whether having a restrictive spirometry pattern is associated with incident heart failure hospitalization. METHODS: Community-dwelling African-Americans from the Jackson Heart Study (total n=5,306; analyzed n=4,210 with spirometry and heart failure outcome data) were grouped by restrictive (FEV1/FVC≥0...
July 16, 2018: Annals of the American Thoracic Society
Miranda Laurant, Mieke van der Biezen, Nancy Wijers, Kanokwaroon Watananirun, Evangelos Kontopantelis, Anneke Jah van Vught
BACKGROUND: Current and expected problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasis on healthy lifestyle and prevention, and substitution for care from hospitals by care provided in the community encourage countries worldwide to develop new models of primary care delivery. Owing to the fact that many tasks do not necessarily require the knowledge and skills of a doctor, interest in using nurses to expand the capacity of the primary care workforce is increasing...
July 16, 2018: Cochrane Database of Systematic Reviews
Alexander R Opotowsky, Anne Marie Valente, Laith Alshawabkeh, Susan Cheng, Allison Bradley, Eric B Rimm, Michael J Landzberg
Aims: Despite the well-defined association of high-sensitivity hsCRP with cardiovascular outcomes in apparently healthy adults and those with acquired heart disease, the relevance of this inflammatory marker in adults with congenital heart disease (ACHD) remains unclear. We aimed to examine the clinical correlates and prognostic value of high-sensitivity C-reactive protein levels in ACHD. Methods and results: We conducted a prospective cohort study of (n = 707) outpatient ACHD (age 39 ± 14 years, 49% women), enrolled mainly at a referral centre, who had serum hsCRP measured in conjunction with a clinical assessment between 2012 and 2016...
July 12, 2018: European Heart Journal
Hjördis Steen, Christopher Malefors, Elin Röös, Mattias Eriksson
Public sector food service is a major contributor to food waste generation in Sweden, with schools, pre-schools, elderly care homes, hospitals etc., producing approximately 70,000 tons of food waste each year. Sweden has appropriate infrastructure for handling food waste in place, recycling nutrients and energy, but there is still great potential to move upwards in the waste hierarchy and prevent waste. An important step in designing waste reduction measures is to identify and quantify the importance of different risk factors, in order to start by solving the problems with the greatest potential benefit and the lowest cost...
July 2018: Waste Management
Mithu Molla, Duncan S Warren, Susan Leroy Stewart, Jacqueline Stocking, Hershan Johl, Voltaire Sinigayan
BACKGROUND: Hospital overcrowding has become a widespread problem, with constrained bed capacity and admission bottlenecks having far-reaching negative impacts on quality and safety. Focus on timing of discharge may be the least disruptive and most effective way to address constrained bed capacity, yet there may be significant institution-specific barriers to implementation. METHODS: With the creation of a "Value Team," a 627-bed, tertiary care academic medical center embarked on a quality improvement (QI) project using Lean Six Sigma process improvement methodology...
July 2018: Joint Commission Journal on Quality and Patient Safety
Yu-Hui Zhang, Zhi-Kai Yang, Jin-Wei Wang, Zu-Ying Xiong, Jin-Lan Liao, Li Hao, Gui-Ling Liu, Ye-Ping Ren, Qin Wang, Li-Ping Duan, Zhao-Xia Zheng, Jie Dong
RATIONALE & OBJECTIVE: Cognitive impairment is an independent predictor of technique failure and mortality in patients on peritoneal dialysis (PD) therapy. We investigated changes in cognitive function and factors associated with it in this population. STUDY DESIGN: Multicenter prospective cohort study. SETTING & PARTICIPANTS: 458 PD patients were enrolled and followed up for 2 years. PREDICTORS: Global and specific domains of cognitive function were measured at baseline and after 2 years...
July 11, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Lorena Perdices, Lorena Fuentes-Broto, Francisco Segura, Neyla Ben Gdara, Ana Isabel Sánchez-Cano, Gema Insa Sánchez, Elvira Orduna Hospital, Isabel Pinilla
Retinitis pigmentosa (RP) comprises a group of inherited retinal degenerative conditions characterized by primary degeneration of the rod photoreceptors. Increased oxidative damage is observed in the retina, aqueous humor, and plasma of RP animal models and patients. The hepatic oxidative status may also be affected in RP due to oxidative damage influencing soluble macromolecules exiting the retina or to alterations in the melanopsin system resulting in chronic circadian desynchronization that negatively alters the oxidative stress defense system...
July 10, 2018: Free Radical Biology & Medicine
Christian Tapking, Daniel Popp, David N Herndon, Ludwik K Branski, Ronald P Mlcak, Oscar E Suman
PURPOSE: In burned children, exercise training increases maximal oxygen consumption (VO2 max) and can be combined with the nonspecific beta-blocker propranolol to decrease cardiac work. VO2 max is estimated if indirect calorimetry is not available. We compared measured and estimated VO2 max in severely burned children treated with or without propranolol to determine the suitability of commonly used formulas in these populations. METHODS: Patients received propranolol or placebo (control) during acute hospitalization...
July 10, 2018: Burns: Journal of the International Society for Burn Injuries
Yun Chen, Guorong Wu, Ruichun Wang, Junping Chen
OBJECTIVE: Postoperative pulmonary complications (PPCs) can contribute to increased mortality and prolonged hospital stay in surgical patients with gastric cancer (GC). This study aimed to investigate potential risk factors for PPCs in elderly GC patients following elective laparoscopic gastrectomy. METHODS: Eligible consecutive elderly GC patients (aged over 65 years) who were scheduled to undergo elective laparoscopic gastrectomy were enrolled in this study. The demographic, clinicopathological characteristics and laboratory variables were compared in patients with or without PPCs within postoperative 30 days...
July 12, 2018: Current Pharmaceutical Design
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