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District Hospital (district + hospital)

Distribution by Scientific Domains

Medical Sciences	96%

Distribution within Medical Sciences

General & Internal Medicine	15%
Neurology	7%

Selected Abstracts

GS12P MANAGEMENT OF UPPER GASTROINTESTINAL HAEMORRHAGE IN A DISTRICT HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 2007
I. Dayoub
Background This study was conducted to assess the management of acute upper gastrointestinal bleeding in a district hospital and to compare these results with national guidelines and the published literature. Materials And Methods This prospective and retrospective study included 112 patients, mean age 66 years, who presented with acute upper gastrointestinal bleeding between July 2004 and February 2005. All patients were assigned a Rockall risk assessment score. Results The surgical on-call teams managed all the patients according to an agreed protocol. 49 patients had a Rockall score > or = 4. Endoscopy was performed in all patients, with 60% accomplished within the first 24 hours. The most common cause found was peptic ulcer (30%). Therapeutic endoscopy was undertaken in 10 patients (9%) with a success rate of 70%. Open surgery was performed in 3 patients. One patient died after having surgery and the Rockall score was >5. Of the patients admitted with acute upper gastrointestinal bleeding, 90.2% were discharged without complication. 11 patients died (9.8%) and all of them from the high risk group with Rockall scores >5. Their mean hospital stay was 17.8 days (range, 2,43 days). Conclusion High-standard results in acute upper gastrointestinal bleeding can be achieved in a district hospital. The management, including the use of the operating theatre facilities with operative and anaesthetic support, was safe and efficient. A 24-hour-a-day endoscopy service is important to achieve early diagnosis and to plan management. A protocol and early endoscopy improve clinical outcome and reduce mortality, which occurred mostly among elderly patients with high risk scores. It is advisable to introduce the Rockall scoring system in practice. [source]

Severe falciparum malaria and acquired childhood language disorder

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2006
Julie A Carter BSc (Hons) MSc PhD
Language disorders have been reported after severe falciparum malaria but the deficits have not been described in detail. We assessed language outcome in three groups of children aged 6 to 9 years (n=487): those previously admitted to Kilifi District Hospital, Kenya, with cerebral malaria (CM; n=152; mean age 7y 4 mo [SD 1y 1mo]; 77 males, 75 females); or those with malaria and complicated seizures (M/S; n=156; mean age 7y 4mo [SD 1y 2mo]; 72 males, 84 females); and those unexposed to either condition (n=179; mean age 7y 6mo [SD 1y 1mo]; 93 males, 86 females). Median age at hospital admission was 28 months (interquartile range [IQR] 19 to 44 mo) among children with a history of CM and 23 months (IQR 12 to 35mo) among children with a history of M/S. A battery of eight assessments covering the major facets of speech and language was used to measure language performance. Cognitive performance, neurological/motor skills, behaviour, hearing, and vision were also measured. Eighteen (11.8%) of the CM group, 14 (9%) of the M/S group, and four (2.2%) of the unexposed group were found to have a language impairment. CM (odds ratio 3.68,95% confidence interval 1.09 to 12.4, p=0.04) was associated with significantly increased odds of an impairment-level score relative to the unexposed group. The results suggest that falciparum malaria is one of the most common causes of acquired language disorders in the tropics. [source]

Rural hospital generalist and emergency medicine training in Papua New Guinea

EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2007
David Symmons
Abstract The present paper describes the role of the hospital generalist in rural Papua New Guinea (PNG) and the contribution of emergency medicine training to that practice. Generalist practice in Tinsley District Hospital in Western Highlands Province is described, with emphasis on emergency surgery and anaesthesia. The potential of the PNG emergency medicine training programme for preparing generalists is discussed. Tinsley Hospital served a population of 40 000 people, with 4000 admissions and 300,400 operations performed annually. Two doctors and 50 nurses and community health workers provided care with minimal resources. The doctors provided supervision and teaching for nurses, community health workers, hospital administrators and primary health carers, including on long range medical patrols. Over 16 months, doctors performed 243 emergency surgical procedures including orthopaedics, general surgery, obstetrics and gynaecology. The generalist in rural hospitals is required to perform a wide variety of medical tasks in isolated settings yet there is no active postgraduate training programme. The Master of Medicine, Emergency Medicine programme includes rotations through the major disciplines of surgery, anaesthesia, internal medicine, paediatrics, obstetrics and gynaecology. It has the potential to train doctors in PNG for a generalist role as graduates will learn the foundations of the required skills. [source]

Comparison of patch test results among white Europeans and patients from the Indian subcontinent living within the same community

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008
DA Fairhurst
Abstract Background, There are few studies comparing the incidence of allergic contact dermatitis among different racial groups living within the same community. Objectives, The objectives of this study were to compare white European patients with Fitzpatrick's skin phototypes (FSP) I to IV and patients from Indian, Pakistan and Bangladesh with FSP V living within the same community. Referral rates for patch testing, incidence of contact allergies and differences in contact allergens found were assessed. Method, All patients referred to the Contact Dermatitis Unit at Dewsbury and District Hospital between 2004 and 2006, inclusive, were included in the study. All patients were patch tested to the British Contact Dermatitis Society standard series, plus other series according to their clinical history, occupational history and clinical findings. Results, Four hundred and thirty-five consecutive patients from the patch testing clinic were included in the study. Fewer patients from the Indian subcontinent underwent patch testing (11.5%) than would have been expected for the size of the local population (18%). Fewer patients from the Indian subcontinent (44%) had one or more positive reactions compared with the white European patients (56%). No significant differences in the contact allergens responsible were detected between the two racial groups. Conclusion, There is a lower incidence of positive patch test results among patients with racial origins from the Indian subcontinent compared with white Europeans. This modest difference could be explained by a lower average age within the study population, and increased or differing exposure to contact allergens rather than demonstration of variability in the susceptibility to develop contact sensitivities following equal exposure. [source]

Emergency department performance at a small rural hospital: An independent in-depth review

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2009
Paul Tescher
Abstract Objectives:,This study aims to provide a retrospective review of the recent performance of the emergency department of Cobram District Hospital, a small rural hospital located on the border of Victoria and New South Wales. Design:,Retrospective review. Setting:,Small rural accident and emergency department. Intervention:,All available data collected from the emergency department from the previous three financial years (July 2005 to June 2008) were compiled onto a computerised spreadsheet and analysed by two independent investigators. Main outcome measures:,Key performance indicators, including time for patient to be seen by a doctor and frequency of patient presentations to the emergency department. Results:,Cobram District Hospital has fewer than 5000 patients presenting to the emergency department each year. 12 p.m. to 12 a.m. accounts for 69% of all presentations, with three notable time periods that experience most presentations. Life-threatening emergencies represented <3% of all presentations to the emergency department. Patients in triage categories 1,3 did not met Australasian triage scale (ATS)-suggested time for maximum waiting timing, while categories 4 and 5 well exceeded ATS standards. Conclusion:,The small size and lack of dedicated emergency department staff place restrictions on the ability of an unfunded rural hospital to match the performance of major metropolitan emergency departments. ATS guidelines should be revised to improve clarity and reflect the different performance capabilities between metropolitan and rural centres. [source]

Quality improvement and its impact on the use and equality of outpatient health services in India

HEALTH ECONOMICS, Issue 8 2007
Krishna Dipankar Rao
Abstract This paper examines the impact of quality improvements in conjunction with user fees on the utilization and equality of outpatient services at a range of public sector health facilities in India. Project impact on outpatient visits was estimated via the difference-in-difference method using pooled time series visit data from project and control facilities. The results indicate that the quality improvements significantly increased visits at all facility types. The project effect was largest at primary health center (PHC) and community health center (CHC), followed by district hospital (DH) and female district hospital (FDH). Pro-rich inequalities in outpatient visits increased at DHs and FDHs while at CHCs and PHCs the distribution remained equitable. This suggests that quality improvements at public sector health facilities can increase utilization of outpatient services in the presence of nominal user fees, but can also promote greater inequality favoring the better-off. At the referral hospital level, quality improvements should be made in conjuction with programs which encourage utilization by the poor. In contrast, the benefit of quality improvements at PHCs and CHCs is equitably distributed. Copyright © 2006 John Wiley & Sons, Ltd. [source]

The effects of traumatic experiences on the infant,mother relationship in the former war zones of central Mozambique: The case of madzawde in Gorongosa

INFANT MENTAL HEALTH JOURNAL, Issue 5 2003
Victor Igreja
This article addresses the ways in which years of war and periods of serious drought have affected the cultural representations of the populations in Gorongosa District, Mozambique. In the wake of these events different cultural and historical representations have been disrupted, leaving the members of these communities with fragmented protective and resilience factors to cope effectively. Emphasis is placed on the disruption of madzawde, a mechanism that regulates the relationship between the child (one to two years of life) and the mother, and the family in general. The war, aggravated by famine, prevented the populations from performing this child-rearing practice. Nearly a decade after the war ended, the posttraumatic effects of this disruption are still being observed both by traditional healers and health-care workers at the district hospital. The results suggest that this disruption is affecting and compromising the development of the child and the physical and psychological health of the mother. An in-depth understanding of this level of trauma and posttraumatic effects is instrumental in making a culturally sensitive diagnosis and in developing effective intervention strategies based on local knowledge that has not been entirely lost but is nonetheless being questioned. ©2003 Michigan Association for Infant Mental Health. [source]

Establishment of a stroke unit in a district hospital: review of experience

INTERNAL MEDICINE JOURNAL, Issue 2 2007
A. Chiu
Abstract Background: The experience and outcomes of co-locating acute stroke and stroke rehabilitation care in a district hospital were reviewed. Method: Information for patients admitted to Blacktown and Mt Druitt Hospitals before and after setting up an acute stroke unit (SU) (12 months data for each period), including mortality and length of stay (LOS) at the hospital were obtained from various sources, including the diagnosis-related group and subacute and non-acute casemix databases. Results: There was a significant reduction of mortality (18 vs 10%; P = 0.01) and reduced total LOS (46 vs 39 days; P = 0.01) with similar functional outcomes in the post-SU period. Fifty per cent of patients were unable to access the acute SU. Patients admitted into the SU had lower mortality (5 vs 14%; P = 0.01) and were also discharged from hospital earlier (35 vs 54 days; P = 0.01) than patients admitted into general wards during the post-SU period. Thirty-four per cent of patients received rehabilitation within the rehabilitation facility in the post-SU period compared with 19% in the pre-SU period. Conclusion: The Blacktown experience showed the feasibility of establishing a co-located SU within rehabilitation facility with good outcomes as illustrated by the significant reduction in the stroke mortality, a reduction in the total LOS and an increase in the number of patients receiving rehabilitation post-stroke. [source]

Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2010
M. Aboud
Summary Aims:, The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. Methods:, It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. Results:, The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 ± 9 years, systolic blood pressure 120 ± 14 mmHg, total cholesterol 4.70 ± 1.05mmol/l, high-density lipoprotein-C 1.32 ± 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0,56) % in men and 1.4 (0,37) % in women; CHD risks were 3.5 (0,36) % and 0.6 (0,16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy. Conclusions:, Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. Discussion:, Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy. [source]

Azathioprine or mercaptopurine-induced acute pancreatitis is not a disease-specific phenomenon

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010
E. J. M. VAN GEENEN
Aliment Pharmacol Ther,31, 1322,1329 Summary Background, Several reports suggest an increased rate of adverse reactions to azathioprine in patients with Crohn's disease. Aim, To compare the incidence of thiopurine-induced acute pancreatitis in patients with inflammatory bowel disease (IBD) with that in patients with vasculitis. Methods, This retrospective analysis was performed using data collected in three databases by two university hospitals (241 patients with IBD and 108 patients with vasculitis) and one general district hospital (72 patients with IBD). Results, The cumulative incidence of thiopurine-induced acute pancreatitis in Crohn's disease equalled that of ulcerative colitis (UC) (2.6% vs. 3.7%) and this did not differ from vasculitis patients (2.6% vs.1.9%). In addition, the cumulative incidence of thiopurine-induced acute pancreatitis in UC patients was not different from that in vasculitis patients. In the IBD group, 100% of thiopurine-induced acute pancreatitis patients were women, whereas in the vasculitis group the two observed thiopurine-induced acute pancreatitis cases (n = 2 of 2) concerned were men (P = 0.012). Conclusions, In this study, the alleged higher cumulative incidence of thiopurine-induced acute pancreatitis in Crohn's disease compared with vasculitis or UC patients was not confirmed. Female gender appears to be a risk factor for developing thiopurine-induced acute pancreatitis in IBD patients. [source]

Changing patterns of coeliac serology requests

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
K. E. EVANS
Summary Background, Accurate serological tests have revolutionized the diagnosis of coeliac disease. Aim, To quantify the volume of coeliac serology requests at a district hospital over a decade, identify their origin, assess positivity rates and subsequent duodenal biopsy and histological confirmation rates. Methods, Details of patients in whom coeliac serology was requested from 1997 to 2006 were obtained from laboratory databases. The origins of request were categorized into gastroenterology, general practice, paediatrics and other specialities. Duplicate requests were excluded. Results, A total of 9976 serological tests were requested. Testing increased from 302 in 1997, to 1826 in 2006. In all, 66% of requests were in females. Tests in children accounted for 14,25% of each year's total. General practitioner requests increased from 3.3% in 1997 to 52% in 2006. The proportion of positive serological results fell from 5.7% in 1997 to 2.6% in 2006. Duodenal biopsies were performed in approximately 85% of seropositive patients in earlier years and approximately 75% of seropositive patients in later years. Most nonbiopsied seropositive patients had serology requested by general practitioners. Biopsies confirmed coeliac disease in 91% of seropositive patients. Conclusion, Increasingly, coeliac serological testing is requested by general practitioners. Twice as many females are tested. Increasing test numbers but diminishing positivity rates suggest testing is requested at lower symptom thresholds. Positive serological results are often not confirmed histologically. [source]

An observational study of CT scanning in psychiatric patients

PROGRESS IN NEUROLOGY AND PSYCHIATRY, Issue 4 2007
Abhaya Gupta MRCP
Opinion is divided on the proper use of brain scans in psychiatry. In this study, the authors reviewed CT scanning in common psychiatric conditions in a district hospital. In their study about 64 per cent of brain scans showed some abnormality. CT scanning influenced patient diagnosis, prognosis and treatment. In addition,almost 3 per cent of patient scans identified potential reversible,previously unknown,intracranial pathology. Copyright © 2007 Wiley Interface Ltd [source]

A prospective study of the time to evacuate acute subdural and extradural haematomas,

ANAESTHESIA, Issue 3 2009
D. Bulters
Summary We performed a prospective, single-centre study of times to treatment of patients with life-threatening, traumatic, extra- and subdural haematomas requiring surgical evacuation between May 2006 and May 2007. The mean time to surgical decompression was 5.0 h and 32% were performed within 4 h. Patients who initially presented to a district hospital and required transfer for neurosurgery were decompressed in 5.4 h vs 3.7 h for those admitted directly. The current standard of surgical evacuation of all haematomas within 4 h is not being met. Delays were identified in every stage in the management of these patients and no single step was identified as the major cause. Initial treatment in district hospitals led to delays greater than the added driving time. There may be time savings from carrying out treatment steps in parallel instead of in series. [source]

GS12P MANAGEMENT OF UPPER GASTROINTESTINAL HAEMORRHAGE IN A DISTRICT HOSPITAL

Routine investigations might be useful in pre-eclampsia, but not in gestational hypertension

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005
David J. BAILEY
Abstract Background:, Women referred to secondary care with suspected pregnancy-induced hypertension (PIH) are commonly investigated with blood tests and cardiotocography (CTG), regardless of the clinical severity of their condition. Over-investigation might lead to inappropriate intervention. Aims:, To investigate how often abnormal blood test and CTG results occur in women with pre-eclampsia and gestational hypertension and in women who do not have pregnancy-induced hypertension. Methods:, Retrospective case note review of 526 consecutive women referred with suspected pregnancy-induced hypertension to a district hospital. The frequency of abnormal test results and the pregnancy outcomes were analysed according to clinical classification. Results:, 36% of women referred did not meet the clinical criteria for a diagnosis of pregnancy-induced hypertension. Abnormalities of platelet count and/or liver function were seen in 11% of women with pre-eclampsia and in less than 2% of women with gestational hypertension and in a similar proportion of women who did not have pregnancy-induced hypertension. Gestational hypertension was associated with increased induction and caesarean birth rates, but not with low birthweight or preterm delivery. Progression from gestational hypertension to pre-eclampsia was not predicted by blood test abnormalities. Support for the routine use of antenatal CTG was not found. Conclusions:, A clinical diagnosis of pregnancy-induced hypertension should be confirmed before blood tests are ordered. The incidence of test abnormalities was only increased in pre-eclampsia and in gestational hypertension before term. CTG might only be of use in selected cases. [source]

Palliative care in the hinterlands: A description of existing services and doctors' attitudes

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2005
Glenn J. Pereira
Abstract Objective:,To describe palliative care services as they exist in the hinterlands (towns away from regional centres) of Midwest New South Wales, including an estimation of the numbers of cases treated by local doctors, and the service they provide to their patients. Generalist doctors' attitudes to palliative care are also explored, as this information is lacking in the literature but is important for service provision. Design:,Descriptive survey. Setting:,Rural primary care and district hospitals. Participants:,Generalist doctors in hinterland areas. Results:,In total, 38% (19/50) of surveys were returned. ,Visiting rights' to the district hospital were held by 78.9% of local doctors, and patients are admitted under the care of their own doctor for symptom control and terminal care, 94.1% and 76.5% of the time, respectively. All doctors surveyed perform home visits for terminally ill patients, and 68.4% make themselves routinely available after hours. Doctors surveyed estimated that they managed a mean of 8.4 deaths due to chronic illness in the past 12 months. Most (78.9%) said that they would continue to manage dying patients even if they had a choice, and they feel between moderately and very satisfied that they provide quality care. However, only 21.1% considered their undergraduate training in palliative medicine to be adequate, and all said that they would refer to a specialist service if it were available. Conclusions:,Generalist rural doctors not only treat many dying patients, but also provide a continuity of care that is rarely seen in other settings. Proposals of models for ,rural' palliative care should, therefore, take this unique setting into account. One such suggestion is given in this article. [source]

The diagnostic accuracy of external pelvimetry and maternal height to predict dystocia in nulliparous women: a study in Cameroon

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2007
AT Rozenholc
Objective, In many developing countries, most women deliver at home or in facilities without operative capability. Identification before labour of women at risk of dystocia and timely referral to a district hospital for delivery is one strategy to reduce maternal and perinatal mortality and morbidity. Our objective was to assess the prediction of dystocia by the combination of maternal height with external pelvimetry, and with foot length and symphysis-fundus height. Design, A prospective cohort study. Setting, Three maternity units in Yaoundé, Cameroon. Population, A total of 807 consecutive nulliparous women at term who completed a trial of labour and delivered a single fetus in vertex presentation. Methods, Anthropometric measurements were recorded at the antenatal visit by a researcher and concealed from the staff managing labour. After delivery, the accuracy of individual and combined measurements in the prediction of dystocia was analysed. Main outcome measures, Dystocia, defined as caesarean section for dystocia; vacuum or forceps delivery after a prolonged labour (>12 hours); or spontaneous delivery after a prolonged labour associated with intrapartum death. Results, Ninety-eight women (12.1%) had dystocia. The combination of a maternal height less than or equal to the 5th percentile or a transverse diagonal of the Michaelis sacral rhomboid area less than or equal to the 10th percentile resulted in a sensitivity of 53.1% (95% CI 42.7,63.2), a specificity of 92.0% (95% CI 89.7,93.9), a positive predictive value of 47.7% (95% CI 38.0,57.5) and a positive likelihood ratio of 6.6 (95% CI 4.8,9.0), with 13.5% of all women presumed to be at risk. Other combinations resulted in inferior prediction. Conclusion, The combination of the maternal height with the transverse diagonal of the Michaelis sacral rhomboid area could identify, before labour, more than half of the cases of dystocia in nulliparous women. [source]

Outcomes of pregnancies in women with pre-existing type 1 or type 2 diabetes, in an ethnically mixed population

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2005
Evelyn C.J. Verheijen
Objective To compare the outcomes of pregnancies in women with pre-existing, type 1 and type 2, diabetes and to examine the influence of ethnicity on these outcomes. Design Prospective cohort study. Setting Large district hospital in Yorkshire with an ethnically mixed population. Sample Case series of all 202 pregnancies in women with pre-existing diabetes, ending in miscarriage, termination of pregnancy or delivery between January 1994 and December 2002. Methods Univariate and multivariate logistic regression analysis comparing outcomes in type of diabetes and in ethnic group. Main outcome measures Fetal loss, perinatal and infant mortality and congenital anomaly. Results All 14 stillbirths and infant deaths and 13 of the 15 congenital malformations were to Asian women. Analysis within this ethnic group showed a very high rate of adverse birth outcome for type 1 diabetic women and for type 2 diabetic women on insulin before the pregnancy. Total pregnancy loss among type 1 diabetic women was 156 per 1000 and among type 2 diabetic women on insulin was 167 per 1000. Congenital abnormality rates were 156 per 1000 for type 1 diabetic women and 261 per 1000 for type 2 diabetic women on insulin. Asian type 2 diabetic women not on insulin prior to pregnancy had significantly better outcomes: Total pregnancy loss was 123 per 1000 and congenital abnormality rate was 32 per 1000. After adjustment for confounders, including type of diabetes, Asian women had significantly worse outcomes (combined perinatal loss and malformation) than Caucasian women [odds ratio (OR) 4.96, 95% confidence interval (CI) 1.16,21.1]. Conclusion Ethnicity has a significant impact on the outcome of diabetic pregnancies, with worse outcomes for babies born to Asian mothers compared with Caucasian mothers. The use of insulin pre-pregnancy rather than type of diabetes appears to predict adverse outcome. [source]

Factors associated with lower quality of life among patients receiving palliative care

JOURNAL OF ADVANCED NURSING, Issue 9 2009
Ying Yu Chui
Abstract Title.,Factors associated with lower quality of life among patients receiving palliative care. Aim., This paper is a report of a study conducted to (1) assess the quality of life (QoL) and physical functioning status of patients diagnosed with advanced cancer and receiving palliative care; (2) determine if there was a statistically significant relationship between their physical functioning and QoL and (3) identify the demographic and disease-related variables related to their QoL. Background., Achieving the best possible QoL is a major goal in palliative care. However, research findings about the relationship between QoL and demographic variables have been inconsistent. Method., Three hundred patients with advanced cancer were recruited from four district hospitals in Hong Kong between February 2005 and July 2006. Their QoL and physical functioning status were assessed by face-to-face interview, using the McGill Quality of Life Questionnaire (Hong Kong version) and the Palliative Performance Scale respectively. Results., Participants reported reduced ambulation, inability to perform hobbies or housework, and the need for occasional assistance in self-care (mean: 64·6 out of 100, sd: 19·3, range: 20,100). QoL was fair (mean: 6·2 out of 10, sd: 1·5, range: 0·9,10). There was a weak positive association between physical functioning and QoL scores. Multiple regression analysis showed that patients who were older, female, had ever been married, or had higher physical functioning tended to have better QoL. Conclusion., More could be done in symptom and psychosocial management to improve patients' QoL, in particular for those who are younger, male or single, or who have lower physical functioning. [source]

Organisational climate, organisational commitment and intention to leave amongst hospital nurses in Taiwan

JOURNAL OF CLINICAL NURSING, Issue 11-12 2010
Shwu-Ru Liou
Aims and objectives., To examine: (1) Taiwanese nurses' perceptions of organisational climate, levels of organisational commitment and intention to leave, as well as relationships between these three variables; (2) demographic differences in the levels of these variables; and (3) mediating effects of organisational commitment on the relationship between organisational climate and intention to leave. Background., Organisational climate is related to organisational commitment and affects nurses' performances and attitudes towards an organisation. Design., A cross-sectional, descriptive design. Method., Registered nurses working in eight hospitals in southern Taiwan for more than six months were recruited. Data were collected using the Litwin and Stringer's Organisational Climate Questionnaire, Organizational Commitment Questionnaire and a five-item scale measuring intention to leave. Questionnaires were distributed to 612 potential participants; 486 valid returned questionnaires were analysed. Results., The study's participants were generally satisfied with their hospital's climate and yet claimed low commitment to their organisation and, nevertheless, reported low intention to leave their job. Single nurses were more satisfied with their hospital's climate and were more committed to their hospital and had a lower intention to leave their job compared to married nurses. Nurses working in district hospitals perceived a better hospital climate and had a lower intention to leave than nurses working in teaching or regional hospitals. Staff nurses perceived a better organisational climate than did nurse managers. Organisational climate, organisational commitment and intention to leave were intercorrelated. Organisational climate had almost 60% indirect effect on organisational commitment related to intention to leave. Conclusions., Creating a good organisational climate may increase nurses' organisational commitment and, in turn, decrease their intention to leave. Relevance to clinical practice., To motivate nurses' positive organisational behaviours and to address their diverse needs, hospital administrators are encouraged to understand nurses' work-climate perceptions and to address nurses' varied demographic factors. [source]

Preventable but not prevented: the reality of cervical cancer,

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2003
Usha B. Saraiya
Abstract Introduction: The incidence of invasive cervical cancer has decreased in the last 50 years in the developed countries substantially due to the use of routine pap smears. However, in the Asia,Oceanic region it continues to be high as screening programs are not established. Credit for starting cytology services in India goes to Professor P.N. Wahi of Agra. He became Founder President when about 34 cytologists got together in 1970 to form the Indian Academy of Cytologists. Since then cytology has spread through all parts of India. The Cytology Clinic in Cama & Albless Hospital was started in the same year. Since then over 100 000 women have been screened. Approximately 1200 cases of pre- and early cancers have been detected and treated. Since 1982 we are aware of the important role of human papillomavirus infection. We diagnose it by cytology and colposcopy and histology. Facilities for polymerase chain reaction, in-situ hybridization and other virology studies are not available to us. CO2 laser treatment is found particularly useful in multicentric human papillomavirus disease. Screening for the State of Maharashtra: Since 1984 we have planned for a screening program for our State. We have a population of 78.9 million. Approximately 15 million women in the age group of 35,64 years have to be screened. The health care infrastructure is good with 36 medical colleges and over 35 district hospitals. Screening is planned in phases. Trained personnel are the key to a successful program. In the final analysis, cervical cancer is not just a biomedical disease. It has socio-cultural and economic implications. [source]

Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2008
Karen M. Edmond
Summary This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area. There were 20 317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies. [source]