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Healthcare Facilities (healthcare + facility)
Selected AbstractsState of Research in High-consequence Hospital Surge CapacityACADEMIC EMERGENCY MEDICINE, Issue 11 2006Carl H. Schultz MD High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on trauma data. The most significant part of the HRSA target, the need to care for 500 victims stricken with an infectious disease per one million population in 24 hours, was not developed using a biological model. If HRSA's recommendation is applied to a sample metropolitan area such as Orange County, California, this translates to a goal of expanding hospital capacity by 20%,25% in the first 24 hours. Literature supporting this target is largely consensus based or anecdotal. There are no current objective measures defining hospital surge capacity. The literature identifying the components of surge capacity is fairly consistent and lists them as personnel, supplies and equipment, facilities, and a management system. Studies identifying strategies for hospitals to enhance these components and estimates of how long it will take are lacking. One system for augmenting hospital staff, the Emergency System for Advance Registration of Volunteer Health Professionals, is a consensus-derived plan that has never been tested. Future challenges include developing strategies to handle the two different types of high-consequence surge events: 1) a focal, time-limited event (such as an earthquake) where outside resources exist and can be mobilized to assist those in need and 2) a widespread, prolonged event (such as pandemic influenza) where all resources will be in use and rationing or triage is needed. [source] Knowledge of disease and adherence in adult patients with haemophiliaHAEMOPHILIA, Issue 4 2010K. LINDVALL Summary., Patients with moderate and severe haemophilia are evaluated on a regular basis at their haemophilia centres but patients with mild haemophilia are seen less often because of fewer problems related to their disease. The needs of patients with milder forms of haemophilia, however, are often underestimated, both by the patient and staff at healthcare facilities. This study evaluated the knowledge of disease and adherence to treatment among patients with severe, moderate and mild haemophilia. This was a prospective multicentre study performed in Haemophilia Centres in Scandinavia. A total of 413 (67%) of 612 patients aged >25 years with mild, moderate and severe haemophilia completed a self-administered questionnaire. The mean age of the respondents was 49.7 years (range 25,87 years). Of the 413 respondents, 150 had a mild, 86 had a moderate and 177 had a severe form of haemophilia. A total of 22 (5%) patients did not know the severity of their disease, and 230 (56%) patients knew the effect of factor concentrate in the blood. Of the 413 respondents, 53 (13%) of the cohort never treated a haemorrhage. Patients with mild haemophilia, P , 0.001, were the least likely to treat a haemorrhage. The relative number of patients who were afraid of virus transmission by factor concentrate was about similar in the three groups, 27% of those with severe haemophilia, 26% with moderate and 24% with mild haemophilia. This study shows that the amount of knowledge among haemophilia patients about their disease and treatment is somewhat limited, and demonstrates the importance of continually providing information about haemophilia and treatment, especially to patients with a mild form of the disease. [source] Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literatureINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2001Pedro Saz Abstract Background No recent attempt has been made to synthesize information on mortality and depression despite the theoretical and practical interest in the topic. Our objective was to estimate in the older population the influence on mortality of depression and depressive symptoms. Methods Data sources were: Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged ,,65 years at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from healthcare facilities were excluded. Effect sizes were extracted from the papers; if they were not included in the published papers, effect sizes were calculated if possible. No attempt was made to contact authors for missing data. Results We found 21 reports on 23 cohorts using depression diagnosis. For 15 of these, odds ratios were pooled using the Greenland method based on confidence intervals (CIs), giving an estimated odds ratio for mortality with depression of 1.73 (95% CI 1.53 to 1.95). A fixed effects meta-regression of these studies suggested that longer follow-up predicted smaller effect sizes (log odds ratios ,0.096 per year (95% CI ,0.179 to ,0.014)). There is a weak suggestion of a reduced effect of depression on mortality for women. We were unable to pool effect sizes from the 17 studies using symptom totals and scales, or from eight studies of specific symptoms. Conclusions The studies show that diagnosed depression in community-resident older people is associated with increased mortality. The picture for sex differences is still unclear. Copyright © 2001 John Wiley & Sons, Ltd. [source] Characterizing violence in health care in British ColumbiaJOURNAL OF ADVANCED NURSING, Issue 8 2009Rakel N. Kling Abstract Title.,Characterizing violence in health care in British Columbia. Background., The high rate of violence in the healthcare sector supports the need for greater surveillance efforts. Aim., The purpose of this study was to use a province-wide workplace incident reporting system to calculate rates and identify risk factors for violence in the British Columbia healthcare industry by occupational groups, including nursing. Methods., Data were extracted for a 1-year period (2004,2005) from the Workplace Health Indicator Tracking and Evaluation database for all employee reports of violence incidents for four of the six British Columbia health authorities. Risk factors for violence were identified through comparisons of incident rates (number of incidents/100,000 worked hours) by work characteristics, including nursing occupations and work units, and by regression models adjusted for demographic factors. Results., Across health authorities, three groups at particularly high risk for violence were identified: very small healthcare facilities [rate ratios (RR) = 6·58, 95% CI =3·49, 12·41], the care aide occupation (RR = 10·05, 95% CI = 6·72, 15·05), and paediatric departments in acute care hospitals (RR = 2·22, 95% CI = 1·05, 4·67). Conclusions., The three high-risk groups warrant targeted prevention or intervention efforts be implemented. The identification of high-risk groups supports the importance of a province-wide surveillance system for public health planning. [source] Healthcare for Older Persons, A Country Profile: NigeriaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2002Bola O. Akanji PhD The Nigerian population is undergoing demographic transition, with an increasing population of older people. Nuclear and extended family members traditionally care for older persons at home. We have observed changes in home living conditions due to reduced family size, and urban migration for economic reasons are likely to affect the care of older people. The inadequately funded healthcare system has placed little emphasis on the care of older people because there are more-pressing health problems and funding for older people is limited. This paper advocates improved attention to the health needs of older people through improved budgetary allocation, revision of the training curriculum of all cadres of health staff to include geriatrics, and utilization of primary healthcare facilities. [source] Public sector institutions, politics and outsourcing: Reforming the provision of primary healthcare in Punjab, PakistanJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 4 2010Iram A. Khan Abstract Lodhran/Rahim Yar Khan (RYK) model of primary healthcare is a home-grown experiment in Pakistan. The model envisaged transferring the management of primary healthcare facilities to a public sector NGO. The paper finds that through the re-alignment of interest groups, the model was replicated in several other districts of the province. It also examines the evolution of stakeholders' behaviour, interest, position and influence in its implementation over a period of time. The study concludes that sustainability of the model remains doubtful unless public sector health bureaucracy is restructured and made to work effectively. Copyright © 2009 John Wiley & Sons, Ltd. [source] The Prevalence of Acute Respiratory Symptoms and Role of Protective Measures Among Malaysian Hajj PilgrimsJOURNAL OF TRAVEL MEDICINE, Issue 2 2010Zakuan Zainy Deris MD Background. Respiratory symptoms including cough, runny nose, sore throat, and fever are the most common clinical manifestations faced by hajj pilgrims in Mecca. The aim of the study was to determine the prevalence of respiratory symptoms among Malaysian hajj pilgrims and the effect of a few protective measures taken by hajj pilgrims to reduce respiratory symptoms. Methods. A cross-sectional study was conducted by distributing survey forms to Malaysian hajj pilgrims at transit center before flying back to Malaysia. The recruitment of respondents to the survey was on a voluntary basis. Results. A total of 387 survey forms were available for analysis. The mean age was 50.4 ± 11.0 years. The common respiratory symptoms among Malaysian hajj pilgrims were: cough 91.5%, runny nose 79.3%, fever 59.2%, and sore throat 57.1%. The prevalence of hajj pilgrims with triad of cough, subjective fever, and sore throat were 40.1%. The symptoms lasted less than 2 weeks in the majority of cases. Only 3.6% did not suffer from any of these symptoms. Seventy-two percent of hajj pilgrims received influenza vaccination before departure and 72.9% wore facemasks. Influenza vaccination was not associated with any of respiratory symptoms but it was significantly associated with longer duration of sore throat. Wearing masks was significantly associated with sore throat and longer duration of sore throat and fever. Conclusions. The prevalence of respiratory symptoms was high among Malaysian hajj pilgrims and the current protective measures seemed inadequate to reduce it. Beside standardization of the term used in hajj studies, more collaborative effort should be taken to reduce respiratory symptoms. The hajj authority should prepare for the challenge of pandemic influenza by providing more healthcare facilities and implementation of more strict measures to reduce the transmission of pandemic influenza strain among hajj pilgrims. [source] The ED of the Future: an Interdisciplinary Graduate Course in Healthcare DesignACADEMIC EMERGENCY MEDICINE, Issue 2009David Cowan Six faculty members from Georgia Institute of Technology, Emory University School of Medicine, Emory Healthcare, and Perkins + Will created and taught a one-semester course titled "The Emergency Department of the Future". The goals of the course were to provide an environment for students to be exposed to the unique challenges of healthcare design, to experience and learn techniques for successful interdisciplinary design, and to create innovations with impact. Twenty graduate students representing five disciplines (architecture, health systems, human-computer interaction, computer science, and systems engineering) participated in this class. The course included a series of didactic lectures covering a wide range of issues including architectural design of hospitals and emergency departments, observation techniques for working environments, electronic medical records, and patient-centered care. Lecturers included emergency physicians, nurses, architects, human-computer interaction researchers, and design specialists. Students developed problem statements along with prototype design solutions through these lectures, direct observation, and interaction with course faculty. The resulting projects include a mobile triage chair that takes vital signs, equipment sliders for easy functional transformation, an integrated lighting design, as well as patient assistants for self registration, communication, environmental control, and discharge support. The developed projects have generated ideas to improve emergency care that may be implementable commercial products as well as fundable projects for future research. The final presentation open house attracted over a hundred visitors from local and national healthcare facilities and industry. This presentation will highlight the structure and organization of the course as well as the resulting projects. [source] Pharmacokinetics and clinical efficacy of midazolam in children with severe malaria and convulsionsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2008Simon N. Muchohi WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Midazolam (MDZ), a water-soluble benzodiazepine, can be administered via several routes, including intravenously (IV), intramuscularly (IM) and buccal routes to terminate convulsions. It may be a suitable alternative to diazepam to stop convulsions in children with severe malaria, especially at peripheral healthcare facilities. The pharmacokinetics of MDZ have not been described in African children, in whom factors such as the aetiology and nutritional status may influence the pharmacokinetics. WHAT THIS STUDY ADDS , Administration of MDZ (IV, IM, or buccal) at the currently recommended dose (0.3 mg kg,1) resulted in rapid achievement of median maximum plasma concentrations of MDZ within the range 64,616 ng ml,1, with few clinically significant cardio-respiratory effects. A single dose of MDZ rapidly terminated (within 10 min) seizures in all (100%), 9/12 (75%) and 5/8 (63%) children following IV, IM and buccal administration, respectively. Although IM and buccal MDZ may be the preferred treatment for children in the pre-hospital settings the efficacy appears to be poorer. AIM To investigate the pharmacokinetics and clinical efficacy of intravenous (IV), intramuscular (IM) and buccal midazolam (MDZ) in children with severe falciparum malaria and convulsions. METHODS Thirty-three children with severe malaria and convulsions lasting ,5 min were given a single dose of MDZ (0.3 mg kg,1) IV (n = 13), IM (n = 12) or via the buccal route (n = 8). Blood samples were collected over 6 h post-dose for determination of plasma MDZ and 1,-hydroxymidazolam concentrations. Plasma concentration,time data were fitted using pharmacokinetic models. RESULTS Median (range) MDZ Cmax of 481 (258,616), 253 (96,696) and 186 (64,394) ng ml,1 were attained within a median (range) tmax of 10 (5,15), 15 (5,60) and 10 (5,40) min, following IV, IM and buccal administration, respectively. Mean (95% confidence interval) of the pharmacokinetic parameters were: AUC(0,,) 596 (327, 865), 608 (353, 864) and 518 (294, 741) ng ml,1 h; Vd 0.85 l kg,1; clearance 14.4 ml min,1 kg,1, elimination half-life 1.22 (0.65, 1.8) h, respectively. A single dose of MDZ terminated convulsions in all (100%), 9/12 (75%) and 5/8 (63%) children following IV, IM and buccal administration. Four children (one in the IV, one in the IM and two in the buccal groups) had respiratory depression. CONCLUSIONS Administration of MDZ at the currently recommended dose resulted in rapid achievement of therapeutic MDZ concentrations. Although IM and buccal administration of MDZ may be more practical in peripheral healthcare facilities, the efficacy appears to be poorer at the dose used, and a different dosage regimen might improve the efficacy. [source] Integrated care of childhood disease in Brazil: Mothers' response to the recommendations of health workersACTA PAEDIATRICA, Issue 8 2005Antonio JL Alves da Cunha Abstract Aim: To describe the process of follow-up in primary care facilities where the Integrated Management of Childhood Illness (IMCI) strategy was implemented. IMCI was developed by WHO and UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality and morbidity. Methods: From August 2001 to February 2002, 229 sick children who had a health condition included in the IMCI case management guidelines were seen in six family healthcare facilities in Brazil. We analysed the care provided to 153 children who were recommended for a 2- or 5-d follow-up visit. Children who did not return were visited and assessed at home. Results: Only 87 children (56.9%) timely returned for follow-up: 70 had improved, eight presented the same health conditions, five were worse and four had a new problem. The main reasons given for not returning for follow-up were: the child had improved (35.1%) and other family priorities (47.4%). Home visits showed that, although most children had improved (n=49), some had a new health problem and one child was sick enough to be referred. Prescription of antibiotics was associated with increased probability of returning for a follow-up visit (RR =1.64 [1.22,2.20], p=0.001). Conclusion: Adherence to follow-up was just over 50%, mostly because the condition had already resolved, but some children were still sick and needed intervention. Training on counselling on the recognition of danger signs and when to return for a follow-up visit must be reinforced. [source] Facing highly infectious diseases: new trends and current conceptsCLINICAL MICROBIOLOGY AND INFECTION, Issue 8 2009P. Brouqui Abstract A highly infectious disease (HID) that is transmissible from person to person causes life-threatening illness and presents a serious hazard in the healthcare setting and in the community that requires specific control measures. Due to environmental factors, changes in lifestyle and many other unknown factors, the emergence of such HIDs is becoming more and more likely. As has already been demonstrated during the SARS outbreak, healthcare facilities are likely to be the origin of future HID outbreaks. Preparedness planning will be essential in helping facilities manage future outbreaks of emerging or resurgent infectious diseases. Guidelines have been developed by national and international institutions. To avoid contamination of healthcare workers, the care of HID patients should follow the same infection control rules that are applied to laboratory workers exposed to similar agents. Here, the current knowledge concerning the clinical care of patients with HIDs is reviewed, and specific aspects of the management of such diseases are introduced. [source] Factors influencing job satisfaction of front line nurse managers: a systematic reviewJOURNAL OF NURSING MANAGEMENT, Issue 7 2008HOW LEE BScN Aim, The purpose of this study was to systematically review the research literature that examined the determinants of front line nurse managers' job satisfaction. Background, Front line managers are the vital link between senior management and clinical nurses. They influence organizational culture and outcomes for patients and staff so their job satisfaction and ultimately retention is of importance. Evaluations, A review of research articles that examined the determinants of front line nurse managers' job satisfaction was conducted. These managers supervise staff nurses and have direct responsibility for the management of a nursing unit or team in any type of healthcare facility. Fourteen studies were included in the final analysis. Key issues, Evidence of significant positive relationships were found between span of control, organizational support, empowerment and the job satisfaction of front line nurse managers. Conclusion, The review suggests that job satisfaction of front line managers may be improved by addressing span of control and workload, increasing organizational support from supervisors and empowering managers to participate in decision-making. Implications for Nursing Management, Healthcare organizations may enhance the recruitment, retention and sustainability of future nursing leadership by addressing the factors that influence job satisfaction of front line managers. [source] Implementation of kangaroo mother care: A randomized trial of two outreach strategiesACTA PAEDIATRICA, Issue 7 2005Robert C Pattinson Abstract Aim: To test whether a well-designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. Setting: Thirty-four hospitals in KwaZulu-Natal Province, South Africa. Method: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress-monitoring tool. Outcomes: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. Results: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29,22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08,21.13). Conclusion: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation. [source] | ||||||||||