Private Hospitals (private + hospital)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Can we predict recurrence of pre-eclampsia or gestational hypertension?

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2007
MA Brown
Objective, To estimate the rates of recurrence of pre-eclampsia or gestational hypertension in a subsequent pregnancy and to determine factors predictive of recurrence. Design, Retrospective cohort study. Setting, St George Public and Private Hospitals, teaching hospitals without neonatal intensive care units. Participants, A total of 1515 women with a diagnosis of pre-eclampsia or gestational hypertension between 1988 and 1998 were identified from the St George Hypertension in Pregnancy database, a system designed initially for ensuring quality outcomes of hypertensive pregnancies. Of these, 1354 women were followed up, and a further 333 records from women coded as having a normal pregnancy during that period were selected randomly as controls. Main outcome measures, Likelihood of recurrent pre-eclampsia or gestational hypertension and clinical and routine laboratory factors in the index pregnancy predictive of recurrence of pre-eclampsia or gestational hypertension. Methods, The index cases from our unit's database were linked to the matched pregnancy on the State Department of Health database, allowing us to determine whether further pregnancies had occurred at any hospital in the State. The outcome of these pregnancies was determined by review of medical records, using strict criteria for diagnosis of pre-eclampsia or gestational hypertension. Results, Almost all women with a normal index pregnancy had a further normotensive pregnancy. One in 50 women hypertensive in their index pregnancy had developed essential hypertension by the time of their next pregnancy. Women with pre-eclampsia in their index pregnancy were equally likely to develop either pre-eclampsia or gestational hypertension (approximately 14% each), while women with gestational hypertension were more likely to develop gestational hypertension (26%) rather than pre-eclampsia (6%) in their next pregnancy. Multiparous women with gestational hypertension were more likely than primiparous women to develop pre-eclampsia (11 versus 4%) or gestational hypertension (45 versus 22%) in their next pregnancy. Early gestation at diagnosis in the index pregnancy, multiparity, uric acid levels in the index pregnancy and booking blood pressure parameters in the next pregnancy significantly influenced the likelihood of recurrence, predominantly for gestational hypertension and less so for pre-eclampsia. No value for these parameters was significant enough to be clinically useful as a discriminate value predictive of recurrent pre-eclampsia or gestational hypertension. Conclusions, Approximately 70% of women with pre-eclampsia or gestational hypertension will have a normotensive next pregnancy. The highest risk group for recurrent hypertension in pregnancy in this study was multiparous women with gestational hypertension. No readily available clinical or laboratory factor in the index pregnancy reliably predicts recurrence of pre-eclampsia. [source]


A theory of meaning of caregiving for parents of mentally ill children in Taiwan, a qualitative study

JOURNAL OF CLINICAL NURSING, Issue 1-2 2010
Wen-Jiuan Yen
Aims and objectives., The aim of this study is to generate a theory of meaning of care-giving for parents of mentally ill children in Taiwan. Background., Studies indicate that the meaning of care-giving plays an important role in the psychological adjustment of care-givers to care-giving. With a positive meaning of care-giving, care-givers can accept their roles and adapt to them more readily. Design., The research employs the qualitative method of grounded theory, the inquiry is based on symbolic interactionism. Methods., Twenty parental care-givers of children with schizophrenia were recruited at a private hospital in central Taiwan. Semi-structured interviews were conducted. A comparative method was used to analyse the text and field notes. Results., Responsibility (zeren) emerges as the core category or concept. Responsibility expresses broadly the behavioural principles that are culturally prescribed and centred on familial ethics and values. Related concepts and principles that influence caregiver actions and affections include a return of karma, challenges from local gods and fate. By maintaining their culturally prescribed interpretations of care-giving, parents hope to give care indefinitely without complaints. Conclusions., The findings clearly suggest that the meaning of care-giving is determined through a process of internal debate that is shaped by culturally specific concepts. The paper attempts to explain some of these culturally specific determinants and explanations of care-giving behaviour. Relevance to clinical practice., The theory contributes knowledge about the meaning of care-giving for parents of mentally ill children in Taiwan. It should be useful reference for mental health professionals, who provide counselling services to ethnically Taiwanese care-givers. [source]


Factors influencing Macao nurses' intention to leave current employment

JOURNAL OF CLINICAL NURSING, Issue 6 2009
Moon Fai Chan
Aims., To investigate factors associated with nurses' intention to leave current employment in Macao. Background., The shortage of nursing staff and nurses voluntarily leaving their jobs has continued to be a problem affecting the delivery of health care all over the world. One way to alleviate this shortfall is via recruitment, but this is not always successful. Another way is to reduce the rate at which nurses voluntarily leave their work places. Design., A descriptive survey was conducted and data were collected using a self-reported structured questionnaire. Nurses were recruited in the Health Bureau and one private hospital in Macao. The status of nurses' intention to leave current employment (yes vs. no) was the dependent variable and nurses' predisposing characteristics, organisational environments and five components on job satisfaction outcomes were independent variables. Results., Of 426 nurses, 166 (39·0%) indicated an intention to leave current employment. The results showed that age (p < 0·001), work experience (p < 0·001), workplace (p = 0·015) and job satisfaction: pay and benefits (p < 0·001) were significant risk factors to predict nurses' intention to leave current employment. Conclusions., More than one-third of the nurses in Macao indicated an intention to leave current employment. This figure may be a cause of concern for the hospital management and highlights the need to implement strategies to improve the communication between nurses and the organisation, to enhance nurse job satisfaction and commitment to the organisation. Relevance to clinical practice., Our findings outline some issues contributing to this problem and provide the nurse manager with information regarding specific influences on nurses' turnover in Macao. Given the complexity of issues outlined in this analysis, nurse managers should assist their nursing staff to deal with those influences, make efforts to address the nursing shortage that will require additional communications and recognise the needs and values of their staff and empower them to create a better work environment. As a consequence, their commitment to the organisation can be fostered. [source]


Rotavirus diarrhea in children and adults in a southern city of Brazil in 2003: Distribution of G/P types and finding of a rare G12 strain

JOURNAL OF MEDICAL VIROLOGY, Issue 9 2006
Eduardo Pietruchinski
Abstract Between May and August in 2003, a total of 251 fecal samples were collected from children and adults with diarrhea (5 inpatients and 246 outpatients) at a private hospital in the city of Ponta Grossa, the state of Paraná, Brazil. Group A rotavirus was detected in 71 of 251 (28.3%) specimens: 55 (77.5%) from children under 5 years of age and 16 (22.5%) from individuals aged 6,72 years. All 71 strains exhibited a "long" RNA pattern when analyzed by PAGE. Sixty-one positive samples that yielded enough RNA were submitted to PCR genotyping. The most frequent G/P genotype combination detected was G1P[8] (86.9%; 53/61) followed by G9P[8] (3.3%; 2/61) and G12P[9] (1.6%; 1/61). Rotaviruses with G2, G3, G4, P[4], or P[6] specificity were not detected. For three strains (4.9%) bearing G1 genotype, the VP4 specificity could no be determined, and two specimens (3.3%) remained G/P non-typeable. One rotavirus strain (HC91) bearing G12P[9] genotype with a "long" electropherotype was isolated from an 11-month-old boy with diarrhea for the first time in Brazil. The cell-culture grown HC91 strain was shown to belong to serotype G12 by neutralization. J. Med. Virol. 78:1241,1249, 2006. © 2006 Wiley-Liss, Inc. [source]


Effects of socioeconomic status on presentation with acute lower respiratory tract disease in children in Salvador, Northeast Brazil

PEDIATRIC PULMONOLOGY, Issue 4 2002
Cristiana M. Nascimento-Carvalho MD
Abstract Two different socioeconomic groups of children with pneumonia were studied, and their clinical and demographic aspects were evaluated. The diagnosis of pneumonia was based on findings of cough and tachypnea, or on crackles on auscultation or on radiologically confirmed infiltrate. This was a prospective cross-sectional study conducted at the Professor Hosannah de Oliveira Pediatric Center, which cares for children of lower socioeconomic status (PHOPC), and at one private hospital which cares for children from middle to high socioeconomic status (Aliança Hospital, AH). Demographics and clinical differences were assessed by the Pearson chi-square test or Fisher's exact test as appropriate; means of continuous variables were compared by Mann-Whitney U-test. In a 26-month period, 3,431 cases were recruited. The 2,476 cases identified at the PHOPC were younger than the 955 identified at AH (2.2,±,2.3 vs. 4.5,±,3.1 years, P,<,0.0001) and had higher scores for severity (3.5,±,1.5 vs. 2.7,±,1.7, P,<,0.0001), duration of hospitalization (days) (10.9,±,12.1 vs. 6.2,±,7, P,<,0.0001), frequency of tobacco smoker in the household (48% vs. 31%, P,<,0.0001), cardiopathy (15.3% vs. 5.9%, P,=,0.003), fever (44.4% vs. 36.3%, P,=,0.0001), tachypnea (67.6% vs. 32.3%, P,<,0.0001), crackles (69.5% vs. 64.9%, P,=,0.02), somnolence (19.9% vs. 10.4%, P,<,0.0001), malnutrition (13.7% vs. 5%, P,<,0.0001), hospitalization rate (27.4% vs. 22.5%, P,=,0.003), and death (0.9% vs. 0.1%, P,=,0.009). However, other features were more frequent among AH cases: parent's university level of education (38.2% vs. 1.0%, P,<,0.0001), underlying chronic illness (40.6% vs. 28.5%, P,<,0.0001), asthma (62.7% vs. 50.8%, P,=,0.01), rhinitis (9.2% vs. 0.4%, P,<,0.0001), previous use of antibiotics (34.3% vs. 27.1%, P,=,0.001), and wheezing (53.1% vs. 42.2%, P,<,0.0001). Children of lower socioeconomic status have more serious lower respiratory tract disease, whereas children with pneumonia of middle to high socioeconomic status have more allergic diseases (rhinitis, asthma) and wheezing. Pediatr Pulmonol. 2002; 33:244,248. © 2002 Wiley-Liss, Inc. [source]


HARMONIZING REGULATIONS FOR BIOMEDICAL RESEARCH: A CRITICAL ANALYSIS OF THE US AND VENEZUELAN SYSTEMS

DEVELOPING WORLD BIOETHICS, Issue 3 2008
DANNIE DI TILLIO-GONZALEZ
ABSTRACT This article aims to compare the national legal systems that regulate biomedical research in an industrialized country (United States) and a developing country (Venezuela). A new international order is emerging in which Europe, Japan and the United States (US) are revising common guidelines and harmonizing standards. In this article, we analyze , as an example , the US system. This system is controlled by a federal agency structured to regulate research funded by the federal government uniformly, either in the US or abroad. In contrast, in Venezuela, a developing country, the creation of a centralized system is a slow process. Different types of ethical committees review research projects using non-uniform criteria. Consequently, various parallel organizations that conduct biomedical research, such as universities, research institutes and private hospitals have diverse regulations operating at a local level. Thus, the most relevant difference between the Venezuelan and the US systems is the degree of standardization. In the US, the review process is performed by institutional review boards (IRBs), which have a similar organization and maintain relationships with a centralized agency, following standard regulations. Although new proposals for establishing national regulations are currently being considered in Venezuela, the success of these initiatives will depend on promoting governmental efforts to create a more structured centralized system supported by a national regulatory framework. This system will need governmental financial support at all levels. This article proposes an integrated system to regulate research with human participants in Venezuela and other developing countries. [source]


Patterns and trends in alcohol-related hospitalizations in Victoria, Australia, 1987/88,1995/96

DRUG AND ALCOHOL REVIEW, Issue 4 2000
KIRSTEN HANLIN
Abstract The objective of this study was to examine patterns and yearly trends in alcohol-related hospitalization rates during the period 1987/88,1995/96 for men and women living in metropolitan and rural/remote Victoria. Alcohol-related hospitalizations were extracted from the Victorian Inpatient Minimum Dataset (VMD) for the years 1987/88,1995/96 (public hospitals) and 1993/94,1995/96 (private hospitals), and adjusted by the appropriate aetiological fractions. Sex-specific age-adjusted rates we expressed per 10000 residents/year. During 1993/94,1995/96, alcohol-related hospitalizations comprised 1.0% of all Victorian hospitalizations (about 12000/year), with men accounting for over two-thirds of alcohol-related hospitalizations. Approximately half of the alcohol-related hospitalizations were for disease conditions and the other half for external cause (injury) conditions. About 80% of all alcohol-related hospitalizations were to public hospitals, with the exception of alcohol dependence (63% to private hospitals). Alcohol-related hospitalization rates were generally higher for people living in rural/remote areas compared to urban areas. During 1987/88,1995/96, the age-adjusted alcohol-related hospitalization rates in public hospitals did not change significantly for disease conditions (14.8,14.7 for men and 6.3,6.4 for women) or female external cause conditions (6.7,6.1), but decreased for external cause conditions (18.4,15.5). In private hospitals during 1993/94,1995/96, the age-adjusted alcohol-related hospitalization rates for disease conditions decreased (5.4,4.1 for men and 3.7,3.0 for women) but increased for external cause conditions (1.8,2.4 for men and 1.0,1.2 for women). These patterns and time-trends in Victorian alcohol-related hospitalizations reflect a combination of alcohol-related morbidity levels, hospital admission practices and patterns and levels of service provision. They suggest a potential need to focus on services and programmes in rural/remote Victoria. [source]


Resource settings have a major influence on the outcome of maintenance hemodialysis patients in South India

HEMODIALYSIS INTERNATIONAL, Issue 2 2010
ABRAHAM Georgi
Abstract Chronic kidney disease is reaching epidemic proportions and the number of patients on renal replacement therapy (RRT) is increasing worldwide and also in developing countries. To meet the challenge of providing RRT, a few charity organizations provide hemodialysis units for underprivileged patients, as the private hospitals are unaffordable for the majority. There is a paucity of information on the outcome of dialysis in these patients. Here, we describe the outcome of hemodialysis patients comparing the middle- and upper-class income group with the lower class income group. A retrospective analysis was carried out in 558 CKD patients initiated on maintenance hemodialysis in two different dialysis facilities. Group A (n=247) included those who belonged to the lowermost socioeconomic status and were undergoing dialysis in two nonprofit, charity (TANKER)-run dialysis units, and Group B (n=311) was undergoing dialysis in a nonprofit hospital setting where no subsidy was given. Those patients of a low socioeconomic status, especially those who are diabetics, have a higher death rate (Group A-38.1%, Group B-4.2%) and loss to follow-up (Group A-25.9%, Group B-0.3%) compared with those who are in the middle- and high-income group. Higher EPO use and hence higher hemoglobin levels (Group A-6.4±1.2, Group B-8.9±1.5 P<0.001) were observed in those who were in the middle and the higher income group. Lower serum phosphorus level was observed in the low-socioeconomic group (Group A-4.7±1.5, Group B-5.5±1.9, P<0.001). Patients belonging to the middle and higher socioeconomic group undergo more transplantations compared with the lower socioeconomic group (Group A-2.4%, Group B-65.6%). [source]


Home clinic programme: An alternative model for private mental health facilities and sufferers of major depression

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2006
Eddie Blacklock
ABSTRACT:, Depression demands high emotional and social costs to people suffering it while private hospitals and health funds are economically affected in respect to elongated episodes of care and readmission rates. There is a dearth of nurse-led initiatives aimed to reduce length of stay. An innovative model of care is proposed, offering the opportunity for depressed clients to return home earlier from hospital where they will receive the professional guidance and support of mental health registered nurses (RNs) providing contemporary counselling. Clinical links between the home and the hospital would be maintained by the RNs for a specified time frame. The framework of home clinic programme is to discharge clients from hospital into community within specified time frame (maximum 14 days hospitalization) and the clients will be visited by RNs in their homes five times in the first week, twice in the second week and once in the third week to ascertain their emotional and clinical needs and provide biopsychosocial support. The use of this model has potential benefits for mental health consumers, clinicians, services, and funders. [source]


Determining the professional behaviour of nurse executives

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 4 2010
Filiz Hisar PhD RN
Hisar F, Karada, A. International Journal of Nursing Practice 2010; 16: 335,341 Determining the professional behaviour of nurse executives This study was carried out with the aim of determining the professional behaviour of nurse executives. The sample of the study included 104 nurse executives working in university, state and private hospitals in Turkey. Data were collected using a questionnaire, which included demographic characteristics of nurses and a Behavioral Inventory Form for Professionalism in Nursing (BIPN). The questionnaire was filled out by the nurses. The BIPN results showed that the mean score of nurse executives was low. Although the scores of nurse executives who had completed postgraduate studies in nursing were the highest, those who had only completed an associate degree programme were the lowest. In conclusion, the professionalism scores for Turkish nurse executives were found to be low; recommendations for improving these scores were made. [source]


Indigenous children and receipt of hospital dental care in Australia

INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 5 2006
L. M. JAMIESON
Summary., Objective., The aim of this study was to investigate dental procedures received under hospital general anaesthetic by indigenous and non-indigenous Australian children in 2002,2003. Methods., Separation data from 1297 public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database for 2002,2003. The dependant variable was the admission rate of children receiving four categories of dental care (i.e. extraction, pulpal, restoration or other). The explanatory variables included sex, age group, indigenous status and location (i.e. major city, regional or remote). Rates were calculated using estimated resident population counts. Results., The sample included 24 874 children aged from 2 to 14 years. Some 4·3% were indigenous (n = 1062). Admission rates for indigenous and non-indigenous children were similar, with indigenous males having 1·2 times the admission rate of indigenous females (P < 0·05). Indigenous children aged < 5 years had 1·4 times the admission rate of similarly aged non-indigenous children (P < 0·001) and 5·0 times the admission rate of 10,14-year-old indigenous children (P < 0·001). Remote-living indigenous children had 1·5 times the admission rate of their counterparts in major cities or regional areas (P < 0·001), and 1·4 times the admission rate of remote-living non-indigenous children (P < 0·01). The extraction rate of indigenous males was 1·3 times that of non-indigenous males (P < 0·01), and 1·2 times that of indigenous females (P < 0·05). Pre-school indigenous children had 2·2 times the extraction rate of similarly aged non-indigenous children (P < 0·001), and 5·3 times that of indigenous 10,14-year-olds (P < 0·001). The extraction rate of remotely located indigenous children was 1·5 times that of indigenous children in major cities (P < 0·01), and 1·8 times that of remote-living non-indigenous children (P < 0·001). Conclusions., In certain strata , particularly males, the very young and those in remote locations , indigenous children experienced higher rates of extractions than non-indigenous children when undergoing care in a hospital dental general anaesthetic setting. [source]


Do-Not-Resuscitate Policy on Acute Geriatric Wards in Flanders, Belgium

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2005
Cindy De Gendt MSc
Objectives: To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. Design: Structured mail questionnaires. Setting: All 94 acute geriatric wards in hospitals in Flanders in 2002 (the year Belgium voted a law on euthanasia). Participants: Head geriatricians. Measurements: A questionnaire was mailed about the existence, development, and implementation of the DNR policy (guidelines and order forms), with a request to return copies of existing DNR guidelines and DNR order forms. Results: The response was 76.6%, with hospital characteristics not significantly different for responders and nonresponders. Development of DNR policy began in 1985, with a step-up in 1997 and 2001. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. Geriatric wards in private hospitals implemented their policy later (P=.01) and more often had order forms (P=.04) than those in public hospitals. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. Conclusion: Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions. [source]


Epidemic of Cesarean Section at the General, Private and University Hospitals in Thailand

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2000
Dr. Boonsri Chanrachakul
Abstract Objective: To undertake a survey of cesarean section in the general, private and university hospitals in Thailand. Methods: Postal questionnaires were sent to all the general, private and university hospitals with 200 beds or more. The questionnaires were prepared to find out the percentage, the indications and the trend of cesarean delivery, the measures taken to decrease cesarean section rate, and the practice of external cephalic version (ECV) and vaginal birth after cesarean section (VBAC) in the hospitals. Results: The overall response rate was 88%. Mean cesarean section rates were 24, 48, and 22% in the general, private and university hospitals, respectively. Cesarean section rates in most of the hospitals were increased in the past 5 years namely 78% in the general hospitals, 50% in the private hospitals, 66% in the university hospitals. However, only 38% of the hospitals had measures to regulate this operation. Repeated cesarean section was the most common indication in the private (63%) and the university hospitals (88%) while failure to progress was the most common indication in the general hospitals (55%). ECV and VBAC were performed in 26 and 12% of the hospitals. They were, however, not the standard practices. Conclusion: Rising of cesarean section rate without any measure to regulate it is the problem in the developing countries. Standardised labor management and reduction of unnecessary primary cesarean section will automatically reduce repeated operation and overall cesarean section. [source]


A Survey of the Current Practice of Obstetric Anaesthesia and Analgesia in Malaysis

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2000
Dr. Y. K. Chan
Abstract Objective: A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996. Results: From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all. Conclusions: Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom. [source]


Risk factors for low birthweight in north-east Brazil: the role of caesarean section

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2001
Antônio A.M. Silva
Summary Caesarean section (CS) delivery is associated with low birthweight (LBW) in south-east Brazil. A hospital-based study was conducted on singleton infants from mothers residing in São Luís, to assess if an association between CS and LBW was found in the northern part of the country, where the CS rate is lower than in the south-east. A standardised questionnaire was administered to a sample of 2541 mothers in 10 hospitals, representing 94% of all deliveries, from March 1997 to February 1998. In a logistic model, type of delivery was the independent variable, the other variables were treated as confounders, and interaction terms were added between type of delivery and all other factors. LBW was associated with low maternal height, maternal smoking, primiparity, previous LBW, public insurance, preterm birth and CS. The CS rate was 33.7%. The risk of CS was higher for primiparous and married mothers, those with high level of schooling and attended by the same physician during prenatal and delivery care, deliveries held in private hospitals, daylight hours or evenings, and for those mothers who had adequate prenatal care. Because it appears unlikely that only medical reasons are operative, it is a possibility that CS could cause LBW, reflecting abusive indications for elective CS. [source]


Inguinal hernia repair: Where to next?

ANZ JOURNAL OF SURGERY, Issue 8 2002
Martina Zib
Background: Hernia repair is one of the most frequently performed operations in general surgery , a total of 39 000 elective inguinal hernia repairs were performed in public and private hospitals in Australia between July 1998 and June 1999 , and, as such, even minor alterations in outcome and resource use have appreciable impact. However, decisions regarding choice of operation for hernia repair remain controversial. The purpose of the present paper is to critically evaluate the evidence available regarding recently introduced open mesh repair techniques and to try to identify meaningful directions for future hernia research. Methods: A thorough search of all published surgical literature was undertaken. Medline, EMBASE and the Cochrane databases were searched by title, by key words and by author. References in review articles and in textbooks were pursued. The manufacturing companies were contacted for trials evaluating their product. Results: Eight original articles evaluating either the Kugel Patch, the PerFix Plug or the Prolene Hernia System were located. None of these trials directly compared two or more of these repair systems. To date, there has been no published review of the evidence regarding the newer mesh repair techniques. With one exception, all of these articles qualify as Level IV evidence. Highlighted is the lack of evidence regarding chronic significant posthernioplasty pain , this has an incidence of 6,12%. This complication is 3,5 times more common than recurrence after open repair, is clinically relevant, is poorly understood and has been poorly studied. Arguably it is a more important end point than recurrence. Conclusion: Only one study comparing the newer techniques of open hernia repair (PerFix Plug) constitutes Level II evidence. The PerFix Plug appears to be quicker to insert and uses a smaller incision. Chronic significant posthernioplasty pain is a more important endpoint in hernia research than is recurrence, and this review concludes with a proposal for a multicentre, randomized, controlled trial evaluating the incidence of chronic significant posthernioplasty pain following elective mesh repair of primary, unilateral ­hernias. [source]


Factors influencing medical oncology referral in Dukes' C colonic cancer

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010
Cu-Tai LU
Abstract Aim: Colorectal cancer (CRC) is one of the most common malignancies worldwide and adjuvant chemotherapy is proven to improve survival in patients with Dukes' C CRC. The purpose of this study was to analyze factors influencing referral to medical oncology in patients with Dukes' C colonic cancer in our institutions. Methods: Patients who underwent resection for Dukes' C colonic cancer were assessed for factors that influence the pattern of postoperative referral to the medical oncology department, including demographic and perioperative data. Results: Overall, 466 patients were identified to have Dukes' C colonic cancer, with 53.9% of these being female. Referral to medical oncology occurred for 58.4% patients. Multivariable logistic regression modeling identified age, elective admission and resection in private hospitals as factors. The likelihood of medical oncology referral in patients who had elective resection was 63% versus 41% in those who had emergency resection and resection in private hospitals was 69% versus 50% in public hospitals. Conclusion: Referral to a postoperative medical oncology clinic for adjuvant chemotherapy in Dukes' C colonic cancer was more likely in younger patients, those who underwent elective resection and those treated in private hospitals. [source]


The impact of the baby bonus on maternity services in New South Wales

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010
Samantha J. LAIN
Background:, In 2004, the Federal Government introduced the baby bonus, a one-off payment upon the birth of a child. Aims:, To assess the impact of an increase in the number of births on maternity services in New South Wales following the introduction of the baby bonus payment in July 2004. Methods:, A population-based study, using NSW birth records, of 965 635 deliveries from 1998 to 2008 was carried out. The difference between the predicted number of births in 2005,2008, estimated from trends in births from 1998 to 2004, and the observed number of births in NSW hospitals in 2005,2008 were calculated. We also estimated the increase in cost to the health system of births in 2008 compared with previous years. Results:, Compared with trends prior to the introduction of the baby bonus, there were an estimated 11 283 extra singleton births per year in NSW hospitals by 2008. There were significant increases in the number of deliveries performed in tertiary, urban and rural public hospitals; however, the number of deliveries in private hospitals remained stable. Compared with predicted estimates, in 2008, there were over 8700 more vaginal deliveries, over 1000 more preterm births and over 45 000 extra infant hospital days each year. Compared with 2004, in 2008, the estimated cost of births in NSW hospitals increased by $60 million, Conclusions:, The increase in births following the introduction of the baby bonus has significantly impacted maternity services in NSW. [source]


Role of general practitioners in primary maternity care in South Australia and Victoria

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
Georgina SUTHERLAND
Background:, Recent policy debates about the challenges facing maternity services in Australia provide an opportunity to reflect on current care practices. Aims:, To identify the provision of primary maternity care models in two Australian states: South Australia (SA) and Victoria. Methods:, All public and private hospitals with maternity facilities in SA and Victoria were mailed a survey requesting information about the organisation and provision of maternity care. Results:, All hospitals in SA (35) and 99% (75/76) in Victoria completed the survey. Among public hospitals, approximately 50% (14/30 in SA and 29/56 in Victoria) reported primary care arrangements where all antenatal care is provided by medical practitioners working in the community. The vast majority of hospitals offering this type of care were located outside metropolitan areas. Twenty per cent of public hospitals in SA (6/30) and 36% in Victoria (20/59) reported offering primary midwifery models, such as team, caseload and/or birth centre care. In SA, hospitals offering these models were located in both metropolitan and regional areas. In Victoria, 60% of hospitals offering women primary midwifery care were large hospitals with more than 1000 births per annum. Conclusions:, This study shows that community-based medical practitioners, general practitioners in particular, are major providers of maternity care despite the emergence of primary midwifery models of care. With 25% of the population living outside metropolitan areas in both states, providing access to choice and continuity of care for women living in regional and rural areas will be a challenge for maternity reform. [source]


Evolution of the complications of laparoscopic hysterectomy after a decade: A follow up of the Monash experience

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009
Jason J. TAN
A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment. [source]


Complications of laparoscopic hysterectomy: the Monash experience

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2002
J Tsaltas
ABSTRACT A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy. Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates. [source]


Long-term follow up of uterine artery embolisation,an effective alternative in the treatment of fibroids

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2006
WJ Walker
Objectives, To evaluate the long-term efficacy and complications of uterine artery embolisation (UAE) for treatment of symptomatic uterine fibroids. Design, A prospective observational study. Setting, A district general hospital and two private hospitals in the southeast of England. Population, Women with symptomatic fibroids who had been offered surgical options for treatment. Methods, Postal questionnaire follow up at 5,7 years to assess long-term clinical effects among women who had undergone UAE. Main outcome measures, The questionnaire was subdivided into sections dealing with menstrual flow, amenorrhoea and menopause, fibroid-related symptoms, fertility, vaginal discharge, sexual function, subsequent treatments for fibroids and satisfaction with the procedure. Results, A total of 258 women were identified as being between 5 and 7 years post-UAE and suitable for long-term follow up in October 2004. One hundred seventy-two completed questionnaires were analysed (67% response rate). Seventy-five percent of women still had either a return to normal or an improvement in menstrual flow compared with how they were prior to UAE. More than 80% of fibroid-related symptoms were still resolved or improved. Sixteen percent of women required further treatment for fibroids. Premature menopause directly following UAE occurred in only one woman in the study group. Eighty-eight percent of women were satisfied with the outcome of the procedure at 5,7 years and would choose it again or recommend it to others. Conclusions, These findings show that UAE is of benefit to women wishing to avoid hysterectomy and it carries a low risk of complications. [source]


The rise of multiple births in Brazil

ACTA PAEDIATRICA, Issue 8 2008
Clécio Homrich da Silva
Abstract Aim: The aim of this study was to assess the rise in multiple births and its influence on trends of low birth weight (LBW) rates in Porto Alegre, Brazil. Methods: This is a registry-based study of live births from 1994 to 2005 obtained from the national live birth information system. Chi-square tests for trends were assessed for LBW and multiple birth rates. The impact of multiple births on LBW trends was assessed by sequential modelling, including year and further adjustment for multiple births. Risk factors for multiple births were assessed using the Poisson regression. Results: A total of 263 252 live births were studied. The LBW rate increased from 9.70% to 9.88% (p < 0.001) and the multiple birth rate rose from 1.95% to 2.53% (p < 0.001). LBW rate increased among twins, from 57.14% to 63.46% (p = 0.001). The twin birth rate rose by 24.7%, while the rate of triplets or higher-order increased by 150%. Multiple births may be responsible for 23.9% of the increase in the LBW rate over the period. Mothers with higher levels of schooling, older mothers and mothers delivering in private hospitals were more likely to deliver multiple births. Conclusions: It seems that both the increase in multiple births and in the LBW among multiple births contributed to this rise in overall LBW rate. [source]


Correlates of breastfeeding duration in an urban cohort from Argentina

ACTA PAEDIATRICA, Issue 8 2003
S Berra
Aim: To analyse factors associated with the duration of breastfeeding in a representative cohort of mothers and children, including socio-demographic and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices. Methods: The study was conducted in the city of Cordoba, between 1993 and 1998. Mother-child binomials from all public and private hospitals were asked to participate. Follow-up consisted of home visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650 healthy newborns. Cessation of breastfeeding during the first 24 mo of life was analysed using the Kaplan-Meier method, and factors associated with weaning were studied using Cox's proportional risk regression. Results. The median duration of breastfeeding was 4 mo. Factors associated with weaning were: the introduction of artificial formulas within 30 d postpartum [relative risk (RR) = 2.27; 95% confidence interval (CI) = 1.82,2.82]; breastfeeding of a previous child for less than 6 mo (RR=1.64; 95% CI = 1.32,2.02); delay in the first mother-child contact for over 90 min (RR=1.50; 95% CI = 1.17,1.93); mother's having completed primary or partially completed secondary education (RR= 1.40; 95% CI = 1.01,1.92) or completed secondary education or higher (RR= 1.59; 95% CI = 1.14,2.22); primiparous mother (RR= 1.39; 95% CI = 1.12,1.74) and; the mother recalling having been breastfed for less than 6 mo (RR = 1.27; 95% CI = 1.01,1.61). Conclusions. The purpose of strategies to promote breastfeeding should be to eliminate inappropriate care practices, such as delay in the first mother-child contact, as well as reducing the impact of other factors leading to the introduction of artificial milk. Moreover, mothers need more and better support from professionals and peers. [source]