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YAMADA, M. "In-House Medical Care and Medical Information : Medical Optical Card." JAPANES JOURNAL OF MEDICAL INSTRUMENTATION 60, no. 12 (December 1, 1990): 552–55. http://dx.doi.org/10.4286/ikakikaigaku.60.12_552.
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Landers, Steven H., Paul W. Gunn, and Kurt C. Stange. "An Emerging Model of Primary Care for Older Adults: The House Call–Home Care Practice." Care Management Journals 10, no. 3 (September 2009): 110–14. http://dx.doi.org/10.1891/1521-0987.10.3.110.
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House calls to older adults have become more common, in part related to the emergence of medical practices that either emphasize or exclusively provide house calls. In this article we seek to describe organizational, clinician, and patient characteristics of house call–home medical care practices in the United States. We conducted telephone interviews with clinicians representing 36 randomly selected practices from across the United States. This study found that house call–home care practices typically are recently formed small groups of physicians and nurse practitioners that provide in-home primary care, especially chronic disease care, to Medicare beneficiaries. Clinicians are motivated by the opportunity to improve care and to maintain autonomy. This emerging model may represent a mutually beneficial trend for older adults and physicians.
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Hayhurst, Chris. "Enhancing Care Delivery Operations through an In-House Medical Physics Program." Biomedical Instrumentation & Technology 53, no. 1 (January 1, 2019): 59–63. http://dx.doi.org/10.2345/0899-8205-53.1.59.
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Seitman, David T. "In-house medical personnel scheduler: A computerized on-call scheduling program." International Journal of Clinical Monitoring and Computing 11, no. 1 (February 1994): 7–10. http://dx.doi.org/10.1007/bf01132838.
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Soh, Ling Ling, and Lian Leng Low. "Attitudes, perceptions and practice patterns of primary care practitioners towards house calls." Journal of Primary Health Care 10, no. 3 (2018): 237. http://dx.doi.org/10.1071/hc18022.
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ABSTRACT INTRODUCTION Historically, doctors routinely delivered medical care to sick patients in their homes, with house calls accounting for 40% of all doctor–patient encounters in the 1940s. This proportion has dwindled to less than 1% today. Advantages of house calls include decreased mortality rates, admissions to long-term care in the general elderly population and increased patient appreciation. Therefore, we asked ‘Why do some primary care practitioners do house calls and what are the reasons that others do not?’. AIM This review aims to understand the attitudes, perceptions of Primary Care Practitioners (PCPs) towards house calls and their practice patterns. METHODS A search of PubMed and Embase was conducted for articles published before 31 December 2017. A total of 531 articles with 44 duplicates was generated. Of these, 13 were shortlisted along with three hand-searched articles for a total of 16 articles included in this review. RESULTS Primary care providers were aware of the role of house calls and their advantages in enabling comprehensive care for a patient. They saw making house calls as a responsibility with rewards that enhanced the doctor–patient relationship. However, opportunity cost, time, medical liability and miscellaneous reasons such as the lack of training precluded some PCPs from making more house calls. DISCUSSION Primary care practitioners recognise the importance of house calls, especially in the care of elderly patients, but there are many unaddressed issues such as opportunity cost and clinical inadequacy in the home setting that have caused a decline in house calls over the years.
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Aakjær Andersen, Camilla, Martin Bach B. Jensen, Berit Skjødeberg Toftegaard, Peter Vedsted, Michael Harris, and Örenäs Research group. "Primary care physicians’ access to in-house ultrasound examinations across Europe: a questionnaire study." BMJ Open 9, no. 9 (September 2019): e030958. http://dx.doi.org/10.1136/bmjopen-2019-030958.
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ObjectiveThe overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe.DesignCross-sectional study.SettingPrimary care.ParticipantsPrimary care physicians (PCPs).Primary and secondary outcomes measuresThe primary aim was to describe the variation in in-house primary care ultrasonography availability across Europe using descriptive statistics. The secondary aim was to explore associations between in-house ultrasonography availability and the characteristics of PCPs and their clinics using a mixed-effects logistic regression model.ResultsWe collected data from 20 European countries. A total of 2086 PCPs participated, varying from 59 to 446 PCPs per country. The median response rate per country was 24.8%. The median (minimum–maximum) percentage of PCPs across Europe with access to in-house abdominal ultrasonography was 15.3% (0.0%–98.1%) and 12.1% (0.0%–30.8%) had access to in-house pelvic ultrasonography with large variations between countries. We found associations between in-house abdominal ultrasonography availability and larger clinics (OR 2.5, 95% CI 1.2 to 4.9) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 2.1, 95% CI 1.1 to 3.8). Corresponding associations were found between in-house pelvic ultrasonography availability and larger clinics (OR 1.9, 95% CI 1.3 to 2.7) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 3.0, 95% CI 1.8 to 5.1). Additionally, we found a negative association between urban clinics and in-house pelvic ultrasound availability (OR 0.5, 95% CI 0.2 to 0.9).ConclusionsAcross Europe, there is a large variation in PCPs’ access to in-house ultrasonography and organisational aspects of primary care seem to determine this variation. If evidence continues to support ultrasonography as a front-line point-of-care test, implementation strategies for increasing its availability in primary care are needed. Future research should focus on facilitators and barriers that may affect the implementation process.
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Breugelmans, Raoul, and J. Patrick Barron. "The Role of In-House Medical Communications Centers in Medical Institutions in Nonnative English-Speaking Countries." Chest 134, no. 4 (October 2008): 883–85. http://dx.doi.org/10.1378/chest.08-1068.
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Kaul, Karen L. "Molecular Detection of Mycobacterium tuberculosis: Impact on Patient Care." Clinical Chemistry 47, no. 8 (August 1, 2001): 1553–58. http://dx.doi.org/10.1093/clinchem/47.8.1553.
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Abstract Background: Nucleic acid amplification technologies such as PCR are revolutionizing the detection of infectious pathogens such as tuberculosis (TB). Amplification technology offers the potential for the diagnosis of TB in a few hours with a high degree of sensitivity and specificity. However, molecular assays neither replace nor reduce the need for conventional smear and culture, speciation, and antibiotic sensitivity assays. Methods: We undertook prospective studies of sputum samples to assess the performance of two PCR-based assays for the detection of TB as well as the impact of more rapid availability of test results on patient care. Results: The sensitivity of both the in-house and Amplicor PCR assays was 100% for smear-positive sputa. For smear-negative sputa (two sputum samples collected during the first 24 h of hospitalization), the sensitivity was 85% for our in-house PCR assay and 74% for the Roche PCR assay. Approximately 10% of the smear- and culture-negative sputa yielded positive PCR results; however, more than one-half of these were positive with both the in-house and Amplicor assays, suggesting the presence of TB DNA or organisms. Several of these came from patients whose other samples grew Mycobacterium tuberculosis during the same admission, and others came from patients who had previously treated TB. Overall, the specificities of the in-house and Amplicor PCR assays in smear-negative patients were 86% and 93%, respectively. Conclusions: Molecular detection of slow-growing pathogens such as M. tuberculosis have the potential to improve clinical care through a dramatic reduction in the time required for detection and may provide substantial savings in the overall cost of care of a patient compared with conventional smear, culture, and speciation alone, despite the fact that conventional assays must still be performed for speciation of nontuberculous mycobacteria and for full assessment of antibiotic sensitivity.
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Barnes, John, and Greg Wilkinson. "Patterns of mental health care in a seaside lodging house." Psychiatric Bulletin 17, no. 2 (February 1993): 82–83. http://dx.doi.org/10.1192/pb.17.2.82.
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Much of the medical care of the long-term mentally ill falls to the general practitioner (Wilkinson et al, 1985) and, for example, a survey in Buckinghamshire showed that these patients consult their general practitioner (GP) twice as often as mental health services. Lodging house dwellers are known to show an increased prevalence of major mental illness and to suffer much secondary social handicap, presenting a challenge to helping services of all disciplines. For this reason we chose a lodging house in which to explore further the relationships between mental illness and residents' present contact with their GP, mental health services and other local sources of help.
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Parande, Malangori A., Namrata D. Mule, Sangita C. Shelke, Muralidhar P. Tambe, Rupali N. Baviskar, Ganesh R. Jagadale,, Minal B. Hatnapure, and Priyanka H. Salunke. "An outbreak investigation of dengue in medical students and health care workers in a tertiary care hospital, Pune." Indian Journal of Forensic and Community Medicine 8, no. 4 (December 15, 2021): 214–19. http://dx.doi.org/10.18231/j.ijfcm.2021.044.
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Dengue is fast emerging mosquito borne viral disease. There was sudden outbreak of dengue cases among Medical students and Health Care Workers in tertiary care hospital from September to November 2019. Therefore, outbreak investigation carried out and corrective actions taken to halt the outbreak. Study Objectives are to investigate outbreak of dengue cases in medical students and Health Care Workers and to take corrective actions to halt the outbreak.The outbreak investigations of Dengue cases was done as 28 cases were admitted which includes medical students and Health Care Workers in tertiary care hospital from September to November 2019. A thorough search for breeding sites of Aedes mosquito was done in premises of hospital, college and residential area. 5 teams were made consisting of Sanitary Inspector, interns, resident doctors and lecturer. House to house surveys were done for container index in Resident quarters and employees quarters. Health education on prevention of dengue was given to Medical students and Health Care Workers including interns, resident doctors, undergraduate students. Antilarval measures like abating, fogging and spraying of oildone.The mean age was 27.2 years, ranged for 14-68 years. Males 15(53.5%) and Females 13(46.4%). Out of 28,12(42.8%) Undergraduate students, 9(32.1%) Resident doctors and 7(25%) employees. 22(78.5%) NS-1positivecases and 16(57.1%) IgM dengue positive cases. The most common symptom found in this was fever (100%). Thrombocytopenia was most common abnormal laboratory finding which was present in 22(79%) patients out of 28 patients. Out of 22 patients having thrombocytopenia, platelet transfusion was done to 4 patients. Mean duration of stay in the hospital was 4 days.With the corrective measures taken, no new case of dengue was notified in November 2019 among Medical Students and Health Care Workers.
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Marx, M. S., D. Wolf, L. Pheng, V. Walker, A. Elises, R. C. Feldman, P. Werner, J. Cohen-Mansfield, S. Dubroff, and S. Lipson. "Eye Care in a Nursing Home." Journal of Visual Impairment & Blindness 85, no. 3 (March 1991): 105–7. http://dx.doi.org/10.1177/0145482x9108500305.
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This article describes an example of an in-house eye care clinic for elderly nursing home residents. The success of this clinic is due not to any one person, but to the combined efforts of a team: a clinic supervisor, a nursing assistant, a medical assistant, an ophthalmic technician, and an ophthalmologist. The implications of providing good and effective eye care to nursing home residents are discussed.
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Palupi, Tantri Dyah Whidi, Tri Wahyu Suprayogi, and Ismudiono Ismudiono. "Medical Treatment for Pyometra in Cat." Jurnal Medik Veteriner 5, no. 1 (April 22, 2022): 124–30. http://dx.doi.org/10.20473/jmv.vol5.iss1.2022.124-130.
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The Pyometra case is a case that is often found in Female Cat. This case report will discuss the handling of a case of pyometra in a 7-year-old mixed breed cat who is being treated at Harmoni Pet Care, Menanggal, Gayungan, Surabaya, Indonesia. Reports from the owner that these cats are still in good appetite but sanguino-purulent discharge from the vagina was found. In clinically diagnosed with a pyometra, the treatment used to treat pyometra case was ovariohysterectomy. Postoperative care was carried out by administering antibiotics (Clanexi; Amoxicillin-Clavulanic Acid, 1 cc/kg, IM) given twice a day for 14 days, with the first 3 days being treated in the Harmoni Pet Care inpatient room and the 4th day to the 14th day of care is done at the owner's house, local antiseptic dressing at the incision site is continued for up to 14 days until the sutures in the skin sutures were absorbed by the cat's body.
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Honigmann, Philipp, Neha Sharma, Ralf Schumacher, Jasmine Rueegg, Mathias Haefeli, and Florian Thieringer. "In-Hospital 3D Printed Scaphoid Prosthesis Using Medical-Grade Polyetheretherketone (PEEK) Biomaterial." BioMed Research International 2021 (January 11, 2021): 1–7. http://dx.doi.org/10.1155/2021/1301028.
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Recently, three-dimensional (3D) printing has become increasingly popular in the medical sector for the production of anatomical biomodels, surgical guides, and prosthetics. With the availability of low-cost desktop 3D printers and affordable materials, the in-house or point-of-care manufacturing of biomodels and Class II medical devices has gained considerable attention in personalized medicine. Another projected development in medical 3D printing for personalized treatment is the in-house production of patient-specific implants (PSIs) for partial and total bone replacements made of medical-grade material such as polyetheretherketone (PEEK). We present the first in-hospital 3D printed scaphoid prosthesis using medical-grade PEEK with fused filament fabrication (FFF) 3D printing technology.
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Engelke, Martha Keehner, Bonnie Perry Britton, Linda Burhans, and Sandy Hall. "Is there a doctor in the house? Integrating Medical Education and Home Health Care." Home Care Provider 3, no. 5 (October 1998): 260–65. http://dx.doi.org/10.1016/s1084-628x(98)90194-0.
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Hack, Nawaz, Umer Akbar, Erin H. Monari, Amanda Eilers, Amanda Thompson-Avila, Nelson H. Hwynn, Ashok Sriram, et al. "Person-Centered Care in the Home Setting for Parkinson’s Disease: Operation House Call Quality of Care Pilot Study." Parkinson's Disease 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/639494.
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Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson’s disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery.Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity.Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson’s disease was confirmed using standardized criteria, and the Unified Parkinson’s Disease Rating Scale was performed and best treatment practices were delivered.Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS).Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.
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Burdaev, Nikolay, Sanna Sboeva, Oksana Zaharova, Nikolay Chebyshev, and Svetlana Chebysheva. "A methodological approach to organizational evaluationofinpatient, medical social and pharmaceutical care institutions that assist seniors (on the example of the Moscow boarding house for labor veterans)." Bangladesh Journal of Medical Science 20, no. 4 (June 18, 2021): 809–16. http://dx.doi.org/10.3329/bjms.v20i4.54139.
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Objective: This study aims to develop methodological bases of medical social and pharmaceutical care for elderly with systemic diseases in inpatient institutions.
Materials and methods: The study was done by using system, comparative, logical and retrospective analyses, as well as through content analysis and with the help of the survey method. Based on the research findings, a methodological approach was developed.
Results and Discussion: This study examined the organizational structure and living environment of the Moscow boarding house for labor veterans and determined the distribution of diagnoses in the population of boarding house residents. The paper also provides information on gender and age differences in cardiovascular morbidity among older adults.
Conclusion: The paper presents patient satisfaction ratings with the quality of medical, social and pharmaceutical services provided in the examined boarding house against 6 criteria. The satisfaction survey results suggested high quality of care delivery.
Bangladesh Journal of Medical Science Vol.20(4) 2021 p.809-816
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Williams, Chris, and Simon Wilson. "Pre-registration house officers' psychiatric knowledge in practice." Psychiatric Bulletin 20, no. 7 (July 1996): 398–400. http://dx.doi.org/10.1192/pb.20.7.398.
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Psychiatric distress is commonly found in general hospital patients and is associated with a poorer outcome and increased complexity of care. It is important for non-psychiatric hospital doctors to possess skills of assessment and treatment of common psychiatric problems. This survey of all house officers in their first pre-registration posts in three large teaching hospitals found that Junior doctors rarely ask about or consider the presence of psychiatric problems in their patients. Where psychiatric problems are found, house officers often feel they lack the appropriate skills of assessment and management. This has important implications for medical school course content and emphasis.
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Alvarez-Uria, Gerardo, Praveen Kumar Naik, Manoranjan Midde, and Raghavakalyan Pakam. "Predictors of Delayed Entry into Medical Care of Children Diagnosed with HIV Infection: Data from an HIV Cohort Study in India." Scientific World Journal 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/737620.
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Data about the attrition before entry into care of children diagnosed with HIV in low- or middle-income countries are scarce. The aim of this study is to describe the attrition before engagement in HIV medical care in 523 children who were diagnosed with HIV from 2007 to 2012 in a cohort study in India. The cumulative incidence of children who entered into care was 87.2% at one year, but most children who did not enter into care within one year were lost to followup. The mortality before entry into care was low (1.3% at one year) and concentrated during the first three months after HIV diagnosis. Factors associated with delayed entry into care were being diagnosed after mother’s HIV diagnosis, belonging to scheduled castes, age <18 months, female gender, and living >90 minutes from the HIV centre. Children whose parents were alive and were living in a rented house were at a higher risk of delayed entry into care than those who were living in an owned house. The results of this study can be used to improve the linkage between HIV testing and HIV care of children diagnosed with HIV in India.
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Palacherla, Surekha, Bheemesh Naidu Mattam, Kodanda Ramu Burli, and Sachidananda Moorthy. "Assessment of knowledge on pharmacotherapeutics among undergraduate medical students in a South Indian medical college." International Journal of Basic & Clinical Pharmacology 9, no. 7 (June 26, 2020): 1119. http://dx.doi.org/10.18203/2319-2003.ijbcp20202952.
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Background: Pharmacotherapeutics knowledge is important for rational drug therapy. Assessment of knowledge on emergency and non-emergency medical conditions in medical students will be helpful to develop a methodological approach in building knowledge on patient care and in improving quality of medical education.Methods: It was a questionnaire based cross- sectional study conducted among undergraduate medical students in MIMS college after taking Institutional ethical committee permission. The students of final MBBS part-I and final MBBS part-II and house surgeons were given semi-structured questionnaires. It constitutes questions on awareness of pharmacotherapeutics of non-emergency (20) and emergency (8) medical conditions.Results: Received a total of 284 responses, of them 43.32%, 39.43% and 17.25% are from final MBBS part-I, final MBBS part-II and house surgeons respectively. 48.1% students agreed that undergraduate training sufficient to confidently give a safe prescription to the patient. The overall knowledge of the students in pharmacotherapeutics relating to certain non-emergency conditions is found to be 64.89% and relating to emergency conditions, it is 62.98%.Conclusions: Knowledge on emergency and non-emergency PT is moderate. Appropriate training programs are needed to improve this situation. Regular evaluative measures also help to overcome the present situation.
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Prodinger, C. M., M. Laimer, J. Bauer, and H. Hintner. "Epidermolysis bullosa House Austria as a role model for the care of a rare disease." Almanac of Clinical Medicine 47, no. 1 (February 26, 2019): 2–11. http://dx.doi.org/10.18786/2072-0505-2019-47-008.
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The evolution of the Epidermolysis bullosa (EB) House Austria in Salzburg has demonstrated from its beginning in 2005 in an exceptional way the establishment of an optimized health care for a hitherto neglected group of patients, suffering from a rare but devastating skin disease: Epidermolysis bullosa. Patients with this hereditary mechanobullous skin disease, characterized by a heterogenous clinical course, multisystemic manifestations and increased morbidity and mortality, find in the EB House Austria a multidisciplinary, medical and psychosocial, family-centered support, optimally customized to this condition and individualized to each patient. Its unique structure of four divisions (Outpatient Unit, Research Laboratory, Academy, Clinical Research and Study Center) has set the basis for the delivery of best medical practice and state-of-the-art care as well as the establishment/ performance of high quality and patient centered research and translational medicine. Initially the (ongoing) close collaboration with the powerful patient group and medical research charity “DEBRA Austria” that is dedicated to a multidimensional support of EB patients and their relatives living in Austria and neighboring countries, has enabled the construction of the EB House Austria. The acknowledgement of this institution as a successful model has been officially obtained in 2017 by its designation as a national Center of Expertise for Genodermatoses with special focus on EB and its inclusion into the European Reference Network (ERN) for Rare Skin Disorders in September 2018. Therefore, the history of the EB house is worth reviewing since it can be regarded as a role model for the care of other rare and multisystemic diseases.
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Jordan, Larry. "Federal Trauma Legislation: The 101st United States Congress." Prehospital and Disaster Medicine 5, no. 3 (September 1990): 255–59. http://dx.doi.org/10.1017/s1049023x00026923.
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The United States Congress presently is considering comprehensive legislation regarding emergency medical services (EMS) and trauma systems planning. This legislation amends the Public Health Service Act and, if enacted, would represent the federal government's first significant statutory mandate to exercise a leadership role in EMS since the federal EMS program was abolished in the early 1980s. On 14 November 1989, the House passed House Resolution (H.R.) 1602, Trauma Care Systems Planning and Development Act of 1989, authored by Representative Jim Bates. The Senate is considering similar legislation (S. 15) by Senator Alan Cranston, titled the Emergency Medical Services and Trauma Care Improvement Act of 1989. The Senate Bill is awaiting final action by the full Senate. If the Senate approves S. 15, a joint House and Senate conference committee will meet to present its own conference report to each of those bodies for consideration and passage.
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Dobanovacki, Dusanka, Milan Breberina, Bozica Vujosevic, Marija Pecanac, Nenad Zakula, and Velicko Trajkovic. "Reminiscence on the municipal out-of-hospital Maternity unit and the Motherhood Home in Novi Sad." Medical review 66, no. 1-2 (2013): 93–97. http://dx.doi.org/10.2298/mpns1302093d.
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Introduction. In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. Out-of-Hospital Maternity Unit. One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women?s health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. Motherhood Home. After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children?s health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. Epilogue. The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.
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Trowbridge, Robert L., Lisa Almeder, Marc Jacquet, and Kathleen M. Fairfield. "The Effect of Overnight In-House Attending Coverage on Perceptions of Care and Education on a General Medical Service." Journal of Graduate Medical Education 2, no. 1 (March 1, 2010): 53–56. http://dx.doi.org/10.4300/jgme-d-09-00056.1.
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Abstract Background An increased emphasis on patient safety has led to calls for closer supervision of medical trainees. It is unclear what effect an increased degree of faculty presence will have on educational and clinical outcomes. The aim of this study was to evaluate resident and attending attitudes and preferences regarding overnight attending supervision. Methods This study was a cross-sectional electronic survey of physicians. Participants were resident and faculty physicians recently on inpatient service rotations after implementation of an overnight attending coverage system. Results Of 58 total respondents, most faculty (91%) and resident (92%) physicians reported they were satisfied with the overall quality of care delivered and believed the quality of care delivered overnight improved with an in-house attending system (90% and 85%, respectively). Most resident physicians (82%) believed the educational experience improved with the system of increased attending availability. Nearly all faculty (95%) and resident (97%) physicians preferred the in-house attending system to the traditional system of attendings being available by pager. The implementation of such coverage resulted in increased cost to the hospital for compensating covering hospitalist physicians. Conclusion In-house attending coverage was acceptable to both residents and faculty, with perceived improvements in quality and educational experience.
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Hoffman, Leslie A., Frederick J. Tasota, Thomas G. Zullo, Carmella Scharfenberg, and Michael P. Donahoe. "Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit." American Journal of Critical Care 14, no. 2 (March 1, 2005): 121–30. http://dx.doi.org/10.4037/ajcc2005.14.2.121.
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• Background Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.• Objective To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.• Methods During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes.• Results Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02).• Conclusions In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.
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Afzal, Javeria, Muhammad Ahmed, Muhammad Ali, Nousheen Khan, Muhammad Jamil, and Asif Noor. "Awareness and Practice Regarding Cross Infection Control Among Dental House Officers in a Tertiary Care Setting." Pakistan Journal of Public Health 12, no. 2 (August 20, 2022): 60–63. http://dx.doi.org/10.32413/pjph.v12i2.964.
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Background: Dental care workers including dental assistant & doctors are at joint risk of receiving infection. Cross infection can be defined as “the spread of infection between staff members & patients in clinical setting.” Precautions should be adopted while treating or checking the patients. Methods: This cross-sectional study of 3 months duration was carried on dental house officers of Multan Medical and dental college Multan. 60 dental house officers willingly participated in our study. Universal sampling technique was utilized in order to collect the data. Informed consent was sign up from the partakers. Results: Out of sixty dental house officers, males were twenty seven while females were thirty three . 85% participants consider that dental clinics/hospitals are more predisposed to the infection/contamination than other medical fields. 73.3% partakers wash the hands regularly after providing the treatment to every patient. All the partakers reported that usage of PPE has a foremost part in the prevention of cross contamination. Majority of the partakers use gloves as well as facemask but goggles or protective eyewear, head caps & aprons were not in use by most of participants. Conclusion: Adequate awareness/knowledge but less satisfactory practice about infection control was reported. Knowledge acquired must also be transferred into everyday practice. Continuous infection control education through lectures/ tutorials or seminars must be organized. Cross-contamination control guidelines should also be established by dental colleges.
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Tanios, Maged A., Daniel Teres, Hyunsoon Park, Antonio Beltran, Arunpal Sehgal, and James D. Leo. "The Impact of Implementing an Intensivist Model With Nighttime In-Hospital Nocturnist and Effect on ICU Outcomes." Journal of Intensive Care Medicine 35, no. 5 (February 19, 2018): 461–67. http://dx.doi.org/10.1177/0885066618758246.
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Background: Various intensivist staffing models have been suggested, but the long-term sustainability and outcomes vary and may not be sustained. We examined the impact of implementing a high-intensity intensivist coverage model with a nighttime in-house nocturnist (non-intensivist) and its effect on intensive care unit (ICU) outcomes. Methods: We obtained historical control baseline data from 2007 to 2011 and compared the same data from 2011 to 2015. The Acute Physiological and Chronic Health Evaluation outcomes system was utilized to collect clinical, physiological, and outcome data on all adult patients in the medical ICU and to provide severity-adjusted outcome predictions. The model consists of a mandatory in-house daytime intensivist service that leads multidisciplinary rounds, and an in-house nighttime coverage is provided by nocturnist (nonintensivists) with current procedural skills in airways management, vascular access, and commitment to supervise house staff as needed. The intensivist continues to be available remotely at nighttime for house staff and consultation with the nocturnist. A backup intensivist is available for surge management. Results: First year yielded improved throughput (2428 patients/year to 2627 then 2724 at fifth year). Case mix stable at 53.7 versus 55.2. The ICU length of stay decreased from 4.7 days (predicted 4.25 days) to 3.8 days (4.15) in first year; second year: 3.63 days (4.29 days); third year: 3.24 days (4.37), fourth year: 3.34 days (4.45), and fifth year: 3.61 days (4.42). Intensive care unit <24 hours readmission remained at 1%; >24 hours increased from 4% to 6%. Low-risk monitoring admissions remained at an average 17% (benchmark 17.18%). Intensive care unit mortality improved with standardized mortality ration averaging at 0.84. Resident satisfaction surveys improved. Conclusions: Implementing an intensivist service with nighttime nocturnist staffing in a high-intensity large teaching hospital is feasible and improved ICU outcomes in a sustained manner that persisted after the initial implementation phase. The model resulted in reduced and sustained observed-to-predicted length of ICU stay.
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Hockaday, Sarah, Kate Krause, Catherine Sobieski, Jeffrey N. Li, Rachel Hurst, Benjamin Ryan, Michael Leader, et al. "Protocols for Personal Protective Equipment in a COVID-19 Medical Shelter." Disaster Medicine and Public Health Preparedness 14, no. 4 (July 14, 2020): 551–57. http://dx.doi.org/10.1017/dmp.2020.244.
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AbstractThe coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.
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Vellani, Shirin, Franziska Zuniga, Karen Spilsbury, Annica Backman, Nancy Kusmaul, Kezia Scales, Charlene H. Chu, et al. "Who’s in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic." Gerontology and Geriatric Medicine 8 (March 2022): 233372142210908. http://dx.doi.org/10.1177/23337214221090803.
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Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic. Five broad categories of staff working in LTC homes were as follows: (1) those responsible for personal and support care, (2) nursing care, (3) medical care, (4) rehabilitation and recreational care, and (5) others. There is limited availability of data related to measuring staff complement in the home and those with similar roles had different titles making it difficult to compare between countries. Nevertheless, the survey results highlight that some categories of staff were either absent or deemed non-essential during the pandemic. We require standardized high-quality workforce data to design better decision-making tools for staffing and planning, which are in line with the complex care needs of the residents and prevent precarious work conditions for staff.
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Dash, I., JE Bickley, and JD Morgan. "Training Foundation Year Doctors in the Operating Theatre: A Missed Opportunity?" Bulletin of the Royal College of Surgeons of England 95, no. 2 (February 1, 2013): 68–70. http://dx.doi.org/10.1308/147363513x13500508917693.
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Foundation trainees replaced the pre-registration house officers in August 2005 after Modernising Medical Careers was set up to 'drive up the quality of care for patients through reform and improvement in postgraduate medical education and training'. Doctors qualifying from UK medical schools entered into the foundation years, which consisted of two years of training designed to form a bridge between medical school and specialty training. All doctors wanting to apply for specialty training in the UK must complete their foundation programme or equivalent.
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Ney, Philip G., William W. K. Tam, and William L. Maurice. "Factors that Determine Medical Student Interest in Psychiatry." Australian & New Zealand Journal of Psychiatry 24, no. 1 (March 1990): 65–76. http://dx.doi.org/10.3109/00048679009062887.
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Our study of pre-medical and medical students attending the Universities of British Columbia, Hong Kong and Otago, together with house surgeons, general practitioners, surgeons and psychiatrists in New Zealand, demonstrated many agreements regarding both positive and negative factors affecting their interest in psychiatry. Positive factors included: interest in human behaviour, personal aptitude, and quality of patient care. Negative factors included: the stress of practising psychiatry, faculty attitude and the quality of the science. Differences were determined by age of the students and cultural and personal experiences. We concluded that if more students are to be interested in psychiatry then psychiatrists will need to show that they enjoy their work and give effective treatment.
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Raza Perwez, Mohammad, Naveed Ahmad, Muhammad Sajid Javaid, and Muhammad Ehsan ul Haq. "A Critical Analysis on Efficacy of Clinical Decision Support Systems in Health Care Domain." Advanced Materials Research 383-390 (November 2011): 4043–50. http://dx.doi.org/10.4028/www.scientific.net/amr.383-390.4043.
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Clinical Practice guidelines strongly relies on evidence based medical literature. In Health care domain decision support systems are playing a competent role in diagnosis and treatment from multiple diseases. Among different Hospitals all over the world the Information technology domain emphasis key roles in improvement of patient health care to great extent. The Concept of Data Mining (DM) and Decision Support systems (DSS) in medical domain provides an efficient mechanism to extract the multiple records of patient treatment diagnostics from previously stored records in Data base (DB) or Data Ware House (DWH) and compare these guidelines to perform strong analysis that results in efficient decision making. Along the previously mentioned techniques the era of Telemedicine has also being developed that results in generation of multiple techniques in diagnosis of multiple diseases and health improvement using Mobile Health care systems specially worth full for the rural areas where latest medical facilities are unavailable at the point of need. The required information in Database or in Data Ware House might be the historical data of patient or the health based summery of different patients in diverse stages. Now these days the emergence of distributed decision support systems in health care domain covers the health care treatment procedures in more comprehensive manner including surgical procedures and radiological treatment. In this paper we are going to analyze the multiple health care diagnosis procedures and treatment techniques using various decision support systems designed and implemented by various researchers all over the world and compare the effectiveness and efficiency of each decision support system in health care domain. Our research study is also helpful for physicians and health care practioners in analyzing multiple scenarios related to interesting pattern recognitions and intelligent decision making.
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Hotvedt, Ragnar, and Mads Gilbert. "Decentralized Teaching in Emergency Medicine in a Thinly Populated Area in Norway." Prehospital and Disaster Medicine 1, S1 (1985): 86–88. http://dx.doi.org/10.1017/s1049023x00043892.
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Norway has fairly well developed primary health care. It is developed around general practitioners who, in their local regions, are responsible for total health care, including emergency medical care. During the last few years, there has been an increasing buildup of resources in the hospitals in the area. Modern technical equipment, increasing knowledge and practical training among the house physicians have greatly improved standards of CPR and emergency health service inside hospitals. Unfortunately, there has not been a proportional build up of resources, knowledge and practical skills in the districts and rural areas. An increasing gap between the treatment offeredinsideandoutsidehospitals has developed.
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Gamondi, Claudia, Angèle Gayet-Ageron, Gian Domenico Borasio, Samia Hurst, Ralf J. Jox, and Bara Ricou. "Attitudes of university hospital staff towards in-house assisted suicide." PLOS ONE 17, no. 10 (October 27, 2022): e0274597. http://dx.doi.org/10.1371/journal.pone.0274597.
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Objective To investigate staff attitudes toward assisted suicide in the hospital setting in Switzerland. Design Cross-sectional study. Setting Two University Hospitals in French speaking regions of Switzerland. Participants 13’834 health care professionals, including all personnel caring for patients, were invited to participate. Main outcome measures and other variables Attitudes towards the participation of hospital health care professionals in assisted suicide were investigated with an online questionnaire. Results Among all invited professionals, 5’127 responded by filling in the survey at least partially (response rate 37.0%), and 3’683 completed the entire survey (26.6%). 73.0% of participants approved that this practice should be authorized in their hospital and saw more positive than negative effects. 57.6% would consider assisted suicide for themselves. Non-medical professionals were 1.28 to 5.25 times more likely to approve assisted suicide than physicians (p<0.001). 70.7% of respondents indicated that each professional should have the choice of whether to assist in suicide. Conclusions This multiprofessional survey sheds light on hospital staff perceptions of assisted suicide happening within hospital walls, which may inform the development of rules considering their wishes but also their reluctances. Further research using a mixed-methods approach could help reach an in-depth understanding of staff’s attitudes and considerations towards assisted suicide practices.
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Nadash, Pamela. "THE IMPLICATIONS OF THE BUILD BACK BETTER BILL FOR AGING HEALTH POLICY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 36. http://dx.doi.org/10.1093/geroni/igac059.137.
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Abstract The Build Back Better Bill passed by the U.S. House of Representatives (HR 5376) included ambitious healthcare and long-term care provisions that would have greatly benefited older people, although the Bill itself represents a considerable scaling down of the Biden Administration’s original proposals. This presentation reviews key provisions of the Bill that would impact older people: paid family and medical leave, efforts to strengthen the direct care workforce, and investments in home and community-based services. In addition, the Bill expanded Medicare coverage to include hearing, dental, and vision coverage, and expanded tax credits for the medical expenses associated with family caregiving. Although the House bill failed to make it through the Senate intact, some of the provisions are likely to have staying power. This presentation reviews the Bill’s progress and assesses implications for future efforts to expand access to these benefits.
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LEYAKATH ALI, Dr M., Dr R. SUNDAR, and Mrs C. USHARANI. "HEALTH INSURANCE AWARENESS AMONG THE CUSTOMERS - A STUDY IN UDUMALPET, TIRUPPUR DISTRICT." YMER Digital 20, no. 10 (October 28, 2021): 207–17. http://dx.doi.org/10.37896/ymer20.10/24.
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Health care has become very much concern to each individual and the family too. Health care in the Easter years has been a house hold, where consumption of food itself was thought of as a health care, however, handy medicines were available in the home to take care of simple and manageable illness, for severe sickness people used to go the doctors for treatment, as of now food habit among the people is changing, most prefer to take fast foods, packed foods, etc, which are harmful to the health of the people, this often leads to sickness which are very much costly some sickness needs hospitalization, some with intensive care, etc. Mushroom growth of medical clinics, hospitals and dispensaries is being seen in today's' scenario. Growing demand for modern medical care, brought on by a rapidly, expanding population, rising literacy levels, and technological advancement lead to high expectation from the health services. This has shifted demand in favour of health care
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Holmes, Cynthia H. "Poisonous Plants: Perils in Nature." Journal of Pharmacy Practice 13, no. 2 (April 2000): 125–29. http://dx.doi.org/10.1177/089719000001300203.
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Poisonous plants are of great concern to any parent or health care practitioner. Household and landscape plants account for 7.1 % of all poisonous exposures in children. Many parents and health care professionals are aware of other potential poisons in the house; however, many times plants are overlooked as a potential poison. Though most plants are associated with only minor symptoms from dermal contact or ingestion, there are some that are associated with significant toxic effects that can be fatal. Poisonous plants are classified as anticholinergic, cardiac glycoside, cyanogenic, central nervous system stimulant/hallucinogens and severe gastrointestinal irritants. Many times these toxic plants produce a multitude of symptoms called a toxidrome. It is important for health care professionals to recognize these toxidromes and be knowledgeable about the proper treatment modalities.
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Van Kessel, Karla. "Gertrude Lamb’s Pioneering Concept of the Clinical Medical Librarian." Evidence Based Library and Information Practice 7, no. 1 (March 13, 2012): 125. http://dx.doi.org/10.18438/b8ns5g.
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Abstract
Objective – To determine if “the medical librarian with special skills and training in tested methods for approaching medical literature serve a valuable interface between the professional who is taking care of patients and the knowledge explosion in medicine wherein lies the key to better patient care” (p. 78).
Design – Qualitative study involving the participant librarians keeping a reflective journal of all interactions with the subjects involved in the first 6 months of the study (September 1974 – March 1975).
Setting – Hartford Hospital, Connecticut.
Subjects – Teaching physicians, house staff, and medical students at Hartford Hospital.
Methods – This pilot project, funded by a two-year grant from the U.S. Public Health service and the National Library of Medicine, placed three medical librarians (two full-time and one part-time) on rounds with pediatrics, medicine, and surgery teams.
The librarians kept diaries to record “critical incidents” (p. 86), including the “acceptance of the program, its impact on patient care, its potential for changing the information seeking behavior of health professionals, and its usefulness for developing a core collection of clinical readings” (p. 86).
Main Results – Despite a few physicians’ initial apprehension, each of the three clinical librarians recorded indications of acceptance by clinical staff, including a dramatic increase in literature search requests; increased phone calls, drop-ins, pages, and requests for research assistance; and gestures of acceptance from house staff and students.
More broadly, the literature searches in Lamb’s report identifies direct patient care (including to “resolve a debate” (p. 84)), medical teaching/education, and searching techniques for clinicians. It is implied that these interactions resulted in a higher profile of the resources and services offered through the library; as one patron queried, “Would you show me how to find articles and where everything is in the library sometime?” (p. 83).
Conclusions – The authors state that while their conclusions are only preliminary and no firm conclusions can be drawn, there are four observations of note:
1. The clinical librarian can be accepted as part of a patient care teaching team by contributing to educational activities.
2. The clinical librarian provides quick and useful information to assist in the decisions and management of patient problems.
3. There is an opportunity to strengthen and modify the information seeking behavior of the health professional.
4. As patient care questions recur, there is a need for a “patient care information system” which can be initiated and supported through the provision of photocopied articles (p. 86).
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Mace, Sharon, and Connie Doyle. "Caring for the Vulnerable Geriatric Individual in a Disaster." Prehospital and Disaster Medicine 34, s1 (May 2019): s107. http://dx.doi.org/10.1017/s1049023x19002231.
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Introduction:The elderly have the highest rates of morbidity/mortality in a disaster and are therefore the most vulnerable. 50% of deaths in Hurricane Katrina were ≥75 years old. In the California wildfires, most deaths were people in their 70s and 80s living in areas with unreliable communication services (without cell phone service, etc.), and were uninformed of the disaster or unable and/or unwilling to evacuate. Issues include social isolation and limited technology skills (may not receive messages).Methods:A review of the literature and after action reports from multiple disasters.Results:Augmented services are needed for persons with decreased mobility (impaired access to transportation and shelters); impaired senses; dependence on devices/technology, comorbidities requiring medications/equipment/oxygen, special feedings, sanitary/hygiene needs increased susceptibility to environmental extremes (heat, cold), inability to do ADLs (need for caregivers), increased susceptibility and increased morbidity/mortality with infections, illnesses, trauma; exacerbation of underlying conditions/illnesses when in crowded transportation vehicles and shelters. Additional stress may precipitate or exacerbate coping skills especially in those with dementia, delirium, or mental health illnesses.Discussion:Recommendations include the following: 1.Communications: messages in various forms: closed captioning, TTY deaf phones, use of family, friends, neighbors, officials for notification in addition to mass communication notices, house-to-house notification.2.Medical: Medical/Special Needs Shelters to provide medical care (dialysis, etc.), cache of common medications (diabetic and BP medications) and devices (BP monitoring, glucometers), oxygen, wound care supplies, potable and non-potable water, special diets/formulas, feeding tubes, catheter care, diapers and other hygiene supplies.3.Independence: Health care professionals to assist with medical and psychiatric needs. Caregivers to assist with ADLs.4. Supervision: Those with dementia, delirium, mental health conditions may need supervision.5. Transportation: Need for ambulances, wheelchair vans, specially equipped buses/vans in addition to “usual” school buses/vans with access to water, food, and sanitation if traveling long distances.
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Denney, William, Laura Behlen, and Jessie Harvey. "IMPACT OF A MEDICAL ICU IN-HOUSE NIGHT FELLOW ON RESIDENT EDUCATION, PROCEDURAL SUPERVISION, AND WELLNESS." Chest 156, no. 4 (October 2019): A1025. http://dx.doi.org/10.1016/j.chest.2019.08.947.
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Majette, Gwendolyn Roberts. "From Concierge Medicine to Patient-Centered Medical Homes: International Lessons & the Search for a Better Way to Deliver Primary Health Care in the U.S." American Journal of Law & Medicine 35, no. 4 (December 2009): 585–619. http://dx.doi.org/10.1177/009885880903500404.
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Primary care is crucial to the United States health care system. It is essential to the provision of high quality care; including the ability to reach health outcomes, ensure patient satisfaction, and facilitate efficient resource use. Primary care also places strong “emphasis on health promotion, disease prevention, and care of the chronically ill.”Physicians have introduced two business models in their attempts to improve the delivery of primary care: Concierge Medicine (“CM”) and the Patient Centered Medical Home (“PCMH”). Both models provide personalized, comprehensive preventive care services.CM is a private medical practice in which the physician charges patients an annual fee to be a patient in the practice. In exchange, the physician limits the number of patients in order to offer more personalized services and amenities such as: direct access through email or cell phone, same day or next day appointments, longer, more personalized appointments, house calls, and physician accompaniment to a specialist.
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O'Connor, P. M., K. E. Dowey, P. M. Bell, S. T. Irwin, and C. H. Dearden. "Unnecessary delays in accident and emergency departments: do medical and surgical senior house officers need to vet admissions?" Emergency Medicine Journal 12, no. 4 (December 1, 1995): 251–54. http://dx.doi.org/10.1136/emj.12.4.251.
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Жидченко, Александр Владимирович. "MATERNITY HOUSE IN THE SOVIET CITY OF THE MIDDLE OF THE XX century: MEDICAL, SOCIAL AND PSYCHOLOGI-CAL AND MATERIAL-HOUSE ASPECT." Тверского государственного университета. Серия: История, no. 3(55) (December 25, 2020): 65–77. http://dx.doi.org/10.26456/vthistory/2020.3.065.
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Статья посвящена анализу роли родильного дома в жизни советской городской жительницы в 1950-1960-е гг. сквозь призму медицинского, социально-психологического и материально-бытового аспекта. В данный период происходит формирование нового образа родильного дома, связанного с представлениями о квалифицированной медицинской помощи, безопасностью родов, а также соответствующими церемониями и традициями при рождении ребёнка. Однако декларируемый официальной советской пропагандой образ родильного дома и реальное положение дел в городских роддомах не всегда соответствовали друг другу. В ходе соотнесения двух этих образов был выявлен ряд противоречий, которые формировали реальный облик и реальное место родильного дома в советском городе в 1950-1960-е гг. The article is devoted to the analysis of the role played by a maternity home in the life of a Soviet urban resident in the 1950s-1960s. through the prism of medical, sociopsychological and material-everyday aspects. During this period, a new image of the maternity hospital is being formed, related to the notions of qualified medical care, the safety of childbirth, as well as the corresponding ceremonies and traditions at the time of the birth of the child. However, the image of the maternity hospital declared by the official Soviet propaganda and the real state of affairs in the city maternity homes did not always correspond to each other. During the correlation of these two images, a number of contradictions were identified that formed the real appearance and the real place of the maternity hospital in the Soviet city in the 1950s-1960s.
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Shaikh, Zulfiqar Ali, Noshaba Noor, Aisha Farooq, Maryam Khaleel, Darakhshan Naqvi, Usama Ahmed, Huzefa Ahmed, et al. "ASSESSING THE RISK FACTORS OF WORK-RELATED STRESS AMONG HOUSE OFFICERS OF TERTIARY CARE HOSPITALS, KARACHI." Pakistan Journal of Public Health 8, no. 2 (August 5, 2018): 117–22. http://dx.doi.org/10.32413/pjph.v8i2.107.
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Background: House Officers report significant levels of work-related stress that demands to be immediately addressed as it adversely affects their ability to function their best as doctors. This study aimed to assess the risk factors of psychological distress among the currently working house officers (2016-2017). Objectives: To assess the various risk factors of work-related stress amongst the house officers working in tertiary care hospitals, Karachi Methods: A cross sectional study was carried out in Civil Hospital, Jinnah Postgraduate Medical Centre and Abbasi Shaheed Hospital, Karachi during October 2016 and March 2017. A total of 384 house officers were approached for the study as per the sample size calculated using the Open-epi software. The questionnaire comprised of demographic data, 10-items perceived stress scale, and 12-items list of potential stressors. The severity of each stressor was measured using a five-point Likert scale (1-5) ranging from always (1) to never (5). Results: A total of 384 house officers were approached out of whom 315 (82%) participated. Among them, 115 (36.50%) were found to be under stress of whom 24 (20.8%) were males and 91(79.2%) were females. Significant difference for stressors by gender was found, these included their job having an effect on their health, change in eating habits and lack of paramedical staff cooperation (P < 0.05). Factors like increased hesitancy to take on tasks and increased tendency to make errors were found to have an impact on clinical performance (P value <0.05). Conclusion: There is high level of perceived stress in house officers of tertiary care hospitals, Karachi. Therefore, adequate steps are needed for stress management which should be dealt in terms of preventive rather than curative strategy.
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Arif, Muhammad-Maaz, Abdul Qadir, Sajid Rashid Ahmad, Mujtaba Baqir, and Muhammad Irfan. "Occupational Stress among Medical and Paramedical Staff in Tertiary Care Hospitals Based on Observational Study." Pakistan Journal of Public Health 10, no. 4 (March 29, 2021): 231–41. http://dx.doi.org/10.32413/pjph.v10i4.623.
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Background: Occupational stress is a common concern among employees, particularly those working in tertiary care hospitals. In Pakistan, both medical and paramedical staffs face many stressors because of their high job demand, dealing with multiple patients, excessive duty hours, and strict rules and regulations. The objective of the study was to measure occupational stress among the tertiary care hospital employees of the Lahore District using different demographic and workplace determinants. Methods: It was a cross-sectional study. A total of 138 hospital employees recorded their responses, which included 71 medical staff/doctors and 67 paramedical staff members. Primary data was obtained through a detailed structured questionnaire based on the Likert scale with the stress level index ranging from 1-5. Results: In terms of the six staff designations, stress index from top to bottom was observed in house officers/ internees (3.47), medical officers/ postgraduate trainees (3.04), technicians (2.74), consultants/ specialists (2.73), emergency/ ward assistants (2.61) and nurses (2.46). Among all the employees, the most significant factors leading to stress bottom-down were justice/ fairness (3.30), tasks and roles (3.14), management (3.03), environment/ working conditions (3.01), decision-making autonomy (2.84), work schedule (2.62) and profession/ job entitlement (1.63). Analysis of demographic characteristics showed that males (2.99) faced greater stress than females (2.64) and people of young age group (? 30 years) showed the highest stress value (3.01) than other age groups. It was observed that moderately experienced (5-10 years) employees were more prone to occupational stress (3.03) than other groups. Furthermore, the employees of public hospitals (3.13) bear more stress than those of private hospitals (2.67). On the basis of locality, the locals showed slightly higher stress values (2.89) as compared to non-locals (2.77). Conclusion: The current study showed that occupational stress is a prevalent problem in hospitals, particularly among house officers and postgraduate residents. Several useful steps can be undertaken to improve the health and safety of hospital employees like alleviating duty hours, working in shifts, focusing on a single task, and motivating the employees in decision-making.
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Hussain, Erfan, Ali Mojaverian, Mary Nelson, Mitchel C. Jacobs, Dana Lustbader, Brooks Micheline, Adel F. Hanna, and Elizabeth Cohn. "THE EFFECT OF A 24-HOUR IN-HOUSE INTENSIVIST MODEL ON THE PRIMARY CARDIAC ARREST RATE IN A MEDICAL INTENSIVE CARE UNIT (MICU)." Critical Care Medicine 30, Supplement (December 2002): A74. http://dx.doi.org/10.1097/00003246-200212001-00257.
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Atkinson, J., Lorna Barton, Andrew Harrison, and Nick Roper. "An Effective System to Measure and Report Quality Indicators in Acute Medical Units." Acute Medicine Journal 11, no. 4 (October 1, 2012): 210–15. http://dx.doi.org/10.52964/amja.0577.
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The Society for Acute Medicine has developed a number of clinical quality indicators by which all UK Acute Medicine Units can bench mark their activity. These will help to ensure high quality care for patients, inform the continuing development of acute medical services and demonstrate the positive impact of this new speciality. Prospective collection of these data may be a challenge for many busy units. This paper describes a local solution developed in house in a North East hospital. It demonstrates how the data collected can be analysed to assess the effect of changes in consultant presence on the unit and also time taken for patients to be seen by a doctor. The limitations of the system and potential for future development are considered.
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Heineman, Herbert S., and Valerie S. Watt. "All-inclusive Concurrent Antibiotic Usage Review: A Way to Reduce Misuse Without Formal Controls." Infection Control 7, no. 3 (March 1986): 168–71. http://dx.doi.org/10.1017/s0195941700064018.
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AbstractDuring an 11-week period, all antibiotic usage on a 113-bed medical teaching service was reviewed concurrently in weekly sessions between house staff and a review team. Recommendations for change, based on accepted criteria, were communicated by the house officer to the attending physician. In one-half of the patients no change was suggested; in one-third, a recommended change was made; and in only one-sixth was a recommendation not followed. Cost savings were conservatively estimated to approach $10,000 in this pilot study; this extrapolates to almost $300,000 per year for the 714-bed medical center, or more than 18% of the antibiotic expenditures.This program achieves its objective in a nonthreatening, noncontrolling manner, provides continuing education, and contributes to improved patient care.
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Croisant, Sharon, Krista Bohn, and John Prochaska. "4309 Ascertaining the Medical Needs of Galveston County." Journal of Clinical and Translational Science 4, s1 (June 2020): 79. http://dx.doi.org/10.1017/cts.2020.255.
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OBJECTIVES/GOALS: Data were collected or abstracted from a wide variety of sources related to health and health care needs to determine the current health status of the Galveston community including: DemographicsSocial Determinants of HealthHealth Care Access and Insurance StatusPoverty and Socio-Economic Indicators Impacting HealthHealth BehaviorsChronic DiseaseCommunicable DiseaseBirth OutcomesMortalityCancerData on Services Provided at UTMBData on Services Provided through the Galveston County Health DistrictData on Services Provided through the St. Vincent’s House Clinics, student-led clinics operated at a local non-profit organizationPrevious Galveston County Community Health Needs AssessmentIdentifying Gaps in ServicesPrevention Quality Indicator DataMETHODS/STUDY POPULATION: In addition to collection and analysis of secondary data, we also interviewed key stakeholders to solicit their input and recommendations. We met with leadership from St. Vincent’s House regarding current services provided, perceived issues and concerns, and needs for improvements. We met with leaders from UTMB’s academic enterprise to discuss the operation of our current student-led clinics as well as ways in which clinical practice experiences might be expanded and included more formally in the student curricula should the clinical capacity of St. Vincent’s House also be significantly expanded. This would increase the number of services that could be offered at St. Vincent’s and greatly increase the capacity for enrolling patients without relying on faculty volunteers to staff the clinics. We also met with UTMB leaders in a position to provide insight to issues that bridge the UTMB practice arena and public health and with Community Health leaders from the Galveston County Health District and Teen Health Clinics. Information Services leadership and Institute for Translational Science informatics faculty and staff were instrumental in determining what data could be abstracted from the Electronic Medical Record (without patient identifiers) to determine the specific need for services at St. Vincent’s. RESULTS/ANTICIPATED RESULTS: The City of Galveston has a population just under 50,000. Since 2010, the proportion of elderly has increased, and the proportion of families with younger children has decreased. Poverty is high at 22.3% for all people, and especially high for children at 32.1%. Poverty disproportionately affects racial and ethnic minorities, with 36.5% of the Black population living below the poverty level, compared to 25.5% Hispanic, 30.5% Asian, and 14.7% White. Home ownership is decreasing, and median rent costs have sharply increased. The percentage without health insurance is considerable, driven by educational attainment, age, and race. In 2017, >40% of renters spent more than 35% of their income on housing. Upwards of 2,650 reported not having access to a vehicle for transportation. While residents of Galveston County as a whole are less impoverished, those that are impoverished share marked similarities. Lower educational attainment, in particular failure to complete high school or obtain a college degree, are correlated with race. Lower educational attainment then is highly predictive of poverty and low income. The income inequality ratio, i.e., the greater division between the top and bottom ends of the income spectrum in Galveston County is higher than in Texas or the nation and has increased every year but one since 2010. Issues of concern for Galveston County include obesity, Type II diabetes, and disability. These are exacerbated by built and social environment issues such as food insecurity, limited access to healthy foods, and food deserts in some neighborhoods. Pre-term birth rates are higher in Galveston than in the state or nation, and approximately 40% of women do not receive prenatal care until the 2nd or 3rd trimester or receive no prenatal care at all. 8.4% of births are low-birth weight. Marked disparities by race and ethnicity exist for each of these indicators. Age-adjusted death rates for all-cause mortality are higher in Galveston County than they are in Texas or the United States. Perhaps of most concern are the rates of death from septicemia, which are nearly triple that of the U.S. and nearly double that of the state, and cancer. Cancer incidence is not particularly remarkable, however, cancer age-adjusted mortality rates for many specific cancers well exceed state rates. DISCUSSION/SIGNIFICANCE OF IMPACT: With a clearer picture of the medical and other needs impacting health or health care access for our community, all stakeholders and experts can provide more detailed recommendations about prioritizing care and especially, preventive care—much of which could conceivably be provided in St. Vincent’s House clinics. Opportunities exist for enhanced practice and education opportunities for UTMB students from all schools. Preventive Care and Population Health practices can be brought to bear in novel practice settings that could serve as models for provision of integrated services. Social and other services provided by non-profit organizations can be coordinated and streamlined. It is our hope that the considerable data presented herein will enable stakeholders to begin to prioritize issues and to make some evidence-based decisions about the next steps in this process. Throughout the interview and data collection process, all stakeholders have expressed both enthusiasm and hope at the prospect of re-visioning how they can contribute to a process that will improve how we as a community care for our most vulnerable members. CONFLICT OF INTEREST DESCRIPTION: The authors have no conflicts of interest to disclose.
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Sultana, Rifat, Dewan Shahida Banu, Mahmuda Khatun, Fatima Dolon, Mahmuda Nahar, and Nasrin Sultana. "Socio-demographic Factors Associated with Emergency Caesarean Section Cases admitted at Tertiary Care Hospital in Dhaka City." Journal of Current and Advance Medical Research 4, no. 1 (April 5, 2018): 23–26. http://dx.doi.org/10.3329/jcamr.v4i1.36171.
Full textAbstract:
Background: Socio-demographic factors are related with the need of emergency obstetric care.Objectives: The purpose of the present study was to see the socio-demographic characteristics of emergency caesarean section.Methodology: This cross-sectional of study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College, Dhaka from the duration July 2006 to December 2006 for a period of six (6) months. The pregnant women underwent emergency caesarean section admitted at Dhaka Medical College Hospital during the mentioned period of the study were my study population. The cases were selected from the patients who got admitted at obstetrics ward of DMCH with an indication of emergency caesarean section with stable general condition at that moment. Every 10th patient was selected for the study. Data has been collected after taking written consent from the patients as per consent form. Then a thorough history, clinical examination was done and information were collected. Intraoperative complications such as haemorrhage, cardiac arrest were noted.Result: The study was performed on 100 cases of which 35(35.0%) emergency caesarean section cases belonged to the age group of 20 to 24 years and 56.0% were from lower socio economic class. Among them 42.0% of the cases of emergency caesarean section had education SSC and above level; furthermore 12.0% were illiterate. In addition 92.0% cases were house wife.Conclusion: In conclusion young house wives from lower socio economic status are mostly underwent emergency caesarean section.Journal of Current and Advance Medical Research 2017;4(1):23-26
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Leo, MD, FCCP, James D., Desiree Thomas, RN, MSN, CCRN, and Ginger Alhadeff, BA, RN, MA. "A unique hospital physician disaster response system for a nonemployed medical staff." American Journal of Disaster Medicine 4, no. 2 (March 1, 2009): 95–100. http://dx.doi.org/10.5055/ajdm.2009.0014.
Full textAbstract:
Private hospitals with nonemployed, volunteer medical staffs face a special challenge in meeting the patient-care needs posed by a mass casualty incident (MCI). Although most disaster response systems focus on emergency department and trauma management, such systems often do not provide for the need to triage existing inpatients to create room for incoming casualties, for continuity of physician care for those patients, as well as for MCI victims in case of major disaster. Such systems must also provide a mechanism for ethical and appropriate rationing of limited resources during a MCI. Community hospitals without 24/7 in-house physicians must provide a mechanism for physician care for patients in situations in which access to the hospital may be limited by the disaster (eg, major earthquake or flood). This article describes a system established at Long Beach Memorial Medical Center, a 740-bed not-for-profit hospital with a volunteer medical staff, to ensure continuity of physician care in a major disaster. To our knowledge, this is the first published report of such a system.