Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals

BackgroundIncreasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan.MethodsIn the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin.ResultsA total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P < 0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7 g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals.ConclusionBlood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required.     

Assessment of costs to donor hospitals for organ transplantation

In 1987, die Department of Health in the UK set up a working party to identify reasons contributing to a shortfall in donor organs. One recommendation was reimbursement to the District Health Authorities for costs incurred in providing the donor organs. The figure chosen was not to be seen as an incentive to donate organs, merely as an appropriate compensation for the costs incurred. There would be no direct payment to doctors, trustees or relatives of the donor. With the development of the competitive health care environment in the United Kingdom, the reimbursement of donating hospital costs is being considered with these data.     

Pressure ulcer prevalence across Welsh orthopaedic units and community hospitals: surveys based on the European Pressure Ulcer Advisory Panel minimum data set

The survey used the European Pressure Ulcer Advisory Panel (EPUAP) methodology for the collection of pressure ulcer prevalence data. The orthopaedic survey was conducted across all National Health Service Trusts in Wales between 2 and 6 July 2007 while the community hospital survey covering 25% of all community hospital beds was conducted between 21 April 2008 and 2 May 2008. Data were gathered upon 1196 patients (581, 48·6% within orthopaedic units with 615 located in community hospitals). Of these patients, 81 (13·9%) and 162 (26·7%) had pressure ulcers in orthopaedic and community hospitals, respectively. Where patients presented with multiple pressure ulcers, the most severe pressure ulcer was recorded. Across both surveys, most pressure ulcers were reported to be either category I or II with 91 category I wounds (33 in orthopaedic units and 58 in community hospitals). Severe (categories III and IV) pressure ulcers affected 78 patients (19 in orthopaedic units and 59 in community hospitals). Adoption of the EPUAP pressure ulcer prevalence methods can help achieve consistent data upon pressure ulcer prevalence in different health care organisations and specialities. The adoption of a consistent data collection capture methodology is a clear prerequisite for the compilation of meaningful pressure ulcer prevalence data sets at a national level.     

Standards of surgery beyond metropolitan centers: a fresh look at perioperative quality measures in small-town America

Background

Surgical quality measures have room for improvement in both large- and small-town hospitals.

Methods

We sought concurrence of surgical specialists (general, orthopedic, gynecologic) to study accepted quality and safety parameters using a surgical time-out-based platform.

Results

Surgeons and hospitalists participated promptly and actively and recorded enhanced performance measures compared with prior work and within the period of study. Practice patterns varied, and interchange among participating hospitals was helpful.

Conclusions

Smaller institutions are more nimble than larger ones and developed interchangeable ideas for improvement. Surgical process measures improved such that all 4 hospitals are concerned about and committed to maintaining the gains.     

湖北省一级医院等级护理实际成本测算与分析

目的 了解湖北省乡镇卫生院(一级医院)等级护理实际成本,为有关部门改革等级护理收费标准提供参考.方法 自行设计湖北省一级医院等级护理实际成本调查表,对来自湖北省816所一级医院的护理管理人员进行问卷调查.结果 816所一级医院等级护理实际成本测算,一级护理(79.82±33.68)元／d,是现行收费标准的15.96倍;二级护理(48.10±24.19)元／d,是现行收费标准的24.05倍;三级护理(21.56±17.69)元/d,是现行收费标准的21.56倍.结论 湖北省一级医院等级护理价格标准与价值严重偏离,各等级护理实际成本显著高于收费标准.现行等级护理收费标准不合理,有待改革.     

Changes in county hospitals during Sheldon's tenure

Dramatic changes took place in county hospitals during Dr. Sheldon's tenure, 1964 to 1985. The primary impact came from Medicaid and Medicare legislation in 1965. The secondary impact came as the result of the drug culture entering American cities.     

两孔法腹腔镜阑尾切除术在基层医院的临床应用

目的:探讨基层医院开展两孔法腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的可行性、优越性及疗效。方法:将临床确诊的阑尾炎患者分为两孔法LA组和传统开腹阑尾切除术(open appendectomy,OA)组,各56例,对比分析两组的临床资料。结果:两组手术时间、治疗费用差异无统计学意义,但LA组患者术后疼痛程度、肛门排气时间、进食时间、下床活动时间、住院时间、切口感染及脂肪液化等方面与OA组相比差异有统计学意义(P<0.05,P<0.01)。结论:两孔法LA是治疗阑尾炎的新术式,安全、经济、可行且更微创,美容效果好,操作简单,适于在基层医院开展。     

基层医院腹腔镜胃肠肿瘤手术应用分析

目的：通过腹腔镜技术在我院胃肠肿瘤手术中的大量应用,评价其安全性、疗效性、优越性及经济性,以探究其推广应用价值。方法回顾性分析我院2009年12月－2013年12月263例使用腹腔镜技术诊治胃肠肿瘤患者的临床资料。结果263例手术中成功242例。术中平均失血量100．5 ml,平均手术时间160．8 min,术后平均离床活动时间26．4 h,术后平均52．4 h 胃肠功能恢复,术中、术后未出现严重并发症,疗效满意。结论腹腔镜胃肠肿瘤手术在基层医院安全可行、疗效确切,且具有创伤小、出血少、疼痛轻、恢复快等优势,经济学评价良好,值得在基层医院推广开展,以提升广大患者的生活质量。     

Getting under the hood of the volume-outcome relationship for radical cystectomy

PURPOSE: Hospital and surgeon volumes independently explain variations in outcomes for a host of surgical procedures. However, the mediators of the volume effect remain unclear. We assessed whether differences among hospitals could explain some or all of the volume effect on short-term outcomes after cystectomy for bladder cancer. MATERIALS AND METHODS: Using the Nationwide Inpatient Sample a 20% sampling of hospital discharges in the United States and the American Hospital Association file we applied International Classification of Diseased, 9th revision, clinical modification procedure codes to identify 1,847 patients who underwent cystectomy for bladder cancer in 2003. Multivariable mixed models were fit to quantify the differences in measures of hospital structure (capacity, staffing and health services) by hospital volume. Separate models were fit to determine the impact of accounting for these differences on the volume-outcome relationship. RESULTS: There were substantial differences in hospital structure according to radical cystectomy volume, including those characterizing capacity, staffing levels and the breadth of available health services. For example, 40.7% of low and 87.8% of high volume hospitals for radical cystectomy offered open heart surgery (OR 10.4, 95% CI 1.3-85.3). After adjusting for case mix patients treated at low volume centers were 3.2 times (95% CI 0.8-13.4) more likely to die postoperatively. Accounting for differences in hospital structure attenuated the volume effect by 59% (OR 1.9, 95% CI 0.4-8.6). CONCLUSIONS: Measurable differences in the availability and breadth of consultative, diagnostic and ancillary services may at least partially explain the association between procedure volume and short-term cystectomy outcomes.     

基层医院人力资源现状及对策研究

近年来，随着我国经济水平的发展，医疗技术也逐渐进步。目前，医疗正面临着改革和创新的 新阶段，人力资源管理对于提高医院竞争力、促进医院医疗改革进程具有重要意义。在当前的新时代背景 下，传统的医院人力资源管理模式已无法适应新时代的医院医疗发展需求，进一步提高基层医院人力资管 理水平是大势所需，有利于强化基层医院的卫生服务职能，提升基层医院医疗服务质量。因此，本文通过 对基层医院人力资源现状进行分析，提出一些解决对策，以期推动医疗整体水平的发展。     

High-Volume versus Low-Volume for Esophageal Resections for Cancer: The Essential Role of Case-Mix Adjustments based on Clinical Data

BACKGROUND: Most studies addressing the volume-outcome relationship in complex surgical procedures use hospital mortality as the sole outcome measure and are rarely based on detailed clinical data. The lack of reliable information about comorbidities and tumor stages makes the conclusions of these studies debatable. The purpose of this study was to compare outcomes for esophageal resections for cancer in low- versus high-volume hospitals, using an extensive set of variables concerning case-mix and outcome measures, including long-term survival. METHODS: Clinical data, from 903 esophageal resections performed between January 1990 and December 1999, were retrieved from the original patients' files. Three hundred and forty-two patients were operated on in 11 low-volume hospitals (<7 resections/year) and 561 in a single high-volume center. RESULTS: Mortality and morbidity rates were significantly lower in the high-volume center, which had an in-hospital mortality of 5 vs 13% (P < .001). On multivariate analysis, hospital volume, but also the presence of comorbidity proved to be strong prognostic factors predicting in-hospital mortality (ORs 3.05 and 2.34). For stage I and II disease, there was a significantly better 5-year survival in the high-volume center. (P = .04). CONCLUSIONS: Hospital volume and comorbidity patterns are important determinants of outcome in esophageal cancer surgery. Strong clinical endpoints such as in-hospital mortality and survival can be used as performance indicators, only if they are joined by reliable case-mix information.     

社区医院院前急救护理配合在急性心肌梗死患者抢救中的意义

目的：探讨社区医院院前急救护理配合在急性心肌梗死患者抢救临床意义。方法选择患者80例,分为两组,各40例,观察组患者采用本组护理干预方法,对照组实施常规护理,如一般护理,心理干预,健康教育等,比较两组患者获得医疗处理,并统计两组预后情况。结果观察组明确诊断时间、采取救治时间及转院时间均显著快于对照组（P ＜0.05）,观察组痊愈出院率显著高于对照组（P ＜0.05）,临床死亡率显著低于对照组（P ＜0.05）。结论社区医院良好的院前急救护理配合,能显著提高就治疗率及救治成功率,值得临床重视。