Humanized birth in high risk pregnancy: barriers and facilitating factors

The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional’s preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals’ perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and health administrator professionals from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants’ consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women’s active involvement in the decision making process and the heavy burden of responsibility on the physician’s shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities.     

Nutritional status of adult patients in two acute care hospitals: A university hospital and an affiliated Veterans Administration Medical Center

Paired surveys designed to assess the nutritional status of adult inpatients were conducted in two acute care medical centers: University of Maryland Hospital (UMH) and its affiliated Veterans Administrtion Medical Center (VAMC). Nutritional profiles of the patients were determined by anthropometric measurements: measured height and weight, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC), and by a chart review. The criteria used to define severe deficits were less than 80% for ideal body weight (IBW) and MAMC and less than 50% for TSF of sex specific standards. A serum albumin of 2.8g/100ml or less was regarded as a severe deficit. Chart review revealed missing admission weights in UMH and VAMC charts in 40% and 65% and missing heights in 60% and 88%, respectively. The VAMC had a greater percentage of patients that were below standards for IBW (p<.005) and TSF (p<.005). However patients at UMH without insurance were not significantly different from VAMC patients in any measured parameter. Patients with Third Party Payment coverage had significantly better nutrition profiles in all parameters (p<.01) than the VAMC and UMH patients without insurance. Patients from both medical centers were combined to compare the nutritional profiles of medical vs. surgical patients and of various disease classifications. Medical patients were not significantly different from surgical patients in any anthropometric measurement. However, medical patients had more significant deficits in serum albumin (p<.005) than surgical patients. Thirty-six percent of the total medical center population had evidence of protein-calorie malnutrition (PCM) and only 19% of these malnourished patients were receiving physician ordered supplements. Patients diagnosed with cancer, cardiovascular or pulmonary disease were at significant risk for PCM when compared to the rest of the patient populations (p<.01).     

5+2轻断食减重法在某医大附属医院员工减重中的应用

目的:肥胖是一种代谢性疾病,其严重危害人类的健康.5+2轻断食膳食模式是《中国超重/肥胖医学营养治疗专家共识(2016年版)》推荐的科学减重方法之一,近年来受到关注.但是,其在团体体重管理中少有报道.本研究利用轻断食膳食模式对某医科大学附属医院的员工进行减重管理,并评价其效果.方法:对报名参加某医科大学附属医院减重的工...     

医源性多胎妊娠患者心理健康情况及影响因素分析——以贵州医科大学附属医院为例

目的 探讨医源性多胎妊娠患者心理健康情况及其影响因素。方法 采用一般情况调查问卷和症状自评量表对182例医源性多胎妊娠(IMP)患者进行面对面调查。结果 IMP患者心理健康情况较全国常模差,其影响因素有年龄,职业为专业技术人员、办事人员和有关人员或商业和服务业人员,学历为小学及以下或中学/中专,家庭人均月收入为1500元及以下,居住地为城镇,不孕的原因为男方,不孕时间大于4年,夫妻关系好或一般,从家庭成员得到的支持和照顾一般或较多,不注重胎儿的性别,对IMP的了解程度为很了解或基本了解。结论 年龄较大,家庭主妇,学历为小学及以下,家庭月收入为1500元及以下,居住地为农村,不孕原因为女方,不孕时间大于4年,夫妻关系差,从家庭成员得到的支持和照顾较少,注重胎儿性别以及对IMP不了解为IMP患者心理健康的危险因素,应有针对性的进行心理干预。     

Incidence, causes and outcome of obstructed labor in jimma university specialized hospital

Background

Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births. This study was conducted to assess the incidence, causes and outcome of obstructed labor in Jimma University Specialized Hospital.

Methods

Hospital-based, cross-sectional study was conducted on all mothers who were admitted and delivered in the labor ward of Jimma University Specialized Hospital from November 1, 2008 to April 30, 2009. Data was collected using structured questionnaire and checklist, and then analyzed using SPSS for windows version 16.0.

Results

The incidence of obstructed labor was 12.2%. Out of these 61.5% did not have antenatal care follow-up. Most of the cases, accounting for 145(81.0%), 160 (89.4%) and 170 (93.9%) were referred from health centers, visited the hospital after at least 12 hours of labor and came from a distance of more than 10 kilometers, respectively. The causes of obstructed labor were cephalo-pelvic disproportion in 121(67.6%) and malpresentation in 50 (27.9%) of the cases. The commonest maternal complications observed were uterine rupture in 55 (45.1%) and sepsis in 48 (39.3%) of the cases with complications. Forty-five point eight percent of fetuses were born alive and all had low first minute APGAR score.

Conclusion

The incidence of obstructed labor was high with high rate of complications. The antenatal care follow-up practice was also found to be low. Improved antenatal care coverage, good referral system, and availing comprehensive obstetric care in nearby health institution are recommended to prevent obstructed labor and its complications.     

Puerperal infection from the perspective of humanized delivery care at a public maternity hospital

This is an epidemiological, prospective and non-concurrent study of the cohort type about puerperal infection from the perspective of humanized delivery care, based on information from 5,178 records of patients who went through the experience of humanized delivery. The study aimed at describing the women who underwent humanized delivery, determining the incidence and time for manifestation of puerperal infections and investigating the association between the infection and the risk factors. An accumulated puerperal infection rate of 2.92% was found. The risk factors associated to puerperal infection in Cesarean delivery were the duration of labor and the number of digital examinations. No variable behaved as a risk factor for infection in normal delivery. Cesarean delivery was an important risk factor for puerperal infection. The results reinforce the need to develop alternative forms of delivery care that provides effective conditions for normal delivery, in order to reduce the number of Cesarean sections.     

The use of intensive care: a comparison of a university and community hospital.

We compared 223 consecutive intensive care unit (ICU) admissions to a community hospital (CH) with 613 such admissions at a university hospital (UH) using a new clinical scale aimed at quantifying severity of illness. Both ICU's had similar technical resources and treatment capabilities. At the CH, however, patients were more often admitted for monitoring rather than for treatment of UH admissions had a substantially greater acute severity of illness (p less than .001) than CH patients in most diagnostic categories. These findings suggest that use of the ICU was substantially different in the two hospitals, with the CH admitting many more stable patients. This study also suggests that evaluation of ICU use is improved by quantitative measurement of severity of illness.     

Magnitude and pattern of injury in jimma university specialized hospital, South west ethiopia

Background

Injury statistics in Ethiopia provides little knowledge about its magnitude and related information needed for prevention. This study, therefore, aims to determine the magnitude and pattern of injury in Jimma University Specialized Hospital (JUSH).

Methods

A retrospective review of records of all injured patients seen at surgical outpatient department from April 09, 2010 to January 07, 2011; was conducted in January 2011. Data were collected using a structured checklist that was developed by adapting the World Health Organization instrument. Five degree holder nurses collected the data while investigators closely supervised. Socio demographic characteristics of the patients and injury related information were collected. Data were analyzed using SPSS for windows version 16.0.

Results

Of 13500 patients who visited surgical outpatient department of JUSH during the study period, 1102(8.2%) were injury cases. The commonest mechanism of injury was blunt assault, 341(30.9%), followed by road traffic accident, 334(30.3). Fracture was the leading outcome of injury, 454(41.2%), followed by bruise or skin laceration, 404(36.7%). Significantly more males had cut, (AOR=2.0; 95% CI=1.2, 3.3) and stab, (AOR=3.0; 95% CI=1.6, 5.7), injuries compared to females. Conversely, significantly fewer males had burn, (AOR=0.4, 95% CI=0.2, 0.8) and road traffic accident, (AOR=0.7, 95% CI=0.5, 0.9), than females. Most, 715(95.8%), patients were presented to the hospital within one week. The commonest functional limitations were; difficulty to use hands, 312(28.3%) and difficulty to use legs, 217(19.7%). Eighty three, (7.5%) of the patients died and road traffic accident alone accounted for almost half, 179 (49.7%), of the severe injuries.

Conclusion

The magnitude of injury in the hospital was considerably high. Age and sex were predictors of injury. Appropriate prevention strategies should be designed and implemented against assault, road traffic accident and cut by sharp tool.     

Referral from secondary care and to aftercare in a tertiary care university hospital in Japan

Background  

In Japan, all citizens are covered by the national insurance system in which universal free access to healthcare services is promised to everybody. There are no general physicians or gatekeepers in the Japanese healthcare system.     

Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study

Selective episiotomy and the active management of labor have been shown by numerous studies to benefit women's experience of labor as well as its outcomes. However, many Latin American public hospitals have not updated their clinical practices to reflect these findings. Limited access to new knowledge, limited time and physical resources and attitudes resistant to change are factors limiting the adoption of new practices in such hospitals. Interviews were conducted with three department heads, and focus groups were conducted with 31 physicians and midwives working in 10 public hospitals in Argentina and Uruguay. All were asked about facilitators and barriers to making changes in clinical practice. In addition, three focus groups were conducted with 16 pregnant women served by public hospitals. Responses were grouped according to stages of change in incorporating new evidence into practice. Numerous facilitators and barriers were identified by participants, as well as potential strategies for promoting change that could be incorporated into interventions. Barriers included limited access to information, negative attitudes toward changes in practice, lack of skills in performing new practices, lack of medical resources and explicit guidelines and a perceived need to practice defensive medicine. Changing long-standing clinical practice is difficult. Interventions must be adapted to translate evidence-based approaches to new cultures and contexts. Improving information access, use of role models, skill development and improved resources and support may be effective ways to overcome barriers to change in Latin American obstetric care.     

从安徽医科大学第一附属医院科研课题中标情况谈医院科技人才队伍建设

目的探讨医院科技人才队伍建设的优势与问题,提出改革措施.方法对安医大一附院2000-2004年间中标的科研课题与学科分布,课题负责人的年龄结构、学位、职称以及梯队人才分布等展开分析研究.结果中青年科技人才是医院科技队伍的中坚力量,高学位、高职称、入选的各层次梯队人才是中标科研课题的主力军.结论①充分发挥重点学科的人才优势,多中标高级别科研课题,创建“品牌”效应.同时加大普通学科人才队伍建设的力度.②加大中青年科技人才,特别是35岁以下青年科技人才的培养力度是科技人才队伍建设的关键.③完善激励机制,充分调动高层次科技人才的积极性和创造性,促进医院人才队伍建设.     

新疆医科大学第一附属医院2005—2012年发表论文计量分析

目的：评价某院专业技术人员科研工作绩效。方法以 CNKI《中国期刊全文数据库》为依据,运用文献计量法对某院2005—2012年在国内医学期刊发表的论文进行分析。结果某院2005—2012年发表论文共6347篇,年平均增长速度1.1%,年平均发表793篇,发文量呈逐年递增趋势。6347篇论文刊载在628种期刊上,期刊平均发文量10篇。6347篇论文第一或独立作者3054人,论文作者占各类专业技术人员总数的87.13%。发表论文合作度3.74人、合著率72.74%。核心期刊和高影响力期刊发表论文相对较少。产出高质量学术论文的高产核心作者群尚待形成。结论某院在学科建设上具有较强的实力,应更加优化各种激励政策和措施,同时将发表论文作为卫生技术人员服务能力考核以及专业职称聘任的重要指标,实施科研论文的定量管理,促进专业技术人员的科技产出。     

医院影像传输系统的应用

本文介绍了内蒙古医学院第四附属医院YJPACS系统在临床应用中作用以及使用效果。介绍了YJPACS的主要功能和特点。     

The role of expectations in patient assessments of hospital care: an example from a university hospital network, Turkey

PURPOSE: The aim of this paper is to document a study, in which the SERVQUAL scale was used to evaluate hospital services, conducting a preliminary assessment of patient attitudes regarding the important aspects of service dimensions. DESIGN/METHODOLOGY/APPROACH: The SERVQUAL scale was implemented into routine use at the Baskent University Hospitals Network in Baskent, Turkey. The study consisted of 550 randomly chosen patients who presented to any member hospital in that network during January and February 2006 and received treatment as inpatients or outpatients at those healthcare facilities. The SERVQUAL scale was utilised to evaluate hospital services. FINDINGS: A questionnaire was completed by a total of 472 (86.0 per cent) patients. The perceived scores of the patients were higher than expected for an ordinary hospital but lower than expected for a high-quality hospital. The highest difference between the perceived service score and the expected service score was found at the Alanya Application and Research Center in Alanya, Turkey. ORIGINALITY/VALUE: The paper demonstrates the use of the SERVQUAL scale in measuring the functional quality of the hospitals assessed.     

Reasons and outcomes of admissions to the medical wards of jimma university specialized hospital, southwest ethiopia

Background

Non-communicable diseases are the main reasons for admission to the medical wards in high-income countries. While in low and middle income countries communicable diseases are the main reasons for admission to the medical wards. However, in some low and middle income countries the reasons for admission are changing from communicable diseases to non-communicable diseases. But, data on reasons for admission to the medical wards of low income countries is scarce. Therefore, this study takes one year data from a low income country referral hospital aiming at describing the recent reasons and outcomes of medical admissions to see whether there is a change in reasons for admission and the outcome.

Methods

A retrospective study examined patient case notes and ward registration books of medical admissions at Jimma University Specialized Hospital from January 1, 2008 to December 31, 2008. Socio-demographic variables, reasons and outcomes of admission were some of the variables recorded during the data collection. The International Statistical Classification of Disease was used for sorting and categorizing the diagnosis. The data was then analyzed using SPSS windows version 13.0.

Result

A total of 610 patient case notes were reviewed. The mean age of the patients was 36 years (SD ± 15.75). The highest number of admissions 218 (35.7%) was among the age groups 21 to 30 years. Communicable diseases; namely severe community acquired pneumonia 139(22.8%), all infectious and parasitic diseases category 100 (16.4%), and pyogenic as well as chronic meningitis 80(13.1%) were the most common reasons for admission. The death rate among patients admitted to the medical wards was 12.6%.

Conclusions

Communicable diseases were still the common reasons for medical admissions at Jimma University Specialized Hospital. The outcome of medical admissions has not changed over sixteen years.