Distribution of antivenoms in Cameroon

Two snake antivenoms are distributed in Cameroon, though their availability in district hospitals varies. These snake antivenoms are FAV-Afrique (Aventis Pasteur) available at Centre Pasteur Cameroun and Polyvalent serum (Serum Institute of India = SII) distributed by a wholesaler (CENAME). The price remains a very important factor. We have noted that some district hospitals do not stock antivenom at all, while others stock very few and sometimes only one vial whereas a good management of snakebite may require up to 14 vials for some envenomations. However, data collected by the CAMHERP project that permit to identify high-risk areas of envenomation might be used as a database for the distribution of snake antivenom in Cameroon.     

Cost control of out-of-hours laboratory services in district general hospitals.

AIMS--To survey methods for cost control of out-of-hours laboratory services in district general hospitals in England and Wales. METHODS--A questionnaire was distributed to 66 district general hospital laboratories in England and Wales. RESULTS--The response rate was 61%. Most laboratories for which budgetary information was provided had on-call costs ranging between 10-21% of staff costs. Ninety five per cent of respondents had attempted to reduce workload by the use of various strategies. Seventy two per cent of responding laboratories had negotiated a wide variety of on-call agreements outside Whitley Council arrangements. Seventy two per cent were not satisfied with their on-call arrangements, the main desired objective being the introduction of the extended working day. CONCLUSIONS--From this study it seems that Whitley Council agreements for out-of-hours work are no longer appropriate for the average district general hospital laboratory. Workload reduction strategies should include the use of a limited list, audit of the use of the on-call service, and continued education of medical staff. Consideration may also be given to the introduction of fixed payments, extension of the working day, increased multidisciplinary on-call and increased bedside testing.     

The role of the district hospital in child survival at the Kenyan Coast

Strategies for improving child survivorship in sub-Saharan Africa by the year 2000 have focused on low-cost, peripheral preventative and curative activities often with little reference to essential clinical services offered by hospitals at the district level. However, the recent World Bank World Development Report has re-emphasised the potential of district hospitals within selective PHC activities. We have estimated the likely impact of in-patient care offered by a rural district hospital on the Kenyan coast on under 5's mortality through comprehensive demographic and hospital surveillance. Within this population, childhood mortality may have been reduced by 44% as a result of hospital in-patient care. Strengthened referral systems, improvements in hospital accessibility, and better hospital care should be an integral part of PHC and other health promotion activities in sub-Saharan Africa.     

Audit of general surgical pathology experience of histopathology trainees.

Surgical histopathology is learnt principally by the practical experience of reporting routine cases. This study performed a quantitative audit of the types of specimens reported by trainees at a teaching hospital and a district general hospital. At the teaching hospital all cases are seen by trainees and it was predicted that the distribution of specimens among trainees would be entirely random. Significant variations were found in the number of skin, breast, cervix, prostate, and endometrial cases reported by each trainee. In some cases this related to a trainee having a special interest (skin and breast pathology) or areas requiring special techniques (breast pathology). At the district general hospital the workload was much higher so that juniors did not see all cases and junior trainees were not seeing bronchial, liver, or lymph node biopsy specimens. This type of audit shows that in teaching hospitals specialisation by some trainees (as encouraged by the new MRCPath exam) may be to the detriment of others and that in district general hospitals pressure of work may actually reduce a trainee's exposure to difficult cases. Without systematic audit this would not be recognised and remedied.     

étude de la résistance de Mycobacterium tuberculosis chez les patients bacillifères au Tchad

Culture and resistance testing of Mycobacterium tuberculosis are not regularly performed in Chad. Sputa were obtained from three different categories of hospitals (district, regional and national) in Chad. All examined sputa were smear-positive and were investigated by culture and drug resistance testing for first-line antituberculosis drugs. From 232 sputa positive for acid-fast bacilli, 135 isolates of M. tuberculosis from different patients (46 women, 89 men, mean age 34 years) were analyzed. All the patients except one corresponded to new cases of tuberculosis. In total, 27 out of 135 isolates (20%) were resistant to at least one major antituberculosis drug. Resistance to isoniazid was the most frequent resistance observed, with 18 isolates (13%) presenting at least this resistance. Three isolates (2.2%) were resistant to isoniazid and rifampicin (multidrug resistance MDR) including one isolate being concomitantly resistant to streptomycin and ethambutol. The resistance rate differed in relation to the category of the hospital; the most important resistance rate was observed in regional hospitals (33%), while it was 16% and 14% in the national and district hospitals, respectively. HIV serology was performed in 81 patients, among whom 20 (25%) were positive. This is the first study that shows that drug resistance of M. tuberculosis is present in Chad. Besides single drug-resistant isolates, multidrug-resistant strains of M. tuberculosis could also be identified. This result highlights the urgency of initiating actions to detect drug resistance and limit the spread of drug-resistant strains.     

Clinical efficacy of telemedicine in emergency radiotherapy for malignant spinal cord compression

The authors developed a Telecommunication-HElped Radiotherapy Planning and Information SysTem (THERAPIST), then estimated its clinical benefit in radiotherapy in district hospitals where consultation with the university hospital was required. The system consists of a personal computer with an image scanner and a digital camera, set up in district hospitals and directly connected via ISDN to an image server, and a treatment planning device set up in a university hospital. Image data and consultative reports are sent to the server. Radiation oncologists at the university hospital determine a treatment schedule and verify actual treatment fields. From 1998 to 1999, 12 patients with malignant spinal cord compression (MSCC) were treated by emergency radiotherapy with the help of this system. Image quality, transmission time, and cost benefit also were satisfactory for clinical use. The mean time between the onset of symptoms and the start of radiotherapy was reduced significantly from 7.1 days to 0.8 days (P < .05) by the introduction of the system. Five of 6 nonambulant patients became ambulant after the introduction of THERAPIST compared with 2 of 8 before the introduction of THERAPIST. The treatment outcome was significantly better after the introduction of the system (P < .05), and suggested to be beyond the international standard. The telecommunication-helped radiotherapy and information system was useful in emergency radiotherapy in district hospitals for patients with MSCC for whom consultation with experienced radiation oncologists at a university hospital was required.     

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan

PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. SETTING: TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. METHODS: We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. RESULTS: The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). CONCLUSIONS: Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.     

The fundholding fandango.

General practitioner fundholding allows flexible use of resources at the coal-face, provides incentives to alter practice such as prescribing within cash limits and forces hospitals to be more responsive to general practitioner demands. However, the additional administrative costs both in time and money, the fragmentation of purchasing power compounded by a lack of expertise and experience in contracting, and the poor information and financial systems which exist in the National Health Service are severe constraints. A suggested way forward is to delegate responsibility for running the scheme, including the contracting and billing, to district health authorities offering more flexible budgets to all practices and extending the scheme as local information systems allow. This will reduce fragmentation of purchasing power and administrative costs and re-establish local accountability. It will also give the general practitioner more time to see and treat patients, who will see the system as being fairer.     

An external quality assessment scheme in histopathology

The details of an external quality assessment scheme in histopathology based on district general hospitals in south west England are described. The scheme is supplementary to internal audit carried out in individual departments.     

深圳市7家医院常见病原菌耐药性分析

目的了解深圳市区级、街道人民医院常见病原菌的耐药情况,为临床合理使用抗菌药物提供依据。方法对深圳市7家区级、街道二级甲等医院2009年1～9月分离的1765株病原菌进行药敏试验,用WHONET5.5软件对数据进行统计分析。结果大肠埃希菌对广谱青霉素、头孢呋辛、复方新诺明的耐药率均〉60%,肺炎克雷伯菌对广谱青霉素、第一和第二代头孢菌素的耐药率〉40%,两种菌对碳青酶烯类的敏感率为95%～100%,对氨基糖苷类阿米卡星敏感率达90%～95%,产ESBLs率分别为44.6%和29.0%。铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦、第一和第二代头孢菌素的耐药率〉90%,对氨基糖苷类阿米卡星的敏感率为91.4%,对碳青酶烯类和氟喹诺酮类药物敏感率为70%～80%。未发现耐万古霉素的葡萄球菌。结论深圳市区级、街道人民医院常见病原菌对抗菌药物的耐药性普遍存在,应长期开展对病原菌的耐药性监测。     

深圳市宝安区先天性畸形的前期监测研究

目的：为了解深圳市宝安区先天性畸形的发病情况和分布特征,为进一步研究提供线索和参考资料。方法：我们于1997年1月－1999年12月,对宝安区住院分娩的34613例围产儿进行了先天性畸形监测研究,对检出的269例畸形儿进行了流行病学分析。结果：宝安区先天性畸形的总发生率为77．72／万,常住和流动人口中先天性畸形的发生率分别为69．65／万、80．33／万。常住人口中先天性畸形发生率最高的镇为石岩（100．00／万）;其次为观澜（93．21／万）;最低的为光明（未监侧到）。先天性畸形的发生无性别差异,其中发病居前四位的畸形依次为：大腹儿,（Hb病）,短肢或缺肢畸形,先天性脑积水,唇裂合并腭裂。结论：尽管宝安区先天性畸形的发生率比国内外报道的要低,但发生规律有自己的特点,应引起重视和进一步研究。     

An Early Stage Evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital''s facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

Graphical Abstract

相似文献   

Rural versus urban parasuicide—referral and management

The referral and management of parasuicide patients from urban and rural areas were compared in a retrospective study of hospital and general practice records. Whereas most urban patients were physically and psychiatrically managed in general hospitals, the majority of rural patients were managed at home or in cottage hospitals by general practitioners. The overall parasuicide rate of the rural population was found to be similar to that of the city. Although there were no clinical differences between the two groups of patients, relatively more middleaged rural patients were admitted to hospital. The results suggest that parasuicide is now as commonly seen in rural situations, but that the problem is managed outside district general hospitals by general practitioners.     

Dying from cancer in community hospitals or a hospice: closest lay carers' perceptions.

BACKGROUND: Despite there being around 400 community hospitals in the United Kingdom, there is little published research on the quality of service provided by these hospitals. AIM: To compare the quality of terminal cancer care in community hospitals with a hospice as assessed by patients' closest lay carer (relative or friend). METHOD: Structured interview (or questionnaire based on the interview proforma) with closest lay carers of all patients dying over one year in 12 community hospitals in east Devon and a purpose-built hospice in the city of Exeter. RESULTS: A total of 292 cases (176 in community hospitals and 116 in a hospice) were identified, resulting in 238 carers being eligible for interview or questionnaire survey. Overall, 106 successful interviews and 55 questionnaires were completed, giving a response rate of 67.6%. Carers gave a near unanimous vote of excellence for the total care given by the hospice, while around 40% of carers of patients in community hospitals considered that improvements were possible. Community hospitals attracted more negative comments than hospices, with criticism being directed at problems of communication, lack of nursing staff, and lack of support in bereavement. Carers of hospice patients were significantly more likely to be present at the time of death than those of community hospital patients [45/70 (64%) vs. 31/89 (35%); chi 2 = 13.6, P < 0.001], an observation possibly because nursing staff in community hospitals are less experienced at dealing with terminally ill patients and such hospitals have fewer adequate facilities. CONCLUSIONS: Lay carers indicated great satisfaction with care given in the hospice and less satisfaction with care given in the community hospitals. However, the community hospitals are non-specialist units with far lower levels of trained staff. Improvements in terms of the communication skills of doctors and nurses, specific training for nurses in palliative care, and structured bereavement care could be made without necessarily increasing staffing numbers.     

Acute medicine in a general practitioner hospital

Admissions during 1980 to a hospital staffed by general practitioners are analysed. Almost all (94 per cent) were acute admissions. The mean length of stay was 11.7 days and the mean age of the patients 63.3 years, with 40 per cent of them under 65 years of age. Two thirds of the patients were discharged to their homes and only 7 per cent of patients spent more than four weeks in hospital. General practitioner hospitals have medical, social and economic advantages over large district hospitals for certain acutely ill patients and have an important role in primary medical care.     

An international strategy in medical equipment maintenance

In many developing countries, the growth in maintenance services has lagged far behind the rate of increase in medical equipment use. Urgent attention to maintenance services is required by district health facilities supporting primary healthcare. To date, most international assistance has been devoted to training technicians who are usually associated with major hospitals. A change of strategy is necessary to place priority on training technicians and on strengthening capabilities to maintain basic, essential medical equipment in district health facilities. Not only would such an approach meet urgent current needs, it would take less time to benefit a larger sector of the population, and it can also facilitate the development of higher maintenance capabilities. The advantages are illustrated by examining an empirical model. This strategy is in full support of the global goal to achieve "Health for All by The Year 2000."     

A general-practitioner ward in a new district general hospital

So far there are relatively few general-practitioner wards in district general hospitals in the National Health Service. The work of one such general-practitioner ward at Queen Mary's Hospital, Sidcup, is described and the advantages of this system of care for patients and doctors discussed.