• Title/Summary/Keyword: Hospital unit

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Pediatric Inflammatory Bowel Disease: A Multicenter Study of Changing Trends in Argentina Over the Past 30 Years

  • Arcucci, Maria Soledad;Contreras, Monica Beatriz;Gallo, Julieta;Antoniska, Mariela Andrea;Busoni, Veronica;Tennina, Cecilia;D’Agostino, Daniel;Kakisu, Maria Hisae;Weyersberg, Christian;Orsi, Marina
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.25 no.3
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    • pp.218-227
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    • 2022
  • Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods: We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results: Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn's disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion: This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.

Testing The Healing Environment Conditions for Nurses with two Independent Variables: Visibility Enhancement along with Shortening the Walking Distance of the Nurses to Patient - Focused on LogWare stop sequence and space syntax for U-Shape, L- Shape and I-Shape NS-

  • Shaikh, Javaria Manzoor;Park, Jae Seung
    • KIEAE Journal
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    • v.15 no.2
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    • pp.19-26
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    • 2015
  • Purpose: Maximizing human comfort in design of medical environments depends immensely on specialized architects particularly critical care design; the study proposes Evidence-Based Design as an apparent analog to Evidence-Based Medicine. Healthcare facility designs are substantially based on the findings of study in an effort to design environments that augment care by improving patient safety and being therapeutic. On SPSS (Statistical Package for Social Science) t-test is applied to simulate two independent variables of PDR (Pre Design-Research) and POE (Post- Occupancy Evaluation). PDR is conducted on relatively new hospital Hallym University Dongtan Sacred Heart Hospital to analyse visibility from researchers' point of view, here the ICU is arranged in I-Shape. POE is applied on Dongguk University Ilsan Hospital to simulate walking on LogWare where two NS are designed based on L- Shape and Seoul St. Mary's Hospital, The Catholic University of Korea where five NS are functional for ICU Intensive Care Unit, Surgical Intensive Care Unit (SICU), Medical Intensive Care Unit (MICU), Critical Care Unit (CCU), Korean Oriental Medical Care Unit which are mostly arranged in U-Shape, and walking pattern is recognized to be in a zigzag path. Method: T-Test is applied on two dependent communication variables: walkability and visibility, with confidence interval of 95%. This study systematically analyses the Nurse Station (NS) typo-morphology, and simulates nurse horizontal circulation, by computing round route visits to patient's bed, then estimating minimum round route on LogWare stop sequence software. The visual connectivity is measured on depth map graphs. Hence the aim is to reduce staff stress and fatigue for better patients care by minimizing staff horizontal travel time and to facilitate nurse walk path and support space distribution by increasing effectiveness in delivering care. Result: Applying visibility graph and isovist field on space syntax on I- Shape, L- Shape and U- Shape ICU (SICU, MICU and CCU) configuration, I-shape facilitated 20% more patients in linear view as they stir to rise from their beds from nurse station compared to U-shape. In conclusion, it was proved that U-Shape supply minimum walking and maximum visibility; and L shape provides just visibility as the nurse is at pivot. I shape provides panoramic view from the Nurse Station but very rigorous walking.

Analyses of the Efficiency in Hospital Management (병원 단위비용 결정요인에 관한 연구)

  • Ro, Kong-Kyun;Lee, Seon
    • Korea Journal of Hospital Management
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    • v.9 no.1
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    • pp.66-94
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    • 2004
  • The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

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Successful Treatment with Rituximab and Immunoadsorption for an Auto-Antibody Induced Bile Salt Export Pump Deficiency in a Liver Transplanted Patient

  • Quintero, Jesus;Juamperez, Javier;Gonzales, Emmanuel;Julio, Ecaterina;Mercadal-Hally, Maria;Collado-Hilly, Mauricette;Marin-Sanchez, Ana;Charco, Ramon
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.2
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    • pp.174-179
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    • 2020
  • We present an 8 years old girl who was diagnosed at 6 months of age of Progressive Familial Intrahepatic Cholestasis type 2. Although liver transplantation (LT) was classically considered curative for these patients, cholestasis recurrence with normal gamma-glutamyl transpeptidase (GGT), mediated by anti-bile salt export pump (BSEP) antibodies after LT (auto-antibody Induced BSEP Deficiency, AIBD) has been recently reported. Our patient underwent LT at 14 months. During her evolution, patient presented three episodes of acute rejection. Seven years after the LT, the patient presented pruritus with cholestasis and elevation of liver enzymes with persistent normal GGT. Liver biopsy showed intrahepatic cholestasis and giant-cell transformation with very low BSEP activity. Auto-antibodies against BSEP were detected therefore an AIBD was diagnosed. She was treated with Rituximab and immunoadsorption with resolution of the AIBD. As a complication of the treatment she developed a pneumocystis infection successfully treated with corticoids, cotrimoxazol and anidulafungin.

A Study on the User Needs for Renovation of Race Track Type of Nursing Units in K University Hospital (K대학병원 병동부 이중복도형의 개선을 위한 사용자 요구 조사연구)

  • Kim, Youngaee;Yim, Ohyon;Kim, Jungshin;Yi, Jongse;Ahn, Uijong
    • Journal of The Korea Institute of Healthcare Architecture
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    • v.19 no.3
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    • pp.21-28
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    • 2013
  • Purpose: General hospital in korea is getting large-scaled, specialized and upgraded. So, nursing unit of race track type has been advanced along with a spatial organization, building equipment and environmental approach. This study is to search the guidelines for renovation of nursing unit with race track type in the case of K university hospital in Daejeon. Methods: 9 cases of recently opened general hospital has been analyzed for spatial and environmental design solution. Questionnaires and interviews about user needs of nursing staff, patient and visitors, have been conducted for a nursing care system and facility of nursing units in K university hospital. Results: The user needs are represented as followings. Center core public zone in each floor plan and center core nursing station and supporting areas in nursing unit are good for an adjacency and separation of spatial organization. Toilet of group patient room is necessary to equip for easy, safe and infective aspects, and so toilet install will decrease the patient number and increase the nursing care service. Hall type of station front is good for visibility and observation. It is appropriate to renovate into south facing group patient room for privacy, enough space for nursing care facility and supporting area, enough width of door to move portable medical equipment, room for medical doctor and practical student, noise absorbing of day room. Implications: Upgrading the nursing care service and facility equipment is necessary to reflect the user needs and cooperate with hospital management.

Factors influencing the appropriateness of hospital stays (재원 적절성에 영향을 미치는 요인)

  • Hwang, Jee In
    • Health Policy and Management
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    • v.15 no.3
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    • pp.94-113
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    • 2005
  • The purpose of this study was to determine the level of appropriateness in hospital stays and factors influencing inappropriate hospital stays. The study was conducted at fifteen general care units in a tertiary university hospital. Appropriateness of hospital stay was assessed using Appropriateness Evaluation Protocol by trained head nurses. The total of 447 patient records were reviewed. Among them, 352 patient data were included in the final data set. A unit of observation was patient day. A rate of appropriate hospital stay was calculated per patient as a unit of analysis. Multiple regression analysis was performed to determine the factors affecting inappropriate hospital stay. The eighty-three percent (2030/2651) of hospital stays were evaluated as appropriate. There were significant differences in appropriateness of hospital stay according to patient's age, type of health insurance, medical specialty, and length of stay(p<0.05). In the multiple regression analysis, medical speciality was the most significant factor to predict the inappropriate hospital stay. The study showed a substantial proportion of hospital stay was found to inappropriate. Level of appropriateness was significantly different from medical specialty. Interdepartmental approach should be required to coordinate and improve appropriate resource utilization.

Development and Application of a Specialized Mentor Program for New Graduate Nurses - Focused on Intensive Care Unit of a Tertiary University Hospital - (신규간호사를 위한 맞춤형 멘토 프로그램(새싹프로그램)의 개발 및 적용 - 일개 대학병원 중환자실을 중심으로 -)

  • Kwon, Eun-Ok;Cho, Jung-Sook;Song, Kyung-Ja;Choi-Kwon, Smi;Chang, Sun-Ju;Kim, Ju-Hee;Park, Seung-Hyun;Shin, Hyo-Youn;Yu, Mi;Kim, Jeong-Ah
    • Journal of Korean Academy of Nursing Administration
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    • v.15 no.4
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    • pp.563-570
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    • 2009
  • Purpose: The purpose of this study was to develop specialized mentor program to improve adaptation for new nurses of intensive care unit and to identify the effect of the program on early resignation rate. Methods: The study adopted nonequivalent control group, non synchronized design. Based on the identification of problems and the needs of new nurses, a 6 month specialized mentor program was developed. The program was consisted of three parts; developing knowledge, improving interpersonal relationship and increasing coping competency for emergency situation. Data were collected between July 2006 and 2008 from 37 nurses and the early resignation rate was compared before and after the implementation of the mentoring program. Results: Early resignation rate of the nurses who received the mentor program was significantly lower than that of the nurses who didn't. The resignation rate within 1 year dropped from 44.5% to 8.3%(p=.034). Conclusions: The specialized six month mentoring program was effective in reducing early resignation rate.

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Risk Factors related to Delirium Development in Patients in Surgical Intensive Care Unit (외과계 중환자실의 섬망 발생 위험요인 조사연구)

  • Lee, Eun-Joon;Shim, Mi-Young;Song, Suk-Hee;Lee, Mi-Mi;Kim, Hye-Mi;Kang, Bong-Sun;Yang, Eun-Jeen;Lim, Ji-Young;Kim, Jin-A;Lee, Mi-Na
    • Journal of Korean Critical Care Nursing
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    • v.3 no.2
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    • pp.37-48
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    • 2010
  • Purpose: The purpose of this study was to examine the frequency and the course of delirium, and identify risk factors for the development of delirium in surgical intensive care unit (SICU). Methods: Subjects older than 19 years admitted to the SICU were recruited. After informed written consent, enrolled subjects had baseline cognitive and functional assessments. Subjects were assessed daily for delirium using the Confusion Assessment Method-ICU (CAM-ICU). Results: During the study period, 110 patients were enrolled. The overall incidence of delirium was 20% (22/110). The average time to onset of delirium was 3.04(${\pm}1.25$) days. Several variables were associated with an increased risk of delirium including older age (p<.05), higher admission APACHE II score (p<.001), use of opioid and analgesics (p<.01), using physical restraints (p<.001), and intraoperative hypotension (p<.05). In a multivariate logistic regression model, using physical restraints (p<.001), intraoperative hypotension (p<.05), and older age (p<.05) remained significant predictors of the delirium development. Conclusion: Using physical restraints, intraoperative hypotension and older age was strongly associated with development of delirium in the SICU. Prevention measures need to focus on identifying patients at higher risk for delirium development.

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Analgesic and antiinflammatory activity of Alstonia macrophylla and Mallotus peltatus leaf extracts: Two popular ethnomedicines of Onge, a Negrito tribe of little Andaman

  • Chattopadhyay, Debprasad;Arunachalam, G.;Sur, T.K.;Bhattacharya, S.K.;Mandal, Asit B.
    • Advances in Traditional Medicine
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    • v.5 no.2
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    • pp.124-136
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    • 2005
  • Two popular ethnomedicines of the Onge, a Negrito tribe of Andaman Islands, were evaluated for analgesic and antiinflammatory activity. The methanol extract as well as the different fractions of methanol extract of both Alstonia macrophylla and Mallotus peltatus leaves were studied using Swiss albino mice and Wistar albino rats. Acetic acid induced writhing, Tail flick and Tail immersion; Carrageenin- and Dextran-induced paw oedema tests were used. Dose-dependent analgesic and antiinflammatory activity were demonstrated for both methanol leaf extracts as well as fractions. Results were highly comparable with that of the standard drug pethidine.

Endoscope-Assisted Trans-Sphenoidal Approach for Treatment of Sternberg's Canal

  • Maselli, Giuliano;Ricci, Alessandro;Galzio, Renato J.
    • Journal of Korean Neurosurgical Society
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    • v.52 no.6
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    • pp.555-557
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    • 2012
  • We report an uncommon case of a 45-year-old woman who presented with spontaneous rhinorrhea. A computed tomography (CT) scan of the head revealed an abnormally large sphenoid sinus associated with a parasellar bony defect (Sternberg's canal) through which magnetic resonance imaging could detect an encephalocele of the right temporal lobe. An endoscope-assisted trans-sphenoidal approach was performed and, with the aid of image guided surgery, reduction of the encephalocele was obtained and followed by surgical repair of the dural and bony defects. The postoperative course was uneventful and the cerebrospinal fluid fistula was closed as confirmed by the postoperative CT scan and by the absence of rhinorrhea. After three years of monitoring the patient remained asymptomatic.