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1.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31594430

RESUMEN

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Asunto(s)
Glucemia , Hospitales Rurales/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Monitoreo Fisiológico/normas , Sistemas de Atención de Punto/normas , Hospitales Rurales/normas , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Unidades de Cuidados Intensivos/normas , Estándares de Referencia , Índice de Severidad de la Enfermedad
2.
Int J Clin Pharm ; 41(3): 728-733, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30937695

RESUMEN

Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.


Asunto(s)
Actitud del Personal de Salud , Relaciones Interprofesionales , Enfermeras y Enfermeros/psicología , Grupo de Atención al Paciente , Farmacéuticos/psicología , Médicos/psicología , Femenino , Hospitales Rurales/normas , Humanos , Masculino , Enfermeras y Enfermeros/normas , Grupo de Atención al Paciente/normas , Farmacéuticos/normas , Servicio de Farmacia en Hospital/métodos , Servicio de Farmacia en Hospital/normas , Médicos/normas , Rol Profesional/psicología , Suecia/epidemiología
3.
J Crit Care ; 49: 64-69, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30388490

RESUMEN

PURPOSE: To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. MATERIALS AND METHOD: Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010-2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33). RESULTS: In rural hospitals, patients (N = 9665) were less likely to have a respiratory (12.9% v. 18.9%; p < .001) diagnosis, more likely diagnosed with sepsis (17.6% v. 4.9%), and had a higher illness severity score (42.0 vs. 41.4; p = .01) compared to urban (N = 65,846) counterparts. Mortality within ICU did not vary across facility rurality. In unadjusted analyses, facility rurality (rural vs. urban) was associated with reduced inter-hospital transfers (OR = 0.74; 95% CI = [0.69, 0.80]; p < .001) and a shorter ICU length of stay (RR = 0.82; 95% CI = [0.74, 0.91]; p < .001). This did not hold when the hierarchical data was accounted for. CONCLUSIONS: Despite challenges, low complexity ICUs in rural VA facilities fare similarly to urban counterparts. Being part of a national healthcare system may have benefits to explore in sustaining critical care access in rural areas outside the VA healthcare system.


Asunto(s)
Hospitales Rurales/normas , Hospitales Urbanos/normas , Hospitales de Veteranos/normas , Unidades de Cuidados Intensivos/normas , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Transferencia de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos
4.
J Stroke Cerebrovasc Dis ; 28(2): 430-434, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30415916

RESUMEN

BACKGROUND: Developing quality metrics to assess hospital-level care and outcomes is increasingly popular in the United States. The U.S. News & World Report ranking of "America's Best Hospitals" is an existing, popular hospital-profiling system, but it is unknown whether top-ranked hospitals in their report have better outcomes according to other hospital quality metrics such as the Centers for Medicare and Medicaid Services (CMS) publicly reported 30-day stroke measures. METHODS: The analysis was based on the 2015-2016 U.S. News & World Report ranking of the 50 top-rated hospitals for neurology and neurosurgery and 2012-2014 CMS Hospital Compare Data. We used mixed models adjusted for hospital characteristics and weighted by hospital volume to compare 30-day risk-standardized mortality and readmission between top-ranked and other hospitals. Among the 50 top-ranked hospitals, we determined whether ranking order was associated with the CMS outcomes. RESULTS: Compared with 2737 other hospitals, the 50 top-ranked hospitals had lower 30-day mortality (14.8% versus 15.3%) but higher readmission (14.5% versus 13.3%). These patterns persisted in adjusted analyses with top-ranked hospitals having .72% (95% confidence interval [CI] -1.09%, -.34%) lower mortality and .41% (95% CI .16%, .67%) higher readmission. Among top-ranked hospitals, rank order was not associated with mortality (.05% decrease in mortality with each rank, 95% CI -.10%, .01%) or readmission (.02% increase; 95% CI -.03%, .06%). CONCLUSION: Admission to a top-ranked hospital for neurology or neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission after ischemic stroke. There was heterogeneity in outcomes among the 50 top-ranked hospitals.


Asunto(s)
Isquemia Encefálica/terapia , Hospitales/normas , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/terapia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Capacidad de Camas en Hospitales/normas , Mortalidad Hospitalaria , Hospitales de Alto Volumen/normas , Hospitales de Bajo Volumen/normas , Hospitales Privados/normas , Hospitales Rurales/normas , Hospitales de Enseñanza/normas , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Readmisión del Paciente/normas , Complicaciones Posoperatorias/mortalidad , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
5.
J Nurs Manag ; 27(3): 482-490, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30204275

RESUMEN

AIM: To critically analyse the international literature describing the experiences of nurses working in rural hospitals. BACKGROUND: Nursing shortages in rural areas is an ongoing issue. Given the significant role nurses play in the delivery of rural health care, a sufficient workforce is essential. However, maintaining this workforce is challenging. Understanding the experiences of nurses working in rural hospitals is essential to inform strategies around job satisfaction and staff retention. EVALUATION: An integrative review was conducted. Six primary sources were included related to the experiences of nurses working in rural hospitals. RESULTS: Four themes emerged, namely: (a) Professional Development; (b) Workplace stressors; (c) Teamwork; and (d) Community. CONCLUSION: There is a need for further research exploring the experiences of nurses working in rural hospitals and its impact on job satisfaction, turnover intention and patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: This review highlights some key issues impacting nurses' working in rural hospitals. This understanding can be used by nurse managers to inform strategies for recruitment and retention of nurses in these areas.


Asunto(s)
Satisfacción en el Trabajo , Enfermeras y Enfermeros/psicología , Lugar de Trabajo/normas , Actitud del Personal de Salud , Hospitales Rurales/normas , Humanos , Intención , Enfermeras y Enfermeros/normas , Enfermeras y Enfermeros/provisión & distribución , Reorganización del Personal/tendencias , Población Rural/tendencias , Estrés Psicológico/complicaciones , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Lugar de Trabajo/psicología
7.
BMC Med Educ ; 18(1): 119, 2018 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-29855298

RESUMEN

BACKGROUND: In 2012, 12 medical schools were opened in Ethiopia to tackle the significant shortage of doctors. This included Aksum School of Medicine situated in Aksum, a rural town in Northern Ethiopia. The new Innovative Medical Curriculum (NIMC) is a four-year programme designed by the Ethiopian Federal Ministries of Health and Education. The curriculum is designed to train biomedical science graduates to become doctors in 4 years, with a focus on the healthcare needs of rural people living in poverty. METHODS: This research was conducted at Aksum School of Medicine and included two hospitals (Aksum Referral Hospital and St Mary's District Hospital). This study focused on medical students during their clinical years across multiple specialities (61 Clerkship 1 students and 13 Clerkship 2 students). We used primarily qualitative research methods supplemented with quantitative measures. There were 3 stages of data collection over a 1 month period, this included qualitative group interviews, direct observation of students in a clinical setting and direct observation of skills sessions followed by a questionnaire on the sessions. We analysed the data by reconstructing the student experience and comparing it with the NIMC. RESULTS: The proposed typical week set out in the NIMC tended to differ from the real clinical experience of these students. Through qualitative group interview and direct observation of teaching, the main theme that was consistent throughout was the lack of doctors with specialist postgraduate training. Clinical need often took priority over education. However, students enjoyed taking early responsibility and gaining practical experience. Through direct observation of skills sessions and short questionnaires, these sessions were highly valuable to the students and they felt confident in carrying out the taught procedures in the future. CONCLUSIONS: The combination of poorly resourced hospitals and lack of specialist doctors provides a challenging environment for medical students to learn. However, it is a unique clinical experience that is rarely seen in developed countries and facilitates the acquirement of skills from an early stage. Supervision and specialist input is fundamental in enabling students to learn and this is a key area that was lacking in the students' clinical experience.


Asunto(s)
Curriculum , Educación Médica/organización & administración , Áreas de Pobreza , Salud Rural/educación , Facultades de Medicina , Dermatología/educación , Etiopía , Cirugía General/educación , Ginecología/educación , Hospitales Rurales/normas , Humanos , Obstetricia/educación , Oftalmología/educación , Médicos/provisión & distribución , Investigación Cualitativa , Estudiantes de Medicina , Factores de Tiempo
8.
N Z Med J ; 131(1476): 81-84, 2018 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-29879729

RESUMEN

We describe a phenomenon of self-reinforcing inequality between New Zealand rural hospitals and urban trauma centres. Rural doctors work in remote geographical locations, with rare exposure to managing critical injuries, and with little direct support when they do. Paradoxically, but for the same reasons, they also have little access to the intensive training resources and specialist oversight of their university hospital colleagues. In keeping with international experience, we propose that using simulation-based education for rural hospital trauma and emergency team training will mitigate this effect. Along with several different organisations in New Zealand, the University of Otago rural postgraduate programme is developing inter-professional simulation content to address this challenge and open new avenues for research.


Asunto(s)
Educación de Postgrado en Medicina/métodos , Servicios Médicos de Urgencia/normas , Disparidades en Atención de Salud , Hospitales Rurales/normas , Servicios de Salud Rural/normas , Entrenamiento Simulado/métodos , Traumatología/educación , Hospitales Universitarios/normas , Humanos , Nueva Zelanda , Centros Traumatológicos/normas
9.
BMC Pregnancy Childbirth ; 18(1): 164, 2018 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-29764384

RESUMEN

BACKGROUND: Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. METHODS: Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. RESULTS: During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). CONCLUSIONS: Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.


Asunto(s)
Cesárea/normas , Hospitales Rurales/normas , Servicios de Salud Materna/normas , Auditoría Médica/métodos , Derivación y Consulta/normas , Adulto , Femenino , Humanos , Embarazo , Estudios Prospectivos , Mejoramiento de la Calidad , Estudios Retrospectivos , Tanzanía
10.
Injury ; 49(6): 1070-1078, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29602489

RESUMEN

BACKGROUND: An understanding of stakeholders' views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals. METHODS: This is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system. RESULTS: We conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care. CONCLUSIONS: This study provides insight into rural professionals' perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty, discontent and disengagement towards trauma system development, and concerns regarding staffing levels and governance. These issues are unlikely to be unique to Scotland and warrant further study to inform service planning and the effective delivery of rural trauma systems.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Hospitales Rurales , Desarrollo de Programa/normas , Centros Traumatológicos , Actitud del Personal de Salud , Personal de Salud , Hospitales Rurales/organización & administración , Hospitales Rurales/normas , Hospitales Rurales/tendencias , Humanos , Entrevistas como Asunto , Innovación Organizacional , Investigación Cualitativa , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Población Rural , Escocia , Centros Traumatológicos/organización & administración
11.
J Nurs Adm ; 48(3): 141-148, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29461350

RESUMEN

OBJECTIVE: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®. BACKGROUND: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources. METHODS: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed. RESULTS: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged. CONCLUSIONS: The journey to Magnet leads to improved nurse, patient, and organization outcomes.


Asunto(s)
Hospitales Rurales/organización & administración , Enfermeras Administradoras/organización & administración , Personal de Enfermería en Hospital/organización & administración , Actitud del Personal de Salud , Hospitales Rurales/normas , Humanos , Relaciones Interprofesionales , Liderazgo , Enfermeras Administradoras/normas , Personal de Enfermería en Hospital/normas , Estudios de Casos Organizacionales , Cultura Organizacional , Innovación Organizacional , Recursos Humanos
12.
West J Nurs Res ; 40(6): 775-778, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29471742

RESUMEN

Missed care is associated with adverse outcomes such as patient falls and decreased nurse job satisfaction. Although studied in populations of interest such as neonates, children, and heart failure patients, there are no studies about missed care in rural hospitals. Reducing care omissions in rural hospitals might help improve rural patient outcomes and ensure that rural hospitals can remain open in an era of hospital reimbursement dependent on care outcomes, such as through value-based purchasing. Understanding the extent of missed nursing care and its implications for rural populations might provide crucial information to alert rural hospital administrators and nurses about the incidence and influence of missed care on health outcomes. Focusing on missed care within rural hospitals and other rural health care settings is important to address the specific health needs of aging rural U.S. residents who are isolated from high-volume, urban health care facilities.


Asunto(s)
Hospitales Rurales/normas , Enfermería/normas , Evaluación del Resultado de la Atención al Paciente , Calidad de la Atención de Salud , Humanos , Enfermería/métodos , Personal de Enfermería en Hospital/normas
13.
Pediatr Emerg Care ; 34(1): 17-20, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29232353

RESUMEN

OBJECTIVES: Critical access hospitals (CAH) see few pediatric patients. Many of these hospitals do not have access to physicians with pediatric training. We sought to evaluate the impact of an in situ pediatric simulation program in the CAH emergency department setting on care team performance during resuscitation scenarios. METHODS: Five CAHs conducted 6 high-fidelity pediatric simulations over a 12-month period. Team performance was evaluated using a validated 35-item checklist representing commonly expected resuscitation team interventions. Checklists were scored by assigning zero point for "yes" and 1 point for "no". A lower final score meant more items on the list had been completed. The Kruskal-Wallis rank test was used to assess for differences in average scores among institutions. A linear mixed effects model with a random institution intercept was used to examine trends in average scores over time. P < 0.05 was considered significant. RESULTS: The Kruskal-Wallis rank test showed no difference in average scores among institutions. (P = 0.90). Checklist scores showed a significant downward trend over time, with a scenario-to-scenario decrease of 0.022 (P < 0.01). One hundred percent of providers surveyed in the last month stated they would benefit from ongoing scenarios. CONCLUSIONS: Regularly scheduled pediatric simulations in the CAH emergency department setting improved team performance over time on expected resuscitation tasks. The program was accepted by providers. Implementation of simulation-based training programs can help address concerns regarding pediatric preparedness in the CAH setting. A future project will look at the impact of the program on patient care and safety.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Hospitales Rurales/normas , Resucitación/educación , Entrenamiento Simulado/métodos , Lista de Verificación , Niño , Humanos , Grupo de Atención al Paciente/normas , Simulación de Paciente , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud
14.
Ann Surg ; 267(3): 473-477, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28288068

RESUMEN

OBJECTIVE: The aim of this study was to compare the surgical outcomes of emergency operations performed at critical access and non-critical access hospitals. BACKGROUND: Critical access hospitals are often the only source of surgical care for rural populations. Previous studies have demonstrated that patients undergoing common, elective operations at these rural hospitals have similar outcomes to their urban counterparts. Little is known, however, about the quality of care these hospitals provide for emergency operations for which they are most essential. METHODS: We performed a cross-sectional retrospective review of 219,170 urgent or emergency colon resections among Medicare beneficiaries between 2009 and 2012. We compared mortality, serious complications, reoperation, and readmission rates at critical access and non-critical access hospitals using a multivariable logistic regression to adjust for patient factors (age, sex, race, Elixhauser comorbidities,) indication (cancer, diverticulitis, obstruction, inflammatory bowel disease, bleeding), year of operation, and type of operation. RESULTS: Operative indications were similar at both critical access and non-critical access hospitals with the most common being cancer (38.5% vs 31.1%) followed by diverticulitis (26.9% vs 28.0%). Compared with patients treated at non-critical access hospitals, patients undergoing surgery at critical access hospitals were less likely to have multiple comorbid diseases (% of patients with 2 or more comorbid conditions, 67.5% vs 75.9%; P < 0.01). After accounting for these differences, patients in critical access hospitals had lower risk-adjusted 30-day mortality rates (14.3% vs 16.2%; P = 0.012) and lower rates of serious complications (11.1% vs 27.2%; P < 0.001). However, critical access hospitals had higher rates of reoperation (2.1% vs 1.4%; P = 0.009) and readmissions (22.3% vs 19.4%; P < 0.001). CONCLUSIONS: For emergency colectomy procedures, Medicare beneficiaries in critical access hospitals experienced lower mortality rates but more frequent reoperation and readmission. These findings suggest that critical access hospitals provide safe, essential emergency surgical care, but may need more resources for postoperative care coordination in these high-risk operations.


Asunto(s)
Colectomía/estadística & datos numéricos , Cuidados Críticos/normas , Urgencias Médicas , Hospitales Rurales/normas , Medicare/estadística & datos numéricos , Colectomía/mortalidad , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/normas , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos
15.
Afr J Prim Health Care Fam Med ; 9(1): e1-e8, 2017 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-28893080

RESUMEN

INTRODUCTION: Rural radiographers require, over and above traditional radiographic expertise, additional competencies which to a certain degree are unique however not limited to rural practice. Previous studies, however, have focused more attention primarily on other rural health professionals such as doctors and nurses leaving a research need in this field. This article focuses on the additional competencies that may be required for rural radiographers. AIM: To investigate and identify additional core competencies required by radiographers working in rural hospitals of KwaZulu-Natal in order to propose a continuous professional development strategy aimed at rural radiographers. METHODS: An exploratory sequential design was utilised with qualitative (Phase I) and quantitative (Phase II) strands involving seven participants and 109 respondents, respectively. Only radiographers working in rural KwaZulu-Natal hospitals were included in the study. The four major themes and categories identified in Phase I were used to develop data collection instrument for Phase II of the study. RESULTS: Collectively, the results revealed that there were a number of additional core competencies such as, but not limited to, teamwork, ability to do basic obstetric ultrasound scans, leadership, management and reporting on plain radiographs, all of which are required by rural radiographers. In 2014 when these competencies were checked against a single curriculum, it was found that majority of them were either partially covered or not at all covered. CONCLUSION: The study provides additional information on context specific core competencies and, therefore, may act as a catalyst to influence the future of radiographers working in rural areas of South Africa.


Asunto(s)
Competencia Clínica , Hospitales Rurales/normas , Radiografía/normas , Radiólogos/normas , Adulto , Curriculum , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Radiólogos/educación , Sudáfrica
16.
PLoS Negl Trop Dis ; 11(8): e0005847, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28827807

RESUMEN

INTRODUCTION: Sri Lanka records substantial numbers of snakebite annually. Primary rural hospitals are important contributors to health care. Health care planning requires a more detailed understanding of snakebite within this part of the health system. This study reports the management and epidemiology of all hospitalised snakebite in the Kurunegala district in Sri Lanka. METHODOLOGY: The district has 44 peripheral/primary hospitals and a tertiary care hospital-Teaching Hospital, Kurunegala (THK). This prospective study was conducted over one year. All hospitals received copies of the current national guidelines on snakebite management. Clinical and demographic details of all snakebite admissions to primary hospitals were recorded by field researchers and validated by comparing with scanned copies of the medical record. Management including hospital transfers was independently assessed against the national guidelines recommendation. Population rates were calculated and compared with estimates derived from recent community based surveys. RESULTS: There were 2186 admissions of snakebites and no deaths in primary hospitals. An additional 401 patients from the district were admitted directly to the teaching hospital, 2 deaths were recorded in this group. The population incidence of hospitalized snakebite was 158/100,000 which was significantly lower than community survey estimates of 499/100,000. However there was no significant difference between the incidence of envenomation of 126/100,000 in hospitalised patients and 184/100,000 in the community survey. The utilisation of antivenom was appropriate and consistent with guidelines. Seventy patients received antivenom. Anaphylactic reactions to antivenom occurred in 22 patients, treatment reactions was considered to be outside the guidelines in 5 patients. Transfers from the primary hospital occurred in 399(18%) patients but the majority (341) did not meet the guideline criteria. A snake was identified in 978 cases; venomous snakebites included 823 hump-nosed viper (Hypnalespp), 61 Russell's viper, 14 cobra, 13 common krait, 03 saw scaled viper. CONCLUSIONS: Primary hospitals received a significant number of snakebites that would be missed in surveys conducted in tertiary hospitals. Adherence to guidelines was good for the use of antivenom but not for hospital transfer or treatment of anaphylaxis. The large difference in snakebite incidence between community and hospital studies could possibly be due to non-envenomed patients not presenting. As the majority of snakebite management occurs in primary hospitals education and clinical support should be focused on that part of the health system.


Asunto(s)
Anafilaxia/epidemiología , Antivenenos/uso terapéutico , Hospitales Rurales/normas , Mordeduras de Serpientes/mortalidad , Mordeduras de Serpientes/terapia , Adulto , Anafilaxia/inducido químicamente , Animales , Antivenenos/efectos adversos , Bungarus , Femenino , Adhesión a Directriz , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Víbora de Russell , Sri Lanka/epidemiología , Resultado del Tratamiento
17.
Neurology ; 89(2): 144-152, 2017 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-28600460

RESUMEN

OBJECTIVE: Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). METHODS: Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years. RESULTS: At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals. CONCLUSIONS: Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures.


Asunto(s)
Servicio de Urgencia en Hospital/normas , Hospitales Rurales/normas , Hospitales Urbanos/normas , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Garantía de la Calidad de Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Enfermedad Aguda , Adulto , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Gambia , Hospitales Rurales/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia
18.
J Glob Health ; 7(1): 010411, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28567280

RESUMEN

BACKGROUND: Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services. METHODS: We report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before-and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries. RESULTS: The implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and outcomes to support continuous quality improvement. CONCLUSIONS: This study will evaluate the feasibility and sustainability issues in improving oxygen systems and providing reliable power on a large scale in remote rural settings in PNG, and the impact of this on child mortality from pneumonia over 3 years post-intervention. Taking a continuous quality improvement approach can be transformational for remote health services.


Asunto(s)
Países en Desarrollo/economía , Suministros de Energía Eléctrica/provisión & distribución , Hipoxia/complicaciones , Oximetría/instrumentación , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/provisión & distribución , Neumonía/mortalidad , Energía Solar/estadística & datos numéricos , Niño , Mortalidad del Niño , Preescolar , Países en Desarrollo/estadística & datos numéricos , Suministros de Energía Eléctrica/estadística & datos numéricos , Estudios de Factibilidad , Instituciones de Salud/estadística & datos numéricos , Hospitales Rurales/normas , Humanos , Hipoxia/terapia , Oximetría/economía , Papúa Nueva Guinea/epidemiología , Evaluación de Programas y Proyectos de Salud/métodos , Mejoramiento de la Calidad , Población Rural , Energía Solar/economía
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