Development of ACSC list as indicator of access and quality in primary careNeung Arnat
This study aimed to develop an Ambulatory Care Sensitive Conditions (ACSC) list in the Thai context based on consensus among Thai health professionals. The researchers conducted a qualitative study using the Delphi technique with 15 health professionals over two rounds. In the first round, the professionals provided opinions on ICD codes and their relationship to primary care in Thailand. Codes with lower consensus based on Kappa testing would be excluded. In the second round, the remaining codes would be assessed again to determine which reach an accepted consensus level to comprise the final ACSC list for Thailand. This list could then be used to measure access and quality of primary care by analyzing hospitalization rates for these conditions.
Clinical and ct features in pediatric patients with covid19 infection differe...gisa_legal
- The study examined 20 pediatric patients with COVID-19 infection confirmed by testing, analyzing their clinical features, lab results, and chest CT scans.
- Key findings included higher rates of procalcitonin elevation and coinfection compared to adults, as well as consolidation with surrounding halo signs on CT scans.
- The results suggest underlying coinfection may be more common in pediatric COVID-19 patients than adults, and consolidation with halo is a typical CT sign.
The study evaluated 51 patients who underwent laparoscopic cholecystectomy based on the informed consent form from the Association of Polish Surgeons. Despite signing the form, patient responses to a post-operative survey varied considerably. For some questions, over 40% of patients did not provide any response. The study concluded that obtaining informed consent may require further consideration, such as using multimedia resources, given the small sample size. Adherence to diet was identified as the most important post-operative recommendation by most patients.
This document summarizes the first experience using the prospective version of the Appropriateness Evaluation Protocol (AEP) in Portugal. The study evaluated 175 admissions to an internal medicine ward and found 17.7% were inappropriate, similar to other studies in Iberia. The most common reason for appropriateness was need for IV therapy. Admissions on weekends had longer average stays, suggesting improved elective care on weekends could help.
Classification and Regression Tree Analysis in Biomedical Research Salford Systems
This document discusses using classification and regression tree (CART) analysis to develop clinical decision rules for three clinical settings: 1) emergency department triage of HIV-infected patients, 2) survival prediction of patients with colon and rectal cancer, and 3) prediction of neurologic survival in patients following out-of-hospital cardiac arrest. For each setting, the document describes developing CART models using various clinical variables to classify patients into risk groups and reports validation results for predicting outcomes like medical urgency and survival.
A Study on Awareness of Needle sticks injury in students undergoing paramedic...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides an overview of oral diagnosis and laboratory investigation processes. It discusses obtaining a thorough medical history from patients, conducting comprehensive oral examinations, establishing differential diagnoses, and ordering appropriate laboratory tests and diagnostic imaging to reach final diagnoses. Key steps in the diagnostic process include gathering patient histories, examining patients, developing differential diagnoses, acquiring additional test results, and formulating treatment plans. The document also covers specific examination techniques, types of biopsy and imaging procedures, interpreting laboratory results, and documenting findings in SOAP notes.
Development of ACSC list as indicator of access and quality in primary careNeung Arnat
This study aimed to develop an Ambulatory Care Sensitive Conditions (ACSC) list in the Thai context based on consensus among Thai health professionals. The researchers conducted a qualitative study using the Delphi technique with 15 health professionals over two rounds. In the first round, the professionals provided opinions on ICD codes and their relationship to primary care in Thailand. Codes with lower consensus based on Kappa testing would be excluded. In the second round, the remaining codes would be assessed again to determine which reach an accepted consensus level to comprise the final ACSC list for Thailand. This list could then be used to measure access and quality of primary care by analyzing hospitalization rates for these conditions.
Clinical and ct features in pediatric patients with covid19 infection differe...gisa_legal
- The study examined 20 pediatric patients with COVID-19 infection confirmed by testing, analyzing their clinical features, lab results, and chest CT scans.
- Key findings included higher rates of procalcitonin elevation and coinfection compared to adults, as well as consolidation with surrounding halo signs on CT scans.
- The results suggest underlying coinfection may be more common in pediatric COVID-19 patients than adults, and consolidation with halo is a typical CT sign.
The study evaluated 51 patients who underwent laparoscopic cholecystectomy based on the informed consent form from the Association of Polish Surgeons. Despite signing the form, patient responses to a post-operative survey varied considerably. For some questions, over 40% of patients did not provide any response. The study concluded that obtaining informed consent may require further consideration, such as using multimedia resources, given the small sample size. Adherence to diet was identified as the most important post-operative recommendation by most patients.
This document summarizes the first experience using the prospective version of the Appropriateness Evaluation Protocol (AEP) in Portugal. The study evaluated 175 admissions to an internal medicine ward and found 17.7% were inappropriate, similar to other studies in Iberia. The most common reason for appropriateness was need for IV therapy. Admissions on weekends had longer average stays, suggesting improved elective care on weekends could help.
Classification and Regression Tree Analysis in Biomedical Research Salford Systems
This document discusses using classification and regression tree (CART) analysis to develop clinical decision rules for three clinical settings: 1) emergency department triage of HIV-infected patients, 2) survival prediction of patients with colon and rectal cancer, and 3) prediction of neurologic survival in patients following out-of-hospital cardiac arrest. For each setting, the document describes developing CART models using various clinical variables to classify patients into risk groups and reports validation results for predicting outcomes like medical urgency and survival.
A Study on Awareness of Needle sticks injury in students undergoing paramedic...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides an overview of oral diagnosis and laboratory investigation processes. It discusses obtaining a thorough medical history from patients, conducting comprehensive oral examinations, establishing differential diagnoses, and ordering appropriate laboratory tests and diagnostic imaging to reach final diagnoses. Key steps in the diagnostic process include gathering patient histories, examining patients, developing differential diagnoses, acquiring additional test results, and formulating treatment plans. The document also covers specific examination techniques, types of biopsy and imaging procedures, interpreting laboratory results, and documenting findings in SOAP notes.
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
Development of the A-DIVA Scale (Medicine) (1) - KopieLisette Puijn
This study developed and validated the A-DIVA scale, a predictive scale to identify adult patients at high risk of difficult intravenous access based on 5 clinical factors. Researchers prospectively observed 1063 adult patients undergoing a procedure requiring IV access. They found that 17% had failed first attempt cannulation. Through logistic regression, they identified 5 independent predictors of difficult access - poor vein palpability/visibility, history of difficult access, unplanned surgery, and small vein size. These factors were used to create the additive A-DIVA scale, which classified patients into low, medium, and high risk groups with failure rates of 5%, 37%, and 93% respectively. The A-DIVA scale provides a reliable method to prospectively
Incidence of Glaucoma & Diabetic Retinopathy in Patients with Diabetes Mellit...QUESTJOURNAL
Background: Vision is a means of communication of man with the external world. The impact of visual loss due to various ocular morbidities has profound implications for the person affected and the society as a whole. Diabetes has become one of the world’s most important public health problems & WHO indicate that 19% of world’s diabetic population lives in India. Diabetes related microvascular complications cause visual disability even in younger age group individuals. Aim: To estimate the magnitude of Glaucoma and diabetic retinopathy in diabetic patients in our institution. To create awareness about avoidable blindness in diabetic patients.To enlighten and thereby motivate the patient for further evaluation and follow up. Materials and methods: The study is a hospital- based , non- interventional, cross-sectional study. The ocular disorders are evaluated in 500 consecutive diabetic patients attending ophthalmology out patient department of Kanyakumari medical college hospital. Estimation of visual acuity, slit lamp examination, intraocular pressure, retinoscopy & fundus examination, visual field analysis , gonioscopy are done to detail the defective vision. Result analysis Data is analysed using SPSS. The common manifestations are cataract- 346 (69%), diabetic retinopathy- 94 patients (18.8%), glaucoma– 34 (6.8%). Patients with cataract are well managed by cataract extraction techniques. Prime importance is to create awareness and also diagnose the early changes of retinopathy and glaucoma.Treatment of glaucoma if instituted early will go a long way in preventing avoidable blindness Therefore periodic visual screening along with control of hyperglycemia and associated risk factors is needed to ensure good quality of vision.
The Universal Protocol is a set of procedures implemented in 2004 to prevent wrong site, wrong procedure, and wrong patient surgery. It includes three key elements: pre-procedure verification, marking the intended site, and conducting a time-out immediately before starting the procedure. The goal is to use data on adverse events collected by JCI to prevent similar errors in other healthcare organizations.
The document outlines various workflows for different services at a medical facility called Medi-Infotec. It describes patient flows for outpatient and inpatient services including appointments, consultations, admissions, discharges and billing. It also maps out workflows for specific departments like laboratory, radiology, OT, pharmacy, inventory management, credit notes and returns.
Max Neeman International is India’s leading contract research organization providing full range of clinical development services to small, mid-size and global pharmaceutical, biotech and medical device companies. The portfolio of the services include comprehensive Phase II-III clinical trials, regulatory submissions, phase IV post approval programs & commercialization services.
This document summarizes the history and current state of ambulatory surgery centers (ASCs) in the United States. It discusses how the first ASC opened in 1970 in Arizona and how the industry has grown significantly since then, with over 5,300 ASCs operating today. The document provides data on ASC procedures, specialties, ownership trends, and regulatory bodies like CMS that oversee ASCs.
This document discusses the benefits and necessity of day care surgery in India. It notes that day care surgery provides high quality surgery at affordable costs, providing both time and cost savings. It establishes that day care surgery can reduce costs to patients by at least 30% compared to corporate hospitals. The document then outlines various statistics that demonstrate the need for more accessible and affordable healthcare options in India, given factors like population size, income levels, and lack of public spending on health. It provides details on the work of the Indian Association of Day Surgery to promote and establish standards and protocols for day care centers across various medical specialties.
The Top 5 Ancillary Services For Urology PracticesClark Love
The document discusses potential ancillary services for urology practices to increase revenue. It identifies the top 5 services as: 1) lithotripsy, 2) CT/ultrasound equipment, 3) ambulatory surgery centers, 4) pathology labs, and 5) clinical labs. The document provides details on each service, noting benefits like facilitating comprehensive patient care, diversifying income streams, and offsetting losses from decreased reimbursement. It also discusses factors to consider when adding ancillary services like compliance, reimbursement rates, developing a financial model to determine feasibility, and properly marketing new services.
2018 ASH guidelines for management of venous thromboembolism prophylaxis fo...Vinh Pham Nguyen
1. The guidelines provide 19 recommendations for preventing venous thromboembolism (VTE) in hospitalized and non-hospitalized medical patients and long-distance travelers.
2. Strong recommendations include providing pharmacological VTE prophylaxis to acutely or critically ill hospitalized patients at low bleeding risk, and using mechanical prophylaxis for those at high bleeding risk.
3. Conditional recommendations suggest not routinely using VTE prophylaxis for long-term care patients, outpatients with minor risk factors, or low-risk long-distance travelers. Prophylaxis may be considered for high-risk groups such as recent surgery or cancer patients.
This document is a checklist used to assess standards and measurable elements for inpatient care at a healthcare facility. It covers areas like scope of service, patient safety goals, assessment of patients, patient and family education, and patient and family rights. For each standard, staff are asked questions to determine if the element is met, not met, not applicable, or not tested. Remarks can also be included. The goal is to evaluate areas like patient identification, communication, safety of medications, infection control, fall risk reduction, documentation, consent processes, privacy and more.
Patients are screened for risk of developing venous thromboembolism (VTE) using an assessment tool upon admission and within 24 hours. Patients at risk receive prophylaxis according to evidence-based guidelines, with treatment options ranging from pharmacological to mechanical based on the patient's risk level. Prophylaxis is reviewed when a patient's clinical status changes or twice weekly.
The document provides guidelines for echocardiography providers on imaging patients during the COVID-19 pandemic. It recommends (1) only imaging patients who will clinically benefit, (2) imaging in locations that minimize virus transmission risk, and (3) taking precautions like protective equipment and focused exams to protect providers. Providers should limit non-essential exams and involve only essential personnel to reduce exposure. Comprehensive exams may still be needed in some cases. Strict cleaning protocols are advised to prevent equipment contamination.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
The document summarizes three studies related to amputation prevention programs:
1) A retrospective analysis found that a comprehensive amputation prevention program at a community hospital decreased amputation rates from an average of 8.2% before the program to an average of 2.54% after, as more patients received diagnostic testing and interventions.
2) A treatment protocol for diabetic foot ulcers and Charcot deformities achieved successful limb salvage in 92% of patients through staged reconstruction and proper pre-operative vascular evaluation.
3) Implementing skin perfusion pressure (SPP) testing identified 80% of patients as having peripheral artery disease who had normal ankle-brachial indices, allowing for improved treatment and no major amputations
This document discusses patient flow management in an outpatient department. It aims to understand problems patients face such as long wait times, identify bottlenecks causing delays, and recommend solutions. Data was collected through observation of 300 random patients to record wait times at various stages. On average, patients waited longest for doctor consultation at 37.1 minutes and report dispatch at 63.1 minutes. The analysis found the main bottlenecks were improper scheduling of doctors and radiologists, leading to delayed report dispatch. Solutions are suggested to improve patient care delivery and optimize patient flow.
This document discusses day care surgery performed at a tertiary level hospital in India from 2014-2017. Some key points:
- Over 4,500 day care surgical procedures and 2,757 outpatient procedures were performed. Only 212 (2.9%) day care patients required admission.
- The benefits of day care surgery include lower costs (20-75% less than inpatient), increased access to treatment, and improved patient satisfaction.
- Common low-risk procedures performed included hernia repairs, hydrocele operations, circumcisions, and hemorrhoidectomies. Local anesthesia and short-acting general anesthesia were primarily used.
The Malaysian National Stroke Registry was initiated in 2009 to evaluate the quality of ischemic stroke care using nine key performance indicators developed by the CDC, American Heart Association, and Joint Commission. This study analyzed data from the registry for patients admitted to Hospital Sultanah Nur Zahirah between 2010-2014. It found improvements over time for most indicators, such as increasing rates of DVT prophylaxis, anticoagulation for atrial fibrillation, and patients discharged on medications. The study aims to assess trends in the nine indicators and quality of stroke management at this hospital.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
CHC15 - EHR adoption in a european environment and public management hospital...Carlos Sousa
SOURCE:
Invited speaker for CERNER HEALTH CONFERENCE, Educational Session, held during Oct 11-14 in Kansas City (MO) - US.
ABSTRACT:
After 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
Prospective Study of Acute Appendicitis with its Clinical, Radiological Profi...semualkaira
Acute appendicitis is the most common condition encountered in general surgical practice. Alvarado and Modified Alvarado Scores (MASS) are the commonly used scoring
systems for its diagnosis, but its performance has been found to
be poor in certain populations. Hence, we compared the RIPASA
score with MASS, to find out which is a better diagnostic tool for
acute appendicitis in the Indian population.
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
Development of the A-DIVA Scale (Medicine) (1) - KopieLisette Puijn
This study developed and validated the A-DIVA scale, a predictive scale to identify adult patients at high risk of difficult intravenous access based on 5 clinical factors. Researchers prospectively observed 1063 adult patients undergoing a procedure requiring IV access. They found that 17% had failed first attempt cannulation. Through logistic regression, they identified 5 independent predictors of difficult access - poor vein palpability/visibility, history of difficult access, unplanned surgery, and small vein size. These factors were used to create the additive A-DIVA scale, which classified patients into low, medium, and high risk groups with failure rates of 5%, 37%, and 93% respectively. The A-DIVA scale provides a reliable method to prospectively
Incidence of Glaucoma & Diabetic Retinopathy in Patients with Diabetes Mellit...QUESTJOURNAL
Background: Vision is a means of communication of man with the external world. The impact of visual loss due to various ocular morbidities has profound implications for the person affected and the society as a whole. Diabetes has become one of the world’s most important public health problems & WHO indicate that 19% of world’s diabetic population lives in India. Diabetes related microvascular complications cause visual disability even in younger age group individuals. Aim: To estimate the magnitude of Glaucoma and diabetic retinopathy in diabetic patients in our institution. To create awareness about avoidable blindness in diabetic patients.To enlighten and thereby motivate the patient for further evaluation and follow up. Materials and methods: The study is a hospital- based , non- interventional, cross-sectional study. The ocular disorders are evaluated in 500 consecutive diabetic patients attending ophthalmology out patient department of Kanyakumari medical college hospital. Estimation of visual acuity, slit lamp examination, intraocular pressure, retinoscopy & fundus examination, visual field analysis , gonioscopy are done to detail the defective vision. Result analysis Data is analysed using SPSS. The common manifestations are cataract- 346 (69%), diabetic retinopathy- 94 patients (18.8%), glaucoma– 34 (6.8%). Patients with cataract are well managed by cataract extraction techniques. Prime importance is to create awareness and also diagnose the early changes of retinopathy and glaucoma.Treatment of glaucoma if instituted early will go a long way in preventing avoidable blindness Therefore periodic visual screening along with control of hyperglycemia and associated risk factors is needed to ensure good quality of vision.
The Universal Protocol is a set of procedures implemented in 2004 to prevent wrong site, wrong procedure, and wrong patient surgery. It includes three key elements: pre-procedure verification, marking the intended site, and conducting a time-out immediately before starting the procedure. The goal is to use data on adverse events collected by JCI to prevent similar errors in other healthcare organizations.
The document outlines various workflows for different services at a medical facility called Medi-Infotec. It describes patient flows for outpatient and inpatient services including appointments, consultations, admissions, discharges and billing. It also maps out workflows for specific departments like laboratory, radiology, OT, pharmacy, inventory management, credit notes and returns.
Max Neeman International is India’s leading contract research organization providing full range of clinical development services to small, mid-size and global pharmaceutical, biotech and medical device companies. The portfolio of the services include comprehensive Phase II-III clinical trials, regulatory submissions, phase IV post approval programs & commercialization services.
This document summarizes the history and current state of ambulatory surgery centers (ASCs) in the United States. It discusses how the first ASC opened in 1970 in Arizona and how the industry has grown significantly since then, with over 5,300 ASCs operating today. The document provides data on ASC procedures, specialties, ownership trends, and regulatory bodies like CMS that oversee ASCs.
This document discusses the benefits and necessity of day care surgery in India. It notes that day care surgery provides high quality surgery at affordable costs, providing both time and cost savings. It establishes that day care surgery can reduce costs to patients by at least 30% compared to corporate hospitals. The document then outlines various statistics that demonstrate the need for more accessible and affordable healthcare options in India, given factors like population size, income levels, and lack of public spending on health. It provides details on the work of the Indian Association of Day Surgery to promote and establish standards and protocols for day care centers across various medical specialties.
The Top 5 Ancillary Services For Urology PracticesClark Love
The document discusses potential ancillary services for urology practices to increase revenue. It identifies the top 5 services as: 1) lithotripsy, 2) CT/ultrasound equipment, 3) ambulatory surgery centers, 4) pathology labs, and 5) clinical labs. The document provides details on each service, noting benefits like facilitating comprehensive patient care, diversifying income streams, and offsetting losses from decreased reimbursement. It also discusses factors to consider when adding ancillary services like compliance, reimbursement rates, developing a financial model to determine feasibility, and properly marketing new services.
2018 ASH guidelines for management of venous thromboembolism prophylaxis fo...Vinh Pham Nguyen
1. The guidelines provide 19 recommendations for preventing venous thromboembolism (VTE) in hospitalized and non-hospitalized medical patients and long-distance travelers.
2. Strong recommendations include providing pharmacological VTE prophylaxis to acutely or critically ill hospitalized patients at low bleeding risk, and using mechanical prophylaxis for those at high bleeding risk.
3. Conditional recommendations suggest not routinely using VTE prophylaxis for long-term care patients, outpatients with minor risk factors, or low-risk long-distance travelers. Prophylaxis may be considered for high-risk groups such as recent surgery or cancer patients.
This document is a checklist used to assess standards and measurable elements for inpatient care at a healthcare facility. It covers areas like scope of service, patient safety goals, assessment of patients, patient and family education, and patient and family rights. For each standard, staff are asked questions to determine if the element is met, not met, not applicable, or not tested. Remarks can also be included. The goal is to evaluate areas like patient identification, communication, safety of medications, infection control, fall risk reduction, documentation, consent processes, privacy and more.
Patients are screened for risk of developing venous thromboembolism (VTE) using an assessment tool upon admission and within 24 hours. Patients at risk receive prophylaxis according to evidence-based guidelines, with treatment options ranging from pharmacological to mechanical based on the patient's risk level. Prophylaxis is reviewed when a patient's clinical status changes or twice weekly.
The document provides guidelines for echocardiography providers on imaging patients during the COVID-19 pandemic. It recommends (1) only imaging patients who will clinically benefit, (2) imaging in locations that minimize virus transmission risk, and (3) taking precautions like protective equipment and focused exams to protect providers. Providers should limit non-essential exams and involve only essential personnel to reduce exposure. Comprehensive exams may still be needed in some cases. Strict cleaning protocols are advised to prevent equipment contamination.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
The document summarizes three studies related to amputation prevention programs:
1) A retrospective analysis found that a comprehensive amputation prevention program at a community hospital decreased amputation rates from an average of 8.2% before the program to an average of 2.54% after, as more patients received diagnostic testing and interventions.
2) A treatment protocol for diabetic foot ulcers and Charcot deformities achieved successful limb salvage in 92% of patients through staged reconstruction and proper pre-operative vascular evaluation.
3) Implementing skin perfusion pressure (SPP) testing identified 80% of patients as having peripheral artery disease who had normal ankle-brachial indices, allowing for improved treatment and no major amputations
This document discusses patient flow management in an outpatient department. It aims to understand problems patients face such as long wait times, identify bottlenecks causing delays, and recommend solutions. Data was collected through observation of 300 random patients to record wait times at various stages. On average, patients waited longest for doctor consultation at 37.1 minutes and report dispatch at 63.1 minutes. The analysis found the main bottlenecks were improper scheduling of doctors and radiologists, leading to delayed report dispatch. Solutions are suggested to improve patient care delivery and optimize patient flow.
This document discusses day care surgery performed at a tertiary level hospital in India from 2014-2017. Some key points:
- Over 4,500 day care surgical procedures and 2,757 outpatient procedures were performed. Only 212 (2.9%) day care patients required admission.
- The benefits of day care surgery include lower costs (20-75% less than inpatient), increased access to treatment, and improved patient satisfaction.
- Common low-risk procedures performed included hernia repairs, hydrocele operations, circumcisions, and hemorrhoidectomies. Local anesthesia and short-acting general anesthesia were primarily used.
The Malaysian National Stroke Registry was initiated in 2009 to evaluate the quality of ischemic stroke care using nine key performance indicators developed by the CDC, American Heart Association, and Joint Commission. This study analyzed data from the registry for patients admitted to Hospital Sultanah Nur Zahirah between 2010-2014. It found improvements over time for most indicators, such as increasing rates of DVT prophylaxis, anticoagulation for atrial fibrillation, and patients discharged on medications. The study aims to assess trends in the nine indicators and quality of stroke management at this hospital.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
CHC15 - EHR adoption in a european environment and public management hospital...Carlos Sousa
SOURCE:
Invited speaker for CERNER HEALTH CONFERENCE, Educational Session, held during Oct 11-14 in Kansas City (MO) - US.
ABSTRACT:
After 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
Prospective Study of Acute Appendicitis with its Clinical, Radiological Profi...semualkaira
Acute appendicitis is the most common condition encountered in general surgical practice. Alvarado and Modified Alvarado Scores (MASS) are the commonly used scoring
systems for its diagnosis, but its performance has been found to
be poor in certain populations. Hence, we compared the RIPASA
score with MASS, to find out which is a better diagnostic tool for
acute appendicitis in the Indian population.
Using real-world evidence to investigate clinical research questionsKarin Verspoor
Adoption of electronic health records to document extensive clinical information brings with it the opportunity to utilise that information to support clinical research, and ultimately to support clinical decision making. In this talk, I discuss both these opportunities and the challenges that we face when working with real-world clinical data, and introduce some of the strategies that we are adopting to make this data more usable, and to extract more value from it. I specifically discuss the use of natural language processing to transform clinical documentation into structured data for this purpose.
Current Pharmacovigilance Practice And Improving Methodsavinashkhairnar
1. The document discusses the history and current state of pharmacovigilance in India, including the establishment of the National Pharmacovigilance Programme in 2004 and challenges faced.
2. Methods to improve pharmacovigilance are proposed, including intensive event monitoring, consumer reporting, use of triggers to identify adverse drug reactions, and monitoring laboratory values for early detection of adverse reactions.
3. A proposed structure is described to strengthen pharmacovigilance in India through collaboration between various stakeholders like consumers, healthcare professionals, and the regulatory authority.
Compliance of icd 10 in hospitals of pune Jenny Mishra
The document discusses a case study on the compliance of ICD-10 coding in hospitals in Pune, India. It found that larger hospitals with over 200 beds have generally implemented ICD-10, while smaller hospitals under 100 beds have lower compliance. Clinicians have varying awareness of ICD-10, from knowing it is used for mortality reporting to being unaware of its purpose. Challenges to compliance included improper diagnosis documentation and a lack of electronic methods and software. Recommendations include cost-benefit analyses, training, and customized software to improve ICD-10 implementation.
British Journal of Anaesthesia, 120(1) 146e155 (2018)doiVannaSchrader3
British Journal of Anaesthesia, 120(1): 146e155 (2018)
doi: 10.1016/j.bja.2017.08.002
Advance Access Publication Date: 23 November 2017
Quality and Safety
Q U A L I T Y A N D S A F E T Y
The surgical safety checklist and patient outcomes
after surgery: a prospective observational cohort
study, systematic review and meta-analysis
T.E.F. Abbott1, T. Ahmad1, M.K. Phull2, A.J. Fowler3, R. Hewson2,
B.M. Biccard4, M.S. Chew5, M. Gillies6 and R.M. Pearse1,*, for the
International Surgical Outcomes Study (ISOS) groupa
1William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK, 2The Royal
London Hospital, Barts Health NHS Trust, London E1 1BB, UK, 3Guys and St. Thomas’s NHS Foundation
Trust, London SE1 7EH, UK, 4Department of Anaesthesia and Perioperative Medicine, Groote Schuur
Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 5Department of
Anaesthesia and Intensive Care, Faculty of Medicine and Health Sciences, Link€oping University, 58185
Link€oping, Sweden and 6Department of Anaesthesia, Critical Care and Pain Medicine, University of
Edinburgh, Edinburgh EH48 3DF, UK
*Corresponding author. E-mail: [email protected]
a Complete details for the collab authors are available in Supplementary data.
Abstract
Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians
continue to debate the clinical effectiveness of this tool.
Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international obser-
vational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published
literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the
secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear
model was used to test associations. To further contextualise these findings, we included the results from the ISOS
cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.
Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%)
patients exposed to the checklist, whilst 7508 (16.8%) sustained �1 postoperative complications and 207 (0.5%) died
before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32e0.77);
P<0.01], but no difference in complication rates [OR 1.02 (0.88e1.19); P¼0.75]. In a systematic review, we screened 3732
records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated
with both reduced postoperative mortality [OR 0.75 (0.62e0.92); P<0.01; I2¼87%] and reduced complication rates [OR 0.73
(0.61e0.88); P<0.01; I2¼89%).
Conclusions: Patients exposed to a surgical safety checklist experience bett ...
Compliance of icd 10 in hospitals of pune Jenny Mishra
The document discusses a case study on the compliance of ICD-10 coding in hospitals in Pune, India. It found that larger hospitals with more than 200 beds have generally implemented ICD-10, while smaller hospitals below 100 beds have lower compliance. Clinicians have varying awareness of ICD-10, from knowing it is used for mortality reporting to being unaware of its purpose. Challenges to compliance included improper diagnosis documentation and a lack of electronic health record systems and staff training. Recommendations include cost-benefit analyses, training programs, and integrating ICD-10 into medical education curricula.
Compliance of icd 10 in hospitals of pune Jenny Mishra
The document discusses a case study on the compliance of ICD-10 coding in hospitals in Pune, India. It found that larger hospitals with more than 200 beds have generally implemented ICD-10, while smaller hospitals below 100 beds have lower compliance. Clinicians have varying awareness of ICD-10, from knowing it is used for mortality reporting to being unaware of its purpose. Challenges to compliance included improper diagnosis documentation and a lack of electronic methods and software. Recommendations include cost-benefit analyses, training, and customized software to improve ICD-10 implementation.
Assessing the quality of the management skills required for lower respiratory...Ben Mbwele
1) The study assessed the quality of care for lower respiratory tract infections (LRTI) provided by clinicians in Tanzania by analyzing patient files and interviewing clinicians.
2) It found that medications prescribed for LRTI varied greatly between patient files and clinicians' responses. No files showed attempts to assess the severity of pneumonia.
3) Only a small minority of clinicians could correctly identify atypical causes of pneumonia like Q-fever or mention appropriate treatment guidelines. Monitoring of patient progress was not consistent across different levels of care facilities.
The National Confidential Enquiry into Peri-operative Deaths (NCEPOD) was established in the UK in 1988 to comprehensively and authoritatively review clinical practice surrounding deaths within 30 days of surgery. NCEPOD aims to maintain and improve standards of care for both adults and children through confidential case reviews, research, and publishing results. The National Early Warning Score (NEWS) is an excellent initiative that helps staff recognize patient deterioration earlier through standardized scoring of physiological parameters, enabling sicker patients to receive timely intensive care.
The Integrated Disease Surveillance Project (IDSP) aims to establish a decentralized disease surveillance system in India to improve disease control. It integrates existing surveillance programs, coordinates surveillance activities, and establishes quality data collection, analysis, and feedback using information technology. The IDSP covers diseases like malaria, acute diarrheal diseases, tuberculosis, and measles. It is implemented in phases across states and union territories of India and involves strengthening laboratories, training health professionals, and creating an IT network to link surveillance sites. The goal is to provide data to enable efficient public health decision making and interventions for priority diseases.
Lisa Hancock OIG Board Quality PresentationLisa Hancock
IU Medical Group's quality improvement goals are to decrease mortality and morbidity, increase patient satisfaction, improve patient safety, and link these goals to management accountability. Metrics such as UHC reports and patient satisfaction surveys are used to measure progress. Clinical department chairs must annually report progress on these goals to the board. The organization utilizes numerous quality reports and surveys to measure and improve patient care. Each clinical department is responsible for quality and safety programs within their department.
This document proposes establishing the Pan-Asian Resuscitation Outcomes Study (PAROS) to track out-of-hospital cardiac arrest across Asia. It would collect data on incidence, outcomes, and emergency medical systems from multiple countries to allow for comparisons and identify best practices. The study would be modeled after the Cardiac Arrest and Resuscitation Epidemiology study in Singapore and involve over 13,000 cases collected electronically using common definitions and procedures. Participating countries would study populations totaling over 100 million people. The goal is to understand and improve resuscitation systems to reduce deaths from out-of-hospital cardiac arrest across the region.
Thailand has successfully implemented universal access to antiretroviral therapy (ART) through its universal health coverage (UHC) scheme. The country established its ART program in 2006, providing ART to over 176,000 people living with HIV by 2013. Key factors in Thailand's success include establishing a national ART database to coordinate drug supply and reimbursement, centralized drug procurement to reduce costs, and routine laboratory monitoring of patients on treatment. Through these measures, Thailand has achieved universal access to HIV treatment while maintaining a low average cost of less than $1 per patient per day.
adult inpatient care and inpatient experience presentation - uhnd.pptAnanthakrishnanC2
This document summarizes an audit of inpatient care and experience for adults with ulcerative colitis in the UK. It discusses two parts of the audit: 1) Inpatient care, which assessed treatment for patients admitted to hospitals, collecting data on over 4,000 admissions. Key indicators like mortality, previous admissions, and medication use are presented. 2) Inpatient experience, which assessed patient care quality through nearly 1,700 post-discharge questionnaires. Key indicators like ratings of care, confidence in doctors, pain control, and cleanliness are presented. The document concludes with recommendations to improve inpatient care and experience based on the audit results.
Stroke in India: Disease, systems, and TreatmentDr Vipul Gupta
The document discusses mechanical thrombectomy for stroke treatment in India. It summarizes several key trials from 2015 that supported the use of endovascular therapy. The AHA/ASA 2015 guidelines recommend endovascular therapy with a stent retriever for certain stroke patients. The document then reviews the epidemiology of stroke in India and prevalence of intracranial atherosclerotic disease. It provides an overview of the current state of mechanical thrombectomy in India, including the limited number of centers (around 60) and cases performed annually. Challenges to further adoption are discussed like lack of training programs, guidelines, infrastructure and public awareness. Potential solutions proposed include dedicated training programs, developing a consensus on standards, and increasing awareness through education
Similar to Ambulatory care sensitive conditions (20)
2013 jiraluck how can stroke patients have better accessibility to stroke fas...Neung Arnat
In Thailand, the mortality rate from strokes has been increasing, reaching 24.3 deaths per 100,000 people in 2005. From 2008 to 2010, the prevalence of strokes rose from 216.6 to 307.9 cases. Conditions like diabetes, hypertension, and hyperlipidemia are major contributors to strokes and heart attacks. To prevent strokes and their complications, Thailand implemented a Stroke Fast Track policy in 2009. This policy aimed to increase accessibility to stroke care and reduce mortality and disability rates through measures like subsidizing CT scans, thrombolytic drugs, physical therapy, and home visits. However, similar policies did not exist for civil servants and social security. Additionally, low utilization of thrombolytic drugs remains an issue partly due to lack
2013 phatthanawilai impact of elective surgery in private hospitals under the...Neung Arnat
This study assessed the impact of allowing elective surgeries in private hospitals under Thailand's Civil Servant Medical Benefit Scheme (CSMBS). It analyzed utilization trends and expenditures for cataract surgery, childbirth and knee replacement before and after the 2011 policy change. The findings showed increased access and utilization of cataract surgery, especially among universal coverage patients. However, expenditures for knee replacement posed a significant burden on patients due to co-payments. Overall, allowing elective surgeries in private hospitals increased access but also increased costs for CSMBS, though expenditures remained a small portion of national healthcare spending. The study recommends expanding participation of private hospitals and covered procedures.
2013 harmonization of three public health insurance schemes on emergency medi...Neung Arnat
This study analyzed the effects of harmonizing Thailand's three public health insurance schemes (UCS, SSS, CSMBS) on emergency medical services policy. The study found that:
1) Most emergency patients were of working age, and half were aware of the new policy, though many did not fully understand its provisions.
2) While the policy aimed to provide free emergency care, most patients still had to pay upfront and seek reimbursement.
3) Access to emergency services was often through self-referral to hospitals rather than the emergency medical hotline 1669, indicating a need to improve the emergency response system.
The recommendations were to better promote the emergency hotline, prevent up
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
1. Development of Ambulatory Care Sensitive
Conditions (ACSC) in Thai Context:
Hospitalization Rates for ACSC as Indicator
of Access and Quality in Primary Care
HealthInsuranceSystemResearchOffice
สำำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย เครือ
Arnat Wannasri. (Master student: NU; HISRO);
Nipaporn, S., Inmai, P., Sakunphanit, P., Srithamrongsawat, S., (HISRO);
Suriyawongpaisal, P. (Faculty of Medicine Ramathibodi Hospital, Mahidol University)
3. Introduction
HealthInsuranceSystemResearchOffice
สำำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย เครือ
•Healthcare infrastructures in Thailand have been developed
for many decades to improve access to health care and equity
of service utilization across the country.
•Three levels of health care service system: Primary,
Secondary and Tertiary.
•Outpatient utilization rate: 2.45 visits/person in 2003 3.22
visits/person in 2010.
•Better accessibility and what about the quality?
population-based surveys!
•ACSC rate as indicator: helps states assess the quality of
and access to primary health care services, but “what is
ACSC list of Thailand?”
6. Methodology
HealthInsuranceSystemResearchOffice
สำำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย เครือ
2) The health professional’s criteria:
- have experiences with primary care system more than
10 years
3) Questionnaire development
- Review of international and national literature
- Identified ICD-9, ICD-10 and procedure codes
- Analysing of hospitalization rates of each ICD code:
using public health insurance database of 3 health
schemes
- Making a questionnaire
7. Methodology
HealthInsuranceSystemResearchOffice
สำำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย เครือ
4) Selection ACSC list: Consensus panel process
- 15 professionals give opinions: relationship between
ICD-code and primary care in the Thai context.
- 2 rounds for consensus (during July and August, 2013)
- Kappa test: analysing consensus level ( 0.41)≥
Kappa Interpretation
< 0 Poor agreement
0.0 – 0.20 Slight agreement
0.21 – 0.40 Fair agreement
0.41 – 0.60 Moderate agreement
0.61 – 0.80 Substantial agreement
0.81 – 1.00 Almost perfect agreement
11. Next step
• Consensus panel round 1
Kappa test analysis
ICD codes with lower consensus level ( 0.41) will be≤
excluded.
All relevant data will be used for the second round
• Consensus panel round 2
Kappa test analysis
ICD codes with accepted consensus level will be used as
ACSC list in the Thai context.
HealthInsuranceSystemResearchOffice
สำำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย เครือ