The importance of the hospital in Canadian society is undisputed. Despite this, the hospital has traditionally received relatively little attention from the archival community. It is only now becoming apparent to both hospital administrators and archivists that this situation must change if the valuable records contained in hospitals are to be preserved. This thesis examines the archival preservation of hospital records, concluding that their retention is of great benefit to those operating the institution as well as the rest of society and that this preservation can be effectively carried out if certain basic considerations are borne in mind. Before archival operations are established in a hospital, it is necessary to investigate various aspects of the institution and its record keeping practices. It is only when the nature and uses of these records are understood that effective programmes can be implemented. A hospital archives will not achieve its full potential unless it is established on a sound foundation with adequate policy and resources. Similarly, the records contained therein must be properly appraised to ensure all the valuable material is retained and protected from improper access. Through an investigation of these and related issues, the viability of hospital archives will be confirmed. / Arts, Faculty of / Library, Archival and Information Studies (SLAIS), School of / Graduate

A sample of motor vehicle accident victims hospitalized at Vancouver General Hospital, Vancouver, British Columbia, was chosen to analyze the relationship between hospital costs and the severity of the patient's injury or illness. Severity was measured using two scales, specifically, the Injury Severity Scale and the Abbreviated Injury Scale. Hospital costs were also measured, using two different methodologies. The first was the Per Diem costs that were derived by dividing all related annual costs by the number of patient separation days in 1975. A Per Diem episodic cost was determined by multiplying length of stay by the daily average cost. The second approach used a step-down technique that distributed all non-patient care related hospital services across direct patient care departments, cost centres or programs. Unit costs were then developed for each cost centre, depending upon their annual workload. The 1975 medical record for each patient in the sample was analyzed to determine the number of work units used in each cost centre during the patient's hospital stay. A Step-Down episodic cost was determined by totalling all costs from each cost centre that provided services to the patient. A paired t-Test did not show a significant difference between the Per Diem and Step-Down episodic costs. It was assumed that the range of severity of the patient in the sample weakened this t-Test, severity measured by I.S.S. was grouped in low, medium, and high categories, or when severity was measured by A.I.S., the paired t-Test did show that there was a significant difference in the two costing methodologies. The regression analysis identified a significant relationship between both episodic costs and severity. The strongest relationship occurred when severity was measured by I.S.S. and costs were determined, using the Step-Down methodology (R² = 0.26, F = 35.45). When other related independent variables (i.e., death as outcome and operation not performed) and all interaction terms were introduced, the regression co-efficient increased to R² = 0.45 and the F value increased to F = 24.9. Recommendations were made to include a severity rating on all hospitalized patients' records to assist in patient classification. A final outcome of this study was identifying the value of a Step-Down approach to determining hospital costs and identifying the limitations of the Per Diem methodology of hospital accounting. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Orientador: Maria Cecilia Cardoso Benatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-03T15:15:16Z (GMT). No. of bitstreams: 1 Pousa_PatriciaCarneiroPessoa_M.pdf: 31527975 bytes, checksum: b42e3e92d950fc4c099cc7c2de7e364f (MD5) Previous issue date: 2002 / Resumo: Os acidentes do trabalho tem sido objeto de estudo por parte dos profissionais que atuam na área da Saúde do Trabalhador - vivenciar este problema é conhecer as conseqüências que acarreta na saúde do trabalhador e no processo produtivo da empresa. Hoje quando a conquista da cidadania é crescente é impossível, na dinâmica diária do trabalho, ignorar que o acidente e a série de danos que acarreta faz parte da realidade. Feito por uma profissional da área, este trabalho analisa aspectos epidemiológicos dos acidentes do trabalho em uma instituição hospitalar privada de Campinas - São Paulo, no período de 1° de janeiro de 1996 a 31 de dezembro de 2000. O objetivo é comparar os resultados com a literatura disponível, cujos referenciais são instituições públicas. Foram ressaltados os aspectos epidemiológicos ligados a dados referentes aos trabalhadores acidentados; dados referentes aos acidentados na empresa e dados referentes aos acidentes ocorridos. O instrumento utilizado para a coleta de dados foi a Comunicação de Acidente de Trabalho - CAT. A partir das variáveis estudadas é possível afirmar em relação a dados referentes aos trabalhadores que os acidentes do trabalho ocorreram predominantemente em trabalhadores na faixa etária de 19 -29, com ocorrência discretamente maior para trabalhadores do sexo feminino. Em relação a dados referentes aos trabalhadores acidentados do hospital, dos acidentes estudados os auxiliares de enfermagem apresentaram proporcionalmente a maior acidentalidade, o que levou a uma análise das características do trabalho desta categoria. Em relação a dados referentes aos acidentes, merecem ser mencionados aqui, os altos índices de acidentes de trajeto e o fato de que o local com maior número de ocorrências foi a área do Serviço de Nutrição e Dietética. Os dados analisados indicam que 70% dos acidentes ocorreram nas unidades de trabalho, sendo que a causa ou o objeto causador de maior índice de acidentes foi o material do tipo perfurocortante. Os membros superiores, principalmente as mãos, foram as regiões mais atingidas. Acredita-se que em função do modelo de gestão do hospital, é nítida uma significativa e crescente queda no número absoluto de acidentes no decorrer do período abordado por este estudo. Para avaliar esta importante tendência foram extraídos, do modelo de gestão adotado, os referenciais e formas de atuação que o delineiam: conscientização, formas organizacionais e recursos materiais. Acredita-se que este estudo irá contribuir para mudanças futuras do quadro atual / Abstract: The accidents of work have been study object for professionals who work in the of Workers' Health area. Fully experiencing such problem is to know the consequences that they bring about to the health of the worker and to the productive process of an enterprise. Nowadays, when the conquest of the citizenship has been increasing, it is impossible, in the daily dynamics of work, to ignore that accidents and the series of damages they cause are part of reality. This work - done by a professional in the area - analyzes the epidemiological aspects of accidents of work at a private hospital institution in Campinas, São Paulo, from January 1st, 1996 through December 31st, 2000. Its purpose is to compare its results with the available literature - whose referentials are the public institutions - and to present suggestions for reduction of accidents of work. The accidents were approached from the humanist point of view which has the human being as its highest priority. Emphases were given to the epidemiological aspects connected to the affected population, temporal distribution, missed days of work and the place where the accidents happened. The instrument used for the collection of data was the ACCIDENT OF WORK REPORT (AWR). From the studied variables it is possible to state that the risk of accidents of work is discreetly bigger for female workers; thus being, it was necessary to ponder the woman's role in the society. The nurse aid showed they are more accident-prone, which led to an analysis of the work features of this category. Other two relevant points to be mentioned here are: the high level of passage accidents and the fact that the place with the highest number of accident occurrences was the Nutrition and Dietary Service area. Due to the hospital management model, it is clear the significant and increasing fali in the absolute number of accidents during the elapsed time approached by this study. In order to evaluate such important trend, the referentials and the forms of action which delineate the adopted management model were extracted. They are: awareness, organizational forms and material resources.We believe that this study will aggregate value for future changes in the present situation / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Children, who are the future of the country, are the most important asset. If cancer in children is diagnosed at an early stage, effective precautionary measures can be taken in order to save their lives. Children sense their physical space in a very immediate and detailed manner and their response to spaces can be far more direct and energetic than adults. For children, visiting hospitals can be particularly difficult emotionally, as they are stressed by ill-health, painful medical procedures. The objectives of this research are first to understand what constitutes a supportive pediatric setting from children’s and adolescents’ perspectives and try to explore the role of architecture in making hospital stays more pleasant. Second, to define a vision for the sustainable hospital design movement; and third, to illustrate the value of participatory research for healthcare design. The outline is a new design of the children hospital and how architectural design steps can be taken to improve cancer patients’ care.

Objetivo: Evaluar la utilidad del índice de PCR/albúmina como factor predictor de mortalidad a los 30 días en menores de 5 años hospitalizados por neumonía adquirida en la comunidad en un hospital peruano. Doseño: Se realizará un estudio analítico observacional de cohorte retrospectiva. Este evaluará las historias clínicas sistematizadas desde el año 2015 al 2020 de los pacientes menores de 5 años con neumonía adquirida en la comunidad. La sede del estudio es el hospital Edgardo Rebagliati Martins, ubicado en el distrito de Jesús María en el departamento de Lima Metropolitana. Este hospital de referencia (categoría III-2), fue construido en 1958 bajo el nombre de “Hospital del empleado”, y se caracteriza por su especialización y alta capacidad resolutiva en enfermedades de complejidad.

1 / SPK / archives@tulane.edu

The quality of human life is eternally dependent on the harmony of man and his environment. Man’s basic needs are food, clothing and shelter. As society has advanced his expectations of life has grown to enhancement and fulfillment. This is only possible through what is “justly referred to as the most complex of contemporary social institutions.” 1 The hospital. Conversely where man finds life he also finds one of the leading causes of death. One in every twenty five hospital patients are affected by a hospital-acquired infection (HAI).2 The architects behind hospitals are not only responsible for impacting the emotional experience of the space but the health of the patients being cared for and the staff who is tending to them. The design is thereby crucial to the hospital’s success at treating patients and keeping them healthy. The current design process begins with new relationships between each of the essential entities. The design suffers from these “tabula rasa” connections when they could be improving exponentially with each project through a continuously transformative process. The static logic of space is used in an effort to overcome the inherent complexities of each project. Hospital-acquired infections can be prevented through a new paradigm of collaborative hospital construction. Can changing the approach to hospital design be a catalyst to preventing HAIs? Incorporating LEAN principles from both healthcare and construction will evolve the current framework in which hospitals are constructed. This will break many of the current boundaries and setup a new platform for future hospital developments. / 0 / SPK / specialcollections@tulane.edu

M.P.H., Faculty of Health Science, University of the Witwatersrand, 2011 / Needlestick Injuries (NSI) that occur at Kimberley Hospital Complex (KHC) are reported by various categories of staff ranging from general workers to managers. They are regarded as medico-legal events and are classified as specific adverse events (AE). An AE is defined as any unexpected, unintended, unwanted event or circumstance that could have or did lead to unintended or unexpected harm, loss or damage. Although there were regular meetings related to NSI, there has been no systematic analysis of applicable data related to employees at KHC. The aim of this study was therefore to describe the NSI at KHC over a 1 year period (1 Jan 2009 – 31 Dec 2009) in order to obtain baseline information which will contribute towards improved planning of targeted preventive strategies in this setting. Methodology: A descriptive cross-sectional study was undertaken. This involved a retrospective review of selected hospital records relating to NSI reported by employees during this study period. No primary data was collected. Results: A total of 32 employees reported NSI during the study period. The prevalence of NSI was 2% of overall staff compliment. The highest reported prevalence was amongst the doctors (13, 10.4%) and the lowest amongst the general assistants (5, 0.6%). The majority of NSIs occurred during the recapping activity (20, 62.5%), was reported by female employees (27, 84.4%), took place mainly during normal working hours (23, 72%), and were mostly located within the Internal Medicine Department (10, 31.3%). About a third of the employees who reported NSIs were between 26 to 35 years (31%). The total treatment costs including drugs and vaccines provided during the study period were R 13 509.12, and the total laboratory test costs were R20 978.24. Overall the costs for drugs, vaccines and laboratory tests that made up the post-exposure measures amounted to R34 487.36. Results from this study suggest that reporting of NSI and other adverse events involving employees should be handled separately from those of patients. It is also important to profile the diverse employees that maybe at risk for this specific exposure and ensure that they are provided with the necessary training in this regard. There is a need to strengthen the relationship between the Quality Assurance Unit and the Wellness Clinic in order to optimize utilization of data regarding reported NSIs. Strategies to prevent NSIs should consider training on a regular basis and supervisors should work more closely with safety representatives in preventing NSIs.

Truth telling forms part of the contemporary debate in clinical bioethics and centers around the right of the patient to know honest information concerning his or her medical condition / illness and the duty of the doctor to inform the patient of such. Anecdotal evidence seems to imply that patients have concerns with the practice of truthtelling. Many often complain that they are not being informed and sometimes simply being ignored in matters that primarily concerns their health. On the other hand, there may be patients who do not to want a truthful answer to their health problems-they would in fact rather not know. The aim of this study was to explore my intuition that patients who attend the Johannesburg General Hospital are not given full information about their condition(s) and / or treatment(s) although they would like to know. The study explored the preferences of patients regarding the practice of truth telling and their attitudes toward truth telling in four out patient clinics of the Johannesburg General Hospital. Four hundred and sixty five participants completed and retuned the questionnaire from four different out patient clinics, namely oncology, surgical (general surgery and orthopedics), medical (gastro, renal and general internal medicine) and the nuclear medicine unit that represented the mixed out patient clinic. The majority of participants stated that the doctor had disclosed information about their condition (92.90%). Almost all participants were of the opinion that patients have the right to know about their condition (98.28%) and also that the doctor has the duty to inform them of their condition (98.02%). If they were suffering from a serious condition, a higher percentage of participants (86.28%) would prefer to know about their condition while a small but significant percentage (13.72%) would prefer not to know. The vast majority of participants (96.64%) also preferred to know about information relating to their treatment in detail while a high percentage (87.83%) supported disclosure to relatives. Variables such as gender, age and level of education did not seem to impact on the participants’ opinions of the truth telling process with significance with the exception of iv gender in relation with knowledge of one’s condition (p=0.0176) and education with regard to opinions on the right of patients to disclosure (p=0.0430). From the above results it can then be concluded that: 1. Participants in our study supported the right of patients to disclosure and the vast majority also felt that doctors have the duty to inform patients of their condition. 2. A significant percentage of participants felt that the level of information given to them was not satisfactory even when they have requested for more. This should be looked at and means for improvement should be sought. 3. A small but significant group did not support disclosure and must be respected as autonomous beings. 4. Gender seems to influence opinions of patients concerning their condition and education impacts on opinions relating to right of patients to disclosure of information. 5. To our appeasement, we found that patients attending the Johannesburg hospital are in fact given information about their condition. It is rather the quality and the quantity of information given that should be subject to scrutiny if we would like to move towards full disclosure in the process of truth telling in our institution. 6. Future studies should be considered to assess the attitudes of doctors towards disclosing, as well as further assess conflicting opinions in small group of patients by means of direct interviews.

Thesis (M.Sc.(Med.) Emergency Medicine--University of the Witwatersrand, Faculty of Health Sciences, 2014. / This study was designed to investigate how confident South African medical interns are to perform emergency medical procedures and to investigate how their experiences or demographic differences might influence these confidences. A transverse descriptive study using a cross sectional questionnaire was undertaken. A combination of the paper-based and electronic questionnaires were distributed to doctors currently performing their internship in South Africa. The data were analysed using a Fishers exact test and applying a Bonferroni correction where necessary. The study showed a high level of confidence in the majority of procedures studied and identified some points of influence on this confidence. The confidence of South African interns compares favourably with international colleagues at a similar qualification level.