The profile of psychosocial disorders in children and the attendant patterns of referrals and health communication, were investigated within the context of a tertiary referral centre in the Eastern Cape Province. Literature on childhood disorders points to a high level of functional and substance related disorders in technologically developed countries of Europe and North America, in contrast to the developing countries of Asia and Africa, where the burden of infectious diseases and disorders of deprivation and lack still predominate in the profile of psychosocial disorders in children. In South Africa however, there is almost non-existent research on clinical psychosocial disorders profile and the research sets out to be an exploratory study in this area. A combination design was employed in which interviews and observations complemented a primarily quantitative descriptive cross sectional analysis of hospitalcase records. A pilot study was performed using an information gathering questionnaire and interviews, with findings subsequently explored in the main study. The International Classification of Diseases (ICD-10) (WHO, 1992) diagnostic categories were used to create a profile of all ailments in the paediatric unit. Psychosocial disorders both in terms of aetiology and illness course, can be viewed from the perspective of socialadjustment and functioning (in which there is a potential role of social factors as provoking, causal or modifying factors) (Williams &Clare, 1979); and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) (American Psychiatric Association,1994) criteria was used to create the profile of these disorders in the paediatric unit at Frere Hospital which accounted for 45% of the ailments managed in one year. The derived profile is a picture in between the profile found in technologically advanced countries, and developing countries. While the infection burden and malnutrition appear to be readily contained or curtailed, there appears to be a serious problem with access to health care services which manifest especially at the level of perinatal events, with resultant high level of hypoxic brain damage and consequently mental retardation and varying levels of impairment or disability. These medical consequences in turn are fundamentally psychosocial, requiring psychosocial care with heavy reliance on strategic communication and referrals. The referrals in respect of psychosocial disorders are mainly at primary care level revolving around local health care clinics, private clinics, special schools and rehabilitation centres.

Foi analisada a totalidade das saídas (105.116) de pacientes dos 31 hospitais de assistência hospitalar geral da 3a. Região Administrativa do Estado de São Paulo, no ano de 1975, segundo as variáveis: hospital, procedência, idade, sexo, condição de saída, fontes de financiamento e tempo de permanência, sempre relacionadas ao diagnóstico principal. As causas de internação mais freqUentes foram em primeiro lugar as relativas à gravidez, parto e puerpério (27,1 por cento ), seguidas pelas doenças do aparelho respiratório (11,4 por cento ), doenças do aparelho circulatório (8,9 por cento ) e doenças infecciosas e parasitárias (8,2 por cento ). A grande maioria dos atendimentos foi feita no próprio município de residência (83,8 por cento ); os porcentuais de residentes fora do município de atendimento mais significativos foram os referentes às neoplasias e doenças do sistema nervoso e órgãos dos sentidos. Não houve diferença no comportamento das internações quanto ao sexo, quando excluídas as doenças da gravidez, parto e puerpério, sendo que os maiores coeficientes de saídas foram dos grupos etários extremos: menores de 1 ano e maiores de 65 anos. Nos primeiros, o grupo de causas mais importante foi o das infecciosas e nos últimos, o das doenças circulatórias. O coeficiente de mortalidade hospitalar do Vale do Paraíba foi 2,8 por 100 saídas, variando bastante na dependência dos diagnósticos, das idades e fontes de financiamento. Estas se mostraram com distribuição diferenciada nas internações do Vale, mesmo quando analisadas\'por diagnósticos ou idade. O tempo médio de permanência se mostrou diferente nas internações pagas pelas várias fontes, assim como na dependência de cada hospital, de grupos etários (os extremos foram maiores), sexo e condição da saída. O fato de serem ou não os pacientes procedentes do próprio município de atendimento, não interferiu no resultado da duração média de permanência. / The total of 105.116 hospital discharges from 31 hospitals belonging to the Third Administrative Region of the State of São Paulo (Vale do Paraiba), Brazil, ocurred in 1975, were analyzed according to the following variables: hospital, origin (patient\'s place of residence), age, sex, health status of the patient discharged, sources of financing and length of stay, always related to the main diagnose. The leading causes of hospitalization were (ICD-9): - complications of pregnancy, childbirth and the puerperium (27.1 per cent ) - diseases of the respiratory system (11.4 per cent ) - diseases of the circulatory system (8.9 per cent ) - infective and parasitic diseases (8.2 per cent ) The majority of the attendances was done in the same city of the patients\' residence (83.8 per cent ) except for neoplasms and diseases of the nervous system and sense organs. No difference was found in the analysis of the hospitalizations by sex, when\'excluded complications of pregnancy, childbirth and the puerperium. The group of patients under one year and 65 years and over showed highest hospitalization rates. The leading cause of hospitalization within the first group was infective and parasitic diseases and within the second group, diseases of the circulatory system. The hospital mortality rate was 2.8 deaths per hundred discharges for the Vale do Paraiba as a whole, having a large variability according to the diagnoses, the patients age and the financial source. The average length of stay varied with financial source, the hospital, patients\' age (the more prolonged stays were those of the youngest and oldest age group), sex and health status at the moment of discharge. Average length of stay did not vary when taking into account the fact that patient was or was not hospitalized in his own city of residence.

Submitted by Gisely Teixeira (gisely.teixeira@uniceub.br) on 2018-06-16T14:41:15Z No. of bitstreams: 1 51500856.pdf: 1876222 bytes, checksum: a88339e9528b0ffcf6c41b60a9c3ec86 (MD5) / Made available in DSpace on 2018-06-16T14:41:15Z (GMT). No. of bitstreams: 1 51500856.pdf: 1876222 bytes, checksum: a88339e9528b0ffcf6c41b60a9c3ec86 (MD5) Previous issue date: 2018 / O Brasil possui vários hospitais e um grande quantitativo de normas que buscam estabelecer medidas que visam proteger os frequentadores em caso de incêndio. Grande parte dessas normas determinam ações e equipamentos que os hospitais devem ter em caso de desastre com fogo, pois há alguns exemplos tanto na literatura mundial quanto na brasileira desse tipo de desastre. Nesse contexto o trabalho tem por objetivo analisar os riscos globais de incêndio em edificações hospitalares de saúde, orientar com relação as medidas de prevenção,apontar as possíveis falhas e nortear a retirada dos usuários em um estudo de caso no Hospital Universitário de Brasília. O referido estudo de caso mostrou que o HUB não respeita as normas de prevenção de incêndio. A metodologia escolhida para a efetivação dos objetivos foi a descritiva, pois foi realizado um levantamento de dados sobre a arquitetura, os projetos, equipamentos e a manutenção desses sistemas de prevenções de incêndios nas unidades hospitalares.

Neste estudo busca-se a compreenção dos significados dos conteúdos vividos e percebidos pela criança doente e sua família ao experimentar a doença sob o olhar existencial de Heidegger, Merleau-Ponty, Emmanuel Levinas e Paul Ricoeur.É um caminhar no cotidiano do mundo do hospital com a criança, família e equipe de saúde , tentando entender as características básicas do Dasein e as representações das mudanças existenciais, provocadas pela doença, no viver da criança e da família. Neste processo emergem tríplices mundos, intimamente interligados: o mundo do hospital,da família e da criança. A partir da relação e interação nestes mundos, num espaço e tempo determinados, constrói-se o compreender do modo de ser da criança doente. Trata-se de um estudo fenomenológico desenvolvido na Unidade de Oncologia Pediátrica do Hospital de Clínicas de Porto Alegre do Rio Grande do Sul, que utiliza, para coleta de dados, a observação participante, a entrevista e a filmagem, sendo o método hermenêutico selecionado para a interpretação. A criança surge, emerge, como um ser em construção no mundo,e a doença desarticula sua existência, abala e desestrutura a ordem familiar.O modo de ser da criança doente é desvelado na relação com a família e com o mundo do hospital. A criança e a família reorganizam-se como ser-no-mundo e enfrentam esta dimensão existencial que os caracteriza como seres autênticos, que manifestam seus sentimentos, angústias e sofrimento ao perceber as mudanças no mundo da vida e sua finitude. A equipe de saúde compartilha o sofrimento vivido pela família e a criança com câncer, e sensibilidade e solicitude desempenham um papel fundamental em sua prática, além do seu conhecimento técnico-científico. Este momento existencial é sempre inacabado, possibilitando novas construções e interpretações, entretanto a riqueza vivida, neste encontro, com o outro mundo do hospital, é revelador de uma infinidade de possibilidades no ato de conhecer e de cuidar, a partir da estrutura existencial do ser-no-mundo. O enfoque filosófico existencial de Heidegger torna possível vislumbrar novos caminhos em direção à compreensão e ao cuidado do ser-no-mundo que enfrenta a doença.

Nurses are an integral part of the health care system and their job encompasses a wide range of responsibilities including the promotion of health, prevention of illness and care for physically, mentally ill and disabled people. Nurses have a mandate to be responsible and accountable to the public they serve. For these reasons, it is crucial that nurses possess attitudes that allow them to provide optimal care in a supportive manner for patients. Despite the fact that considerable research on the experiences of nurses caring for the mentally ill in general hospitals has been done globally, none has been conducted in the Eastern Cape, South Africa. Additionally, no studies could be obtained from anywhere in the world on the experiences of non-psychiatric trained nurses caring for mental health care users on 72 hour observations. Studies indicated that nurses have different experiences when caring for mental health care users. It was therefore considered necessary to find out how non-psychiatric trained nurses perceive the caring of mental health care users during the 72 hour observations. The research design used to explore and describe their experiences was qualitative, descriptive, explorative, phenomenological and contextual in character. Semi-structured interviews were conducted with eight (8) participants who were purposively selected. This was done after necessary permission from the Department of Health and informed consent from the research participants. Steps were taken throughout the course of the study to ensure trustworthiness. Data were analysed using Tesch’s methods and the services of an independent coder were used. The results indicate that there are different experiences with regard to the caring for mental health care users during the 72 hour observations. The major themes identified are: feelings experienced by these nurses, lack of knowledge, challenges and strategies used for coping with a violent user, need for support from security staff and lack of policies. v Guidelines as a supportive action are suggested. From the results of the study recommendations are made in the areas of nursing education, nursing practice and nursing research. It is concluded that for non-psychiatric trained nurses to provide optimal care to mental health care users, the nurses need knowledge and skills in order to facilitate the promotion, maintenance and restoration of mental health of these patients as an integral part of health.

The objective of this research study was to describe and explore challenges faced by professional nurses in implementing six ministerial priority standards of care in selected units of an identified institution in O.R. Tambo region. Nurses are trained and employed to provide nursing care to patients according to scope of practice set by their statutory body (South African Nursing Council). Setting of standards forms part of quality improvement in nursing care and standards need to be monitored and evaluated (Muller 2006:206). In South Africa, the Minister of Health has identified six priority areas to fast-track improvement and ensure quality in health services. These priority areas are as follows: attitudes and values of health workers, cleanliness of the facility, waiting times, patient safety and security, infection prevention and control, and availability of medicines (National Health Plan: Strategic plan 2010/2013). Standard of nursing care in OR Tambo region according to available statistics, is lower than the expected ministerial standards, regardless of continued monitoring and evaluation. Staff attitudes is an ongoing problem, long queues, linen shortages, low standards of cleanliness as well as shortage of medication remain a challenge in health care institutions. This study is a qualitative, descriptive, exploratory, and contextual study that explored challenges faced by professional nurses in implementing the six ministerial priority standards of care. A purposive sampling of 10 professional nurses, meeting the selection criteria was utilised. In depth, semi structured interviews were used as a method of data collection. A digital voice recorder was used to record the interviews and consent from participants was obtained. Ethical considerations were adhered to. The interview question was: “What challenges are you facing in implementing expected standards of care with reference to the six ministerial priority standards of care?” Data was analysed using content thematic analysis approach. An independent coder with a Master’s degree and studying towards a doctorate helped with coding the results of the interviews. The Theory for Health Promotion in nursing as propounded by Botes (2006) was used to analyse the findings. The approach used was based on the external environment and its dimensions – social, physical and intellectual. v The findings of the research revealed the following themes: Lack of resources, demotivation of nurses, attitude of nurses, lack of monitoring and evaluation, environment and overcrowding, lack of patient safety, negligence, availability of policy and procedure manuals, and incompetency of health care professionals. The findings of this study revealed that nurses faced many challenges with regard to improving the standard of nursing care. According to Botes (2006), the purpose of nursing research is functional by nature, it provides guidelines for practice. Therefore in this study, a description of guidelines to improve nursing care has been done. Trustworthiness of the findings was ensured by utilising Lincoln and Guba’s model of trustworthiness. Limitations of the research are highlighted and recommendations for further and related studies are made.

In an effort to reduce hospital 30-day readmissions a Transitional Care Coach Program (TCCP) was developed in 2014 at a Southwest Urban Medical Center. The CDC Framework for Program Evaluation (2012) applies insight and experience gained from past program experience to effect change in practice and improve patient outcomes. The evaluation seeks to determine TCCP utilization, to assess its impact on 30-day readmission rates for high-risk patients, to inform stakeholders of a viable follow-up program, and to determine evidence-based interventions for program improvement. This TCCP program evaluation describes characteristics of patients who participated in the program, assesses whether interventions were delivered as intended, and determines if interventions reduced hospital 30-day readmission rates compared to readmission rates prior to program implementation. Descriptive statistics are used to describe the patient population, health status, and program utilization. For the diagnoses of acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), and pneumonia (PNA), Chi-square test analyses were performed to compare 30-day readmission rates of the TCCP participants and readmission rates for this medical center for the time period prior to program implementation. The primary finding of this program evaluation is an overall numerical decrease in hospital readmission rate by 3% compared to the baseline data. Although the change (a decrease) was in the desired direction, the degree of change was not statistically significant based on pooled data. A statistically significant decrease was observed only for the AMI diagnosis. However, as any decrease in readmissions decreases the financial burden to both the organization and the patient, the TCCP appears to have had a positive impact. It is recommended that a renewed TCCP be conducted to allow for (1) an increased timespan for data collection, (2) an increased number of medical categories assessed to allow for more non-parametric statistical analysis (e.g. adding categories of Total Joint Replacement and Sepsis diagnoses), (3) tracking of number of days to readmittance to allow for improvement to be measured and analyzed beyond a single dichotomous category. Evidence-based recommendations have been made to continue and improve interventions that further reduce hospital readmissions.

This thesis deals with the architecture of the inclusive built environment. The hypothesis argues that social barriers can be challenged through the physical formation of the city, its buildings and spaces. The platform used to explore this premise is Weskoppies Hospital situated in Pretoria West. The stigmatization and institutionalisation of the mentally ill has been a hotly debated issue for a long time. Recently the topic has received a lot of attention in the media, parliament and medical circles. The issues underpinning the hypothesis deals with the “power of architecture to address social, economic, political and cultural forces by way of form- and place-making.” (Yudell 1997:134) / Dissertation (MArch (Prof))--University of Pretoria, 2007. / Architecture / unrestricted

Class of 2013 Abstract / Specific Aims: The purpose of this project was to determine inpatient charges, as well as define the frequency and mortality associated with the various sites of melanoma metastasis. Methods: Data was taken from the national database Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Nationwide Inpatient Sample (NIS) and was collected on patients admitted into hospital with any diagnosis of melanoma with disease progression of distant metastasis. Logistic multivariate regression was used to find odds ration by patient characteristic. Overall charges were assessed using a gamma multivariant regression. Multiariant regression was used to determine other patient demographics. Main Results: Average inpatient charges for stage IV melanoma was $32,296 per patient with a national inpatient total bill of $5.56 billion. The metastatic sites associated with the highest inpatient charges were genitourinary tract (exp B = 1.276), gastrointestinal tract (exp B=1.146), bone (exp B=1.132), lung (exp B=1.097), and lymph (exp b=1.092). The most common sites of melanoma dissemination for in-patient mortality cases were lymph (21.7%), lung and respiratory (19.2%), central nervous system (17.1%), and bone (17.1%). Conclusion: The annual average hospital charges per patient for melanoma with distant metastasis is about $32,000. We suggest that metastases of the genitourinary tract, gastrointestinal tract, bone, lung, and lymphatic system are associated with the highest hospital charges, while metastases to the CNS, bone, liver, lung, GI, and wide dissemination are associated with increased mortality.

No description available.