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Class of 2010 Abstract / OBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.

M.A. / This study explores the narratives of two South African women, who have previously been admitted as patients, to various psychiatric institutions in Gauteng. In particular, this study focuses on the women’s perceptions of the ward round process, within the context of hospitalisation. An attempt has been made to explore the wider context of the ward round and hospitalisation, by examining the medical model, its philosophy and the various problems associated with the medical model. The concepts of power, respect and pathologising discourse in particular, are focussed on. The study suggests that an ecosystemic model might serve as a useful alternative to the medical model in addressing the above-mentioned problems. This research was conducted in the form of an inquiry, within the context of a social constructionist perspective. As such, the research methodology employed is also based within the social constructionist paradigm. The themes raised in the conversations with the participants, are seen to be a social co-construction, which has evolved between the researcher and the participants. The social constructionist approach also means that the researcher has applied a reflexive stance, whereby narratives of the participants and the researcher, are linked to a reflection of the content and the various processes that took place within the context of the research. The narratives of the participants suggest that ward rounds are seen to be useful and necessary, but that within the context of the ward round, issues such as respect and transparency are important and should be taken into account. It is stressed within the context of this research, that these findings are localised and specific. As such they can not necessarily be seen to reflect the ‘truths’ of all people, who have experienced the process of ward rounds within the context of hospitalisation.

O Sistema Único de Saúde (SUS) foi configurado tendo como linha mestra de sua organização a descentralização de suas ações, cabendo ao nível central a elaboração e gestão das políticas de saúde. Diante da necessidade de racionalizar recursos, a regionalização se apresenta como meio para implementar uma descentralização que considere a atuação em nível ampliado, além do município, e propicie melhor acesso aos diferentes níveis de complexidade da assistência com melhor aproveitamento de recursos e economia de escala. Organizar um sistema de saúde em nível regional significa a consideração de diferentes variáveis como o fluxo espontâneo de usuários influenciado pelo papel socioeconômico exercido pelos diferentes municípios, o conflito de interesses devido ao direcionamento de recursos, a identificação das necessidades regionais e sua contraposição às propostas dos prestadores e a dificuldade para mensurar a demanda por serviços. Este trabalho estudou o fluxo de internações hospitalares dos sistemas público e supletivo de assistência na região de Ribeirão Preto no intuito de identificar sua distribuição e fatores associados. A origem dos dados foi a Folha de Alta Hospitalar do Centro de Processamento de Dados Hospitalares (CPDH) do Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP–USP), preenchida em todas as altas hospitalares – SUS e não SUS - de todos os hospitais da região que, depois de recolhida e processada eletronicamente, onstitui um banco de dados no referido centro. A análise dos dados foi feita através do gerenciador de banco de dados Epi-Info™ versão 3.2. Os resultados obtidos foram comparados e estudados à luz do Plano Diretor de Regionalização do Estado de São Paulo para a região de Ribeirão Preto –SP. / The Brazilian National Health System (SUS) was established with a basis in decentralized administration. The central level performs the function of producing the policy and coordinates its application into practice. Facing limited resources, the regionalization represents a way to conduct a decentralized system in larger territories than the municipalities. The expectations are to improve access to the different levels of complexity of care avoiding unnecessary expenditure. The regionalization of hospital care implies various variables, as the spontaneous movement of people influenced by socioeconomic factors, the imbalance because of resources, the region’s needs under an epidemiological basis and interests of providers. This work studies the flux of people receiving hospital care in both public (SUS) and private (NSUS) health assistance in the region of Ribeirão Preto, São Paulo State, Brazil. It tries to identify factors which influence the flux and demand distribution. The data came from the Centro de Processamento de Dados Hospitalares (CPDH) do Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP–USP), which registers all hospital discharge in the region. The analysis was done using the software Epi Info™ 3.2 version. The results were compared with the plan for the regionalization in São Paulo State for the region of Ribeirão Preto.

O Sistema Único de Saúde (SUS) foi configurado tendo como linha mestra de sua organização a descentralização de suas ações, cabendo ao nível central a elaboração e gestão das políticas de saúde. Diante da necessidade de racionalizar recursos, a regionalização se apresenta como meio para implementar uma descentralização que considere a atuação em nível ampliado, além do município, e propicie melhor acesso aos diferentes níveis de complexidade da assistência com melhor aproveitamento de recursos e economia de escala. Organizar um sistema de saúde em nível regional significa a consideração de diferentes variáveis como o fluxo espontâneo de usuários influenciado pelo papel socioeconômico exercido pelos diferentes municípios, o conflito de interesses devido ao direcionamento de recursos, a identificação das necessidades regionais e sua contraposição às propostas dos prestadores e a dificuldade para mensurar a demanda por serviços. Este trabalho estudou o fluxo de internações hospitalares dos sistemas público e supletivo de assistência na região de Ribeirão Preto no intuito de identificar sua distribuição e fatores associados. A origem dos dados foi a Folha de Alta Hospitalar do Centro de Processamento de Dados Hospitalares (CPDH) do Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP–USP), preenchida em todas as altas hospitalares – SUS e não SUS - de todos os hospitais da região que, depois de recolhida e processada eletronicamente, onstitui um banco de dados no referido centro. A análise dos dados foi feita através do gerenciador de banco de dados Epi-Info™ versão 3.2. Os resultados obtidos foram comparados e estudados à luz do Plano Diretor de Regionalização do Estado de São Paulo para a região de Ribeirão Preto –SP. / The Brazilian National Health System (SUS) was established with a basis in decentralized administration. The central level performs the function of producing the policy and coordinates its application into practice. Facing limited resources, the regionalization represents a way to conduct a decentralized system in larger territories than the municipalities. The expectations are to improve access to the different levels of complexity of care avoiding unnecessary expenditure. The regionalization of hospital care implies various variables, as the spontaneous movement of people influenced by socioeconomic factors, the imbalance because of resources, the region’s needs under an epidemiological basis and interests of providers. This work studies the flux of people receiving hospital care in both public (SUS) and private (NSUS) health assistance in the region of Ribeirão Preto, São Paulo State, Brazil. It tries to identify factors which influence the flux and demand distribution. The data came from the Centro de Processamento de Dados Hospitalares (CPDH) do Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP–USP), which registers all hospital discharge in the region. The analysis was done using the software Epi Info™ 3.2 version. The results were compared with the plan for the regionalization in São Paulo State for the region of Ribeirão Preto.

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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informants / Doctor of Philosophy (PhD)

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, June 2001. / Includes bibliographical references. Also available on the Internet.

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