Através da metodologia “Observação Estruturada” foram estudados 5 (cinco) adm inistradores hospitalares de hospitais filantrópicos gerais de grande porte no estado do Rio Grande do Sul, durante uma semana cada um, observando, minuto após minuto, dia após dia, como eles executam seus trabalhos. O estudo, que utilizou as mesmas categorizações de Mintzberg (1973), conclui no mesmo sentido de Mintzberg de que também o Administrador Hospitalar “não é um planejador sistemático e reflexivo, mas sim um profissional que executa suas atividades em ritmo intenso, com as características de brevidade, fragmentação e variedade. É firmemente orientado para a ação e vê-se constantemente bombardeado por telefonemas, correspondências e por pessoas que às vezes irrompem em sua sala para fornecer-lhe ou dele receber informações” (pág. 28-53, 1973). Utiliza-se intensamente da comunicação verbal e apóia-se em extensiva rede de contatos externos à organização hospitalar para a obtenção e troca de informações. A principal diferença entre os Administradores Hospitalares por mim pesquisados e os gerentes analisados por Mintzberg é que aqueles envolvem-se num número expressivamente maior de negociações do que estes. Enquanto que 10% (dez por cento) do total de contatos dos Administradores Hospitalares referem- se a negociações, apenas 1% (um por cento) do total de contatos dos gerentes estudados por Mintzberg refere-se a esse papel. A dinâmica e complexa interação dos quatro mundos do hospital (Mintzberg,1977): cura, cuidados, controle e comunidade são fontes de constante pressão em seu trabalho, desafiando suas habilidades (técnicas, humanas e conceituais) e exigindo-lhe elevada capacidade de observação, de negociação, de administração do tempo e de controle emocional, ao lado da competência em argumentar, em falar em público, em conhecer o sistema de saúde e em inter-relacionar-se com os demais profissionais da saúde.

Estudio de tipo cualitativo, que utilizó como abordaje metodológico estudio de caso. Sus objetivos fueron caracterizar, analizar y comprender la percepción de enfermeras y pacientes sobre el respeto a la intimidad en el servicio de ginecología del Hospital Regional Docente las Mercedes de Chiclayo. Para la obtención de datos se aplicó la entrevista semiestructurada a profundidad y la observación no participante, estos datos se procesaron a través del análisis de contenido temático y de la técnica de triangulación. El estudio se desarrolló basándose en los principios éticos de Ellio Sgreccia y de rigor científico planteados por Guba y Linconl. Las categorías emergidas fueron: Apreciaciones de enfermeras y pacientes sobre el respeto a la intimidad, desposesión de la intimidad de la paciente mujer, condiciones desfavorables para ejercer el cuidado de la intimidad y reacciones de la mujer frente a la intimidad vulnerada. Los resultados demostraron que las enfermeras perciben la intimidad como una dimensión holística, pero se ve violentada por el gran número de pacientes, la inadecuada infraestructura, los deficientes recursos materiales, la intervención de otros profesionales, deficiente empatía, formación y resistencia al cambio. La mujer percibe la intimidad como el respeto a su cuerpo, enfocado a sus partes íntimas, asegurando sufrir situaciones de desposesión durante los cuidados, por falta de vocación y empatía, manifestando actitudes pasivas, sentimientos de vergüenza e incomodidad, tristeza y llanto, justificando dichas reacciones de pasividad por estar enferma, sentirse vulnerable y por miedo a que los profesionales tomen venganza, renieguen o se desquiten con ellas. / Tesis

Abstract A study is made of the volume of hospital treatment provided for cases of pneumonia in Finland from 1972 to 1993, employing as a source the National Hospital Discharge Register. The results are used to predict changes in the utilization of hospital resources in this respect up to the year 2020. A total of 452 474 treatment periods and 5 935 615 hospitalization days attributable to pneumonia were recorded for the total population over the given period, of which just under 20% applied to children aged under 15 years, over 30% to persons of working age, 15-64 years, and over 50% to elderly persons aged 65 years and over. The mean duration of hospitalization was reduced from 18.4 days to 14.3 days for males and from 19.6 days to 17.5 days for females over the period in question. The number of treatment periods for pneumonia in children per year relative to population decreased by 28.3%, the greatest reduction being in the group under one year of age, 5.7% for boys and 5.5% for girls. The mean duration of treatment decreased from 9.6 days to 4.1 days for boys and 9.7 days to 4.3 days for girls. The numbers of treatment periods and hospitalization days were consistently greater for men than for women in the working-age population, the difference between the sexes being most pronounced in the age group 15 - 24 years, where the number of treatment periods for men was 7.2 times that for women. Likewise, the number of treatment periods for men began to increase with age from 40 years onwards and that for women from 50 years onwards. The mean treatment time for patients of working-age decreased over the period studied, from 10.5 days to 8.2 days for men and from 9.9 days to 8.2 days for women. The duration of treatment similarly increased with advancing age. The absolute numbers of treatment periods increased by 139% among the elderly population, even when standardized for age, whereas the number of hospitalization days diminished. The clearest increase in treatment periods of all was recorded for men aged over 84 years, 3.16%. The mean duration of treatment increased with age in both sexes, being significantly longer for women than for men in each age group. The forecast for changes in the utilization of hospital services for the treatment of pneumonia up to the year 2020 was examined by methods based on both an age structure model and a time series model. Both predicted an increase of over 50% in the total number of treatment periods for the population as a whole, being of the order of 70% for men and 30% for women. The predicted increase in the age group over 64 years was in excess of 90% with both models. The use of hospital services for the treatment of childhood pneumonia decreased significantly over the period examined here, while the majority of the treatment periods recorded for the working-age population concerned young men or persons aged over 40 years. The most significant increase was seen in treatment periods for persons aged over 64 years, and this figure is also predicted to increase in the future, on account of the frequent use made of hospital services by the elderly in general. Preparations should be made for dealing with this increase in demand by improving treatment methods, developing the treatment system and undertaking preventive measures.

Class of 2012 Abstract / Specific Aims: The incidence of non-response, recurrence, relapse, and rate of complications of Clostridium difficile infections treated with combination of metronidazole and vancomycin versus vancomycin or metronidazole alone over a one-year period by treatment and strain type (i.e. NAP1/BI/027) were evaluated. The incidence of mortality in patients with moderate to severe Clostridium difficile associated diarrhea prescribed metronidazole, vancomycin, or combination metronidazole plus vancomycin as initial therapy was also determined. Additionally, significant factors associated with the use of combination vancomycin-metronidazole as initial therapy for moderate to severe CDAD were characterized. Methods: T This retrospective medical record review has been approved by the Institutional Review Board. Adult patients with stool specimens tested for detection of Clostridium difficile toxin B by PCR between April 2010 and March 2011 at a tertiary care, academic medical center were evaluated. Patients were included in the study if diagnosed with moderate to severe disease and received either monotherapy with metronidazole, monotherapy with oral vancomycin, or combination therapy with metronidazole and oral vancomycin for at least 80% of the first 10 days of treatment. Patients who are discharged alive within 72 hours of admission or who received therapy for less than 48 hours were excluded. Main Results: All patients (N=411) with laboratory evidence of Clostridium difficile during the study time period were evaluated. A total of 26 subjects who received oral vancomycin monotherapy and 56 subjects who received oral vancomycin along with metronidazole for at least 80% of the first 10 days of treatment were identified. Of the subjects who received oral vancomycin monotherapy during the first ten days of therapy, 5 (19%) were classified has a treatment failure or died within the first 21 days of therapy and 5 (19%) had either a recurrence or reappearance of Clostridium difficile associated diarrhea between 22 and 65 days post start of therapy. Of the subjects who received a combination of oral vancomycin and metronidazole during the first 10 days of therapy, 14 (25%) were classified has a treatment failure or died within the first 21 days of therapy and 22 (39%) had either a recurrence or reappearance of Clostridium difficile associated diarrhea between 22 and 65 days post start of therapy. In the combination therapy group, 5 (9%) were reported to have an ileus, toxic megacolon, or necrotic bowel during the first 10 days of therapy. Conclusions: In this study, the subjects who received a combination of oral vancomycin and metronidazole had higher rates of clinical failure, death, and recurrence than subjects who received monotherapy. Current guideline statements recommend combination therapy only in patients with an ileus with Clostridium difficile-associated diarrhea.

A study on assessing communication challenges between clerks and deaf patients at Nelson Mandela Academic Hospital was conducted in 2010. The aim was to assess the existence of communication challenges, possible reasons and solutions to these. The literature reviewed identified a gap in the knowledge of communication between staff and deaf patients. A health systems’ study was conducted using a descriptive, cross sectional survey. The study population was made up of 33 clerks who worked at the registration and records area and deaf patients who stayed at Efata and received health services from the hospital. All clerks were interviewed and a random sample of 106 deaf patients was estimated using Epidat statistical software. Self administered questionnaires were used for data collection. Results confirmed the existence of communication challenges between the two groups. A majority of clerks were not trained in Sign Language. They used a combination of methods to communicate with deaf patients, and few clerks could use Sign Language. The patients also used a combination of methods due to the frustration of not having a common method of communication with clerks. The findings clearly showed that there are communication challenges between the two groups and Sign Language needed to be introduced to clerks in order to accommodate deaf patients. Further research may be done on all healthcare providers and to all deaf patients in the region served by Nelson Mandela Academic Hospital, and this could have a positive impact on the quality of service offered by the hospital to the deaf community.

The information transfer in the context of hospitals in two countries, the UK and Brazil has been observed and analysed. This entailed identifying patterns of information use and need by medical professionals and ancillaries in both countries, and especially in determining deficiencies in satisfying such needs.

In the Department of Pathology and Laboratory Medicine, at the beginning of each month, the clinical managers use expert knowledge to assign pathologists to expected daily specimens based on the criteria of workload restrictions, clinical sub-specialties, and availability. Since the size of the pathologists’ assignment problem is large, finding a feasible assignment manually is a very time-consuming process that takes a number of iterations over a number of days to complete. Moreover, every time there is a need to make a revision, a new assignment needs to be developed taking into account all the above criteria. The goal of this research is to develop an optimization model and a decision support tool that will help with monthly staffing of pathologists based on the criteria outlined above. The developed model is rooted in the classical operations research assignment problem and it is extended to account for the following requirements: each pathologist should be assigned to a similar specimen type throughout a week; for a given pathologist, there should be a rotation of the specimen types between the weeks; and the clinical managers’ preferences in terms of assigning a particular specimen type to a particular pathologist on a specific day need to be considered. A monthly assignment model covering 36 pathologists and 26 specimen types was solved using IBM ILOG CPLEX Optimization Studio. It is embedded in a decision support tool that helps clinical managers to make staffing decisions. The decision support tool has been validated using data from The Ottawa Hospital (TOH).

Background: Effective collaboration between health professionals can reduce medical errors and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) has been suggested as a potential framework to help health professionals develop a common language for better collaboration and to provide more holistic care. In the main, Rwandan district hospitals still utilise the hierarchical medical model of health. Aim: The aim of the study was to determine whether training on interprofessional practice, using the ICF framework, resulted in improved knowledge, attitudes and behaviour(as determined by improved recording of interprofessional assessment and management in patient records) in randomly selected Rwandan District Hospitals. Methodology: This study was composed of two phases. Phase I: Preparation. The intervention programme was developed based on a literature review and input from an international panel of experts. A feasibility study in which self-designed instruments and the training programme were tested was undertaken in one district hospital. Phase II: A Cluster Randomised Control Trial. Four district hospitals were randomly allocated to receive a day’s training in interprofessional practice using the ICF (experimental hospitals) or a short talk on the topic (control hospital). Participants included medical doctors, nurses, physiotherapists, social workers, nutritionists, and mental health nurses/clinical psychologists. Using self-designed and validated measures, pre- and postmeasurements of knowledge and attitudes towards Interprofessional Practice (IPP) were performed at baseline and after training and audit of patients’ records after discharge was performed at baseline and at two, four and six months. The independent t-test and Mann-Whitney U test were used to establish if the two sets of groups were equivalent before and after training at baseline and at two, four and six months. Repeated measures ANOVA and the post-hoc Tukey test were used to compare the audit scores at each time point. The Kruskal Wallis test was used to compare rankings of the scores of attitudes of different professions before and after the intervention. Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town and the Rwandan National Ethics Committee.

Includes bibliographical references. / Some people have argued that there is no reason to expect economic efficiency in a government enterprise because the funds allocated to various ends have to be exhausted to meet targets. In a social and welfarist sense, this argument seems valid if in essence, such earmarked targets, to improve societal welfare, are met. However, in the face of rising hospital costs and insufficient government funds, the issue of effectively allocating government funds to alternative uses becomes paramount. The setting for this research paper is Nigeria. This research work aims at investigating how well financial resources are used in government hospitals in Nigeria. It not only explores the resources employed in hospitals, but also how well these hospitals use minimum resources to achieve maximum outpatient and inpatient output. Hospital cost and expenditure data are collected from 40 government cottage and general hospitals in South East Nigeria (Anambra and Enugu states specifically). The data is collected by means of open-ended questionnaires, which are filled in by relevant administrators in the hospitals visited and also by ministry of health personnel at the state levels. The main research question asked is whether hospitals in this part of the country (and indeed Nigeria as a whole) are allocatively inefficient. A second question as to whether hospitals in Anambra State are more efficient than Enugu State is also posed. The major component of the research involves using the cost and expenditure data to build cost functions for the entire hospitals studied. The main thrust of analysis is the stochastic frontier process, which also incorporates an efficiency effects model. The choice of this model, above all else, is because it provides numerical efficiency estimates and thus provides quantifiable proof of how well poorly Nigerian hospitals fare. It is found in the analysis of the data collected that the hospitals studied are generally inefficient, as 70 percent of them operate at costs above the average permissible cost frontier.

Forty-six million individuals in the United States used tobacco products. People who use tobacco products attempt numerous strategies before giving up smoking habit altogether. The goal of this project was to evaluate the impact of a tobacco cessation program by evaluating pre-and post-cessation program data, and hospital records of participants attending the hospital smoking cessation program over a 6-month period to ascertain the degree of reduction in tobacco use and hospitalization from smoking-related diseases. The population sample comprised of both men and women between the ages of 18 years and above. The project question addressed whether the smoking cessation program had an impact on reducing the rate of tobacco use and hospital readmissions after attending a cessation program at a medical center. A paired samples t-test was conducted to analyze the pretest and posttest results. There was a statistically significant decrease (p <.001) in the participants' (N=49) rate of smoking after completing the smoking cessation program that lasted 6 months. The mean on smoking cessation pre-participation was 13.7 (SD = 1.56). The mean on smoking cessation post-six months participation was 6.67 (SD = 1.81). There was a statistically significant decrease in the rate of hospital admissions among participants. The mean on pre-participation hospital admissions was 4.18 (SD = .727). The mean on post-participation hospital admissions was 1.41 (SD = .643). Smoking cessation programs impact social change by improving the quality of life of participants and their families and decreasing the financial impact of hospital readmission cost