Decision-making Support and Patients’ Care Progress in a Palliative Care Outpatient Clinic at a Community Hospital

Purpose: This study aimed to investigate the decision-making support and patients’ care progress in a palliative care outpatient clinic at a community hospital. Methods: We conducted a retrospective examination of patients who visited our palliative care outpatient clinic and subsequently died between January 2020 and December 2021. The clinic, staffed by two palliative care physicians, operated twice weekly and accepted patients irrespective of their treatment status. Result: 93 patients were included in the analysis. At the onset of the outpatient clinic, 72 patients were asked about their preferred location for end-of-life care should their condition deteriorate. Of these, 25 patients preferred to receive end-of-life care in a palliative care unit (“PCU” group). Another 25 patients initially sought medical treatment at home through home-visits but later expressed a preference for care in a palliative care unit as their condition worsened (“home-visit→PCU” group). Additionally, 17 patients preferred home care from the end-of-life until death (“home-visit” group). Among the “PCU” patients, 96% received care in a palliative care unit, and 84% passed away in the same unit. In the “home-visit→PCU” group, 76% received care through home visit, and 80% passed away in a palliative care unit. In the “home-visit” group, 76% of patients received care at home, and 47% passed away in their own homes. Conclusion: These findings suggest that delivering end-of-life care in patients’ preferred locations is feasible with continuous decision-making support provided in the palliative care outpatient clinic.

Necrotizing fasciitis: presentation, microbiology and outcomes in a community hospital

Background: Necrotizing fasciitis (NF) is an aggressive and often fatal, soft tissue infection. Delayed surgical therapy leads to worsened outcomes. This study evaluates the mortality, outcomes, and characteristics of patients with NF in a diverse New York City Community Hospital Network.Methods: Retrospective chart review from 2012 to 2019 using ICD-9 and ICD-10 codes of gas gangrene, Fournier’s gangrene, and necrotizing fasciitis was done. Of the 297 patients reviewed 28 met inclusion criteria of imaging findings, operative reports, and clinical diagnosis of NF by an attending surgeon.Results: On average patients in ER were seen by the surgical team within less than 12 hours. Most patients were debrided within 10 hours of surgical consultation and on average received 2.2 procedures. Of the wound cultures obtained 65.38% were polymicrobial in nature. The average length of stay was 17.4 days and 32% of patients required ICU admission. The surgical mortality rate was 7.61%.Conclusions: Necrotizing fasciitis is a rare entity and increasing provider knowledge on patient characteristics as well as the complexity of these patients and the types and number of procedures they require may help guide clinical decision making. We identified that while most of our patients had negative blood cultures on admission, those that had positive blood cultures had multiple organisms growing. Knowing that these patients are complex and likely require multiple procedures, prompt operative intervention is key.

Comparison of outcome measures from different pathways following total knee arthroplasty

<p><b>INTRODUCTION</b>The benefits of extended inpatient rehabilitation following total knee arthroplasty (TKA) in local community hospitals (CHs) are unproven. Our study compared functional outcomes between patients discharged home and to CHs following TKA.</p><p><b>METHODS</b>A case-control study was conducted of patients undergoing primary unilateral TKA. Consecutive patients (n = 1,065) were retrospectively reviewed using the Knee Society Clinical Rating System (KSCRS), 36-item Short Form Health Survey (SF-36) and Oxford Knee Score (OKS) preoperatively, and at the six-month and two-year follow-ups.</p><p><b>RESULTS</b>Overall, 967 (90.8%) patients were discharged home and 98 (9.2%) to CHs. CH patients were older (mean age 70.7 vs. 67.2 years; p < 0.0001), female (86.7% vs. 77.5%; p = 0.0388) and less educated (primary education and above: 61.7% vs. 73.8%; p = 0.0081). Median CH length of stay was 23.0 (range 17.0-32.0) days. Significant predictors of discharge destination were older age, female gender, lower education, and poorer ambulatory status and physical health. Preoperatively, CH patients had worse KSCRS Function (49.2 ± 19.5 vs. 54.4 ± 16.8; p = 0.0201), SF-36 Physical Functioning (34.3 ± 22.6 vs. 40.4 ± 22.2; p = 0.0017) and Social Functioning (48.2 ± 35.1 vs. 56.0 ± 35.6; p = 0.0447) scores. CH patients had less improvement for all scores at all follow-ups. Regardless of preoperative confounders, with repeated analysis of variance, discharge destination was significantly associated with KSCRS, SF-36 and OKS scores.</p><p><b>CONCLUSION</b>Older, female and less educated patients with poorer preoperative functional scores were more likely to be discharged to CHs after TKA. At the two-year follow-up, patients in CHs had less improvement in functional outcomes than those discharged home.</p>

Using the SBAR4 model for Management of a Patient with Complex Comorbidites in the Community Hospital - A Case Study

Patients who require a stay in a community hospital usually tend to be more complex, presenting not only with biomedical issues with complications, but also with a myriad of psychological and social issues as well. If they were to be discharged from an acute hospital directly to primary care and community, the patients and caregivers may feel helpless, overwhelmed and unsure of how to navigate the healthcare system to get their complex issues sorted out. Family physicians in the community hospitals need to hone their skills in such an area of care. The SBAR4 model can be effectively used to categorise the patients’ multiple bio-psycho-social issues, coordinate the multi-disciplinary team to bring hospital and community resources to help such patients, provide holistic care for such patients, and transit them safely into the care of our family physicians in primary care and community.

Development Status of WeChat Public Platforms of Community Hospitals in Shanghai Downtown and Its Ethical Countermeasure / 中国医学伦理学

Objective:To investigate the current situation in construction and operation status of official WeChat public platform of community hospitals in Shanghai Downtown and provide the reference for effective application of WeChat public platform in community hospitals.Methods:The current situation of health service provided with WeChat public platform of community hospitals was investigated by website survey.We focused on the opening rate,menu services,information push and off-line operations of WeChat public platform from the perspective of ethics.Results:Of the investigated 98 hospitals,a total of 48 WeChat public platforms were established,accounting for 49.0％.Among which 28 public platforms provided menu bar service,accounting for 58.3％.The public platforms still needed to be improved in terms of article push quantity,reading quantity and daily management.Conclusion:The development level of WeChat public platform of community hospital in shanghai downtown is uneven and WeChat public platform of community hospital exists low service level,imperfect management,lack of publicity and other problems generally.It is recommended that hospitals strengthen the construction of WeChat platform from three aspects,including strengthening team management,keeping the "Six in One" and seeking for commercial assistance.

Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth

PURPOSE: This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). METHODS: We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. RESULTS: From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. CONCLUSIONS: Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities.

Investigation and Analysis of Pharmaceutical Affairs Management of 23 Hospitals in Hanyang District of Wu-han / 中国药房

OBJECTIVE:To provide reference for promoting the standardization construction of pharmaceutical affairs manage-ment in primary medical institutions. METHODS:Completing the survey forms was combined with field trip to investigate the phar-maceutical affairs management in 23 hospitals in Hanyang district of Wuhan,and the results were summarized and analyzed. RE-SULTS:Totally 23 survey forms were sent out,and 23 were effectively received with effective recovery rate of 100%. In the sur-veyed hospitals,3 community hospitals had no adjust management system,all community hospitals had no clinical pharmacists management system,3 community hospitals had no pharmaceutical management and pharmacotherapeutics system,the information-ization management system in hospitals below third-grade had no statistics function,5 community hospitals had no standardized cool warehouse;use rate of antibiotics in the outpatient of 13 community hospitals was more than 20%;among the 21 hospitals with special management drugs,18 hospitals below third-grade did not use the unified state identification;4 community hospitals did not train pharmacy staff every year. CONCLUSIONS:Medical institutions in Hanyang district of Wuhan,especially the commu-nity hospitals,exist some problems,including construction of pharmaceutical institutions,clinical pharmacy disciplines,equipment and facilities,management and training of pharmacy staff. It is suggested that primary medical institutions should enhance pharma-ceutical management level by expanding pharmacy staff,paying attention to the basic construction and informationization construc-tion,performing job duties,attaching importance to training and effect evaluation and focusing on the construction of clinical phar-macy disciplines.

Rehabilitation in the Intermediate and Long Term Care (ILTC) Sector

Outside acute hospital rehabilitation units, inpatient rehabilitation is also provided in the ILTC sector. Facilities providing such inpatient rehabilitation include Community Hospitals, Chronic Sick Hospitals, Nursing Homes, Inpatient Hospice Care, Day Rehabilitation Centres and Home Care Services. After the initial acute episode of a disabling disease (e.g. a stroke) has settled, the elderly patient will often than not, require a longer period for inpatient rehabilitation compared to a younger person. Such patients are transferred to a community hospital inpatient rehabilitation unit. The length of stay is about 1 month. However, it can be longer (3 to 6 months) depending on the condition and progress of the patient. The patient is then discharged home or to a nursing home if the family is unable to manage the patient at home. Elderly patients who require continuation of rehabilitation can receive this in various settings in the ILTC sector like the outpatient departments of the community hospital; Day Rehabilitation Centres (DRCs); and Singapore Programme of Integrated Care for the Elderly (SPICE) centers.

Role of Family-Community-Hospital Rehabilitation Management on Community Schizophrenics / 中国康复理论与实践

@#Objective To investigate the rehabilitation role of family-community-hospital rehabilitation management for communityschizophrenics. Methods 110 schizophrenic patients were divided into the control group (n=60) and the training group (n=50). The controlgroup were followed up once a month, while the training group participated in the family-community-hospital rehabilitation care. They wereassessed with Social Disability Screening Schedule (SDSS), General Well-Being Schedule (GWB), Self-Esteem Scale (SES) before and afterthe treatment, as well as the compliance and management of medcine questionnaire. Results No significant difference was found betweenthese groups with SDSS, happiness, self-esteem, compliance and management of medcine before the training(P>0.05), but were significantlyhigher in the training group(P<0.01). Conclusion Family-community-hospital rehabilitation management can significantly improvethe social function, the happiness, the self-esteem, the medication compliance and self-management of schizophrenia patients.

Provider-initiated HIV counseling and testing of out patients at community hospitals in Thailand: an economic evaluation using the Markov model.

Background: Provider-initiated HIV counseling and testing (PIHIVCT) is an important intervention that improves the access to care to HIV-infected patients and subsequently contributes to the success of national HIV/AIDS control efforts. However, in Thailand, the cost-effectiveness of this program is unknown. Objective: Determine the incremental cost-effectiveness ratios (ICER) in terms of Thai Baht per Quality Adjusted Life Year (QALY) of PIHIVCT for outpatient department (OPD) patients in community hospitals of Thailand compared with the current practice. Methods: A model-based health economic evaluation study was conducted based on results from cluster randomized controlled trials in 16 community hospitals of Thailand. The Markov model and the probabilistic sensitivity analysis were used. One-thousand two-hundred seventy-seven HIV-infected patients completed questionnaires on their household expenditure and quality of life using the visual analog scale. Results: In social perspectives, the PIHIVCT program increased a patient’s life span by 5.18 days or 4.15 qualityadjusted days per OPD case and the ICER was 63,588 Baht per QALY gained. The subgroup analysis showed that the PIHIVCT program would be cost-effective for cases younger than 50 years if the ceiling threshold of willing to pay equaled the per capita Gross Domestic Product (GDP). However, this intervention would be cost-effective for all cases of 13-64 year old if the ceiling threshold equaled three times of GDP. Conclusion: The provider-initiated HIV counseling and testing program for OPD patients is more cost-effective than the current practice and should be implemented in health care setting in Thailand.

Short stature in Indian children: Experience from a community level hospital.

Objective To study prevalence and aetiological profile of short stature in children attending outpatients department (OPD) of a community level hospital. Method Six hundred and twenty five consecutive children (> 2 and < 16 years) attending OPD of a community level hospital, catering mostly to rural and lower socioeconomic strata of society, were screened for short stature using NCHS charts of mean and standard deviations. A diagnosis of familial short stature was made after allowing for mid-parental stature. Prepubescent children were classified as short stature using percentile charts (< 5th centile being taken as short stature) for affluent Indian children. All children were followed up for 6-12 months to establish growth velocity. To allow for onset of puberty and stage, Tanners chart for early (+ 2SD) and late (- 2SD) maturers was considered. Results Eighty six children were identified as having short stature on first visit. Commonest cause of short stature was protein energy malnutrition (PEM) & chronic diseases occurring in 46 (53.5%) cases. Other causes included normal variant short stature (24.4%), endocrine problems (4.7%) and miscellaneous (5.8%). 11.6% could not be classified due to loss to follow up and inability to refer to tertiary centres. Overall prevalence of short stature was 13.8%, significantly higher than prevalence reported from tertiary centres (p < 0.05). Conclusion Prevalence of short stature is higher than previously reported. A large number of children with short stature may go undiagnosed in rural and lower socioeconomic strata of developing countries. Prevalence and aetiological profile of children with short stature in present study is more representative of community than previous studies in India.

Chronological Changes of Gastric Cancer in Community Hospital

PURPOSE: Gastric cancer remains the most common type of cancer in Korea, however, early diagnosis and surgical advancements have resulted in a better prognosis in the last few decades. The aim of this study was to investigate chronological changes of the clinicopathological features in patients with primary gastric cancer who had undergone gastric operations in Department of Surgery of Seoul Municipal Boramae Hospital. METHOD: Between November 1991 and April 2001, 634 primary gastric adenocarcinoma patients having undergone gastric operations were included in this study and divided into the two groups: 298 patients between 1991 and 1996 (early group) and 336 patients thereafter (late group). The clinicopathological characteristics, including age, gender, type of operation, gross and histologial findings, stage, and ratio of early gastric cancer, were compared between the two groups. RESULTS: The overall male-to-female ratio was 2: 1, with a mean age of 59.0 years. As the community hospital, eighty two percents of patients were resident within the same administrative district. There were no statistical differences in age, gender, type of operation, and total number of resected lymph nodes between the two groups. In contrast, cancers with a larger size, the distal one third of the location, well-differentiated adenocarcinoma, low depth of invasion, and high nodal metastasis were more prevalent in the late group (P < 0.05). Also, the proportion of earlier stages was increased in the late period (P<0.001). The ratios of early gastric cancers were 24.8, and 38.4% in the early and late groups, respectively (P<0.001) CONCLUSION: Our results suggest that the chronological changes of gastric cancer were closely related to the increased number of early gastric cancer patients, primarily due to the early detection of cancer. Therefore, to obtain the better outcomes from gastric cancer, an early diagnosis was essential from routine health check-ups and the well- organized establishment of a nation- and community-wide screening program and information on public health.

A Study of the Tutorial System at Gifu University School of Medicine. Part 2: Evaluation by Physicians in Community Hospitals / 医学教育

To assess the effectiveness of a problem-based learning tutorial system introduced at Gifu University School of Medicine in 1995, we conducted a questionnaire survey of medical knowledge, attitudes about learning, communication ability, and social behavior in sixth-year medical students. The questionnaire was given to instructors and attending physicians at community hospitals who were involved in clinical education. Many of the evaluators felt that students who trained with the tutorial system showed improved understanding, a more active attitude toward learning, and a better attitude toward patients than did students who received traditional, lecture-based education.

Correctly Handle Mutual Relationship of Community and Higher-level Hospitals in order to Make the Most of Community Health Services / 中国医学伦理学

The reasonable disposition of health resources and convenient access to medical service for citizens can be realized by correctly handling the workload inequality between Community and Higher-level Hospitals,expanding the development of community hospitals,and making the most of community health services.By conducting research on the community health services in Wenzhou,we believe the creation of first medical treatment in community hospitals and the "two-way referral system" between superior and subordinate hospitals to be a "win-win" pattern to reduce the burden from patients,improve the operational efficiency of higher-level hospitals and also make benefits for community hospitals.

The feasibility of applying microcomputer in community hospital management in Thailand.

The feasibility of applying microcomputer in seven sections of a community hospital was studied. The areas were :- administration of drugs stock, drugs store control, mobile health team drugs control, out patient record, finance, epidemiological surveillance and immunization record of children. The 60 bed Kratomban Hospital, in Samuthsakorn Province was the selected site of study. The computer programmes was developed on the basis of dbase II language. The results reveal that using microcomputer decreases the steps of work in all jobs, mostly in administration of drugs stock and lastly in out patient record. The use of microcomputer also decreases working time for all jobs except out patient record. The most decreased working time is in administration of drugs stock and the least, the immunization record of children. The application of microcomputer for increasing the effectiveness of community hospital management is possible and will be more beneficial if the storage capability of microcomputer is not less than 20 mb.