Survival analysis of patients with severe acute malnutrition admitted at the in-patient therapeutic care of the Bicol Regional Training and Teaching Hospital

Background@#Severe acute malnutrition (SAM) in children under five years remains a major global health concern. It carries a burden to the overall health of a child, contributes to mortality, and adds financial strain to the family and the hospital. The Philippine Integrated Management of Acute Malnutrition was established to address acute malnutrition in Filipino children. @*Objective@#This study aimed to determine the factors affecting survival of patients admitted at Bicol Regional Training and Teaching Hospital (BRTTH) In-patient Therapeutic Care (ITC).@*Methods@#This is a retrospective cohort study design utilizing survival analysis. Accrual period was from January 1, 2018 to December 31, 2018. Follow-up ended on March 31, 2019. There were 154 admissions and excluded 17 missing charts. Survival analysis was done utilizing STATA 14.@*Results@#The prevalence of SAM requiring ITC admission was 3.0 percent. Majority belonged to 6-59 months of age (63%), with equal predilection for both sexes (1:1) and 71% came from the home province, Albay. Most of patients’ caretakers had middle educational attainment. Sixty-eight percent (68%) were new patients, 16% readmitted, 15% transferred from the Out-patient Therapeutic Care (OTC) and <1% relapsed. The top three most common complications and co-morbidities include: pneumonia, low electrolytes, and fever. Sixty-three percent (63%) of patients at the ITC had a desirable treatment outcome, of which, 8% were cured and 55% transferred to OTC. Undesirable outcomes accounted for 37% of the cases which included non-cured, defaulter, and died at 12%, 8%, and 17%, respectively. The risk of dying was higher in SAM patients with parents having middle and low educational attainment as compared to those with high educational attainment (2-5 folds to 100-200 folds). SAM patients presenting with hypovolemic shock were likely to die by 1.5-19 times (1.5-19x) as compared to those without. SAM patients with malignancy were more likely to die 4-44 folds as compared to patients without malignancy.@*Conclusion and Recommendations@#Educational attainment of parents, malignancy, and hypovolemic shock were significant predictors of mortality. We recommend prompt intervention by educating families, strengthen policies targeting socio-economic determinants, capacitate medical staff, refine current clinical practice guidelines and treatment pathways to reduce the number of children who die from severe acute malnutrition.

Development of intelligent monitoring system based on Internet of Things and wearable technology and exploration of its clinical application mode / 生物医学工程学杂志

Wearable monitoring, which has the advantages of continuous monitoring for a long time with low physiological and psychological load, represents a future development direction of monitoring technology. Based on wearable physiological monitoring technology, combined with Internet of Things (IoT) and artificial intelligence technology, this paper has developed an intelligent monitoring system, including wearable hardware, ward Internet of Things platform, continuous physiological data analysis algorithm and software. We explored the clinical value of continuous physiological data using this system through a lot of clinical practices. And four value points were given, namely, real-time monitoring, disease assessment, prediction and early warning, and rehabilitation training. Depending on the real clinical environment, we explored the mode of applying wearable technology in general ward monitoring, cardiopulmonary rehabilitation, and integrated monitoring inside and outside the hospital. The research results show that this monitoring system can be effectively used for monitoring of patients in hospital, evaluation and training of patients' cardiopulmonary function, and management of patients outside hospital.

Exploration and Practice of the Whole-course Care Mode from Hospital to Home for an Advanced Malignant Tumor Patient / 中国医学科学院学报

This paper depicted the whole-course care for an advanced cancer patient from hospital to home.In this case,telemedicine was employed to provide guidance on the symptom control,comfort care,psychotherapy,and bereavement counseling.The patient got the holistic care from the whole family and team.The holistic care finally gave a good death of the patient and aided in the recovery of the family members from grief.

Study of cross-referrals to the dermatology department in an inpatient setting at a tertiary care centre

Background: Till recently, dermatology was primarily being considered to be an outpatient focused discipline. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. This study was conducted to analyse the incidence and indications for inpatient dermatology referrals and the impact of dermatology consultation on patient management.Methods: A cross-sectional study was undertaken by analyzing the records of 243 patients referred to dermatology department over a 2-year period. Descriptive analysis was conducted in the form of study of presumptive diagnoses by the referring clinicians, causes of referral, distribution of referrals across specialties and the dermatological opinions with respect to diagnosis and management etc.Results: Clinically significant change was documented in the course of skin lesions management of almost two-thirds of referred patients. Maximum referrals were from the department of general medicine with “skin rash” being the most common cause for seeking 2nd opinion. Concordance for diagnosis between the referring clinician and the dermatologist was observed in only 30.2% of the cases.Conclusions: Dermatologic referral does lead to improved patient care. But there is need for better training of non-dermatologists enabling them to recognize and treat common skin lesions.

UP Philippine General Hospital Division of Endocrinology, Diabetes & Metabolism Consensus recommendations for in-Patient managementof Diabetes Mellitus among persons with COVID-19 / Journal of the ASEAN Federation of Endocrine Societies

@#Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.

An evaluation of the in-patient feedback services in a tertiary care hospital of Northern India

Background: Patient satisfaction is an important indicator of the quality of services provided by any healthcare organization and directly or indirectly affects patient retention, legal issues, revenues, reputation and success of a healthcare organization. Patient’s feedback about the clinical as well as non-clinical services can be recorded for gap analysis and improvement of services.Methods: The cross-sectional study was carried out in a large tertiary care hospital in North India from May 2012 to December 2012. A pre-tested internally developed questionnaire was used to collect the data.Results: It was observed that the average satisfaction score was relatively high for the criteria like doctor’s counselling, attitude of nurse and availability and behaviour of attendant. The average scores for medical and nursing care (clinical services) provided in wards were high (70-74% satisfaction). However, approximately 45% and 50% patients were dissatisfied with the housekeeping and dietary services respectively. This resulted in a dip in the overall impression of the hospital services to 68%.Conclusions: The percentage of patients satisfied with the overall services (clinical and non-clinical) of the hospital is only 68% which goes on to prove that the patients’ perception of quality is changing with the times and non-clinical areas like housekeeping, dietary, billing, security services are becoming as important as clinical care services that are provided by hospitals.

Validación del cuestionario CTM-3-modificado sobre satisfacción con la continuidad de cuidados: un estudio de cohortes / Validation of the CTM-3-Modified Questionnaire on Satisfaction with Continuity of Care: A Cohort Study / Validação do questionário CTM-3-modificado sobre a satisfação com a continuidade de cuidados: um estudo de coortes

RESUMEN Objetivos: validar el contenido y constructo de la encuesta CTM-3 (Care Transitions Measure- 3 preguntas) modificada. Determinar el nivel de satisfacción de los usuarios con la continuidad de cuidados de enfermería interniveles y relacionarlo con la presencia de Informe de Cuidados de Enfermería tras su última hospitalización. Material y método: estudio de cohortes retrospectivo, con 131 pacientes hospitalizados en el Complejo Hospitalario de Cartagena (España).La satisfacción con la continuidad de cuidados se valoró con el cuestionario CTM-3-modificado, resultado de un proceso de validación realizado sobre el mismo. Resultados: un 94% de los encuestados presenta una satisfacción aceptable con el proceso de continuidad de cuidados. Los pacientes con Informe de Cuidados tienen un nivel alto de satisfacción con la continuidad de cuidados, RR= 0,90 (IC 95%: 0,831-0,990). Conclusiones: La validez de contenido y constructo realizadas, han permitido medir la satisfacción de los usuarios con la continuidad y su correlación con la presencia de informe, obteniendo como resultado que la realización de Informe de Cuidados influye ligeramente en la satisfacción con el proceso de continuidad de cuidados. Sin embargo, el hecho de que el informe se entregue en mano y/o se explique no parece afectar a la misma.

ABSTRACT Objectives: validate the content and construction of the modified CTM-3 survey (Care Transitions Measure - 3 questions). Determine the level of user satisfaction with the continuity of intermediate-level nursing care and relate it to the presence of a nursing care report after the most recent hospitalization. Material and method: A retrospective cohort study was conducted with 131 patients hospitalized at the Cartagena Hospital Complex (Spain). Satisfaction with the continuity of care was assessed with the CTM-3-modified questionnaire, which is the result of an earlier validation process. Results: Ninety-four percent (94%) of those who responded to the questionnaire indicated acceptable satisfaction with the continuity-of-care process. Patients with a care report have a high level of satisfaction with the continuity of care: RR = 0.90 (95% CI: 0.831-0.990). Conclusions: The content and construct validity of the questionnaire make it possible to measure user satisfaction with the continuity of care and its correlation to the presence of a care report, the result being that preparation of a care report slightly influences the level of satisfaction with the continuity-of-care process. On the other hand, the fact that the report is delivered by hand and/or explained appears to have no effect.

RESUMO Objetivos: validar o conteúdo e constructo do questionário CTM-3 (Care Transitions Measure - três perguntas) modificado. Determinar o nível de satisfação dos usuários com a continuidade de cuidados de enfermagem interníveis e relacioná-lo com a presença de relatório de cuidados de enfermagem após sua última hospitalização. Material e método: estudo de coortes retrospectivo, com 131 pacientes hospitalizados no Complexo Hospitalar de Cartagena (Espanha). A satisfação com a continuidade de cuidados foi avaliada com o questionário CTM-3-modificado, resultado de um processo de validação realizado sobre este. Resultados: 94 % dos entrevistados apresentam satisfação aceitável com o processo de continuidade de cuidados. Os pacientes com relatório de cuidados têm nível alto de satisfação com a continuidade de cuidados, RR= 0,90 (IC 95 %: 0,831-0,990). Conclusões: a validade de conteúdo e constructo realizada permite medir a satisfação dos usuários com a continuidade e sua correlação com a presença de relatório, obtendo como resultado que a realização de relatório de cuidados influencia levemente na satisfação com o processo de continuidade de cuidados. Contudo, o fato de que o relatório seja entregue em mãos e/ou seja explicado não parece afetá-la.

Analysis on operational status of the New Rural Cooperative Medical Scheme：Based on the field survey in 14 counties of 6 provinces / 中国卫生政策研究

Objective:To Compare the operational status of the New Rural Cooperative Medical Scheme( NCMS) in 14 Counties of 6 provinces. Methods:Two provinces were selected from eastern, central and western areas respec-tively and then two counties were chosen randomly from each province, but each of Jiangsu and Guangxi Provinces pro-vided 3 to reach the sample number of 14 counties. Excel 2007 was used for descriptive and comparative analysis of fund and in-patient service for NCMS. Results:The average funding standard was about 300 and 350 Yuan for 2012 and 2013. Hospitals outside county were frequently used and the ratio was over 40% in county I. Except Jiangsu and An-hui, the rate of enrollees who get compensation for inpatient service was over 10% and the actual compensation rate more than 50%, Fujian being an exception. Average hospitalization costs per time were different among counties and significantly rose in 2013. The ratio of out of pocket inpatient service expenses to the net rural household income was diverse among counties and it declines in some of them in 2013. The rate of fund for hospitals outside county was high and that of G counties was more than50%. The fund surplus rate was negative in that same year and was accumulatively ranging between 1 and 2%. Conclusions:The NCMS financing level was low and the personal financing responsibility was lighter;the enrollees didn’t contribute enough. In-patient service utilization structure was not rational in different level hospitals. The actual compensation rate for inpatient service didn’t increase a lot and the medical expenses burden didn’t alleviate apparently. The funds supervision was weak and it probably leaded to a high risk fund deficit.

Determinants of Out-of-Pocket and Catastrophic Health Expenditure: A Cross-sectional Study.

Background: In India, Out of Pocket Health Expenditures (OOPHE) is as high as 70-80% of total health expenditures, borne by the families of ailing persons. In most cases such high OOPHE is catastrophic in nature, in the backdrop of high poverty level in the country. High OOPHE and Catastrophic Health Expenditures (CHE) have a potential to impoverish people. It is therefore important to identify the predictors of OOPHE and CHE, to formulate an equitable and efficient financial protection measure from health expenditure. Methods: The study tried to understand the factors of out-of-pocket health expenditure and catastrophic health expenditure using the cross-sectional data from 986 sampled households in Koderma district of the state of Jharkhand in India. A multi-staged sampling method was followed to select households with incidences of in-patient care in the last one and child birth in the last two years and of out-patient care in the last one month. Alongside health expenditure data of the sampled households, their socio-demographic and socio-economic information were also collected using survey questionnaire. Findings: Male headed households, families with more than five members, household head who were unemployed or were engaged in agriculture or labour works as compared to those in service; household head aged above 60 years, households from higher expenditure quintiles, households with any member suffering from chronic illness, households reporting any episode of hospitalisation, in-patient or delivery services availed from private providers in the reference periods, families living closer to service providers especially private providers were significant predictors of high OOPHE. Residence in rural area (aOR: 1.65, 95% CI 1.10 - 2.49), families living in ‘kutcha’ (mud house) houses (aOR: 1.46, 95% CI 1.06 - 2.0), families with lower social status like Schedule Tribe (aOR: 1.76, 95% CI 1.0 – 3.13), Scheduled Caste (aOR: 1.73, 95% CI 1.02 - 2.92) and Other Backward Classes (aOR: 1.42, 95% CI 1.02 - 2.01) compared to General castes, families where any member suffering from chronic illness (aOR: 2.33, 99% CI 1.48 – 3.67), families where any member had received in-patient care in the last one year irrespective of type of providers (aOR: 2.18, 99% CI 1.60 - 2.97), longer distance from health service providers, had higher likelihood of CHE. Conclusion: The study tried to identify different predictors of Out of Pocket Health Expenditure (OOPHE) and Catastrophic Health Expenditure (CHE), incurred by families seeking medical care for various ailments. OOPHE was found higher among families from higher expenditure quintile; however, people from disadvantaged socio economic profile had higher likelihood of CHE. Apparently, even smaller OOPHE is proving to be catastrophic for families from lower socio-economic segments. Families with any member suffering from chronic illness were at a higher risk of CHE. OOPHE was considerably higher when services have been sought from private providers compared to public health providers, however, for in-patient care, expenditure incurred in both situations were found to be catastrophic. Urgent action is needed for designing healthcare finance policies that is more equitable and efficient and has a potential to reduce OOPHE and incidences of CHE.

The investigation of early rehabilitation of in -patients with traumatic brain injury in Eastern China / 中国基层医药

Objective To master the rehabilitation in patients with traumatic brain injury in Eastern China, and provide evidence for clinicians to rehabilitate early,correctly and effectively.Methods All sampling of the TBI patients from 80 hospitals in Eastern China were clustered and were analyzed using SPSS 13.0.Results The rate of in -patients in Eastern China with early rehabilitative intervention was 4.68%,and the rate of male was higher than female(male to female ratio was 3.80:1),mean age was (40.10 ±16.33)years old,but there was no difference in gender(χ2 =3.23,P =0.072)and age(t =-0.819,P =0.413)for the early rehabilitative intervention.Local resi-dent patients in early rehabilitative intervention was lower(χ2 =8.28,P <0.05).The average length of stay for the early rehabilitative intervention patients was(39.57 ±34.22)d(t =-17.74,P <0.05),the average cost of hospitali-zation was(42 741.50 ±43 186.69)yuan(t =-18.96,P <0.05).The rate of average length of stay and average cost of hospitalization of the rehabilitative intervention patients were higher and more expensive than the patients who did not obtain early rehabilitative intervention,but did have higher unfavourable prognosis rate(χ2 =85.45,P <0.05). Conclusion We advocate correct and early rehabilitative intervention for traumatic brain injury in patients with different degree,and promote not only the physical and functional rehabilitation,but also comprehensive rehabilitation such as the psychological treatment,family treatment and social regression.

A retrospective study on drug interaction for pediatric in-patients at Central Public Hospital Haji Adam Malik, Medan for the period of January-June 2012.

Background: Drug interaction is one of the factors causing a drug-related problem. Pharmacoepidemiology of drug interaction for pediatric patients at Central Public Hospital Haji Adam Malik, Medan has not come to light. The objective of this study was to find out the correlation between the amount of drug, the age and sex of patients, the number of patients diagnosed with drug interaction, the drug involved, the frequency, the mechanisms of drug interaction, and its severity levels for pediatric in-patients at Central Public Hospital Haji Adam Malik, Medan. Methods: The data for this study were collected by conducting a retrospective analysis to 232 medical records, which were kept from January to June 2012. The data collected for this study included demography, the amount of drug, and patient diagnoses. The drug interaction was confirmed in the website http://www.drugs.com and Tatro Drug Facts interaction. To determine the correlation between dependent and independent variables, Spearman’s bivariate correlation (for amount of drug, age of patient, and diagnoses) and Mann-Whitney’s Comparative Test (for sex) were used. Results: The frequency of drug-drug interaction was 75.43%. Based on drug interaction mechanism, the interaction was divided into pharmacokinetics interaction (24.76%), pharmacodynamics interaction (3.45%), and unknown interaction (71.78%). The drugs commonly involved in drug interactions were dexamethasone, vitamin E, captopril, spironolactone, phenytoin, and furosemide. The severity levels were major (8.83%), moderate (66.41%), and minor (24.76%). Conclusion: The statistical data analysis results showed that there was a significant correlation between the amount of drugs and the number of diagnoses, while age and sex did not show any significant correlation.

Trend of psychiatric disorders among out-patients and in-patients of a tertiary care center of India.

Background: Pattern of psychiatric disorders found among patients visiting the hospital helps in understanding the epidemiology, heath seeking behavior as well as strategic service planning and development. Methods: A retrospective health record review, of all the patients visiting out-patient care and in-patient care of psychiatry department of a tertiary care hospital in a period of two years, was conducted to assess the prevalence and trend of most common psychiatric disorders among them. Results: Major depressive disorder and Alcohol use disorder were the most common conditions found in out-patient and in-patient settings respectively. Out-patient consultations were consistently increasing whereas in-patient admissions were variable and decreasing with time. Conclusion: Current scenario and trends of psychiatric disorders among this group of patients is in line with epidemiological patterns and reflects a healthy trend of community oriented (out-patient based) care.

Establishment of prevention and assessment system of deep venous thrombosis for unattended in-patients / 中国实用护理杂志

Objective To build unattended in-patient deep venous thrombosis (DVT) assessment system through literature review and clinical practice.Methods Making out the first items through looking up literature review and guidelines and expert consultation,the unattended in-patients were chosen in hospital to scan the items,power the score and set degrees,then different suggestions were made for different degrees.Results The in-patient deep venous thrombosis assessment system included 13 items and 4 degrees.The value was increasing with the danger of deep venous thrombosis,and seven was the point of the curve of deep venous thrombosis incidence.The higher the score was,the higher the rate of composition,and the danger will be more probable.Hence we should pay more attention on patients who had two or more items.Conclusions The study assesses the items quantitatively and make suggestions according to different evaluation levels.The system help nurses to prevent deep venous thrombosis in early stage and make reference for clinical practice.

Knowledge and Practice of Diabetic Foot Care in an In-Patient Setting at a Tertiary Medical Center

Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients’ knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 ‘yes’ or ‘no’ questions on foot care knowledge and practice. Score of 1 was given for each ‘yes’ answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.

Medication Turnaround time in Hospital Pharmacy Department.

Medication turnaround time is defined as the interval from the time a medication order is written (manually or electronically) to the time the medication was administered. Monitoring medication turnaround time in inpatient settings allows organization to measure the impact of their efficiency of patient care. Objective: To trace the delays in the order and delivery system of In-patient pharmacy and check the average total time consumed in delivering drugs and medical consumables to the patients. Method: A time motion study was done in the in- patient pharmacy at a multi specialty hospital in Jaipur. A sample size of 300 indents was taken by using nonprobability convenient sampling method. Out of 300 indents, 56.6% were normal indents, 26.6% were new admission indents and 16.6% were urgent indents. Both primary and secondary data has been used in the study. The secondary data was obtained from the track care software, which was used in the pharmacy. SPSS and Microsoft excel was used for data analysis. Results: The study found that 25.2% of the normal indents, 48.7% of the new admission indents and 60% of the urgent indents were delayed. In addition, the average time taken to deliver normal indent was found to be 1hour 8 minutes, for new admission indent it was 48 mins and for urgent indent it was 1hr 20 minutes i.e. more than the normal indent and new admission indent. It was also found that the peak hours of the indent order were 10:00 pm to 12:00 am, also the peak hours of indent order and the availability of work force at that time was contradicting. The average number of indents per day was found to be 1224. Conclusion: Through this study, we were able to identify various points of delays, which were occurring in delivering indents to the patients. The results of the study revealed that all types of indents were delayed; especially urgent indents also got delayed, which became the major area of concern. In addition, if hospital follows indenting practices by the nursing staff, than the training for nursing staff is essential requirement regularly, to overcome this problem. The results of the study will definitely benefit in improving TAT of the pharmacy indents and most importantly the patient care.

Continuidade do cuidado ao portador de doença crônica em uma unidade de atendimento imediato / The continuity in patient assistance with chronic disease in the emergency medical services

Este estudo teve como objetivo compreender a continuidade do cuidado ao portador de doença crônica não transmissível (DCNT) no sistema de atenção à saúde na perspectiva de gerentes, profissionais e usuários de uma Unidade de Atendimento Imediato (UAI) no município de Betim – MG, escolhida como cenário da pesquisa pelo critério de acessibilidade. Trata-se de uma pesquisa descritiva de natureza qualitativa. Participaram da pesquisa 22 sujeitos, sendo três gerentes (gerente da unidade, coordenador médico e coordenador de enfermagem), 12 profissionais (duas assistentes sociais, cinco enfermeiros e cinco médicos) e sete usuários portadores DCNT. As DCNT foram escolhidas por sua magnitude, pela crescente morbimortalidade e pela necessidade de se pensar em políticas específicas. Os dados foram coletados por meio de entrevista individual com roteiro semiestruturado. Para a análise dos dados, utilizou-se a técnica da análise de conteúdo. Da análise, emergiram três categorias: “Continuidade do cuidado: uma análise à luz do conceito de continuidade informacional”, “Continuidade gerencial: do gerenciamento das condições crônicas à complexidade gerencial” e “O Programa de Internação Domiciliar como expressão da continuidade do cuidado”. A análise de dados na primeira categoria evidenciou que a comunicação no contexto interno da UAI apresentou lacunas como: problemas relacionados aos prontuários dos pacientes e comunicação deficitária entre os integrantes da equipe que fragilizam as ações voltadas para a continuidade do cuidado. A interação entre a UAI e os demais serviços de saúde mostrou-se problemática. A assistente social é profissional-chave nessa interação. Evidenciou-se, ainda, que a referência dos usuários está mais consolidada que a contrarreferência. Na segunda categoria, viu-se que o gerenciamento das DCNT na UAI apresentou pontos de fragilidade que podem interferir na continuidade do cuidado, sendo prioritárias as abordagens...

This study’s goal was to understand the continuity of care provided to the carrier of non-communicable chronic disease (NCCD) within the system of health care, through the perspective of managers, employees and users of an Immediate Care Center (ICC) located in Betim - Minas Gerais State, which was selected as the setting of this research under the criterion of accessibility. The present research is descriptive and qualitative in its nature. 22 individuals were part of it, according to the following division: three managers - one of the center as a whole, another of the medical body, and the last one of the nursing department; 12 employees - two social assistants, five nurses and five doctors; and seven users who are carriers of NCCD. The NCCDs were chosen for they can be classified as diseases of great magnitude, increasing morbidity, and because of the pressing need to think of policies concerned with assisting their carriers. The data were collected in the format of individual interviews with a semi-structured guide. Content analysis was the technique employed in examining the data, and it generated the emergence of three categories: “Continuity of care: an analysis under the light of the concept of informational continuity”, “Management Continuity: from managing chronic conditions to management complexity” and “The Home Care Program as an expression of continuity of care”. For the first category, it was revealed that there were gaps in communication inside the ICC, such as problems related to the records of patients, and poor communication among the members of the same team, which minimized the potential to take proper measures to enhance continuity of care. Interaction between the ICC and other health services appeared to be troublesome, though it was verified that the social assistant is an important key in making this interaction work. Moreover, there was evidence that the reference of users is more solid than the counter-reference...

Hospital Based Nutrition Rehabilitation of Severely Undernourished Children Using Energy Dense Local Foods.

Objective: To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit. Design: Retrospective cohort. Setting: In-patient ward at a tertiary care government pediatric hospital in Hyderabad. Patients: Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005. Intervention: A diet based on energy dense local foods along with multivitamin-multimineral supplements. Main outcome measures: Catch up growth (g/kg/day) during each week of hospital stay. Results: Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was –4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week. Conclusions: The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.

Study on the process standardization for in-patient charge management / 中华医院管理杂志

In-patient charge remains a bottleneck in the practice of healthcare charges for its numerous items, complex procedures, high amount, numerous persons involved, and long duration. In terms of healthcare charge information system, in-patient charge items pricing and input, and in-patient charge review, this study probes into the standardization of the information system for healtheare charges. In addition, it summarizes standardized paths for in-patient charges management, in order to provide worthy experiences for standardization management of in-patient charges.