ABSTRACT
Background: Identifying the magnitude of this improper use and applying interventions to eliminate unnecessary hospitalization will reduce health-care expenditure, improve the quality of care for patients, and increase the accessibility to care for actual patients in need on waiting lists. Aim of Work: To measures the rate of inappropriate admissions at the Ain Shams University Hospital. Methods: This research is the preintervention phase of a study conducted to improve the appropriateness of patient admission at this hospital. The appropriateness evaluation protocol (AEP) was used to review the appropriateness of 576 hospital admissions over 100 days. The patients’ medical records were stratified according to the admission route into two groups, namely emergency and outpatient admission. Next, the systematic random samples were taken from each stratum based on the admission list of the previous day. Results: The results showed that 20.5% of the sampled cases were inappropriately admitted. Furthermore, a statistically significant difference was observed between appropriately and inappropriately admitted cases regarding gender and shifts during which admission occurred in addition to body systems affected; inappropriate admissions were more among females, and admissions occurred most frequently during the morning shifts (8:00 am–2:00 pm). The remaining other factors that were studied also proved insignificant. Conclusion: It can be concluded that a considerable proportion of hospital admissions is inappropriate, especially in the elective surgery department, and these admissions vary according to patient’s gender, shifts during which admission occurred, and the affected body systems. Recommendations: Adopting hospital admission policies based on the AEP criteria in addition to training of physicians on these criteria would help prevent inappropriate admission and ensure optimization during use of hospital facilities.
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O bem-estar dos animais, além dos aspectos individuais, depende do entendimento e dedicação dos responsáveis pelo abrigo. O objetivo do presente trabalho foi avaliar o bem-estar dos cães mantidos em abrigos municipais do estado do Paraná, mediante a aplicação do protocolo Shelter Quality. Foram avaliados 16 abrigos, 439 cães e 165 recintos, na estação do outono de 2017. A maioria dos abrigos apresentou cães com condição corporal adequada e pelagem limpa, em recintos seguros, com metragem e suprimento de água adequados e conforto térmico. Além disso, a maioria dos cães eram mantidos em recintos coletivos e em ambientes abertos, com baixo nível de ruído e demonstravam mais emoções positivas, desejáveis na adoção. Como aspectos negativos, 58% (96/165) dos recintos avaliados tinham camas inadequadas ou inexistentes e 30% (50/165) dos recintos mantinham cães individualmente, sendo indicadores de baixo grau de bem-estar para os cães envolvidos. Além disso, nenhum abrigo disponibilizava ração para cães idosos e 81% (13/16) dos abrigos negligenciavam o diagnóstico e tratamento da dor. Apesar de a maioria dos abrigos apresentarem mais pontos positivos que negativos em sua avaliação, a gestão dos abrigos deve sempre visar à correção dos pontos críticos que comprometam o bem-estar dos animais.(AU)
Animal welfare, in addition to individual aspects, depends on the understanding and dedication of those responsible for the shelter. The objective of this study was to evaluate the welfare of dogs kept in municipal shelters in the state of Paraná, using the Shelter Quality protocol. A total of 16 shelters, 439 dogs and 165 enclosures were evaluated in the fall season of 2017. Most shelters presented dogs with adequate body condition and clean coat, in secure enclosures with adequate water supply and thermal comfort. In addition, most dogs were kept in collective enclosures and in open environments, with low noise levels and showing more positive, desirable emotions in adoption. As negative aspects, 58% (96/165) of the precincts evaluated had inadequate or inexistent beds and 30% (50/165) of the enclosures kept dogs individually, being indicators of a low degree of well-being for the dogs involved. In addition, no shelter provided elderly dog rations and 81% (13/16) of the shelters neglected the diagnosis and treatment of pain. Although most shelters present more positive than negative points in their evaluation, shelter management should always aim at correcting critical points that compromise animal welfare.(AU)
Subject(s)
Humans , Dogs , Quality of Life , Animal Welfare , /methods , Housing, Animal/standards , Brazil , DrinkingABSTRACT
OBJECTIVES: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. METHODS: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. RESULTS: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. CONCLUSIONS: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.
Subject(s)
Humans , Administrative Personnel , Hospitals, District , Hospitals, Public , Judgment , Korea , Medical Records , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.
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When the device is installed,it needs to be verified by some special tests to evaluate its performance and to determine whether the device is in accordance with the requirements of the relevant inspection specifications.The projects of the automated coagulation analyzer are particularity different from other tests,especially the biochemistry tests.So the clinical laboratory should establish and implement the matching performance validation protocol.This article refers to the CLSI related documents to summarize a feasible and applicable evaluation protocol,helping for evaluating automated coagulation analyzer.
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O objetivo deste trabalho foi descrever os procedimentos de atendimento no Ambulatório de Neuroplasticidade do Núcleo de Atendimento Neuropsicológico Infantil Interdisciplinar (NANI), com foco no detalhamento do protocolo psicopedagógico de avaliação. Para isso, foi realizada descrição dos procedimentos de atendimento, do protocolo psicopedagógico de avaliação e o perfil dos usuários atendidos no ano de 2011, a fim de explicitar como se deu a atuação psicopedagógica nesse contexto. Os indivíduos foram submetidos a anamnese, avaliação neuropsicológica, avaliação terapêutica-ocupacional, exame neurológico e avaliação psicopedagógica. Os resultados da avaliação psicopedagógica foram: 25% realizavam leitura ortográfica, 25% leitura alfabética e 50% leitura logográfica. O nível de escrita na qual se encontravam foi: 63% no nível alfabético e 37% no nível pré-silábico. No domínio matemático, 63% tinham consolidado o sistema de numeração decimal e realizavam operações aritméticas de adição e subtração, enquanto que os outros 37% não dominavam ainda esse conceito. O protocolo mostrou-se sensível e eficaz na avaliação de sujeitos com lesão cerebral, uma vez que propõe a avaliação de questões relacionadas a linguagem, escrita, leitura, matemática e aspectos comportamentais...
The objective of this article was to describe the procedures used in attendance of children and adolescents with brain injury in the clinic of neuroplasticidade of the Núcleo de Atendimento Neuropsicológico Infantil Interdisciplinar (NANI), focusing on detailing the psychopedagogical procedures of evaluation. For that, it has been held the description of attendance procedures, of the psychopedagogical protocol of evaluation and the profile of the users served in the year of 2011, willing to demonstrate how the psychopedagogical acting has happened in this context. The individuals have gone through anamnesis, neuropsychological evaluation, occupational therapy, neurological exam and psychopedagogical evaluation. The results of the psychopedagogical evaluation were: 25% did orthographic reading, 25% alphabetical reading and 50% logographic reading. Their level of writing was: 63% in alphabetical level and 37% in pre syllabic level. As for mathematical domain, 63% had the decimal numbering system consolidated and performed arithmetic operations of addition and subtraction, while 37% have not yet had the domain of the concept. The protocol was sensitive and effective in the evaluation of subjects with brain injury, once it proposes the evaluation of matters of language, writing, reading, mathematics and behavior aspects...