Antibiotic Use, Cost, and Consumption in Tertiary Hospitals in Lebanon: A Comparative Study Before and After an Implementation of Antibiotic-Restriction Program (ARP).

Aims: To compare the antibiotic use, cost, and consumption before and after an implementation of an antibiotic-restriction program (ARP) in governmental hospitals setting in Lebanon. Study Design: A retrospective cohort study on hospitalized patients who were prescribed antibiotics prior to, and after the application of the ARP, was conducted over a three month period, between March 2013 and June 2013. Methodology: The studied population included patients on antibiotic therapy. The sample size that was enrolled was equal to 612 patients prior to ARP and 606 patients after ARP. Results: The average age of the patients was 34.6±23.5 years, 55.6% of whom were females, and 79.2% had no comorbidity. Respiratory diseases, and gynecological surgeries motivated the antibiotics prescriptions. The physicians prescribed combinations of intravenous antibiotics in 91% of the cases. The most frequently ordered antibiotics were second, third- generation cephalosporins, and penicillin derivatives. After ARP, the rate of restricted antibiotic use decreased by 11% (P<.0001), while the use of gentamicin increased with a potential for increased rates of nephrotoxicity and ototoxicity; Prior to and after the ARP, a microbiological exam was done in 12.6% of cases, and 67.3% of the cases of prescribed antibiotics were sensitive. The expenditure of all, and restricted antibiotics decreased by 22.3% and 9% respectively. The cost savings were US$ 8099 per month. The compliance with the ARP by prescribers was very high (>90%). Conclusion: The ARP reduces the amount of antibiotic usage, cuts down the healthcare expenditure, and may prevent a higher prevalence of some resistant bacterial strains; it is, therefore, in the interest of policymakers to propose an antimicrobial stewardship program based on mHealth system that allows patients, and healthcare providers an on-line and mobile consultation.

THINKING ABOUT THE INDEBTEDNESS OF THE LARGE PUBLIC HOSPITAL / 现代医院

Public hospital is a public medical institutions , but at the present, the government's financial abil-ity is limited, which input for the hospital is symbolic .In fact, in order to survive and develop , the hospital debts be-come the main means of financing of public hospital .The liabilities of hospital mainly include two aspects : one is the current liabilities, such as the credit payment which is formed by the drug ; the other is the long term liabilities, such as the borrowing from financial institutions , which is used to construct the fixed asset of the hospital .Now, the man-agement of the debts has become an important means for the development of hospital , although, the hospital can solve the problem of the shortage of the funds to expand the scale of development and the power of competing , but inevita-bly, which will accompany by some risks , at the same time of indebtedness .So, hospital should carry on the scientif-ic decision, and make the early warning and management about the necessary financial risk .

Investigations into non governmental hospitals in Guangdong / 中华医院管理杂志

Objective To find out about the current state of development and existing problems in non governmental hospitals and to explore their development direction by collecting quantitative and qualitative data. Methods Investigations in the form of questionnaires were made into all the non governmental hospitals province wide and a descriptive analysis was made of the data collected. Results Non governmental hospitals in the province witnessed fast development, and yet they were generally small scaled, lacked actual strength, and were unevenly distributed, claiming only 3% of the market share; they paid special attention to the unique features of specialties and employed flexible operational modes, and yet they were still confronted with such problems as insufficient support policies from the government and personnel instability. Conclusion There is still a long way to go before the monopoly of state run hospitals is broken, diversified modes of hospital running are developed, and fair and orderly competition is formed so as to enhance the vitality of medical institutions. Administrative departments of health should fully realize the role and social functions of non governmental hospitals and actively lead their development in a healthy direction with sound policies.

Government in Korea with the Special Reference to the Clinical Activities at the Colonial Governmental Hospital: 'Chosun-Chong-Dok-Bu Ui-Won' (1913-1927) / 의사학

The purpose of this study is to elucidate the ways of introduction of modern psychiatric care into Korea and to demonstrate the changing patterns of psychiatric care during the time between 1913 and 1927. The study was focused on the clinical activities of the colonial governmental hospital on the basis of the annual reports of the hospital from 1912 to 1928. The investigation has revealed the fact that the first special institution for the care of the mentally ill patients was founded in 1911 in Seoul by the colonial government which was called 'Che Saeng Won'. It was also confirmed that the first clinical department of the psychiatry in Korea was established in 1913 at the colonial governmental hospital, 'Chong-dok-bu Ui-won' which has taken over the role of psychiatric care from Che Saeng Won. The first chairman of the department of psychiatry was Misuzu Nobuharu and his assistant was Shim Ho-Sub, the first Korean psychiatrist who became assistant professor of psychiatry at Kyongsung medical college in 1916-1917 but moved to Severance hospital and changed his speciality to neurology of internal medicine. The department had two physicians and 4 care persons at the beginning stage and 22 beds for the mentally ill patients in the hospital which had total 330 beds. Later, the department has developed to 54 bed clinic with 4 staff physicians.It was noteworthy, however, that the treatment and care for the mentally ill patients by the western medical facilities in Korea probably began since 1880s at the general hospitals and clinics, such as Che-saeng Ui-won in Pusan, Royal hospital, Che-choong-won in Seoul, Paton memorial hospital in Chinjoo, Tai-Han hospital and Severance hospital in Seoul.In 1911, Australian psychiatrist McLaren began to work at Paton memorial hospital in Chinjoo, who became professor of neurology and psychiatry at Severance Union Medical College in Seoul. At Severance hospital, the psychiatric ward opened in 1923 with 10 beds. Dr. McLaren as missionary physician allegedly carried out humanitarian treatment and care of the mentally ill patients.The patterns of admission rates in accordance with diagnostic categories and racial differences at In- and Outpatient clinic of psychiatric department have offered no significant clues for the cultural psychiatric interpretation except for the case of hysterical psychosis. Among the total number of admitted cases of hysterical psychosis at psychiatric ward of Chong-dok-bu Ui-won the number of Japanese women were predominantly high throughout the period of investigation in comparison with the Korean patients. Some possible factors which might have influenced to this fact were suggested. Discussion was also held on the changing patterns of psychiatric diagnosis and nomenclature during the period.Colonial governmental hospital made great effort to expand the clinical and research facilities, therefore, Japanese psychiatrists have introduced the advanced knowledges of German psychiatry into Korea. Regrettably, however, the knowledges could not be transmitted to the Korean psychiatrists continuously until 1927 probably due to the discriminative policy of colonial government on the medical education for the Korean people.