ABSTRACT
We wished to determine the reasons for an average missed appointment rate of 28% in a high-risk pregnancy clinic. Only 41% of the 261 women in the study group could be reached by telephone. The reasons included not having a phone, the phone had been disconnected, incorrect phone number on the chart, the patient had moved, and the patient did not respond to the answering machine message. The reasons for missing the appointment included lack of transportation, scheduling problems, overslept or forgot, presence of a sick child or relative, and lack of child care. The response of patients to assessing prenatal care may reflect their priority of medical care relative to other priorities associated with day-to-day existence. There may be a baseline missed appointment rate for prenatal care in lower socioeconomic populations of women. The commitment of personnel time and energy to attempt to modify the no-show rate should be reexamined.
Subject(s)
Appointments and Schedules , Patient Compliance , Prenatal Care , Chi-Square Distribution , Female , Humans , Pregnancy , Pregnancy, High-Risk , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The purpose of this study was to determine the prevalence of nosocomial infections, associated risk factors, microbiology, use of antibiotics, and associated mortality among hospitalized children. MATERIAL AND METHODS: A 1-day prevalence survey was conducted among 1,183 children hospitalized in a nationwide network of 21 public hospitals caring for children. To attain consistency between hospitals, CDC nosocomial infection definitions were used. Adjusted relative odds of bacteremia were estimated using logistic regression analysis. RESULTS: The prevalence of nosocomial acquired infection was 9.8% (CI 95%, 8.1-11.6). The more prevalent infections were pneumonia (25%), sepsis/bacteremia (19%), and urinary tract infection (5%). The main microorganism isolated in blood cultures drown from patients with nosocomial infection was K. pneumoniae (31%). The prevalence of antibiotics use was 49% with substantial variation between hospitals (range 3-83%). Using logistic regression analysis, four factors were independently associated with the risk of nosocomial infection: central venous catheters (OR 3.3; CI 95% 1.0-5.9), total parenteral nutrition (OR 2.1; CI 95% 1.0-4.5) mechanical ventilation (OR 2.3; CI 95% 1.2-4.1), and low birth weight (OR 2.6; CI 95% 1.0-6.8). The overall mortality was 4.8%; however, patients with nosocomial infection had two times greater risk to die as compared to non-infected children (OR 2.6; CI 95% 1.3-5.1). CONCLUSIONS: This rapid assessment survey using a standard methodology allows to document the prevalence of nosocomial infections in children. The results were used to develop targeted programs on central catheters and mechanical ventilation aimed to reduce bacteremia/sepsis and pneumonia, two nosocomial infections characterized by high prevalence and mortality.
Subject(s)
Cross Infection/epidemiology , Adolescent , Age Factors , Catheterization/adverse effects , Child , Child, Preschool , Cross Infection/etiology , Cross Infection/mortality , Cross-Sectional Studies , Data Collection , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Logistic Models , Mexico/epidemiology , Parenteral Nutrition, Total/adverse effects , Respiration, Artificial/adverse effects , Risk FactorsABSTRACT
Referring to the above said paper by Narendra-Parthasarathy (ibid., vol.1, p4-27 (1990)), it is noted that the given Example 2 (p.15) has a third equilibrium state corresponding to the point (0.5, 0.5).