[Malaria in the triple border region between Brazil, Colombia and Peru]. / Situação da malária na tríplice fronteira entre Brasil, Colômbia e Peru.

This article aims to analyze the malaria surveillance situation on the triple border between Brazil, Colombia, and Peru. This was a qualitative study using questionnaires in the border towns in 2011. The results were analyzed with the SWOT matrix methodology, pointing to significant differences between the malaria surveillance systems along the border. Weaknesses included lack of linkage between actors, lack of trained personnel, high turnover in teams, and lack of malaria specialists in the local hospitals. The study also showed lack of knowledge on malaria and its prevention in the local population. The strengths are the inclusion of new institutional actors, improvement of professional training, distribution of insecticide-treated bed nets, and possibilities for complementary action between surveillance systems through cooperation between health teams on the border. Malaria control can only be successful if the region is dealt with as a whole.

Difficulties with the organ donation process in small hospitals in Germany.

The discrepancies between the need and the number of organs donated in Germany lead to a search for the causes of this deficit. In the present study, 78 small hospitals in Germany were interviewed about the difficulties with the organ donation process. Data were acquired by means of a structured telephone interview. No organ donor between 2004 and 2008, was reported by 44% of the participating hospitals while the remaining 56% had >or=1 donor. The main results show that one third of these small hospitals already had difficulties communicating with bereaved relatives about donation. In addition, 31% of the respondents reported problems during the organ removal process and 41% in identifying potential organ donors.

MRSA infections in smaller hospitals, Victoria, Australia.

BACKGROUND: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) cause significant morbidity, mortality, and associated costs. METHODS: Trained infection control (IC) nurses in 84 smaller (<100 acute beds) hospitals during a 20-month period collected data on MRSA infections. RESULTS: The aggregate rate for all MRSA infections confirmed by the Victorian Hospital Acquired Infection Surveillance System Coordinating Centre IC nurse was 1.5 per 10,000 acute care occupied bed days (OBDs) (95% CI: 1.2-1.8). MRSA infections of 0.5 per 10,000 OBDs were detected >48 hours after admission (95% CI: 0.3-0.7). The aggregate rate for MRSA infections in sterile sites was 0.2 per 10,000 OBDs (95% CI: 0.0-0.4) and in nonsterile sites was 1.3 per 10,000 OBDs (95% CI: 1.0-1.6). CONCLUSION: The results suggested that serious MRSA infections in Victoria's smaller hospitals are an infrequent event. Most are "inherited" either from the community or other health care facilities.

Quality of data reported to a smaller-hospital pilot surveillance program.

This data quality study assessed the accuracy of data collected as part of a pilot smaller-hospital surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) infection and bloodstream infection (BSI). For reported MRSA infection, estimated values were as follows: sensitivity, 40%; specificity, 99.9%; and positive predictive value, 33.3%. For reported BSI, estimated values were as follows: sensitivity, 42.9%; specificity, 99.8%; and positive predictive value, 37.5%.

Measuring rural hospital quality.

CONTEXT: Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. PURPOSE: This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context. METHODS: We develop a conceptual model for measuring rural hospital quality, with a focus on the special issues posed by the rural hospital context for quality measurement. With the assistance of a panel of rural hospital and hospital quality measurement experts, we review hospital quality measures from national and rural organizations for their fit to rural hospitals. FINDINGS: Based on this analysis, we recommend an initial core set of quality measures relevant for rural hospitals with less than 50 beds. This core set of 20 measures includes 11 core measures from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) related to community acquired pneumonia, heart failure, and acute myocardial infarction; 1 measure related to infection control; 3 measures related to medication dispensing and teaching; 2 procedure-related measures; 1 financial measure; and 2 other measures related to the use of advance directives and emergency department monitoring of trauma vital signs. CONCLUSION: Based on the special measurement needs posed by the rural hospital context, we suggest avenues for future quality measure development for core rural hospital functions (eg, triage, stabilization, and transfer, and emergency care) not considered in existing quality measurement sets.

Removing the roadblocks to medical and health student training in rural hospitals in Victoria.

OBJECTIVE: To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia. METHOD: Cross sectional postal survey with telephone follow-up in north-east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North-east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements. RESULTS: Large regional hospitals accounted for two-thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals. CONCLUSIONS: Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas.

Uncovering pressure ulcer incidence.

Researchers compare state-specific pressure ulcer incidence, staff mix, and nursing care quality outcomes data.

Rural hospital HIPAA readiness and resource needs.

PRINCIPAL FINDING: rural hospitals with fewer than 50 beds were most in need of assistance and resources to prepare for HIPAA indicating that the Small Hospital Improvement Program chose well in making HIPAA readiness one of three purposes for grants to those hospitals.

Oxygen therapy for children with acute respiratory infections in small hospitals.

Oxygen administration is one of the most important modalities of therapy for a patient with hypoxaemia to prevent death and disability from common conditions such as acute lower respiratory tract infections. Oxygen needs to be available at all times in hospitals, however, it is too expensive for many developing countries. There is little information for health professionals regarding indications for initiating oxygen therapy, selecting appropriate method of oxygen administration and deciding on the source for oxygen. A review of the literature using medline citations and cross references from published articles and other manuscripts was made. The review described the two main sources of oxygen for small hospital-cylinders and oxygen concentrators and their advantages and disadvantages. It also looked at the evidences for clinical indications to initiate and discontinue oxygen therapy. Studies on efficient and safe methods of administration of oxygen were reviewed as well. The review concluded that oxygen may be administered in children with cyanosis, chest indrawing, inability to drink or breastfeed, tachypnea with respiratory rate above 70/minute or in a child who develops restlessness and improves on oxygen. The initial capital cost of concentrators is high but the running cost is low and it does not require transport while oxygen cylinders are expensive to transport and need continuous refilling. The safest method of oxygen administration are the prongs followed by the nasal catheters.

Análisis epidemiológico de las causas de consultas más frecuentes en un servicio de urgencia de un hospital tipo cuatro / Epidemiologic analysis of more frequent causes of consultation at an emergency service of a type 4 hospital

El hospital de Chimbarongo es un hospital tipo 4 que atiende una población de 32943 habitantes, en su mayoría rural (62 por ciento). El objetivo de este análisis epidemiológico es determinar las causas de consultas más frecuentes en el servicio de urgencia, describir, entre éstas, la más frecuente (enfermedades respiratorias) en base a factores biológicos, geográficos y de patología; asimismo, mostrar la importancia del servicio de urgencia como puerta de acceso a la atención en salud. El 60 por ciento de las consultas corresponden a uno de estos grupos de patologías: respiratorio, traumatismos y envenenamientos o enfermedades infecciosas, siendo la primera la más frecuente. En las enfermedades respiratorias el 65 por ciento de las consultas son por población infantil, de origen rural en un 45 por ciento; las infecciones respiratorias bajas representan el 17 por ciento de este grupo, siendo ésta la principal causa de hospitalización en edades extremas. Se concluye que el servicio de urgencia es un eficiente sistema de acceso a la atención de salud y adecuado filtro para enfermedades y grupos de riesgo