Investigation of Relationship Between Spatial Distribution of Medical Equipment and Preventable Mortality.

The aim of the study is to investigate the relationship between the spatial distribution of the selected medical equipment and the preventable mortality rate in the regions of the Slovak Republic. The main analytical approach is carried out through the cluster analysis based on a Euclidean distance technique in order to get similarity of the administrative divisions in form of a district and a pseudot2 approach aimed at the determination of a number of the districts in a cluster. A number of medical equipment had a rising tendency from the year 2008. The most extreme position according to a localisation distribution of the computed tomographs and the magnetic resonance imaging scanners is held by the Kosice IV District at the level of 7.50630. From an angle of view of the preventable mortality, the Piestany District holds the most extreme position peaking at the level of 10.97969 for the female sex and the Kezmarok District with the value of 9.44088. The study has the significant dissemination outputs for health policy interventions, especially to draw up regional health plans for computed tomography and magnetic resonance imaging deployment, mainly in locations with a high preventable mortality rate for both sexes.

Incidence, clinical distribution, and patient characteristics of childhood cancer in Saudi Arabia: A population-based analysis.

PURPOSE: Information regarding the incidence and patterns of childhood malignancies is disproportionately overrepresented by high-income countries, representing mainly the Caucasian population. There is a need to evaluate and disseminate information for other ethnicities, particularly from the Middle East. METHODS: Data from the National Cancer Registry, Saudi Arabia (SA-NCR), for pediatric patients (age 0-14 years) diagnosed between 2005 and 2009 and for similar patients at our institution during the same period were analyzed. Population numbers reported in the 2007 national census were used to calculate the annual incidence of childhood cancer. RESULTS: Data from SA-NCR on 3885 patients were included in this analysis. The median age was 5.58 years, and 57.3% were males. The annual age-specific cancer incidence rate (ASR) for children in SA is 99.83 per million population; ASR per million for lymphoid leukemia is 25.75, 12.05 for brain tumors, and 9.82 for Hodgkin lymphoma. Of all childhood cancers in SA, 35% were treated at our institution. The five-year overall survival for these 1350 patients is 74.6% (median follow-up 7.52 years [95% confidence interval: 7.36-7.68]). Significant differences in the distribution of childhood malignancy subtypes were evident compared with other countries. CONCLUSION: We have reported differences in the cancer ASR and cancer subtype distribution for children in SA as compared with the worldwide incidence and with other populations. This paper provides a comprehensive epidemiological overview of childhood cancer in SA, which could be extrapolated to other regional Arab populations.

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.

BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature.

AIMS OF THE STUDY: We aimed to determine the benefit of an expanded use of TH. We also described the impact of a targeted temperature management on outcomes at discharge. DATA SOURCES: We identified studies by searching MEDLINE, EMBASE and Cochrane Library databases. We included RCTs and observational studies restricted to those reporting achieved temperature during TH after OHCA. No other patient, cardiac arrest or hypothermia protocol restrictions were applied. Outcomes of interest were hospital mortality and neurological outcome at discharge. Appropriate risk of bias assessment for meta-analyzed studies was conducted. Studies contrasting hypothermia and normothermia outcomes were meta-analyzed using a random-effect model. Outcomes of cooling arms, obtained from enrolled studies, were pooled and compared across achieved temperatures. RESULTS: Search strategy yielded 32,275 citations of which 24 articles met inclusion criteria. Eleven studies were meta-analyzed. The use of TH after OHCA, even within an expanded use, decreased the mortality (OR 0.51, 95%CI [0.41-0.64]) and improved the odds of good neurological outcome (OR 2.48, 95%CI [1.91-3.22]). No statistical heterogeneity was found for either mortality (I2=4.0%) or neurological outcome (I2=0.0%). No differences in hospital mortality (p=0.86) or neurological outcomes at discharge (p=0.32) were found when pooled outcomes of 34 hypothermia arms grouped by cooling temperature were compared. CONCLUSION: The use of TH after OHCA is associated with a survival and neuroprotective benefit, even when including patients with non-shockable rhythms, more lenient downtimes, unwitnessed arrest and/or persistent shock. We found no evidence to support one specific temperature over another during hypothermia.

The Study of an Optimal Robust Design and Adjustable Ordering Strategies in the HSCM.

The purpose of this study was to establish a hospital supply chain management (HSCM) model in which three kinds of drugs in the same class and with the same indications were used in creating an optimal robust design and adjustable ordering strategies to deal with a drug shortage. The main assumption was that although each doctor has his/her own prescription pattern, when there is a shortage of a particular drug, the doctor may choose a similar drug with the same indications as a replacement. Four steps were used to construct and analyze the HSCM model. The computation technology used included a simulation, a neural network (NN), and a genetic algorithm (GA). The mathematical methods of the simulation and the NN were used to construct a relationship between the factor levels and performance, while the GA was used to obtain the optimal combination of factor levels from the NN. A sensitivity analysis was also used to assess the change in the optimal factor levels. Adjustable ordering strategies were also developed to prevent drug shortages.

Implementation of a redistribution system for near-outdate red blood cell units.

CONTEXT: Many remote hospitals keep small on-site stocks of red blood cell (RBC) units for emergency use and to support patient care programs. In Canada, the blood supplier does not accept returned units into inventory. Discard rates can, therefore, be high. OBJECTIVE: To transport near-outdate RBC units to a high-usage hospital site, which would reduce overall discard rates, thereby increasing overall stock levels available in the blood system. DESIGN: A blood transportation system was developed and validated. The validation was presented to a high-usage site that agreed to accept near-outdate RBC units transported by this system. Stocks at the remote hospitals were optimized without increasing system-wide discard rates. The redistribution program was implemented in 4 remote sites in northern Alberta, Canada. The final disposition of each transported unit was tracked. Data from the first 2 years were analyzed. RESULTS: Between April 1, 2003, and March 31, 2005, 106 RBC units were successfully transported to and transfused at the high-usage site. The majority of the units were group O. None of the transfused units were involved in any reported transfusion reactions. The success rate of the transportation system varied among the sites (59%-78% successfully transported and transfused). Changes to the transport system were implemented as problems were discovered. The use of a temperature monitor in each shipment allowed for concurrent revalidation after each change. CONCLUSIONS: Redistribution systems can be an effective way to reduce RBC unit discard rates. Even simple transportation systems have many factors affecting the RBC unit temperature. Novel temperature stabilizing materials may make future transportation of RBC units more reliable.

[General services]. / Servicios Generales.

The present article describes the activity performed by the medical support services and, more specifically, by operational services (which include mainly cleaning, laundry, and non-patient transport) and catering. We outline the normal activity of these services and then provide details of how they were affected on 11 March and subsequent days. Data relating to the Rehabilitation Centers and Ophthalmology Institute are not included as they were not significantly affected from the point of view discussed herein.

Health care's most wired. A wired exchange.

There was a time when innovation in health care information technology meant being at the cutting edge of managerial systems. Hospitals made significant investments in financially oriented technology. In the past five years, the investment in clinical IT appears to have outstripped the investment in managerial systems, including enterprise resource planning aimed at improving the supply chain.

Intervención para la disminución de las estancias inapropiadas. Un estudio de tres años en un hospital universitario. Evaluación mediante el empleo del Appropriateness Evaluation Protocol (AEP) / Intervention for lowering inappropriate stays. A 3-years study at an university hospital. Evaluation by means of the employment of the Appropriateness Evaluation Protocol (AEP)

Objetivo: Evaluación de la intervención para disminuir las estancias inapropiadas, estudiando las características de los procesos de los servicios con mayor proporción de las mismas y analizando los resultados obtenidos. Métodos: Estudio concurrente de 569 estancias distribuidas entre los años 2000 a 2002, escogidas mediante muestreo de bloques durante un día único. Se estudia la proporción de estancias inadecuadas para un conjunto de servicios con mayor impacto en la inadecuación de las estancias. Se comparan las proporciones de inadecuación entre las diferentes unidades del hospital y entre los diferentes años. Se estudian los procesos de los dos servicios más desviados y se corrigen determinados defectos en la organización y estructura de éstos. Resultados: En los servicios quirúrgicos la inadecuación global fue del 71,4 por ciento y en los médicos el 70,7 por ciento. La proporción de adecuación global de la estancia varió desde el 70,07 por ciento del año 2000 al 73,06 por ciento del año 2002. La proporción de estancias inadecuadas en los servicios donde se realiza la intervención desciende un 30 por ciento y un 75 por ciento (desde el 47,6 al 33,3 por ciento y del 42,1 al 10,5 por ciento). La causa mas frecuente de inadecuación de la estancia es encontrarse pendiente de resultados y la posibilidad de realizar determinadas pruebas como paciente externo. Conclusiones: El análisis secuencial de la utilización de recursos mediante el AEP (Appropriateness Evaluation Protocol) permite evaluar y corregir defectos organizativos y de la distribución de los recursos. La selección de determinados servicios con niveles mas altos de inadecuación permite focalizar el problema y las soluciones. En nuestro medio la causa corregible más importante fue la mala distribución del horario de algunas pruebas que provocaba estancias inapropiadas y la estancia de pacientes para realizar pruebas que podrían realizarse de forma ambulatoria (AU)

An analysis of catering options within NHS acute hospitals.

Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations.

La medicina privada en México: resultados del Censo Nacional de Unidades Hospitalarias Privadas / Private medicine in Mexico: results from the National Census on Private Hospitalization Units

El objetivo de este estudio fue cuantificar los recursos de la medicina privada mediante un censo de unidades médicas con servicio de hospitalización, realizado en el primer trimestre de 1994 con base en la información jurisdiccional. Se registraron en todo el país 2 723 unidades médicas del sector privado con camas de hospitalización. En el Distrito Federal y los estados de México, Guanajuato, Michoacán, Baja California y Veracruz se concentra cerca de la mitad de las unidades. El total de camas censables registradas en el país de 33 937, de tal manera que la medicina privada es el principal proveedor de camas de hospitalización del Sistema Nacional de Salud; se encontraron resultados similares en cuanto al resto de recursos materiales humanos

A census of private health establishments was carried out by the Secretary of Health, in order to quantify its resources and to describe their geographical distribution. The census, conducted in 1994, was limited to private units which offered hospitalization services, and the reference period was the previous year. Results showed that there are 2 723 private hospitalization units in Mexico, and nearly a half of the units are concentrated in the Federal District, and the states of Mexico, Guanajuato, Michoacan, Baja California and Veracruz. The number of private hospitalization beds registered in the country are 33 937, these figures indicate that private medicine is the main hospital care provider in the national health system. Similar results were obtained regarding other material and human resources. It is important to stress the need for further research regarding the role of private medicine in Mexico, including aspects related to the quality of the services being provided.