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Stolzenberger, Kathleen M. "Nursing practice in a magnet hospital : a descriptive study /." View online ; access limited to URI View online ; access limited to URI, 2004. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/.
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Cartabuke, Richard Henry. "THE EVOLUTION OF CHARITY CARE OF THE UNIVERSITY HOSPITALS OF CLEVELAND." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1244056325.
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Schaub, Katherine Elizabeth. "Give Us an Emergency Hospital, The Sooner, The Better: A Progressive Era Experiment in American Health Care." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1596615005804562.
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Wagganer, Andrea. "Feminine Beauty and the Cancerous Beast: Appearance Management at the Cancer Hospital Salon." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001541.
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Garcia, Munoz Alejandro. "Leadership competencies for effective hospital chief executive officers and chief medical officers in Mexico." Thesis, Pepperdine University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1543405.
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<p> This study identified a leadership competency model for developing healthcare executives in Mexico based on the National Center for Healthcare Leadership (NCHL) Model. Eleven chief executive officers and chief medical officers were interviewed. They considered 86% of the National Center for Healthcare Leadership (NCHL) competencies as very important or vital and perceived a gap in the performance of these competencies. They also identified additional vital competencies beyond the scope of the NCHL's model. Participants also reported that leadership development and succession planning programs were lacking. Recommendations are to design a leadership development program using the NCHL model as a framework and further customizing the approach per the organization's unique mission, vision, strategy, values, and circumstances. The NCHL is offered as a general strategy for leader development that could be useful in the Mexican private healthcare industry, based on some "best practices" in the design and implementation of the leadership programs.</p>
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Rempusheski, Veronica Frances. "EXPLORATION AND DESCRIPTION OF CARING FOR SELF AND OTHERS WITH SECOND GENERATION POLISH AMERICAN ELDERS (ETHNOGRAPHY)." Diss., The University of Arizona, 1985. http://hdl.handle.net/10150/188074.
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The purpose of this study was to describe the meaning of caring from the perspective of community-dwelling individuals 65 years and older, who claim a Polish American ethnic identity. As background and preparation for the study the researcher spent 2 years in the Polish American community from which the key informants were chosen, explored the concept of caring cross culturally in the Human Relations Area Files, and spent a summer in Poland--the country of origin for the second generation sample. These experiences revealed that the care expectations by one group of people who are elderly and identify themselves as Polish American are unknown. Interviews were used to collect data from 7 informants. Participation, observation and written resources within the ethnic community supplemented the interview process. Tape recorded interviews were transcribed; field notes were compiled. All written data were analyzed, organized into categories and validated by the informants. Ten categories represented the Polish American elder's view of caring: kinds of Polish symbols, kinds of greeting, kinds of acknowledgment, kinds of caring, places for Polish people to meet, reasons for joining the Arizona Polish Club, reasons for going to the Arizona Polish Club, reasons for giving acknowledgment, care expectations: characteristics of a caring nurse, and ways to express caring. A primitive view of a 3-staged model was developed for generating universal conceptualizations of care from the Polish American elder's view of caring. Relationships among the categories were inferred from the data by the researcher and discussed as themes. Themes included: Arizona Polish Club as a caring place, being with my own kind, togetherness, neighboring, get moving in the morning, being there, taking time out, and having heart. The themes were discussed in relation to the research questions and the concept of caring that guided the study. This study revealed some of the characteristics, attributes, and conditions of caring that will be useful in expanding nursing's definition of caring, devising psychometric instruments to measure caring, and developing a cross cultural, cross age taxonomy of caring. Recommendations for nursing included care and research strategies with elders and suggestions for future study.
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Clay, Olivio J. "Racial differences in health care utilization betwen older African American and Caucasian Medicare beneficiaries." Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2009r/clay.pdf.
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Thesis (Ph. D.)--University of Alabama at Birmingham, 2007.<br>Title from PDF title page (viewed Sept. 21, 2009). Additional advisors: Richard M. Allman, Karlene K. Ball, Monika M. Safford, David E. Vance. Includes bibliographical references (p. 62-72).
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Ford, Paul Leslie. "Patient Care Provider Safety: Examining one intervention to reduce hospital violence." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4042.
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Abstract
In the summer of 2009, Tampa General care providers met with Hospital Administration to express concern that violence on care units was a growing problem and making it difficult to provide quality care. Nurses stated that such violence was one important reason many of their peers choose to retire. Administration took this situation seriously and formed a committee to gather information and submit suggestions to reduce the violence. The committee consisted of representatives from several nursing units, human resources, risk management, security, and administration. Duties assigned included investigation of the actual number of reports on all units and trends. The committee was also charged with the production of a report regarding reviewing other hospital data, literature review, and developing recommendations.
Internal reports indicated that the total prevalence of reported violence as well as the incidence per patient had increased annually since 2005. The hospital reports contradicted the national literature regarding the emergency department (ED) and psychiatric unit (Psych) being the two hospital units with the highest number of violent events. One possible reason for the difference is that these departments require all care providers to attend de-escalation and self-defense classes annually. Based on these findings, the researcher developed and adapted training similar to that of the ED for other units reporting aggressive, abusive, and violent patients. The committee approved a draft plan for implementation. Following presentation to Nursing Administration, some modifications were made, and the Internal Review Boards of the hospital and University of South Florida (USF) approved the project.
The hypothesis tested in this study was whether training in de-escalation and self-defense modifies providers' behaviors to prevent or reduce aggressive, abusive, or violent behavior by patients and visitors. The independent variable was training. The dependent variable was requests for assistance with unruly, angry, or violent patients or visitors. Event reports of the year prior were used for historical comparison. Event reports for the experimental period were assembled subsequent to the training for comparison.
Nursing Administration selected two units to receive the training intervention. The two units selected were neither the worst nor the best in numbers, but rather the middle. Nursing required that all training be scheduled in normal department meetings and that Nurse Managers of the units agree to participate. The research design presumed that at least 85% of care providers on a unit would attend the training. Schedules were developed to accommodate all care providers. The training was presented during June of 2010.
Experimental and comparison units were monitored each month for the number of reported violent events (Code Grays) on each unit. During the fourth months of monitoring, there was a data spike in the Cardiac Care unit. No action was taken until another spike occurred during the sixth month. It was determined that an error had occurred that partially invalidated the data from the Cardiac Care unit: the 85% participation rate among staff had not been reached. Monitoring continued for 12 months after the training. The Eldercare unit showed reduced requests for assistance. Overall, the Cardiac Care unit increased requests for assistance from the year before. Results were adjusted for patient census. Wilcoxon Signed Ranks Testing was performed and displayed using box plots to show how far the median changed during the research from one group to the next. The analysis compared prior year with the year following the interventions, and indicated that there was a movement toward a reduction of Code Grays. To determine if there was a difference between comparison units and experimental units 12 months after the training, Poisson Regression Analysis was utilized. When the comparison units were set as the reference, Poisson analysis indicated the events were decreasing on both units. The Cardiac Care unit did not have a statistically significant p value. The Eldercare unit had a p value of .019.
In conclusion, the results are mixed and statistically inconclusive. From the care providers' perspective, any reduction in violence is significant. The data regarding the training interventions indicates that there was an empirical, albeit not a statistically significant, change in Code Gray reports. Training may have reduced the violence on the Eldercare unit by nearly half.
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Tamulis, Tomas. "Association between area socioeconomic status and hospital admissions for childhood and adult asthma." [Tampa, Fla.] : University of South Florida, 2005. http://purl.fcla.edu/fcla/etd/SFE0001134.
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Grine, Jennifer D. "Serial Murder in Institutional Settings." [Tampa, Fla.] : University of South Florida, 2003. http://purl.fcla.edu/fcla/etd/SFE0000053.
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Denis, Marie F. "Extrapulmonary tuberculosis in HIV-positive and HIV-negative children in Haiti : a hospital-based Investigation." [Tampa, Fla] : University of South Florida, 2005. http://purl.fcla.edu/usf/dc/et/SFE0001404.
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Carter, Andrea Kaye. "Bushnell General Military Hospital And The Community of Brigham City, Utah During World War II." DigitalCommons@USU, 2008. https://digitalcommons.usu.edu/etd/162.
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Bushnell General Military Hospital was an Army World War II hospital in Brigham City, Utah from August 1942 to June 1946. It specialized in treating amputations, maxillofacial surgery, neuropsychiatric conditions, and tropical diseases. It was also one of the first hospitals to experimentally use penicillin. Bushnell was a regional facility for wounded solders from the Mountain States that provided quality medical care to patients. The community of Brigham City and the citizens of other Northern Utah communities were an integral part of the success of Bushnell. Citizens donated time, supplies, and money to support the facility and to assist in the care and rehabilitation of injured GIs. Celebrities also visited Bushnell to promote morale, and some disabled Americans assisted injured patients. The hospital staff, along with Northern Utahns, played an important role in helping to rehabilitate and reintroduce injured soldiers into society. Brigham City was also effected by Bushnell Hospital. One major problem was a shortage of housing in Brigham City, which led citizens to rent to family members of patients in private homes. Another was infrastructure needed to support the hospital. However, the benefits mostly outweighed the problems. The city and surrounding communities benefited from the job growth at Bushnell and in Brigham. Downtown businesses received additional revenue from patrons. Because the hospital came to Brigham City, some citizens also met Japanese Americans and German and Italian POWs in addition to those connected to Bushnell. This led Brigham citizens to develop friendships with people they might have not met otherwise. When the war ended, the subsequent closure of Bushnell General Military Hospital brought these benefits to an end, and Brigham City and other Northern Utahn communities hastened to find a new occupant for the hospital facility to ensure jobs. In 1950, it became the Intermountain Indian School. The school closed in 1984, and now businesses and homes occupy the site.
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Kessler, Melissa Gail. "Risk Factors For Pediatric Community Acquired Methicillin Resistant Staphylococcus aureus." [Tampa, Fla.] : University of South Florida, 2004. http://purl.fcla.edu/fcla/etd/SFE0000253.
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Rodrigues, Yara Kátia Santos. "Isolamento e caracterização fenotípica e molecular de parasitos Leishmania sp. de pacientes co leishmaniose tegumentar americana (LTA) atendidos no Hospital Universitário Lauro Wanderley da Universidade Federal da Paraíba." Universidade Federal da Paraíba, 2012. http://tede.biblioteca.ufpb.br:8080/handle/tede/3644.
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Previous issue date: 2012-08-31<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES<br>Leishmaniasis is a complex of infectious and parasitic diseases endemic in 88 countries, that constitute a serious public health problem. Several species of the genus Leishmania are the causative agents of disease, among them the species L. (V.) braziliensis associated with different clinical manifestations of American Cutaneous Leishmaniasis (ACL). In the present study were obtained nine isolates of Leishmania sp. from cases of ACL. Seven isolates (87%) from patients residing in the municipalities of Pilões, and one (13%) resident in João Pessoa city, both Paraiba state regions. All nine strains were identified as L. (V.) braziliensis by specific PCR. Analyses of molecular characterization by RAPD-PCR showed that these isolates shared 62.63% revealing genotypic differences among them. However, the isolated AF and JSL, both from disseminated lesions had the highest percentage of shared bands among the isolates. Another molecular technique used was a SSR-PCR using the K7 primer, and it was also able to show polymorphism between isolates. In PCR-RLFP analysis of ITS1, different profiles were found among isolates, MRSS, JMTS, AF, JCTS, JRL showed the same band profile and the isolates JSL, JCNS, MFTS and JAS have each had, profiles different band. The analysis of hsp70 gene region by PCR-RLFP reveled that the isolates JSL, AF, JCTS, JRL, MFTS showed the same band profile and the isolates, MRSS, JMTS, JCNS and JAS had each one, different profiles band. In addition were also observed phenotypic differences between these isolates, since at an given time of cultivation, all showed different behavior, and demonstrate differences in sensitivity to drugs used in the treatment of leishmaniasis. Therefore, these studies show that the isolates of L. (V.) braziliensis obtained in the state of Paraiba demosntraram a significant genetic polymorphism, revealing a high level of intraspecific variation.<br>As leishmanioses são um complexo de doenças infecto-parasitárias endêmicas em 88 países que constituem um grave problema de saúde pública. Diversas espécies do gênero Leishmania são os agentes causadores da doença, dentre elas a espécie L. (V.) braziliensis associada a diferentes quadros clínicos da Leishmaniose Tegumentar Americana. No presente trabalho foram obtidos nove isolados de Leishmania sp. oriundos de LTA, sendo sete isolados (87%) oriundos de pacientes residentes no município de Pilões, um (13%) da cidade de João Pessoa, ambas regiões, do estado da Paraíba. Todos os nove isolados foram identificados como sendo da espécie L. (V.) braziliensis através de PCR específica. As análises de caracterização molecular pela técnica de RAPD-PCR mostraram que esses isolados compartilharam 62,63% revelando diferenças genotípicas entre elas. Contudo, os isolados AF e JSL, ambos provenientes de lesões disseminadas, tiveram o maior percentual de bandas compartilhadas dentre os isolados. Outra técnica molecular utilizada foi o SSR-PCR com o iniciador K7 que também foi capaz de demontrar polimorfismo entre os isolados. Nas análises de PCR-RLFP das regiões ITS1, foram encontradas perfis diferentes entre os isolados, onde MRSS, JMTS, AF, JCTS, JRL apresentaram o mesmo perfil de bandas e os isolados JSL, JCNS, MFTS e JAS tiveram, cada um, perfis de bandas distintos. Na análise de PCR-RLFP da região do gene hsp70, JSL, AF, JCTS, JRL, MFTS apresentaram o mesmo perfil de bandas e os isolados, MRSS, JMTS, JCNS e JAS perfis de bandas distintos. Adicionalmente foram também observadas diferenças fenotípicas entre estes isolados, visto que em dado momento de cultivo, todos apresentaram comportamento diferenciado, além de demonstrarem diferenças quanto à sensibilidade às drogas utilizadas na terapêutica das leishmanioses. Portanto estes estudos revelam que os isolados de L. (V.) braziliensis obtidos no estado da Paraíba demonstraram um significativo polimorfismo genético, revelando um alto nível de variação intraespecífica.
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Eaton, Michelle C. "An Analysis of Slip, Trip, and Fall Incidents among Workers at a Veterans Hospital." [Tampa, Fla. : s.n.], 2003. http://purl.fcla.edu/fcla/etd/SFE0000095.
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Prewitt, Sybil N. "Difference in hearing screening failure rates as a function of ethnicity in well newborns screened at Tampa General Hospital." Scholar Commons, 2000. https://scholarcommons.usf.edu/etd/1547.
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The difference in otoacoustic emission (OAE) hearing screening failure rates as a function of ethnic category was investigated in a population of newborns at Tampa General Hospital, Tampa, Florida. Clinical observation led to a concern that due to a higher incidence of outer and middle ear dysfunction in Hispanic newborns and children, screening could result in disparate failure rates, with a larger number of these infants requiring further testing. This result would warrant changes in current protocols, as well as screener training,and parent counseling practices.
Between January and July of 2000, 1407 newborns were tested utilizing distortion product otoacoustic emission screening protocols. Of those infants,only 68 failed, yielding a higher than average overall program referral rate of 5%. It is hypothesized that since later reported referral rates for this program fall below 1%, the individuals performing the screenings had not yet become experienced enough to yield low refer rates. In addition, initial screens are not repeated in this program due to staffing and funding issues, which may contribute to higher than average fail rates.
More important, however, results indicated that there is indeed a difference in failure rates as a function of ethnicity, with a greater proportion of Hispanic and African-American and "Other" newborn referrals that Caucasian or Asian newborns. This difference, however, was not significantly reliable. It is hypothesized that this difference may be the result of a generally lower socioeconomic status and access to medical care within urban minority populations in Hillsborough County, Florida. Implications are discussed.
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Stevens, Ashley Marie. "American Society, Stereotypical Roles, and Asian Characters in M*A*S*H." Bowling Green State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1459520345.
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Rivera, Frances. "The Use of Proteomic Techniques to Study the Physiology and Virulence of Staphylococcus aureus." Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/3603.
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Staphylococcus aureus is a bacterial pathogen that is believed to be the most common agent of human infectious disease, causing conditions ranging from common skin lesions to life-threatening illnesses. S. aureus has also shown a remarkable ability to develop resistance to antimicrobial treatment, making infections difficult to treat. In the post-genomic era, proteomic studies analyzing the protein complement of a genome in a particular organism at any given time, have gained real significance. This result is largely due to dynamic changes in protein expression profiles which can lead wide alterations in physiology and behavior. For proteomics, it is necessary to maximize protein concentration and to devise a method that can be easily employed and provide reproducible results. Most proteomic studies of S. aureus involve 2D gel electrophoresis (2-DE); however, 2-DE has many drawbacks. Proteins that are too large, hydrophobic, acidic, or basic are poorly resolved. Multi-dimensional protein identification (MudPIT) allows complex protein samples to be analyzed in solution. As yet, there has not been a study involving solely 2D liquid chromatography followed by mass spectrometric analysis in S. aureus
; therefore we sought to catalogue the intracellular proteome and secretome of a commonly used and well-studied lab strain, SH1000. This was conducted during post-exponential and stationary phases of growth so as to understand its adaptation over time by utilizing differential protein synthesis. We found cytoplasmic proteins involved in glycolysis to be highly expressed in post-exponential phase while proteins involved in tricarboxylic acid cycle to be prevalent in stationary phase. We also found
production of agr-regulated secreted toxins and proteases to be upregulated in stationary phase. In addition to this we employed proteomic approaches to quantitatively profile the secretomes of leading clinical isolates of S. aureus, as such a study is currently lacking. These included the two most common hospital-associated S. aureus strains (USA100 and USA200), and the two most common community-associated S. aureus strains (USA300 and USA400). We found agr-regulated proteins are generally upregulated in CA-MRSA strains USA300 and USA400 and surface-associated proteins to be upregulated in HA-MRSA strains USA100 and USA200. This finding concurs with literature regarding transcriptomic studies showing a hyperactive agr in CA-MRSA strains compared to HA-MRSA strains.
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Galindez, Araujo Luis J. "Factors surrounding and strategies to reduce recapping used needles by nurses at a Venezuelan public hospital." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003166.
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Barrington, James D. "Analysis of Two Strategies for Structuring Medicare Reimbursement to Maximize Profitability in Acute Care General Hospitals." Scholar Commons, 2010. https://scholarcommons.usf.edu/etd/1569.
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The healthcare literature sometimes cites Medicare as a negative determinant of hospital profitability. However, a review of Florida acute care short-term general hospital data revealed a subset of profitable hospitals with high percentages of their revenue structure comprised of Medicare reimbursements. Some investigators might contend that these hospitals are just better managed; that hospital profitability is not related to patient mix or payer source. Although good management enhances financial health, there are perhaps other reasons why certain hospitals can become profitable with Medicare as their primary revenue source.
Research findings indicate there is wide geographic variability shown for per-capita volumes of discretionary procedures reimbursed by Medicare, and broad variations in Medicare spending per enrollee for general acute care short-term hospitalizations. It was also found that many of the hospitals performing higher rates of discretionary procedures and showing the ability to make a profit with Medicare are investor owned.
The focus of this study, covering years 2000-2005, was to examine two strategies using discretionary procedures under Medicare that Florida investor owned hospitals may employ to increase profitability and maintain long-term financial health.
Part 1 of the study examined the association between long-term financial viability, measured by the total assets divided by total liabilities (TATL) ratio (the reciprocal of the debt ratio) and percentages per hospital of two discretionary cardiac and orthopedic procedure variables, reimbursed by conventional Medicare. A positive association was found between the TATL ratio and these variables, as well as significant marginal effects in the association between the TATL ratio and interaction terms for hospital ownership (where investor owned = 1 and not-for-profit = 0) and the discretionary cardiac procedure variable and ownership and the discretionary orthopedic procedure variable.
Part 2 used total charges as the dependent variable for patient discharges reimbursed by Medicare HMO. It was found that investor owned hospitals generally assess significantly higher charges than not-for-profits for discretionary CABG and valve replacement procedures for patients with equivalent levels of medical services and hospitalization. It was also found that charges significantly increase for both investor-owned and not-for-profit hospitals located in the southern region of Florida.
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Munro, Jacqueline Cecilia. "Nurse Manager Emotional Intelligence as a Predictor to Registered Nurse Job Satisfaction and RN Perceptions of the Practice Environment and the Relationship to Patient, Nursing and Hospital Outcomes." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3259.
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The purpose of this study was to determine if the level of Nurse Manager (NM) emotional intelligence (EI) predicted registered nurse (RN) job satisfaction and RN perceptions of the practice environment. In addition, relationships to patient, nursing, and hospital outcomes were explored. Participants included RNs (N=659) and NMs (N=38) from 53 nursing units at eight hospitals located in the southeast region of the United States. A cross-sectional, correlational research design was used to test the hypotheses. Pearson product-moment correlation coefficients, simple linear and multiple regression statistics were conducted to analyze the data. Level of NM EI had a positive, not significant relationshp to RN job satisfaction and RN perceptions of the practice environment. A direct, positive significant relationship was observed between the variables NM EI and patient satisfaction with nursing care. There was a positive, significant relationship noted between the variables RN job satisfaction and RN perceptions of the practice environment. The indirect relationships between the level of NM EI and patient, nursing and hospital outcomes were not significant. There was a direct significant, positive relationship noted between the variables RN perceptions of the practice environment and patient satisfaction with nursing care. In addition, the interaction between RN job satisfaction and RN hours of care had a positive, significant relationship with unit level pressure ulcer rates. This study indicated that units with higher RN hours of care have increased pressure ulcer rates. In addition, results illustrate a marked increase in pressure ulcer rates on those units with higher levels of job satisfaction. In this study, pressure ulcer rates depended on the level of RN job satisfaction.
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Israelsen, Trevor L. ""Nothing remains stationary": Child Welfare and Health in Cincinnati's Episcopal Hospital for Children, 1884-1931." Miami University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=miami1467370529.
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Cunningham, Zachary A. "Project HOPE as Propaganda: A Humanitarian Nongovernmental Organization Takes Part in America's Total Cold War." Ohio : Ohio University, 2008. http://www.ohiolink.edu/etd/view.cgi?ohiou1198092879.
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Khlifi, Abdmalek S. "Etiological characterization of emergency department acute poisoning." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002475.
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Ancheta, Irma B. "The relationship between B-type natriuretic peptide levels and hospital length of stay and quality of life in congestive heart failure patients." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001871.
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Claux, Juan Alberto. "Social route : Peruvian psychiatrists and the politics of mental health reform." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33227.
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This thesis is about the prospect of change in the Peruvian mental health services system as seen through the lens of public psychiatry. It is based on the depiction of the work of psychiatrists in two of Lima's mental hospitals -Hospital Valdizán and Instituto Noguchi- and the projects of mental health services reform that I found in both of these institutions and an advocacy group sponsored by the Pan American Health Organisation. Ethnographic fieldwork was conducted from April 2012 to July 2013. I portray the current paradigm of care that dominates the public psychiatric sphere by describing the practice of specialists in outpatient consultations and hospitalisation wards. What I call the empirical model of psychiatry is an objectivistic, pharmaceuticalized, and top-down practice that finds its most augmented version in the wards. It loses sight of such therapeutic mandates as cultivating rapport, giving voice, and providing social support, elements that can be encountered in alternative paradigms of care that hold a marginal position in today's mental health system, such as the community mental health model that was developed in the 1980s at Instituto Noguchi and has progressively faded into near oblivion. The multiple inadequacies of treatment reviewed in this thesis, which are fuelled by a historical relegation of mental health policy in the country, speak of a psychiatry that is far from effectively improving the lives of service users. This was the greatest blind spot revealed by the mental health reform agenda; the need to improve psychiatry as a therapeutic practice was largely absent from reform discourse. Another important issue encountered was the failure of initiatives focused on training primary healthcare professionals in detecting and treating mental health problems (task-sharing). I argue that sustainable task-sharing strategies, added to comprehensive and locally-sensitive models of mental health services, should be explored. Finally, there is a paradox to be solved in relation to mental health governance in Peru. Psychiatry has hegemony; it owns the national institute of mental health and presides over the national mental health direction at the Ministry of Health. However, as a profession it has remained alienated from public health matters, absorbed in the daily practice of public hospitals and private practices. Mental health governance, then, needs to be balanced with the contribution of other professions and this is where the social route of the mental health system gains significance: anthropology has great potential to help develop a richer understanding of people's mental health and craft effective services in socially unequal and multicultural societies.
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Webb, Silky Fanyelle. "Hospitalizations associated with pneumococcal infection within the Medicare population among vaccinated and non-vaccinated patients." [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002032.
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Ballou, Charles F. "Hospital medicine in Richmond, Virginia during the Civil War : a study of Hospital No. 21, Howard's Grove and Winder hospitals /." Thesis, This resource online This resource online, 1992. http://scholar.lib.vt.edu/theses/available/etd-02092007-102013/.
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Ott, Kenneth Brad. "The Closure of New Orleans' Charity Hospital After Hurricane Katrina: A Case of Disaster Capitalism." ScholarWorks@UNO, 2012. http://scholarworks.uno.edu/td/1472.
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Abstract
Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, took advantage of the mass internal displacement of New Orleans’ populace in the aftermath of Hurricane Katrina in an attempt to abandon Charity Hospital’s iconic but neglected facility and to supplant its original safety net mission serving the poor and uninsured for its neoliberal transformation to favor LSU’s academic medical enterprise.
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Sahagún, Sandoval Julio Antonio, and Estrada Everardo Ibarra. "Resultados perinatales en pacientes con Diabetes Mellitus Gestacional diagnosticadas mediante criterios de Carpenter, Coustan y Ada (American Diabetes Association) 2011, en el Hospital Materno Infantil ISSEMYM Toluca, del 1 de enero del 2011 al 31 de octubre del 2013." Tesis de Licenciatura, Medicina-Quimica, 2014. http://ri.uaemex.mx/handle/123456789/14754.
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Gipson, Linda Stephens. "The Impact of Managed Care on the Utilization and Distribution of Inpatient Surgical Procedures with Demonstrated Volume and Outcome Endogeneity." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3118.
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Abstract
Purpose
This study is designed to determine whether managed care has had an influence on the number and distribution of procedures with demonstrated volume and outcome endogeneity in Florida healthcare markets; in addition, methods are developed to determine which measures of managed care activity best predict the impact of managed care on surgical procedure utiliation.
Rationale
A shift in surgical procedure volume on the basis of preferred provider arrangements has the potential to redistribute surgical procedures within hospital markets. The surgical procedures for which such a distribution could have the greatest impact on population health are those for which the volume of cases performed has a strong inverse influence on the outcomes observed. A shift in high risk surgical procedures to low volume hospitals could potentially reduce the number of cases performed at high volume centers and increase cases at low volume centers, adversely impacting quality in both.
Methods
A retrospective population based cohort design is used to capitalize on the variability among Florida metropolitan statistical areas between 1995 and 1999, a period which captured the full business life cycle of managed care plans in Florida. Multiple regression models are used to measure the impact of changes in managed care activity as measured by penetration, index of competition and consolidation on the change in the number and distribution of seven procedures for which volume is associated with patient outcome, controlling for socio-demographic and market factors known to influence surgical procedure utilization. Difference scores derived for each of the model variables were used to measure change from the baseline in 1995 to 1999. Post hoc analysis of the count data models was performed using the cases from all study years in a log linear generalized estimating equation to provide validation of the difference score approach.
Key Findings
Study procedure volume increased over the period, and remained a consistent proportion of the total inpatient surgical procedure volume. Procedure rate remained stable over the study period with substantial small area variation. Change in managed care concentration was consistently and negatively associated with procedure volume at both the MSA (&betaâ&beta = -19.67; p = 0.0489) and hospital level (&betaâ&beta = -4.088; p = 0.0027).Change in the total population and the number of specialty surgeons had a substantial, consistent and positive relationship to change in procedure volume at both the market and hospital level. The change in the index of competition was positively associated with change in hospital market share (&betaâ&beta = 0.1005; p = 0.05); whereas, neither change in managed care penetration nor change in managed care index of competition was predictive of change in procedure volume at the market level. The managed care variables were not correlated when difference scores were tested providing evidence that the managed care variables measure different constructs and behave differently.
Implications
As markets for managed care became more concentrated, the number of surgical procedures with volume and outcome endogeneity declined; the specific reasons for the observed decline require additional study. Competitive managed care markets have a favorable impact on hospital market share for these high risk, high margin procedures. Studies of managed care require consideration of the stage of managed care development in order to understand its influence and the use of difference scores as a method to measure change over time has substantial potential for the study of health care markets.
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Newton, Andrew. "Ambulance Service 2030 : the future of paramedics." Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/15437.
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Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.
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Mason, William C. "Dimensions of Servant-Leadership in American Not-for-Profit Hospitals." UNF Digital Commons, 2002. http://digitalcommons.unf.edu/etd/98.
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The leadership of American not-for-profit hospitals is one context in which servant-leadership finds appropriate expression. However, little research exists that explores the sources of servant-leadership within the leader, what processes leaders use to engage in servantleadership, or what impact servant-leadership has on organizations and communities. This research presents a new perspective offering insight into those questions.
The Dimensions of Servant-Leadership in American Not-for-Profit Hospitals is a qualitative study of the lives and works of four chief executive officers of successful not-for-profit health systems identified as exemplars of servant-leadership. The researcher further examined perceptions of servant-leadership among colleagues of each of the four CEOs and their health systems.
The findings of the study indicated that the common denominators of servant-leadership, as perceived by those served by these four CEOs and their organizations, are that the people grew as individuals; the people felt that they were healthier, wiser, freer, more autonomous, and more likely themselves to become servants. The servant-leader CEOs gave strong evidence of a group-oriented approach to decision making. They fostered strong organizational involvement in programs of community betterment, they each had a strong commitment to continuing education for their associates, and they demonstrated in all their activities a great love and compassion in caring for the health of their communities. Finally, the study offers valuable insights into servant-leadership which might be useful in the postsecondary education of future healthcare leaders.
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Del, Valle Juan Ramon. "In the Hour of Their Great Necessity: The Hodgins/Crile Collaboration." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1595858152102433.
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Al, Hassani Mattar S. S. "Development of a System Based Approach for Strategic Implementation of Occupational Health and Safety Practices in Health Care Organizations." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4884.
Full textAbstract:
This thesis aims at investigating the importance of effective implementation of health safety and
hygiene legislations and practices in Health Care delivery systems. A new System Based
Approach for Strategic Implementation of Occupational Health & Safety Practices is proposed in
this thesis. The underlying principle of the approach is based on involvement and inputs from staff
and management rather than by pre-specified requirements and objectives. Furthermore, the
development process is a closed loop process that provides a mechanism for continuously
evaluating system performance and monitoring activities that have considerable impact on health
and safety practices. A case study was conducted in the medical laboratories of five major
hospitals in the Emirate of Abu Dhabi. Data were collected through questionnaires, staff
interviews, and reviewing laboratory safety reports compiled over a three years period. The main
conclusions from this study are:
1. The proposed approach has proven to be useful in analyzing existing health and safety
systems. The methodology and tools proved to be instrumental in defining inefficiencies and
determining the status of the Health & Safety policies & practices in the selected medical
laboratories.
2. Effective implementation of the proposed approach has shown improvements in
productivity, operational cost, service quality, staff and management satisfaction.
3. The case study has demonstrated that a developing country such the UAE, with no
previously existing Health & Safety legislation and little risk prevention culture, can rapidly and
effectively introduce effective industry specific H&S by adopting an integrated systems based
approach.
4. UAE has highly advanced and economically developing base, there is a general
willingness at senior level within the UAE to achieve high levels of competence and standards in
all industrial sectors.
5. CAP is a system based management tool which has been implemented globally, but only
limited in the gulf region; CAP has been implemented by the author and colleges within Zayed
Military Hospital between 2003-2007.
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Mike, Derrick. "Lived Experiences of African Americans 65 and Older After Rural Hospital Closures." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7825.
Full textAbstract:
African Americans 65 and older have had varied experiences due to losing immediate access to nearby hospitals for urgent treatment for emergency medical conditions. This phenomenological study was conducted to explore the lived experiences of those residing in areas after a rural hospital closure occurred. The hospital was the primary and nearest facility for receiving immediate access to urgent treatment. The research questions focused on the encounters experienced by the participants after the hospital closure. The Health Belief Model was the conceptual framework used for this study. The method and data analysis procedures included interviews, field notes, a life-course chart, and specified demographic information. Eight African Americans 65 and older from Webster and Stewart County Georgia were interviewed. The other inclusion criteria were the participants' previously being treated for an emergency medical condition at Stewart Webster Hospital at least 1 year before the hospital closure and at another hospital at least 1 year after the hospital closure. The results of this research were that the participants encountered negative experiences on a higher level than positive experiences with accessing immediate treatment. Also, participants encountered and needed to make various, and undue changes to receive treatment for the critical medical condition treatment. The positive social change significance included providing information on experiences encountered by the participants after rural hospital closures and suggestions for others in rural areas to prepare for hospital closures. Moreover, this research could help state, local, and federal agencies provide alternatives for immediate treatment for emergency medical conditions in other rural towns after hospital closures occurred.
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Malone, Cheryl Knott 1954. "LABOR WITHOUT PAY: WOMEN'S VOLUNTEER WORK IN AMERICAN HOSPITALS, 1945-1965 (ARIZONA)." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/291190.
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Al, Hassani Mattar Saeed S. "Development of a System Based Approach for Strategic Implementation of Occupational Health and Safety Practices in Health Care Organizations." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4884.
Full textAbstract:
This thesis aims at investigating the importance of effective implementation of health safety and hygiene legislations and practices in Health Care delivery systems. A new System Based Approach for Strategic Implementation of Occupational Health & Safety Practices is proposed in this thesis. The underlying principle of the approach is based on involvement and inputs from staff and management rather than by pre-specified requirements and objectives. Furthermore, the development process is a closed loop process that provides a mechanism for continuously evaluating system performance and monitoring activities that have considerable impact on health and safety practices. A case study was conducted in the medical laboratories of five major hospitals in the Emirate of Abu Dhabi. Data were collected through questionnaires, staff interviews, and reviewing laboratory safety reports compiled over a three years period. The main conclusions from this study are: 1. The proposed approach has proven to be useful in analyzing existing health and safety systems. The methodology and tools proved to be instrumental in defining inefficiencies and determining the status of the Health & Safety policies & practices in the selected medical laboratories. 2. Effective implementation of the proposed approach has shown improvements in productivity, operational cost, service quality, staff and management satisfaction. 3. The case study has demonstrated that a developing country such the UAE, with no previously existing Health & Safety legislation and little risk prevention culture, can rapidly and effectively introduce effective industry specific H&S by adopting an integrated systems based approach. 4. UAE has highly advanced and economically developing base, there is a general willingness at senior level within the UAE to achieve high levels of competence and standards in all industrial sectors. 5. CAP is a system based management tool which has been implemented globally, but only limited in the gulf region; CAP has been implemented by the author and colleges within Zayed Military Hospital between 2003-2007.
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Gil, Isaac. "Contratos de comunicação e estratégias de convocação de hospitais latino-americanos em seus sites na internet." Pontifícia Universidade Católica de São Paulo, 2011. https://tede2.pucsp.br/handle/handle/4305.
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Previous issue date: 2011-06-07<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>This thesis discusses the proposed contracts for communication sites in twenty hospitals in Latin America on the Internet and analyzes the strategies used by the speaker to convene hospital to seek to establish links with their target audiences. To form the corpus of this research used a supervised study for seven Latin American specialists, who worked out the conceptual framework, method and strategy to analyze hospitals, submitting them - in order to develop a ranking classification - an assessment six dimensions: patient safety, respect him, knowledge management, the technical capacity of the hospital, the efficiency and prestige of the institution. A quantitative index was developed and resulted in a ranking of twenty hospitals in Latin America, published in American Economy - Brazil, Volume 319, nov. 09, p. 62-71. The theoretical framework used to analyze the sites is based in contract theory of communication Charaudeau Patrick. The usability study was based on the concepts of Jakob Nielsen, Hoa Loranger and Marie Tahir and other authors who observed sites of hospitals. Accessibility was considered the concepts of the Center for Rehabilitation Engineering and Accessibility. We used the concept of hypermedia Vicente Gosciola that describes how to structure a non-linear and interactive technology, because it enables the user to establish connections and isolate, which was an important component of analysis in this thesis. These theoretical frameworks were applied because they consider the possible forms of enunciation of these institutions to promote and introduce the enunciatee's about what the utterer proposes on its website and that can influence the preference for a specific hospital. To analyze this set of narrative schemes, which aim to engage audiences in a hospital, was drawn up, based on several authors, a method to examine the sites and giving rise to a condition called Axiology To Site Analysis of Hospitals. It was examined, also, sites of non-hospital and other hospitals outside the corpus, with the goal of adding support to the framework and the communication processes of hospitals sites. Finally, communication strategies are proposed to subsidize syncretic and improve communication interface which comprises communicative contracts between hospitals and their various target audiences in the sites of these types of institutions<br>Esta tese discute os contratos de comunicação propostos nos sites de vinte hospitais latino-americanos na internet e analisa as estratégias de convocação utilizadas pelo enunciador-hospital para buscar estabelecer vínculos com seus públicos-alvo. Para constituir o corpus desta pesquisa, foi utilizado um estudo supervisionado por sete especialistas latino-americanos, que elaboraram o marco conceitual, o método e a estratégia para analisar hospitais, submetendo-os com a finalidade de elaborar um ranking de classificação a uma avaliação de seis dimensões: a segurança do paciente, o respeito a ele, a gestão do conhecimento, a capacidade técnica do hospital, a eficiência e o prestígio da instituição. Um índice quantitativo foi elaborado e resultou em uma classificação de vinte hospitais latino-americanos, publicada na revista América Econômica Brasil, volume 319, de nov. 09, p. 62-71. O referencial teórico utilizado na análise dos sites está embasado na teoria do contrato de comunicação de Patrick Charaudeau. A usabilidade foi estudada a partir dos conceitos de Jakob Nielsen, Hoa Loranger e Marie Tahir, entre outros autores que observaram sites de hospitais. A acessibilidade foi considerada a partir dos conceitos do Centro de Engenharia de Reabilitação e Acessibilidade. Foi utilizado o conceito de hipermídia de Vicente Gosciola, que a descreve como uma estrutura tecnológica não linear e interativa, porque possibilita ao usuário estabelecer conexões e as individualizar, o que foi componente importante de análise nesta tese. Esses referenciais teóricos foram aplicados porque possibilitaram considerar as formas de enunciação dessas instituições, para incentivar e instaurar a adesão do enunciatário sobre o que propõe o enunciador em seu site e que pode influenciar a preferência por um determinado hospital. Para analisar esse conjunto de esquemas narrativos, que visam engajar os públicos-alvo de um hospital, foi elaborado, fundamentado em diversos autores, um método para examinar os sites e que originou um quadro denominado Axiologia para Análise de Sites de Hospitais. Foram também examinados sites de organizações não hospitalares e de outros hospitais fora do corpus selecionado, com o objetivo de acrescentar subsídios para o arcabouço e para os processos comunicacionais de sites de hospitais. Ao final, foram propostas estratégias comunicativas sincréticas para subsidiar e aperfeiçoar a interface comunicacional que materializa os contratos comunicativos entre os hospitais e os seus diferentes públicos-alvo, nos sites desses tipos de instituições
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Caldart, Raquel Voges. "Morbidade hospitalar materno-infantil Yanomami, Brasil (2008-2012)." Universidade Federal de Roraima, 2014. http://www.bdtd.ufrr.br/tde_busca/arquivo.php?codArquivo=271.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>Este estudo teve como objetivo levantar as causas de morbidade hospitalar da população materno-infantil Yanomami, residente nos estados de Roraima e Amazonas, no período de 2008-2012. As causas de hospitalização foram pesquisadas nas Autorizações de Internação Hospitalar e Documentos de Registro de Internação Hospitalares de dois hospitais públicos da cidade de Boa Vista/RR, o Hospital da Criança Santo Antônio e o Hospital Materno Infantil Nossa Senhora de Nazareth, referencias para a população sob responsabilidade sanitária do Distrito Sanitário Especial Indígena Yanomami. Foram localizados 1023 registros de crianças e 332 registros de internação obstétrica nos arquivos dos referidos hospitais. As principais causas de hospitalização infantil, segundo a Classificação Internacional de Doenças foram: doenças do aparelho respiratório (53,9%); doenças infecciosas e parasitárias (19,5%); e doenças nutricionais (12,1%), caracterizando hospitalizações por condições sensíveis à atenção primária. Os menores de um ano foram responsáveis pelo maior número de internações e pelas maiores taxas de mortalidade hospitalar e ao longo dos cinco anos pesquisados observou-se um aumento das internações por doenças do aparelho respiratório. Entre as internações obstétricas predominaram as hospitalizações por assistência ao parto (51,5%); seguida das intercorrências clínicas na gravidez (32,8%); aborto (11,4%) e intercorrências clínicas no puerpério (4,2%). A maioria dos partos realizados foram partos espontâneos, no entanto, a taxa de parto cesáreo foi superior a preconizada pela Organização Mundial de Saúde. Predominaram as internações das mulheres entre 15 e 35 anos de idade, não foi observado registro de óbito materno no período do estudo. A análise das hospitalizações por regiões da Terra Indígena Yanomami demostra perfis diferentes e situações complexas para as regiões com os menores coeficientes de internação, relacionadas à dificuldade de acesso aos serviços de saúde.<br>The aim of this study was to identify the causes of morbidity in maternal and child Yanomami population, from Amazonia, Brazil, in the period 2008-2012. The causes of hospitalization were investigated in two public hospitals located in Boa Vista, Roraima, Brazil: Hospital da Criança Santo Antônio and Hospital Materno-Infantil Nossa Senhora de Nazareth, both hospitals are the only references to the population under health responsibility of the Distrito Sanitário Especial Indígena Yanomami. It was identified 1023 records regarding to children hospitalization and 332 records regarding obstetric hospitalization. The main causes of hospitalization among children, according to the International Classification of Diseases were: respiratory diseases (53,9%); infectious and parasitic diseases (19,5%); and nutritional diseases (12,1%), this profile of hospitalization causes is in accordance with poor health conditions. Children under one year old were responsible for the highest number of hospitalizations and the highest rates of hospital mortality. During the five years surveyed observed an increase in hospitalizations for respiratory diseases. Among obstetric admissions predominated hospitalizations for childbirth care (51,5%); followed by clinical complications during pregnancy (32,8%); abortion (11,4%) and clinical events after delivery (4,2%). Most deliveries were vaginal deliveries, however, the rate of cesarean section was higher than recommended by the World Health Organization. Women between 15-35 years old were responsible for the highest number of obstetric hospitalization, no record of maternal death was observed during the five years of survey. The analysis of hospitalizations in the different regions of Yanomami Territory demonstrated different profiles and complex situations in the regions with lower rates of hospitalization related to poor access to health services.
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Stanley, Leisa J. "Association among neonatal mortality, weekend or nighttime admissions and staffing in a Neonatal Intensive Care Unit." [Tampa, Fla.] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002421.
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Guerra, Glaucia Virginia de Queiroz Lins. "Indução do trabalho de parto na America Latina : inquerito hospitalar." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310041.
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Previous issue date: 2008<br>Resumo: Objetivo: Avaliar a prevalência da indução médica e eletiva do trabalho de parto, métodos utilizados, índice de sucesso, fatores associados e resultados maternos e perinatais em oito países da América Latina. Método: Foi realizada a análise referente à indução do trabalho de parto no banco de dados da Pesquisa "2005 WHO global survey on maternal and perinatal health", referente a oito países aleatoriamente selecionados da América Latina. Obtiveram-se os dados individuais de todas as mulheres que tiveram seus partos em 120 instituições, no período do estudo. Avaliaram-se as indicações de indução por país, a taxa de sucesso por método, os fatores associados à indução e os resultados maternos e perinatais comparativamente aos partos iniciados espontaneamente (primeira abordagem). Após foi feita uma análise independente da indução eletiva comparada com o início espontâneo do trabalho de parto entre gestações de baixo risco, para avaliar os fatores associados a essa prática e seus resultados maternos e perinatais (segunda abordagem). Foram estimados os odds ratios (OR) para os possíveis fatores associados à indução e as razões de risco (RR) para os resultados maternos e perinatais, com seus respectivos intervalos de confiança (IC95%). Posteriormente, foram aplicados os modelos de regressão logística múltipla para o ajuste dos riscos estimados. Resultados: Do total de 97.095 partos do inquérito, 11.077 (11,4%) foram induzidos. Os hospitais públicos foram responsáveis por 74,2% das induções. A ruptura prematura das membranas (25,3%) e a indução eletiva (28,9%) foram as indicações mais freqüentes. A taxa de sucesso de parto vaginal foi de 70.4%, com 69.9% para a ocitocina e 74.8% para o misoprostol, os principais métodos isoladamente utilizados. O risco de indução do parto foi maior em mulheres com mais de 35 anos, com companheiro, nulíparas, sem cesárea no parto anterior, com rotura de membranas, hipertensão arterial, baixa altura uterina, diabetes, anemia grave, com menor número de consultas de pré-natal, pós-datismo, apresentação cefálica e naquelas que deram a luz em hospitais do seguro social. As complicações maternas mais associadas com a indução do parto foram a necessidade de uterotônicos no período pós-parto, laceração perineal, histerectomia, admissão em unidade de terapia intensiva, permanência hospitalar maior que 7 dias e maior necessidade de procedimentos analgésicos. Já os resultados perinatais desfavoráveis mais freqüentes foram Apgar menor que sete ao quinto minuto, ocorrência de muito baixo peso, admissão em UTI neonatal e início mais tardio da amamentação. Em relação à análise da indução eletiva entre gestantes de baixo risco, não foi encontrada diferença na taxa de cesariana e nos resultados perinatais, porém ocorreu maior necessidade do uso de uterotônico no pós-parto, risco cinco vezes maior de histerectomia pós-parto e maior necessidade de procedimentos de anestesia/analgesia. Conclusão: Na América Latina a taxa global de indução do trabalho de parto foi um pouco maior que 10%, enquanto a de indução eletiva entre gestantes de baixo risco foi de 4,9%. A taxa de sucesso para o parto vaginal foi elevada independentemente do método e da indicação da indução. Há, contudo, alguns riscos maternos e perinatais associados com essa prática, seja ela eletiva ou não<br>Abstract: Objective: To evaluate the prevalence of both medical and elective labor induction as well as employed methods, success rates, associated factors and maternal and perinatal outcomes in eight Latin American countries. Methods: it was performed an analysis on labor induction in the database of the "2005 WHO global survey on maternal and perinatal health" on deliveries occurring in eight randomly allocated Latin American countries. Data of all women who gave birth to children in the 120 included institutions during the period of the study were collected. The indications for labor induction according to the country, the success rate for each method, the factors associated with labor induction as well as maternal and perinatal outcomes were compared with deliveries with spontaneous onset of labour (Approach 1). A second independent analysis on elective induction compared with spontaneous onset of labor in low-risk pregnancies was performed in order to evaluate factors associated with elective labor induction and also maternal and perinatal outcomes (Approach 2). The odds ratios (OR) for possible factors associated with labor induction and the risk ratios (RR) for maternal and perinatal outcomes, with respective confidence interval (95%CI) for all types of labor induction and for elective induction were estimated. Additionally, multiple logistic regressions were applied to adjust the estimated risks. Results: Among the total 97,095 deliveries included in the survey, 11,077 (11.4%) underwent labor induction. Public hospitals accounted for 74.2% of them. Premature rupture of membranes (25.3%) and elective induction (28.9%) were the most frequent indications. The success rate in obtaining vaginal delivery was 70.4%. Oxitocin and misoprostol - the most employed methods - had success rates of 69.9% and 74.8%, respectively. Labor induction occurred more frequently in women older than 35 years, with a partner, nulipara, without cesarean section in the last pregnancy, ruptured membranes, hypertension, low fundal height, diabetes, severe anemia, vaginal bleeding, few prenatal visits, post term, cephalic presentation and those who gave birth in social security hospitals. The most frequent maternal complications associated with labor induction were need for uterotonic agents in postpartum period, perineal laceration, need for hysterectomy, and admission to intensive care unit, length of hospital stay above seven days and increased need of anesthetic/analgesic procedures. The most frequent adverse perinatal outcomes were low 5-minute Apgar score, very low birth-weight, admission to neonatal intensive care unit and delayed initiation of breastfeeding. Concerning elective induction in low-risk pregnancies there was no difference in cesarean section rate or perinatal outcome. However, there were increased needs for uterotonic agents in the postpartum period and for analgesic/anesthetic procedures, and a further than fivefold risk for postpartum hysterectomy. Conclusions: In Latin America, the overall labor induction rate was slightly more than 10%, while for elective indication among low risk pregnancies it was 4.9%. The vaginal delivery rate was high irrespective of the method or indication. However, there are some maternal and perinatal risks associated with this intervention, in spite of medically or
electively indicated.<br>Doutorado<br>Tocoginecologia<br>Doutor em Tocoginecologia
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Almeida, Neto Walfrido Salmito de. "Aspectos clínicos, epidemiológicos e laboratoriais da Leishmaniose tegumentar americana em hospital de referência de Teresina, Piauí." reponame:Repositório Institucional da FIOCRUZ, 2015. https://www.arca.fiocruz.br/handle/icict/13813.
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Previous issue date: 2015<br>Universidade Federal do Piauí. Teresina,PI, Brasil<br>INTRODUÇÃO: A Leishmaniose Tegumentar Americana (LTA) é uma doença infecciosa, não contagiosa, reconhecida pela OMS no grupo das doenças negligenciadas causada por diferentes espécies de protozoários do gênero Leishmania spp., que acomete pele e mucosas. OBJETIVOS: O trabalho objetiva descrever aspectos clínicos, epidemiológicos e laboratoriais dos casos de LTA atendidos no Instituto de Doenças Tropicais Natan Portella (IDTNP) em Teresina, Piauí entre 2007 e 2014. A casuística apresentada corresponde a cerca de 50% de todos os casos piauienses de LTA no período de 2007 a 2014. Os demais foram notificados em outros serviços de saúde. MÉTODO: Foi realizado um estudo do tipo série de casos, sendo os dados obtidos através de formulário do Sistema Nacional de Agravos de Notificação (SINAN). RESULTADOS: Observou-se que o hospital atende uma média de 85 casos por ano, com registro de picos superiores a 100 casos/ano em 2007, 2011 e 2014. Entre os 676 casos, 463 (68,5%) foram autóctones do Piauí, 182 (26,9%) procedentes do Maranhão e 27 (4%) do Pará. No Piauí, os municípios que apresentaram maior casuística foram Teresina 260 (56,15%) e Altos 17 (3,67%). Em Teresina os bairros com maior número de casos foram: Santa Teresa 23 (8,8%) e Santa Maria da Codipi 11 (4,2%). Do total de atendidos no IDTNP, 240 (35,5%) eram do gênero feminino e 436 (64,5%) eram do gênero masculino. A média de idade das pessoas com LTA foi 43,9 ± 20,7 anos. A distribuição por faixa etária mostrou: 0 a 4 anos 20 (3%), 5 a 12 anos 27 (4%), 13 a 17 anos 34 (5%),18 a 30 anos 111 (16,4%), 31 a 50 anos 228 (33,7%), 51 a 65 anos 142 (21%), maior de 65 anos 114 (16,9%). A coinfecção com o HIV foi documentada em 20 (3%) dos pacientes
Dentre os 676 casos, cerca de 615 (91%) foram confirmados por critérios laboratoriais e 282 (46%) tiveram apenas a intradermorreação de Montenegro positiva. O histopatológico mostrou lesões compatíveis com LTA, porém sem a visualização do parasita, sendo mais frequente nos casos da forma mucosa 63 do total de 77 (81,8%), nos casos de forma cutânea 144 dos 245 casos (58,8%). O tratamento com antimonial pentavalente foi aplicado em 511 (75,6%), 116 (17,2%) com anfotericina B e apenas 1 (0,1%) com pentamidina. Entre os casos, 570 (84,3%) tinham a forma cutânea e 106 (15,7%) tinham a forma mucosa da doença. Dos casos com comprometimento de mucosa, 24 (22,6%) apresentavam cicatrizes cutâneas. Entre os pacientes com a forma cutânea, 451 (79,1%) foram tratados com antimonial pentavalente e 79 (13,9%) com anfotericina B, entre as formas mucosas 43 (56,6%) foram tratados com antimoniais pentavalente e 27 (34,9%) com anfotericina B. O modelo multivariado demonstrou que a forma mucosa se associa a residir no Pará (OR = 5,43; IC 95% = 2,34 \2013 12,59), residir no Maranhão, (OR = 2,70; IC 95% = 1,72 \2013 4,25) e ter mais de 50 anos (OR = 1,94; IC 95% = 1,25 \2013 2,97). O gênero feminino apresentou apenas tendência a proteger do comprometimento da forma mucosa (OR = 0,64; IC 95% = 0,39 \2013 1,03). CONCLUSÕES: Conclui-se que a LTA vem sendo cada vez mais diagnosticada em Teresina e demais municípios do Piauí, em indivíduos do gênero masculino, sendo a forma mucosa identificada em níveis superiores à média nacional<br>The American Cutaneous Leishmaniasis (ACL) is an infectious disease, not contagious, recognized by WHO in the group of neglected diseases caused by different species of protozoa of the genus Leishmania, which affects the skin and mucous membranes. OBJECTIVES: The paper aims to describe the clinical, epidemiological and laboratory cases of ACL treated at a referral center in Teresina-Piauí between 2007 and 2014. The case presented corresponds to about 50% cases of ACL in Piaui during the period 2007 to 2014, others were reported in other health services. METHOD: A study of case series, and data obtained form the National Notifiable Diseases System (SINAN) was performed. RESULTS: It was observed that the hospital serves an average of 85 cases per year, with record peaks above 100 cases / year in 2007, 2011 and 2014. Among the 676 cases 463 (68.5%) were native of Piauí, 182 (26.9%) coming from Maranhão and 27 (4%) of Para. In Piaui, the municipalities that had larger samples were Teresina 260 (56.15%) and Altos 17 (3.67%). Teresina in the districts with the highest number of cases were: Santa Teresa 23 (8.8%) and Santa Maria da Codipi 11 (4.2%). Of the total, 240 (35.5%) were female and 436 (64.5%) were male. The average age of people with ACL was 43.9 ± 20.7 years. The age distribution showed: 0-4 years 20 (3%), 5-12 years 27 (4%), 13-17 years 34 (5%), 18-30 years 111 (16.4 %), 31-50 years 228 (33.7%), 51 to 65 142 (21%), greater than 65 114 (16.9%). Co-infection with HIV has been reported in 20 (3%) patients. Among the 676 cases, about 615 (91%) were confirmed by laboratory criteria, 282 (46%) had the only positive Montenegro's reaction
Histopathological showed injuries consistent with ACL, but without viewing the parasite, most frequently in cases of mucosal form 63/77 (81.8%) than in cutaneous cases 144/245 (58.8%). The treatment with antimonial was applied in 511 (75.6%), 116 (17.2%) with amphotericin B, and only 1 (0.1%) with pentamidine. Among the cases 570 (84.3%) had the cutaneous form and 106 (15.7%) had the mucosal form of the disease. Part of cases with mucosal involvement, 24 (22.6%) had cutaneous scars. Among patients with cutaneous 451 (79.1%) were treated with antimonials, and 79 (13.9%) with amphotericin B, between the mucosal forms 56.6% were treated with antimonials and 34, 9% with amphotericin B. The multivariate model showed that the shape mucosa associated to reside in Pará (OR = 5.43; 95% CI = 2.34 to 12.59), reside in Maranhão (OR = 2, 70; 95% CI = 1.72 to 4.25) and have more than 50 years (OR = 1.94; 95% CI = 1.25 to 2.97). The females showed only tendency to protect the impaired mucosal form (OR = 0.64; 95% CI = 0.39 to 1.03). CONCLUSIONS: We conclude that the LTA has been increasingly diagnosed in Teresina and other cities of Piauí, in male subjects, the mucosal form identified at levels above the national average
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Ball, Rachael I. "An Inn-Yard Empire: Theater and Hospitals in the Spanish Golden Age." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1281290896.
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Simão, José Cláudio. "Espectro clínico e prognóstico de pacientes com Leishmaniose Visceral Americana internados no Hospital Estadual Bauru (Bauru - SP)." Botucatu, 2018. http://hdl.handle.net/11449/155856.
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Orientador: Carlos Magno Castelo Branco Fortaleza<br>Resumo: A Leishmaniose Visceral (LV) é uma zoonose negligenciada e emergente na Região Sudeste do Brasil. Sua alta letalidade e as dificuldades para prevenção e controle fazem da LV um grave problema de saúde pública. Nós realizamos um estudo em casuística de um hospital de referência no município de Bauru, São Paulo. Foram realizadas: (I) descrição do quadro clínico e laboratorial; (II) estudo de preditores de óbito, recidiva e aquisição de infecções relacionadas à assistência à saúde (IRAS, anteriormente denominadas “infecções hospitalares”); (III) análise de preditores de incidência de LV e da coinfecção LV-HIV em setores censitários de Bauru. A coorte de base deste estudo foi composta de 683 sujeitos. O quadro clínico típico, com febre e hepatoesplenomegalia, foi mais frequente em monoinfectados que na coinfecção. Os preditores de óbito foram a idade e a soropositividade para HIV, sendo esta última também associada à recidiva. A carga de comorbidades e a inserção de cateteres venosos centrais foram fatores associados à aquisição de IRAS. Por fim, na análise espacial, observou-se maior incidência de LV e coinfecção LV-HIV em áreas periféricas de baixa renda e com urbanização precária.<br>Abstract: Visceral Leishmaniasis (VL) is a neglected and emerging zoonosis in the Southeastern Region of Brazil. Its high lethality and the difficulties for prevention and control make VL a serious public health problem. We studied VL cases attending a referral hospital in the city of Bauru, São Paulo State, Brazil. The following analyses were performed: (I) description of clinical and laboratory conditions; (II) study of predictors of death, recurrence and acquisition of healthcareassociated infections (HAIs, formerly referred to as "nosocomial infections"); (III) analysis of predictors of VL incidence and VL-HIV coinfection in Bauru census sectors. The baseline cohort of this study was composed of 683 subjects. The typical clinical picture, with fever and hepatosplenomegaly, was more frequent in monoinfected subjects than in coinfection. The predictors of death were age and HIV seropositivity, the latter being also associated with relapse. The burden of comorbidities and the insertion of central venous catheters were factors associated with the acquisition of HAIs. Finally, in the spatial analysis, we found higher incidence of VL and VL-HIV co-infection in peripheral areas of low income and with precarious urbanization.<br>Doutor
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Brosemer, Sandra L. McMackin. "The American Heart Association 2005 emergency cardiovascular care guidelines impact on myocardial infarction mortality in Nevada hospitals." abstract and full text PDF (UNR users only), 2009. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1472946.
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Craig, Jean E. "An Evaluation of the Economic Impact of P.L., 101-336, Americans with Disabilities Act on a Community Hospital." TopSCHOLAR®, 1993. http://digitalcommons.wku.edu/theses/1679.
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Public Law 131-336, Americans With Disabilities Act (ADA), is comprehensive legislation created with the intention of integrating the disable into the work place and every segment of society. Forty-three million Americans are disabled. Of these, twenty-three million seek employment, but because of discrimination are unable to find work. The law provides requirements for access to public accommodations. All disabled Americans deserve the opportunity to enjoy the same public services as the non-disabled.
Businesses are now required to provide reasonable accommodations to a disabled employee if these accommodations will allow the employee to perform the essential functions of the job. Businesses are also required to make necessary renovations to their facilities to allow the disabled to move freely about and enjoy the services and amenities of the facility.
This researcher attempts to compile the costs of complying with the ADA in one hospital. The analysis is limited to one facility. However, the findings may be beneficial to other facilities because severe civil penalties can be levied on facilities which do not comply.
The study involved surveying a healthcare facility using points from Title I of the ADA determined by the researcher to be necessary for compliance. Title III compliance was accomplished using a facility survey from developed by the American Hospital Association.
The researcher complied total expenditures by The Medical Center at Bowling Green, Bowling Green, Kentucky, to comply with Titles I and III of the ADA as well as projected costs associated with recommendations to resolve deficiencies.
The findings support the hypothesis that practical approaches and inexpensive solutions are readily available so facilitates can fully comply with the intent of the law and avoid undue hardship.
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Peixoto, Marco Aurélio da Silva. "Forma mucosa da Leishmaniose Tegumentar Americana : estudo histopatológico e imuno-histoquímico de casos do Hospital Universitário de Brasília." reponame:Repositório Institucional da UnB, 2009. http://repositorio.unb.br/handle/10482/3968.
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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2009.<br>Submitted by Thaíza da Silva Santos (thaiza28@hotmail.com) on 2010-03-07T17:17:10Z
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Previous issue date: 2009-02-05<br>A Leishmaniose Tegumentar Americana (LTA) é uma doença parasitária endêmica, principalmente na região Centro-Oeste. A Leishmania é um parasita que através de seus antígenos secretados e não secretados desencadeiam, respectivamente, uma resposta imune predominantemente celular (inata e adquirida) e em menor proporção humoral. Na resposta inata participam o sistema complemento, polimorfonucleares, macrófagos e células natural killer numa resposta inicial. Desta resposta inicial, há produção de citocinas (IL-12 e INF-γ e TNF-α) que ativam linfócitos T CD4+ e T CD8+ para resposta imune celular adquirida. A IL-12 diferencia os linfócitos T CD4 numa resposta Th1, com produção de INF-γ, ativação de macrófagos e resolução da doença. Enquanto, a IL-4 tem efeito reverso direcionando para uma resposta Th2 com diminuição da ativação de macrófagos, prevenindo o dano tecidual e permitindo a persistência do parasita. Foram descritos casos de pacientes com a forma mucosa da LTA do Hospital Universitário de Brasília, analisando dados epidemiológicos, clínico-laboratoriais e correlacionando com os aspectos histopatológicos e imuno-histoquímico (CD45ro, CD4, CD8, CD20, CD15, CD68 e Bcl-2). Perfil mais freqüente dos pacientes: sexo masculino, com média de idade de 50 anos, da região Centro-Oeste, com queixa de obstrução nasal e lesão de mucosa nasal infiltrada com ulceração e perfuração de septo ao exame otorrinolaringológico. A maioria com exames laboratoriais (IFA, inoculação em hamster, cultura, esfregaço e intradermorreação de Montenegro) compatíveis com a doença, sendo que em 44,44% dos casos foi possível a identificação da Leishmania por algum método auxiliar. Na histopatologia, de maneira geral, encontrou-se um infiltrado inflamatório linfohistioplasmocitário, às vezes acompanhado de uma reação granulomatosa com ou sem necrose. As classes histopatológicas encontradas foram: REC (reação exsudativa celular), REN (reação exsudativa necrótica), RENG (reação exsudativa necrótico-granulomatosa) e REG (reação exsudativa granulomatosa), sendo a primeira a mais freqüente (66,67%). Essas classes são estatisticamente significantes (p<0,05) diferentes quando comparadas entre si em relação à quantidade de células positivas na imuno-histoquímica, exceto entre as classes REG e REN (p>0,05). Esse estudo atestou a aplicabilidade e a praticidade do programa UnBVision na análise quantitativa das células nas reações imuno-histoquímicas. Na imuno-histoquímica, os linfócitos T predominaram em relação aos linfócitos B, comprovando que a doença tem reação imune mais celular do que humoral, sendo que dentre os linfócitos T, prevaleceu os linfócitos T CD4+ em relação aos linfócitos T CD8+, exceto em único exemplo de caso REG. Houve expressão considerável de Bcl- 2 no infiltrado inflamatório. Grupos com contato prévio com o antimonial pentavalente e com presença de granulomas ou de Leishmania ao método histopatológico não tiveram significância estatística (p>0,05) para explicar a diferença de número de células positivas para todos os marcadores aplicados no estudo. Em estudos complementares, o uso da imuno-histoquímica para identificar as citocinas e marcadores pró e antiapoptóticos podem contribuir para melhores esclarecimentos da imunopatologia da doença.
__________________________________________________________________________________________ ABSTRACT<br>The American Integumentary Leishmaniasis (AIL) is a parasitic endemic disease, mainly in the Center-West region. Leishmania is a parasite that through its secreted and not secreted antigens trigger, respectively, a predominantly cellular immune response (innate and acquired) and to a lesser extent humoral. In the innate response, complement system, neutrophils, macrophages and natural killer cells work in an initial response. In this initial response, there is production of cytokines (IL-12, INF-γ and TNF-α) that activate T CD4+ and T CD8+ cells for acquired cellular immune response. The IL-12 action differentiates CD4 T cell to Th1 response and production of INF-γ, activation of macrophages and resolution of the disease. While the IL-4 has reverse effect directing to Th2 response with decreased activation of macrophages, this reaction prevents tissue damage and allows the persistence of the parasite. In this study, we have described patients with the mucosal form of AIL, they were treated in the University Hospital of Brasilia, analyzing epidemiological, clinical and laboratory data and correlating with the histopathologic features and the following immunohistochemical antibodies: CD45RO, CD4, CD8, CD20, CD15, CD68 and Bcl-2. Most common profile of patients: male, mean age 50 years, from Center-West region, with complaint of nasal obstruction and injury of nasal mucosa infiltrated with septum ulceration and perforation detected in the otorhinolaryngologic examination. Most of them with laboratory tests (indirect immunofluorescence, inoculation in hamster, smear, culture and Montenegro Skin Test) compatible with the disease, and in 44.44% of the cases it was possible the identification of Leishmania by some auxiliary method. In histopathology, in general, there was an inflammatory infiltrate lynphohistioplasmocitary sometimes accompanied by a granulomatous reaction with or without necrosis. The histopathological grades found were: ECR (exudative cellular reaction), ENR (exudative necrotic reaction), NEGR (necrotic-exudative granulomatous reaction) and EGR (exudative granulomatous reaction), the first one was the most frequent (66.67%) These classes are statistically significant (p <0.05) different when compared to each other with the amount of positive cells in immunohistochemistry, except between ENR and EGR classes (p> 0.05). This study attested the applicability and practicality of the program UnBVision in quantitative analysis of cells in immunohistochemical reactions. In immunohistochemistry, the T cells were predominant on B cells, confirming that the disease as more cellular immune response than humoral, and in T cells, prevailed the CD4+ T on CD8+ T cells, except in only one instance case EGR. There was considerable expression of Bcl-2 in inflammatory infiltrate. In groups with previous contact with pentavalent antimony and presence of granulomas or Leishmania the histopathologic method were not statistically significant (p> 0.05) to explain the difference in the number of positive cells for all markers used in the study. In further studies, the use of immunohistochemistry to identify the cytokines and markers pro and antiapoptosis can contribute to better explanations of the immunopathology of disease.
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Khuspe, Shaila. "Effects of Staffing and Expenditure Variables on After Surgery Patient Safety in Florida Hospitals." Scholar Commons, 2004. https://scholarcommons.usf.edu/etd/1113.
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Objective: To investigate the association between hospital investment in human resources variables and patient safety, specifically after surgery adverse events in Florida hospitals. We performed the analysis to identify the association of after surgery complication rates with full time equivalent employees (FTEs) per admission and per patient day, expenses per admission and per patient day and, the percent of total operating expense accounted for by payroll expenses.
Design: A cross sectional analysis using inpatient hospital discharge data and financial data from seventy short-term general hospitals, both for-profit and not-for-profit.
Methods: Discharge data from year 2000 was obtained from Agency for Health Care Administration (AHCA). This data was used to calculate Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) related to after surgery complications in 840,945 hospital discharge records from 70 short-term general hospitals across the state of Florida. The predictor variables include: payroll expenditures per admission, payroll expenditures per patient day, personnel (FTE) per admission, personnel (FTE) per patient day and payroll expense as a percent of total operating expenses.
Main outcome measures: Nine patient safety indicators defined by AHQR and specific to after surgery complications: complications of anesthesia, foreign body left during procedure, postoperative hemorrhage or hematoma, postoperative physiologic and metabolic derangement, postoperative pulmonary embolism or deep vein thrombosis, postoperative respiratory failure, postoperative sepsis, postoperative wound dehiscence.
Results: Patient safety indicator rate showed an inverse relationship with the percent of total operating expense represented by payroll, Personnel per patient day and personnel per admission. The patient safety indicators showing significant relationship with hospital human resource characteristics are postoperative hemorrhage or hematoma (p=0.0002), postoperative hip fracture (p<0.0001), and postoperative sepsis (p=0.0371).
Conclusion: Human resource investment is positively related to favorable outcomes, although the effect varies across the type of outcomes.
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O'Grady, Taylor Jacob. "Women's health care in American Catholic hospitals : a proposal for navigating ethical conflicts in accessing reproductive health care." Thesis, University of St Andrews, 2018. http://hdl.handle.net/10023/16588.
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The Catholic Church is one of the largest providers of medical care in the US, with 1 in 6 acute-care beds residing in a Catholic hospital. One third of these hospitals are in rural or underserved areas in the US, and advocacy for the vulnerable is a central platform of the Catholic Healthcare Association. Despite this, the Church has been under attack for allegedly putting women at risk of injury or death due to the care restrictions concerning reproductive health stipulated in the Ethical and Religious Directives (ERDs). Additionally, scholars are questioning the distinctiveness of the Catholic healthcare mission in practice, pointing to the increased homogenization of Catholic and non-Catholic hospitals. For these reasons, it is necessary to assess if and how women are being harmed in Catholic hospitals and, if there is harm being done, if there is a way to prevent these harms while preserving the Catholic Social Tradition in medicine. In carrying out this assessment, I read the current literature closely to explore both the origins and the practical consequences of these ethical conflicts. Subsequently, I use Chris Durante's "pragmatic perspectivism" to formulate a proposal that considers both Catholic medical ethics and secular medical ethics on the same plane. The proposal suggests the adoption of an alternative and complementary lens for Catholic health care. Using this framework would allow the Church to pursue its health care mission in a fuller sense, unencumbered by the inertia of the medical industry towards homogenization due to legal and economic pressures. It also provides the potential for Catholics to more easily receive Catholic care in all hospitals, not just those under Catholic sponsorship. Importantly, it would also prevent any American woman from being practically forced to receive Catholic care, circumventing many of the ethical conflicts present in the current system.