Dissertations / Theses: 'Baragwanath Hospital. Department of Medicine'

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Ajudua, Emmanuel Enuagwuna. "Profile of diabetic complications amongst diabetics attending internal medicine outpatient department and family medicine outpatient department in Dora Nginza Hospital, PE hospital complex." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97196.

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Thesis (MFamMed)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Introduction: Diabetes is the most prevalent endocrinology problem encountered in primary care practice. If recent trends showing a dramatic increase in prevalence (believed to be a consequence of a decline in physical activity and excessive caloric intake) continue, then the condition will soon affect nearly 20 million people in the U.S a reflection of the global trend. Effective management requires care that is thoughtful and meticulous, incorporating intensive patient education. Euglycemic control, with the level of glycosylated haemoglobin (HbA1c) kept below 7.0mmol/L, has emerged as a major treatment objective because of its association with a marked reduction in the risk for micro vascular complications. The primary physician is in the unique position to provide comprehensive care to the diabetic patient. Setting: The aim of this study is to evaluate the profile of complications arising due to diabetes mellitus among adult diabetics attending internal medicine outpatient department and family medicine/primary care outpatient department in the Dora Nginza hospital, PE hospital complex. Method: The study is a descriptive retrospective study in which names of patients were collated from clinic records of both clinics, files sought at the records department covering the period between Jan 2007 and Jan 2008 inclusive. Prevalence of statistical variables was generated using frequency tables, bar graphs, cross tabulations and chi square test. Results: Hyperglycemia was the major complication which predominantly was associated with high haemoglobin A1c (HbA1c) levels. However, some hyperglycaemic cases were also found to be associated with normal HbA1c. Complications were found to be more in type 2 diabetics. Patients with hypertension, obesity, smoking and alcohol use were observed to have a higher risk of developing diabetic complications. The findings on retinopathy in this study was inconclusive in view of the fact that patients sent for fundoscopy did not return with documented results from the sister hospital PE provincial hospital. Family Medicine outpatient department overall did better in patient care compared to the Internal Medicine outpatient department. Conclusion: The challenge for the primary care physician is to design a therapeutic program that is safe practical and acceptable to the patient. The ultimate goal of therapy is the prevention of micro vascular and macro vascular complications, consequence of diabetes that makes the condition a major risk factor for cardiovascular disease, stroke, visual impairment, renal failure, impotence, peripheral neuropathy, limb loss and ultimately death. These can be averted through appropriate education of both hospital staff, patients and their care givers. The recommendations made are based on the findings of the study.
AFRIKAANSE OPSOMMING: Nie beskikbaar.

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Presley, Belinda Denise. "The Influence of On-Site Surgical Pathology Department Services in Rural Hospital Physician Satisfaction." Thesis, Walden University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3728643.

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There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional study was employed utilizing three primary instruments: the Henry Ford Hospital Survey, Standardized (Synoptic) Pathology Reports, and PAR Medical Colleague Questionnaire. Statistical analyses including ANOVA, linear regression, and t tests were used to examine the relationships between the study’s variables. The results revealed that there is statistically significant evidence to support that on-site surgical pathology department services influence physician satisfaction. Potential implications for positive social change from this study include a better understanding and awareness of the relationship between physician satisfaction and utilization of on-site pathology services, which may ultimately benefit healthcare facilities by more intently addressing quality of care and patient satisfaction.

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Amin, Khan Mandokhail Boonyong Keiwkarnka. "Patient satisfaction towards outpatient department services of medicine in banphaeo autonomous hospital Samut Sakhon Province, Thailand /." Abstract, 2007. http://mulinet3.li.mahidol.ac.th/thesis/2550/cd399/4937996.pdf.

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Eiselen, Thea. "Working towards the implementaion of an international accreditation programme in a Nuclear Medicine Department of a South African teaching hospital." Thesis, Stellenbosch : Stellenbosch University, 2005. http://hdl.handle.net/10019.1/50550.

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Thesis (MSc)--Stellenbosch University, 2005.
ENGLISH ABSTRACT: Introduction: Quality assurance in Nuclear Medicine is of utmost importance in order to ensure optimal scintigraphic results and correct patient management. A customised Quality Management System (QMS) should be documented and implemented by following the international guidelines set by the International Standardisation Organization (ISO). Materials & Methods: A Quality Control Manual (QCM), defining the departmental quality policy, mission, vision and objectives was customised following the framework of a tried and tested design. As ISO focuses on client satisfaction and staff harmony, the following departmental objectives were audited in working towards the accreditation of the Nuclear Medicine Department of Tygerberg Hospital: referring physician satisfaction, patient satisfaction as well as staff satisfaction and harmony. Information was collected by means of questionnaires completed by referring physicians and staff members. One-on-one interviews were executed on patients. An international ISO accredited Nuclear Medicine department was visited to establish the suggested path to follow en route to successful ISO accreditation and certification. Results: Referring physicians indicated overall satisfaction with service provision, but a need for electronic report and image transfers seemed too dominant. The patient satisfaction survey resulted into overall satisfaction with personal service providing, but the provision of written and understandable information, long waiting times and t equipment must receive attention. Staff questionnaires indicated a general lack of communication between different professional groups and the need for interpersonal loyalty and team building. Improvement measures were identified to ensure the continuous improvement of the QMS by focusing on these quality parameters. Conclusion: The department has QA procedures in place, but does not meet all criteria for external accreditation. In order to ensure departmental harmony and sustainability of client and staff satisfaction, the departmental objectives in measured and improved where needed. The successful implementation and continuous improvement of a customised QMS, following the guidelines outlined in the QCM will lead to successful accreditation.
AFRIKAANSE OPSOMMING: Inleiding: Die belangrikheid van kwaliteit versekering in Kerngeneeskunde vir die versekering van optimale flikkergrafiese resultate en korrekte pasient handtering kan nie onderskat word me. 'n Klantgerigte Kwaliteitsbeheersisteem (KBS) moet gedokumenteer en geimplimenteer word vir die Kerngeneeskunde Departement deur die riglyne te volg soos uiteengesit deur die Internationale Standardiserings Organisasie (ISO). Materiale & Metodes: 'n Kwaliteitskontrol handleiding (KB), wat die departementele kwaliteitsbeleid, die missie en visie asook die departementele doelwitte definieer is ontwerp en saamgestel vir die Kerngeneeskunde departement van Tygerberg Hospitaal. Hierdie ontwerp is gebaseer op die raamwerk van 'n aanvaarde kwalteitsbeheersisteem. ISO fokus op klante tevredenheid asook personeel harmonie en tevredenheid. Vir hierdie rede is daar 'n tevredenheidpeiling uitgevoer op die klante en personeel in die strewe na ISO akkreditasie en sertifikasie. Inligting was versamel deur vraelyste wat ingevul was deur die verwysende geneeshere, pasiente en personeel. Resultate: 'n Kwaliteitskontrole handleiding was saamgestel VIr gebruik in die Kerngeneeskunde department. Die interne audit resultate het aangedui dat die verwysende geneeshere tevrede is met die algehele dienslewering. Die behoefde aan elektronies versende verlae en beelde was dominerend. Die pasient tevredenheidspeiling het bevestig dat die pasiente tevrede is met persoonlike dienslewering, maar 'n tekort aan verstaanbare en geskrewe inligting was geidentifiseer. Die lang wagtye en stukkende apparaat is ook gebiede wat verbertering benodig. Algemene gebrek aan komminukasie tussen die verskillende beroepsgroepe, die behoefte aan interpersoonlike lojaliteit en span werk was die hoof bevindinge van die personeel tevredenheidspeiling. Verbeterings maatreels, gefokus op hierdie departementele doelwitte, was geidentifiseer ten eide te verseker dat die KBS voordurend verbeter en in stand gehou word. Samevatting: Alhoewel die departement wel KB prosedures in plek het, voldoen dit nie aan al die criteria vir eksterne akkreditasie nie. Ten einde departementele harmonie en kliente tevredenheid te verseker, met die oog op ISO sertifikasie, moet die departmenteIe doelwitte deurlopend gemeet en verbeter word.

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Page, Jacqueline. "Parent and physician decision making in children with suspected ear infection presenting to a children's hospital emergency department." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0017/MQ48175.pdf.

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Wong, Chi-pang, and 黃志鵬. "The impact of the establishment of emergency medicine ward at accident& emergency department on hospital admission." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45174416.

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Procter, Claire. "Lumbar punctures in the paediatric emergency medicine department at Red Cross War Memorial Children's Hospital: An evaluation." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20854.

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Background: Lumbar punctures (LPs) are frequently performed in the paediatric medical emergency unit (MEU) department to diagnose or exclude meningitis. Unsuccessful lumbar punctures (LPs) cause diagnostic uncertainty which may prolong hospital stay and result in unnecessary antibiotic treatment and increased costs to the hospital and patients. It is important to determine factors that may be effective in reducing unsuccessful LPs. There is a paucity of studies on this topic from sub-Saharan Africa. Previous studies have shown inconsistent results and the use of sedation has not previously been studied. Aims: To determine the prevalence of unsuccessful lumbar punctures(LPs) and the factors influencing this in the medical emergency unit (MEU) and short stay ward (SSW) at Red Cross War Memorial Children's Hospital, Cape Town.

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Blom, Alice, and Susanna Olsson. "Improved Patient Admission Planning - A Discrete Event Simulation Study at the Department of Pulmonary Medicine, Linköping University Hospital." Thesis, Linköpings universitet, Kommunikations- och transportsystem, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-137678.

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The Swedish health care system plays a vital role in satisfying the citizens demands for quality health care services. To deliver the right services in time in a hospital, an efficient admission plan is required, but this can be difficult to achieve. The Department of Pulmonary Medicine at the University Hospital in Linköping needs a better admission plan for their patients. In the department, the patient demand does not match the capacity, which leads to overcrowding at the ward. The aim of this thesis is to improve the admission plan of patients for the ward at the Department of Pulmonary Medicine by using discrete event simulation. To fulfil the aim, a simulation study is performed to understand how the system is working, where the problems emerged and how to prevent overcrowding. Different experiments are performed to check what could improve the admission plan at the ward. The results from this study shows that an improvement of the admission plan could be reached by better cooperation between involved units, improved documentation at the Department, a queue system of patients based on medical priorities and changed number of care beds. These solutions can prevent overcrowding and deliver health care services in time.

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Montazeri, Amine. "Developing a Pathologists’ Monthly Assignment Schedule: A Case Study at the Department of Pathology and Laboratory Medicine of The Ottawa Hospital." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/33028.

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In the Department of Pathology and Laboratory Medicine, at the beginning of each month, the clinical managers use expert knowledge to assign pathologists to expected daily specimens based on the criteria of workload restrictions, clinical sub-specialties, and availability. Since the size of the pathologists’ assignment problem is large, finding a feasible assignment manually is a very time-consuming process that takes a number of iterations over a number of days to complete. Moreover, every time there is a need to make a revision, a new assignment needs to be developed taking into account all the above criteria. The goal of this research is to develop an optimization model and a decision support tool that will help with monthly staffing of pathologists based on the criteria outlined above. The developed model is rooted in the classical operations research assignment problem and it is extended to account for the following requirements: each pathologist should be assigned to a similar specimen type throughout a week; for a given pathologist, there should be a rotation of the specimen types between the weeks; and the clinical managers’ preferences in terms of assigning a particular specimen type to a particular pathologist on a specific day need to be considered. A monthly assignment model covering 36 pathologists and 26 specimen types was solved using IBM ILOG CPLEX Optimization Studio. It is embedded in a decision support tool that helps clinical managers to make staffing decisions. The decision support tool has been validated using data from The Ottawa Hospital (TOH).

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Wilson, Merna Akram. "Triage Template to Improve Emergency Department Flow." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1622280768033809.

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MacKinnon, Paul Steven. "Emergency Department Nurses' Experiences of Violent Acts in the Workplace." eScholarship@UMMS, 2009. https://escholarship.umassmed.edu/gsn_diss/14.

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Emergency department nurses are at high risk for violence in the workplace (Keely, 2002; Fernandez et al., 1998; Nachreiner et al., 2005; Mayer et al., 1999). It is estimated that between 52% and 82% of emergency nurses will experience physical violence and 100% of emergency department nurses will experience non-physical violence in their careers. Despite this fact, there are limited studies examining workplace violence among this vulnerable group (Fernandez et al., 1998; Levin et al., 1998). Therefore, the purpose of this qualitative descriptive study was to examine the experiences of emergency department nurses with workplace violence. Levin et al.’s (2003) Ecological Occupational Model (EOHM) was used to guide this study. Four focus groups were conducted with 27 nurses who represented different types of emergency departments (rural community facility to large urban Level 1 trauma center). Results of the study suggested that the majority of participants (96%) experienced some form of work-related violence and 75% had attended at least one violence education class. The major themes of frustration and powerlessness emerged from the data. Sub themes included professional conflict while caring for violent patients, personal detachment as an emotional survival mechanisms, and feelings of victimization. Additional factors contributing to workplace violence included: personal attributes of the nurse, the workplace, and the community where the emergency department was located. These study results have potential to guide intervention development aimed at reducing workplace violence in the emergency department setting.

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Miyelani, Maringa Ignecious. "Implementation of an Aseptic Service for Radiolabelling of Autologous Blood Cells at the Department of Nuclear Medicine, Dr George Mukhari Hospital." Thesis, University of Limpopo (Medunsa Campus), 2013. http://hdl.handle.net/10386/1075.

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Thesis (MSc(Med)(Pharmacy))-- University of Limpopo, 2013.
Introduction: The Department of Nuclear Medicine at Dr George Mukhari Hospital (DGMH) received a biological safety cabinet (Laminar airflow hood - LAF) as a donation from the International Atomic Energy Agency (IAEA) in 2007, for the specific purpose of preparing radiolabelled blood cells. The laminar airflow hood was installed but has never been commissioned for use. Radiolabelled white blood cells are used in a range of Nuclear Medicine applications related to infection and pyrexia of unknown origin. Correct handling of the blood is essential for both patient and operator safety. A laminar airflow procedure is required for the radiolabelling of autologous blood. Therefore, there was a need to further investigate the guidelines for radiolabelling autologous blood cells with a view to commissioning the LAF and implementing a service for radiolabelling of autologous blood elements. Objectives: 1. Identify the equipment 2. Identify and development of the SOPs 3. Implement aseptic services to radiolabelling blood cells. Method: The study was conducted at the Department of Nuclear Medicine, Dr George Mukhari Hospital. The design of the study was prospective, descriptive and interventional. Data were collected through independent (objective) observation, questionnaires (subjective). In order to involve staff in the implementation of aseptic services in the respective department a focus group discussion (FGD) followed. The International Atomic Energy Agency (IAEA); Operational Guidance on Hospital Radiopharmacy and United Kingdom Radiopharmacy Group (UKRG) Guidelines were consulted to identify equipment and operational standards required. Permission to conduct the study was obtained from the Head of Department of Nuclear Medicine and Chief Executive Officer (CEO) of the Hospital. The proposal was approved by the Medunsa Campus Research and Ethics Committee (MCREC). xii Results: Premises: The room in which the LAF is situated is not in use as a clean room; hence few of the IAEA infrastructure and LAF requirements were met. Only, three aspects (18.75%) were compliant (type of LAF, lighting and dedicated equipment availability) and thirteen (81.25%) were not. For the hot lab only two (16.67%) of the fourteen items regarding structure and facilities were compliant, twelve (83.33%) were not (e.g. access, layout, cleanliness levels). The short term plan devised is to partition the area in which LAF is currently situated into a clean room and change room, seal the ceiling and windows, paint and ensure that walls, floors and surfaces are smooth and impervious in both the clean room and hot lab. The cost of alterations is (+/-) R50 000. The long term plan is to obtain funds (approximately R960 000) for the full development of the aseptic suite which will comply with local and international standards for radiolabelling of autologous blood cells recommended by ISORBE. Environment and Personnel: None of the four survey items on environment was compliant for the clean room (e.g. air not filtered, no temperature or humidity monitoring or control). Only in the hot lab was the temperature monitored. The LAF/clean room is not currently in use. In the hot lab, gowns and overshoes are not available. The plan is to have thermometers installed in both the clean room and hot lab and have log books for recording temperature. Microbial Contamination: In the Department, monitoring of microbial contamination is not performed. The IAEA recommends that surfaces, environment and equipment should be monitored for microbial contamination in an area where sterile products are handled. Staff Training & Improvement of Aseptic Services: Two staff had been trained in aseptic admixing. All eight respondents agreed that training on aseptic handling of radiopharmaceuticals is necessary. Hygiene and SOPs: Six respondents rated hygiene as satisfactory and two as not satisfactory. Despite these views, all felt that hygiene should be improved in the hot lab and that standard operating procedures (SOPs) should be developed. A group xiii was set up to develop SOPs. Four SOPs were developed - cleaning the clean room and LAF, hand washing, gowning/degowning and leukocyte radiolabelling. Radiolabelling of Autologous Blood Cells: Doctors in the Department want this service to help with the diagnosis of pyrexia of unknown origin (PUO) and infections. Therefore, they were supportive to the researcher in the project set-up the processes and facilities for radiolabelling cells. The short term plan is to train staff in radiolabelling of autologous blood cells. The long term plan is to have the facility to set-up correctly to facilitate service provision and research. Equipment: Staff mentioned that a centrifuge dedicated to the radiolabelling of blood cells should be obtained to ensure that all the procedures for labelling blood cells are followed. The short term plan is to commission the LAF (Cost: approximately R15 000 including VAT) and obtain a cooled centrifuge with sealable buckets (Cost: approximately R40 000 including VAT) for the purpose of commencing with the radiolabelling of blood cells service in the Department. Finance: Staff indicated that some of the problems in the department can be solved if they can obtain funding for infrastructure development. The short term plan is to have the budget for the upgrade of the facility included in the Departmental budget. And the long term plan is to obtain funds from the Gauteng Government for the full development of the facility Conclusion: Required standards and guidelines for radiolabelling of autologous blood cells in a radiopharmacy unit have been identified. Therefore, the upgrading process of the facility should commence and SOPs developed should be implemented. Recommendations: Necessary structural changes on the facility should be made to meet the local and international standards for radiolabelling blood products. Therefore, funds should be obtained for upgrading the facility and obtain the necessary minimum equipment for radiolabelling of autologous blood cells. It is recommended that a post for a radiopharmacist be created to increase capacity and help improve standards with regards to pharmaceutical services in the Department.

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Hlahla, Mmachuene I. "Discrepancies between antemortem computed tomography scan and autopsy findings of traumatic intracranial haemorrrhage at Pietersburg Hospital forensic pathology Department." Thesis, University of Limpopo, 2019. http://hdl.handle.net/10386/3050.

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Thesis (MMED. (Forensic Medicine)) --University of Limpopo, 2019
Traumatic intracranial haemorrhages are common, carry a high mortality rate and are therefore commonly known in the practice of forensic pathology as unnatural deaths. Studies have demonstrated a significant decrease in mortality rate among patients who received surgical interventions compared to patients who were treated medically. Missed or mis-diagnoses, which may be apparent during an autopsy procedure, present possible missed treatment opportunities. Aim/objective and methods The study investigated the discrepancy rate and discrepancy pattern of diagnosis between antemortem brain computed tomography (CT) scan findings and autopsy findings in deceased patients with traumatic intracranial haemorrhage (TIH). A quantitative retrospective descriptive study was conducted based on bodies presented with TIH at Pietersburg Hospital Forensic Pathology Department. A total of consecutive 85 cases with antemortem CT (ACT) scan findings were compared to autopsy findings using percentage agreement and Cohen’s kappa statistics. Results and conclusion There was a fair overall agreement (k=0.38) with overall discrepancy rate of 24.74%, ranging from 9.41% to 34.12% for individual TIH between ACT scan and autopsy findings. Subarachnoid haemorrhage had the lowest agreement between the ACT scan and autopsy findings for TIH. Patient and doctor factors associated with the discrepancies were assessed. Those associated factors, if addressed, may have a positive impact on patient outcome. As far as the debate on non-invasive autopsy procedure is concerned, as a result of existing discrepancy rate, we conclude that ACT should not be used alone in the determination of cause of death but may be used in conjunction with autopsy findings.

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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/710.

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Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population. In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands. We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable. We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models. In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group. In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).

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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/710.

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Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population. In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands. We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable. We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models. In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group. In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).

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Shaw, Elbert Turner, and Joan Phillips Zimmerman. "Detailed requirements analysis for a management information system for the Department of Family Practice and Community Medicine at Silas B. Hays Army Community Hospital." Thesis, Monterey, California. Naval Postgraduate School, 1989. http://hdl.handle.net/10945/25833.

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Maxym, Maya. "Hypnosis for Relief of Pain and Anxiety in Children Receiving Intravenous Lines in the Pediatric Emergency Department." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08212007-115631/.

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Intravenous line placement is one of the most common procedures performed on children presenting to the Emergency Department. Anxiety about needles is widespread, and many children experience high levels of fear and/or pain with their IV line placements. Hypnosis is a behavioral intervention that shows significant promise for alleviating procedure-related pain and anxiety in children. Twenty-five developmentally normal, English-speaking children between the ages of five and fifteen who required IV line placement in the Pediatric Emergency Department at Yale-New Haven Childrens Hospital were randomized to receive either the standard of care or standard of care plus a brief hypnotic intervention. The groups were similar with regard to baseline demographic and socioeconomic status, previous experience with medical care, and presence or absence of chronic medical conditions. Childrens pre-procedural anxiety ratings on a 10cm visual analog scale (VAS) and expected procedural pain ratings by 10-point oucher and 10cm VAS were not significantly different between the groups. Children randomized to the hypnosis group reported less anxiety during the procedure (mean 5.0 vs 3.1, median 7.2 vs 2.2, p = 0.28) than children randomized to the standard of care group. Cases also had a decrease in anxiety from expected to actual of 1.6 on a 10cm scale, while those randomized to the control group had an increase from expected to actual anxiety of 1.1 (p=0.01). A smaller trend towards decreased pain in the hypnosis group was also present. As measured by VAS, cases had lower mean pain scores (3.4 vs 4.3) than controls. In a comparison of anticipated and actual pain scores between groups, the hypnosis group had a mean decrease of 0.8 on a 10cm VAS , while the control group had a mean increase of 0.5 (p=0.14). Recruitment of subjects is ongoing, but preliminary results suggest that hypnosis is effective for alleviating needle-related anxiety in children undergoing IV line placement and may be helpful for alleviating the pain of IV line placement as well.

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Maree, Leana. "Investigating the aetiology of respiratory tract infections in children admitted to Tygerberg Children’s Hospital using molecular methods and viral culture." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71902.

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Thesis (MMed)--Stellenbosch University, 2012.
Includes bibliography
ENGLISH ABSTRACT: Introduction Acute respiratory tract infections cause significant morbidity and mortality worldwide, and are the main reason for the utilisation of health care services. Identifying the aetiological cause of lower respiratory tract infections (LRTIs) is difficult at the best of times, and more than 20 viruses and bacteria have been associated with LRTIs, which cannot be distinguished with clinical examination alone. Viruses can be detected in respiratory samples by a variety of methods, and without exception molecular methods have proven to be more sensitive than non-molecular-based tests. The increased sensitivity of molecular methods may assist in expanding our knowledge of the pathogenesis of severe respiratory tract infections, and could have a positive influence on patient management, infection control, vaccination strategies and public health. Aims and objectives 1. Determine the viral causes of lower respiratory tract infections requiring admission in using shell vial culture with immunofluorescent staining and two multiplex PCR assays, the Seeplex® RV15 ACE Detection system (Seeplex® RV15 ACE) and the Respiratory Multiplex Real-Time RT-PCR LightMix® Customised Kit (Resp Multiplex RT-PCR). 2. Compare the Seeplex® RV15 ACE and the Resp Multiplex RT-PCR with shell vial culture for the detection of respiratory viruses in routine diagnostic respiratory samples. 3. Examine the demographic and clinical characteristics associated with each respiratory viral pathogen. Materials and Methods One hundred and thirty-eight paediatric patients, admitted to Tygerberg Children’s Hospital from May 2010 to August 2010 with a presumptive diagnosis of an acute respiratory tract infection were included in the study. Nasopharyngeal or tracheal aspirates were collected, and all samples were tested by all three diagnostic methods. Clinical, demographic and laboratory data were collected through a systematic review of medical and laboratory records and subsequently anonymised Results Thirty-seven viruses were detected in 36 samples (26.1%) by shell vial culture with immunofluorescent staining; 169 viruses in 102 samples (73.9%) with the Seeplex® RV15 ACE; and 90 viruses in 73 samples (52.9%) with the Resp Multiplex RT-PCR. Shell vial culture had excellent specificity, but low sensitivity for all of the respiratory viruses. Conversely, the Seeplex® RV15 ACE had excellent sensitivity for all viruses, but slightly lower specificity. This was due to the detection of additional viruses, which may have been true positives due to the increased sensitivity of this assay. The Resp Multiplex RTPCR had excellent sensitivity and specificity. At least one respiratory pathogen could be identified in 80% of the patients. At least one virus was detected in 57% of patients, bacterial micro-organisms in 6%, and both viral and bacterial pathogens in 17%. Viral-bacterial co-infections were associated with increased severity compared to other infections, as these children were more likely to receive steroids and a blood transfusion (p = 0.002), and more likely to require mechanical ventilation (p < 0.001) and admission to the intensive care unit (p = 0.04). Conclusions We confirmed that molecular techniques are significantly more sensitive than shell vial culture for the detection of respiratory viruses in children. Due to their highly specific nature and the genetic variability observed in viruses, an excellent, continuous quality control programme is essential to ensure the continued superiority of these assays. Viral-bacterial co-infection is associated with increased severity of LRTIs in children. Further research is needed to elucidate the precise pathogenic and immunologic mechanism of this interaction.
AFRIKAANSE OPSOMMING: Inleiding Akute lugweg infeksies is verantwoordelik vir beduidende morbiditeit en mortaliteit wêreldwyd en is die hoofrede vir die benutting van gesondheidsdienste. Identifisering van die oorsaak van laer lugweg infeksies is baie moeilik en meer as 20 virusse en bakterieë word hiermee geassosieer. Ongelukkig kan kliniese ondersoek alleen nie onderskei tussen die verskillende organismes nie. Respiratoriese virusse kan deur ‘n wye verskeidenheid van toets metodes aangetoon word. Molekulêre metodes is sonder uitsondering meer sensitief as nie-molekulêre metodes. Hul verhoogde sensitiwiteit mag help om ons kennis oor die patogenese van erge lugweg infeksies te verbreed en kan ’n positiewe invloed op pasiëntbehandeling, infeksiebeheer, immunisasie strategieë en publieke gesondheidsorg hê. Doel van die Ondersoek 1. Bevestig die virale oorsake van laer lugweg infeksies deur gebruik te maak van “shell vial” kultuur met immunofluoressensie en twee veelvoudige molekulêre toetse, die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR. 2. Vergelyk die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR met “shell vial” kultuur vir die aantoning van respiratoriese virusse in roetine diagnostiese monsters. 3. Ondersoek die demografiese en kliniese eienskappe wat met elke respiratoriese patogeen geassosieer word. Metodiek en Materiaal Een honderd agt-en-dertig kinders wat toegelaat is tot Tygerberg Kinderhopitaal vanaf Mei 2010 tot Augustus 2010 met ’n voorlopige diagnose van ’n akute lugweg infeksie is in die studie ingesluit. Nasofaringeale of trageale aspirate is van elke pasiënt gekollekteer en met al drie diagnostiese metodes ondersoek. Kliniese, demografiese en laboratorium data is gekollekteer deur ’n sistematiese ondersoek van mediese en laboratorium rekords en daarna anoniem gemaak. Resultate Sewe-en-dertig virusse is in 36 monsters (26.1%) aangetoon deur “shell vial” kultuur met immunofluoressensie; 169 virusse in 102 monsters (73.9%) deur die Seeplex® RV15 ACE; en 90 virusse in 73 monsters (52.9%) deur die Resp Multiplex RT-PCR. “Shell vial” kultuur het uitstekende spesifisiteit gehad, maar sensitiwiteit was laag vir al die virusse. Teenoorgesteld hiermee het die Seeplex® RV15 ACE hoë sensitiwiteit vir al die viruses gehad, maar effe laer spesifisiteit. Dit was as gevolg van die aantoning van addisionele virusse, wat moontlik ware positiewe resultate kon wees as gevolg van die verhoogde sensitiwiteit van hierdie toets metode. Die Resp Multiplex RT-PCR het uitstekende sensitiwiteit en spesifisiteit gehad. Ten minste een respiratoriese patogeen is in 80% van die pasiënte geidentifiseer. Een of meer virusse was in 57% van die pasiënte aangetoon, bakterieë in 6% en beide virale en bateriële patogene in 17%. Virale-bakteriële ko-infeksies, in vergelyking met ander infeksies, was geassosieer met meer ernstige lugweg infeksies aangesien hierdie kinders meer geneig was om steroïede en ’n bloedtransfusie te ontvang (p = 0.002). Hulle het ook meer waarskynlik meganiese ventilasie (p < 0.001) en toegang tot die intensiewe sorg eenheid benodig (p = 0.04). Gevolgtrekkings Ons het bevesitg dat molekulêre tegnieke aansienlik meer sensitief is as “shell vial” kultuur vir die aantoning van respiratoriese virusse in kinders. As gevolg van hul hoogs spesifieke aard en die genetiese variasie waargeneem in virusse, is ’n uitstekende deurlopende kwaliteitsbeheer program noodsaaklik vir die voortgesette uitneemendheid van hierdie metodes. Virale-bakteriële ko-infeksies word geassosieer met meer ernstige laer lugweg infeksies in kinders. Verdere navorsing is nodig om die presiese patogenetiese en immunologiese meganisme van hierdie interaksie toe te lig.

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Reynolds-Wilcox, Wendy Lee. "The impact of child life non-pharmacologic pain interventions on pediatric patient's pain perception in the emergency department." CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2645.

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The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.

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Asvat, Hasina. "Adherence to attending appointments at Chris Hani Baragwanath Hospital outpatient physiotherapy department." Thesis, 2011. http://hdl.handle.net/10539/10563.

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MSc,Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2011
Eighty percent of South Africa‘s population utilizes public health care facilities. Chris Hani Baragwanath Hospital is such a facility and provides outpatient services to a population of approximately 3.5 million people with approximately 500 000 outpatients seen in the hospital annually. An audit conducted over a two month period (June 2009 and July 2009) in the general orthopaedic outpatient physiotherapy department brought to light that 38% of new patients that had appointments scheduled failed to arrive for their appointment. Non-attendance for an outpatient appointment results in a waste of resources, inefficiency, underutilization of facilities, potentially long waiting lists and potential complications for both attendees and non-attendees. Conducting research in the area of compliance to appointments would provide a better understanding of the nature of non-attendance, allow exploration of ways to reduce non-attendance, help to achieve set targets, improve efficiency in the services provided and thereby improve health service delivery. Statistics on non-attendance to initial outpatient physiotherapy appointments in South Africa is not readily available. Although non-attendance rates have been established internationally very little research has been done in developing countries on this area. The aim of this study was to identify the reasons for non-attendance at initial outpatient physiotherapy appointments. A retrospective audit and prospective descriptive series were utilized in the research project with face to face interviews conducted with attendees and telephonic interviews conducted with non-attendees. Questions used in the interview were based on areas that had been investigated previously in other studies and thought to have some impact on attendance as well as open ended question to obtain qualitative data. All data obtained in the interview were recorded on a 5 data collection sheet. Quantitative data was analysed using epi-info version 3.5.1 and qualitative data was analysed by formulating themes. Results revealed a non-attendance rate of 33% for initial scheduled outpatient physiotherapy appointments with the main reasons for non-attendance being transport problems (14%) followed by forgetting about the appointment (13%). Improved signage in the hospital, standardized information leaflets, SMS reminders, adjusting of appointment times, monitoring of waiting lists and disseminating of physiotherapy services into communities are some of the systems that can be put into place in an attempt to reduce the high non-attendance rate and thereby reduce inefficiencies, improve quality of services provided, better utilise human resources and improve productivity.

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Rockson, Esther. "Indications for referrals to Chris Hani Baragwanath academic hospital gynaecological outpatients department." Thesis, 2016. http://hdl.handle.net/10539/21221.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics and Gynaecology Johannesburg, October 2015
Introduction Chis Hani Baragwanath Academic Hospital (CHBAH) is a tertiary (level 3) hospital located in Soweto, Johannesburg. There is no currently no fully functioning district hospital in Soweto. The CHBAH Gynaecological Outpatients Department (GOPD) is burdened by large numbers of patients with a case mix from all levels of care. Objective To describe the clinical characteristics of patients referred to Chris Hani Baragwanath Academic Hospital Gynaecological Outpatients Department and classify them according to levels of care, to assess the lower level case burden carried by the hospital. Methods A prospective cross sectional study was conducted over one week, and 200 participants were selected from the GOPD queue. The researcher interviewed each participant and studied their records to determine their demographic data, reasons for referral and presenting complaints. Upon the participant being seen by the on duty doctor, a provisional diagnosis was made and the appropriate level of care (clinic, level 1 hospital, level 2 hospital, level 3 hospital) was assigned to each based on predetermined classifications of gynaecological conditions into their most suitable levels of care. Results One hundred and ninety three (96.5%) of the participants were referred, and seven (3.5%) were brought by paramedics in ambulances. The most common reason for referral was lower abdominal pain and or vaginal bleeding in pregnancy (n=60; 30%), and the majority of these patients were treated for miscarriages (n=34; 57%). Twenty-four (12%) required admission to hospital. The bulk of patients were classified as level 1 (n=89; 44.5%), with 51 (25.5%) being level 2 and 50 (25%) being level 3 patients. Ten (5.0%) were considered to be primary healthcare (clinic) patients based on their gynaecological conditions. Conclusion The study found that the referral system around Soweto is in place and utilized appropriately and the majority of patients were referred. The study further found that CHBAH serves largely as a district hospital for the surrounding clinics. A fully functioning district hospital would likely relieve CHBAH of much of its burden of patients in the GOPD.
MT2016

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Tenea, Zenaida. "An audit of the referrals to the Chris Hani Baragwanath academic hospital psychiatry outpatients department." Thesis, 2016. http://hdl.handle.net/10539/22374.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2016
Aim The aim of this study was to conduct a clinical audit of all new referrals to the Chris Hani Baragwanath Academic Hospital (CHBAH) Psychiatry Outpatients Department (OPD) over a six month period, in order to assess the appropriateness and the quality of these referrals for the level of care provided. Objectives The study objectives were as follows: to describe, in a group of patients referred to CHBAH Psychiatry OPD, their socio-demographic characteristics, the sources of referral, the reasons for the referral, diagnoses and interventions prior to referral, as well as diagnoses, interventions and final outcomes following an assessment by the CHBAH psychiatry outpatients staff. Based on these an assessment of the appropriateness of referral was made. This was a retrospective record review of all consecutive new outpatients referred to the CHBAH Psychiatry OPD for the period of 1 July 2012 to 31 December 2012. The study was conducted at Chris Hani Baragwanath Academic Hospital, which is a tertiary level hospital whose psychiatric department caters for mental health care users in the Southern Metro District Johannesburg area in the province of Gauteng, South Africa. Results The study found that most patients who were referred were female (68.8%), aged 18-39 years (48.9%), unemployed (70.5%), single (47.2%) and had attained a secondary level of education (57.4%). The largest source of referrals was from other disciplines within CHBAH (32.4%), in particular the department of internal medicine (20.5%). The commonest referral reason, referral diagnosis (29%) and diagnosis made by the CHBAH Psychiatry OPD staff was that of depressive disorders (35.8%, 29% and 31.3% respectively). 74.4% of patients did not have investigations done prior to referral; the commonest intervention at Psychiatry OPD was the initiation of psychotropic medication (56.8%) and the commonest outcome was follow-up at Psychiatry OPD (67.6%). Only 14.8% of new referrals were assessed as being appropriate, as 55.7% of patients did not have a diagnosis on referral, the diagnosis on referral was correct in 34.7% of cases, 39.2% of patients had not been initiated on any treatment prior to referral and the majority of patients did not have investigations performed on them prior to referral. Discussion The study provides further evidence that referral pathways are often bypassed, with many patients requiring simple interventions unable to access these at lower levels of care for a variety of reasons. Thus higher levels of care may become overburdened, further impacting on quality of care. Additional resource constrictions may be incurred, which has a ripple effect across all levels of care, often with far-reaching economic consequences. It is evident that the practical implementation of policies is faced with a number of challenges; these need to be addressed in order for the health care system to appropriately perform its function.
MT2017

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Thomas, Preetha. "Assessment of African patients with fragility fractures in the orthopaedic department at Chris Hani Baragwanath academic hospital." Thesis, 2017. http://hdl.handle.net/10539/23342.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Medicine (MMed). Johannesburg 2017
BACKGROUND: The aim of the study was to assess whether African subjects with fragility fractures were being identified for assessment for osteoporosis on presentation to the orthopaedic department at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto. In addition, the recommendation for secondary prevention of disease for these subjects, was also assessed. METHOD: One hundred African subjects over the age of 50 years with fragility fractures were identified in the orthopaedic wards and clinics at CHBAH. These subjects were interviewed with two separate questionnaires addressing risk factors and education regarding osteoporosis, and whether further management was suggested. The first interview was conducted in June and July 2015. After 18 months, a follow up telephonic interview was conducted, in December 2016, with 37 of the original 100 subjects. RESULTS: Of the 100 subjects evaluated, 89 (89%) were asked at least one screening question. The most frequently asked question about risk factors for osteoporosis in the first interview, was regarding previous fractures and was asked of 61 (61%) of the 100 subjects. A further 37 (37%) of all subjects had been given advice regarding appropriate bone strengthening exercises to prevent osteoporosis. Only five subjects (5%) were asked to return for further assessment. The second interview showed that the most frequently asked question was regarding previous fractures in 24 (64.9%) of the 37 subjects and 18 (48.6%) of the 37 subjects had been advised to do bone strengthening exercises. Only two (5.4%) new subjects could confirm receiving a date to return for assessment. CONCLUSION: In this study, orthopaedic surgeons were proven to be inadequately assessing risk factors for osteoporosis and were infrequently referring patients for therapy. Orthopedic surgeons are often the only practitioners to see patients with fragility fractures and thus they have a crucial role in identifying and appropriately referring these patients for further investigations and medical management for osteoporosis.
MT2017

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Makhambeni, Wilheminah Hendrika. "The underlying causes and management of intracranial subdural empyema in the neurosurgery department, Chris Hani Baragwanath Academic Hospital." Thesis, 2017. https://hdl.handle.net/10539/24903.

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Intracranial subdural empyema (SDE) is a potentially life-threatening condition. A retrospective study of the Chris Hani Baragwanath Academic Hospital’s neurosurgery unit’s SDE patients revealed a mean age of presentation of 15 years and male predominance (70%). In 61.7% SDE was linked with sinusitis and in 83% with immunocompetence. There was a statistically significant correlation between immunocompromise and death (40% mortality rate in the immunocompromised subset). Among the patients’ culture positive specimen, 57.1% yielded a Streptococcus spp., gram negative isolates were found in patients with immunocompromise or previous head trauma/surgery, and 78.6% of the micro-organisms were sensitive to 3rd generation cephalosporins. There was an 86.7% survival rate. A determinant of residual neurological deficit could not be found among the parameters investigated. Keywords: intracranial subdural empyema, complicated sinusitis, burrholes
LG2018

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Walters, I. D. "Geriatric attendance at Outpatients Department Addington Hospital, Durban." Thesis, 1997. http://hdl.handle.net/10413/7935.

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This is a cross section study of the White elderly patients who attended Addington Hospital, Durban, Out-patient Department during a two week period in July 1985. Screening was by means of systematic sampling, a standard questionnaire was administered to 321 of them and their characteristics and needs were identified. In order to determine the attitudes of the medical and nursing staff who work in Addington Out-Patient Department, a further questionnaire was used. It was found that 88,37% of health professionals did not have a particular leaning towards looking after the elderly, but 88% agreed that the needs of the elderly were different in comparison with other age groups. 92,8% considered that geriatrics is a speciality in its own right. Recommendations are made for a 24 hour community geriatric service, the establishment of day centres to serve the needs of the greater Durban area, and for the establishment of a Chair of Geriatrics at the University of Natal.
Thesis (M.Med.)-University of Natal, 1987.

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Tadiri, Sarah. "Analyzing risk factors, resource utilization, and health outcomes of hospital-acquired delirium In elderly emergency department patients." Thesis, 2016. https://hdl.handle.net/2144/17043.

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BACKGROUND: Delirium is a disorder that is characterized by an acute change in cognitive functioning including inattention, and disordered thinking. Delirium disproportionately affects the population over the age of 65, and is associated with increased costs, worse outcomes and longer lengths of stay. Although delirium is estimated to affect approximately 10% of elderly patients in the emergency department (ED) and 42% of elderly inpatients, it often goes unrecognized by the clinical staff. There is evidence that delirium can be prevented through non-pharmacologic prevention strategies, however it is less clear which patients should be targeted for these measures. OBJECTIVES: The objective of this study is to identify risk factors for development of hospital-acquired delirium during the most proximal aspect of a patient’s hospital course, namely the ED. Secondary objectives of this study are to analyze resource utilization and outcomes associated with the development of hospital-acquired delirium. METHODS: This study is a secondary analysis of a prospective observational study conducted over 3 years at a single urban university hospital. Patients over the age of 65, who could complete a structured cognitive assessment interview, were screened for delirium by a trained research assistant. Patients that were judged to be not delirious in the ED, and who were then admitted to an inpatient unit were included in the final cohort. A validated chart review method was used to determine if patients developed delirium during the course of their hospitalization. Potential predictors of hospital-acquired delirium, including demographics, laboratory values, comorbidities and outcomes, were also abstracted from the medical chart. We performed a univariate analysis of these predictors and included those covariates with a p values ≤0.2 in multivariate analysis. We allowed 1 predictor per 10 outcomes in the final model to avoid over-fitting and evaluated the discriminatory ability and calibration of the model using the c-statistic and Hosmer-Lemeshow goodness-of-fit test. RESULTS: Of the 520 patients included in our cohort, 77 developed delirium over the course of their inpatient visit. Multivariate analysis identified 7 risk factors to predict delirium in elderly emergency department patients admitted to the hospital. Patients were more likely to develop delirium during their stay if they were age 80 or older, had a history of dementia, had a history of stroke or transient ischemic attack, were hypoxic or hyponatremic in the ED, or had an ED admitting diagnosis of acute stroke/transient ischemic attack or fall. The model had a c-statistic of 0.73 and a non-significant p-value of 0.7 in the Hosmer-Lemeshow goodness-of-fit test. CONCLUSION: The predictive model that we created may help identify a population to target for delirium prevention strategies in elderly emergency department patients, thereby reducing delirium incidence in hospitalized patients, and the associated morbidity, mortality, and healthcare utilization.

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Chang, Ying-Chun, and 張櫻淳. "A study on the hospital image positioning:outpatient visits in six medical centers' family medicine department." Thesis, 1996. http://ndltd.ncl.edu.tw/handle/65090663323141258426.

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Chen, Wei-Ta, and 陳威達. "Development Strategy for Department of Chinese Medicine of a Regional Hospital in Taiwan -A Case Report." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/11498394104202131898.

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碩士
國立臺灣大學
財務金融組
103
Due to the impact of the National Health Insurance Program and the rapidly changing environment in Taiwan, most of the hospitals were facing great challenges. According to the global budget system of National Health Insurance Administration, almost all medical institutions tried their best to increase their medical service revenue as much as possible to capture the most portion of global budget managed by National Health Insurance Administration. However, the reimbursed floating values appeared to decline gradually. The medical industry has become a highly competitive but extremely low profitable industry. The operating and financial performances of most medical institutions, which include Traditional Chinese Medicine (TCM) industry, have deteriorated dramatically. Thus, it is urgent for the medical community to find a way out of the crisis. Based on the characteristics of TCM industry, corporate environmental analysis, Porter’s five forces model, and Strengths, Weaknesses, Opportunities and Treats (SWOT) analysis, this study focuses on developing a successful operation strategy for a department of Chinese Medicine in a regional hospital. We found that this TCM case fully leveraged the advantages, resources, and inter-department collaboration of a Health Care Group to create differential services compared to other TCM institutions. Basic concepts of organizational change and a framework for strategic alliance for management team of other TCM institutions and researchers were also provided in the TCM field.

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Tu, Chih-Tsung, and 涂志聰. "The research of testing process improvement of clinical biochemistry, department of laboratory medicine, National Taiwan university Hospital." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/16651831199624058837.

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碩士
國立臺灣大學
商學研究所
90
Abstract This thesis is the application of computer simulation to the testing process improvement of clinical biochemistry, department of laboratory medicine, National Taiwan University Hospital and the analysis of different improving scenarios. The objective is to decrease the waiting time for the testing report, to increase the service rate and efficiency of clinical biochemistry. Results can be obtained as follows: 1. Scenario 1 (remove the Receive part), 2 (change the transportation time) and 3 (change the Machine 7450) could decrease the average total testing time of basic model by 13.99%、18.2% and 43.9%. 2. Scenario 4 (change the three factors) could decrease the average total testing time of basic model by 44.93% and the waiting time of bottleneck is 34.602 minutes, 76.05% decreased. The average waiting time of Machine 7450 is 22.71% of the total testing time. 3. If the ‘Service Rate’ is set to be ‘the completion of 90 percent test tubes’, Scenario 3 will have the best improvement. That is because the improvement of bottleneck in the process. The results of different scenarios could be obtained quickly by computer simulation and indicate the bottleneck of whole process. By improving the bottleneck, the total testing time could be decreased and the service quality would be increased.

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Ogungbire, John Ayodeji Abiola. "Analysis of patients presenting to the emergency department at Ceza Hospital for period of 1 year (1st January to 31st December 2010)." Thesis, 2013. http://hdl.handle.net/10539/12563.

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Patients present daily to the emergency department of Ceza hospital, Kwazulu Natal for medical treatment. Some of these patients are self-referral or referred by other health care workers. Analysis of demography of patients presenting to the emergency department from 1st January to 31st December 2010 was conducted to provide a general overview and characteristics of the studied population. It was a retrospective, transverse and descriptive study that involved patients’ records reviewed from a hospital register. The results showed that the commonest primary diagnosis was assault with a patient population of 81 (16.9%) followed by gastroenteritis (12.3%) and soft tissue injuries (8.5%) respectively. Most patients were single (94.6%), black (100%) and mostly males (57.7%). The highest number of the patient population seen at the emergency department was in February (14.8%) and the patients seen were mostly in the age range of 21 to 30 years. Most cases that presented to the emergency department were non-emergencies that constituted 67.2% of the cases seen and the emergency cases were only 32.8%. The highest patient population at the emergency department of Ceza hospital was 34.83% in summer with presentation peaking from 8.00 am until 11.59 am. The highest proportion of patients’ presentation was found to be during the weekends.

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Popovici, Ilinca. "Patient-centered Perspectives of Communication and Handover between the Emergency Department and General Internal Medicine." Thesis, 2011. http://hdl.handle.net/1807/31390.

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Effective communication among clinicians is critical for patient safety. This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Department to General Internal Medicine. The study provides insight into clinician workflow, evaluates current hospital communication systems, and identifies key issues affecting communication. It suggests opportunities for improvement: • extending the role of the electronic patient record, • rendering it available on a mobile platform, • developing an improved paging system. It also identifies design trade-offs to be negotiated: • synchronous communication vs. reducing interruptions, • notification of patient status vs. reducing interruptions, • portability vs. screen size of mobile devices, • speed vs. quality of handovers, • information privacy vs. accessibility. The results inform the potential development of an intervention meeting seven principles: interconnectivity, context awareness, accessibility, redundancy, user customization, security, and intuitive user interfaces.

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TSAI, MING-CHANG, and 蔡明璋. "Parents’ and Service Providers’ Perceptions of Hospital-Based, Family-Centered Services:Implementation in the Department of Pediatric Rehabilitation Medicine." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/62qske.

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碩士
國立屏東大學
特殊教育學系碩士班
106
The National Health Insurance Administration of the Ministry of Health and Welfare introduced the"Pay-for-performance Program for Early intervention Outpatient under National Health Insurance". Itwas the first time that the healthcare system provides a family-centered services to improve the quality of medical services. The aim of this study is to investigateparents’ and service providers’ perceptions of Family-Centered Servicesimplemented in a Hospital-Based Pediatric Rehabilitation in Pingtung city, as well as its related factors. 　　The Measure of Processes of Care (MPOC-20)for parents/caregivers and Measure of Processes of Care for Service Providers (MPOC-SP) for service providers were utilized. A total of 42 families completed the MPOC questionnaire. A total of 19 staffs, allied physiatrists physical therapies, occupational therapies, speech therapies and other staff who have direct contact with clients and their families. The results showed that women were more likely to be the primary caregivers in a family, and they usually canactively involve in the treatment.The average monthly income of the familieswas between 30,000 and 60,000, and most were single-income families.There were far more female than male professionals in the field of physical medicine and rehabilitation.Aggregated mean ratingsof MPOC-20varied from 4.5 to 6.0 for all five scales of the MPOC-20 indicating that, on average, parents rated Family-Centered Services as "agreat extent".Coordinated and comprehensive care for child and family received the highest rating, while providing specific information about the child the lowest.Aggregated mean ratingsof MPOC-SP varied from 4.5 to 6.0 for all four scalesof the MPOC-SP, which indicating that service providers rated Family-Centered Services as "agreat extent".Communicating specific information about the child and family received the highest rating, while providing general information about the child the lowest. No child or parents’ effects were revealed on the parents’ perceptions of Family-Centered Services. There were significant effects of professional category and program year on service providers’ perceptions of Family-Centered Services. Service providers are encouraged to focus on child and family needs for general information. Research is needed to better understand parent perspectives which are important for engaging families in intervention processes.

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Wang, Chien-Hao, and 王健豪. "Discussion on the use of local herbs by patients of Chinese Medicine Department in Hualien Tzu Chi Hospital." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/j54ptn.

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碩士
慈濟大學
生命科學系碩士班
107
People in Taiwan have multiple healthcare choices. Besides modern therapies and traditional Chinese medicine (TCM) which are covered by National Health Insurance (NIH), various folk treatments are also widely- used. Common folk treatments in Taiwan includes local herbal medicine, chiropractic, Yoga, meditation and prayer. Although clinicians can access patients’ modern and TCM medication records through the NIH database (NIH Pharma Cloud), they are not able to know whether their patients uses local herbal medicine without the patients’ informing. This study surveyed the using of local herbal medicine of patients visiting TCM outpatient clinics in Hualien TzuChi hospital, interviewed patients planting or using local herbal medicine, investigated local markets, and visited people collecting and selling local herbal medicine. Moreover, the author integrated the result and crosschecked different references, consequently screened out toxic medicinal plants. The using of local herbal medicine involves present medical environment and people’s concepts spreading. The field developed when experience was acquired by users, spread over among different patients. Thus, impressions of users contributed into and a lot of homonyms or synonyms produced. The variance of terms not only increased difficulty of doing relative research, but also caused potential risk to user. The author categorized local herbal medicine used by patients visiting TCM outpatient clinics in Hualien TzuChi hospital into several groups by the effects, reducing heat and decreasing toxin, improving digestive function, nourishing kidney and musculoskeletal system, and anti-cancer herbs. Among all common-used local herbs, Androkgraphis paniculata, Erycibe henryi Prain, Cycas taitungensis, Polygonum cuspidatum, Morinda citrifolia, Euphorbia neriifolia, Coleus amboinicus, Wikstroemia indica, and Plumbago zeylanica induce toxic effects easily.

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Tseng, Yi-Hsuan, and 曾嬑嫙. "The Application of TRM in the Laboratory Medicine Department-A Case Study of a Teaching Hospital in Southern Taiwan." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/y69466.

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碩士
義守大學
醫務管理學系
102
Background: In Taiwan, medical safety issues have been highlighted, since several medical adverse events occurred in the hospitals in 2002. Based on the patient safety, team resource management (TRM) is widely applied in the hospital to practice the medical teamwork conception. Method: The study subjects were medical technologists who work in southern Taiwan hospital. In order to investigate the teamwork conception and team satisfaction, the questionnaire survey was used. The questionnaire content dimensions include TRM cognitive, TRM practice(leadership, communication, situation monitor, mutual support) and team satisfaction. Result: Overall response rate accounted for 90.6% of the 58 questionnaires. The effective sample was 100% after rechecking the questionnaires individually. SPSS was analyzed in the study, the result were (1) TRM cognitive has significant effect to underwent TRM training course; (2) TRM practice has significant effect to age, position and seniority; (3) team satisfaction has no significant difference to demographic; (4) TRM cognitive has positive correlation to communication, situation monitor and mutual support; (5) team satisfaction has positive correlation to TRM practice; the more TRM implement, the more harmony among the team members. Conclusion: The laboratory manager should promote TRM conception and TRM practice. For team satisfaction raised and turnover rate reduced, team member need to be comforted and cohered. The conclusions can provide the medical laboratory manager and future researchers, which is as a reference for the further practice and research.

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Tseng, Pei-ching, and 曾佩菁. "Implementation of the Activity-Based Costing System－A Case Study of the Laboratory Medicine Department of Regional Teaching Hospital." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/52520749891908973305.

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碩士
國立雲林科技大學
全球運籌管理研究所碩士班
99
Bureau of National Health Insurance limits the growth of the medical costs growth by means of the operation of piece rate, globe budget, case Payment and diagnosis related groups (DRGs) payment system. It will have a significant hospital impact on survival and profits so that the hospital has been increasing emphasis on cost analysis and control. Basis of apportionment of the traditional cost system does not reflect the actual cost of inspection services, with the help of its limited effectiveness of sector management, to be built for the department''s cost management system. Therefore, the laboratory medicine department should provide the correct, quick and effective test results and data, as a physician to determine the exact disease to patient important reference in order to enhance the operational efficiency of laboratory medicine department. To better understand the case of laboratory medicine department cost allocation methods currently used, and the implementation of ABC''s exclusion of this study to test the medical sector, for example, adopted "case study method" to study the application of activity based cost system architecture for the department features, build laboratory medicine department operations and product analysis mode. The results show that the current cost system, the biochemical test time test time operations center and emergency operations center costs are overestimated; In addition, ninety-nine in December to test the actual number of break-even point and required pieces number comparison, osmotic pressure test, urine routine examination, stool routine examination, pregnancy tests and body fluid analysis, five actual number of tests below the break-even point are the number, making the month showed a loss. After the final test operations process analysis and time consuming analysis of the results, some test items centrifugation time, the second operations center in order to improve the overall test time. ABC''s cost-sharing by way of step by step analysis of resource driver and activity driver, rationalize the cost of ownership of resources in the test operation, may assist the department to obtain more accurate cost information can also be a clear understanding of the human resources units, equipment and reagent supplies management situation, to assist the unit in charge of cost control, to improve the examination quality. Future development of new test project, ABC''s cost-sharing formula can also be purchased as a reference instrument and a basis for pricing decisions. ABC''s combination of cost-sharing approach if further performance management, financial indicators and use them effect, can really enhance the management efficiency.

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Chuang, Mei–Ying, and 莊梅櫻. "An CNS17799-Based Information Security Management System Self-Evaluating Model－ Taking a Local Hospital Medicine Record Department as an Example." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/91816686585749895714.

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碩士
中國文化大學
資訊管理研究所碩士在職專班
95
National Information Security Management Standard, CNS 17799, were be used in this study to establish an Information Security Management system self- evaluating Model. This stud took a Record deportment in a hospital as a case to verify this model. Through analyzing the results, we found the security situations and deficiencies. There are eleven security categories in the self- estimate model. We first tabulated a grading form for all controls. Then, We gave a form to every persons in the organization assessed. to fill according to the reality of her work After that, we used the “arithmetic mean” to calculate the total grades and draw the kavit graphs for all categories. The graphs showed the overall situation of the Information Security in the organization visually. The case we picked belonged to a special sector which needed to conform regulations of the Bureau of National Health Insurance Based on this reason, we found that most of their security categoried are compliant. “Business Continuity Management” and “Information Security Incident Management” are their strongest categories. “Asset Management”, “Security Policy” and “Organizing Information Security” are the three they have to reinforce.

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Duguay, Darren Caine. "Integration of recognition, diagnostic, and treatment strategies between prehospital emergency medical services and hospital emergency departments in the management of patients with acute sepsis and septic shock." Thesis, 2019. https://hdl.handle.net/2144/36352.

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Sepsis and its manifestation as a shock state in “septic shock” have long caused medical issues and death worldwide. The disease requires quick identification, diagnosis, and intervention with very high mortality rates prevalent otherwise. Historically this has been due to limited awareness of the disease and misclassification of its prevalence, severity, and incidence. Luckily in the past decade there has been increased interest and therefore resources devoted towards improving care and further understanding a disease that is one of the leading causes of mortality in hospitals worldwide. Over the past handful of years novel interventions and diagnostic techniques have become available. Unfortunately, in many cases these new discoveries have not yet trickled down to many of the providers on the frontline and a large amount of variation in care exists across the country. Because of the time sensitivity of sepsis, it is imperative that individuals working in the areas of healthcare who first come in contact with these patients have a clear understanding of the newest advances and resources available. In this thesis the goal is to first analyze the current protocols and standards of care for sepsis and then secondly consider new developments available both in the hospital and in prehospital emergency medical services (EMS). From the current information, strategies and protocols based on improvement of patient outcomes, can be streamlined and optimized moving forward. As predicted, there is currently an incredibly large amount of variation and knowledge on the subject with some areas implementing very progressive protocols while others still lack a sepsis protocol all together. In general, the current consensus in the field is that rapid identification and initiation of treatment is the most important component to long term survival. Improvement of outcomes therefore relies on standardization of protocols with incorporation of education components for healthcare providers. This aims to raise awareness and encourage utilization of the newest information and suggestions available. Increased interdisciplinary cooperation between prehospital providers in EMS and care providers in the hospital can also lead to improvement of recognition and treatment times for these patients. Future considerations were also examined that may potentially be applicable moving forward to improve these standards even further. There is a much opportunity available in each of these areas currently and progress is key to improving outcomes.

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Tseng, Pi-yun, and 曾碧雲. "The study of intra-hospital service and marketing management: Modeling base on the experince of a nuclear medicine department in a southern Taiwan medical center." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/79282326612007809918.

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碩士
國立中山大學
醫務管理研究所
95
Along with the enormous impacts resulted from the change of National health insurance policy, there has been a great influence on health-care seeking behaviors of people, thus leading to a extensively vigorous competition and challenge for management spreading among health-care industries. Therefore updated management concept, assuring health-care quality, rising standard of health-care and realization of ideals of perpetual service-providing are desperately required for all hospitals. Also for hospital marketing, to ascertain the customers need, to establish relationships with customers, to set an effective marketing-strategy to satisfy customers need and to match the assessment of customers response with improvements are necessary. Marketing is not only for external customers but also for internal ones (intra-hospital customers). In this study we aim to promote nuclear medicine through understanding colleagues need, providing decent service and to lead intra-department health-care marketing activities to hospital-wide ones by way of education and elevating service quality. Conclusively, despite an insignificant achievement quantitatively, the qualitative analysis reveals we could facilitate our colleagues understanding nuclear medicine practice by utilization of E-trsnsmission, detailed flowchart, and mobile educational service.

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HUNAG, I. PIAO, and 黃儀標. "A Clinical Appraisal of the High-Quality-Chinese-Medical Outpatient Care Project for Children with Cerebral Palsy: A Case of Hospital Chinese Medicine Outpatient Department." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/46081349537973514395.

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碩士
長庚大學
醫務管理學研究所
96
The purpose of the study is to explore the effects of the high-quality Chinese medical outpatient care for cerebral palsy. The treatment effect of children, the promotion in quality of life, and the assessment of the psychological and physiological conditions of the children-caretaker were concerned. 13 children with cerebral palsy and their primary caretakers were recruited by the purposive sampling method in this study. Physical condition of these children and quality of life of their primary caretakers would be tracked in the Chinese-medicine department of a municipal hospital. Structured questionnaires were used to collect the data of these children and their primary caretakers every 3 months from May of 2006 to December of 2007. Data was analyzed by descriptive and non-parametric method. The Chinese Child Development Inventory (CCDI) and Gross Motor Function Measure (GMFM) were used to measure the physical condition of children with cerebral palsy and the quality-of-living inventory SF-36 was used to measure the status of quality of life of primary caretakers in the study. It was found that some measures of children with in CCDI and GMFM demonstrated remedial change after 3 months and 6 months of therapy respectively. The measures of children’s primary caretakers with SF-36 showed that the “Status of physiological functions” of children’s primary caretaker indicated significantly impovred, whereas “Status of liveliness”, “Status of physical pain”and “Status of general self-conscious health” of children’s primary caretaker indicated significantly declined. Cerebral palsy is a chronic disease accompanied by physical impairment. Children with cerebral palsy will be dependent on their family in daily living and need long-termed medical care. We suggested that the sessions of weekly therapy available from high-quality Chinese medical outpatient care should be increased, the span of high-quality Chinese medical outpatient care should be extended, and the social workers should be recruited to assist primary caretakers of the children in facing the psychological difficulty and stress. So that, much more medical care of Chinese medicine will be provided for children with cerebral palsy and thus will benefit these children and their primary caretakers.

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40

陳貽善. "A Comparative Study Of Physicians Productivity, Income & Deartmental Performance Before And After The Implementation Of RB-RVS In The Department Of Nuclear Medicine, Chang Gung Memorial Hospital." Thesis, 1994. http://ndltd.ncl.edu.tw/handle/60801439833417848651.

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Wu, Kuan-Ta, and 吳冠達. "The prevalence of nonalcoholic fatty liver disease and the incidence of hypertension and diabetes study: Cross-sectional and cohort studies of health check-up database in fifteen years of Department of Preventive Medicine of Kaohsiung Medical University Chung-Ho Memorial Hospital." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/pz4z8g.

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碩士
高雄醫學大學
臨床醫學研究所
103
Background and aim: The relationship between nonalcoholic fatty liver disease (NAFLD) severity and total cholesterol-to-high-density lipoprotein cholesterol (TC/HDL-C) and triglyceride-to-high-density lipoprotein cholesterol (TG/HD-C) ratios were not clear. People also cannot well identify the order of newly onset hypertension and diabetes in their lifetime. Material and method: Adult with comprehensive health check-up in 1999-2013. In cross-sectional study, the 39846 subjects were divided by the lipid ratios into four subgroups and were analyzed with the severity of NAFLD. In cohort study, the 34865 subjects without hypertension or diabetes were analyzed with the risk factor of incident hypertension and diabetes. Lifetime cumulative incidence were also illustrated by the survival curve. Result: The prevalence rate of NAFLD in our study population was 53.87%. In cross-sectional study, the both higher ratios of TC/HDL-C and TG/HDL-C were strong associated with the high grade fatty liver. In cohort study, male gender, smoke, prehypertension, NAFLD, and higher BMI were independent risk factor for both newly onset hypertension and diabetes. In addition, impaired fasting glucose, hypertriglyceridemia, and incident hypertension were also the independent risk factor for newly onset diabetes. Conclusion: In cross-sectional study, those with higher lipid ratios were easily to get hypertension, diabetes and NAFLD. Abdominal ultrasounds is a popular and easily to get examination tool in Taiwan, not worldwide. Adult people should go for health check-up their blood pressure, fasting glucose and lipid profile especially in their middle age. NAFLD was one of the independent risk factors for newly onset hypertension and diabetes. Younger and higher incidence of hypertension and diabetes were found in those with NAFLD. NAFLD is an important issue for health promotion.

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Junge, Marina. "Prozess- und Diagnosequalität in Präklinik und Notaufnahme des Universitätsklinikums Göttingen." Doctoral thesis, 2010. http://hdl.handle.net/11858/00-1735-0000-0006-AFB1-1.

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Dissertations / Theses on the topic 'Baragwanath Hospital. Department of Medicine'

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