Transmissions of hepatitis C virus during the ancillary procedures for assisted conception.
Since mother to child transmissions of hepatitis C virus (HCV) have been reported to be low, teams involved in assisted reproductive technologies have accepted HCV positive patients into their programmes. We report in the present paper two cases of undoubted patient to patient HCV transmission while patients were attending for assisted conception. In both cases, HCV genotyping and sequencing of the first hypervariable region of the HCV genome provided molecular evidence for nosocomial transmission. Investigations made to elucidate the route of contamination have shown that the most likely route of contamination is through healthcare workers. Such nosocomial HCV infection has been reported in other healthcare situations, mainly in dialysis units, and physical proximity was also suspected to be at the origin of the infection. We conclude that assisted reproduction teams must be very prudent when including such patients in their programmes. (+info)
Accidents with potentially hazardous biological material among workers in hospital supporting services.
Descriptive study was carried out to characterize the occupational accidents involving potentially contaminated material among workers of hospital supporting services. The study reviewed records of workers involved in these accidents and attended at a specialized outpatient clinic of a large tertiary care hospital between January 1997 and October 2001. A total of 2814 workers from different professional categories were attended during this period. Of these, 147 (5.2%) belonged to the hospital supporting services and were the victims of 156 accidents, auxiliary cleaning personnel (80.2%), and over a third of the workers had not received any dose of hepatitis B vaccine (35.4%). Most accidents were due to sharp injuries (96.8%) caused by inadequately discarded hollow needles. Chemoprophylaxis for HIV was not indicated in only 23.1% of cases. We conclude that these workers are also exposed to the possibility of acquiring blood-borne pathogens and that periodical education programs are needed. (+info)
Factors for satisfaction among providers of ancillary health services in a community-based cancer prevention program: a pilot study in Nevada.
Providers of ancillary health services are essential members of any health care delivery system. They supply laboratory, radiology, and other diagnostic modalities necessary for quality medical care. Assessment of the providers' factors for satisfaction in participating in cancer prevention programs can contribute to better services and can serve as a model for other community-based health programs. We conducted a pilot survey of providers of ancillary services in the Nevada Women's Health Connection, a community breast and cervical cancer prevention program. Of the 93 participating providers, a total of 44 providers completed the survey. We subjected the survey data to factor analysis using iterative principal axis factoring with Varimax rotation. Three components of satisfaction were identified, comprising satisfaction with the (1) reimbursement process, (2) positive perception of the program, and (3) familiarity with program's requirements. All three components accounted for 72.08% of the total variance before the rotation. Amount of financial gain was not a significant factor for satisfaction among participating providers. Providers of ancillary health services were satisfied in their participation in this community-based cancer prevention program. There were three components of satisfaction identified. Further attention should be given on these issues as they have implications for quality improvement in health services for community-based programs dealing with low income and uninsured patients. (+info)
The impact of different rehabilitation strategies after major events in the elderly: the case of stroke and hip fracture in the Tuscany region.
BACKGROUND: On a regional level, our aims were to describe rehabilitation patterns for elderly patients with stroke and hip fracture and to investigate mortality risk during the 6-month post acute period. METHODS: Data sources included administrative data relative to patients aged 65+ resident in Tuscany admitted in hospital for stroke or hip fracture between 2001 and 2003, traced up to 3 years before and 6 months following index admission. The study design involves computerized linkage of administrative data, and an exploratory analysis of the association between rehabilitation patterns and 6-month mortality, adjusting for clinical, demographic, and acute-related care characteristics using multivariate Cox regression. RESULTS: Rehabilitation patterns vary greatly across Tuscany with considerable cost implications. Six month mortality risk for stroke patients is significantly lower among residents of Local Health Authorities where patients are more frequently rehabilitated, specifically in extra-hospital settings. CONCLUSION: Our study, targeting two crucial conditions for elderly patients, found a high variability of rehabilitation patterns across a region, albeit coherent between the two pathologies, associated with remarkable differences in average expenditure. Differences in hazard rates for 6-month mortality after stroke at population level were also found. These results need to be confirmed and further investigated through a more robust information framework. (+info)
Per-click, under arrangement, mark-up, and other dirty words.
So, the winners under these CMS proposals are OBs in rural areas and people who make minor mistakes when trying to meet a Stark exception. The losers are diagnostic test purchasers, per-click lease participants (at least when the lessor is a physician), and hospitals and physicians who are involved in UA arrangements. Those left in limbo (since they were not addressed) are block lease participants as well as per-click lease parties where the physician is both the lessee and the source of patients. Of course, this is not the last word. CMS will take public comments on the proposals until August 31, 2007. We will then have to wait in suspense for the final rule, which could take years (although it is possible that at least some of the current proposals could be finalized soon since they are currently part of the 2008 Physician Fee Schedule proposal.) This suspense is only heightened by the impending Stark II Phase III rules. For the full text of the CMS proposals, go to www.cms.hhs.gov/physicianfeesched/downloads/CMS-1385-P.pdf?agree=yes&next= Accept. (+info)
The impact of an enhanced interpreter service intervention on hospital costs and patient satisfaction.
BACKGROUND: Many health care providers do not provide adequate language access services for their patients who are limited English-speaking because they view the costs of these services as prohibitive. However, little is known about the costs they might bear because of unaddressed language barriers or the costs of providing language access services. OBJECTIVE: To investigate how language barriers and the provision of enhanced interpreter services impact the costs of a hospital stay. DESIGN: Prospective intervention study. SETTING: Public hospital inpatient medicine service. PARTICIPANTS: Three hundred twenty-three adult inpatients: 124 Spanish-speakers whose physicians had access to the enhanced interpreter intervention, 99 Spanish-speakers whose physicians only had access to usual interpreter services, and 100 English-speakers matched to Spanish-speaking participants on age, gender, and admission firm. MEASUREMENTS: Patient satisfaction, hospital length of stay, number of inpatient consultations and radiology tests conducted in the hospital, adherence with follow-up appointments, use of emergency department (ED) services and hospitalizations in the 3 months after discharge, and the costs associated with provision of the intervention and any resulting change in health care utilization. RESULTS: The enhanced interpreter service intervention did not significantly impact any of the measured outcomes or their associated costs. The cost of the enhanced interpreter service was $234 per Spanish-speaking intervention patient and represented 1.5% of the average hospital cost. Having a Spanish-speaking attending physician significantly increased Spanish-speaking patient satisfaction with physician, overall hospital experience, and reduced ED visits, thereby reducing costs by $92 per Spanish-speaking patient over the study period. CONCLUSION: The enhanced interpreter service intervention did not significantly increase or decrease hospital costs. Physician-patient language concordance reduced return ED visit and costs. Health care providers need to examine all the cost implications of different language access services before they deem them too costly. (+info)
Building rehabilitation capacity in rural in New South Wales.
INTRODUCTION: The aim of this article is to report on a study of the expansion of specialist rehabilitation services in central New South Wales, Australia, through the introduction of rehabilitation as a new service type at 2 small rural multi-casemix hospitals, within an integrated area-wide model of rehabilitation service delivery. METHODS: Mixed methods were used. Information about bed occupancy and patient participation in rehabilitative activities were collected from hospital data bases and patient observation by staff over a 10 month period, and analysed quantitatively using descriptive statistics. During the same time period 10 staff from each hospital participated in a series of 3 audio-taped interviews each. These semi-structured interviews were conversational in nature and asked about the staff member's experiences and perceptions of the introduction of rehabilitation. Inductive qualitative analysis of the interview transcripts captured the enablers and threats to rehabilitation at each site. RESULTS: The introduction of rehabilitation as a new service type at 2 small rural hospitals was facilitated by an integrated area-wide model of rehabilitation service delivery, and the support of a regional specialty rehabilitation service provider. The formal introduction of rehabilitation at the 2 small hospitals was delayed while processes to ensure that patients were transferred to the appropriate hospital were developed, equipment purchased and building modifications undertaken. Despite this, staff came to appreciate the benefits of rehabilitation for their patients and to see rehabilitation potential in their usual patient population. Some staff took longer than others to embrace the changes; however, staff generally appreciated that the introduction of rehabilitation was not hurried. CONCLUSIONS: When linked to a specialty rehabilitation provider, small multi-casemix rural hospitals appear to have the potential to support the rehabilitation of patients in their local communities whose rehabilitation needs are uncomplicated. To fully realise the potential of small rural hospitals, and because these hospitals are primarily staffed by nurses, nursing staff working in these facilities need to be supported to develop their rehabilitative potential. This support should come from the collective wisdom of specialist rehabilitation nurses, medical rehabilitation specialists and allied health staff, and must be provided at the broader structural level. Through cross-disciplinary sharing of knowledge and skills, residents of rural communities could spend less time hospitalised at long distances from their homes. (+info)
Routine use of ancillary investigations in staging diffuse large B-cell lymphoma improves the International Prognostic Index (IPI).