Improving compliance with requirements on junior doctors' hours.
(65/831)
PROBLEM: Compliance with UK regulations on junior doctors' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed. DESIGN: Audit of change. SETTING: Paediatric night rota in large children's hospital. KEY MEASURES FOR IMPROVEMENT: Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through critical incident reports. STRATEGIES FOR CHANGE: Development of new staff roles, followed by change from a partial shift rota comprising 11 doctors and one senior nurse, to a full shift night team comprising three middle grade doctors and two senior nurses. EFFECTS OF CHANGE: Compliance with regulations on working hours increased from 33% to 77%. Workload changed little and was well within the capacity of the new night team. The effect on patient care and on medical staff requires further evaluation. LESSONS LEARNT: Reduction of junior doctors' working hours requires changes to roles, processes, and practices throughout the organisation. (+info)
Do parents understand emergency department discharge instructions? A survey analysis.
(66/831)
BACKGROUND: Understanding discharge instructions is crucial to optimal healing but may be compromised in the hectic environment of the emergency department. OBJECTIVES: To determine parents' understanding of ED discharge instructions and factors that may affect it. METHODS: A convenience sample of parents of children discharged home from the ED of an urban tertiary care pediatric facility (n = 287) and a suburban level II general hospital (n = 195) completed a 13 item questionnaire covering demographics, level of anxiety, and quality of physician's explanation. Parents also described their child's diagnosis and treatment instructions and indicated preferred auxiliary methods of delivery of information. Data were analyzed using the BMPD statistical package. RESULTS: Full understanding was found in 72% and 78% of the parents at the respective centers for the diagnosis, and in 82% and 87% for the treatment instructions (P = NS between centers). There was no statistical correlation between level of understanding and parental age, gender, education, level of anxiety before or after the ED visit, or time of day. The most contributory factor to lack of understanding was staff use of medical terminology. Parents suggested further explanations by a special discharge nurse and written information as auxiliary methods. CONCLUSIONS: Overall, parental understanding of ED discharge instructions is good. However, there remains a considerable number (about 20%) who fail to fully comprehend the diagnosis or treatment directives. This subset might benefit from the use of lay terminology by the staff, institution of a special discharge nurse, or use of diagnosis-specific information sheets. (+info)
Kawasaki syndrome hospitalizations and associated costs in the United States.
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OBJECTIVES: To describe the epidemiologic characteristics of patients hospitalized with Kawasaki syndrome (KS) and estimate associated costs in the United States, using a large national hospital discharge dataset. METHODS: Hospitalization discharge records with KS for 1997 through 1999 for U.S. residents <18 years of age were selected from Solucient's hospital discharge records. These records are collected from most of the self-governing children's hospitals and approximately one-third of short-term, non-federal general hospitals in the United States. RESULTS: A total of 7,431 hospital discharges with a KS diagnosis were identified; 2,270 of the discharges were in 1997, 2,700 in 1998, and 2,461 in 1999. Boys comprised 60.0% of the discharges, and 76.4% of discharges were among children ages <5 years. For the 44 states and the District of Columbia with at least one hospital reporting KS, the average annual KS hospitalization rate was 10.2 per 100,000 children ages <5 years. The KS hospitalization rate for boys (12.0 per 100,000) was higher than that for girls (8.3 per 100,000) (risk ratio 1.45; 95% confidence interval 1.37, 1.52). Extrapolation to the U.S. population showed an estimated average annual KS hospitalization rate of 21.6. The median KS hospitalization cost for children <5 years of age during the study period was $6,169 US dollars. CONCLUSIONS: The KS hospitalization rate was consistent with that of previous U.S. studies, although the extrapolated rate may be an overestimation. The median hospitalization cost for KS was higher than that for respiratory syncytial virus-associated bronchiolitis and diarrheal diseases. Large hospitalization datasets can be used to monitor the occurrence of KS in the United States. (+info)
Surveillance of pediatric infections in a teaching hospital in Mato Grosso do Sul, Brazil.
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Nosocomial infections (NI) result in considerably high mortality and morbidity rates, especially among pediatric patients. Considering current worldwide changes, information about the occurrence of pathogens and susceptibility tests are now seen as decisive for optimizing treatment. The purpose of this research was to determine the frequency of microorganisms, antimicrobial and genetic profiles, and risk factors associated with nosocomial infections in a teaching hospital in Campo Grande, Mato Grosso do Sul. From January 1998 to December 1999, 108 patients were characterized as having nosocomial infection, from which 137 pathogens were isolated. Identification and antimicrobial susceptibility was determined by conventional and automated techniques. Staphylococcus aureus and Klebsiella pneumoniae strains were characterized by Pulsed Field Gel Electrophoresis (PFGE). Pathogens were most often isolated from infants one-month old or younger, and bloodstream infections were the most frequent. The main isolated agents isolated were: coagulase-negative staphylococci (38), Pseudomonas aeruginosa (19), S. aureus (26), K. pneumoniae (18), and Candida spp. (13). The risk conditions that were most closely related to NI acquisition were: prolonged hospital stays (69.4%), prematurity (60.9%) and exposure to high-risk device procedures (95.4%). Ciprofloxacin and imipenem were the most effective drugs, inhibiting all or almost all of the Enterobacteriaceae, P. aeruginosa and Acinetobacter calcoaceticus isolates. Only 23% of the S. aureus samples were resistant to oxacillin. Genomic typing revealed 10 distinct patterns for S. aureus and 13 for K. pneumoniae, suggesting that most them did not belong to the same clone. PFGE was effective in differentiating the strains. (+info)
ICU cornerstone: high frequency ventilation is here to stay.
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With favourable and extensive experience in the neonatal intensive care unit (ICU) and the recent positive experience in the adult ICU, high-frequency ventilation has become a valuable alternative to conventional ventilation in acute lung injury. To arrive at this point, physicians' understanding of the characteristics and kinetics of acute lung injury had to become more distinct, and it was necessary to merge accumulated knowledge from experience with high-frequency ventilation in the neonatal population and that with conventional ventilation in adults. However, this now calls for a better designed clinical trial in the adult population that combines the three most important concepts for lung protection: early intervention (before acute respiratory distress syndrome is established); optimal lung recruitment; and careful avoidance of lung over-distention over the entire period of mechanical ventilation. (+info)
Academic careers: choice and activity of graduates of a pediatric residency program 1974-1986.
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In summary, our data suggest that the playing field for academic medicine is changing. It is more patient care oriented, more multifaceted and supported more by clinical dollars than in the past. Greater flexibility in what constitutes "academic success" is necessary to assure a supportive environment in which tomorrow's academic faculty can develop and flourish. To accomplish these goals promotion systems that reward not only research but also teaching and clinical care accomplishments will be necessary. Clinicians will need to be compared with clinicians, teachers with teachers, clinical investigators with clinical investigators and basic investigators with basic investigators. Sources of support will need to be more clearly targeted along activity lines with clinical dollars supporting the clinician, medical education dollars supporting the teacher-educators and federal and foundation dollars supporting research. In our department, time and effort for research (45%) approximates dollar support for this activity (44%), while clinical dollars (43%) fund to a greater degree time and effort committed to clinical care (34%), and administration and teaching dollars (13%) under fund time and effort committed to these activities (21%). This suggests the need to identify increased funding to support teaching and education. Promotion expectations for women will need to be more flexible and adjusted to family responsibilities and demands. Most of all, however, we academic faculty must support enthusiastically the importance and joy of our work. We must be encouraging to our colleagues and our students and continue to recognize that for all of the difficulties and challenges, academic life is a rewarding and fulfilling enterprise. (+info)
Ribotyping provides efficient differentiation of nosocomial Serratia marcescens isolates in a pediatric hospital.
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Ribotyping with a nonradioactive probing system was used for the epidemiological evaluation of 15 Serratia marcescens nosocomial strains isolated from the stools of 12 children with no apparent illness in five different hospital wards over a 20-day period. Our results indicate that the occurrence of S. marcescens colonization was the result of the spread of a single epidemiological strain in the hematology ward, the oncology ward, and the gastroenterology ward and in two neonates in the neonatology ward, suggesting cross-contamination between the patients in these four wards. This isolate was genotypically unrelated to the bacterial strain found in the three other patients in the neonatology ward. Interestingly, one patient in the neonatology ward harbored these two genotypically different strains. Finally, the patient in the intensive care unit was colonized with a different strain. We find ribotyping to be a more reliable technique than biochemical typing. The results of ribotyping are more easily interpreted than are those of total DNA analysis, with an equivalent degree of discrimination. (+info)
A one-year study of streptococcal infections and their complications among Ethiopian children.
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Post-streptococcal complications are known to be common among Ethiopian children. Little is known, however, about the epidemiology of beta-haemolytic streptococci in Ethiopia. A total of 816 children were studied during a one-year period: 24 cases of acute rheumatic fever (ARF), 44 chronic rheumatic heart disease (CRHD), 44 acute post streptococcal glomerulonephritis (APSGN), 143 tonsillitis, 55 impetigo, and 506 were apparently healthy children. Both ARF and APSGN occurred throughout the year with two peaks during the rainy and cold seasons. The female:male ratio among ARF patients was 1.4:1 and 1:1.9 among APSGN. The monthly carrier rate of beta-haemolytic streptococci group A varied from 7.5-39%, average being 17%. T type 2 was the most frequent serotype. Marked seasonal fluctuations were noted in the distribution of serogroups among apparently healthy children. Beta-haemolytic streptococci group A dominated during the hot and humid months of February-May. Strains were susceptible to commonly used antibiotics, except for tetracycline. (+info)