Suchergebnisse

Abstract
Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting.
Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique.
Results Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02).
Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

Reviews the historical facts of Zimbabwean university governance since the colonial days of the 1950s. It appears that the state (or the party that controls the state) intends to deprive the University of all independent control over who it admits, what and how it teaches and examines them, and the standards of attainment to be applied. They contravene directly the World University Service's 1988 Lima Declaration. (SJK)

Volunteer programs are expected to positively impact the organizations in which they exist. This article reviews the literature on volunteerism, including what volunteers do, how their contributions can be measured, and the financial- and quality-related outcomes of volunteer programs. The focus is on volunteerism in health care settings, particularly hospitals. The article summarizes the existing theoretical and empirical literature concerning the roles of volunteers, the economic value of volunteers, cost–benefit analysis of volunteer labor, and the impact of volunteers on quality and patient satisfaction. The review indicates that the use of volunteers offers significant cost savings to hospitals and may positively impact profit margins. Volunteers are also likely to enhance quality indicators such as patient satisfaction and safety. Implications of these findings for management and future research are discussed.

Purpose: Diabetes mellitus (DM) is a chronic condition that can have a major impact on life expectancy and quality of life, especially if undetected or poorly controlled. Glycaemic control and management of co-morbid conditions and diabetes complications are alarmingly sub-optimal and perhaps one of the worst conditions in the world. This study aimed to assess the utilization pattern of antidiabetic medications in Hiwot Fana Specialized University Hospital (HFSUH). Methods: A cross sectional study was conducted from April 1 to May 31, 2014 and data were collected using structured questionnaire and data collection format. The data were entered and analyzed with the help of SPSS version 16. Descriptive statistics was used for most variables and Chi-square test was used. Resultsá¡ A total of 296 diabetes patients were involved in this study, 42.6% and 57.4% were males and females, respectively. Large proportion of the patients (42.4%) was unable to read and write. Majority of the respondents (64.9%) were from urban. Two hundred and twenty three (75.3%) of the respondents were diagnosed with type-2 diabetes. Almost all patients were on pharmacological therapy at the time of the study. Among those who were on pharmacological therapy, majority of them (42.9%) were taking insulin. Conclusionsá¡ The most prescribed antidiabetic medication was insulin, followed by glibenclamide and metformin, respectively. More than half of the patients used two syringes for monthly consumption. Most of the patients rotated major injection site and some of them also injected on lipodystrophied site. The incidence of microvascular complication was higher. What this study adds: It adds on the current trend of utilization of antidiabetic medications as well as indicates the widespread of diabetes in the study setting, which will be a baseline for the government and different stakeholders to intervene. What is already known about this subject: In the study setting, such a study has never been conducted. Key words: Antidiabetic medications, Diabetes mellitus, Co-morbid conditions, Glycaemic control, Hiwot Fana Specialized University Hospital.Â

This short paper is describing in brief the need that developed the last years for a radical change in hospitals spatial structure in order to help both patients and the staff to have mutual gains. Contemporary hospitals are in need of structural changes due to several political, economic, social paragons as well as due to technological advances and progress in medical science. It is the authors goal to provide the guidelines that need to be followed in order several potential changes in terms of spatial re- organization to be achieved.

There is some evidence that a kind of hospital already existed towards the end of the 2nd millennium BC in ancient Mesopotamia. In India the monastic system created by the Buddhist religion led to institutionalised health care facilities as early as the 5th century BC, and with the spread of Buddhism to the east, nursing facilities, the nature and function of which are not known to us, also appeared in Sri Lanka, China and South East Asia. One would expect to find the origin of the hospital in the modern sense of the word in Greece, the birthplace of rational medicine in the 4th century BC, but the Hippocratic doctors paid house-calls, and the temples of Asclepius were visited for incubation sleep and magico-religious treatment. In Roman times the military and slave hospitals were built for a specialised group and not for the public, and were therefore not precursors of the modern hospital. It is to the Christians that one must turn for the origin of the modern hospital. Hospices, originally called xenodochia, initially built to shelter pilgrims and messengers between various bishops, were under Christian control developed into hospitals in the modern sense of the word. In Rome itself, the first hospital was built in the 4th century AD by a wealthy penitent widow, Fabiola. In the early Middle Ages (6th to 10th century), under the influence of the Benedictine Order, an infirmary became an established part of every monastery. During the late Middle Ages (beyond the 10th century) monastic infirmaries continued to expand, but public hospitals were also opened, financed by city authorities, the church and private sources. Specialised institutions like leper houses also originated at this time. During the Golden Age of Islam the Muslim world was clearly more advanced than its Christian counterpart with regard to the magnificent hospitals which were built in various countries, institutions which eventually became the true forerunners of the modern teaching hospital.

Intro -- CONTROLLING DISEASE OUTBREAKS: THE CHANGING ROLE OF HOSPITALS -- CONTROLLING DISEASE OUTBREAKS: THE CHANGING ROLE OF HOSPITALS -- CONTENTS -- PREFACE -- AUTHOR AFFILIATIONS -- Chapter 1 INTRODUCTION -- Chapter 2 PREPARING THE HEALTH CARE SYSTEM -- Chapter 3 IMPACT OF AVIAN INFLUENZA IN THE NETHERLANDS -- Chapter 4 HOSPITAL CAPACITY -- Chapter 5 INTENSIVE CARE UNIT CAPACITY -- Chapter 6 WORKFORCE -- Chapter 7 GENERAL PRACTITIONERS -- Chapter 8 AGE DISTRIBUTION -- Chapter 9 UNDERLYING DISEASE AND CO-MORBIDITY -- Chapter 10 MITIGATION OF PANDEMIC INFLUENZA -- Chapter 11 CONTAINMENT MEASURES FOR PANDEMIC INFLUENZA -- Chapter 12 HEALTHCARE SYSTEM READINESS -- Chapter 13 INTERNAL PREPARATION -- Chapter 14 BUSINESS CONTINUITY -- Chapter 15 EXTERNAL PREPARATION -- Chapter 16 EVIDENCE-BASED MANAGEMENT -- Chapter 17 EVIDENCE FROM FOCUSED MODELLING: A CASE STUDY FROM THE NETHERLANDS -- Chapter 18 HEALTHCARE SYSTEM READINESS -- Chapter 19 HOSPITAL AND INTENSIVE CARE UNIT CAPACITY -- Chapter 20 WORKFORCE -- Chapter 21 GENERAL PRACTITIONERS -- Chapter 22 AGE DISTRIBUTION -- Chapter 23 UNDERLYING DISEASE AND CO-MORBIDITY -- Chapter 24 MITIGATION AND CONTAINMENT MEASURES FOR PANDEMIC INFLUENZA -- Chapter 25 METHODOLOGICAL CONSIDERATIONS -- Chapter 26 CONCLUSION -- ACKNOWLEDGEMENT -- REFERENCES -- INDEX.

Background: Despite prospective randomized control trials showing that beta blockers, aspirin, angiotensin‐converting enzyme (ACE) inhibitors, and lipid‐lowering agents improve survival rates after myocardial infarction (MI), these agents are routinely underutilized. Hypothesis: Our aim was to determine the frequency with which cardiologists at a government, university‐affiliated teaching hospital prescribe aspirin, beta blockers, ACE inhibitors, calcium‐channel blocking agents (CCBs), and lipid‐lowering agents in patients post MI. The patients were followed by their primary care physicians in this hospital after discharge. We evaluated changes in patients' medical management at an average of 24 months after discharge from the acute event. Methods: Clinical data relative to long‐term use of life‐saving drugs in 156 survivors of definite MI (WHO criteria) at a government, university‐affiliated teaching hospital were analyzed over a 24‐month follow‐up period. Results: Over 90% of patients with acute MI were given aspirin and beta blockers at discharge. About 50% of these patients were given ACE inhibitors, only 25% were prescribed CCBs, and 21% were given lipid‐lowering agents. At 24 months of follow‐up, the percentage of patients receiving aspirin, beta blockers, and ACE inhibitors had fallen to 88% (p = 0.0408), 71% (p < 0.0001), and 43% (p = 0.1122), respectively, whereas use of lipid‐lowering agents slightly increased (p = 0.4277). Use of CCBs had also fallen (p = 0.0001). Nonetheless, the use of aspirin, beta blockers, and ACE inhibitors was higher than that in the National Registry of similar patients at discharge (p < 0.0001). Conclusions: Patients at a government, university‐affiliated teaching hospital are likely to receive life‐saving therapy at discharge, in accordance with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. There is a modest decrease in intake of these life‐saving drugs during the follow‐up period. As documented earlier, cardiologists in a teaching ...