scholarly journals Medicine and Local Community -Hospital Construction and Formation of New Community

2015 ◽  
Vol 63 (6) ◽  
pp. 901-906
Author(s):  
Hideomi FUJIWARA
Keyword(s):  
Local Community ◽  
Community Hospital ◽  
Hospital Construction ◽  
New Community

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

scholarly journals MENINGKATKAN PARTISIPASI MASYARAKAT MELALUI PEMBANGUNAN INFRASTRUKTUR DI DESA SUKATANI KECAMATAN NGAMPRAH KABUPATEN BANDUNG BARAT

2019 ◽  
Vol 2 (1) ◽  
pp. 101
Author(s):  
Desi Arisanti Gustiyani
Keyword(s):  
Community Participation ◽  
Research Method ◽  
Local Community ◽  
Implementation Process ◽  
Development Planning ◽  
Infrastructure Development ◽  
Development Policies ◽  
Qualitative Descriptive ◽  
New Community ◽  
Descriptive Method

Community participation in development policies in countries that implement democracy including in Indonesia is not new. Community participation is a technical process to provide wider opportunities and authority to the community together to solve various problems. As a concept and practice of development, the concept of participation was only discussed in the 60s when various international institutions promoted participation in development planning, implementation and evaluation practices. The importance of the community in village development is to remember the local community who are more aware of various problems such as the construction of village infrastructure and facilities, the development of local economic potential, and the utilization of existing natural and environmental resources so as to facilitate the development planning and implementation process. The purpose of this study: To describe the condition of the community of Sukatani village, to determine community participation in infrastructure development, to determine efforts to increase community participation and to find out the supporting and inhibiting factors in efforts to increase participation. The research method used in this study is adapted to the objectives of the researcher, so this research method uses a qualitative descriptive method. The results of the pre-survey research showed that the issue of public participation in the development process was not as expected and there were still problems with community participation in development in Sukatani Village. The conclusion of the explanation above is that community participation in Sukatani Village is still relatively low. It needs an increase in the awareness and concern of the local community that it is important to participate in maintaining, caring for, and maintaining every outcome of village development that has been carried out.

scholarly journals P027: Development of a physician assistant lead stroke protocol to provide timely and equitable access to hyperacute stroke care in a telestroke community hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S74-S74
Author(s):  
L. Shoots ◽  
V. Bailey
Keyword(s):  
Acute Stroke ◽  
Local Community ◽  
Community Hospital ◽  
Stroke Care ◽  
Physician Assistants ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Hyperacute Stroke ◽  
Phone Calls ◽  
Triage Time

Background: The Brant Community Healthcare System (BCHS) has consistently been well above the recommended 30 minute benchmark for door-to-needle (DTN) for eligible acute stroke patients. As a large community hospital with no neurologists, and like many other hospitals internationally, we rely on telestroke support for every stroke case. This is a time-consuming process that requires a multitude of phone calls, and pulls physicians from other acutely ill patients. We sought to develop a system that would streamline our approach and care for hyperacute stroke patients by targeting improvements in DTN. Aim Statement: We will decrease the door-to-needle (DTN) time for stroke patients arriving at the BCHS Emergency Department (ED) who are eligible for tissue plasminogen activator (tPA) by 25% from a median of 87 minutes to 50 minutes by March 31, 2018 and maintain that standard. Measures & Design: Outcome Measures: Door-to-needle time for acute stroke patients receiving tPA Process Measures: Door-to-triage time, Door-to-CT time, Door-to-CTA time; INR collection-to-verification time, telestroke callback time Balancing Measures: Number of stroke protocol patients per month Model Design: We simultaneously designed and implemented a robust program to train physician assistants in hyperacute stroke care. Evaluation/Results: Through vast stakeholder engagement and implementing a multitude of change ideas, by March of 2018 we had achieved an average DTN of 53 minutes. Our door-to-triage time went from an average of 7 minutes to 3 minutes. Our door-to-CT time decreased from 17 minutes to 7 minutes and our time between CT and CTA from an average of 13 minutes to 3 minutes. One and a half years later, our average DTN is maintained at 55 minutes and physician assistants continue to effectively lead and liaise with telestroke neurologists and stroke patients. Discussion/Impact: Prior to this program, acute stroke care was a very contentious topic at our local community hospital. Creating a program that streamlined the care and standardized the work has proven successful, and not only allowed for improved DTN times but also freed up physicians to better simultaneously care for other acutely ill patients.

Campylobactercolitis leads to toxic megacolon and multiple organ failure

2020 ◽  
Vol 13 (3) ◽  
pp. e233373 ◽  
Author(s):  
Clair Louise Taylor Clark ◽  
Elspeth Victoria Murray
Keyword(s):  
Local Community ◽  
Community Hospital ◽  
Toxic Megacolon ◽  
Kidney Injury ◽  
District General Hospital ◽  
Multiple Organ ◽  
Causative Organism ◽  
Campylobacter Coli ◽  
Fulminant Colitis ◽  
General Surgeons

A 58-year-old woman presented to the emergency department in a district general hospital with severe abdominal pain and diarrhoea, after collapsing at home. She was admitted to the intensive care unit (ICU) in septic shock, and with acute kidney injury. An initial CT scan was suggestive of colitis. She was treated for suspected gastroenteritis and her microbiology results showed Campylobacter coli as the causative organism. She failed to respond to antibiotics, and underwent serial contrast CTs which showed no progression of colitis. Colonoscopy performed on day 10 of her admission, however, revealed fulminant colitis. After a multidisciplinary meeting among gastroenterologists, general surgeons and intensivists, the patient underwent total colectomy with ileostomy. She made a slow but steady recovery in ICU, and subsequently in the ward, and was discharged to a local community hospital for further rehabilitation.

Consultation with the Specialist

1993 ◽  
Vol 14 (6) ◽  
pp. 237-238
Author(s):  
James Seidel
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Physical Examination ◽  
Local Community ◽  
Community Hospital ◽  
Vital Signs ◽  
Neurologic Examination ◽  
The Right ◽  
Spine Radiographs ◽  
Large Hematoma

Case Report Bobbi, a 5-year-old, was playing "catch" on the lawn of his surburban home. When he went to fetch the ball that had rolled into the street, he was struck by an automobile traveling about 25 miles per hour. Witnesses reported that Bobbi's body was lifted up by the car and thrown about 12 feet onto the pavement. A neighbor responded immediately and noted that Bobbi was responsive to verbal commands and had a large bump on the front of his head and a swollen right thigh. The Emergency Medical Services System was activated, and within 10 minutes he was transported to the emergency department at the local community hospital. Bobbi was in obvious pain but was awake and responded to questions. He knew his sister's and teachers' names, but did not remember being struck by the car. His vital signs were: respirations 35/min; pulse, 100/min; blood pressure, 98/68 mm Hg; and temperature, 36.5°C. Physical examination was remarkable for a large hematoma on the right frontal and parietal areas of the skull and a swollen tender right thigh. Bobbi's spine was normal upon physical examination, and the neurologic examination was normal except for some retrograde amnesia. There was no spinal swelling or tenderness, and cervical spine radiographs were normal

Use of Local Community Hospital Data for Surveillance of Antimicrobial Resistance

2006 ◽  
Vol 27 (3) ◽  
pp. 299-301 ◽  
Author(s):  
Susan M. Farner
Keyword(s):  
Streptococcus Pneumoniae ◽  
Confidence Interval ◽  
Catchment Area ◽  
Local Community ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Hospital Data ◽  
Susceptibility Data ◽  
Central Illinois ◽  
Local Antibiotic

We sought to determine whether antimicrobial susceptibility data from a nonteaching community hospital could be used to detect statistically significant local increases in resistance among Streptococcus pneumoniae over a 5-year period. Minimum inhibitory concentrations (MICs) of penicillin and ceftriaxone from 1997-1998 were compared with those from 2000-2001. MICs of penicillin and ceftriaxone for organisms collected in a nonteaching community hospital in central Illinois were used for analysis. The hospital has 224 beds and a catchment area of approximately 40 miles. There were significant increases in MICs of penicillin and ceftriaxone between 1997-1998 and 2000-2001. The MIC of penicillin increased from 0.042 to 0.121 μg/mL (P = .001; 95% confidence interval, -1.713 to -0.388), and the MIC of ceftriaxone increased from 0.028 to 0.071μg/mL (P = .005; 95% confidence interval, -1.353 to -0.188). There were no significant changes in the percentage of S. pneumoniae isolates that were resistant, intermediate, or susceptible to penicillin and ceftriaxone. MIC data from a community hospital can be used to detect local increases in the rate of resistance before antibiogram data show significant changes. This information is important for demonstrating to physicians the need to review local antibiotic use in the attempt to slow the development of resistant organisms in the community.

Factors Influencing the Prioritization of Injured Patients for Transfer to a Burn or Trauma Center Following a Mass Casualty Event

2020 ◽  
pp. 1-8
Author(s):  
Elizabeth A. Lancet ◽  
Wei Wei Zhang ◽  
Patricia Roblin ◽  
Bonnie Arquilla ◽  
Rachel Zeig-Owens ◽  
...  
Keyword(s):  
New York ◽  
Large Scale ◽  
Local Community ◽  
Injury Severity ◽  
Community Hospital ◽  
Clinical Information ◽  
Mass Casualty ◽  
Patient Profile ◽  
Mass Casualty Event ◽  
Consultation Team

ABSTRACT Objectives: In New York City, a multi-disciplinary Mass Casualty Consultation team is proposed to support prioritization of patients for coordinated inter-facility transfer after a large-scale mass casualty event. This study examines factors that influence consultation team prioritization decisions. Methods: As part of a multi-hospital functional exercise, 2 teams prioritized the same set of 69 patient profiles. Prioritization decisions were compared between teams. Agreement between teams was assessed based on patient profile demographics and injury severity. An investigator interviewed team leaders to determine reasons for discordant transfer decisions. Results: The 2 teams differed significantly in the total number of transfers recommended (49 vs 36; P = 0.003). However, there was substantial agreement when recommending transfer to burn centers, with 85.5% agreement and inter-rater reliability of 0.67 (confidence interval: 0.49–0.85). There was better agreement for patients with a higher acuity of injuries. Based on interviews, the most common reason for discordance was insider knowledge of the local community hospital and its capabilities. Conclusions: A multi-disciplinary Mass Casualty Consultation team was able to rapidly prioritize patients for coordinated secondary transfer using limited clinical information. Training for consultation teams should emphasize guidelines for transfer based on existing services at sending and receiving hospitals, as knowledge of local community hospital capabilities influence physician decision-making.

scholarly journals 159 Utility of universal preadmission COVID-19 testing in labor and delivery unit at local community hospital

2021 ◽  
Vol 224 (2) ◽  
pp. S108-S109
Author(s):  
Oxana Zarudskaya ◽  
Ibrahim Tsolakian ◽  
Jayne Roth ◽  
Amy Bitto ◽  
Nauman Khurshid
Keyword(s):  
Local Community ◽  
Community Hospital ◽  
Labor And Delivery ◽  
Delivery Unit ◽  
Labor And Delivery Unit
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