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The project aimed to characterize the exposure to seismic hazard in the emergency area of a high-complexity hospital in Cali, Colombia.
Methods
The occupancy of the emergency area was analyzed over 6 months, determining the value of material elements exposed to the seismic hazard. Four phases were executed: search for pre-existing information, occupancy analysis, evaluation of exposed assets, and results analysis. The information was analyzed using a Geographic Information System (GIS), which allowed the visualization of demographic behavior in different locations and times.
Results
The results confirmed that the seismic hazard is high, exacerbated by local geomechanical characteristics. It was observed that the average occupancy of most studied areas exceeded capacity. The value of the exposed assets was estimated at COP 3 221 008 640 (USD 959 844.76), the demolition value at COP 10 582 770 000 (USD 3 153 613.49), and the reconstruction value at COP 30 293 640 275 (USD 9 027 356.03). In the worst-case scenario, the losses were equivalent to 12.4% of the hospital’s annual budget.
Conclusions
The data allow the hospital to take preventive measures and educate the staff to identify and mitigate critical areas. It also contributes to the knowledge of the approximate value of economic losses and the impact of potential human losses.
This chapter examines Gaza’s socio-spatial organization and the demographic features of its population. It presents Gaza’s main urban features during the late Ottoman period, including divisions into neighborhoods, main landmarks and thoroughfares. It then offers an in-depth portrayal of Gazan society, including data on economy and lifestyles, social hierarchies, marriage patterns, migration and health, based on a detailed analysis of the Ottoman census of 1905 and surviving court records (1857–1861), in light of evidence from the literature, maps and images.
A surge of pediatric respiratory illnesses beset the United States in late 2022 and early 2023. This study evaluated within-surge hospital acute and critical care resource availability and utilization. The study aimed to determine pediatric hospital acute and critical care resource use during a respiratory illness surge.
Methods
Between January and February 2023, an online survey was sent to the sections of hospital medicine and critical care of the American Academy of Pediatrics, community discussion forums of the Children’s Hospital Association, and PedSCCM—a pediatric critical care website. Data were summarized with median values and interquartile range.
Results
Across 35 hospitals with pediatric intensive care units (PICU), increase in critical care resource use was significant. In the month preceding the survey, 26 (74%) hospitals diverted patients away from their emergency department (ED) to other hospitals, with 46% diverting 1-5 patients, 23% diverting 6-10 patients, and 31% diverting more than 10 patients. One in 5 hospitals reported moving patients on mechanical ventilation from the PICU to other settings, including the ED (n = 2), intermediate care unit (n = 2), cardiac ICU (n = 1), ward converted to an ICU (n = 1), and a ward (n = 1). Utilization of human critical care resources was high, with PICU faculty, nurses, and respiratory therapists working at 100% capacity.
Conclusions
The respiratory illness surge triggered significant hospital resource use and diversion of patients away from hospitals. Pediatric public health emergency-preparedness should innovate around resource capacity.
Publicly-funded healthcare facilities in Australia(1) and New Zealand(2) have adopted healthy food and drink policies to enable staff and visitors to choose and consume healthier options. However, adopting such policies does not translate to their full implementation and compliance by food providers, who face barriers to providing healthier food and drinks(3). As part of the wider HealthY Policy Evaluation (HYPE) study, we interviewed hospital food providers and public health dietitians/professionals to understand their experiences implementing the voluntary National Healthy Food and Drink Policy introduced in New Zealand in 2016. Semi-structured interviews focused on the awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. All semi-structured interviews were transcribed verbatim, inductively coded with the assistance of QSR’s NVivo software, and analysed using the reflexive thematic analysis method by Braun and Clarke(4). Twelve participants from across New Zealand were interviewed. Time in their roles ranged from one to 14.5 years, and many were not in the position when the Policy was first adopted. There was a discrepancy in the awareness of the voluntary Policy. However, there was agreement that hospitals should be healthy eating role models for the wider community. Reflexive thematic analysis identified three themes relating to the implementation of the Policy in New Zealand: 1) complexities of operating food outlets under the Policy in hospitals; 2) adoption, implementation and monitoring of the Policy as a series of incoherent ad-hoc actions; and 3) the Policy as (currently) not achieving the desired impact. Participants recognised that the current food supply, presence of food outlets nearby hospitals serving unhealthy foods and culture of unhealthy eating, combined with the difficulty of changing people’s eating habits, leaves doubts if the Policy and healthier options served in the healthcare facilities have any tangible positive impact on staff or visitors. Key suggestions to promote successful Policy implementation included adoption of a mandatory National Policy, funding of central government support for implementation (including supportive implementation tools), regular and systematic monitoring of food availability in each region, and frequent and ongoing communication with staff and visitors using positive messaging around healthy eating and non-health related benefits (e.g. sustainability) to increase their buy-in. Findings from stakeholder interviews and the remaining parts of the HYPE evaluation study are informing the update of the National Policy and associated supportive tools, and highlight the potential positive impact a comprehensive policy evaluation could have on improving policy implementation.
Research on psychiatry in the United States has shown how, since the 1980s, the discipline has sought to increase its prestige and preserve its jurisdiction by embracing biomedical models of treatment and arguing it is a medical specialty like any other. While this strategy is consistent with what the literature on professions would expect, this paper analyzes an alternative case: French public psychiatry, which has remained in a position of marginalized autonomy, combining low status and economic precarity with state recognition of its specificity. Drawing on Bourdieu’s theory of fields, I analyze how the persistence of specialized psychiatric hospitals in France—most of which have closed in the United States—has shaped the conflict between psychiatrists favoring autonomy and actors in university hospitals and the Ministry of Health seeking to reduce it. These specialized hospitals have functioned as institutional anchors that contribute to maintaining the discipline’s autonomous position in the medical field in three ways: by socializing psychiatrists into viewing themselves as a distinctive branch of medicine, linking psychiatry to powerful actors in the state interested in maintaining the discipline’s distinctive role in social control, and concentrating a population of chronically ill persons not amenable to traditional medical interventions. This analysis expands on the literature on professionals and field theory by emphasizing the role of institutions in structuring the reorganization of jurisdictions and relationships between fields.
The COVID-19 pandemic created many challenges for in-patient care including patient isolation and limitations on hospital visitation. Although communication technology, such as video calling or texting, can reduce social isolation, there are challenges for implementation, particularly for older adults.
Objective/Methods
This study used a mixed methodology to understand the challenges faced by in-patients and to explore the perspectives of patients, family members, and health care providers (HCPs) regarding the use of communication technology. Surveys and focus groups were used.
Findings
Patients who had access to communication technology perceived the COVID-19 pandemic to have more adverse impact on their well-beings but less on hospitalization outcomes, compared to those without. Most HCPs perceived that technology could improve programs offered, connectedness of patients to others, and access to transitions of care supports. Focus groups highlighted challenges with technology infrastructure in hospitals.
Discussion
Our study findings may assist efforts in appropriately adopting communication technology to improve the quality of in-patient and transition care.
It is common for income tax systems around the world to contain a broad range of exemptions. From a policy perspective, there are many reasons why governments provide exemptions. The most obvious is to grant concessional treatment to certain ‘deserving’ entities. Tax exemptions may be total or partial and are usually provided because the relevant entities serve some social, community or philanthropic purpose that the government wishes to support. By providing particular entities with tax exemptions, the government delivers support to them indirectly (ie via tax expenditures) rather than directly (ie via grants or subsidies). Clearly, providing tax exemptions comes at a cost, since governments do not collect revenue from the benefiting entities. However, this needs to be balanced against the fact that many of these entities provide important services to the community, which governments might otherwise feel they would have to provide themselves. By supporting such entities under their tax systems, governments can relieve themselves (either wholly or partly) from having to directly provide certain services that may, in any case, be best delivered through the private sector.
Chapter 9 explores the hospital as an economic entity. The chapter discusses the differences between for-profit and not-for-profit hospitals, the organization of hospital workforces, and how the for-profit/not-for-profit distinction interacts with the organization. Then the chapter explores how different parties involved with the hospital seek to exert influence over how hospital resources are used: what they want and how they get it. Finally, the chapter covers topics in how hospitals operate within the sector: hospital growth, hospital competition, and operation of hospital systems.
The gold rush in the 1890s and the discovery of oil in 1920 prompted the Canadian government to negotiate treaties 8 and 11 with the Dene and Gwich’in. With the arrival of the Royal Canadian Mounted Police, these treaties formalized colonial control over the Yukon and Northwest Territories. Medicine, hospitals, and healthcare were promised as part of treaty negotiations, but the infrastructure of care erected in this period was underfunded and racially contingent, prioritizing settlers and sojourners. Sanitary infrastructure appeared as a necessary response to the surge of newcomers in search of gold in the Yukon. Otherwise, healthcare for Indigenous northerners was designed around the objectives of the Christian missions upon whom the government depended to deliver its treaty promises.
Peru’s health infrastructures, particularly hospitals, are exposed to disaster threats of different natures. Traditionally, earthquakes have been the main disaster in terms of physical and structural vulnerability, but the coronavirus disease 2019 (COVID-19) pandemic has also shown their functional vulnerability. Public hospitals in Lima are very different in terms of year constructed, type of construction, and number of floors, making them highly vulnerable to earthquakes. In addition, they are subject to a high demand for care daily. Therefore, if a major earthquake were to occur in Lima, the hospitals would not have the capacity to respond to the high demand.
Objective:
The aim of this study was to analyze the Hospital Safety Index (HSI) in hospitals in Lima (Peru).
Materials and Methods:
This was a cross-sectional observational study of 18 state-run hospitals that met the inclusion criteria; open access data were collected for the indicators proposed by the Pan American Health Organization (PAHO) Version 1. Associations between variables were calculated using the chi-square test, considering a confidence level of 95%. A P value less than .05 was considered to determine statistical significance.
Results:
The average bed occupancy rate was 90%, the average age was 70 years, on average had one bed per 25,126 inhabitants, and HSI average score was 0.36 with a vulnerability of 0.63. No association was found between HSI and hospital characteristics.
Conclusion:
Most of the hospitals were considered Category C in earthquake and disaster safety, and only one hospital was Category A. The hospital situation needs to be clarified, and the specific deficiencies of each institution need to be identified and addressed according to their own characteristics and context.
Tuberculosis was the most devastating infectious disease of the 20th century. Spread initially in the nineteenth-century fur trade, tuberculosis rose in intensity after 1900, with its greatest impacts in the 1920s and 1930s. This chapter shows the prevalence of tuberculosis infection, its interaction with other pathogens, and the impacts of tuberculosis on children and young adults especially, including how the residential school system amplified the epidemic in the North. More than any other disease, tuberculosis changed Indigenous relationships with the land. The colonial state belatedly responded to this epidemic, relocating the sick to institutions in southern Canada. This policy of medical relocations became emblematic of Northern health history and colonialism in the decades to come.
The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) lacks a rigorous enrollment audit process, unlike other collaborative networks. Most centers require individual families to consent to participate. It is unknown whether there is variation across centers or biases in enrollment.
Methods:
We used the Pediatric Cardiac Critical Care Consortium (PC4) registry to assess enrollment rates in NPC-QIC for those centers participating in both registries using indirect identifiers (date of birth, date of admission, gender, and center) to match patient records. All infants born 1/1/2018–12/31/2020 and admitted 30 days of life were eligible. In PC4, all infants with a fundamental diagnosis of hypoplastic left heart or variant or who underwent a surgical or hybrid Norwood or variant were eligible. Standard descriptive statistics were used to describe the cohort and center match rates were plotted on a funnel chart.
Results:
Of 898 eligible NPC-QIC patients, 841 were linked to 1,114 eligible PC4 patients (match rate 75.5%) in 32 centers. Match rates were lower in patients of Hispanic/Latino ethnicity (66.1%, p = 0.005), and those with any specified chromosomal abnormality (57.4%, p = 0.002), noncardiac abnormality (67.8%, p = 0.005), or any specified syndrome (66.5%, p = 0.001). Match rates were lower for patients who transferred to another hospital or died prior to discharge. Match rates varied from 0 to 100% across centers.
Conclusions:
It is feasible to match patients between the NPC-QIC and PC4 registries. Variation in match rates suggests opportunities for improvement in NPC-QIC patient enrollment.
Artificial intelligence (AI) is being tested and deployed in major hospitals to monitor patients, leading to improved health outcomes, lower costs, and time savings. This uptake is in its infancy, with new applications being considered. In this Article, the challenges of deploying AI in mental health wards are examined by reference to AI surveillance systems, suicide prediction and hospital administration. The examination highlights risks surrounding patient privacy, informed consent, and data considerations. Overall, these risks indicate that AI should only be used in a psychiatric ward after careful deliberation, caution, and ongoing reappraisal.
Excavations in Rome have long focused on the early city; only recently has attention turned to the archaeology of the medieval and later periods. Here, the authors present a rare sixteenth-century context, dating to a time when European cities contended with repeat epidemics and implemented measures to control the spread of disease. A contextual approach to the assemblage leads to its identification as a ‘medical dump’ of clinical equipment, including glass urine flasks and ‘single-serve’ ceramics, many of the latter specifically produced for the Ospedale dei Fornari. Drawing on Renaissance medical treatises, the authors argue that this material represents the disposal of potentially infected objects, shedding light on urban waste-management practices.
The study aimed to identify the factors that influence the disaster preparedness of hospitals and validate an evaluation framework to assess hospital disaster preparedness (HDP) capability in the Eastern Province of Saudi Arabia.
Methods:
A cross-sectional survey of all hospitals (n = 72) in the Eastern Region of Saudi Arabia was conducted. A factor analysis method was used to identify common factors and validate the evaluation framework to assess HDP capacity.
Results:
Sixty-three (63) hospitals responded to the survey. A 3-factor structure was identified as key predicators of HDP capacity. The first factor was the most highly weighted factor, which included education and training (0.849), monitoring and assessing HDP (0.723), disaster planning (0.721), and command and control (0.713). The second factor included surge capacity (0.708), triage system (0.844), post-disaster recovery (0.809), and communication (0.678). The third factor represented safety and security (0.638) as well as logistics, equipment, and supplies (0.766).
Conclusion:
The identified 3-factor structure provides an innovative approach to assist the operationalization of the concept of HDP capacity building and service improvement, as well as serve as a groundwork to further develop instrument for assessing HDP in future studies.
Private hospitals, clinics, and pharmacies, and the doctors, nurses, and other medical personnel who staff them provide a large portion of healthcare services in low- and middle-income countries (L&MICs). In some, the private sector delivers much more care than the government. Understanding the scale, capacity, quality, constraints and motivations of private providers and private facilities – whether for-profit, non-profit, formal or informal – is critical to assuring that health services and medicines support and expand the goals of access to quality health care for all. This chapter sets out what is known regarding private care provision, from world-class hospitals to unlicensed and untrained village drug-sellers and summarizes the experience and frameworks being applied around the world to measure, regulate, and assure the efficient and effective provision of private health care as part of mixed-health-systems in L&MICs. In many settings the challenges of private sector governance are complicated by limited data, minimal financial transfers, and weak regulatory systems. Despite this, advances have been made in L&MICs to defining and applying good governance strategies.
This introductory chapter briefly outlines the main theme of this volume, namely, to review the new opportunities and risks of digital healthcare from various disciplinary perspectives. These perspectives include law, public policy, organisational studies, and applied ethics. Based on this interdisciplinary approach, we hope that effective strategies may arise to ensure that benefits of this ongoing revolution are deployed in a responsible and sustainable manner. The second part of the chapter comprises a brief review of the four parts and fourteen substantive chapters that make up this volume.
The emergence of digital platforms and the new application economy are transforming healthcare and creating new opportunities and risks for all stakeholders in the medical ecosystem. Many of these developments rely heavily on data and AI algorithms to prevent, diagnose, treat, and monitor diseases and other health conditions. A broad range of medical, ethical and legal knowledge is now required to navigate this highly complex and fast-changing space. This collection brings together scholars from medicine and law, but also ethics, management, philosophy, and computer science, to examine current and future technological, policy and regulatory issues. In particular, the book addresses the challenge of integrating data protection and privacy concerns into the design of emerging healthcare products and services. With a number of comparative case studies, the book offers a high-level, global, and interdisciplinary perspective on the normative and policy dilemmas raised by the proliferation of information technologies in a healthcare context.
We argue that concentration of power in religious hospitals threatens disestablishment values. When hospitals deny care for religious reasons, they dominate patients’ bodies and convictions. Health law should — and to some extent already does — constrain such religious domination.