[Regional geriatric team--a model for cooperation between nursing homes and hospitals]

Few studies describe and evaluate the use of ambulatory geriatric teams in nursing homes. This article gives an account of a model in which a multidisciplinary group from the local hospital has been visiting 17 communities in Norway twice a year for 11 years. The ambulatory geriatric team includes a geriatrician, a geriatric nurse, a physiotherapist and an occupational therapist. Their aim is to raise the quality of geriatric assessment and care and to enhance the cooperation between the hospital and the nursing homes in the communities. The team members are doing a comprehensive geriatric assessment of some of the patients; they assess cases for further referral, and examine patients with declining functioning with a view to rehabilitation. The team provides instruction in various aspects of geriatrics to community care professionals. Much time is devoted to discussions on problems raised by the staff, such as management of patients with dementia-related behavioural problems, and to provide feedback to staff-members. The team liaise between hospitals, nursing homes and community care services in the communities in order to enhance communication between the professionals involved. An evaluation of the team was done on behalf of the National Institute of Health through a postal questionnaire which was returned by 223 doctors, nurses and allied health care professionals. The results indicate that visits by the ambulatory team improve the knowledge of doctors and allied professionals about diseases in the elderly; 92% reported that they now felt they were doing a better job.

[Work experience of the fluorography department in the municipal clinic of Truskavets city]

The article presents the experience of photofluorographic room belonging to the X-ray diagnostics unit of the hospital staffed with all kinds of specialists. The 10 years experience of the unit (1994-2003) is analyzed. Fluorography is one of the most widely used methods of early X-ray diagnostics of organs of the thorax, support apparatus. This method can be used by ENT specialist, traumatologist, gastroenterologist and urologist as an easy accessible and relatively cheap technique to diagnose different kinds of diseases.

The role of U.S. public hospitals in urban health

Public hospitals in the United States play a key role in urban health. In many metropolitan communities, public hospitals maintain the health care safety net. Most urban public hospitals have evolved to not only provide care for the indigent but also to serve their communities in other ways, including serving as major providers for tertiary services such as trauma and those that support homeland security; serving as the foundation for primary care services; continuing to train a significant number of physician, nurses, and other medical personnel; and providing laboratories for clinical medical research. Federal budget cuts such as those in the Balanced Budget Act of 1997, recent state budget deficits, competition for Medicaid Managed Care, and the growth in the number of uninsured have led to a decline in revenues among urban public hospitals. To be better stewards of scarce resources, public hospitals have moved to reduce inpatient demand by adopting prevention strategies that are aimed at addressing the determinants of health, the complex interactions among social and economic factors, the physical environment, and individual behavior. These factors contribute to health status and offer opportunities to intervene and improve community health. Urban public hospitals, to be successful in the next stage of their evolution, need to learn to manage the "in-betweens"--partnering with governmental and nongovernmental entities to identify and work together on common health and safety issues. If public hospitals engage the community successfully, building trust and establishing new capability and capacity, urban public hospitals will survive, evolve, and continue their tradition of service.

A management information system to plan and monitor the delivery of health‐care services in government hospitals in India

Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.

[Role of computed tomography in every day practice of municipal health care of the Russian Federation]

The basic idea of the paper is due to its authors' wish to provide a comprehensive objective assessment of the role and place of currently available technologies of radiation diagnosis in municipal health care of the Russian Federation on the basis of the computed tomography (CT) room of the Stupino Central Town Clinical Hospital that performs the function of the leading medical institution of the whole Stupino District, Moscow Region. The paper presents a detailed characterization of the basic lines of CT studies and an analysis of their scope in a great variety of clinical subunits of the multidisciplinary Stupino hospital offering 795 beds. The paper lays a great emphasis on the particularly organizational aspects associated with the CT diagnosis of different diseases at the level of municipal heart care. Moreover, the authors express the idea that the findings may be applied not only to CT, but also to the whole group of new radiation diagnostic technologies. By assessing CT at the level of municipal health care, the authors fix their attention on the technological aspects of this technique. Recommendations are given on the most suitable type of CT units for municipal health care depending on the size of the population under service and on the capacity of health care structures. One of the authors' main conclusions suggests that, in addition to the radiation diagnosis service, the administrators of both regional and municipal organizational entities of practical public health care of the Russian Federation should obligatorily participate in order to obtain the high efficiency of radiation techniques.

Therapy of Heart Failure in African Americans: Lessons From an Urban Public Hospital

African-American patients with heart failure treated at urban public hospitals are at high risk for adverse outcomes likely due to complex socioeconomic factors. While establishing a heart failure disease management program at Parkland Memorial Hospital in Dallas, TX, the authors completed two studies that address the high rates of heart failure hospitalizations seen in this population. The first study found high rates of adverse outcomes following emergency department discharge for heart failure. The second identified important deficiencies in dietary sodium knowledge. Both 90-day outcomes (return emergency department visit or heart failure hospitalization) following an index emergency department discharge and dietary sodium knowledge represent new potential measures of quality of care of heart failure. Studies of this high-risk population of heart failure patients may offer insights that lead to improved outcomes both in the urban setting and elsewhere.

Case management: an evaluation at Childrens Hospital Los Angeles

This prospective, quantitative, and qualitative evaluation of the case management program at CHLA clearly demonstrated the value of professional service coordination of care for children with complex, special health needs. Most specifically, the program documented improvement in three discrete areas of evaluation: 1. Financial, with decreased unnecessary expenditures and increased revenue. 2. Patient satisfaction, documented with validated questionnaires. 3. Clinical process improvement, using quantifiable clinical outcomes. At the very least, case management is an extremely valuable service in the present managed health care environment, and may in fact be indispensable.

Like parent, like child. A health promoting hospital project

One way to reduce the need and demand for hospital services is via health promotion initiatives. A prenatal instructors' education module preventing the learning of violence as acceptable behaviour by children in their first year of life was developed by a health promoting hospital in partnership with its community. Children learn through observing significant adults in their life. Parents are important influences on the children's behaviour, and good (or bad) patterns are passed on from generation to generation. Some abuse occurs because people (primarily males) lack the skills to resolve conflict and stress in a positive way and resort to abuse. The project's intent is to help expectant parents reduce abusive behaviours. This parental modelling awareness program has the potential to be introduced into different high risk groups, day-care centres and multicultural settings.

Coney Island Hospital focuses on healthcare for ethnic groups

Since its beginnings as a first aid station on the famous New York beach, Coney Island Hospital has evolved as a well-known public hospital serving a multi-cultural community. Part of the New York City Health and Hospitals Corp. it has made extensive efforts to provide "ethnically correct" services to all of its constituents. These measures have been covered by National Public Radio and recognized as a "best practices" example by the U.S. Department of Health and Human Services. Profile's article offers insights about how it's done and how it is publicized, including what its associate director calls "ethnic marketing on the cheap."

New York system vs. challengers. Public hospitals face down privates in $3.5 million campaign

New York City Health and Hospitals Corp. (HHC) reacts to new competition from private hospitals. a result of drastic changes in the state's healthcare program for Medicaid patients. Read about HHC's commitment of $5 million to advertising, including a $3.5 million multi-media campaign to enhance the image and increase awareness of its 11 acute care hospitals and related facilities.

[Five-year activity of new departments of emergency cardiological care with cardiac resuscitation units in Moscow]

AIM

To analyse results of treatment in new cardiological critical care units in Moscow (62 beds).

MATERIAL AND METHODS

Five years reports presented in 1993-1999 to Moscow Public Health Committee.

RESULTS

The activity of the new cardiological units proved efficient: cardiovascular lethality reduced by 20%; quality of diagnosis and treatment improved; bed turnover increased.

CONCLUSION

A new system of medical care for critical cardiological patients is recommended for introduction as basic form of organization of urgent cardiological inpatient care in Moscow.

[Integration activities of a central municipal hospital]

Scientifically-based integration of therapeutic and prophylactic institutions is needed for better meeting the population requirement of medical care, and it is desirable to unite the financial resources and personnel; such is the objective reality for municipal therapeutic and prophylactic institutions of local public health systems. In order to make medical care available for the population and to ensure its high quality, structural changes in the public health of a region are needed. These changes include integration of medical services of these territories; creation of a network of therapeutic and prophylactic institutions corresponding to medical demographic structure of population, so that the scope of medical care be increased and specialized care made easier available for the population; and creation of the optimal managing system. Comparative studies of population health and its time course, public health organization at neighboring territories, where therapeutic and prophylactic institutions, such as Central Municipal Hospital and Central Regional Hospital have autonomous managing and financing, confirmed the need in integration of public health units functioning at a certain territory into a universal system, and in development of approaches to overcome the present-day miscellaneous network by integrating the activities of treatment-and-prophylaxis institutions. Identical economic, geographic, and macroeconomic living conditions of the population, similarity of medical demographic structure and similar changes in it, as well as similar morbidity structure, are sufficient grounds for integration of public health services.

[Neurology in Paris hospitals, particularly the Salpêtrière before Charcot: Rostan on brain softening]

In the beginning of the 19th century, many studies were devoted to the diseases of the nervous system in France, long before the work of Charcot. The researches of Léon Rostan on the cerebral softening (1819, 1823) were based on the anatomoclinic method developed by the School of Paris whose most famous representatives were Corvisart and Laennec for the study of heart and lung diseases. The researches of Rostan were performed in the Salpêtrière hospital which was, at this time, an hospice for old women. Rostan was appointed Inspector of the Health service in the Salpêtrière hospital in 1812 then Head of a department in 1818. He was 28 year old when he published his book "Researches on the cerebral softening" in 1819. Rostan was the first to describe the spontaneous cerebral softening as a special anatomoclinic entity distinct from encephalitis and apoplexy. He compared this entity to the senile gangrene and stated that it was related to the ossification of cerebral arteries. He described the pathologic features of the brain softening and also its clinical symptomatology in opposition to that of apoplexy. The concept of brain softening according to Rostan was harshly fought by the followers of the Broussais's physiological medicine (from Lallemand, 1830 to Calmeil, 1859) who claimed that all brain softenings were due to the inflammation process and thus should be described as encephalitis. In opposite, the ideas of Rostan were accepted and developed by others such as Carswell in England (1835), Abercrombie in Scotland (1836) and Andral in France (1827, 1840). These authors agreed that some type of cerebral softening was related to a disease of the arterial system. Nevertheless, the modern concept of brain softening was not definitively accepted before the description of the thromboembolic mechanisms by Virchow in Germany (1856) with the help of the microscope, and the anatomoclinic studies of Proust, Laborde and Prevost and Cottard in France (1866). The book of Rostan was dedicated to the "Conseil Général des Hospices" which was created in 1801 to unify the administration of the hospitals in Paris and became the "Administration Générale de l'Assistance Publique à Paris" in 1849. One hundred and fifty years after its publication, the work of Léon Rostan was outstanding by its modernity of the form as well as the substance.