Community Public Hospitals Research Articles

Study on Sustainable Development Oriented Community Public Hospital in China Based on Optimal Decision Making Model for Environment Renovation

Community public hospital provides public health and basic medical services, and their construction environment has an important impact on the health and well-being of the residents. Due to the long construction period of most community hospitals, the population expansion and the change in age structure have led to a mismatch between the needs of patients and the current situation, which is in urgent need of renovation. This paper aims to support the government and hospitals in making decisions by eliminating the blind spots in capital investment and benefit evaluation. In this study, environmental modification design variables are first established, and on this basis, the fuzzy Delphi method is used to understand the willingness for renovation on the part of patients, accompanying personnel, staff, healthcare workers as well as hospital administrators. Besides, the I-S model is used to identify the renovation projects that would maximize user satisfaction. Furthermore, the differences between patients and medical staff are compared. The ODM (Optimal Decision-making) model is used to evaluate the cost investment and benefits, which provides support for the decision-making of government and hospitals. The results clarify the key renovation design variables that can significantly improve user satisfaction and extend them into renovation strategies that can be landed, and identify renovation strategies with larger improvement scores and the range of renovation funds that maximize benefits to promote the sustainable development of community public hospitals. It can be seen that the ODM model can also be well applied to the renovation of community healthcare services. In addition, the reference classification and design variables should be adjusted according to the characteristics of China, taking into consideration the specificity of individual hospitals.

Orthopaedic and trauma surgery in France: Do patterns differ across healthcare institution types (public community, public university, private not-for-profit, and private for-profit)?

BackgroundNo studies have evaluated, to our knowledge, potential differences in practices in France according to type of healthcare institution, i.e., university public hospital, community public hospital, or private hospital with or without participation in the public healthcare system. The objectives of this study of the exhaustive information collected in the French hospital-admission database were to: (1) describe the numbers of the main procedures performed in France by orthopaedic and trauma surgeons in each type of institution and each subspecialty; and (2) to determine whether the pattern of procedures differed according to the type of healthcare institution. HypothesisDifferences in surgical practice patterns exist across healthcare institution types and according to the nature of the procedures. Patients and methodsA retrospective observational nationwide study was performed using the exhaustive French hospital database. All surgical procedures done in 2019 for orthopaedic and trauma indications were collected. We then classified the procedures according to the most common diagnoses by distinguishing procedures on the hip, knee, shoulder, hand, spine, ankle, and foot, as well as paediatric and traumatology procedures. ResultsProcedures performed more often in private institutions included those on the hip (93,225 [64.3%] of 144,919), knee (223,542 [75.5%] of 296,255), shoulder (103,923 [76.6%] of 300,577), hand (408,035 [77.6%] of 525,534), spine (for degenerative disease, 27,001 [71.2%] of 37,915), and ankle and foot (75,392 [77.1%] of 105,720). In contrast, of the 19,157 (80.3%) of the 23,848 paediatric procedures and 203,090 (67.7%) of the 300,065 traumatology procedures were done in public institutions. For all eight comparisons, the difference between public and private institutions was statistically significant. The overall trend was towards public university hospitals performing more paediatric and trauma procedures and more complex surgeries such as those required by multiple traumatic injuries. DiscussionOur study provides accurate numbers of surgical procedures done in public and private healthcare institutions in France in 2019. We found major differences not only across categories and specialties but also within specialties depending on the type of procedure. Orthopaedic surgical activity shows a marked imbalance in France between public and private institutions. Further research would be needed to identify the causes. Level of evidenceIV, retrospective observational epidemiological study.

1013P - Incidental early occult ovarian cancer after risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers followed in a community public hospital

BackgroundCarriers of germline BRCA1/2 mutations are at high risk of developing ovarian, tubal or peritoneal cancer. Actually, risk-reducing bilateral salpingo-oophorectomy (RRSO) is the only definite preventive strategy. The aim of this study is to characterize the clinical and pathological features of early occult malignancies incidentally diagnosed after a RRSO in carriers of BRCA1/2 mutations followed at a high risk familial cancer clinic in a community public hospital in NW Spain. MethodsData were prospectively collected from 95 consecutive BRCA-positive women diagnosed at our high risk familial cancer clinic from March 2014 to March 2017. ResultsAmong 95 BRCA1/2 carriers (median age 45 years) 38 women were healthy and 57 have had a previous breast cancer diagnosis. Half of the carriers hold the founder mutation R71G in BRCA1 (69 in BRCA1, 25 in BRCA2, and 1 was a carrier of a mutation in both genes). RRSO was performed in 29 cases (21 in BRCA1 and 8 in BRCA2; median age 50 years). Three BRCA1/2 carriers older than 45 years-old refused to undergo a RRSO. After RRSO two patients (6.4%), both BRCA1-positive, were found to have an early occult adnexal malignancy upon pathology study. One 64-year-old carrier had an invasive serous fallopian tube carcinoma stage I with no involvement of the ovaries plus a stage I endometrial endometrioid carcinoma on the staging hysterectomy. The second 44-year-old women were found at the time of the RRSO a stage Ia invasive high grade serous ovarian carcinoma with no fallopian tubes involvement. ConclusionsA 6.4% incidence of early occult adnexal malignancy after RRSO was found in our cohort of BRCA1/2 carriers. This incidence is similar to that previously published in studies done at international reference centers. The coordinated management of BRCA1/2 mutation carriers between different departments of our institution allows results comparable to international standards. Greater efforts must be made to improve the acceptance of RRSO by BRCA carriers, especially after the age of 40. Legal entity responsible for the studyAuthor: Begoña Graña Suárez. FundingHas not received any funding. DisclosureB. Grana Suarez: Research grant / Funding (institution), Travel / Accommodation / Expenses: Amgen; Travel / Accommodation / Expenses: Celgene; Travel / Accommodation / Expenses: Roche; Travel / Accommodation / Expenses: Servier. All other authors have declared no conflicts of interest.

Establishing a prostate cancer referral pathway between urology and medical oncology at Lyndon B. Johnson Hospital.

60 Background: Treatment for biochemically recurrent (bcr) and metastatic prostate cancer (pc) is evolving, making multidisciplinary evaluation a critical need. Our center, a community public hospital, lacked clear referral criteria between the Urology (Uro) and Medical Oncology (Onc) clinics, resulting in inconsistent care. We aimed to improve multidisciplinary communication and the rate of patient (pt) referrals by establishing standardized referral criteria for pc pts between Uro and Onc. Methods: Referral criteria were based on the presence or concern for primary refractory, bcr, castrate resistant (cr), or metastatic pc, as established by the PCWG3 and RTOG-ASTRO Phoenix consensuses. Primary refractory pc was defined as a failure of the PSA to fall to undetectable levels after radical prostatectomy (rp). Bcr pc was defined as two consecutive PSA values ≥ 0.2ng/mL after rp, or a rise in PSA 2ng/mL above post-treatment nadir after radiation therapy. Cr pc was defined as radiographic (progressive measurable disease) or chemical (two rising PSA levels 6-12 weeks apart) progression despite castrate levels of testosterone (T), defined as a serum T < 50ng/dL. Metastatic pc was defined as the development of bone lesion(s), organ involvement, or lymphadenopathy above the bifurcation of common iliac vessels. The referral criteria were organized into a chart and visibly displayed, discussed during multidisciplinary meetings, and distributed during educational sessions with Uro Residents and Onc Fellows in January 2019. Referral rate was collected from July 2018 through December 2018, and collection of post-intervention referral rate is planned from January 2019 through June 2019. Results: Pre-intervention, 39% (23/59 pts) of the pts that met referral criteria were referred to Onc. Preliminary data from January through April 2019 demonstrated a referral rate of 60% (9/15 pts). Conclusions: In 4 months, our intervention improved the referral rate by 21%. These criteria continue to be reinforced during multidisciplinary meetings and more educational sessions are planned as new personnel establish in the clinics. Ultimately, more time and pts are required to determine the full impact of this project.

Factors associated with duration of inpatient hospital stay for patients with diabetes mellitus admitted to a medical unit in a community public hospital.

The aim was to examine predictors of duration of inpatient hospital stay in people with diabetes mellitus to assist implementation of strategies to reduce hospital stay. This audit prospectively studied patients with diabetes mellitus admitted to a medical unit of an Australian community public hospital. Other outcome measures included glucose treatment optimisation and access to GP and diabetes-specific healthcare professionals. Comparison was made to patients without diabetes mellitus who were admitted concomitantly. Diabetes patients represented 26% of admissions over a 2-month period. In total, 73% had seen a GP within the prior 6 months. Patients with diabetes mellitus (n=79) had a median age of 69 years; 53% were male and median HbA1c was 65mmolmol-1 (8.1%). Diabetes mellitus was associated with a longer inpatient stay (P=0.03), particularly among patients admitted with vascular disease. Age >65 years and seeing <3 members of the community-based diabetes mellitus multidisciplinary team (MDT) in the 2-years pre-admission were independently associated with a longer stay (P=0.02). In total, 10% were referred to an endocrinologist on discharge. Involvement of more of the diabetes-specific MDT, with a skilled GP, in primary care is recommended as it may shorten inpatient hospital stay, improve glycaemia and reduce demand for limited specialist endocrinologists.

Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

Surgical Site Infection in Elective Operations for Colorectal Cancer After the Application of Preventive Measures

To assess the prevalence of surgical site infection (SSI) after elective operations for colon and rectal cancer after the application of evidence-based preventive measures and to identify risk factors for SSI. Prospective, observational, multicenter. Tertiary and community public hospitals in Catalonia, Spain. Consecutive patients undergoing elective surgical resections for colon and rectal cancer during a 9-month period. The prevalence of SSI within 30 days after the operations and risk factors for SSI. Data from 611 patients were documented: 383 patients underwent operations for colon cancer and 228 underwent operations for rectal cancer. Surgical site infection was observed in 89 (23.2%) colon cancer patients (superficial, 12.8%; deep, 2.1%; and organ/space, 8.4%) and in 63 (27.6%) rectal cancer patients (superficial, 13.6%; deep, 5.7%; and organ/space, 8.3%). For colon procedures, the following independent predictive factors were identified: for incisional SSI, open procedure vs laparoscopy; for organ/space SSI, hyperglycemia at 48 hours postoperatively (serum glucose level, >200 mg/dL), ostomy, and National Nosocomial Infection System index of 1 or more. In rectal procedures, no risk factors were identified for incisional SSI; hyperglycemia at 48 hours postoperatively (serum glucose level, >200 mg/dL) and temperature lower than 36°C at the time of surgical incision were associated with organ/space SSI. The prevalence of SSI in elective colon and rectal operations remains high despite the application of evidence-based preventive measures.