Hospitals In Asia Research Articles

Understanding safer practices in health care: a prologue for the role of indicators

Patient safety and safer practices are central themes to many national strategies for accountability. The multinational Quality Indicator Project (QI Project) database is used to identify patterns of indicator use to measure safety of care in Asia, Europe, and the USA. The second objective is to assess, within the context of an indicator project, the usefulness of indicators to measure errors or mishaps. This descriptive study retrospectively analyses indicator use patterns among hospitals in Asia, Europe, and the USA. The QI Project database is used for the 1999-2002 period. Statistical testing (P-value) of the differences in use percentages across five countries is based on 'country' rather than 'hospital' as the unit of analysis. There was a significant increase in overall QI Project indicator use worldwide between 1999 and 2002. The average change in use was 6.8% for safety indicators and 4.2% for all other indicators. When analysed by country (USA, Austria, Belgium, UK, and Taiwan), the average increases in use percentage were highest in Taiwan and Belgium. When the country-specific differences were tested for significance, Taiwan showed the largest (and statistically significant) increase in safety indicator use between 1999 and 2002 (P<0.0001). In the USA, the rates of safety indicator use have decreased (P=0.0502) during the same time period. This paper identifies, perhaps for the first time, how traditional indicators of hospital performance are being used to understand a hospital's performance and associated safety of care. Although the study's time frame is limited to 3 years, the findings seem to suggest that the interest in using these traditional indicators as proxies for safer practice measures is increasing among the QI Project participants worldwide. The challenge of using inherently value-free indicators as indicators of safety (hence de facto labelled as 'error' focused) should be further studied.

ENDOSCOPIC ULTRASONOGRAPHY EDUCATION IN ASIA: ARE WE THERE YET?

The growth of endoscopic ultrasonography (EUS) in Asia outside of Japan has not really kept pace with the development of this technology. One overriding factor inhibiting the wider use of EUS in Asia is the lack of training opportunities. In most hospitals of Asia, no formal training program is available. In order to achieve the highest quality EUS training attainable given these limited resources, we believe efforts will need to be channelled in two directions. One is by sending promising endoscopists to centers of excellence for hands‐on training so that when these endoscopists are trained, they will be able to contribute to the pool of qualified teachers to achieve ‘self‐sufficient’ training of future EUS fellows. The second direction is toward development of well‐structured courses for endoscopy trainees who are unable to obtain formal EUS attachment. These courses should incorporate the opportunity for hands‐on exposure in addition to observational training. We are hopeful that through these measures, we should be able to increase the pool of EUS practitioners and improve acceptance of this imaging modality in Asia in the near future.

Using the hierarchy of control technologies to improve healthcare facility infection control: lessons from severe acute respiratory syndrome.

Health care facilities need to review their infection control plans to prepare for the possible resurgence of severe acute respiratory syndrome, other emerging pathogens, familiar infectious agents such as tuberculosis and influenza, and bioterrorist threats. This article describes the classic "hierarchy of control technologies" that was successfully used by occupational and environmental medicine professionals to protect workers from illness and death during the resurgence of tuberculosis in the 1990s. Also discussed are related guidelines from building and equipment professional organizations and novel infection control techniques used successfully by various hospitals in Asia, Canada, and the United States during the 2003 severe acute respiratory syndrome epidemic. Taken together, they suggest a framework upon which a comprehensive infection control plan can be crafted to prevent the spread of deadly infectious agents to health care workers (clinicians and paraprofessionals), uninfected patients and visitors.

Suprapubic prostatectomy for benign prostatic hyperplasia in rural Asia: 200 consecutive cases

Objectives. To assess the safety and efficacy of a suprapubic prostatectomy technique performed in a rural hospital in Asia. Methods. A retrospective study of 200 consecutive suprapubic transvesical prostatectomies with a removable bladder neck partition suture for benign prostatic hyperplasia from 1995 to 1998 in a rural mission hospital in northern Pakistan was performed. Results. Despite preoperative comorbidities in 28% of patients, the postoperative morbidity (14%) and mortality (1%) was low. The partition suture is credited with a very low transfusion rate (1%) and a lower intensity of nursing care in the postoperative period. Patient satisfaction was high with regard to both relief of symptoms and cost. Conclusions. This study demonstrated that suprapubic prostatectomy with a routine bladder neck partition suture for benign prostatic hyperplasia can be carried out with a high degree of safety and efficacy in a rural setting with limited facilities in a developing country.

Results of Wilms' tumour management in two tertiary-care hospitals in Asia: S. Sen, P. Kadamba, M. Al-AbdulAaly, et al. Pediatr Surg Int 13:42–44, (January), 1998

Results of Wilms' tumour management in two tertiary-care hospitals in Asia: S. Sen, P. Kadamba, M. Al-AbdulAaly, et al. Pediatr Surg Int 13:42–44, (January), 1998

Results of Wilms' tumour management in two tertiary-care hospitals in Asia.

In the period 1985-1995, 87 children underwent surgery for Wilms' tumour; 16 were lost to follow-up. Of the remaining children, 27 presented with stage I disease, 11 with stage II, 12 with stage III, 14 with stage IV, and 6 with stage V. One child was not staged. The histology was favourable Wilms' tumour in 44, anaplastic in 12, unclassified in 8, clear-cell sarcoma in 4, and rhabdoid tumour in 3. Although a total nephrectomy was generally performed, partial renal surgery was performed for 6 bilateral and 4 unilateral tumours, the latter including 2 fused kidneys. Preoperative chemotherapy was employed with benefit in massive tumours, tumour in fused kidneys, bilateral tumours, and preoperatively diagnosed inferior vena caval tumour thrombi. Postoperative chemotherapy, employed in all cases, consisted of actinomycin D and vincristine with the addition of adriamycin in anaplastic and advanced-stage tumours. Ten children underwent second-line chemotherapy for disease unresponsive to the above management, but only 1 of these is currently free of disease. Postoperative tumour-bed radiotherapy, used in selected cases, prevented local recurrence in stage I and II disease. However, 20% of stage I and II patients not receiving radiotherapy developed tumour-bed recurrence. Twenty-three children have died and 5 with advanced disease and incomplete follow-up are presumed to be dead. Nine children are currently on treatment; 34 have successfully completed treatment, the disease-free survival in stages I-V being 81%, 75%, 42%, 14%, and 50%, respectively. Overall disease-free survival was 69% for Wilms' tumour of favourable histology and 50% for anaplastic tumours. The 3 patients with rhabdoid tumours and 3 of 4 with clear-cell sarcomas have died. Wilms' tumour management in the developing world is compromised by cases lost to follow-up and late presentation with massive tumours and advanced stage. Preoperative chemotherapy is advantageous in a number of cases, and postoperative radiotherapy should be deployed more frequently.

Corneal Decompensation after Cataract Surgery: An Outbreak Investigation in Asia

During 5 days in January 1994, two visiting expatriate ophthalmologists performed extracapsular cataract surgery on 111 patients at a nonprofit hospital in Asia. The authors investigated the development of postoperative corneal edema. An epidemiologic and clinical investigation was undertaken by a review of clinical charts, interview of personnel involved, an examination and interview of patients who underwent surgery, and a laboratory simulation of the disinfection procedure used. Follow-up was available on 58% of the patients. The attack rate was at least 37% and likely to be approximately 64%. The attack rate was highest the first 2 days of surgery. Multivariate analysis showed that the day of surgery was the only characteristic significantly associated with the presence of corneal edema. A simulation of the disinfection technique used (soaked in 2% glutaraldehyde and rinsing) showed that significant levels of glutaraldehyde remain in instruments with small lumens after the rinse. The epidemiologic data and simulation information are compatible; the lack of adequate rinsing of small lumen instruments soaked in glutaraldehyde is the most probable cause of this incident. Recommendations for surgeons on surgical expeditions are proposed.