Rehabilitation Facilities in Ontario

Rehabilitation centres in Ontario were surveyed and categorized as in-patient and outpatient services, specialized centres for particular diseases, and vocational retraining centres. It is evident that many gaps exist in the pattern of rehabilitation facilities and services in the province. In some areas the facilities are grouped too closely together, necessitating transport of patients from great distances. The serious shortage of trained personnel is noted. There is little provision for mentally ill patients in existing rehabilitation centres. The use of mobile clinics is discussed. There is no evidence of duplication of services among those at present available.     

A survey of hospital toilet facilities.

OBJECTIVE--To assess the quality of toilet facilities available for disabled people in a large provincial teaching hospital. DESIGN--Survey of toilet facilities for patients on the wards and in the outpatient department. SETTING--Teaching hospital in Leeds. RESULTS--Although the quality of toilet facilities varied, none met the standards recommended by the British Standards Institution. The worst facilities were found on a ward accommodating elderly patients, where the toilets were unsuitable for use by disabled people and bedside commodes had to be used instead. CONCLUSION--Toilet provision within a major hospital failed to meet standards required for disabled people. Admission to hospital may therefore result in loss of independence and dignity. If hospitals are to be centres of excellence, greater consideration must be given to the requirements of disabled people in the design of new wards, and current inadequate facilities should be upgraded.     

Health problems and health care for adolescents in residential facilities in Quebec.

The health problems of 160 adolescents in four residential facilities of the Quebec social welfare court were studied. At the time of admission 44% had at least one problem requiring consultation with a specialist and 80% had an average of two problems requiring primary care. The medical records of 106 youngsters in two re-education centres were also reviewed and similar results were noted. The health services available, particularly physical examination and laboratory testing at the time of admission and arrangements for referral and follow-up were judged to be insufficient in most centres. Although society has taken custody of these adolescents, no one is responsible for their health care. Since February 1976 the social welfare court residential facilities and the network involved in the care of socially disturbed youngsters have been undergoing reorganization. Health programs and services ought to be part of this reorganization, and private physicians, hospitals and government each should have a role in the establishment and functioning of these programs.     

Regional co-ordinator for haemophilia in domiciliary practice.

The North-east Thames Region has appointed a nursing sister to co-ordinate the organisation of care for haemophiliacs in the region. As a result of the appointment, facilities for home treatment have expanded rapidly. Several associate centres providing care to haemophiliacs have been set up around the region in addition to the four main haemophilia centres, which are all in the south-west corner of the region. As well as providing support and supervision of patients on home treatment, the co-ordinator helps to place haemophiliac children in suitable schools, maintains the regional register of haemophiliacs, and has a more general role in ensuring that services are available where they are needed throughout the region.     

Options for Optimal Coverage of Free C-Section Services for Poor Mothers in Indian State of Gujarat: Location Allocation Analysis Using GIS

Background

Gujarat, a western state of India, has seen a steep rise in the proportion of institutional deliveries over the last decade. However, there has been a limited access to cesarean section (C-Section) deliveries for complicated obstetric cases especially for poor rural women. C-section is a lifesaving intervention that can prevent both maternal and perinatal mortality. Poor women bear a disproportionate burden of maternal mortality, and lack of access to C-section, especially for these women, is an important contributor for high maternal and perinatal mortality in resource limited settings. To improve access for this underserved population in the context of inadequate public provision of emergency obstetric services, the state government of Gujarat initiated a public private partnership program called “Chiranjeevi Yojana” (CY) in 2005 to increase the number of facilities providing free C-section services. This study aimed to analyze the current availability of these services in three districts of Gujarat and to identify the best locations for additional service centres to optimize access to free C-section services using Geographic Information System technology.

Methodology

Supply and demand for obstetric care were calculated using secondary data from sources such as Census and primary data from cross-sectional facility survey. The study is unique in using primary data from facilities, which was collected in 2012–13. Information on obstetric beds and functionality of facilities to calculate supply was collected using pretested questionnaire by trained researchers after obtaining written consent from the participating facilities. Census data of population and birth rates for the study districts was used for demand calculations. Location-allocation model of ArcGIS 10 was used for analyses.

Results

Currently, about 50 to 84% of populations in all three study districts have access to free C-section facilities within a 20km radius. The model suggests that about 80–96% of the population can be covered for free C-section services with addition of 4–6 centres in critical but underserved regions. It was also suggested that upgrading of public sector facilities with minimal investment can improve the services.

Conclusion

This study highlights utility of Geographic Information System technology for planning service centres to optimize access to vital lifesaving procedure such as C-section. Although the location allocation methodology has been available for decades, it has been used sparsely by public health professionals. This paper makes an important contribution to the literature for use of the method for planning in resource limited settings.     

Diagnostic differences in psychogeriatric patients in Toronto,New York and London,England.

National statistics on psychiatric illness in the elderly patient from Canada, the United States and the United Kingdom suggest great differences in morbidity in these three centres. The present study shows that these differences stem mainly from different diagnostic habits in the three countries, but also there were more alcoholics in the Canadian sample. In particular, the diagnostic bias of the New York psychiatrists towards diagnosing most elderly patients as senile was not shared by their Toronto colleagues. Some patients were psychiatrically well, in spite of receiving a psychiatric diagnosis, and could have been helped without hospitalization. In addition, some depressed patients were labelled senile. Recommendations include improvement of catchment and treatment facilities for the elderly alcoholic and the provision of psychogeriatric diagnostic centres.     

Centralised interpretation of electrocardiograms.

A system was devised so that a peripheral hospital could transmit electrocardiograms (ECGs) to a central computer for interpretation. The link that transmits both ECGs and reports is provided by the telephone network. Initial results showed that telephone transmission did not significantly affect the accuracy of the ECG interpretation. The centralised computer programme could be much more widely used to provide ECG interpretations. A telephone link would not be justified in health centres, where the demand for ECGs is fairly small, but ECGs recorded at a health centre can be sent to the computer for interpretation and returned the next day. The most cost-effective method of providing computer interpretation for several health centres in a large city would be to have a portable electrocardiograph and transmission facilities, which could be moved from centre to centre.     

conservation in the bush: game breeding centres in South Africa

Approximately 5% of the Republic of South Africa is set aside for national parks, nature reserves, private game reserves or wilderness areas. Within these areas a large variety of animals and plant species is protected. Many of these species are indigenous to the Southern African subregion. Most of the zoological gardens in South Africa are owned privately or by a municipality. The zoo in Pretoria is the only one which has national status. In addition to facilities in Pretoria, the National Zoological Gardens owns two game breeding centres covering an area of more than 7000 ha. The game breeding centres act as important gene pool reservoirs and are used for the breeding of threatened species. They thus fulfill an important role in conserving threatened species and, in some cases, supplementing dwindling populations in protected areas.     

Low quality of routine microscopy for malaria at different levels of the health system in Dar es Salaam

Background

Laboratory capacity to confirm malaria cases in Tanzania is low and presumptive treatment of malaria is being practiced widely. In malaria endemic areas WHO now recommends systematic laboratory testing when suspecting malaria. Currently, the use of Rapid Diagnostic Tests (RDTs) is recommended for the diagnosis of malaria in lower level peripheral facilities, but not in health centres and hospitals. In this study, the following parameters were evaluated: (1) the quality of routine microscopy, and (2) the effects of RDT implementation on the positivity rate of malaria test results at three levels of the health system in Dar es Salaam, Tanzania.

Methods

During a baseline cross-sectional survey, routine blood slides were randomly picked from 12 urban public health facilities in Dar es Salaam, Tanzania. Sensitivity and specificity of routine slides were assessed against expert microscopy. In March 2007, following training of health workers, RDTs were introduced in nine public health facilities (three hospitals, three health centres and three dispensaries) in a near-to-programmatic way, while three control health facilities continued using microscopy. The monthly malaria positivity rates (PR) recorded in health statistics registers were collected before (routine microscopy) and after (routine RDTs) the intervention in all facilities.

Results

At baseline, 53% of blood slides were reported as positive by the routine laboratories, whereas only 2% were positive by expert microscopy. Sensitivity of routine microscopy was 71.4% and specificity was 47.3%. Positive and negative predictive values were 2.8% and 98.7%, respectively. Median parasitaemia was only three parasites per 200 white blood cells (WBC) by routine microscopy compared to 1226 parasites per 200 WBC by expert microscopy. Before RDT implementation, the mean test positivity rates using routine microscopy were 43% in hospitals, 62% in health centres and 58% in dispensaries. After RDT implementation, mean positivity rates using routine RDTs were 6%, 7% and 8%, respectively. The sensitivity and specificity of RDTs using expert microscopy as reference were 97.0% and 96.8%. The positivity rate of routine microscopy remained the same in the three control facilities: 71% before versus 72% after. Two cross-sectional health facility surveys confirmed that the parasite rate in febrile patients was low in Dar es Salaam during both the rainy season (13.6%) and the dry season (3.3%).

Conclusions

The quality of routine microscopy was poor in all health facilities, regardless of their level. Over-diagnosis was massive, with many false positive results reported as very low parasitaemia (1 to 5 parasites per 200 WBC). RDTs should replace microscopy as first-line diagnostic tool for malaria in all settings, especially in hospitals where the potential for saving lives is greatest.

     

Regulation of advanced therapy medicinal products in Europe and the role of academia

Background aimsAdvanced therapy medicinal products (ATMP) are gene therapy, somatic cell therapy or tissue-engineered products regulated under (EC) No. 1394/2007 to ensure their free movement within the European Union while guaranteeing the highest level of health protection for patients. Academic good manufacturing practice (GMP) centers are major contributors in the development of ATMPs and this study assessed the impact of regulations on them.MethodsEuropean academic and non-industrial facilities (n = 747) were contacted, and a representative sample of 50 replied to a detailed questionnaire. Experienced centres were further selected in every Member State (MS) for semi-structured interviews. Indicators of ATMP production and development success were statistically assessed, and opinions about directive implementation were documented.ResultsFacilities experienced in manufacturing cell therapy transplant products are the most successful in developing ATMPs. New centres lacking this background struggle to enter the field, and there remains a shortage of facilities in academia participating in translational research. This is compounded by heterogeneous implementation of the regulations across MS.ConclusionsGMP facilities successfully developing ATMPs are present in all MS. However, the implementation of regulations is heterogeneous between MS, with substantial differences in the definition of ATMPs and in the approved manufacturing environment. The cost of GMP compliance is underestimated by research funding bodies. This is detrimental to development of new ATMPs and commercialization of any that are successful in early clinical trials. Academic GMP practitioners should strengthen their political visibility and contribute to the development of functional and effective European Union legislation in this field.     

Radiotherapy facilities,equipment, and staffing in Poland: 2005–2011

Background and purpose

To evaluate the current status of radiotherapy facilities, staffing, and equipment, treatment and patients in Poland for the years 2005–2011 following implementation of the National Cancer Programme.

Methods

A survey was sent to the radiotherapy centres in Poland to collect data on available equipment, staffing, and treatments in the years 2005–2011.

Results

In 2011, 76,000 patients were treated with radiotherapy at 32 centres vs. 63,000 patients at 23 centres in 2005. Number of patients increased by 21%. In 2011, there were 453 radiation oncologists – specialists (1 in 168 patients), 325 medical physicists (1 in 215 patients), and 883 radiotherapy technicians (1 in 86 patients) vs. 320, 188, and 652, respectively, in 2005. The number of linear accelerators increased by 60%, from 70 units in 2005 to 112 in 2011. The current linac/patient ratio in Poland is 1 linac per 678 patients. Waiting times from diagnosis to the start of treatment has decreased.

Conclusion

Compared to 2005, there are more treatment facilities, more and better equipment (linacs), and more cancer care specialists. There are still large differences between the 16 Polish provinces in terms of equipment availability and ease of access to treatment. However, radiotherapy services in Poland have improved dramatically since the year 2005.     

An international survey of imaging practices in radiotherapy

Improvements in delivery of radiation dose to target tissues in radiotherapy have increased the need for better image quality and led to a higher frequency of imaging patients. Imaging for treatment planning extends to function and motion assessment and devices are incorporated into medical linear accelerators (linacs) so that regions of tissue can be imaged at time of treatment delivery to ensure dose distributions are delivered as accurately as possible. A survey of imaging in 97 radiotherapy centres in nine countries on six continents has been undertaken with an on-line questionnaire administered through the International Commission on Radiological Protection mentorship programme to provide a snapshot of imaging practices. Responses show that all centres use CT for planning treatments and many utilise additional information from magnetic resonance imaging and positron emission tomography scans. Most centres have kV cone beam CT attached to at least some linacs and use this for the majority of treatment fractions. The imaging options available declined with the human development index (HDI) of the country, and the frequency of imaging during treatment depended more on country than treatment site with countries having lower HDIs imaging less frequently. The country with the lowest HDI had few kV imaging facilities and relied on MV planar imaging intermittently during treatment. Imaging protocols supplied by vendors are used in most centres and under half adapt exposure conditions to individual patients. Recording of patient doses, a knowledge of which is important in optimisation of imaging protocols, was limited primarily to European countries.     

Growth of clinical haematology in South Tees Health District 1983-5.

A review of the workload of two newly appointed clinical haematologists in a health district with a population of 307,000 showed that the clinical case load increased rapidly in the first two years. The management of patients with blood disorders, which had previously been dispersed among many departments both within and outside the district, was now concentrated within a single unit with occasional referral as appropriate to regional centres. The development of a clinical haematology service in district general hospitals cannot occur without funding and facilities, including suitably located beds for haematology patients and specifically appointed junior medical staff. Highly trained and experienced nursing staff are essential for the management of patients with bone marrow failure; day care facilities and community nursing are also valuable. Changes and developments in the laboratory as a result of these additional clinical activities are also necessary.     

Tertiary cancer services in Britain: benchmarking study of activity and facilities at 12 specialist centres.

OBJECTIVE--To collate information on current activity and facilities in British hospitals to assist the planning of future cancer services. DESIGN--12 hospitals delivering specialist cancer services provided information on the size of population served, activity levels related to non-surgical oncology for 1994-5, and facilities available. Inconsistencies in the recording of data were resolved through meetings of all participants. SETTING--Five single specialty NHS trusts and seven specialist cancer facilities within multispecialty trusts, serving a combined population of 24.3 million. MAIN OUTCOME MEASURES--Activity levels and facilities per million population served. RESULTS--The facilities available per million population served varied widely between centres. In contrast, the range in the number of new referrals per million population (seen either at the centre or in peripheral clinics) was relatively small. Considerable variations were observed in the number of attendances per patient and amount of radiotherapy and chemotherapy delivered. Overall it was estimated that 40-45% of all new cases of cancer are currently being referred to non-surgical oncologists. For the seven hospitals which could provide data on trends in activity, the average increase in chemotherapy day case episodes between 1992-3 and 1994-5 was 83%. CONCLUSIONS--The results of this study provide a benchmark both for purchasers and providers of cancer care. The increase in the use of chemotherapy points to an urgent need for a unified system for monitoring both activity and outcomes of treatment.     

Cardiac transplantation in 150 patients at Stanford University.

A total of 150 patients underwent cardiac transplantation at Stanford between January 1968 and August 1978. Sixty-two patients were alive at the end of this period, when the expected one-year survival rate was 70%, with an attrition rate of roughly 5% thereafter. Changes in postoperative managment resulting from continuing research contributed to improved survival rates. The results are equal or superior to those for recipients of renal transplants from unrelated donors. Major centres that have suitably trained staff and appropriate facilities for cardiac surgery should perhaps reconsider cardiac transplantation as an alternative to death in certain patients.     

Increased mortality of preterm infants transferred between tertiary perinatal centres.

Over 18 months almost one quarter of infants born before 30 weeks'' gestation in a tertiary perinatal centre who required intensive care had to be transferred to other tertiary centres because intensive care facilities were fully occupied. When infants with lethal congenital malformations were excluded half of the 34 infants who were transferred died; this was twice the mortality (24%) in the 111 infants remaining. The difference between the groups was significant (relative odds = 3.1) and remained so after adjustment for any discrepancies in gestational age (relative odds = 4.0). After adjustment for potential confounding variables by logistic function regression the risk of dying for those transferred remained significantly higher than that for infants who remained (relative odds = 4.6, 95% confidence interval 1.8 to 12.1). As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.     

Distribution of recreational boating across lakes: do landscape variables affect recreational use?

1. Because people impact lake ecosystems, it is important to consider factors influencing the human use of freshwater resources. We investigated the influence of the landscape position, as well as lake area, recreational facilities, and distance to highways and urban centres, on lake use by boaters in the Northern Highland Lake District of Wisconsin, U.S.A.
2. In aerial surveys of ninety-nine randomly selected lakes, we did not see boats on over half of the lakes. Of the lakes with boats, we found a strong correlation between the number of boats and lake area. Recreational boats tended to be found on large, accessible lakes with good boating facilities. Boats were not seen on small, stained lakes with few recreational facilities.
3. Regression models showed that lake size and landscape position explained 63% of the variability in the average number of boats per lake and landscape position explained 24% of the variability in boat density on all ninety-nine lakes. Social variables representing the quality of boating facilities and the perception of good fishing explained 70% of the variability in number of boats per lake and 54% of the variation in boat density on all lakes. A combined model using both physical and social variables increased the explanatory power for both number and density. Lake use by boaters was correlated with landscape position, the quality of fishing and the availability of recreational facilities. When the analysis was restricted to the forty-six lakes where boats were found, only the availability of recreational facilities proved a significant predictor of boat density.
4. Our results suggest that lake choice by recreational boaters may be best predicted by a combination of the location of a lake in a regional hydrologic landscape, and considerations of available facilities and perceptions regarding fishing.     

The geriatric institution as a therapeutic modality.

Geriatric centres complete with day-hospital facilities are essential for good care of the elderly. Institutions for the ill elderly should be upgraded to provide these people with the full range of services required as their diseases wax and wane. Within this community the resident could move as his needs altered, from minimal support in lodge-style accomodation, to continual "heavy" nursing in a hospital setting providing long-term care. Such a concept accepts that, in the elderly, as they age, new diseases develop that are often difficult to diagnose, and that they require diagnostic and therapeutic services of much greater range than is presently considered adequate in most institutions providing long-term care.     

Recruiting new principals in general practice.

New principals in general practice who were appointed from 1981 to 1983 by two family practitioner committees, one in an inner city and one in a combination of an inner city and suburban area, were surveyed to find out if they were making improvements to primary medical care in their new practices. Most were not. The highly trained, motivated, young doctors on the whole had joined group practices and practices in health centres, where facilities tended to be good. Older doctors, who may not be as concerned with change, had joined smaller practices, in which it was difficult to make changes owing to, for example, the type of premises and costs.