Hospital

Running header: Simulation Review Paper Simulation Review Paper HSC/405 January 10, 2012 David Catoe Some point in the lives of many to all there are choices and decisions that are to be made. These individual choices and decisions we make help guide us to a certain destination or point in life where one would like to be. Not to say that reaching these set destinations will be easy to get too but they aren’t hard to accomplish with positive thinking and actions.

Financial and economic decisions in a business perspective are difficult and could feel like we are outside trying to look in at times when put in a tough position. My goal is to further review the financial account of a Cardiac care hospital to implant strategies to resolve some ongoing financial concerns. The cardiac care hospital in review is Elijah Hearts Center (EHC). EHC is facing many critical downfalls that are causing financial concerns to arise. Several of those downfalls are; Capital shortage, capital expansion, accounting systems and funding options.

Critical thinking, planning and leadership skills are needed to help figure out a new financial process for the organization and that is what will be given and shown in today’s paper. After analyzing and reviewing the current status of the company I must figure out what’s beneficial for the organization in regard to capital shortage. Considering my options I decided to reduce cost in funding by cutting down on staff. This decision I made was hard but considering the facts at hand I made this choice with an open mind and positive thinking.

The downsizing of staff has a slight effect on the hospital but nothing to damaging to their functions and operations. Not only have I decided to downsize staff but I have also chosen to change the skill mix. This will better help increase patient volumes and allow for the organization to solve the capital shortfall. As for my choice in loan options I went with loan option one vs. loan option two for a few different reasons. When picking which loan was best it was simple due to the given interest rates and monthly installments which were ery similar in pricing and percentage. However the concern was in that of loan option two. There was a prepayment limitation of 6 represented for loan option two which loan option one had a prepayment limitation of 0. The critical and visual aspect of what was provided helped me in my choices resulting in a solved problem with the capital storage at EHC. Moving on with all the advancements with technology it is considered by Mr. Sanchez to acquire a High-Speed CT Scanner, an X-Ray Machine and a New Ultrasound system.

These systems will provide more satisfying quality of care to EHC patients. My given option of ensuring the hospital has these equipment’s are either buying new or refurbished including loan options of a capital or operating lease. Starting with the high-speed CT scanner, after review of my options and looking over the new equipment details I have made a pick. I chose to have EHC invest into a refurbished machine. The choice was the correct one for EHC and its financial status.

It is shown that the price is cheaper which also technology for tis equipment is bond to change in a few years. The X-ray machine was tough to choose the right option but I chose a capital lease. The reason was the equipment is new and after the lease ends the company is given an option of purchasing the equipment or not. The capital lease also allows for EHC to claim ownership on their balance sheets within the provided lease period. Next is the Ultrasound system and my decision was between a capital lease and an operating lease.

After closer review I believe the operating lease was the best option. The equipment at this point is two years old and change with technology every few years. This would allow EHC to be current with technology and future options of keeping what machinery is needed or if not handing back outdated equipment. As with that said the operating lease is not treated as if its apart of the assets of the company but as a rental. The decisions that I have made were all correct and EHC is now doing better allowing for growths in profits and patient care.

Capital expansion is important for EHC so I chose HUD 242 Loan Insurance Program as the best fit. The company is due to have increased revenues within the seventh year of operating the new expansion which allows time for saving. HUD 242 loan insurance program best fits because interest payments begin 8 years after start date. This is perfect and falls in line with the company’s financial status, future revenue and help save funds. The decisions that I have made have proven to provide well for EHC and now the company is back on track and in good financial status.

The simulation that was provided served me with great hands on experience and knowledge of how critical thinking can benefit not only me but many others in different ways. The choices that I made just don’t happen in a matter of a minute but took a matter of time. Remember the turtle won the race being steady and careful and that’s how I feel I took this simulation review. I had to review and analyze arrears of different categories trying to figure out the best options for EHC. The financial aspect within a business such as EHC has many different bridges which some might be easy to cross while others are difficult.

This simulation did challenge me to consider not only what I wanted for the company but what was best compatible. I worked though the simulation with nervousness but then again I was confident and come out with correct choices. In Conclusion EHC has allowed me a great opportunity to help resolve their financial matters in which all worked out fine. The medical equipment that EHC has now allows for patient to wait in lesser lines for tests or treatments. By being moving more quickly and efficiently patients become less stress when in the hospital.

The downsizing of staff at this point was right but in the future more job opportunities will be open allowing for returning staff growth. Since EHC is moving ahead in a positive manner the organization set forth $75 million dollars for an expansion. The expansion called for a plan that HUD 242 loan insurance program could help with in funding. The choices made lead EHC to have good cash flow resulting in a steady income. Introduced were strategies for future and current use and the purpose is that bridges that one though couldn’t be crossed have been crossed through careful thought and analyzing.

Nowadays organizations determine the type 0f activities that should implemented within their business, through developing strategies that have activities that have more competitive advantage against those of their competitors, in order to earn as much revenue to the company as possible. Heathway Inc. It is a company that was founded in the year 1981 and was formerly referred to as American Health way Company.

It delivers its services to the customers through a phone, mail, internet and face to face interactions. The objectives’ of the company have been: To. Provide health and care solutions that would maintain and improve peoples’ lives and also reduce the cost incurred when patients are receiving treatment. Arrange programs that are meant to train people on issues such as: education, physical fitness, and health coaching, behavioural change, and medications and physicians plans on how to care for the sick.

Health way Inc. companys competitive advantage has been that of delivering health care support services through using methods such as: scalable state –of art call centers, medical information content, behavioural change processing techniques, strategic relationship, health provider networks and proprietary technologies.

The following resources are provided by the company to hospitals in order to enable them develop and operate an integrated system mean to serve patients accordingly; use of programs that are intended to help physicians identify patients diseases’ and methods that would be followed to monitor their treatments, information network services that would be connected to the hospitals and company in order to provide necessary services to its clients, and programs that would be used to monitor company’s performance against in terms of how its employees treat their patients.

Factors that have affected company competitive advantage strategies. Where a firm does not exploit the resources that are within their reach, then it’s considered to be competitively disadvantaged. These firms earn low-income for their organization. In case their competitors learn how to exploit the resources, they compete seriously with their company through direct duplication or substitution at no cost disadvantage (Barney, J. B. 1997). The executive of the Health way Inc.

company have been stating their interest of ensuring that the company would be in a position to compete effectively in the world market. They had also been requesting for access of confidential information about the company so as to improve on its performance for example its business plans, financial data, marketing programs, client information contracts and other trade secrets. The disclosure of this vital information would be competitive disadvantage to the company as some its executive could reveal company’s secret information to the public and this would jeopardize its operations.

The state and federal governments have been subjecting the Hospital and Managed Care Industries to various regulations, that have adversely affected the performance of the company, thus limited it to effectively deliver its services to its customers. Barneys VRIO framework consists of four indicators that show whether a company has potential of resources or capability to have the necessary competitive advantages over its competitors . The indicators include: value, rareness, inimitability and firms’ organizational structure to exploit a resource.

A firm’s resources and capability can be considered to be valuable, if a firm can exploit it environmental opportunities neutralize environmental threats and be in a position to avoid risks that are associated with reduced revenue. A resource is said to be rare if the number of firms that posses the valuable resource are less than those of other firms in the perfect competitive market. Imititability of a resource refers to the situations where a firm cannot duplicate or substitute it resources with those of its other competing firms (Barney, J. B. 1997).

APS Healthcare Company was founded in the year 1992 and has its headquarters in Silver Spring Marlyland. It provides specialty health care services to its customers such as offering customized integrated solutions of two product lines such as: care management and behavioral health services. It’s the only company that has extensive experience in health management employee assistance programs; informatics and quality review or oversight programs. It also develops products and services that enable its customers to meet current healthcare challenges such as rising healthcare costs and quality for its customers.

APS Healthcare Company and Heathway Inc. companys have been providing healthcare services to its customers at affordable rates. It is important for the management of both companies to fully the resources within the organization, as failure to do so would lead to low revenue and could possibly be out performed by their competitors.

References.

Form 10-Q for HEALTHWAYS, INC (-2008) http://72. 14. 205. 104/search? q=cache:LwrR7NV8-VgJ:biz. yahoo. com/e/080408/hway10-q.

html+Healthways,+Inc+resources+and+capabilities+that+serve+as+its+competitive+advantage&hl=en&ct=clnk&cd=1&gl=ke&client=firefox-a Website accessed on September 18 2008 Barney, J. B. (1997). Gaining and Sustaining Competitive Advantage. Don Mills, ON: Addison- Wesley Publishing Company. Health ways, Inc. Form 8-K Change of Control Agreement http://72. 14. 205. 104/search? q=cache:de0cFDlA_BgJ:www. secinfo. com/dwFSg. v2d. d. htm+Healthways,+Inc+competitive+disadvantage&hl=en&ct=clnk&cd=1&gl=ke&client=firefox-a Website accessed on September 18 2008 APS Healthcare Inc (2007)

1-a internal communication you would recommend to ensure that hand over process in hospital wards is made efficiently. Typically handover occurs at two levels. The first is the generic handover, completed by the whole team. This handover is often a summary in nature, with only generic client information included. This handover generally does not allow for provision of detailed profession specific information. The handover is typically provided to a central location, namely the receiving hospital or General Practitioner, with copies provided to relevant health services.

Breakdowns occur when this handover report is not distributed beyond the primary receiving service or professional. Consequently the AHP may not be aware of the handover, and the client will then fail to receive the required service. The second level of handover involves profession specific handover, where clinical handover is provided between individual health professionals at the referring and receiving site. There are limited standard templates or formats for this type of handover.

However, Department of Health (DoH) dietitians have recently collaborated to establish a standard client transfer summary sheet, which includes specific information when handing over within the same discipline. 5 A similar approach may be useful for other allied health professions OBJECTIVE: To describe and evaluate the PACT (Patient assessment, Assertive communication, Continuum of care, Teamwork with trust) Project, aimed at improving communication between hospital staff at handover. DESIGN, SETTING AND PARTICIPANTS: The PACT Project was conducted between April and December 2008 at a medium-sized private hospital in Victoria.

Action research was used to implement and monitor the project, with seven nurses acting as a critical reference group. Two communication tools were developed to standardise and facilitate shift-to-shift and nurse-to-doctor communication. Both tools used SBAR (situation, background, assessment, recommendation) principles. All nurses attended workshops on assertive communication strategies and focused clinical assessment of the deteriorating patient. Questionnaires were distributed to nurses and doctors at baseline, and post-implementation questionnaires and qualitative data were collected from nurses immediately after the project.

MAIN OUTCOME MEASURES: Nurses’ opinions of improvement in structure and content of handover; nurses’ confidence in their communication skills. RESULTS: At baseline, 85% of nurses believed communication needed improvement. After implementation, 68% of nurses believed handover had improved and 80% felt more confident when communicating with doctors. CONCLUSION: Early evidence supports the use of standardised communication tools for handover, together with specific training in assertive communication and patient assessment. Long-term evaluation of patient outcomes is needed.

Learning Team: Review Employees Files Shemika Williams, Maria Rios, Juakita Little, Yanelys Bobey HCS/341 October 8, 2012 Denise R. Holcomb Learning Team: Review Employees Files Bennie Bellamy: Had first occurrence of not taking patient’s vital signs on January 14thand 18th; then again on February 3rd and 6th. Bennie was talked to about this to see why he was not getting them and he stated that he did not have time. He had a year evaluation on May 20, 2003, in this he was rated a 1 for not following directions.

The following year May 21, 2004 Bennie had improved tremendously and got all 2’s on his yearly review and got a 3% raise versus the 2% he got the year before. And in the 3rd year May 20, 2005 he was still improving, so after the incidents in 2003 Bennie made great improvement after being reprimanded for not taking vitals and he has not had a problem since. On February 7, 1997 King Lovell put in an application to work at Patton – Fuller Community Hospital. On February 20, 1997, King Lovell received a letter from Patton – Fuller Community Hospital offering the RN Staff Nurse position.

King official start date was March 17, 1997. King Lovell received his annual employee evaluation in 1998 by the RN Staff Nurse. In his general evaluation different job specifics were evaluated. King in 12 different occasions was late and his dependability was unacceptable. For the first evaluation, King was informed to enroll in documentation classes that were going to start within that month due to needing some work. Another occasion there were two occasion were the wrong patient almost received wrong medicine.

Due to that incident, King was instructed to take a refresher course on medication administration that was being offered in July. On August 12, 1998, King Lovell had a corrective action form by human resource personnel. This was the first conference, King was continuing to be late to work, violating the attendance policy, receiving complaints about rude behavior towards the doctor, failed to sign, and continuing to have medication errors and not helping other co-workers. King Lovell received to verbal warnings on July 10 and August 2 but the problem is still occurring.

King was informed by management of the following: It is expected that you will be to work on time. It is expected that you will show courtesy to staff, physicians, patients and their families, rudeness will not be tolerated. It is expected that you will complete all entries in the patient’s record and that you will properly sign all notations at least once on each shift. King received another annual evaluation in 1999, where his attendance, attitude, and dependability were still lacking.

Due to lack of improvement over the last year’s evaluation, he was terminated. The files show due diligence was followed and given in different occasion by informing King Lovell to take additional classes to improve his job performance and was also given verbal warnings to improve, but the employee failed to show improvement and continued to lack. On March 10, 2007 Louise McFate applied for the position of Director of Infection Control at Patton-Fuller Community Hospital.

On May 9, 2007 Louise McFate received a hire Letter from PFCH offering her the position of Director of Infection Control with an official start date of July 11, 2007. On October 12, 2007, Louise McFate received her 90 day evaluation and received a rating of 2. 0 (Acceptable) in all areas. On January 14, 2008, McFate received her 6 months evaluation and again received a rating of 2. 0 in all areas. On July 14, 2008 McFate received her first annual review and received an improved overall score of 2. 17.

Unfortunately, on November 7, 2008 Louise McFate received a corrective action form stating that the Joint Commission issued a Request for Improvement on a needle disposal violation found during their visit. Although this is McFate’s first and only corrective action they did advise her to continue to establish procedures to prevent any further needle disposal violations. Louise McFate did not sign this corrective action form because she did not agree with it and believes she was singled out unfairly because Mr.

Adair from the joint Commission targeted her in retaliation after she declined a dinner invitation from him. This does require investigation from the organization to determine if indeed there was a violation made or if in fact it was in retaliation towards McFate. In the meanwhile, McFate needs to keep on her toes because this still goes in her file and there may not be a way to prove it. According to McFate there is no need for due diligence and they haven’t followed up with her progress or had any other incidents following this one.

On March 15, 1995 Alva Branham filled out an application for a Security Officer position for Patton-Fuller Community Hospital. Five days later, on March 20, 1995, Branham received a hire letter from Patton-Fuller Community Hospital. Branham official start date would be on April 3, 1995 as followed with orientation dates. Branham annual employee evaluation came up on April 9, 1996 by the Manager of Security. Over the years Branham annual employee evaluation scores has become decreased in some employee evaluations.

On one of Branham employee evaluations, it was commented by the Manager that Branham has misplaced company radios and also not being available for central control or other staff to get up with you especially in an emergency. Branham has also been missing 15 days of work over the past 8 ? months which is unacceptable and in violation of the attendance policy. On January 4, 1998, Branham had her first conference with the human resource department to go over the corrective action form.

Branham had her second conference of corrective action on February 20, 1998 which stated she didn’t use proper policy and procedures of logging patient items when a patient is discharged from the hospital. Branham was then notified again about all policy and procedures. After the last issue, Branham was then warned that if another occurrence happens within the next 3 months that further corrective action will be taken and lastly even termination. Reference University of Phoenix. (2011). Patton- Fuller Community Hospital Virtual Organization. Retrieved from: https://ecampus. phoenix. edu

The medical assistant profession offers numerous benefits. They include the opportunity to work in a helping profession, the potential for competitive wages and advancement, and generous benefit packages. Benefits for medical assistants vary based on the employer. According to the Bureau of Labor Statistics, medical assistants’ responsibilities vary, depending on the location and size of the practice and the practitioner’s specialty. One of the biggest benefits of working as a medical assistant is the reward of helping patients who are hurting or undergoing treatments o have a positive experience.

Medical assistants perform a wide variety of administrative and clinical tasks to keep the offices of physicians, podiatrists, chiropractors, and other health practitioners running smoothly. Another benefit of working as a medical assistant is a steady annual salary. The salary can range between $25,000 and $30,000 depending on the employer and type of medical assistant position. General assistants in surgical hospitals may earn more than assistants in outpatient care centers and smaller physician offices, according to the U.

S. Bureau of Labor Statistics. Many people use the medical assistant position to advance in the medical field. The U. S. Bureau of Labor Statistics explains that medical assistants can advance through working experience and additional training. This can include training to becoming a nurse or another type of health-care worker, or an office manager. A medical assistant may interact with many different patients during a single day. This can include patients of all ages, including the elderly and children.

Being familiar with different cultures and nationalities can help the medical assistant ake the experience more comfortable for patients of different backgrounds. Medical assistants also usually will get a set of paid benefits on the Job. This package can include a health plan, vision plan for glasses and contacts, dental insurance, general discounts in the medical office, paid vacation, pension and retirement plan, 401 k matching and free continuing education. All of these benefits may not be available in all workplaces. More benefits may be available to medical assistants working in hospitals.

Aims: This survey intended to find the prevalence of hypokalemia and its clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose.

Methods: This is a retrospective cohort survey of infirmary admittances for ague Datril overdose conducted over a period of 5 old ages from January 1, 2004 to December 31, 2008. Demographic informations and different types of psychiatric unwellness were compared between hypokalemic and normokalemic patients. Hypokalemia was predefined by a serum concentration & A ; lt ; 3.5 mmol/ L. SPSS 15 was used for informations analysis.

Consequences: Two hundred and eighty patients out of 305 admittances were studied. Hypokalemia was found in 63.6 % of patients with a higher prevalence in the presence of psychiatric unwellness ( 67.7 % ) . Hypokalemic patients were significantly associated with the presence of major depression ( P = 0.04 ) , adjustment upset ( P & A ; lt ; 0.001 ) , anxiousness ( P = 0.01 ) , and self-destructive efforts ( P = 0.04 ) .

Decision: Hypokalemia was common among patients with psychiatric unwellness and ague Datril overdose.

Cardinal Wordss: Acetaminophen ; Hypokalemia ; Overdose ; Potassium ; Psychiatric unwellness.

Introduction

Deliberate self-poisoning ( DSP ) is recognized as a major cause of self-destruction around the world.1 Acetaminophen ( Paracetamol ) is the most common drug employed in DSP in many states, 2, 3 including Malaysia.4 Despite first-class safety in curative doses of Datril ; it is besides one of the prima causes of terrible hepatic necrosis.5

Acetaminophen overdose may be accompanied by electrolyte perturbations including hypokalemia, and these appear to be independent of the hepatotoxic effects.6 These electrolyte alterations appear to be due to the addition in fractional nephritic elimination of K, but the implicit in cellular mechanisms by which Datril might change electrolyte conveyance are still unknown.6-9 In some instances, hypokalemia may be terrible, making a degree of 2.3 mmol/ L after reported consumption of 48 g of acetaminophen.8

Hypokalemia, an easy identifiable and clinically of import status in clinical scenes, has received small attending from research workers worldwide. Not merely is hypokalemia associated with frequent cardiac and neuromuscular complications, but its consequence on mental map may besides worsen psychiatric disturbances.10, 11 Both anxiety12 and intense exercise13 addition go arounding adrenaline, which induces a ?2 – receptor-mediated inflow of K into skeletal muscle.14 As this status may be similar to the acute psychotic province, it was hypothesized that the diminution in serum K concentration could be associated with the presence of psychiatric unwellness during Datril overdose.

To better our cognition of hypokalemia after acute Datril overdose, we carried out a five-year, hospital-based survey with the following aims: 1 ) to find the prevalence of hypokalemia in patients showing to infirmary after Datril overdose, and 2 ) to look into the clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose.

Methods

Settings and Study Design

This is an experimental retrospective instance reappraisal of all patients with acute Datril overdose admitted to a 1200-bed infirmary located in the Northern part of Malaysia. The infirmary provides wellness attention and exigency intervention for all unwellnesss and accidents. All facets of the survey protocol, including entree to and usage of the patients ‘ clinical information, were authorized by the local wellness governments before induction of this survey.

Participants and Data Collection

Datas were collected from January 1, 2004 to December 31, 2008. A computing machine generated list was obtained from the Hospital Record Office. We identified our instances harmonizing to the T-codes of the International Classification of Diseases-Tenth alteration ( ICD-10 ) . All patients with diagnostic codifications T 39.1 ( acetaminophen overdose ) were included in the survey.

Specially designed data-collection signifiers were used to roll up informations refering age, gender, fortunes of overdose ( inadvertent or suicidal ) , stated day of the month and clip of poisoning to cipher the latency clip ( the clip of consumption to the clip the patient was presented at the infirmary ) , measure of Datril ingested, GI decontamination such as tummy wash, research lab trials including serum Datril concentration, and serum K concentrations during the first twenty-four hours of admittance and after a lower limit of 4 hours of consumption. Data on serum Datril concentration measurings were obtained from the infirmary ‘s curative drug supervising laboratory service. In add-on, informations related to the presence of psychiatric unwellness were obtained. psychiatric unwellness was defined as the presence of any perturbation of emotional equilibrium, as manifested in maladaptive behaviour and impaired operation, caused by familial, physical, chemical, biological, psychological, or societal and cultural factors such as depression, anxiousness, accommodation upsets, unprompted behaviours and emphasis reactions, either emotional or behavioural ; these causes were noted by the infirmary psychiatric specialist study.

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Hypokalemia was defined as a serum K degree of less than 3.5 mmol/ L.11 Patients with hypokalemia were classified into three groups based on K degrees: ( 1 ) mild/ grade 1 ( 3.0 – 3.4 mmol/ L ) , ( 2 ) moderate/grade 2 ( 2.5 – 2.9 mmol/ L ) and, ( 3 ) severe/grade 3 ( & A ; lt ; 2.5 mmol/ L ) .15

The charts of all patients identified through the hunt were reviewed and the information collected. Charts were excluded from analysis for the undermentioned grounds: ( 1 ) baseline K concentrations were non measured, ( 2 ) if patients had taken acetaminophen but the cause of consumption was unknown or undetermined, ( 3 ) the clip of consumption was non known or ( 4 ) the patients were on regular prescribed drugs that lead to hypokalemia, such as Lasix, and ( 5 ) the patients were kids under 13 old ages of age. Charts of patients who had research lab trials at or more than 4 hours post-ingestion were extracted for farther analysis.

Statistical analysis

Datas were entered and analyzed utilizing the Statistical Package for Social Sciences plan version 15 ( SPSS ) . Data were expressed as average ± SD for uninterrupted variables and as frequence for categorical variables. The Chi square or Fischer ‘s exact trial, as appropriate, was used to prove the significance between categorical variables. The independent samples t-test was used to compare agencies of uninterrupted variables. Variables were tested for normalcy utilizing the Kolmogorov-Smirnov trial. Variables that were non usually distributed were expressed as a median ( lower – upper quartiles ) . Statistical significance was considered at P & A ; lt ; 0.05.

Consequences

Three hundred and five instances of Datril overdose were identified. Of these, 25 patients ( 8.2 % ) were excluded. Baseline K concentrations were non measured in eight patients, one patient was given furosemide at admittance, five patients were less than 13 old ages old, the cause of consumption was unknown or undetermined in 11 patients, and hence, the survey population consisted of 280 patients ( 45 male and 235 female patients with a average age of 23.4 ± 7.1, giving a female: male ratio of 5.22: 1 ) .

The bulk ( 72.1 % ) of instances of acetaminophen consumption were presented within eight hours. The average ( interquartile scope ) measure of Datril ingested was 10 g ( 6 – 15 g ) . Initial direction included tummy wash, which was performed in 181 ( 64.6 % ) instances. Activated wood coal was given while patients were in the Accident and Emergency section ; it was given as individual or multiple doses in 173 instances ( 61.8 % ) . Intravenous N-acetylcysteine ( NAC ) was given to 140 patients ( 50 % ) after Datril degrees were estimated. The average ( interquartile scope ) serum acetaminophen concentration was 55.6 mg/ L ( 14 – 120 mg/ L ) .

During the survey period, 63.6 % ( 178 patients ; 33 males and 145 females ) had K degrees of less than 3.5 mmol/ L. For the hypokalemic patients, the average K degree was 3.1 ± 0.26 mmol/ L, while that for the normokalemic patients was 3.76 ± 0.35 mmol/ L. Most of the patients ( 129 ) were in mild phase hypokalemia and 45 patients were in moderate phase hypokalemia. Few patients ( 4 ) were in terrible phase hypokalemia. Psychiatrically sick topics were found to hold hypokalemia, and the prevalence was higher than that in non-psychiatrically sick topics ( 67.7 % versus 43.8 % ; severally, P = 0.002 ) ( Figure 1 ) .

The most common clinical diagnosing among medically treated self-destruction triers was adjustment upset ( 45.7 % ) followed by unprompted behaviour ( 24.3 % ) , major depression ( 10.7 % ) , and anxiousness ( 2.1 % ) . Hypokalemia was significantly associated with the presence of major depression ( P = 0.04 ) , adjustment upset ( P & A ; lt ; 0.001 ) , anxiousness ( P = 0.01 ) , and self-destructive efforts ( P = 0.04 ) . However, normokalemia was significantly associated with unprompted behaviour ( P & A ; lt ; 0.001 ) , the absence of psychiatric unwellness ( P = 0.002 ) , and the presence of inadvertent overdose ( P = 0.04 ) ( Table 1 ) .

One hundred and twelve patients with adjustment upset and six patients with anxiousness were found to hold hypokalemia, and the prevalence of hypokalemia among these patients was higher than that in the overall survey population and in patients with other psychiatric upsets ( 100 % and 87.5 % , severally ) . Similarly, their average K degree was lower than that of the overall survey population ( 3.16 ± 0.41 and 3.2 ± 0.21 mmol/ L, severally ) ( Table 2 ) .

Eight hypokalemic patients ( 4.5 % ) were supplemented with unwritten K medicine, and 85 hypokalemic patients ( 47.8 % ) were treated with endovenous K chloride, and their K degrees were normalized in the following blood trial. Additionally, most of the treated patients ( 59 ) were in mild phase hypokalemia and 32 patients were in moderate phase hypokalemia. Few patients ( 2 ) were in terrible phase hypokalemia.

Discussion

This survey is the first of its sort in Malaysia and has been carried out to find the prevalence of hypokalemia in patients showing to infirmary after acute Datril overdose, and to look into the clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose in 280 patients with acute Datril overdose collected retrospectively from a records register.

In this survey hypokalemia was identified in 178 patients, and the prevalence of hypokalemia among hospitalized patients with acetaminophen overdose was 63.6 % . A old survey found that hypokalemia was common in medical inmate settings.16 About 20 % of shot, 10 % of myocardial infarction patients,17 21.2 % of psychiatric disorders,18 and about one tierce of ague Datril overdose patients suffered from hypokalemia.9 The high prevalence of hypokalemia after Datril overdose might be due to multiple hazard factors. The etiology of hypokalemia is complex. The degree of serum K depends on the balance between unwritten consumption, nephritic and GI losingss every bit good as the balance and motion between excess and intra-cellular compartments.11 A old survey found that 7.6 % of psychiatric patients had nutritionary jobs ; 19 unequal dietetic K consumption was comparatively rare unless day-to-day K consumption was less than 25 mmol.20

This survey found that it was the psychiatrically sick patients, instead than those patients with no psychiatric unwellness, who were more likely to develop hypokalemia. This determination is consistent with other published surveies that showed that hypokalemia was common among acute psychiatric inpatients.18, 21, 22 Adjustment upsets are frequently precipitated by emphasis reactions.23 For most people, emphasis is associated with higher hydrocortisone levels.24, 25 Previous surveies have suggested that high hydrocortisone degrees may be the chief cause of hypokalemia.26-28

In this survey, patients with anxiousness were enduring from a low mean K concentration and a high prevalence of hypokalemia. The exact mechanism was unsure. This determination is in understanding with another published survey that has shown little lessenings in serum K among 200 pre-operative patients who had an addition in anxiety.12 The account of this determination is that anxiousness increases the circulating adrenaline, 12 which induces a ?2 – receptor-mediated inflow of K into skeletal muscle.14

In the present survey, patients with major depression were enduring from a high prevalence of hypokalemia. This determination is similar to a old work that has shown patients with major depression had lower average serum K values and a higher incidence of hypokalemia than other upsets such as dysthymic upset and schizophrenic psychosis.18 This determination may be due to alterations in sympathomimetic thrust or in sensitiveness or denseness of the ?2-receptor. 18

Expected findings in our survey were the low incidence of hypokalemia in the patients with unprompted behaviour. These patients differed significantly from the other types of psychiatric unwellness and considered as a portion of the normal behavior.29 This is supported by findings that impulsivity is a type of human behaviour characterized by the disposition of an person to move on impulse instead than thought.30 It has been concluded in old survey that the reduced peripheral adrenaline degrees may be involved in pathophysiology of unprompted and overactive behaviors.31 This mechanism consequences in a reduced consumption of K by cells.

In add-on, this survey found that it was the self-destructive patients, instead than those with inadvertent overdose, who were more likely to develop hypokalemia. Attempted self-destruction is assumed to be a hyper-adrenergic state.18 A retrospective survey carried out on patients with psychiatric upsets concluded that important differences existed among the attempted self-destruction group with respect to hypokalemia.18 ?-adrenergic receptor stimulation causes hypokalemia in experimental animate beings and humans.32 There is small uncertainty that one of the mechanisms of hypokalemia is a beta 2-receptor-mediated inflow of K into skeletal musculus, induced by go arounding epinephrine.18, 33, 34 It has been demonstrated that adrenaline causes inordinate activation of the sodium/potassium-ATPase pump as a consequence of ?2-adrenergic receptor stimulation.14, 33 This mechanism consequences in an increased consumption of K by cells, taking to a lessening in serum K degrees. As the influence of the sympathomimetic system on serum K is found in many psychiatric state of affairss, 18, 21, 22, 35 it may explicate why a high prevalence of the patients included in our survey were presented with hypokalemia.

A high per centum of patients ( 47.7 % ) were still non being treated for low K degrees, seting their wellness in hazard. The common happening of hypokalemia in patients with acute Datrils overdose should alarm all clinicians to the importance of rectifying K loss, since most of the patients with an Datril overdose might hold received endovenous fluids or N-acetylcysteine in serum dextrose 5 % . However, this may hold altered serum K concentrations through endogenous insulin production induced by 5 % dextroglucose, ensuing in motion of K into the intracellular compartment. However, the extended usage of dextroglucose may expose the patients to higher hazards.

This survey is the first one of its type in Malaysia to look into the clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose. It is besides the first survey suggested that hypokalemia is related to psychiatric position after Datril overdose instead than the old studious that showed a dose-dependent relationship between autumn in serum K and serum Datril at presentation.6, 9 Our survey suffers from a few restrictions. First, farther hazard factors for hypokalemia were non taken into history in the analysis. A 2nd restriction is its retrospective nature and the deficiency of structured interview appraisal of the topics. Third, we can merely propose, instead than turn out, that the psychiatric province is responsible for the high happening of hypokalemia diagnosed in our population.

Decisions and recommendations

In decision, hypokalemia is extremely prevailing among psychiatrically sick patients and after acute Datril overdose. Therefore, monitoring of serum K concentration may be clinically of import on exigency admittance for all instances of ague Datril overdoses to forestall the effects of hypokalemia. Supplemental potassium disposal should be commenced every bit shortly as possible.

Recognitions: The writers would wish to thank the Universiti Sains Malaysia ( USM ) for the fiscal support provided for their research. The aid of the medical and record office staff is appreciatively acknowledged.

Conflict of involvements: We would wish to declare that there was no struggle of involvements in carry oning this research.

2. Public health care services in Hong Kong are to a great extent subsidized by the Government. However, with the ageing population and increasing medical costs, the public outgo on health care is estimated to increase at a much faster gait than the economic system in the coming old ages. With the existent figure that the public wellness outgo may turn from 2.9 % of in 2004 to 5.5 % of GDP by 2033, it is clear that the bing funding theoretical account is non sustainable. Auxiliary funding for health care is needed to supplement authorities ‘s outgo on health care services and for the long term sustainability of our health care system.

Themedical Charge In Hong Kong

3. The medical services in Hong Kong are provided by the public and private sector. The medical charge in Hong Kong can be divided into two facets: Government or Public Services and Private Service.

Government or Public Services

4. Government or Public Services are provided by the Department of Health ( DH ) and the Hospital Authority ( HA ) . Medical charges of common out-patient and in-patient interventions are as follow: intervention at a authorities general out-patient clinic costs $ 45 for Hong Kong occupants ; specializer clinic for audience costs $ 100 for the first attending, $ 60 for followup and $ 10 per drug point ; free intervention for instances of TB, leprosy, genital disease, and pregnancy and kid wellness counsel ; the admittance fee of in-patients in public infirmaries is $ 50, while busying acute beds and non-acute beds are charged $ 100 and $ 68 per twenty-four hours severally. The above charges may be waived if patient can non afford them.

5. Apart from general out-patient and in-patient services, the DH and the HA besides provide Chinese medical specialty services and Student Healthcare Services to the populace. Chinese Medicine Centres will bear down patients $ 120 with two doses of Chinese herb for a intervention per visit. Healthcare services for pupils are free of charge. Immunizations against 10 childhood infective diseases are free as good. Family be aftering service is besides available in maternal and child wellness Centres at a charge of $ 1 for every visit.

Private Servicess

6. Apart from authorities or public services, private medical services besides lead an of import function in Hong Kong ‘s health care system of. However, fees charged by private practicians vary and separate charges are frequently made. Patients are normally required to pay excess fees on services like research lab trials and X-ray scrutinies. With mention to the Report of Doctors ‘ Fees Survey 2010, the medians of some common out-patient and in-patient charges are as follow: audience fees for general patterns and specializer patterns are charged $ 200 and $ 575 severally ; day-to-day infirmary attending charge varies from $ 700 to $ 2,000, runing from remaining in ward to excellent individual suites ; surgical operations charges from $ 4,000 to $ 50,000, runing from degree 6 to level 1 surgeries. Other services such as vaccinums, composing medical studies and finishing insurance claim signifiers are charged individually and the fees varied.

Public Consultation

7. We have conducted two intensive public audiences in order to roll up sentiments from every sector of our society about the health care system.

8. The first phase audience showed that the biggest concerns of the populace were ageing population and increasing medical costs. A comprehensive reform was needed to run into both challenges. The populace expected that the health care reform will make a long-run sustainable system. The bulk of people agreed that the reform should concentrate on both service bringing and funding agreements. Among the six possible auxiliary funding options, the populace expressed divergent positions over the voluntary private wellness insurance and compulsory private wellness insurance. Some doubted the effectivity of the mandatary health care insurance and voted for the voluntary strategy.

9. In the 2nd phase audience, the demand of reform to our health care system is confirmed. The populace called for auxiliary health care funding, and wider picks and better protection in health care services. Therefore, the Government has formulated proposals to reform our health care system and modulating voluntary wellness insurance. The public came to a consensus that the manner of health care insurance should be voluntary. Based on the community ‘s positions, the public support is the chief support beginning for health care. Individualised health care and wider pick with quality confidence to suit everyone ‘s demand were preferred.

10. There was a widely shared concern over the sustainability and the security of the health care insurance system. The Government warrants that the strategy provides uninterrupted protection for participants into their older ages. Besides, the strategy is standardised and regulated by the Government, so as to safeguard the insured involvements harmonizing to the jurisprudence.

Proposed Voluntary Health Insurance System

11. Auxiliary funding is an indispensable constituent of the wellness attention financing reform. The signifier of auxiliary funding is an of import determination as it non merely influences the present community, but our future coevalss. Among the six possible auxiliary funding options, the Government decided to set forward the voluntary wellness insurance system as a portion of the wellness attention financing reform.

12. The proposed Health Protection Scheme ( HPS ) is a strategy that standardizes and regulates the voluntary private wellness insurance. Unlike other voluntary private wellness insurance in current market, insurances under the HPS is regulated to accept all endorsers and offer no exclusion of preexistent medical conditions with guaranteed reclamation for life. The pick of taking out insurance is voluntary either by persons or employers. The premium is based on the endorser ‘s pick and affordability. Subscribers will so hold a better entree to healthcare services under the HPS, and they would non detain primary attention until their unwellnesss worsen. Under the HPS, no one shall be left enduring from disease due to miss of fiscal agencies to pay for health care. Compared to the bing funding theoretical account, the voluntary wellness insurance system ensures effectual pooling and sharing of the health care hazards for persons.

13. Voluntary wellness insurance system aims at supplying the community with better picks for health care protection and heightening the longaˆ?term sustainability of our health care system. The insured are allowed to take both public and private health care services. Persons who can afford could utilize private health care on a sustained footing and even take top-up insurance programs to accommodate their ain demands. By promoting more people to take private health care services, the voluntary strategy can cut down the force per unit area on the public system. The public system could profit those who depend on the populace health care system by concentrating its resources on mark service countries and population groups, particularly low-income households, under-privileged groups and other needy.

14. The footings and definitions of the wellness insurance policy are standardized. Insurance companies take parting in the HPS are required to offer standard wellness insurance programs that follow the specified regulations and demands. However, the insurance companies are free to offer top-up benefits beyond the nucleus demands and specifications, so as to accommodate consumers ‘ demands. The HPS programs are required to supply coverage for hospital admittances or ambulatory processs, and its associate services like specialist outaˆ?patient audiences and probes, advanced diagnostic imagination. Chemotherapy or radiation therapy for malignant neoplastic disease is besides included in the nucleus demands of the program. However, primary attention, specializer services and diagnostic imagination in general, and pregnancy coverage are non included as the program ‘s nucleus demand. Insurance programs under the HPS are besides portable between insurance companies and on go forthing employment. The insured are able to maintain their wellness insurance policy for every bit long as they want, it will non be affected if they change occupations. Unlike the bing wellness insurance, insurance companies under the HPS could exchange their programs to another insurance company or go on their programs after retirement with no loss in coverage.

15. The Government has planned to utilize $ 50 billion financial modesty as fiscal inducements to back up the health care reform. Fiscal inducements are given to protect the bad persons, to offer premium price reduction for new endorsers and to lend to the salvaging constituent of the HPS programs.

Decision

16. The Government will widely publicise the voluntary wellness insurance and beg public support for our attempts to better the health care in Hong Kong. Any question on this brief may be addressed to Ms Li Wan-in, Assistant Secretary for Food and Health Bureau on 3150 8494.