The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

I first read Davidson 30 years ago: at that time it was already in its 5th edition. A brief comparison shows that it then contained about 440,000 words in 1,100 pages: the current edition has compressed 625,000 words into 800 pages. I think I bought it as a student because it was cheap: but also because it seemed to be comprehensive and straightforward, and I have used it as a basis for my medical knowledge ever since. So I miss some of the old pictures of the acute skin rashes such as scarlet fever: in fact infectious disease has been transferred to the back and genetic factors take the first chapters. But careful linguistic comparison will still uncover the old phrases which some of us know by heart-there are minor changes such as 'alarming reactions to intravenous iron are uncommon, but have occasionally been noted', which becomes 'alarming systemic anaphyllactic reactions can occur'. Sir Stanley Davidson made 'no attempt to describe every rare disease or syndrome, but devoted most of the space available to those disorders most commonly encountered in practice'. I have grown up with successive editions, and have gradually come to appreciate the problems of the authors in the compression of knowledge. Having got to know many of them personally as real people rather than as names I can still recommend the book. It is the essential starting point for the study of internal medicine and for many doctors will remain their base reference work. The present editors have kept up-to-date and been prepared to prune the dead wood. There are many competitors in the market, and the publishers must take care with layout and illustration, although Davidson is still the best value for money. I will continue to recommend it to my clinical students: they will need to read it and know it to pass final MB. Postgraduates will need to remember the facts, but also to be able to place them in a broader perspective. The older consultant will still happily read it, and to get to know the authors themselves is really to complete your medical education. Dr John Macleod and his team have successfully kept alive the primary objective 'to provide a rational and easily comprehensible basis for the practice of medicine'. The book is economical in price and compact in size, but still contains the essential truths for the practice of good medicine.

Davidson's Principles and Practice of Medicine

OBJECTIVE
To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.


DESIGN
Case-control and cohort studies of surgical intensive care unit (SICU) patients.


SETTING
A university-affiliated Veterans Affairs medical center.


PATIENTS
Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).


MEASUREMENTS
CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.


RESULTS
When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence interval, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the outbreak period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.


CONCLUSIONS
Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.

The role of understaffing in central venous catheter-associated bloodstream infections [see comments]

Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralized health systems usually have a broadened ‘decision space’ that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. We conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. Overall, 69% of the respondents reported to have turnover intentions. Motivation (OR = 0.74, 95% CI: 0.60 to 0.92) and job satisfaction (OR = 0.74, 95% CI: 0.57 to 0.96) were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development (OR = 0.56, 95% CI: 0.36 to 0.86), workload (OR = 0.58, 95% CI: 0.34 to 0.99), management (OR = 0.51. 95% CI: 0.30 to 0.84), organizational commitment (OR = 0.36, 95% CI: 0.19 to 0.66), and burnout (OR = 0.59, 95% CI: 0.39 to 0.91). Our findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.

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The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study

Background : Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. Objective : The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Methods : We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predic...

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Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa

BACKGROUND: Human power is the back bone for the provision of quality health care for the population. High level of professional satisfaction among health workers earns high dividends such as higher worker force retention and patients satisfaction. There is limited amount of literature in the areas related to factors affecting job satisfaction and retention. The objective of this study was to determine the job satisfaction of health professionals working in Jimma University Specialized Hospital and factors affecting their level of satisfaction. METHOD: A cross-sectional study was conducted to determine the level and factors affecting job satisfaction and retention of health professionals working in Jimma University Specialized Hospital. The study was conducted from March to October 2009 and included all categories of health professionals working in the hospital during the study period. Data was collected using self administered questionnaire and focus group discussion. After the data was collected, it was entered into a computer and analyzed using SPSS version16.0 windows statistical software. Chi-square tests were made to evaluate association of different variables with job satisfaction, and P-value < 0.05, at 95% CI was taken as cut off point for statistical significance. RESULTS: A total of 145 health professionals have responded for the self administered questionnaire. The result showed that sixty seven (46.2%) of the health workers are dissatisfied with their job. The major reasons reported for their dissatisfaction were lack of motivation, inadequate salary, insufficient training opportunities and inadequate number of human resources. Only sixty (41.4%) health professionals were satisfied with their job, the major reasons given were getting satisfaction from helping others and professional gratification. Suggestion given by the respondents to improve job satisfaction and increase retention rate included motivation of staff through different incentives such us bonus, house allowance, salary increment, establishing good administration management system and improving hospital facilities and infrastructure. CONCLUSION: Job satisfaction of health professionals in Jimma University Specialized Hospital was found to be low. Responsible bodies should devise mechanisms to improve job satisfaction and retention of health professional so as to improve the healthcare services of the hospital. KEYWORDS: Job satisfaction, Health Workers, Jimma University Specialized Hospital

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Job Satisfaction and Its Determinants among Health Workers in Jimma University Specialized Hospital, Southwest Ethiopia

This study was conducted with the aim of assessing the treatment outcomes of patients admitted to medical wards at a university hospital in Ethiopia with a diagnosis of community-acquired pneumonia from March 1, 2008 to February 28, 2009. A retrospective cross-sectional study was conducted from May 14 to 19, 2009. Hospital charts of 104 patients admitted to medical wards at Jimma University Specialized Hospital, Jimma, Ethiopia, with a diagnosis of community-acquired pneumonia were reviewed. The male-to-female ratio was 2.5 to 1, the mean duration of hospital stay was 11.49 days, and crystalline penicillin alone was used in 67.3% of cases. Ceftriaxone was the most common second-line antibiotic. There were 26.7% of patients who were treated according to Ethiopian national treatment guidelines. The overall mortality rate was 20.2%. Patient age older than 65 years, respiratory rate greater than 30 breaths per minute, and comorbid tuberculosis were associated with poor treatment outcomes. A high death ratio was observed in the present study. Proper adherence to standard treatment guidelines and better care for risk groups are recommended.

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Treatment and Outcomes of Community-Acquired Pneumonia in Hospitalized Patients: The Case of Jimma University Specialized Hospital

Investigation of dysentery outbreak and its causes, jimma city, southwest ethiopia

Background and Aims: Although bloody dysentery commonly caused by Shigella is wide spread globally and occurs in outbreaks, epidemiological studies regarding shigellosis are rare in Ethiopia in general and none for Jimma City. Investigation team aimed to confirm, control and prevent further spread of suspected dysentery epidemic was formed after several cases visited Jimma University Specialized Hospital and private clinics in the city on 12th December 2008. Methods: A data collection format containing address, demographic variables, risk factors and laboratory findings was prepared and distributed to all health facilities in Jimma City. Stool samples were collected from suspected cases and cultured to identify the causative organism and determine its antimicrobial susceptibility. Inspection of facilities and collection of water samples for bacteriological analyses was done from suspected sources. Data was analyzed using SPSS version 16 and results were presented in tables and figures. Results: A total of 566 cases were seen in different health facilities in Jimma City in a period 29 days. Out of this, 299 (52.8%) were Jimma University students and 56 (11.7%) were residents of Jimma. Shigella flexinneri was identified from some of the stool specimens and was sensitive to most antimicrobial agents. There was a sudden increase in the number of cases starting from December 9, 2008 with a peak (161 cases) on December 12, 2008. The epidemic curve then fell down slowly with one small peak during the decline. 344 (60.8%) of the cases reported that they had consumed food prepared by Mars food factory located in the town. Conclusions: There was dysentery epidemic from December 12-22, 2008 due to Shigella flexinneri most likely caused by food contamination at Mars food factory. To prevent future occurrence, regular health education and screening of food handlers with strong supervision of food establishments should be undertaken. References: Genobile D, Gaston J, Tallis GF, Gregory JE, Griffith JM, Valcanis M et al (2004). An outbreak of shigellosis in a child care centre. Commun Dis Intel ;28 (2)

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Alemshet Yami

Papers

Job Satisfaction and Its Determinants among Health Workers in Jimma University Specialized Hospital, Southwest Ethiopia

Treatment and Outcomes of Community-Acquired Pneumonia in Hospitalized Patients: The Case of Jimma University Specialized Hospital

Investigation of dysentery outbreak and its causes, jimma city, southwest ethiopia

nvestigation of Dysentery Outbreak and its causes, Jimma City, Southwest Ethiopia