On the front lines for women’s health care.” If you’re a woman, this is the place for you. Here you’ll be able to find everything you need about sexual health, gynecology, pregnancy, maternity, and cosmetic surgery.



The importance of Medical Check-Ups

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 26-05-2015

0

post chequeos

Prevention is better than cure for all types of diseases. Therefore we would like to stress the importance of undergoing routine annual check-ups. These checks enable us to make an effective early diagnosis, and furthermore, are the best possible method of monitoring a patients health.

With this in mind, Vithas Xanit has developed a Unit specifically for Medical Checks. Doctors are able to offer different types of explorations according to the patients requirements. These can range from a global evaluation of their health, to the more specific “Premium”, “Special” and “Magnum” check-ups on offer, which are aimed at the early treatment and prevention of problems which could possibly arise in the future. We offer our patients the best medical professionals, the most advanced technology, and one to one personal care.

The medical check-up is an evaluation carried out on those persons with no symptoms in order to detect any risk factors which allow doctors to prevent and to diagnose problems early on. The age and the frequency with which these are carried out depends upon individual factors such as family history, age risk factors, and whether or not the patient has suffered from a previous condition.

Within these medical checks patients are able to undergo complementary tests which are related to the detection of pathological risks discovered through the patients medical history and physical examination. As an example we have listed some of the most prevalent pathologies amongst the general population, as well as the complementary tests which are available depending on whether or not there are risk factors present:

  • Abdominal Aortic Aneurysm: It is recommended that males between the ages of 65-75 with a history of smoking have an abdominal ultrasound.
  • Breast Cancer: It is recommended that women between the ages of 50-74 have a mammogram every two years. In those women younger than 50 years of age specialists take into consideration risk factors and whether or not there is a family history of breast cancer.
  • Cervical Cancer: It is recommended that women between the ages of 21-65 years, with no symptoms, have a cervical smear test every three years.
  • Colorectal cancer: In those patients with no previous history of colorectal pathologies, and aged between 50-75 years, it is recommended that s faecal occult blood test is carried out annually, or a rectosigmoidoscopy and a faecal occult blood test every 5 years, as well as a colonoscopy every 10 years.
  • Pulmonary cancer: In adults between the ages of 55-85 with no symptoms who have a history of smoking more than 30 packets a year, and whom have actively smoked or given up within the last 15 years, it is recommended that a low radiation CT thoracic scan is carried out annually.
  • High Blood Pressure: A check is carried out in adults every two years if the blood pressure is higher than 120/80, and annually if it is 12-139/80-89
  • Mellitus Diabetes: A check is carried out in those patients with no other symptoms if: their blood pressure is higher than 135/85, their body mass index (BMI) is higher than 25 Kg/m2, and if other risk factors exist (physical inactivity, family history….)
  • HCV Infection: Checks are carried out on patients with risk factors, and those adults born between 1945 y 1965.
  • Lipid Alterations: Checks are carried out on males older than 35 years of age, and women older than 45. In the case of the following risk factors, males older than 20 years, and women older than 35 years are checked: Coronary disease, (family history of early coronary disease, diabetes, obesity, high blood pressure….).
  • Osteoporosis: A bone density test is carried out on women older than 65 years who have not had a previous fracture or any secondary problems related to osteoporosis. Tests are carried out on women younger than 65 years with risk factors.

When patients arrive for their appointment with the doctor, two of their greatest fears are that they will have high cholesterol or high sugar levels. The objective of the levels of LDL colesterol (ColLDL) vary in relation to the patients cardiocascular risk factors (CVRF). In the case of those patients with a history of coronary disease or Mellitus Diabetes the target level of ColLDL is <70 mg/dL, whilst in the case of those patients with no, or only one CVRF the control is not so strict, and the target figure is  ColLDL < 160 mg/dL

In those patients with no symptoms the glycemia reading on an empty stomach should be less than 100 mg/dL. Levels of between 100-126 mg/dL correspond to a elevated glycemia reading (a condition also known as prediabetes), therefore it is vital to monitor these patients before the possible onset of Mellitus Diabetes in the future. Levels of glycemia which are higher than 126 mg/dL in more than two determinants, or glycemia levels higher than 200 mg/dL at any given time of the day, accompanied by cardinal symptoms, are diagnosed as  Mellitus Diabetes.

It is also very important to monitor our eyesight, and to have an ocular check-up at least once a year. The visual acuity (VA) is the capacity to read letters or to recognise figures from a normal established distance. These are some of the most important parameters when evaluating ocular health. Their values are expressed in fractions which are considered to be a normal value in those where the VA is equal to 1,0. In the case of a result inferior to this fugure, the patient should complete an ophthalmological study in order to identify the cause of this reading.

Dr. Raquel Martín

Medical Check-up Coordinator

 

How to deal with hay fever

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0


alergia en primavera

 

This year the springtime shall be particularly difficult for those people in the Malaga province suffering from hay fever caused by grass pollen and olive trees. More than 200.000 Malaga inhabitants suffer from this spring related condition which is caused by high levels of pollen.

According to statistics from The Spanish Society for Clinical Allergology and Immunology (SEAIC), in Andalucia it is estimated that the readings in the air from grass pollen shall be some 6.900 grains/m3. This is considered to be intense pollination.  There shall also be elevated levels of pollen from olive trees, which will be higher than those registered in 2014.  Although inland areas are the worst affected, people in coastal areas can also suffer the consequences of  elevated levels of pollen, to which they have grown accustomed to over the past years.

On the other hand, forecasts from the State Meteorological Agency indicate that we shall have a hot spring with lower than average rainfall. This shall result in a higher quantity of pollen in the atmosphere which will remain elevated until well into the month of June.

Specialists from the Allergology Department at Vithas Xanit International Hospital offer some recommendations to alleviate the symptoms of hay fever:

Avoid spending time in the countryside, or in areas with abundant vegetation, particularly on windy days.

If it is necessary to travel, ensure that the car windows are closed, and that anti-pollen filters are fitted into the car’s ventilation system.

  • Sleep with the windows closed.
  • Avoid exposure to irritants such as smoke, dust, strong odours, cold dry air, sprays, gases or vapours.
  • Avoid extreme changes in temperature.

 

When treating allergies, immunotherapy or anti-allergy vaccinations are considered to be a necessary therapeutic tool, as this is the only form of treatment  which can modify the natural evolution of the allergy pathology. Within our Clinical Allergology and Immunology Unit we offer patients the latest diagnostic techniques and allergological and immunological  treatments, such as vaccinations.

The Allergology Unit at the Hospital offers both adult and paedeatric care, with expert staff who are well-reputed in this sector. Last year a High Resolution Unit for Food Allergies and Infantile Respiratory Allergies  was established.  This incorporates the latest techniques in specific oral immunotherapy and molecular diagnosis using foods (SOIT), offering the most specialised treatments  in food allergy processes and/or  respiratory processes which affect the young.

Dr. Clara Isabel Pérez

Head of the Clinical Allergology and Immunology Unit

Improving the quality of life for patients with Parkinson’s Disease

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

Dr. V'ictor Campos1

 

Next Saturday, is World Parkinson’s Day. Therefore we have asked Dr. Victor Campos to give us some information about this particular disease, to discuss his role in the hospital, and most importantly, to inform us about improving the quality of life for patients with this pathology.

What exactly is Parkinson’s Disease? 

This disease is considered to be a result of the degenerative process of structures in the brain (neurodegeneration). This begins in the brain stem and over the course of time extends into the entire brain. This pathology affects the patient’s movement (persons with this condition move in a much slower and rigid manner, and occasionally tremble). The disease also affect’s other vegetative functions (digestive, urinary, vascular), as well as affective, cognitive and conduct impairment.

What are the first warning signs of the disease?

The first symptoms of this disease are motor related: Slowness of movement and muscular rigidness. In 50% of cases patients also have a resting tremor. As the disease becomes more advanced other symptoms begin to appear (constipation, vegetative alternations, urinary problems, pain, etc) which are categorised as non motor symptoms. Curiously, when we ask the patients in detail, we find out that many of them actually had these symptoms at the onset of the disease, but they assumed that they were due to other medical problems, and only related them to Parkinson’s once the motor symptoms had appeared.

Within the Neurosciences Department we have a Movement Disorders Unit. How is the illness dealt with from this department?  

Our professionals have a multidisciplinary approach to this pathology regarding basic neurological and psychological aspects, neuropsycological aspects, psychiatry and neurorehabilitation. We are involved in the investigation of important aspects related to the quality of life of patients and carers thanks to agreements with other national and Andaluz centers.

The relationship between the Department and the Parkinson’s Patients Association is very important to us, as is the release of information related to this problem on the hospital’s social networking sites.

What is the priority of the medical team when treating a patient? 

The priority of our medical team is to improve the quality of life. There are multiple strategies in place in order to achieve this goal. Our priority is to supply honest information, which is as concise as possible, and best suit’s the patient and their environment. We are able to offer the patient the most advanced treatment techniques in our hospital.

What are the most effective forms of treatment for these symptoms?

There exist multiple strategies for controlling and improving the fundamental motor symptoms which are based on the supplementation of the neurotransmitter deficiency called dopamina in the brain.  Levodopa is the most widely used medication,  which the brain converts directly to dopamina once it has been metabolised. There are also other drugs with similar effects (called “Dopamine agonists”), or Rasagilina, a medication with neuroprotective properties. As the disease progresses different strategies are incorporated, which focus on achieving more continual brain stimulation. There also exist surgical methods, such as deep brain stimulation, which has achieved very positive results. In spite of these advancements, to date there is no possibility of completing curing this disease.

How can families help the patient and how can they be helped themselves?

Within our criteria it is essential that there is a constant and fluid relationship with the medical professional in charge of the patient regarding the management of the treatment, and informing the patient and their carers about the possible problems that could arise and the possible solutions to these. In a technologically modern society the professional also know’s how to ‘’redirect’’ patients to truthful and contrasting scientific information  on the internet. Finally, the patient and Family Associations have the capacity to offer physical, social and work related activites, which are not usually covered by the official Healthcare bodies. These are complementary and very useful.

 

Dr. Víctor Campos

Head of the Neurosciences Department

 

II Happiness Vithas Xanit

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

post-xanit

I am very happy that we were able to celebrate International Happiness Day, and for the second consecutive year ‘Happyness Vithas Xanit’.

On the 28th of June 2012 the Secretary General of the World Health Organisation, Ban ki-moon  proclaimed this day as International Happiness Day. Butan, a country recognised for supreme national happiness requested that the 20th of March be recognised as ‘’International Happiness Day’’ whereby people can recognise the relevance of happiness and wellbeing as universal aspirations, and their importance upon human beings, as well as their inclusion in government policies.

This initiative took place for the first time in 2013, and this year we celebrated Happyness Vithas Xanit II.

I firmly believe that organisations are places for both personal and professional growth. We have created a hospital model based on quality and staff. We have a shared culture, where we can choose to be happy.

In reality Vithas Xanit is a happily intelligent organisation because the strength of our business model has developed as a result of the interaction from all of our professionals, and has enabled us to achieve extraordinary results. Today, Vithas Xanit is a success story.

Although happiness is a personal choice, companies should create an open  environment where staff are able to participate, thus stimulating them to be happy. This is beneficial to everyone, when you are happy in what you do you are a better professional, and thus in turn the company achieves better results.

To celebrate Vithas Happyness Xanit II we organised a programme which included laughter and music therapy work shops, a flashmob, a happiness karaoke, and a concert performed by Russian pianist, Yuri Rozum, who has received accolades in Russia. He is a soloist in the state philhamonic orchestra in Moscow, and is president of the “Yuri Rozum’’ international charitable organisation

Furthermore, throughout the course of the day more than 30 professionals from the hospital donated hugs.

Do you know that when we hug, and are hugged, that this activates all of the organs in the human body?: the heart, the brain, our skin, and our endocrine system. When we hug, we are inclined to awaken the inner child that we have inside us………Hug therapy!!!!

 

Mercedes Mengíbar

Managing Director of Vithas Xanit International Hospital

Halitosis or bad breath: the cause of social, personal, and professional rejection

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

bucodental

Halitosis or bad breath is an unpleasant smell from the oral cavity which affects up to 50% of the adult population at some point in their lives. Halitosis is not an illness; it is a problem which has a dramatic social impact on the high percentage of people that are afflicted. The condition affects 25-30% of people and is a symptom of oral and extra-oral physiological processes or pathologies, or a result of inadequate oral higiene. The condition can also develop due to the consumption of certain foods, alcohol, and smoking.

The majority of medical and scientific studies into halitosis estimate that in 90% of cases the cause originates in the mouth, and in a high percentage of cases on the tongue. Normally the oral cavity house’s large quantities of bacteria, many of which are responsable for producing volatile sulfurous compounds (VSC). which have an unpleasant smell. The rest of the cases originate from problems connected to the respiratory system, and from illnesses such as kidney diseases, diabetes, hepatic dysfunction and cancer.

Almost everyone, at some moment in their lives, will suffer from transitory halitosis. This can be present in the morning when waking up, after having eaten food, after drinking alcoholic beverages, smoking, or taking certain medication;  However this can also occur when the person has a cold, has not eaten, or is on a diet. Although halitosis can either be present in a transitory form or permanently in a cronic form, the emphasis in the past has been on masking the problem, instead of finding a permanent solution. There are also people who do not suffer from the problem, but who consume foods which provoke it. Halitophobia is considered as a pyschological disorder whereby the patient convinces themselves that they have halitosis when in actual fact, they do not.

There are various ways of detecting halitosis, and there are two principal methods used to evaluate the bad odour in the mouth: organoleptic method (smell detected by the examiner) or the instrumental method (Chromatography of gases). This method identifies and quantifies the individual components of the exhaled air. Hydrogen sulfide and Methylmercaptan account for approximately 50% of the volatile sulfurous compounds detectable in exhaled air, and are the principle cause of the bad odour.

In the majority of cases this pathology can be cured with treatments which attack the origin of the bad odour. Establishing a correct diagnosis and determining if the origin of the condition is oral or not, is the main objective of the Odontology Department at Vithas Xanit International Hospital. In this way we are able to adapt the treatment to each patient’s individual requirements. However, it is vital that we educate the patient as to the importance of maintaining good oral higiene, in order to successfully treat the condition.

Therefore, a key element is mechanical strenghtening for the removal of dental plaque by brushing, dental floss and by using interproximal brushes. Chemical plaque control can be used with mouthwashes, toothpastes and antimicrobial agents. We offer our patients information on how to keep their prosthesis and removable apparatus clean, and insist that the patient controls and give’s up their smoking habit. We also inform patients about any vital dietary modifications in order to control bad breath.

 

Dr. Alberto Cuevas Millán

Head of the Odontology Department at  Vithas Xanit International Hospital

NEW UNIT FOR RARE AND SYSTEMATIC DISEASES

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

salud-mental

As Worldwide Rare Diseases Day was cekebrated recently, we have taken this opportunity to introduce the New Systematic and Rare Diseases Unit  at Vithas Xanit International Hospital.  This Unit has been incorporated within the Internal Medicine Department, and care’s for those patients suffering from the less common diseases, which require specialised combined care in order to treat them.

For a disease to be considered  rare, it should affect a limited number of people, 1 in every 2000 persons. Nowadays it is estimated that there are between 5000 and 7000 rare diseases in existance, all of which are different.  These conditions affect a patient’s physical capabilities, mental capacity, and also their sensory qualities and behaviour. These diseases are characterised by inter and intra-individual variations. This means that there can be many manifestations in the same patient, and furthermore, that these can vary in different patients.

Amyotrophic lateral Sclerosis, Tourettes Syndrome, Inperfect osteogenesis, and Pompe Disease are just a few examples of diseases which are considered to be rare. The main problems for persons suffering from these conditions are:

  • Lack of correct diagnosis.
  • Lack of information.
  • Lack of scientific knowledge.
  • Problems with social integration at school/ in the workplace.
  • The few drugs in existence are expensive.
  • Lack of available care.

Those conditions which are Systematic Diseases correspond to a group of heterogenic diseases, whose cause is unknown. These diseases create alterations in the regulation of the immune system. They share many similar aspects, but manifest themselves in different ways.

These pathologies can affect different organs and systems within the body, which is why they are called systematic. In the majority of cases they can slightly or severely affect all of the organs in the human body. On many occasions their diagnosis requires an exhaustive and global evaluation.

At the moment there is no cure for systematic diseases. The treatment consists of controlling the diseases’s manifestations which produce pain and inflammation. These pathologies are treated with immune suppressant drugs enabling specialists to stabilise the  immune system in a dormant state in order that it doesn’t fight against our own body.

At Vithas Xanit International Hospital we decided to set up this new unit in order to improve the care and attention given to patients with these types of diseases. Above all, to help them in any way that we can, and to offer the most precise possible diagnosis.

Dr. Tamara Moreno and Dr. Patricia Gallardo

Heads of the Rare and Sysematic Diseases Unit at Vithas Xanit International Hospital

 

KEY INFORMATION ABOUT CROHN’S DISEASE

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

post-crohn

The European Commission for Public Health defines rare conditions as those “diseases, including those of genetic origin, which are cronically debilitating or potentially life threatening, which affect 1 in 2.000 persons, and which require special treatment to combat them’’. Today we would like to offer key information about one of these conditions: Crohns Disease

Crohns Disease is a disease characterised by cronic inflammation of the intestines. There are between 50 and 200 cases in every 100.000 inhabitants suffering from the condition, and it’s cause is unknown. The theory is that there exist a series of inicial unknown factors which trigger changes in the immune system. This modified response depends on genetic factors, therefore not everyone will go on to develop the disease.

Crohn’s Disease doesn’t tend to have continual symptoms, and tend’s to manifest itself in the form of break-out’s characterised by diarrhoea, abdominal pain and a high fever. Apart from these symptoms there are also extra intestinal manifestations due to inflammation of other organs such as the eyes, the bones, or the skin.

There is no way of preventing the disease, and no vaccinations available against it. Even though there is no cure for the disease there exist treatments which can alleviate the symptoms. Given that the disease present’s itself in the form of break-out’s we should differentiate between the two scenarios: the break-out and remission.

During the break-out periods medication is used to reduce the inflammation. As a rule aminosalicylates and topical corticosteroids are used which have a superficial effect on the digestive tract. In cases of more severe break-out’s treatments are used which neutralise the modified immune response. These include intravenous steroids, immune suppressents, and new monocional antibodies. These are antibodies designed by genetic engineering in order to neutralise the antibodies which have a modified response. Also, in some case, we have to use antibiotics. If we are not able to reduce the inflammation with these drugs, it may be necessary to have surgery to remove the affected area. During the remission phase the treatment is maintained depending on how the patient’s break-out was treated. (Even though the patient does not suffer any symptoms, the pathology continues to exist).

At Vithas Xanit International Hospital we have a Digestive Department which work’s with all facets of this speciality. Patient’s are diagnosed in the shortest possible time, and are effectively treated for different illnesses. We have the most highly trained professionals in Spain, and prestigeous specialists from the United States and Japan.  Early prevention and diagnosis in this area is crucial, and for this reason we have set up a programme focusing on the early diagnosis of colorectal cancer.

 

                     Dr. Sánchez Yagüe

Head of the Digestive Department at Vithas Xanit International Hospital

ABOUT THE APHERESIS UNIT

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

Dr.-Rafael-Franquelo1

At Vithas Xanit International Hospital we are fortunate to have the only private Apheresis Unit In Andalucia. This is a system which reduces up to 70% of LDL cholesterol in patients with inherited hypercholesterolemia, a genetic disorder which affects some 100.000 persons in Spain.

Inherited hypercholesterolemia is a genetic condition whereby the liver does not eliminate the necessary amount of LDL colesterol (Low density lypoproteins or more commonly known, bad colesterol). The excess amounts of this are deposited on the internal wall of the arteries  (endotelio). By using this system it is possible to eliminate the atherogenic lipoproteins from the blood. (Total cholesterol, low density LDL – lipoproteins and Lp(a) -lipoproteín [a]-), and to conserve the rest of the components. In this way vascular damage due to the hypercholesterolemia  is reduced, which if left untreated can result in patients suffering a heart attack, a stroke or peripheral arthropathies, amongst other things.

The unit has a specialised machine called a apheresis monitor which operates through an external system to circulate the blood, remove it, and replace it after the treatment. This system is similar to hemodialysis. The procedure takes a relatively small amount of time, and it is necessary to have a session every 3-4 weeks in order to maintain the reduced levels of cholesterol within an adequate range.

This treatment is suitable for children from the age of 6-7 years (in the case of homozygotic forms where both parents carry the gene for this illness), and also for pregnant women. The treatment can mean significant improvements for patients. This is because, unlike others,  it reduces the levels of cholesterol. Within a few months the treatment help’s the patient to reduce the deposits of cholesterol in the arteries, at the same time reducing the damage in the vascular territories where these deposits impide sufficient circulation to the organs. This reduction means that the patient begins to recuperate on all levels: increased tolerance and capacity to exercise in coronary patients, disappearance or improvement of pain for patients with peripheral arteriopathy etc. It also impacts on the state of mind of the patient, and can prolong their lifespan.

This new system is, without doubt, a great advancement in the treatment of this pathology, and has been available at the hospital for a couple of months. We are able to offer this to all our patients, and for the professionals at Vithas Xanit International it is of the upmost importance to be able to offer the latest technologies, along with personalised care….

For more information please visit the following link: http://www.xanit.es/es/content/unidad-af%C3%A9resis-xanit

Dr. Rafael Franquelo

Head of the Nephrology Department at Vithas Xanit International Hospital

How to recharge your batteries after the Christmas holidays

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 22-05-2015

0

post-sueño

 

Returning to a normal routine after the Christmas Holidays is not always easy, and can affect our sleeping patterns. On our blog today we are talking to Dr. González, a specialist Neuro physiologist at Vithas Xanit International Hospital. Dr. González will be explaining to us about the most common symptoms that people suffer from at this time of year and will talk about recharging our batteries after the Christmas holidays, offering us advice in order to help us to  resume normal sleep patterns.

Following the Christmas holidays, it is difficult to return to a normal sleep pattern. What would you recommend?

At times it is normal to be tired in the mornings after returning to a normal daily routine. However, in general it shouldn’t be difficult to resume normal sleep patterns after a few days. It is advisable to prepare for these changes a couple of days prior to returning to work.

What are the main reasons for not sleeping well?

Nowadays, the main reason why people encounter problema when sleeping is stress connected with their Jobs. In many cases this suppressed anxiety manifests itself at night and prevents the person from getting to sleep, and staying asleep. Mood related disorders, such as depression  can also result in sleeping problems.

Is there a connection between sleeping well and other illnesses?

Yes there is normally a connection. Problems with sleep can provoke mood related disorders such as irritability. We have also observed that these patients have problems with concentration, and memory. Excessive tiredness during the daytime can increase the risk of accidents etc. Thesefore it is very important to treat these disorders.

And how can we treat these patients?

If a person is suffering from some of the symptoms described here, then it is recommended that they see a specialist who is able to analyse the origin of the problem. At Vithas Xanit International Hospital we have a Unit for Sleep Disorders within our Neurosciences Department. This Unit offers multidisciplinary care to patients with sleeping problems.  Specialists are able to diagnose the problem, and refer the patient to the relevant specialist who will look at making changes in the patients lifestyle/diet, or if necessary prescribe medication.

What are the objectives of the Neurosciences Department?

To carry out an integral study of patients suffering from all types of illnesses connected with the nervous system. Their objectives are to try and coordinate neurological aspects, psychiatrists, pyschologists, and neuro physiologists, who in the majority of cases are involved in the study.

5 tips to improve sleep patterns.

Avoid elements in the bedroom which distract from sleep (radio, televisión).

Establish an almost fixed routine of going to bed/getting up at the same time.

  • Avoid heavy meals, and eat two hours before going to bed.
  • Avoid alcohol and tobacco in the evenings.
  • Take moderate physical excercise during hours of natural light.

Dr. Daniel González Gálvez

Specialist in Neuro Physiology at Vithas Xanit International Hospital