医院感染病例漏报原因及控制对策

目的分析医院感染病例漏报原因,探讨降低其漏报率的方法及对策。方法对2002年8月~2004年7月全院34 694份出院病历进行回顾性调查。结果34 694例出院患者中,医院感染1164例,漏报264例,月漏报率从52.50%降至0;年漏报率从36.17%降至10.67%。结论感染病例漏报原因与相关人员的医院感染学知识水平不足、管理机制不够健全、支持系统不完善等有关;而强化医院感染管理应有组织整体活动意识;提高相关人员的医院感染学知识水平;完善管理机制及适当的工作技巧和创新是降低医院感染病例漏报率的关键。     

医院感染漏报调查分析

对我院１９９９年１月份，出院病历进行医院感染的漏报调查。１　结　果　　出院患者１１０４例，实查病历１０８０份，调查率９７．８３％。本月已报感染病例３４例，报告发病率３．１５％。实际查出感染病例数５５例，漏报２１例，漏报率３８．１８％。感染部位漏报率泌尿道最高６６．６７％，依次是眼５０％、切口２５％、呼吸道４２．８６％。本次调查中了解到，调查病例病原学检查率为９．０７％，阳性率３３．６７％；感染病例的送检率为２９．０９％，阳性率６２．５０％。２　讨　论　　临床医师积极、主动地填报感染病例，是我们开…     

医院感染漏报率抽样调查方法探索

目的探索出一种既节省人力和时间,又能比较客观地反映出医院感染漏报真实情况的漏报率抽样调查方法,使医院感染监测系统更加完善,进一步提高医院感染管理水平。方法采用两种抽样调查方法对医院2006-2008年的医院感染漏报情况进行回顾性抽样调查,将抽样调查得到的漏报率(样本率)与全面监测得到的实际漏报率(总体率)进行比较,观察二者的差异有无统计学意义。结果 3年同一年度内每周顺延1d抽查全部出院病历得到的抽样漏报率(6.19%、9.74%、13.33%)与当年度实际漏报率(5.15%、7.57%、11.14%)相比较,二者的差异无统计学意义;同一年度内固定抽查每周三全部出院病历得到的抽样漏报率(7.94%、9.94%、14.16%)与当年度实际漏报率相比较,二者的差异无统计学意义;同一年度内每周顺延1d抽查全部出院病历得到的抽样漏报率与固定抽查每周三全部出院病历得到的抽样漏报率相比较,二者的差异均无统计学意义。结论可采用每周顺延1d抽查全部出院病历,或固定抽查每周三全部出院病历两种抽样调查方法,替代查阅全部出院病历获取年度医院感染漏报率的全面监测方法。     

医院感染漏报原因分析与对策

[目的]了解医院感染漏报情况,分析漏报原因,降低医院感染漏报率,提高医院感染监测效率. [方法]对某医院2007年1月和2009年12月份的所有出院病历进行回顾性调查和定期下科室进行前瞻性调查. [结果]医院感染漏报率2007年1月～2008年12月为33.51%、2009年1月～2009年12月为9.60%. [结论]加强医院感染管理和医院感染知识培训,采用多种监测方法,医院感染管理专职人员积极与临床医生沟通,提高医务人员发现感染病例的水平,并可督促临床医生及时报告,从而降低医院感染漏报率,提高监测资料的准确性.     

有效降低医院感染漏报率的路径

目的为有效降低医院感染漏报率,探索漏报监控路径,发挥医院感染监控预警系统作用,避免医院感染暴发和流行。方法以2001年卫生部颁布的《医院感染诊断标准》为诊断依据,对2000年1月-2006年12月全院116 213份出院病历进行了回顾性分析;再度评估医院感染漏报率等监控项目,寻找漏报原因、制定对策,反馈医院感染控制信息;同时在该7年期间根据医院信息系统提供的高危因素进行了前瞻性调查,以此为工作路径。结果通过本路径的实践,医院感染漏报率基本得到控制,低于三级医院的控制标准(20.0%);2005年再度强化措施,使2006年医院感染漏报率下降为7.4%。结论医院感染病例的实时监测,是有效降低医院感染漏报率的路径。     

行政干预对减少医院感染漏报的作用

目的 研究行政干预对减少医院感染漏报的作用.方法 采用同顾性调查的方法,对医院2002-2007年住院患者的医院感染病例进行漏报调查及统计分析;观察自2005年采取行政干预等措施后,医院感染的漏报病例是否有所减少.结果 6年问共检查住院病历9550份,发现医院感染漏报49例,其中2005年前3年漏报32例(65.3%),经加强医院感染知识培训和行政干预后,2005年后3年漏报17例(34.7%),两者比较差异有统计学意义(χ~2=10.67,P<0.05);漏报较多的科室为手术科室,漏报较多的部位为下呼吸道、上呼吸道、皮肤软组织、泌尿道.结论 针对医院感染漏报率较高的科室,加强医院感染知识培训和行政处罚相结合,可减少医院感染的漏报.     

医院感染漏报调查分析

目的:分析医院感染漏报调查情况。方法:通过对2004年～2006年间全部出院病历进行回顾性调查方法。结果:2004年漏报率30.45%。2005年漏报率24.72%,2005年漏报率12.50%。结论:只有提高临床医生诊断医院感染病例的积极性、准确性、感染病例的报告才能逐步趋向正确及时,减少漏报误报。     

医院感染漏报调查分析

目的:分析医院感染漏报调查情况.方法:通过对2004年～2006年间全部出院病历进行回顾性调查方法.结果:2004年漏报率30.45%.2005年漏报率24.72%,2005年漏报率12.50%.结论:只有提高临床医生诊断医院感染病例的积极性、准确性、感染病例的报告才能逐步趋向正确及时,减少漏报误报.     

医院感染信息控制系统应用与评价

目的评价医院感染信息控制系统使用前后对工作效率、漏报率、感染率的影响,利用感染信息控制系统,转变医院感染控制工作方式,实现有效实时监测和控制,提高医院感染管理质量。方法 2012年1-6月使用既往方式对部分科室病例监测,调查病例7 626份,2013年1-6月利用医院感染信息控制系统监测相同科室,调查病例7 682份,对调查结果进行统计分析,采用t检验及χ2检验比较系统上线前后医院感染科工作效率、漏报率、感染率的变化,调查2013年全院抗菌药物使用率。结果信息系统控制后,医院感染科员工病例监测工作效率提升约13倍,2012年抽查病例中,感染344例,上报237例,漏报107例,漏报率31.11%;2013年抽查对应科室,感染369例,上报345例,漏报24例,漏报率6.50%,经对比发现,漏报率明显下降,差异有统计学意义(P<0.05),2013年全院抗菌药物使用率略有降低,抗菌药物使用送检率略有升高。结论医院感染信息控制系统显著提高医院感染控制医师工作效率,明显降低医院漏报率,有效控制医院感染率、抗菌药物使用率、抗菌药物使用及标本送检率。     

医院感染漏报原因调查与分析

采用前瞻性与回顾性调查相结合的方法，对某院2004年1月-2005年12月间10142份病历进行医院感染率及其漏报率的调查。10142例患者，发生医院感染205例，已报116例，漏报89例。漏报较高的科室为手术科室，其中移植科居首位，漏报32例（55．17％）；漏报较高的疾病为真菌性肠炎28例（31．46％），上呼吸道感染19例（21．35％）。漏报原因为诊断标准掌握不准、忽略多次感染、标本送检不够、有意不报、专职人员失误等。经采取措施后，医院感染漏报率由2004年的72．62％下降到2005年的23．14％。提示加强宣教，提高医务人员医院感染控制意识，进行医院感染相关知识培训，采取前瞻性与回顾性监测相结合的方法，是防止医院感染病例漏报的关键。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.