数字化无线野战救护指导系统

“数字化无线野战救护指导系统”是采用先进的数字化微波、视音频双向传输技术研制成功的,实现了野战医院(或战略后方医院)对师(旅)团救护所战伤救治的实时指导,对提高战伤现场救治质量有重要价值。2000年“系统”通过“国家通讯导航设备质量监督检测中心”的质量检测,并先后在     

血清降钙素原与前白蛋白及C-反应蛋白对儿童感染诊断应用的评价

目的 分析C-反应蛋白(CRP)、血清前白蛋白(PA)、血清降钙素原(PCT)对儿童医院感染诊断中的应用以及评价关系,为临床检查及治疗提供帮助。方法 对2012年4月-2013年10月医院儿科收治的81例医院感染患儿进行观察,并与同期随机抽取的100名体检正常儿童进行对比分析,比较两组患儿的CRP、PA、PCT,以及感染患儿治疗前后变化情况,采用SPSS 17.0软件进行统计分析。结果 感染患儿治疗前CRP与PCT浓度明显高于对照组,而PA浓度明显低于对照组,差异有统计学意义(P<0.05);治疗一周后感染组CRP与PCT浓度大幅降低,PA浓度显著升高,治疗前、后CRP、PA、PCT比较差异有统计学意义(P<0.05);cutoff值CRP为0.81mg/L、PA为9.20mg/L、PCT为0.14μg/L;联合应用检测敏感度提高至97.4%,特异性提高至98.5%。结论CRP、PA、PCT检测对儿童医院感染的临床诊断具有较高的特异性及敏感性,联合动态检测不仅能提高感染性疾病的早期诊断,而且还能反映感染程度及治疗效果,值得临床推广和应用。     

铜绿假单胞菌医院感染与外环境关系的研究

目的 分析比较铜绿假单胞菌(PA)医院感染与外环境中PA的相关性，以了解医院感染病原菌来源。方法 比较PA医院感染株、社区感染株、环境株的耐药谱以及随机引物扩增多态性基因分型(RAPD)型别之间的差异，判断三者之间的相关性。结果 收集PA医院感染株18株，社区感染株17株；1190份环境样中共分离到PA21株，环境分离率为1．76％。耐药谱与RAPD分型表明医院感染株与社区感染株、环境株之间无明显相关性。结论 铜绿假单胞菌医院感染可能以内源性途径为主。     

文职护士战伤救护培训实践

本文结合军队医院文职护士战伤救护培训的现状与问题,提出采用多种形式进行系统、全面培训的作法,并从全军事素质培训机制、战伤救护培训理论方法、多种形式相结合的培训方式等方面,对提高文职护士战伤救护的培训实效提出建议。     

军队医院护理人员战伤救护知识调查分析

目的：了解军队医院护理人员掌握战伤救护知识的现状，探讨在军队医院进行战伤救护培训的必要性和方法。方法：对4所军队医院222名军人护士进行问卷调查。结果：222名军人护士中，不同学历、不同职称者对战伤救护知识的掌握无显著差异，平均分均在5分以下，掌握较差。结论：对军队医院护士应从思想教育、强化战备意识着手，从基础救护知识学习训练抓起，不断地学习高新技术知识和技能，开展平战结合的训练模式，以提高军队医院护理队伍整体的备战素质。     

神经外科两次铜绿假单胞菌医院感染暴发的调查

生铜绿假单胞菌 [PA]医院感染暴发流行 ,我们对其进行了调查与处理 ,现将结果报告如下。1　内容与方法1.1　病例调查　将所有病例进行逐个登记、询问和检查 ,并按全国医院感染监控中心制定的《各部位医院感染的诊断标准》[1 ]进行诊断。1.2　菌株鉴定及药敏试验　菌株来于各感染病灶及环境标本中分离的细菌 ,菌株鉴定采用常规双歧鉴定法 ,将已确定为 PA的细菌按美国 NCCL S制定的标准 ,于 M- H琼脂平板上做氨苄青霉素等 12种抗菌素的敏感试验 ,所需试剂均购于浙江省军区后勤部卫生防疫检验所。1.3　环境细菌学监测　环境标本严格按卫生…     

北京地区X射线摄影受检者体表入射剂量调查分析

目的对比不同级别医院在使用数字X射线摄影及屏片X射线摄影对受检者进行摄影诊断时受检者剂量的差别。方法采用热释光剂量计(TLD)法测量X射线摄影成人受检者入射体表剂量(ESD),选择20家医院年龄在20~70岁之间的受检者,男性体重在55~80kg之间,女性体重在50~70kg之间。测量部位包含头颅(PA、LAT)、胸部(PA、LAT)、腰椎(PA、LAT)及胸椎(PA、LAT)。结果共对961次摄影进行了调查,比较各级医院头颅(PA、LAT)、胸部(PA、LAT)、腰椎(PA、LAT)及胸椎(PA、LAT)的受检者体表剂量平均值,三级医院的受检者体表剂量平均值最小,分别为:0.28 mGy、0.37 mGy、0.32 mGy、0.10 mGy、2.59 mGy、1.99 mGy、4.02 mGy和4.73 mGy。结论数字X射线摄影对受检者产生的剂量比屏片X射线摄影低;使用同种摄影设备对受检者产生的剂量中,三级医院最低,一级医院最高。     

后方医院伤病员分配模型构建

本文根据后方医院收治伤病员的卫勤保障特点，建立后方医院伤病员分配数学模型。在设定后方医院数量、接收伤病员床位及配置地点等方面提出建议。     

铜绿假单胞菌医院感染与环境因素相关性研究

目的了解铜绿假单胞菌(PA)在医院感染及环境监测中的分布,探讨二者的关系。方法按常规方法对某院2006年6月-2009年6月各类临床标本进行细菌培养与分离,采用VITEK32全自动微生物鉴定仪进行菌株鉴定。PA血清分型采用日本生研株氏会社分型血清进行。结果196株临床分离的PA血清分型率为90.82%（178株）,以G（26.02%）、E（15.31%）、F（14.29%）、B（10.21%）、H（9.69%）、I（7.14%）型为主,未发现的血清型有A、J和K型;25株环境分离的PA血清分型率为96.00%（24株）,以G（32.00%）、F（24.00%）、B（16.00%）、E（12.00%）型为主。结论从患者标本与环境中分离的PA菌株具有相似的血清型,表明其具有一定相关性;菌株血清分型结果可在一定条件下将细菌检验工作与医院感染监测工作有效地结合起来, 用于临床流行病学调查。     

铜绿假单胞菌医院感染暴发调查

目的　为查明我院ICU 和脑外科发生的铜绿假单胞菌(PA)下呼吸道感染暴发的危险因素;为控制其感染提供依据。方法　通过临床资料、流行病学环境监测、血清学和药敏试验分析。结果　发现本次为PAⅣ-11 型引起的医院感染,其主要危险因素是患者气管切开,使用机械通气、雾化吸入器的消毒不严和接触传播所致。结论　PA 广泛存在于医院环境中,尤其在重危病房,是引起医院感染的主要病原菌。     

Updating disaster plans: a tale of three hospitals

Three hospitals that were struck by disaster in 1977 have undertaken major revision of their disaster plans as a result of unexpected problems that occurred during the crises. Lee Hospital, Johnstown, PA, is installing a tough "floodproofing" system; Jewish Hospital and Medical Center, Brooklyn, NY, and Bellevue Hospital Center, New York City, are revamping their emergency electrical systems.     

Serodiagnosis of Japanese encephalitis among Nepalese patients by the particle agglutination assay

Japanese encephalitis (JE) is a serious health problem in the southwestern region of Nepal. Serological diagnostic kits for routine diagnostic use in this region have not been available. This study was performed to examine if the particle agglutination (PA) assay for Japanese encephalitis virus (JEV) IgM could be applicable to the samples collected in Nepal and also to evaluate the accuracy of clinical diagnosis of JE. One hundred and ninety-three blood samples were collected from the patients clinically diagnosed with JE or other infectious diseases in the JE-endemic, southwestern region of Nepal, in 2000. The PA assay was performed on these 193 serum samples and the results were compared with those by IgM-capture ELISA. Eighty-six samples were IgM-positive by the PA assay, and 71 of 86 were also positive by IgM-capture ELISA (sensitivity, 99%; specificity, 88%; positive predictive value, 0.82; negative predictive value, 0.99). These results suggest that the PA assay is a simple, reliable and useful diagnostic test to support clinical diagnosis in rural hospitals of Asia including Nepal.     

银川市医护人员职业倦怠和工作能力现状及其关系研究

目的了解银川市医务人员的职业倦怠程度及工作能力现状,探讨职业倦怠与工作能力的相关关系。方法采用职业倦怠指数量表(MBI)和工作能力指数量表(WAI),对银川市10所医院的522名医护人员进行问卷调查。结果医生的职业倦怠与护士之间差异有显著性,医生在消极怠慢及成就感方面的得分高于护士(P<0.01和P<0.05),而两者在工作能力方面的得分无统计学意义(P>0.05)。不同性质医院的医务人员的工作能力及职业倦怠得分也均有统计学意义,国营医院医生的情绪耗竭程度高于私立医院的医生(P<0.05),而其成就感低于私立医院的医生(P<0.01),其工作能力得分也低于私立医院的医生(P<0.01);国营医院护士的成就感得分低于私立医院护士(P<0.05),其工作能力得分也低于私立医院的护士,而在情绪耗竭及消极怠慢方面得分国营和私立医院护士间均无统计学意义。经Pearson相关分析显示,医护人员的工作能力及其各因子均与职业倦怠及其各因子均呈显著性负相关关系(r=-0.113～-0.494,P<0.01),即随着职业倦怠程度的增加,医务人员的工作能力随之降低。进一步经逐步回归分析显示,情绪耗竭、成就感、睡眠状况、工龄及工作班类型因素进入了工作能力评分的回归方程中,提示这些因素对医务人员工作能力评分影响较大。结论不同医院、不同职业类型的医护人员的职业倦怠程度有所不同,且已影响到其工作能力状态。通过增进医护人员的成就感、调整职业倦怠程度因素及改善睡眠状态可提高其工作能力状态,为保护医护人员身心健康服务。     

Epidemiological analysis of Pseudomonas aeruginosa strains isolated from a selected patient population in Brno, Czech Republic.

In the 1996/97 period, 1,413 Pseudomonas aeruginosa (PA) strains were isolated from 843 patients of the Brno teaching hospitals of St. Anne and Bohunice together with small groups from other hospitals. In the same period, 203 PA strains, used as controls, were isolated from 187 patients treated outside hospitals. Statistical evaluation was based on 1,023 hospital isolates and 189 control strains. A total of 16 isolates were recovered from the hospital environments and two from therapeutic swimming pools. The epidemiological analysis of these PA strains was based on pyocin typing, serological typing and phage typing. The most frequently occurring pyocin types amongst our strains fell into 8 pyocin-type groups. The prevailing groups differed significantly between the hospital patient and control groups. Similarly, serological typing identified differences in the predominant serotypes between hospital and control patients. The phage typing method revealed that the control PA strains were significantly more sensitive to 21 polyvalent bacteriophages used than the hospital isolates. In relation to pyocin and serological typing, strains isolated from the hospital environment showed characteristics similar to those of the PA strains isolated from hospital patients. Our results indicate that the majority of strain isolated from hospitalised patients had their origin from human or inanimate contacts in the hospitals.     

基层医院抗击新型冠状病毒肺炎疫情一线护士内心真实体验的质性研究

目的了解基层医院抗击新型冠状病毒肺炎疫情一线护士内心真实体验,以便采取针对性的措施满足疫情防控护士的需求,促进疫情防控工作的顺利开展。方法采用描述性现象学研究方法,共采访12名护士,并采用Colaizzi 7步分析法进行资料分析。结果提炼出三大主题,即感控知识及防护知识有待提高、参加疫情防控工作的身心感受、影响身心感受的因素。结论加强对基层医院抗击新型冠状病毒肺炎疫情一线护士感控知识及防护知识的培训,完善应急管理措施,保障疫情一线护士的需求,加强心理疏导。     

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study

Objective

To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.

Data Sources

EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021).

Study Design

We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.

Data Extraction

We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.

Principal Findings

In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.

Conclusions

Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.     

The burden of MRSA in four German university hospitals

In the last few years, a dramatic increase of Methicillin-resistant Staphylococcus aureus (MRSA) detection in German hospitals can be recognized. Under this enormous pressure it is very important for infection control teams to assess the epidemiologic situation correctly. Therefore, a prospective multicenter hospital-based surveillance of MRSA cases was executed in four university hospitals with 1017–1333 beds in Germany. Routine surveillance data were recorded of all patients with MRSA isolates from clinical samples or screening cultures. Patients had been colonized or infected with MRSA during their hospital stay. In 2002 between 183 and 291 MRSA cases were treated in the respective hospitals (between 0.53 and 0.96 MRSA cases per 1000 patient days). Of these, 44.4% were MRSA infections. The most frequent type of MRSA infections were wound infections (56.9%) followed by pneumonia (21.0%) and bloodstream infections (15.1%). Of the infected patients 51.5% were already infected at admission. The median duration of isolation of MRSA patients in private rooms was between 11 and 16 days. Altogether 21,665 isolation days were observed in four hospitals; this means 1.52% of all patient days. On average, 9.0% of roommates were identified as MRSA carriers. Due to the high percentage of imported cases, the four university hospitals introduced a general screening for MRSA at admission in all ICUs and some further departments as well as an automatic alert system for readmitted patient with MRSA during their last hospital stay.     

百日咳、白喉、破伤风的血清流行病学监测及方法学研究

１９９３－１９９４年应用日本国立卫生研究所研制的明胶颗粒凝集试验（ＰＡ）对我国ＤＰＴ的诊断方法进行了研究，同时对人群ＤＰＴ的抗体水平进行了监测。提示应重视加强基础免疫和强化免疫。调查结果还显示，抗体水平城市高于农村，并随年龄增高而下降，大年龄组抗体水平较低，造成目前大年龄组发病较高。     

Some bond authorities fight disclosure rules

While the group that represents tax-exempt bond authorities would like to see that investors receive more financial information from hospitals, some of its members are fighting proposed disclosure guidelines because they're fearful the rules would swamp their staffs with added paperwork and other administrative burdens and, in some cases, even threaten their very existence.     

Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates

During operations for total joint replacement done in operating rooms with conventional ventilation the mean air contamination varied considerably among the 15 hospitals studied. The range was from 51 to as many as 539 bacteria-carrying particles per cubic metre. When the data from all the hospitals were grouped according to the mean level of bacterial airborne contamination, including operations done in control and in ultraclean air, there was a good correlation between the air contamination and the joint sepsis rate. There was also a correlation between the mean values of air contamination and the numbers of bacteria isolated from wound wash-out samples; but the apparent efficiency of the sampling method varied a great deal among the hospitals carrying out this procedure. From this data it would seem that by far the largest proportion of bacteria found in the wound after the prosthesis had been inserted reached it by the airborne route. With the mean air contamination found in the control series, 164 bacteria-carrying particles per cubic metre, this proportion was as much as 95 per cent. The risk of joint sepsis varied widely among the 19 hospitals. The differences between the highest and lowest being probably as much as 20-fold. However, the effect of an ultraclean air environment was asimilar at all hospitals.