某三级医院住院患者医院感染直接经济损失及控制策略研究北大核心CSCD

目的评价某三级医院发生医院感染所增加的直接经济损失,提出控制策略,以降低经济损失。方法采用回顾性调查病例对照研究,对某三级医院2011-2013年发生的医院感染病例的住院费用进行调查分析,按照条件1∶1配对,共成功匹配751对,医院感染病例组和未发生医院感染病例组各751例,根据各科室患者住院总费用构成,采取聚类分析法对各临床科室进行分析。结果发生医院感染病例组平均住院日为25d,与未发生医院感染病例组相比延长了11d,两组间的差异有统计学意义(P<0.01);医院感染病例组患者和对照组的平均住院费用分别为54 138.84、32 436.60元(Z=9.2142,P<0.0001);医院感染患者多支出的费用以医疗费为主,占多支出费用总额的53.48%;在不同分位数下医院感染病例组与对照组住院总费用的差异均有统计学意义(P<0.01),且随着百分位数的增大,病例组与对照组之间的差值呈逐渐扩大趋势;第1类3个科室,即重症医学科、心血管外科和骨科,住院总费用超过9.05万元的患者所占的构成比远高于其他科室,是控制医院感染所造成直接经济损失的重点科室。结论医院感染延长患者住院日,导致患者直接经济损失增加,针对不同类别科室采取相应的医院感染防控措施,能够降低因感染带来的直接经济损失,具有较好的经济效益。     

某三级医院住院患者医院感染直接经济损失及控制策略研究

目的 评价某三级医院发生医院感染所增加的直接经济损失,提出控制策略,以降低经济损失。方法 采用回顾性调查病例对照研究,对某三级医院2011-2013年发生的医院感染病例的住院费用进行调查分析,按照条件1∶1配对,共成功匹配751对,医院感染病例组和未发生医院感染病例组各751例,根据各科室患者住院总费用构成,采取聚类分析法对各临床科室进行分析。结果 发生医院感染病例组平均住院日为25d,与未发生医院感染病例组相比延长了11d,两组间的差异有统计学意义(P<0.01);医院感染病例组患者和对照组的平均住院费用分别为54 138.84、32 436.60元(Z=9.2142,P<0.0001);医院感染患者多支出的费用以医疗费为主,占多支出费用总额的53.48%;在不同分位数下医院感染病例组与对照组住院总费用的差异均有统计学意义(P<0.01),且随着百分位数的增大,病例组与对照组之间的差值呈逐渐扩大趋势;第1类3个科室,即重症医学科、心血管外科和骨科,住院总费用超过9.05万元的患者所占的构成比远高于其他科室,是控制医院感染所造成直接经济损失的重点科室。结论 医院感染延长患者住院日,导致患者直接经济损失增加,针对不同类别科室采取相应的医院感染防控措施,能够降低因感染带来的直接经济损失,具有较好的经济效益。     

综合医院专科重症监护病房住院患者医院感染直接经济损失研究

目的探讨综合医院专科重症监护病房(ICU)住院患者,发生医院感染所造成的直接经济损失。方法采用1∶1病例对照研究方法,分析医院感染的直接经济损失和延长的住院天数共113对。结果感染组比对照组平均每例增加医疗费57 569.51元,不同专科ICU经济损失以神经内科ICU最高,平均每例增加68 905.73元,医院感染部位不同经济损失亦不同,以导管相关性血流感染最多;医院感染延长住院天数平均每例增加18.29 d,两组间差异有统计学意义(P<0.01)。结论医院感染不但增加患者的经济负担,同时增加平均住院日,降低床位周转率,因此,应按医院感染经济损失的特点合理确定医院感染控制工作的重点和优先,充分利用现有的卫生资源,提高医院感染管理工作的社会效益和经济效益。     

5种类型医院感染直接经济损失的病例对照研究

[目的]分析某医院医院感染造成的直接经济损失及其影响因素。[方法]采用1∶1配对病例对照研究方法,调查211对患者的医疗费用,计算医院感染造成的直接经济损失。[结果]病例组的平均住院总费用为19,705.82元,对照组为8672.00元,平均每例医院感染病例多支出住院费用11,033.82元(Z=-12.120,P0.001)。住院总费用的增加以药费、治疗费、材料费和化验费为主。病例组的平均住院日为33 d,对照组为16 d,平均每例医院感染病例延长住院日17 d(Z=-11.172,P0.001)。[结论]医院感染增加了患者的医疗费用,延长了患者的平均住院天数,给患者造成了巨大的经济损失。     

医院感染经济损失的病例对照研究

本次研究采用病例对照研究的方法，调查医院感染的直接经济损失，共１３７对，病例组医疗费用为１４３６８６４元，对照组的医疗费用７４０１８０元，病例组的医疗费是对照组１．９４倍，总的经济损失为６９６６８４元，平均每例感染者多支出５０５８．２８元。不同科室中以外科医院感染经济损失最高，平均每例增加费用６８６７元。感染部位不同经济损失也不同，以血液感染增加费用最高，平均增加１０４７２元，其次为泌尿系感染及下呼吸道感染，平均增加费用分别为９４３４元和８４２９元。多部位感染比一个部位感染医疗费多，平均每例增加费用３５４．２５元。１３７例感染者中，总住院天数为４０７７天，对照组的住院天数为２６５６天，共延长住院日１４２１天，平均每例感染者延长住院日１０．３７天。作者认为只要降低医院感染率１％。就可支付医院感染监控人员的工资及进行医院感染管理或研究所需要的一切费用。     

某三级医院ICU器械相关感染直接经济损失评价

目的了解某三级医院ICU器械相关感染对住院费用及住院天数的影响,评价其导致的直接经济损失。方法采用回顾性调查的分析方法,选取某三级医院2015-2017年入住ICU患者2390例作为研究对象,将发生器械相关感染患者作为病例组,未发生感染患者作为对照组,根据配对原则进行1∶1配对。运用SPSS24.0统计软件对两组住院患者的直接经济损失进行分析。结果 ICU器械使用患者病例组比对照组平均增加住院费用580756.08元,住院天数延长8d;使用呼吸机患者病例组比对照组平均增加住院费用510498.02元,住院天数延长11d;使用中央导管患者病例组比对照组平均增加住院费用441884.68元,住院天数延长9d;尿管插管患者病例组比对照组平均增加住院费用392878.84元,住院天数延长10d,两组比较差异均有统计学意义(P0.05)。结论器械相关感染会导致患者直接经济损失增加,ICU应重点加强器械相关感染的防控。     

老年患者外科术后医院感染的直接经济损失分析

目的分析老年患者外科术后医院感染导致的直接经济损失,为加强老年患者术后医院感染管理工作提供依据。方法调查某市3所三级综合医院2016年1月1日-12月31日的老年手术患者7910例,采用SPSS倾向指数法1∶1匹配得到224例感染病例作为病例组、224例未感染病例作为对照组,分析两组平均住院日、额外住院费用。结果外科手术后医院感染与未感染患者平均住院日中位数差值为10.0d,住院总费用中位数差值为29279.28元;分类别统计住院费用前五位由高到低依次是西药费(14063.13元)、材料费(4560.68元)、手材费(3311.59元)、检验费(2113.5元)、治疗费(2069.26元);泌尿外科术后发生医院感染最长延长平均住院日11.0d,神经外科住院总费用最高损失38476.56元;分类费用损失各科室略有不同,但西药费均占第一位。结论老年患者手术后发生医院感染所致直接经济损失严重,各科室用于控制感染的药物费用大幅度增加,而其他项目例如检查、检验、治疗、护理等费用增加情况因科室手术特点有所区别。     

下呼吸道感染直接经济损失的病例对照研究

目的了解下呼吸道医院感染所造成的直接经济损失。方法采用回顾性1∶1配比病例对照方法对患者进行研究。结果病例组住院费用平均每天为827.62元,对照组为428.09元,病例组明显高于对照组(P0.01);下呼吸道感染的直接额外费用是399.53元,病例组平均住院日为30.59 d,对照组为12.70 d,两组比较差异有统计学意义(P0.01);下呼吸道感染引起的额外住院日平均为17.89 d;呼吸系统感染经济损失因科室、疾病不同而异。结论下呼吸道感染的直接经济损失是巨大的,有效的预防与监管措施是控制下呼吸道感染、减轻患者和医院经济负担的关键。     

综合性医院医院感染经济损失病例对照研究

目的：为探讨某综合性医院感染造成的经济损失。方法：采用1：1病例对照的研究方法，调查78例医院感染造成的直接经济损失。结果：病例组比对照组平均增加医疗费3 342元；不同专业组经济损失以呼吸内科最高，达到了11 414元；不同感染部位经济损失以下呼吸道感染最高，达到了7 491元，多部位感染经济损失高出单部位7 645元；住院日损失病例组比对照组平均延长7.2d。结论：医院感染培养加患者经济负担，延长住院时间，同时也影响医院病床周转率。     

安徽某三甲医院住院患者5种医院感染直接经济损失研究

目的 研究住院患者呼吸道、泌尿道、消化系统、手术部位、血流感染5类医院感染所造成直接经济损失。方法 采用1:3配对方法,回顾调查2015年出院的50例发生医院感染病例,150例同期住院未发生医院感染患者为对照组,对医院感染进行经济学评价。统计分析医院感染组住院日直接经济损失的增长情况。结果 病例组平均住院总费用20 253.80元高于对照组9 572.90元（Z=-3.396,P=0.001）,患者住院费用的增加主要是药费、化验费、治疗费、护理费;病例组平均住院时间23.50 d高于对照组11.00 d（Z=-5.038,P<0.001）。结论 医院感染造成的经济损失较大,延长了患者住院时间,应采取有效管理方法,控制医院感染。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.