医院多指标综合评价结果的比较分析

《中国卫生统计》杂志1993年第10卷第2期第12页介绍了TOPSIS法用于医院工作质量的多指标综合评价的方法,该文指出TOPSIS法作为系统工程中有限方案多目标决策分析中的一种常用决策技术,在医院工作质量多指标综合评价中也有较大的应用价值,而且对数据分布及样本量、指标多少无严格限制。但笔者认为该方法仍然有它的局限性,其综合评价的效果不够理想。现在仍用原文介绍的方法和实际举例说明。     

加权TOPSIS法与RSR法相结合在医疗质量综合评价中的应用

近几年来,TOPSIS法因具有计算简便、结果合理、应用较为灵活的特点已逐渐被用于医院的医疗质量综合评价,本文应用加权TOPSIS法与RSR法相结合对我院7年来住院医疗工作质量进行综合评价。     

应用综合指数法、TOPSIS法对医院医疗质量综合评价

目的 探讨对医院医疗工作质量管理综合评价的方法。方法应用综合指数法和TOPSIS法对医院2002年1～12月的10项主要工作指标进行综合评价。结果通过综合指数法和TOPSIS法的评价，两种评价结果相符，与医院12个月的实际工作情况相符，即4月份医疗工作质量最好，2、3月份医疗工作质量最差。结论综合指数法和TOPSIS法能定量反映不同评价单元的综合水平和优劣程度，并能全面、客观、集中、合理地反映出医院工作质量及管理水平，评价医院医疗工作质量较为直观、可靠，有实用性。对医院的医疗管理工作具有参考价值。可作为医院管理者评价年度或阶段医院医疗工作质量的手段。     

用TOPSIS法评价某院住院科室综合效益

目的了解医院2008年上半年各住院科室医疗工作综合质量状况。方法运用TOPSIS法从工作效率、医疗质量、经济效益等方面,对我院15个临床科室2008上半年的工作进行综合评价分析。结果在15个科室中儿科最好,传染科最差,这与我院实际相符。结论TOPSIS法计算简便,应用灵活,用于综合评价医疗质量具有科学性。     

TOPSIS法在孕产妇保健工作质量评价中的应用

TOPSIS法是系统工程中有限方案多目标决策分析的一种常用方法，可用于效益评价，卫生决策和卫生事业管理等多个领域。国内采用该法对医院工作质量、计划免疫工作、疾病防治效果等方面进行综合评价、取得了较好的效果。本用TOPSIS法对浙江省1998—2003年孕产妇保健工作质量进行综合评价，客观定量、真实地反映了孕产妇保健工作的实际情况，值得推广应用。     

加权TOPSIS法在医院综合评价中的应用

目的用加权TOPSIS法对医院工作质量作出客观准确的评价，为医院管理部门制订决策提供依据。方法应用加权TOPSIS法从医疗工作量、医疗质量、医疗效率3个方面对医院1995--2004年工作质量进行综合评价和分析。结果评价结果与医院的实际情况相符，即2004年最佳，1995年最差。结论TOPSIS法具有计算简便、结果合理、应用灵活的特点，适宜在不同级别、不同层次的医院推广应用。     

某院1994-2003年医疗工作质量的综合评价

目的评价某医院1994--2003年医疗工作质量变化情况，探讨医院综合评价方法。方法运用TOPSIS法进行评价。结果某院医疗质量最佳年度为2002年，且自1998年后呈上升趋势。结论TOPSIS法具有灵活、方便、定量、准确等特点，在医疗工作质量等综合评价中有较大的推广应用价值。     

应用TOPSIS法综合评价某院医疗质量

目的了解某医院近6年来医疗工作综合质量情况,并给予正确评价,为医院管理工作提供有意义的参考.方法 运用TOPSIS法,对医院2001-2006年6年的5项常用指标进行综合评价和分析.结果 评价结果与医院实际情况相符,在6年当中2006年最好,2001年最差.结论 TOPSIS法具有计算简便、应用灵活的特点,在医院工作质量多指标综合评价中有较大的应用价值.     

应用TOPSIS法综合评价10年住院医疗质量

目的对某院住院医疗工作质量进行综合评价，为加强医院管理提供依据。方法用TOPSIS法对该院1999--2008年住院的主要工作指标进行分析，并对相对接近度C的分析进行了扩展。结果2001年度住院医疗工作质量最好，2008年度医疗工作质量最差，与该院近10年间的实际情况相符。结论TOPSIS法简单易行，在医疗工作质量综合评价中的应用具有灵活性和广泛性；应用综合评价法对住院主要工作指标情况进行较全面的评价，能客观反映不同时期住院医疗质量的优劣程度；可以检查医院工作计划的执行情况，对提高医院医疗质量管理具有重要的参考价值。     

应用加权TOPSIS法对某院临床科室医疗质量评价

目的用加权TOPSIS法对医院各临床科室医疗质量做出综合评价,为医院管理部门制定决策提供可靠的依据。方法应用加权TOPSIS法从医疗工作质量、工作效率、经济效益3个方面对我院2007年10个临床科室的医疗质量进行综合评价和横向比较。结果评价结果与医院实际情况相符合,在10个科室当中结核3科医疗质量综合评价最好,骨科最差。结论TOPSIS法计算简便、结果合理、应用灵活,适宜在医院医疗质量的评价中进行推广应用。     

The accuracy of telediagnosis of frozen sections is inferior to that of conventional diagnosis of frozen sections and paraffin-embedded sections

The accuracy of telepathology diagnosis and conventional diagnosis of frozen sections was compared, using the diagnosis established on paraffin-embedded tissue as a reference. Out of a total of 270 cases, remote frozen-section diagnosis was correct in 227 cases (84.1%) and incorrect in 23 cases (8.5%). The latter comprised 12 false positive diagnoses of malignancy (4.4%) and 11 false negative diagnoses (4.1%). A diagnosis was not possible in 20 cases (7.4%). In contrast, the conventional frozen-section diagnosis was correct in 269 cases (99.6%) and incorrect in 1 case (0.4%), the latter being a false negative diagnosis. The average time needed to make a remote diagnosis was 14.2 min (SD 9). Manual examination was not found to be essential for remote frozen-section diagnosis. Overall slide quality was rated as 'satisfactory' to 'fair' by the six pathologists concerned. An improvement in the quality of slides is necessary to guarantee an acceptable level of accuracy of remote frozen-section diagnosis; a shortening of the time needed for diagnosis is a further requirement for the successful implementation of a routine telepathology frozen-section service.     

414例非淋菌性尿道炎中支原体感染的检测与耐药性分析

目的了解非淋菌性尿道炎(NGU)中支原体感染的情况及对药物耐药性的状况。方法对414例NGU患者的分泌物、前列腺液等进行支原体培养、鉴定、计数及药敏试验。结果414例中支原体阳性284例,感染率为68.60%;解脲脲支原体(Uu)、人支原体(Mh)及Uu Mh混合感染的阳性率分别为21.74%(90例)、12.56%(52例)、34.30%(142例);支原体对12种抗菌药物敏感性最高的是米诺环素(76.76%),其次是多西环素(73.24%);耐药性最高的为环丙沙星(77.46%)、司帕沙星(68.31%)、红霉素(68.31%)。结论NGU患者支原体感染率高,以Uu Mh混合感染为主;且对环丙沙星、司帕沙星等药物的耐药性呈上升趋势,并出现多药耐药性;因此,对NGU患者,加强支原体培养和药敏试验,对指导临床用药,最大限度地控制耐药菌株的产生,尤为重要。     

Clinicopathological characteristics of synchronous bilateral breast carcinomas. Report of 30 patients

AIM: The objective of this study is to determine the clinicopathologic characteristics; incidence and prognosis value of synchronous bilateral breast carcinoma (SBBC). METHODS: This is a retrospective study done in Salah Azaiz Institute of Tunis about 30 patients with synchronous bilateral breast carcinomas diagnosed and treated over a 21-years period going from 1977 to 1997. The definition of synchronous breast lesions is the developpement of the contralateral breast cancer within 6 months. RESULTS: Median age was 49 years. The incidence of SBBC was 0.52%. History family was noted in 3% of our population. Mean tumor size was 40 mm (15-145). Breast conserving therapy was done in 16% of cases (9 patients). Five-year overall survival was 40%. Five year survival rates were 72 and 17% for stage II and III, respectively. Main prognostic factors for survival were lymph node involvement (P=0.004) and disease stage (P=0.02). CONCLUSION: Synchronous bilateral breast carcinoma is a rare entity, with a problem of definition concerning the delay of bilaterlisation. Their prognosis is similar to that of unilateral breast carcinoma patients of equal stage. Hence, breast conserving therapy can be used s fely if indicated.     

Determination of a practical pH cutoff level for reliable confirmation of nasogastric tube placement

Background: Enteral feeding is a common method of nutrition support when oral intake is inadequate. Confirmation of correct nasogastric (NG) tube placement is essential. Risks of morbidity/mortality associated with misplacement in the lung are well documented. Studies indicate that pH ≤4 confirms gastric aspirate, but in pediatrics, a pH of gastric aspirate is often >4. The goal of this study was to determine a reliable and practical pH value to confirm NG tube placement, without increasing the risk of not identifying a misplaced NG tube. Methods: Pediatric inpatients older than 4 weeks receiving enteral nutrition (nasogastric or gastrostomy) were recruited over 9 months. Aspirate samples were pH tested at NG tube placement and before feedings. If pH >4, NG tube position was confirmed by chest radiograph or further investigations. In addition, intensive care unit (ICU) patients who required endotracheal suctioning were recruited, and endotracheal aspirate samples were pH tested. Results: A total of 4,330 gastric aspirate samples (96% nasogastric) were collected from 645 patients with a median (interquartile range [IQR]) age of 1.0 years (0.3–5.2 years). The mean (standard deviation [SD]) pH of these gastric samples was 3.6 (1.4) (range, 0–9). pH was >4 in 1,339 (30.9%) gastric aspirate samples, and of these, 244 were radiographed, which identified 10 misplaced tubes (1 with pH 5.5). A total of 65 endotracheal aspirate samples were collected from 19 ICU patients with a median (IQR) age of 0.6 years (0.4–5.2 years). The mean (SD) pH of these samples was 8.4 (0.8) (range, 6–9.5). Conclusion: Given that the lowest pH value of endotracheal aspirate sample was 6, and a misplaced NG tube was identified with pH 5.5, it is proposed that a gastric aspirate pH ≤5 is a safer, reliable, and practical cutoff in this population.     

Endoscopic treatment of residual lithiasis. 661 cases

AIM: Endoscopic sphincterotomy is a well-established procedure for treating choledocolithiasis and particularly residual lithiasis. The aim of this study is to expose our experience with this method and to evaluate his safety and efficacy. METHODOLOGY: It is a retrospectively collected series of 661 patients with residual choledocolithiasis. RESULTS: Endoscopic retrograde cholangio-pancreatographies were performed in 651 patients (98.5%). Standard sphincterotomy was realized in 633 patients (95%) and a pre-cut technique was done in 15 (2%). Bile duct clearance was achieved in 583 cases (91%). Overall, the complication rate of sphincterotomy was about 8.4%. CONCLUSION: Endoscopic sphincterotomy is a safe and effective procedure for patients with residual choledocolithiasis.     

颅脑外科感染假单胞菌培养及其药敏分析

目的研究颅脑外科感染假单胞菌培养及其药物敏感性（药敏）情况。方法调查经病原学检查所证实的医院感染病例56例：细菌鉴定采用由英国制造的细菌鉴定药敏仪；抗菌药物的药敏试验采用微量测定法。结果培养出的13株假单胞菌中铜绿假单胞菌6株，占46．15％；产碱假单胞菌6株，占46．15％；嗜麦芽窄食单胞菌1株。占7．69％。铜绿假单胞菌对亚胺堵南敏感率为83．33％；产碱假单胞菌对亚胺培南敏感率为66．67％。均对第三代头孢菌素和喹诺酮类有较高耐药率。结论颅脑外科感染假单胞菌是抢救危重患者的一个严重问题；细菌耐药和交叉耐药的日趋普遍是当前抗感染治疗的困难所在。     

Estimation of the frequency of Hereditary Persistence of Fetal Hemoglobin in Brazil

Hereditary Persistence of Fetal Hemoglobin (HPFH) is a benign clinical condition characterized by the synthesis of HbF and which continues without hematological alterations during adult life. Since the function of HPFH in many hemoglobinopathies is that of a severity modulator, it is important to learn its frequency. To obtain this information, a study was conducted on 1,846 blood donors from Bragan?a Paulista, S?o Paulo State. Hemoglobin was qualitatively analyzed by hemolytic electrophoresis on agarose gel. Qualitative analysis of gammaG and gammaA chains was performed by electrophoresis in polyacrylamide-triton-urea. Two individuals were found to have a high fetal index (0.1%). The percentage of FHb in one individual was 17% and in the other 18%. The gamma G chain was missing in both electrophoretic chains. Cases screened according to laboratory characteristics were of the pancellular hereditary persistence type due to mutation. The frequency in this sample was thus 1/1,000 individuals.     

276例疑似生殖器疱疹患者单纯疱疹病毒Ⅱ型检测结果分析

目的用实时荧光定量聚合酶链反应(FQ-PCR)检测我院皮肤性病门诊生殖器疱疹疑似患者的单纯疱疹病毒Ⅱ型(HSV-Ⅱ)感染情况。方法用FQ-PCR对276例生殖器疱疹疑似患者进行检测。结果①276例生殖器疱疹疑似患者检测HSV-Ⅱ阳性患者145例,阳性率为52.53%(145/276),其中男性患者阳性率59.76%(101/169),女性患者41.12%(44/107),男性患者与女性患者的发病率比较,差异具有统计学意义(P<0.05)。②三个年龄段患者即<20岁,20～55岁,>55岁的阳性率分别为31.25%(5/16),62.62%(129/206),20.37%(11/54),三个年龄段患者发病率比较,差异均具有统计学意义(P<0.05)。结论①生殖器疱疹疑似患者中HSV-Ⅱ感染率高,感染率有性别差异,男性发病率高于女性。②在不同的年龄发病率不同。③FQ-PCR在单纯疱疹病毒检测中具有快速,简便,灵敏度高等优点,适用于临床检测。     

2016年南阳市结核病耐药监测结果分析

目的了解南阳市区耐药情况,监测南阳市区结核患者的药敏结果,为本市结核病的防控提供科学依据。方法选取本市2016年结核病控制项目患者痰培养阳性的菌株,用比例法对异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)的耐药性进行耐药性监测。结果共有1613例结核患者纳入监测分析,总耐药率为18.9%,耐药率顺位由高到低依次为S(15.9%)、H(10.2%)、R(8.6%)、E(5.6%);耐多药率为7.9%,初始耐多药率为7.2%,获得性耐多药率为27.1%;初始耐多药构成比为87.5%。结论南阳市结核病总体耐药处于较高水平,应加强耐药水平的监测,尤其在初治涂阳患者中的监测,同时采取更全面的举措有效改善耐药结核病的现状。     

Biased odds ratios from dichotomization of age

Dichotomizing a continuous variable is known to result in the loss of information, lower statistical power, and lower reliability. In many epidemiological studies, age is a scaled (continuous) variable prior to statistical analyses; however, despite pleas from methodologists, researchers frequently dichotomize age in their data analysis without an appropriate rationale. Using simulated case-control data, we show that dichotomizing age generally will lead to a biased odds ratio (OR). When age was a confounder (potentially representing common causes of risks and outcomes), including age as a scaled variable (whether the age effect was linear or non-linear in the logit), provided satisfactory control, whereas when age was categorized, the estimated risk factor effect was biased. We also demonstrate that the further the cutpoint is from the median age, the greater the increase in the OR; thus, in cases where age dichotomization is warranted, researchers are cautioned not to allow the size of the empirical OR to influence their choice of cutpoint. Recommendations are made for analysing age in epidemiological data and interpretation of empirical findings.