住院患者抗菌药使用现状调查

目的:了解我院抗菌药的临床使用现状和存在问题,为抗菌药的合理应用和管理提供科学的依据。方法:调查医院2006年8月21个临床科室的1410份住院病历,内容包括抗菌药使用情况、选用原因和依据、联用情况、给药途径、感染病例细菌培养送检情况等,并进行统计分析。结果:共使用抗菌药9大类44种,使用最多的是头孢菌素类和喹诺酮类。抗菌药使用率61.70%,其中预防用药比例35.06%;联合用药比例43.10%;病原体培养及药敏试验的送检率为31.86%,抗菌药物选用依据以经验用药为主。结论:抗菌药物合理应用的管理须进一步加强。     

Effect of changing referral mode to C-L Psychiatry for noncognitively impaired medical inpatients with emotional disorders

Objective: To test the effect of changing referral mode to Consultation–Liaison Psychiatry (C–L Psychiatry) by implementing early screening with systematic multidisciplinary management for emotional disorders in noncognitively impaired medical inpatients. Method: A prospective pre- and postintervention controlled study in the internal medicine division of a university hospital. Results: Out of 515 patients admitted to the internal medicine ward during the study period, 176 were included in the study and gave their informed consent (male=63%); 81 in the control group and 95 in the intervention group. Except for the increase in referral rate to the C–L Psychiatry service (4–32%), there were no significant differences between the baseline and intervention periods either in terms of length of stay in the internal medicine ward and of use and costs of medical resources, or in terms of patients' satisfaction as regards attention paid to psychosocial issues during hospitalization. Conclusion: As a result of changing referral mode to C–L Psychiatry, the lack of effect on length of stay and on medical consumption of medically ill inpatients should be considered in the context of the briefness of the hospitalization periods encountered. Furthermore, the change in referral process does not seem to increase patients' perception of the quality of care provided.     

眼科住院病人流行病学的调查

目的了解眼科住院病人的内部构成比,为眼科的发展提供理论依据。方法收集2002-2004年眼科住院病人2,165例。运用Stata 8．0软件进行统计分析。结果眼科住院病人前四位的疾病是：白内障、眼外伤、青光眼、视网膜脱离；在年龄、性别上有明显差异,以30-40岁(14．48-16．08％)、50-60岁(14．99-18．38％)、60-70岁(18．38-21．22％)为主要病源；性别上,男性为60．31-64．17％,女性为35．84-39．69％。结论白内障、眼外伤、青光眼、视网膜脱离是眼科住院主要病种。     

上海市老年护理医院六年间住院患者死亡分析

目的了解引起老年人死亡的疾病分类,做到早期干预,降低病死率。方法向上海市老年护理医院发放统一调查问卷,对1999—2001年及2004—2006年6年间住院的老年患者资料进行分析。结果两个年段住院老年患者年平均病死率分别为20.99%和7.60%,差别有统计学意义(P<0.01),两个年段老年患者的病死率均随年龄增长而升高(P<0.01)。两个年段死因排位前3位均分别是心脑血管疾病、恶性肿瘤和呼吸系统疾病。结论近年来老年病的防治取得一定成效,但如何降低心脑血管疾病、恶性肿瘤和高龄老人的病死率仍是今后工作的重点。     

Inpatient rehabilitation of patients requiring hemodialysis: improving efficiency of care

OBJECTIVE: To determine if reducing missed therapy sessions by patients requiring hemodialysis will reduce the length of stay (LOS) and improve the efficiency of care in an inpatient rehabilitation unit. DESIGN: Retrospective study. SETTING: Inpatient rehabilitation unit at a university medical center. PARTICIPANTS: All patients discharged from the Albany Medical Center rehabilitation unit between January 1, 2003, and June 30, 2004. The total number of patients was 955, 40 of whom required hemodialysis. INTERVENTION: On January 1, 2003, Albany Medical Center began providing hemodialysis in the late afternoon, allowing patients to complete a full 3-hour program without missing therapy sessions to attend dialysis. We compared the outcomes of 915 patients who did not require hemodialysis with the outcomes of 40 patients who required hemodialysis. We also compared the outcomes of patients treated on the rehabilitation unit in 2003-2004 to the outcomes of patients treated on the rehabilitation unit before dialysis was available at times that did not conflict with therapy (calendar year 2001). MAIN OUTCOME MEASURES: LOS, improvement on the FIM instrument, and FIM efficiency score. RESULTS: The LOS of the hemodialysis patients changed from 16.0 in 2001 to 12.1 in 2003-2004 (P<.05), and the FIM efficiency score of the hemodialysis patients improved from 1.8 in 2001 to 2.9 in 2003-2004 (P<.05). The FIM efficiency score of the nondialysis group in 2003-2004 was 4.0. This was significantly greater (P<.05) than that of dialysis patients in 2003-2004. CONCLUSIONS: A program to reduce conflicts between medical treatments such as hemodialysis and therapy sessions may result in reduced LOS and improved efficiency on an inpatient rehabilitation unit.     

A double-blind randomized study comparing imipramine with fluvoxamine in depressed inpatients

Objective To compare the efficacy of imipramine and fluvoxamine in inpatients from two centers suffering from a depressive disorder according to DSM IV criteria.Methods The study included 141 patients with a depressive disorder according to DSM IV criteria. After a drug-free and placebo run-in period of 1 week, patients were randomized to imipramine or fluvoxamine; doses of both drugs were adjusted to a predefined target blood level. Efficacy was evaluated 4 weeks after attaining predefined adequate plasma level.Results The mean age of the study group (47 males, 94 females) was 51.8 (range 19–65) years. Of these 141 patients, 56 had episode duration longer than 1 year, 48 had mood congruent psychotic features, and 138 patients received medication. Seven patients did not complete the medication trial. The total number of patients using concurrent medication was 12/138 (8.6%). On the primary outcome criteria patients on imipramine improved significantly better on the change of illness severity score of the CGI (² exact trend test=4.089, df=1, P=0.048). There was no significant difference in 50% or more reduction on the HRSD, the other primary outcome criterion. On the secondary outcome criteria the mean reduction of the HRSD scores was significantly larger in the imipramine group than in the fluvoxamine group (mean difference=3.1, standard error (SE)=1.4, t=2.15, df=136, P=0.033). There was no significant difference in the number of patients with an HRSD 7 at the final evaluation.Conclusions In depressed inpatients imipramine is more efficacious than fluvoxamine. Both drugs were well tolerated by all patients.     

慢性心力衰竭住院病例药物治疗的回顾性调查

目的了解慢性心力衰竭(心衰)住院病例治疗药物在30年来的应用情况。方法采用两中心、回顾性研究。对药物治疗在年代、性别、年龄、心功能和病因等的分布进行分析。结果入选5189例次,男女比为1∶1.02(P>0.05)。平均年龄(62.93±13.49)岁。临床诊断依次是冠心病(44.2%)、风湿性心脏病(24.1%)、肺心病(19.0%)、扩张型心肌病(4.8%)等。入院时心功能以纽约心功能分级(NYHA)Ⅲ级、Ⅳ级为主,分别为40.6%和44.5%。治疗药物总体应用比例为硝酸酯类80.0%、利尿剂71.8%、洋地黄制剂68.1%、血管紧张素转换酶抑制剂(ACEI)52.2%和β-受体阻滞剂19.5%,上述药物的应用逐年代增加。肺心病心衰病例的主要治疗药物也是硝酸酯类、利尿剂、洋地黄制剂。男性应用ACEI多于女性,≥60岁患者应用ACEI和血管紧张素受体拮抗剂(ARB)的比例多于<60岁年龄组,β-受体阻滞剂的应用则无性别和年龄差异。结论慢性心衰住院病例的治疗药物以利尿剂、硝酸酯制剂和洋地黄制剂等为主;ACEI和β-受体阻滞剂的应用增加迅速,虽未达到"指南"的要求,但显示了治疗观念的变化。     

安徽省某县乡镇卫生院住院患者就诊原因分析

目的监测和评价乡镇卫生院住院患者的疾病变化趋势以及影响因素,为有效提高居民卫生服务利用、合理配置医疗资源提供依据。方法采用整群抽样的方法,对样本地区乡镇卫生院住院病人的就诊原因进行分析。结果损伤和中毒原因占全部就诊人次的17.76%,妊娠、分娩原因占全部女性就诊人次的16.95%,生殖系统及乳房疾病占全部女性就诊人次的3.46%,循环系统原因占全部就诊人次的16.66%。0～5岁以下婴幼儿就诊原因以呼吸系统疾病为主。5～10岁儿童以呼吸系统疾病与损伤和中毒为主。结论在基层医药卫生体制改革时期,要加强对农村居民损伤和中毒的预防以及女性疾病,老年慢性病和儿童常见病的监测和评价。     

县级医院住院患者对护理服务质量评价调查分析

目的调查2所县级综合医院住院患者对护理服务质量的评价情况,系统分析医院在护理服务质量方面存在的问题,为完善医院护理管理制度和提高服务质量提供参考依据。方法采用忻州市人民医院研制的住院患者对护理服务质量评价量表,对2所县级综合医院的100例住院患者进行调查。结果住院患者对医院护理服务质量的总体评价得分为（92.6±12.75）分,多元回归显示6个自变量对应变量的影响从大到小依次为收入、居住地、年龄、性别、付费方式和文化程度,其中收入和居住地对其评价得分有一定的影响。结论定期运用护理服务质量评价量表结合其他定性评价方法可以较准确地评价医院的护理服务质量,根据患者对护理服务质量的评价给予反馈解决和重新评估,是实现护理服务质量持续改进的根本措施。     

物质依赖住院病人逃逸的分析及其对策

目的：探讨精神活性物质所致精神障碍住院患者私逃的特点和对策。方法：回顾性分析物质依赖科8例住院逃逸患者的临床资料。结果：逃逸者多数为新型非法精神活性物质所致精神障碍患者。患者外逃多发生在晚上非正常上班期间，外逃方法多为毁坏病房窗子后逃跑。逃逸时患者戒断症状已消除或精神病性症状已消失。患者外逃后大多能及时追回或及时办理自动出院手续，外逃期间未发生严重后果。结论：新型非法精神活性物质所致精神障碍住院患者逃逸发生率较高。私逃原因复杂多样，应采取综合措施防范患者外逃。