Comparison of inpatient and outpatient upper gastrointestinal haemorrhage

Background and aims Inpatients developing upper gastrointestinal (GI) haemorrhage are at increased risk of death. This study was performed to elucidate differences in inpatients and outpatients.Patients/methods Three hundred and sixty-two patients who needed esophagogastroduodenoscopy for upper GI bleeding were identified from endoscopy charts. Patients characteristics, bleeding parameters, clinical presentation, pre-existing medication, and laboratory data were compared between patients who were admitted because of upper GI bleeding and patients who developed bleeding while in hospital for other reasons.Results/findings Hospital mortality was 39.0% in inpatients vs. 11.1% in outpatients (p<0.01). Death due to bleeding was observed in 9.5% of inpatients vs. 2.5% of outpatients (p<0.01). Whereas peptic ulcer was the most common source of bleeding in both, variceal bleeding was the most common cause of death because of haemorrhage in both. Recurrent bleeding was associated with mortality in outpatients (p<0.001), but not in inpatients (p=0.11). Rates of bleeding recurrence and need for surgery was similar in both groups. Inpatients suffered more often from renal disease, pulmonary disease, diabetes mellitus, coagulopathy, or immunosuppression, and were treated more frequently with acetylsalicylic acid, glucocorticoids and heparin. The frequency of pre-existing disease was higher in inpatients.Interpretation/conclusion Higher mortality after GI bleeding in inpatients than in outpatients is due to a generally higher prevalence of co-morbidity rather than a single or a few risk factors.     

2010年度卫生部全国细菌耐药监测报告:非ICU住院感染患者细菌耐药监测

目的 了解全国2010年非ICU住院患者临床分离细菌分布及耐药性.方法 收集2010年1月1日-12月31日全国129所医院非ICU住院患者临床分离细菌药物敏感性试验数据,根据2010年美国临床实验室标准化研究所标准,用WHONET 5.6软件进行数据分析.结果 共获得临床分离菌216 872株,其中革兰阴性菌152 351株,占70.2％;革兰阳性菌64 521株,占29.8％;最常见的细菌依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌和金黄色葡萄球菌;耐甲氧西林金黄色葡萄球菌与凝固酶阴性葡萄球菌的检出率分别为52.1％、83.8％;未发现耐万古霉素葡萄球菌,粪肠球菌和屎肠球菌对万古霉素耐药率分别为0.6％和3.3％,未发现耐利奈唑胺肠球菌属;耐青霉素肺炎链球菌检出率为10.7％;有5.9％和1.8％大肠埃希菌及9.1％和3.5％肺炎克雷伯菌对亚胺培南和美罗培南耐药;铜绿假单胞菌对碳青霉烯类抗菌药物的耐药率约为20.0％,鲍氏不动杆菌耐药率超过铜绿假单胞菌.结论 我国非ICU住院患者感染致病细菌耐药现象仍较为普遍,但同上年度相比,多数细菌耐药率未呈上升趋势.     

不同住院人群护理服务满意度调查分析

目的了解不同住院人群的护理服务满意度,为对策制定提供参考。方法采用自行设计的护理服务满意度调查表对2011年10月21-26日的住院患者进行调查。结果不同年龄、不同文化程度、不同职业、不同家庭月收入、不同医疗费用负担方式、不同住院次数及不同陪护方式的患者的护理服务满意度存在统计学差异。结论住院患者的社会人口学特征对护理服务满意度有一定影响。医院应根据不同住院人群的护理服务期望和需求开展个性化护理,真正做到因人施护、因需施护,真正做到患者满意、社会满意、政府满意。     

Nationwide prevalence and clinical characteristics of inpatient diabetic foot complications: A Peruvian multicenter study

ObjectiveTo evaluate the burden of diabetic foot complications amongst inpatients in Peru.Materials and MethodsCross-sectional multicenter study, performed in public hospitals, in one-day enrollment between October and December 2018.ResultsWe included 8346 patients from 39 national hospitals. Diabetic foot (DF) inpatient point prevalence was 2.8% (CI 95% 2.4–3.1), and DF point prevalence among Diabetes Mellitus (DM) inpatients was 18.9% (CI 95% 16.7–21.1). DF prevalence was higher in jungle and coastal hospitals than highlands ones, and there was no difference according to its care complexity level. Of the 234 patients with DF, 73% were males, age average was 62 ± 12 years, with DM mean time duration of 15 ± 9.9 years. Regarding to DF etiology, 91% and 68% had some degree of peripheral neuropathy and peripheral artery disease, respectively. According to the Infectious Diseases Society of America criteria, 61% presented moderate to severe infections, and 40% had bone involvement. Debridement within 48 h was performed in 36% of sepsis cases.ConclusionPeru has a substantial burden of DF disease, with a greater share of that burden falling on less equipped hospitals in the country’s jungle and coastal regions. Interdisciplinary teams and pathways may improve the time of surgical debridement in the highest risk patients.     

2010—2012年住院患者头孢菌素类药物用药分析

目的调查我院住院患者头孢菌素类药物的使用情况,为头孢菌素类药物临床应用管理提供依据。方法采用药物限定日剂量(DDD)分析方法,对我院住院药房2010—2012年头孢菌素类药物的品种、销售金额、用药频度(DDDs)等数据进行统计、分析。结果 3年中我院住院患者使用头孢菌素类药物的用药金额平均每年增长3.15%,第3代和第2代头孢菌素类药物使用量较大。2011—2012年第4代头孢菌素类药物使用明显增加,其DDDs在我住院患者所使用的头孢菌素类药物中排名第三。结论第4代头孢菌素类药物使用明显增加,为减少细菌耐药性的发生,应采取措施防止滥用。     

康复医学科脑卒中住院患者的静脉输液使用率现状调查和分析

目的 调查山东省康复医学科脑卒中住院患者静脉输液使用现状,并进行分析,以期进一步规范脑卒中住院患者静脉输液,降低输液使用率。 方法 采用问卷调查的形式,调查山东省内医疗机构康复医学科脑卒中住院患者静脉输液应用的相关情况。调查内容包括2021年1月1日至5月31日时间段内总出院人次、脑卒中患者出院人次和脑卒中住院患者静脉输液的使用情况（包括静脉输液药物、原因、输液时间、用药天数等）;静脉输液对康复治疗效果、脑卒中并发症和住院费用等的影响,以及所在医院对降低静脉输液率的态度和有效措施等。收集问卷数据进行统计学分析。 结果 山东省康复医学科脑卒中住院患者静脉输液使用率为31.72%,静脉输液药物种类以改善循环和营养神经为主。输液时间短对功能恢复未产生不良影响;输液时间长会影响科脑卒中住院患者的功能恢复,导致其并发症增加。静脉输液脑卒中患者日均费用较无静脉输液患者显著减少,药占比显著增加,差异均有统计学意义（P<0.05）;静脉输液脑卒中患者的平均住院天数与无静脉输液脑卒中患者比较,差异无统计学意义（P>0.05）。 结论 静脉输液提高了药占比,且长时间输液影响功能恢复,对康复治疗产生不良影响,应采取各种措施降低静脉输液使用率,规范其应用。     

住院患者跌倒不良事件的临床特征研究

目的调查分析住院患者跌倒不良事件的临床特征,为预防院内跌倒不良事件的发生提供依据。方法对2017年1月至2018年12月汕头大学医学院第二附属医院及汕头市中心医院上报的110例跌倒不良事件进行回顾性研究分析。结果住院患者跌倒以老年人为主(70.91%),多数发生在夜间,发生跌倒呈现三个高峰时间段,分别为3:00-5:00、6:00-8:00和20:00-22:00。跌倒在病床边的发生率最高,其次为病房卫生间。常见的前三个原因是病情变化、自行离床、体位改变。跌倒的患者疾病种类构成前三位的分别为神经系统疾病、泌尿系统疾病、呼吸系统疾病。ADL评估61~99分(轻度依赖)的患者发生跌倒最多,Morse跌倒风险评估25~45分(中度危险)的患者发生跌倒最多。结论临床护士应关注影响住院患者跌倒的多种因素,充分评估每例患者,并根据患者具体情况制定个性化、动态调整的预防措施,从而减少住院患者跌倒及伤害的发生。     

Comparison of the Self-Administered Alcoholism Screening Test (SAAST) and the Khavari Alcohol Test (KAT): Results from an Alcoholic Population and Their Collaterals

This study examined the reports of patients and their collaterals on drinking practices, as measured by the summary scale of the Khavari Alcohol Test (the annual absolute alcohol intake, AAAI) and alcohol related behavioral patterns, as assessed by the Self-Administered Alcoholism Screening Test (SAAST). In- and outpatients from two Milwaukee area substance abuse treatment hospitals, and a number of their collaterals, participated in this study. Patients' and collaterals' responses on the AAAI and the SAAST were compared through the use of a paired t test. Results indicated no significant differences between patients' self-reports compared with collateral reports, and demonstrated a direct relationship on the AAAI (two tailed p less than 0.001) and SAAST (two-tailed p less than 0.001). Self-reports of patients who volunteered collaterals compared with self-reports of patients who did not volunteer collaterals also showed no significant differences on the AAAI or the SAAST, demonstrating consistency of reporting whether the patients believed their reports would be compared with information provided by a collateral or not. The AAAI and the SAAST corroborated in their diagnoses of patients as suffering from alcoholism (r = 0.515, p less than 0.001). Multivariate analysis revealed no significant effect of demographic variables on either the AAAI or the SAAST. This study shows: (a) impressive concordance between patient and collateral reports; (2) apparent intactness of memory, and little evidence of denial, as measured by the instruments; and (3) the efficacy of measures such as the AAAI and the SAAST, two vastly different scales measuring dimensions of alcoholism.     

普外住院患者营养调查

通过对普外100例住院患者进行身高、体重、三头肌皮褶厚度、血清白蛋白、转铁蛋白、淋巴细胞计数、24h尿肌酐测定。计算理想体重、肌酐、身高指数百分数。对患者营养状况进行客观的综合评价,发现普外住院患者中47％以上存在着不同程度的营养不良。对各项营养状态测定指标进行了评价,并介绍了具体测量方法和营养不良的分型。     

Alcohol and drug use in orthopaedic inpatients

A series of 109 adult orthopaedic inpatients was interviewed about alcohol and other drug use and alcohol-related problems in general in the week preceding admission to hospital. The most frequently used drugs were alcohol (reported by 75%), tobacco (53%), analgesics (28%) and cannabis (15%). Alcohol was used hazardously by 28% of patients. More patients scored as problem drinkers on the Trauma Scale (52%) than the Brief MAST (7%). The detection of alcohol-related problems at an early stage is important. It is suggested that trauma victims in hospital be routinely screened for this.