Trends in deliveries in women with gestational diabetes in Spain, 2001-2008

We examined trends and characteristics of deliveries in women with gestational diabetes in Spain from 2001 to 2008. There were 101,643 deliveries with gestational diabetes among 2,782,369 delivery discharges (3.6%) with no increase over time. Rate of caesarean section increased (19-24.2%) and length of stay decreased.     

Promoting coping in children facing pediatric surgery

Surgery is challenging for children and their families, calling upon them to cope with an invasive procedure, deal with the uncertainty of the surgical outcome, and manage the stress of hospitalization. Contributors to children's distress when facing pediatric surgery include their coping style, interactions with their parents, developmental level, and temperament. A pragmatic approach is outlined that can help surgeons promote successful coping in their patients while at the same time fostering successful working relationships with parents.     

98例住院流浪精神疾病患者的回顾性对照分析

背景随着上海经济的快速发展,流动劳动力的日益增多,流浪精神疾病患者的入院人数上升。然而,国内对此类日益增长的精神疾病患者的特征研究较少。目的比较上海住院流浪精神疾病患者与住院前与家人同住的精神疾病患者的特征。方法对2007年5月-2009年4月期间由当地公安局（n=42）或救助站（n=56）送达上海市嘉定区精神卫生中心住院的98例流浪精神疾病患者进行研究,与98例同期入院的、住院前与家属或监护人同住的非流浪精神疾病患者的特征进行比较。结果两组患者的年龄差异无统计学意义,但其他人口学资料的差异均有统计学意义。与那些住院前和家人同住的精神疾病患者相比,住院的流浪精神疾病患者中较多的为男性（76.5%比59.2%,χ^2=6.76,P=0.009）、单身（88.2%比56.1%,χ^2=15.91,P〈0.001）、来自外省市（84.7%比20.4%,χ^2=83.55,P〈0.001）、无收入来源（73.4%比33.7%,χ^2=27.66,P〈0.001）。流浪组和非流浪组70%以上的患者为精神分裂症或其他精神病性障碍。流浪组患者无物质滥用或酒精使用相关问题。两组间唯一有统计学意义的差异是诊断为精神发育迟滞,流浪组有此诊断的患者比例高于非流浪组（18.4%比6.1%,χ^2=6.84,P=0.009）。流浪组患者更可能伴有躯体疾病（53.1%比33.7%,χ^2=7.50,P=0.006）。结论上海流浪精神疾病患者的住院人数正在快速增加。这些患者与由家属送住院的患者以及其他国家的流浪精神疾病患者具有不同的特征。对这类易受伤害的精神疾病患者应制定出不同的治疗和随访策略。     

急性阑尾炎患者住院费用及影响因素分析

目的:分析急性阑尾炎患者的住院费用构成及其影响因素,为控制医疗费用不合理增长提供统计依据。方法:收集2003年1月1日至2005年10月31日间诊断为急性阑尾炎的出院病例363例,应用多元逐步回归法分析影响住院费用的主要因素。结果:患者平均住院费用(5012.47±5106.54)元,影响住院费用的主要因素分别是:住院日、年龄、诊断类别和药费比例。结论:依据不同诊断类别制定合理的单病种住院日指标和费用指标,同时加强合理用药,控制药品费用比例,可以有效地降低急性阑尾炎患者的住院费用。     

住院复治涂阳肺结核患者的治疗状况调查

[目的]掌握复治涂阳肺结核患者治疗状况,采取更有效的管理对策。[方法]对2006年1~9月住院的复治涂阳肺结核患者行问卷调查。[结果]本组患者特征:①无收入或低收入者占79.5%,自费治疗者占79.5%;②60.2%患者感就医不便;③85.5%疗程中医生未随访,43.9%曾中断用药,25.9%用药不足1疗程;④27.1%未接受过结核病健康知识教育;⑤69.6%耐异烟肼,61.7%耐利福平,二者都耐者占47.8%。[结论]对初治涂阳肺结核一定要规范治疗,同时行耐药监测;普及对病人的健康教育,及时采取防治措施,尽可能减少复治涂阳病例发生。     

城镇医保病人住院费用的影响因素动态分析

通过对兰州市第三人民医院2003～2005年3年来的147例城镇职工基本医疗保险病人的住院费用进行统计,分析影响城镇职工基本医疗保险病人住院费用的各种因素,找出降低医疗费用的途径,为控制医疗费用的不合理增长提供依据。     

经济欠发达地区电视胸腔镜手术治疗体会

目的探索在经济欠发达地区最大限度降低手术费用（接近常规开胸手术费用）开展电视胸腔镜手术（video assisted thoracoscopic surgery,VATS）技术的可行性,以及具体手术方法。方法采用同时期内相同或类似种类的胸部手术病人,随机分为实验组（VATS组）和对照组（开胸手术组）,比较VATS组与开胸组在手术中出血量、手术时间、术后引流量、住院时间、住院总费用差异。结果手术时间对比无显著差异,手术中出血量、手术后胸管引流量、住院天数、手术后并发症对比差异显著,住院总费用对比差异不显著。结论通过改进常规VATS手术技术,不使用一次性器械的电视胸腔镜手术是可行的。     

Growth failure,risk of hospitalization and death for children with end-stage renal disease

Growth failure remains a significant problem for children with chronic renal insufficiency and end-stage renal disease (ESRD). We examined whether growth failure is associated with more-frequent hospitalizations or higher mortality in children with kidney disease. We studied data on prevalent United States pediatric patients with ESRD in 1990 who were followed through 1995. Patients were categorized according to the standard deviation score (SDS) of their incremental growth during 1990: severe (<–3 SDS), moderate growth failure (>–3 and <–2 SDS), and normal growth (>–2 SDS). Among 1,112 prevalent pediatric dialysis and transplant patients (<17 years, Tanner I–IV), those with severe and moderate growth failure had higher hospitalization rates {relative risk (RR) 1.14 [95% confidence interval (CI) 1.1, 1.2] and 1.24 [95% CI 1.2, 1.3]} respectively than those with normal growth after adjustment for age, gender, race, cause and duration of ESRD, and treatment modality (dialysis or transplant) in 1990. Kaplan-Meier survival analysis showed 5-year survival of 85% and 90% for patients with severe and moderate growth failure, respectively, compared with 96% for patients with normal growth (P<0.001, log-rank). Cox proportional hazards analysis revealed that those with severe (RR 2.9, 95% CI 1.6, 5.3) and moderate growth failure (RR 2.01, 95% CI 1.1, 3.6) had an increased risk of death compared with youths with normal growth, after adjustment. A higher proportion of deaths in the severe and moderate growth failure groups were attributed to infectious causes (22% and 18.7%, respectively) than in the normal growth group (15.6%). We conclude that growth failure is associated with a more-complicated clinical course and increased risk of death for children with kidney failure. Received: 15 August 2001 / Revised: 14 January 2002 / Accepted: 15 January 2002     

内科住院患者医院感染的调查与分析

目的为了探讨我院内科住院患者医院感染的基本情况，以采取相应有效的防治措施。方法采用回顾性调查方法，对我院2004年1月1日-12月31日内科、儿科出院患者的临床资料进行汇总，对其临床特点进行整理、统计分析。结果被调查的内科住院患者7101例，发生医院感染的373例，感染率5．5％，发生医院感染475例次，医院感染例次率6．7％，其中以呼吸道感染为首位，依次为胃肠道，泌尿道：抗生素使用人数为2010例，抗生素使用率46．2％：二联用药845例，占42．0％，三联用药150例，占7．4％，四联用药3例，占0．2％。结论加强医院感染管理和重点科室的目标监测，提倡合理应用抗生素，以减少医院感染的发生。