某医院新生儿重症监护病房患者感染病原菌种类变迁

摘要 目的 研究NICU患者感染病原菌种类的变迁及其耐药情况。方法 通过回顾性调查方法,对某医院NICU住院患者连续6年医院感染病原菌种类变化情况及其耐药性进行了调查。结果 该医院NICU患者连续6年共送检病原学标本10 971份,分离出病原菌1 876株,阳性率17.10%。其中革兰阴性菌占67.86%,革兰阳性菌占26.44%,真菌占5.70%。连续6年中,临床标本分离的革兰阴性菌呈现下降趋势,而革兰阳性菌和真菌分离率则出现上升趋势。革兰阴性菌优势菌为肺炎克雷伯菌和大肠埃希菌,革兰阳性菌优势菌为葡萄球菌和B族链球菌。临床分离的革兰阴性菌对头孢类抗菌药物耐药率较高,保持对碳青霉烯类抗菌药物敏感。结论 NICU患者医院感染病原菌仍以革兰阴性菌为主,但革兰阳性球菌和真菌分离率呈现上升趋势。     

How one could once become a registered nurse in the United States without going to a hospital training school

Distant learning in nursing is both a new and old concept. This paper examines an early example of correspondence schools in nursing, namely the Chautauqua School which over the course of its existence enrolled over 20,000 students. Its closing was due in large part to the opposition of organized nursing which had become institutionalized in the hospital training school. It was not until the 1990's when license recertification was required that long distant nursing again assumed importance.     

Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia

What is known and Background: Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial‐based thought record (TBTR), which targets the restructuring of patients’ core beliefs. Objective: To determine whether patients receiving TBTR would report fewer symptoms of social anxiety and general psychiatric distress following treatment, relative to conventional cognitive therapy (CCT). Methods: A two‐arm randomized trial comparing TBTR (n = 17) with a set of CCT techniques (n = 19), which included the standard seven‐column dysfunctional thought record and the positive data log in SAD patients according to DSM‐IV. Results: Scores on many outcome measures decreased significantly across the course of treatment in both groups (P < 0·001), including the Liebowitz Social Anxiety Scale, Fear of Negative Evaluation Scale (FNE), Social Avoidance and Distress Scale (SADS), Beck Anxiety Inventory, and Clinical Global Impression – Improvement. In addition, a one‐way ancova , taking baseline values as covariates, showed that TBTR was significantly more efficacious than CCT in reducing the scores of FNE (P = 0·01 at mid‐treatment and P = 0·004 at post‐treatment), and SADS (P = 0·03 at post‐treatment). What is new and Conclusion: This study provides preliminary evidence that TBTR is at least as efficacious as CCT in reducing symptoms of SAD, pointing to the need for additional studies of TBTR in SAD and other psychiatric disorders.     

Out of hospital cardiac arrests--the experience of one hospital in Singapore.

In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrillators and the crew is trained in their use. This is the first paper from Singapore reporting the survival rate in patients presenting to an urban public hospital with acute coronary syndrome (ACS) who developed out-of-hospital cardiac arrest (OHCA). All consecutive patients who presented to the ED of a public hospital with OHCA or ACS were surveyed from 1 April 1999 to 30 September 1999. There were 392 patients among whom 115 (28.5%) had OHCA. There was no significant difference in age and gender distribution between the OHCA and non-OHCA patients. More than 2/3 of the OHCA patients had no report of chest pain or breathlessness before they collapsed. Forty five (39.1%) of the 115 OHCA patients were noted to have initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF) and received pre-hospital defibrillation. The mean time from collapse to first DC shock was 12.07+/-7.2 min. Twenty (17.4%) of the OHCA patients had return of spontaneous circulation after resuscitation in the ED. Four patients (3.5%), all with an initial rhythm of VF were discharged alive from the hospital. Much remains to be done to reduce the time interval to first DC shock for the OHCA group.     

新形势下如何做好平安社区医院的建设工作

社会主义和谐社会的建设是摆在全国人民面前的一项重大而又长远的课题,社会的和谐必将给人民带来更深入的对社会主义建设成果的共享。作为社会中与人们健康息息相关的医疗卫生服务机构,特别是平安社区医院的建设,是我们医务工作者应当为社会主义和谐社会建设应尽的义务。     

How a crisis at one maternity service became a catalyst for change across the Victorian public hospital system: A discussion paper

BackgroundIn Victoria, Australia, public hospitals are administered through a system of devolved governance. Overall, Victoria's public health system has a record of good performance when comparing measurable safety outcomes to the rest of Australia. However, in 2015 a cluster of preventable perinatal deaths were identified at a health service in Melbourne's outer fringes.QuestionsWhat were the factors that contributed to these preventable deaths, and what were the outcomes of the four key inquiries commissioned by the Victorian government after the identification of the cluster? What can be learnt by comparing this crisis in one Victorian health service to similar events at other health services in Australia and the United Kingdom?MethodsThis paper discusses the crisis at the Victorian health service and expands on the factors that contributed to the crisis, the inquiries, subsequent recommendations, and the response from the Victorian state government. Similarities between this case and others in Australia and the United Kingdom are discussed.FindingsA common theme in the four inquiries into the crisis at the health service in Victoria was that inadequate clinical governance was a key factor that led to these events. As a result, a number of significant changes were implemented across the state to improve patient safety across all areas of health care. When comparing this Victorian crisis to similar events at other health services across the world, inadequate clinical governance consistently appears as a key contributing factor to poor clinical outcomes.DiscussionAll cases discussed had a delay in the identification of clusters of poor clinical outcomes. This was found to be a direct result of inadequate clinical governance structures at both a local and government level.ConclusionA robust clinical governance framework that is enacted at both the government and the health organisation level is essential to deliver high quality and safe patient care.