口腔医院医护人员使用手套情况调查分析

手套的使用能有效地防止医护人员手的污染[1,2].但是使用手套并不能完全阻断手的污染,也不能完全防止医院交叉感染的发生.因为,病原菌可能会通过手套上的细小的破口或在医护人员摘手套时到达医护人员手上[3].     

Factors associated with use of emergency medical services in patients with acute stroke

Purposes

The aim of this study was to investigate the factors associated with use of emergency medical services (EMS) in patients with acute stroke.

Methods

Prospective data on consecutive patients with acute stroke who presented to the emergency department of a university medical center from January 1, 2010, to July 31, 2011, were analyzed. Patients were excluded if they had an unknown residence, had onset of stroke at a nursing home or hospital, or were transferred from another hospital. Variables for all patients with stroke and ischemic stroke who did and did not use EMS were compared.

Results

In total, 1344 patients (60% male; mean age, 68.7 years) were included. Use of EMS (n = 409; 30.4%) was significantly associated with a higher level of education (≧ 6 years vs < 6 years; odds ratio [OR], 1.69; 95% confidence interval [CI], 1.25-2.29), a higher National Institutes of Health Stroke Scale score (OR, 1.08; 95% CI, 1.05-1.11), altered consciousness (OR, 1.88; 95% CI, 1.25-2.84), and atrial fibrillation (OR, 2.43; 95% CI, 1.71-3.44) after adjustment. For patients with ischemic stroke, use of EMS was significantly higher in cases of cardioembolism (OR, 3.04; 95% CI, 1.40-6.60) and large artery atherothrombosis (OR, 2.10; 95% CI, 1.22-3.62) than lacunar infarction.

Conclusion

Patients with stroke who have altered consciousness, a higher level of education, a higher National Institutes of Health Stroke Scale score, atrial fibrillation, and cardioembolic stroke were more likely to use EMS.     

Sterile versus non-sterile glove use and aseptic technique

There is evidence indicating that improvements in infection control practice can reduce the incidence of healthcare-associated infection. This article explores the evidence base for glove use and aseptic technique. There is a lack of evidence regarding the influence of sterile versus clean gloves in clinical care. Therefore in practice, clean and aseptic techniques are often used interchangeably. Nurses must learn to select clean or aseptic technique, and therefore clean or sterile gloves, using a risk assessment protocol. Regular audits of aseptic technique and education are needed to improve care.     

Appropriate glove use in the prevention of cross-infection

This article aims to promote evidence-based practice in glove use and infection control. Evidence indicates that improvements in infection control practice can reduce the incidence of healthcare-associated infection and exposure to communicable disease among healthcare workers. The correct use of gloves is vital in the healthcare environment. Gloves should be worn for invasive procedures, any contact with sterile sites, non-intact skin, mucous membranes and exposure to blood, body fluids and sharp or contaminated instruments. They should be worn only once, for one aspect of care and one patient, disposed of as clinical waste, and the hands decontaminated after removal.     

Healthcare workers' knowledge of inoculation injuries and glove use

Healthcare workers' (HCWs') occupational risk of exposure to blood-borne pathogens has been well documented. Subsequent educational programmes, awareness campaigns and policy implementation made limited impact on HCWs' level of knowledge of these risks and compliance with universal precautions. Two hundred HCWs completed a questionnaire to evaluate their level of knowledge. Results demonstrated that despite a comprehensive educational programme for nurses and training for medical staff, knowledge of inoculation injuries and associated issues remained inadequate. Indeed, policies and procedures were not followed. Furthermore, gloves were not routinely worn in the clinical setting. Educational programmes ware essential to inform HCWs of occupational risk of exposure to blood-borne pathogens and guide practice following an inoculation injury. However, efficacy of such programmes must be reviewed, alternative strategies evaluated, and the cause of HCWs' limited knowledge determined.     

Health care use and costs associated with use of a health club membership benefit in older adults with diabetes

OBJECTIVE—The purpose of this study was to determine whether elective use of a health plan–sponsored health club membership had an impact on health care use and costs among older adults with diabetes.RESEARCH DESIGN AND METHODS—Administrative claims for 2,031 older adults with diabetes enrolled in a Medicare Advantage plan were obtained for this retrospective cohort study. Participants (n = 618) in the plan-sponsored health club benefit (Silver Sneakers [SS]) and control subjects (n = 1,413) matched on SS enrollment index date were enrolled in the plan for at least 1 year before the index date. Two-year health care use and costs of SS participants and control subjects were estimated in regressions adjusting for baseline differences.RESULTS—SS participants were more likely to be male, had a lower chronic disease burden, used more preventive services, and had a lower prevalence of arthritis (P ≤ 05). SS participants had lower adjusted total health care costs than control subjects in the first year after enrollment (−$1,633 [95% CI −$2,620 to −$646], P = 0.001), and adjusted total costs in year 2 trended lower (−$1,230 [−$2,494 to $33], P = 0.06). Participants who made on average ≥2 SS visits/week in year 1 had lower total costs in year 2 ($2,141 [−$3,877 to −$405], P = 0.02) than participants who made <2 visits/week.CONCLUSIONS—Use of a health club benefit by older adults with diabetes was associated with slower growth in total health care costs over 2 years; greater use of the benefit was actually associated with declines in total costs.Health care costs associated with diabetes account for 32% of total Medicare spending (1). Clinical practice guidelines recommend physical activity as an important component of diabetes management (2) and for prevention of cardiovascular complications (3), but only 16% of individuals aged 65–74 years engage in at least 30 min of moderate activity ≥5 days/week (4). The benefits of physical activity for older adults include better health, improved functioning, increased quality of life, lower health care costs, and longer survival (5–8). There is growing recognition that environmental conditions and policies that promote physical activity can have an impact on modifiable behavioral risks and chronic conditions (9,10).Health plan promotion and direct support of physical activity via sponsored exercise programs have the potential to reach many people because 61% of younger Americans had employment-based health insurance in 2004 (11) and nearly 100% of older Americans have Medicare coverage. Two previous studies of a health plan–sponsored community-based group exercise program (EnhanceFitness) for Medicare Advantage plan enrollees showed that participants in a general population (12) and in a subgroup of members with diabetes (13) who made greater use of the exercise program had lower adjusted health care costs than less active participants and control subjects. A third study examined the cost impact of a health club membership (Silver Sneakers [SS]) sponsored by the same Medicare Advantage plan with older adult members and found that SS use was associated with slower growth in total health care costs, particularly for the most active SS participants (14).This study extends prior studies by examining whether the health care use and cost impacts of SS participation found in older adults also apply to the subset of older adults with diabetes who have the most to gain from regular physical activity. We compared dose effects of SS participation on health care use and costs, based on a dose threshold of <2 or ≥2 visits/week. This study may provide further evidence of whether health plan–sponsored health club memberships provide a return on investment for older adults with chronic conditions and the level of participation needed to reduce health care costs.     

Prehospital cardiac arrest outcome is adversely associated with antiarrythmic agent use, but not associated with presenting complaint or medical history

Methods: This prospective multicentre trial enrolled 874 prehospital cardiac arrest patients encountered by urban, suburban, and rural emergency medical services. This group underwent conventional ACLS intervention followed by empiric early administration of sodium bicarbonate (1mEq/l). Survival was measured as the presence of vital signs on emergency department arrival. Data analysis used Student's t test, Fisher's exact test, χ² with Pearson correlation, and logistic regression (p<0.05).

Secondary end points were analysed including an association with common historical variables such as medical history, presenting complaint, or drugs used.

Results: The overall survival rate was 13.9% (110 of 793) of prehospital arrest patients. There was no correlation between historical factors, such as chief complaint or history of present illness (p = 0.277), medical history (p = 0.425), presence of specific disease conditions (p = 0.1125–0.956), or overall drug use (p = 0.002–0.9848). However, there was an adverse association between specific antiarrhythmic use (p = 0.003) and outcome.

Conclusion: There is little relation of patient historical factors on the outcome from prehospital cardiac arrest raising issues of efficiency with history taking in prehospital care and transport.

     

Rationalising examination glove use to improve patient care and reduce costs

An exercise to standardise glove use across three hospitals uncovered incorrect use of gloves in clinical practice. It also found that a wide range of gloves were being used for different purposes and procured at different costs. This paper explores the reasons and looks at strategies to streamline practice and achieve trust-wide standardisation and cost savings     

Hypereosinophilia associated with echinacea use

Echinacea, believed by herbal practitioners to enhance the immune system, is one of the most widely used herbal supplements in the United States. Like most herbal products, it lacks strict FDA regulation and more information is needed about its potential adverse reactions. Here, we report the case of a patient with eosinophilia of unclear etiology whose condition resolved after cessation of this supplement. We feel this likely represents an IgE-mediated allergic process to echinacea.     

Availability of medical care services in drug treatment clinics associated with lower repeated emergency department use

BACKGROUND: Drug users rely heavily on emergency departments (EDs) for care. Medical and other services in outpatient drug treatment clinics may reduce demand for ED care. OBJECTIVE: The objective of this study was to examine the association of services in drug treatment clinics with repeated ED use by clinic patients. DESIGN: This study consisted of telephone interviews of directors of a stratified random sample of 125 New York state outpatient drug treatment clinics linked to Medicaid claims for patients with long-term (>or=6 months) treatment at these clinics. PATIENTS: This study comprised a total of 8397 Medicare enrollees in surveyed clinics in 1996 to 1997. MEASUREMENTS: The surveys addressed drug treatment; general medical, HIV, alcohol, and social support services; location of selected services; primary care, HIV specialty, and mental health provider staffing levels; accessibility; and academic affiliation. From Medicaid claims, we defined patient demographic, clinical, and healthcare variables. Logistic regression models examined associations of availability of onsite medical services with repeated (2 or more) ED visits in 1997, adjusted for patient characteristics and patient clustering in clinics. RESULTS: Repeated ED visits occurred in 15% of the cohort and were less likely when medical services were all onsite versus more distant (12.9% vs 16.8%, P<0.001). An interaction showed that onsite medical care was associated with less ED use only in low-volume (相似文献