不同的抗原和技术检查日本血吸虫病的实验研究

应用ＣＯＰＴ／ＬＥＡ、ＩＦＡＴ／ＡＷＦＳ和ＦＡＳＴ－ＥＬＩＳＡ／ＪＡＭＡ检测系统，用单盲法检查日本血吸虫病人３４４例，华支睾吸虫病人３８例、肺吸虫病人１０例、健康人９３例。ＣＯＰＴ／ＬＥＡ、ＩＦＡＴ／ＡＷＦＳ和ＦＡＳＴ－ＥＬＩＳＡ／ＪＡＭＡ对血吸虫病的敏感性依次为９３．９％、９９．４％和９９．７％；对其它寄生虫病和健康人的特异性诊次为１００％、８２．３％和３７．６％；它们的Ｙｏｕｄｅｎ‘ｓ指数依次     

老年医疗保险人群用冠状动脉内支架植入的效果与医院工作量的关系

美国ＲｉｃｔｈｉｅＪＬ等在ＡｍＨｅａｒｔＪ 1999年 318卷 9月发表的综合资料 ,论述在做冠状动脉内气囊成形术 (ＰＴＣＡ)后加用支架植入 ,能改善治疗效果 ,并重点分析治疗效果和医院工作量的关系。资料包括 1994和 1996两个财政年度 ,共有 36 75 2 6例做了ＰＴＣＡ的 6 5岁以上老年人。病人又分为有急性心肌梗死 (ＡＭＩ)和无ＡＭＩ两大组 ,有ＡＭＩ者在两年中分别占 2 6 %和 2 7%。为分析ＰＴＣＡ工作量与治疗效果的关系 ,将医院分为工作量小 (每年ＰＴ ＣＡ <10 0例次 ) ,中 (10 1～ 2 0 0 )和大 (>2 0 0 )。治疗结果的判断根据院内病…     

运城地区1994—1996年急性弛缓麻痹病例调查分析

运城地区１９９７年６月对全区县级以上医院１９９４－１９９６年住院的ＡＦＰ病例进行调查共调查医院２０所，查出ＡＦＰ病例１２６例，其中地区医院４２例，占３３．３３％，万荣和闻喜县医院无病例。三年平均发病率为４．０２／１０万。远远超过卫生部规定的１／１１０万指标。病例以非为ＡＦＰ病例为主，而非脊灰ＡＦ实现偷名以格林巴利综合症最多，小儿急性偏瘫次之，其余１４种软瘫占４８．７０％。病例分布于１３个县，各月均     

成虫冰冻切片免疫荧光法检测血吸虫病研究

应用ＡＷＦＳ／ＩＦＡＴ检测系统对１０８例血吸虫病人血清并与ＣＯＰＴ、ＬＡＴ、ＩＨＡ三种常用检测方法进行对比。结果表明：ＡＷＦＳ／ＩＦＡＴ检测系统的检测结果与ＣＯＰＴ相似，其ＡＷＦＳ／ＩＦＡＴ和ＣＯＰＴ检测血吸虫病阳性检测率９５％可信限分别为９１．４１％～９９．３３％和９４．１２％～１００．３２％。ＡＷＦＳ／ＩＦＡＴ与ＬＡＴ、ＩＨＡ均有非常显著性差异（Ｐ＜０．０１）。     

肠外营养在老年结肠癌手术后的应用

目的：观察老年结肠癌病人手术后肠外营养（ＰＮ）支持与术后并发症的关系。 方法：选择２０例老年结肠癌病人,术后行ＰＮ治疗７天,另选择末行ＰＮ的结肠癌病人２０例作为对照。 结果：ＰＮ组术后并发症发生率为１０％（２／２０）,对照组为４０％（８／２０,Ｐ〈０．０５）,死亡率为５％（１／２０）。血糖、甘油三酯、ＳＧＰＴ、ｒＧＴ和ＡＫＰ在ＰＮ过程中有显著升高。 结论：老年结肠癌手术后应用ＰＮ具有改善营养状态,     

江苏省肝炎病人血清抗－HCV抗体调查

本文对江苏省不同地区１１个市（县）８１４份各类肝炎病人血清抗丙型肝炎病毒（ＨＣＶ）抗体情况进行了调查。结果表明：急性散发性肝炎抗－ＨＣＶ阳性率为５．７２％（２２／３８４），慢性活动性肝炎１５．４０％（５３／３４４），慢性迁延性肝炎８．１４％（７／８６），同时检测原发性肝癌病人２６例，抗－ＨＣＶ阳性率２３．０８％（６／２６）。在４３０份慢性肝炎病人血清中ＨＢｓＡｇ检出率２３．７２％（１０２／４３０），抗－ＨＣＶ与ＨＢｓＡｇ两项都阳性３．２５％（１４／４３０）。在慢性肝炎中，ＨＢｓＡｇ阳性病例的抗－ＨＣＶ阳性率为１３．１２％（１４／１０２），ＨＢｓＡｇ阴性者为１４．２％（４６／３２８），两组间无统计学差异。     

直接冠状动脉支架植入治疗冠状动脉病变25例

冠状动脉支架植入可以降低经皮冠状动脉成形术(ＰＴＣＡ)后再狭窄率及防止ＰＴＣＡ术中急性血管闭塞等并发症 ,这种观点已获得共识。近年来 ,临床上开始应用直接冠状动脉支架植入技术 ,即未预扩张的单独支架植入技术来治疗冠状动脉病变。本研究旨在探讨直接冠状动脉支架植入治疗冠心病的可行性、效果及适应症。1　材料与方法1·1　对象　冠心病患者 2 5例 ,男 2 3例 ,女 2例 ,年龄4 2～ 71岁 ,平均 (5 8± 11 4 )岁 ,其中心绞痛 2 2例 ,心肌梗死 3例。冠状动脉造影显示 2 4例为单支病变 ,1例为双支病变 ,其中前降支 16支 ,回旋支 3支 ,右冠…     

老年冠心病冠脉支架再狭窄相关因素调查

目的研究老年人冠脉病变的特点及支架植入后再狭窄的发生情况及相关因素。方法随机选择冠脉造影资料较全的老年冠心病患者150例，分析冠脉病变特点．并对其中复查冠脉造影的96例患者再狭窄情况，及再狭窄相关因素（年龄、性别、高血压、糖尿病、高血脂及冠脉病变特点、支架性质）进行分析。结果老年人多支病变多见75．3％，再狭窄率26.3％，其中裸支架再狭窄率36．1％（13／36），紫杉醇23_3％（7／30），雷帕霉素16．7％（5／30）。狭窄及无狭窄组患者的年龄、血脂差异无统计学意义。两组糖尿病病例数、支架长度、支架数量差异具有统计学意义，裸支架组的再狭窄率明显高于药物洗脱支架组。结论糖尿病、支架长度、多个支架、支架性质均为再狭窄的相关因素。     

大肠癌中CD44V6,PCNA表达与淋巴结转移的关系

研究转移相关蛋白ＣＤ４４Ｖ６、ＰＣＮＡ在大肠癌中的表达与淋巴结转移的关系。１０４例经手术切除Ｄ２、Ｄ３淋巴结清扫的大肠癌病例，按有无淋巴结转移分两组，采用免疫组化技术（Ｓ－Ｐ法）检测ＣＤ４４Ｖ６、ＰＣＮＡ的表达。本组大肠癌中有淋巴结转移的５６例ＣＤ４４Ｖ６、ＰＣＮＡ阳性率均为７５．０％（４２／５６）、ＣＤ４４Ｖ６、ＰＣＮＡ蛋白表达与大肠癌淋巴结转移有关（Ｐ〈０．０５）。ＣＤ４４Ｖ６、ＰＣＮＡ蛋白在     

无锡市1998年流感流行的病原学和血清学检测分析

对上海市宝山区细菌性痢疾（菌痢）监测点吴淞中心医院肠道门诊８年间志贺氏菌群、型分布及耐药情况进行分析。监测点１９９０～１９９７年腹泻病例初诊数４８８８７例，菌培养４１６９例，阳性率１７．８５％，阳性菌株占腹泻病例数的１．５２％，与上海市１９９１～１９９３年监测阳性菌株占１．４４％，较为一致。７４４株阳性菌株，分为３个菌群，１２个血清型。监测表明，Ｂ群始终为本区流行菌群，占６６．６７％～１００％；其次为Ｄ群，占５．２４％；Ａ群Ⅱ型仅占０．４％。８年间监测点未检出Ｃ群和Ａ群Ⅰ型。Ｂ群流行菌型在长期变…     

The effect of specialised medical procedures on the hosptial standardised mortality ratio in cardiac centers

OBJECTIVE: To examine the impact of specialised medical procedures (SMPs) on the hospital standardized mortality ratio (HSMR) in Dutch cardiac centres. DESIGN: Retrospective, calculation of the HSMR. METHOD: Data from 2004 from the National Medical Registration (LMR) were used to calculate the HSMR in 12 cardiac centres and all other hospitals in the Netherlands. The HSMRwas then recalculated for the 12 cardiac centres excluding either percutaneous transluminal coronary angioplasty (PTCA) or open heart surgery or both to determine the impact of these SMPs on the HSMR. RESULTS: Exclusion of SMPs from the HSMR calculation changed the HSMR for individual cardiac centres, ranging from a 4.7% decrease to a 5.3% increase. Change in HSMR was related to the relative frequency of the two procedures at each cardiac centre. Mortality risk was lower than average for PTCA and higher than average for open heart surgery. PTCA accounted for 5.6%-20.2% of total admissions in the 12 cardiac centres. A relatively high proportion of PTCA procedures was associated with a lower HSMR, to a maximum decrease of nearly 7% in one cardiac centre. Open heart surgery accounted for 2.1%-12.6% of total admissions per cardiac centre. A relatively high proportion ofopen heart procedures was associated with an increased HSMR, to a maximum increase of nearly 8% in one cardiac centre. CONCLUSION: Specialised medical procedures for heart conditions influence the HSMR of cardiac centres. The increase or decrease in HSMR is related to the relative frequency of PTCA and open heart surgery. These results can be used to help interpret the differences in HSMR among cardiac centres and other hospitals.     

Variation in management of community-acquired pneumonia requiring admission to Alberta,Canada hospitals

Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay.     

PCV13 Prevalence and Cost of Hospitalizations Due to Angina in the United States using a National Database

OBJECTIVE: To determine clinical and economic outcomes of primary PTCA and assess the effects of comorbidities (congestive heart failure, diabetes, hypercholesterolemia, hypertension) on outcomes using a national database.
METHODS: Data were obtained from MarketScanâ Medstatâ, which contains claims data for 4–5 million people. Patients with a hospital admission for PTCA (CPT codes 92982, 92984) in 1992 and one year of follow-up charge data were identified. A total of 2,663 patients with a single vessel and 331 with a multiple vessel procedure were included. Patients who died or were missing prior to one-year follow-up were excluded (n = 653). Total charges were calculated by summing charges for the index procedure plus all inpatient and outpatient charges incurred during the year following PTCA. Multivariate regression was used to assess effects of comorbidities on outcomes (adjusted for age and other factors).
RESULTS: Patients with single vessel versus multiple vessel PTCA did not differ according to comorbid and other characteristics, or most clinical or economic outcomes; therefore combined data are presented. The frequency of clinical outcomes in the year following PTCA was: rehospitalization for angina-41%, myocardial infarction (MI)-33%, repeat PTCA-15%, coronary artery bypass grafting-7%, and stroke-3%. Comorbidities related to clinical outcomes were: congestive heart failure (CHF) for MI (p = 0.0001), diabetes for angina rehospitalization (p = 0.06), and diabetes (p = 0.05) and hypertension (p = 0.004) for repeat PTCA. Total charges per patient at one year after primary PTCA were $35,257, and total charges were strongly related to the presence of diabetes (p = 0.001) and CHF (p = 0.001). There was no association with hypertension or hypercholesterolemia.
CONCLUSION: These findings show that the presence of certain comorbid factors does influence clinical and economic outcomes following PTCA.     

Hospital case fatality associated with coronary angioplasty in Rio de Janeiro State, Brazil, 1999-2003

This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA) covered by the Brazilian Unified National Health System (SUS) and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). There was great variability among PTCA case fatality rates in different hospitals (from 0 to 6.5%). Ongoing monitoring of PTCAs is thus necessary in clinical practice. In conclusion, PTCA performance was still unsatisfactory under the Unified National Health System.     

An epidemiological study of RSV infection in the Gambia

OBJECTIVE: To describe the epidemiology of respiratory syncytial virus (RSV) infection in a developing country. METHODS: The work was carried out in three hospitals for primary cases and in the community for secondary cases in the western region of the Gambia, West Africa. RSV infection was diagnosed by immunofluorescence of nasopharyngeal aspirate samples in children younger than two years admitted to hospital with acute lower respiratory infection (ALRI). Routine records of all children with ALRI were analysed, and the incidence rates of ALRI, severe RSV-associated respiratory illness and hypoxaemic RSV infections were compared. A community-based study was undertaken to identify secondary cases and to obtain information about spread of the virus. FINDINGS: 4799 children with ALRI who were younger than two years and lived in the study area were admitted to the study hospitals: 421 had severe RSV-associated respiratory illness; 55 of these were hypoxaemic. Between 1994 and 1996, the observed incidence rate for ALRI in 100 children younger than one year living close to hospital was 9.6 cases per year; for severe RSV-associated respiratory illness 0.83; and for hypoxaemic RSV-associated respiratory illness 0.089. The proportion of all ALRI admissions due to RSV was 19%. Overall, 41% of children younger than five years in compounds in which cases lived and 42% in control compounds had evidence of RSV infection during the surveillance period. CONCLUSION: RSV is an important cause of ALRI leading to hospital admission in the Gambia. Morbidity is considerable and efforts at prevention are worthwhile.     

1998~2003年巢湖市医疗机构消毒灭菌质量监测分析

目的　研究巢湖市医疗机构消毒灭菌工作状况,探索进一步控制医院感染的策略。方法　依据GB15982-1995《医院消毒卫生标准》和GB15981-1995《消毒与灭菌的评价方法与标准》进行采样监测。结果　1998~2003年各医疗机构消毒监测总合格率呈逐年上升趋势(P<0. 01);市、县两级医疗机构消毒监测总合格率分别为80. 38%、76. 02%,两者差异有显著性(P<0. 05 )。各类监测样本中以压力蒸汽灭菌合格率最高( 93.10% ),空气中细菌含量合格率最低(38. 49% )。结论　应进一步加强对医疗机构特别是县级医疗机构医院感染和医院消毒的管理,进一步提高医务人员的无菌意识。     

Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States

In the period 1975 to 1981, methicillin-resistant Staphylococcus aureus (MRSA) emerged as an important nosocomial pathogen in tertiary care centers in the United States. To determine if the prevalence of this organism has continued to increase, a questionnaire was sent to hospital epidemiologists in 360 acute care hospitals. A total of 256 (71%) of the 360 individuals responded. Overall, 97% (246/256) of responding hospitals reported having patients with MRSA in the period 1987 through 1989. Respondents in 217 hospitals provided estimates of the number of cases seen in 1987, 1988 and 1989. The percentage of respondents reporting one or more patients with MRSA increased from 88% in 1987 to 96.3% in 1989 (p = .0008). The percent of respondents reporting large numbers (greater than or equal to 50) of cases per year increased from 18% in 1987 to 32% in 1989 (p = .0006). Increasing frequency of large outbreaks was observed in community, community-teaching, federal, municipal and university hospitals.     

Learning and the evolution of medical technologies: the diffusion of coronary angioplasty

This study uses longitudinal data on patients receiving percutaneous transluminal coronary angioplasty (PTCA) to examine changes in outcomes and costs. All hospitals achieved substantial reductions in inpatient mortality and emergency bypass surgery over time, regardless of the number of procedures performed. Annual hospital procedure volume was also associated with improved outcomes, although the effect is small. There was no evidence that learning by doing (cumulative PTCA volume) influenced outcomes. The high correlation between annual and cumulative procedure volume precludes a point estimate of the effect of learning by doing on costs, although the upper bound on the potential learning effect is sizeable. The results suggest that centralizing provision of PTCA may lead to lower costs, but only small outcomes improvements.     

Evaluation of quality of care through hospital discharge reports: an example of rectal cancer surgery

This study was undertaken to evaluate the usefulness of hospital discharge data for monitoring the impact of a regional practice guideline on treatment of colorectal cancer. The aims of the study were: i) estimating process and outcome indicators; ii) exploring the relationship between patient and hospital characteristics and these indicators. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for all risk factors analysed. All 3,614 patients undergoing potentially curative resection for rectal cancer in 75 hospitals in Piedmont (Italy) between 1997 and 2000 were included. Occurrences of abdominoperineal resections (APR), postoperative complications, reinterventions and hospital mortality were 16.2%, 11.0%, 5.5% and 4.4%, respectively. APR was performed more frequently in patients with distant metastases or urgently admitted and by hospitals with a lower volume of cases (< 25 per year) compared to hospital with more than 50 cases per year (OR = 1.50, CI = 1.16-1.94). The strongest predictors for mortality and complications were: older age, distant metastases and urgency of admission. Incidence of complications and of reinterventions was also increased among males and in patients with lesions of the lower rectum. The rate of complications showed an increasing trend during the period, from 8.5% to 14.5% likely reflecting improvement in coding during time. Low hospital workload was associated to a reduced risk of complications and reinterventions, but there was evidence of underreporting of secondary diagnoses and procedures in smaller hospitals. Outcome indicator based on secondary diagnoses and procedures are of limited value in monitoring improvement of care since they reflect also differences in coding during time and among providers.     

Waiting for coronary revascularization: a comparison between New York State, The Netherlands and Sweden

OBJECTIVE: To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in New York State, the Netherlands and Sweden and to determine whether queuing adversely affects patients' health. METHODS: We reviewed the medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n = 1486). We measured the median waiting time between coronary angiography and PTCA or CABG. RESULTS: The median waiting time for PTCA in New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sweden (P < 0.001). For CABG, New York patients waited 17 days, while Dutch and Swedish patients waited 72 and 59 days, respectively (P < 0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG candidates and 0.15% for PTCA candidates. CONCLUSIONS: There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experiencing an adverse event. In both the Netherlands and Sweden, the capacity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other areas where quality of care can be improved.