儿科加强医疗病房患儿死因探讨

目的：为降低儿科急重症的死亡率。提高儿科加强医疗病号的诊治质量。方法：回顾性分析了自1995年1月－2000年1月5年中该院儿科加强医疗病房的死亡病例发生器官功能不全及病种分布情况。结果：46例死亡病例发生器官功能不全以肺及胃肠道受累为主,1月－3岁组死亡率明显地高于3－12岁组,两组死亡例数差异有显著性意义（P＜0．01）,可见随着年龄增长死亡率呈下降趋势,引起急重症患儿死亡的原发病各不相同,主要仍以败血症,呼吸系统及消化系统疾病为主,结论：降低急重症患儿的死亡率必须首先降低1月－3岁以内婴幼儿的死亡率,应重视对呼吸系统疾病,败血症及消化系统疾症的诊治,认识危重症患儿的全身炎性反应综合征（SIRS）及时诊断和正确治疗对降低患儿的病死率将有重大意义。     

A review of measles admissions and deaths in the paediatric ward of Goroka Base Hospital during 1989

We reviewed all measles cases admitted to the paediatric ward of Goroka Base Hospital in 1989, and also interviewed a sample of measles patients attending the paediatric outpatient department. Measles accounted for 11% of all paediatric admissions and 32% of deaths. The case fatality rate for measles was 17%. Children with nosocomial infections and children with low birthweight were more likely to die. The most common complications of measles were pneumonia and diarrhoea, pneumonia being the most common cause of death. Twelve cases of subacute sclerosing panencephalitis were admitted during the year (0.5% of paediatric admissions). Measles was underreported because it was frequently omitted from the discharge diagnosis, the emphasis being placed on the complications. The majority of children with measles admitted to the ward and seen in outpatients had not been vaccinated. Nosocomial infections could have been reduced if all paediatric admissions aged 6-35 months had been vaccinated on admission. We strongly endorse the policy of vaccinating children in Papua New Guinea against measles from the age of 6 months.     

优质护理服务在半封闭式精神科病房开展的效果观察

目的：探讨在精神科病房开展优质护理服务的可行性及其效果。方法：选取我院精神疾病患者300例,根据护理方式的不同分为研究组和对照组,各150例。研究组给予优质护理服务,对照组给予常规护理。结果：两组患者在医院和护士满意度（对病区管理、护理人员的工作能力、沟通能力等）、出院1年内随访（不合作、高风险事件、复发率）、知识了解度优良率比较,差异有统计学意义（P〈0.05）。结论：精神科半封闭式病房开展优质护理可显著提高护理质量、患者满意度,值得在后期临床中推广。     

烧伤留观病房诊疗流程探索

以往烧伤病人因经费问题,大多在急诊科进行留观治疗,急诊科有各种须紧急处理的危重病人致烧伤病人得不到最佳处理,休克期难以平稳度过,以后的治疗增加了难度。鉴于此,我科于1999年起将急诊留观的烧伤病人转至病房留观,取得了满意的社会效益及经济效益。     

难忘的一次查房

大约25年前,那时的我是名初出茅庐的会诊医师,一次我正准备和本组的专科主治医生、住院总医生（SeniorHospitalofficer,SHO）和住院医生例行晨间查房。一切照常进行,唯独SHO没露面。我深知她工作勤勉,就揣测她可能在接某个要紧的值班电话。可查到第三位患者的时候,我开始觉得SHO的缺班不太对劲。突然我想起来了：一位同事曾提过SHO正用一种新设备持续自注胰岛素——她是糖尿患者。于是大家中断了查房,聚在护士办公室商榷如何处理。我们了解到SHO与丈夫住在城外。而且她爱人也是位初级医师,在50英里之遥的另一家大医院工作。     

A memorable ward round

Some 25 years ago, I was a young consultant physician about to start an early morning ward round with my usual team of registrar, senior house officer, and preregistration house physician. All started according to plan except that the SHO was absent. I knew her to be diligent, so I assumed she had probably been distracted by some other pressing call of duty. By the time we had progressed to our third patient, however,     

儿科下呼吸道感染铜绿假单胞菌的耐药性分析

目的：比较分析2012年和2013年儿科下呼吸道感染铜绿假单胞菌的耐药性,为I晦床合理应用抗菌药物提供科学依据。方法：对本院2012年和2013年儿科下呼吸道标本中分离的铜绿假单胞菌进行比较分析,用VITEK2微生物分析系统进行病原菌鉴定和药敏分析。结果：儿科下呼吸道标本共分离出82株铜绿假单胞菌,其中2012年分离出35株,多重耐药铜绿假单胞菌检出率为2．9％;2013年分离出47株,多重耐药铜绿假单胞菌检出率为4．3％。2013年儿科下呼吸道感染铜绿假单胞菌对环丙沙星、环丙沙星和氨曲南等8种抗菌药物的耐药率高于2012年,其耐药率均低于10％。结论：2013年儿科下呼吸道标本分离的铜绿假单胞菌对常用8种抗菌药物耐药率高于2012年,应用抗菌药物治疗儿科下呼吸道感染时,临床医师在经验用药后应根据致病菌的耐药特点和药敏结果,合理选用抗菌药物,从而有效控制和减缓细菌耐药性的发生。     

The effect on hospital admission profiles of establishing an emergency department observation ward

OBJECTIVE: To determine the effect of establishing an emergency department observation ward (OW) on admission numbers, average length of stay (ALOS) for the entire hospital and overall bed days for conditions commonly treated in the OW. SETTING: Sir Charles Gairdner Hospital (SCGH), Perth, a tertiary referral teaching hospital. DESIGN: Retrospective analysis of routinely collected hospital data for the 10 most common diagnosis-related group (DRG) categories of patients discharged from the OW for the financial years 1995-96 to 1998-99. Comparison of these data with those for adult patients at the other Perth teaching hospitals over the same period. MAIN OUTCOME MEASURES: For patients in the 10 most common DRGs: numbers of admissions to the OW compared with other inpatient wards; total number of patients admitted to the hospital compared with total bed days; ALOS at SCGH compared with other Perth teaching hospitals. RESULTS: Increased admissions to the OW were paralleled by a decrease in admissions for the same DRG codes to other inpatient wards. ALOS remained approximately the same from 1995-96 to 1998-99 for patients in the OW (one day) and other inpatient wards (4.38 to 4.20 days). However, overall ALOS for patients in these DRGs fell by over a third (from 3.97 to 2.59 days) over this time. The total number of patients in these DRGs treated by the hospital increased by 19% over the four years, but the total number of bed days fell by 23%. By contrast, the ALOS for patients in the same DRGs treated at the other Perth teaching hospitals rose 8% (from 2.12 to 2.28 days). CONCLUSION: Establishment of a formal emergency department OW results in the more efficient management of certain groups of patients, with a decrease in overall hospital bed days and length of stay.     

脑卒中鼻饲患者在优质护理无陪病房中的护理效果观察

目的：观察优质护理无陪病房服务模式在脑卒中鼻饲患者护理中的应用效果。方法将脑卒中鼻饲住院患者46例分为2组,观察组23例,实施优质护理无陪病房服务模式;对照组23例,实施常规护理模式。结果护理14 d后,观察组呕吐、误吸、反流、潴留,鼻饲管堵塞、脱出,腹泻,感染与对照组比较差异有显著统计学意义（P<0.05）;观察组对护理工作满意度明显优于对照组,2组比较差异有统计学意义（P<0.01）。结论优质护理无陪病房中脑卒中鼻饲患者能够得到安全、有效的专业护理,从而使各种相关并发症、不良反应均能得到预防和有效控制,保证护理质量的同时减轻患者经济负担,提高了患者满意度。