某三级综合医院医院获得性感染经济损失评价

目的了解某三级综合医院2011-2013年医院获得性感染(HAI)对住院日及住院费用的影响,评价其造成的经济损失。方法回顾性调查3年出院、HAI、内外科系统感染与非感染、不同感染部位患者的住院日及费用进行统计分析、对比,采用SPSS17.0对HAI及非HAI患者住院日及住院费用进行描述性分析、方差分析或秩和检验。结果 HAI患者平均住院日23.11d明显高于非HAI患者的10.01d及总住院患者的平均住院日10.27d,且3年呈现相同规律,3年HAI患者延长平均住院日为13.10d;手术部位感染(SSI)平均住院日39.89d明显高于其他部位HAI感染的23.11d,是非HAI及总住院患者平均住院日的4倍;3年HAI患者的住院总费用呈逐年增加的趋势,外科系统HAI患者的总费用明显高于内科系统。结论 HAI使患者及医院的经济损失逐年增长,SSI平均住院日明显延长,积极预防控制HAI势在必行。     

医院感染与医疗费用

随着现代医院的发展 ,大量精密仪器设备引进 ,侵入性操作大量增多 ,放疗、化疗十分普及 ,免疫抑制剂及抗生素的大量应用 ,使医院感染的危险性不断增加。国外据美国资料报告 ,医院感染每年至少消耗 4 0亿美元 ,联邦德国每年为医院感染需花费 5～ 10亿马克。国内据中山医科大学附属一院、湖南医科大学附属湘雅医院及福建省人民医院的病例对照研究结果表明 ,平均每例医院感染患者增加医疗费用 2 4 0 0～ 32 0 0元 ,延长住院时间 15～ 16d。中国医科大学附属第一医院调查统计 ,医院感染病例人均增加费用 2 4 13.95元 ,延长平均住院日为 18.2 8d…     

边际分析法评估医院获得性感染经济负担

利用北京市2007-2009年卫生统计年报及全市医院获得性感染(HAI)监测数据,估算社会超额医疗负担,利用边际分析法对因HAI所导致的医院经济收入的损失进行测算。结果显示,2007-2009年该市HAI患者医疗总费用均超过10亿元人民币,导致的超额医疗费用约占HAI患者医疗总费用的70%。医院HAI损失利润比与其HAI发生率系数约为2.5。2007-2009年医院获得性感染所致超额医疗费用比例高,医院运营收益减少。     

预防骨质疏松症要从少儿时期抓起

骨质疏松症是一个普遍存在的健康问题。据估计在美国、欧洲和日本大约有 7500万人受累,且在美国和欧洲,每年大约有230 万由骨质疏松症引起骨折的病人,此项医疗费用大约每年230 亿美元,给社会和个人造成经济负担,并且引起患者疼痛和残疾。随着人口寿命延长,骨质疏松症的全球发病率将上升3倍。预计下半个世纪,由骨质疏松症引起的骨折将增加1倍,并导致惊人的费用。在我国,因骨质疏     

血液病患者医院感染所致直接经济损失

目的分析血液病患者医院感染所致的直接经济损失。方法采用1∶1配对病例对照研究方法调查患者的医疗费用及住院时间,将医院感染患者再分为三组:单部位感染组、多部位感染组、多重耐药菌感染组,分析各组患者医院感染直接经济损失。结果病例组(医院感染患者)平均医疗费用为69 844.70元,对照组为35 077.13元,因医院感染导致患者的医疗费用平均增加34 767.57元,增加的医疗费用主要是药物费、检验费和输血费。不同感染类型患者平均医疗费用比较,差异具有统计学意义(P0.05),多重耐药菌感染组和多部位感染组患者的医疗费用均高于单部位感染组,多重耐药菌感染损失最高(平均医疗费用为121 949.02元)。直接经济损失因病种而异,直接经济损失居前3位的病种分别是伯基特淋巴瘤(BL)、急性早幼粒细胞白血病(APL)、急性髓系白血病(AML),直接经济损失分别为151 960.09、100 419.29、74 298.47元。病例组平均住院时间中位数为30 d,长于对照组的17 d(P0.05),不同感染类型患者平均住院时间比较,差异无统计学意义(P=0.620)。与对照组比较,不同血液病病种医院感染患者住院时间平均延长4～30 d。结论医院感染可增加血液病患者的医疗费用及住院时间,直接经济损失因感染类型及病种不同而存在差异,应加强多重耐药菌管理及专病管理,并积极采取有效的医院感染防控措施。     

住院病人药物不良事件调查及可防范性研究

目的:调查住院病人药物不良事件(ADE)发生率、因ADE而造成的医疗费用、延长的住院时间及ADE的可防范率.方法:随机抽取2007年全年住院病例,进行回顾性调查.结果:住院病人ADE发生率为24.06%,其中可防范的ADE占总ADE的21.5%,越是严重的ADE越可以防范.平均每个ADE增加医疗费用2 010.59元,延长住院时间1.18日.平均每个可防范的ADE增加医疗费用4 666.13元,延长住院时间2.30日,可防范的ADE增加的医疗费用占增加的总费用的49.83%.结论:ADE在住院痛人中普遍存在,其中1/5是可以防范的,而且越是严重的ADE越是可以防范.降低可防范ADE的发生率,将会大大减少医疗费用.     

手术室感染控制及预防对策

手术室担负对病人进行手术和对急危重病人进行抢救的任务。但是,手术室是发生感染的高危科室,其感染的控制与管理直接关系到手术的成败。发生手术室感染,轻者造成花费增加、住院时间延长,重者可危及患者生命。根据美国疾病预防控制中心的统计,在美国每年有200万～300万的患者发生医院感染,这些医院感染直接导致了每年有88000名患者死亡,而每年治疗医院感染的花费达45亿美元。     

神经外科医院感染经济损失的病例对照研究

目的为对神经外科患者因医院感染造成的直接经济损失有一个基本的认识。方法用回顾性调查的方法对８１对患者进行病例对照配对研究。结果平均每例感染者多住院１２．３天,在延长住院期间增加费用７３０２．２元。就单一感染与多重感染相比后发现,多重感染较单一感染住院时间延长、住院费用增加更加显著。结论医院感染所造成的经济损失是巨大的,发生医院感染后住院费用增加的主要原因可能与住院时间延长、抗感染、再次手术或因医院感染导致的病情恶化而需进行抢救等因素直接相关。应逐步把医院感染造成的经济损失纳入医院感染管理的范畴,以达到提高医疗质量的目的     

某三级甲等综合医院医院感染经济损失的研究

目的探讨某三级甲等综合医院患者发生医院感染所造成的经济损失及其影响因素,使医院管理者对医院感染的危害有更直观的认识,从而增加对医院感染管理的重视程度。方法 2013年1-12月采用1∶1病例对照研究方法,回顾性调查394对医院感染和非医院感染患者的相关资料,采用配对秩和检验比较病例组和对照组的医疗费用和住院日数差异,计算医院感染给患者造成的经济损失,并分析经济损失的影响因素。结果医院感染患者平均医疗费用(中位数)为43 407元,住院日数(中位数)为26.0d,非医院感染患者平均医疗费用为16914元,住院日数为13.0d,平均每例患者由医院感染所造成的经济损失为29 846元,其中直接医疗费用损失26493元,直接非医疗费用损失877元,间接经济损失2 476元,延长住院时间13d,增加的医疗费用和住院日数随感染部位不同而异,多部位感染增加的医疗费用最多,为81 196元;手术部位感染延长住院日数最多,为20d。结论发生医院感染明显增加患者的医疗费用和住院时间,给患者造成巨大的经济损失。     

医源性感染的费用

前言医源性感染应考虑其经济后果。联邦德国每年医源性感染的费用估计为5亿-10亿马克。美国每年大约有三千四百万患者被感染。假如平均每人在医院多住4天(每天600美元),那么每年的费用大约要10亿美元。该数字不包括由于缺勤、发病率增加和过早的死亡而造成的间接费用。减少控制医源性感染费用的方法不一致。采用的方法取决于经济制度,且因医院、国家而异。联邦德国的医院管理人员对控制感染不感兴趣,因为保险公司不管病人在医院住多少时间,均支付同样的保险金;住院初期,病人的护理费也很昂贵。各医院应试图分析医源性感染的类型和医院管理机     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.