某医院住院病人满意度调查及其影响因素分析

目的了解医院住院及出院病人的满意度情况，为提高医疗服务质量提供参考。方法采用自制的调查表，分别调查医院的住院及出院病人满意度。结果本调查表测得克朗巴哈的α信度系数为0．98．调查表总分与各项目分的相关系数绝大部分大于0.5。绝大部分病人的满意度评分在8分以上。行风情况得分最高，医护人员（包括医生、护士和其它医务人员）次之，出入院处理和工作效率及辅助检查位居第3，后勤管理是第4位，收费情况得分最低。住院病人与出院病人对医院的评价没有统计学差异。影响病人总评分的关键因素是护士的技术水平、等候手术时问、经治医生检查是否认真负责、病房的整洁安静程度和是否有乱收费现象等指标。病人的建议集中在后勤管理方面。结论①本调查表的信度和效度较高，可尝试作为量表使用；②病人对该医院的总体评价较高，但对后勤管理和收费方面的评价相对较低并要求改进；③出院病人和住院病人对医院的评价没有差别；④提高病人满意度应该从技术、服务、效率和费用等方面入手。     

Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly

STUDY OBJECTIVE: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. DESIGN: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. SETTING: Fourteen municipalities in the Lahti region (P?ij?t-H?me County) in Finland. PARTICIPANTS: A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated. MAIN RESULTS: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). CONCLUSIONS: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in P?ij?t-H?me County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.     

Sex differences in hospital readmission among colorectal cancer patients

BACKGROUND: While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered. OBJECTIVE: To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer. DESIGN: Prospective cohort study. SETTING: Hospital Universitary in L'Hospitalet (Barcelona, Spain). PARTICIPANTS: Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002.Main outcome measurements and METHODS: Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed. RESULTS: Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes's stage, mortality, and Charlson's index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96). CONCLUSIONS: In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients.     

2014年某三甲医院老年病人细菌耐药性监测

摘要:目的　了解2014年某三甲医院老年病人临床分离菌对常见抗菌药物的耐药性。方法　使用自动化细菌鉴定仪VITEK 2- COMPACT对分离菌株的耐药性进行鉴定,药敏结果按CLSI 2014年版标准判断。结果　临床分离的2167株细菌中,G-菌占69.4%,G+菌占30.6%。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林的凝固酶阴性葡萄球菌（MRSCNS）的检出率分别为 29.5%、85.8%。葡萄球菌属中甲氧西林耐药株对所测试抗菌药物的耐药率显著高于甲氧西林敏感株,未发现对万古霉素和利奈唑胺耐药的菌株。对大部分所测抗菌药物,屎肠球菌的耐药率高于粪肠球菌。在屎肠球菌中发现9株万古霉素耐药株,在粪肠球菌中发现2株利奈唑胺耐药株。青霉素耐药的非脑膜炎肺炎链球菌占6.2%,非脑膜炎肺炎链球菌对红霉素耐药率为95.4%。检出53.8%的大肠埃希菌和28.2%的肺炎克雷伯菌产超广谱β-内酰胺酶。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为53.9%、52.9%,铜绿假单胞菌对上述两种药物的耐药率分别为33.9%、28.0%。结论　在大于65岁患者中分离的细菌耐药情况应引起足够重视,加强对医院感染控制和指导抗生素合理使用。     

某医院高龄口腔疾病患者口腔保健知识、态度行为调查

目的选取某院高龄口腔疾病患者进行口腔保健知识、认知态度和行为的调研,旨在为临床医学提供有利的临床数据,并为社会性高龄牙病预防提供意见。方法采用口腔健康问卷调研的形式,于各患者入院时进行调研,调研内容包括文化程度、对口腔健康知识的知晓程度、家庭中与口腔疾病有关的药物储备情况、两年内因口腔疾病就医情况等。结果文化程度越低的患者,其对口腔健康知识的调研及格率越低,而大专以上患者对日常口腔保健方法、口腔有害物和刷牙次数的知晓程度的及格率接近100%,与其他文化程度组别患者数据差异有统计学意义(P﹤0.05)。在所有患者中,家庭中储备与口腔疾病有关的中、西药者比例明显高于未储备药物者,数据经统计学比较差异有统计学意义(P﹤0.05)。临床因口腔疾病发生才入院检查患者较多,明显多于定期检查和不行检查患者(P﹤0.05)。结论高龄口腔疾病患者的口腔保健知识、态度和行为相对薄弱,尤其受到文化程度和影响,建议通过宣传教育提高高龄者的口腔保健意识,提高生活质量。     

Anthropometric measurements in the elderly: age and gender differences

In clinical practice and epidemiological surveys, anthropometric measurements represent an important component of nutritional assessment in the elderly. The anthropometric standards derived from adult populations may not be appropriate for the elderly because of body composition changes occurring during ageing. Specific anthropometric reference data for the elderly are necessary. In the present study we investigated anthropometric characteristics and their relationship to gender and age in a cross-sectional sample of 3,356 subjects, randomly selected from an elderly Italian population. In both sexes, weight and height significantly decreased with age while knee height did not. The BMI was significantly higher in women than in men (27.6 SD 5.7 v. 26.4 SD 3.7; P<0.001) and it was lower in the oldest than in the youngest subjects (P<0.05) of both genders. The 75th year of age was a turning point for BMI as for other anthropometric measurements. According to BMI values, the prevalence of malnutrition was lower than 5 % in both genders, whereas obesity was shown to have a higher prevalence in women than in men (28% v. 16%; P<0.001). Waist circumference and waist: hip ratio values were higher for the youngest men than for the oldest men (P<0.05), whereas in women the waist: hip ratio values were higher in the oldest women, suggesting that visceral redistribution in old age predominantly affects females. In conclusion, in the elderly the oldest subjects showed a thinner body frame than the youngest of both genders, and there was a more marked fat redistribution in women.     

院内老年精神病患者便秘的护理

精神病患者出现便秘的原因多种多样,其中最常见的原因是由于长期服用抗精神病药物引起的抗胆碱能不良反应.便秘不仅给患者带来痛苦,同时也给护理工作增加了难度,尤其是老年精神病患者,如不及时处理,则可能出现麻痹性肠梗阻等严重不良后果,甚至危及生命.积极采取有效措施预防便秘,及时发现并且处理便秘,避免不良后果的发生,已成为精神科护理工作的重点.     

2015年中国分地区恶性肿瘤发病和死亡分析

  目的  测量中国肺癌患者在医疗服务利用、住院费用水平以及费用构成方面的性别差异现状,探讨差异产生的原因,为改善中国健康领域性别不公平、降低肺癌医疗成本提出政策建议。  方法  使用国家卫生健康委统计信息中心2017年肺癌患者个人住院病案首页数据1 408 881例,应用描述性统计方法分析不同性别肺癌患者在医疗服务利用、住院费用水平以及费用构成方面存在的差异。  结果  二级医院中男、女性住院人次分别为167.51和73.92千人次,性别比为2.27;三级医院中男、女性患者住院人次分别为776.21和391.23千人次,性别比为1.98。二级医院中男、女性平均住院日分别为12.14和11.77 d,性别比为1.03;三级医院中男、女性平均住院日分别为11.39和10.62 d,性别比为1.07。二级医院中男、女性次均住院费用分别为10 074.41和9 816.87元,性别比为1.03;三级医院中男、女性次均住院费用分别为19 061.26和20 708.78元,性别比为0.92。药费为住院费用的最主要构成部分。  结论  不同性别肺癌患者在医疗服务利用及住院费用方面都存在较大性别差异,女性患者的医疗服务利用更不充分。社会因素、健康观念、生理因素是对其产生影响的主要原因。     

Anthropometric measurements in the elderly of Havana, Cuba: age and sex differences

OBJECTIVE: We present selected anthropometric data, specific for sex and age group, from a representative sample of elderly subjects living in Havana, Cuba. METHODS: This was a cross-sectional, population-based household survey. A total of 1905 subjects (1197 women and 708 men, > or = 60 y of age) were examined between 1999 and 2000 as selected by probabilistic sampling. Data were presented as means and percentiles for body mass; height or stature; body mass index; waist, arm, and calf circumferences; triceps skinfold thickness; and arm muscle circumference; and differences were described according to age (all variables) and sex (body mass index). RESULTS: All anthropometric variables showed a decrease in average values with aging in men and women. The age of 70 y appeared to be the decisive moment for the main anthropometric differences observed. The values in the female group were higher than those in the male group for body mass index and triceps skinfold thickness. An important segment of the population studied had a body mass index lower than normal values. Reductions in subcutaneous fat (indicated by triceps skinfold thickness) and muscle mass (verified by arm, arm muscle, and calf circumferences) with advancing age appeared to be greater among women than among men. CONCLUSION: The present study provides information that can be used for anthropometric evaluation of elderly people in Havana and other urban areas in Cuba. The observations suggest that there is loss of muscle mass and redistribution and reduction of fat mass with age (that is more severe in women).     

Nutrition knowledge, attitudes and dietary restriction behaviour of Taiwanese elderly

The purpose of this study is to understand knowledge about and general attitudes towards nutrition, dietary restriction attitudes, and dietary restriction behavior in the Taiwanese elderly, and the relationship of these various components to each other. Data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were used for analysis and included 1937 elderly persons aged over 65. The results indicated that the elderly had poor nutrition knowledge, especially about the relationship between nutrition and disease. Elderly nutrition attitudes were fair; they tended to disagree with misconceptions about "healthy" or functional foods and also had quite positive general eating attitudes. However, the Taiwanese elderly hold quite strong attitudes influenced by Chinese traditional or food-texture-related dietary restrictions. Elderly people frequently avoid eating foods considered unhealthy by modern medical science (e.g. high fat/cholesterol foods) as well as foods forbidden by Chinese traditional medicine (e.g. "heating" foods, "cooling" foods). Most of the elderly regularly eat three meals a day, however, they seldom pay attention to dietary and nutrition information. The most important sources of nutrition information are offspring or family members, TV, and medical practitioners. In general, elderly men with a higher educational level and living in less remote areas had better nutrition knowledge, held more positive nutrition attitudes, and kept to dietary restrictions less frequently. Elderly people's nutrition knowledge was positively related to their health-care attitudes, general eating attitudes, high- fat or high-cholesterol food restriction behavior, fermented or pickled food restriction behavior, attention to nutrition information, and regularity of meals. However, nutrition knowledge was inversely related to Chinese traditional or food-texture-related dietary restriction behaviors. The results of this study suggest that education of elderly people about nutrition is important, and the design of such nutrition education programs should consider the low educational levels of the elderly. Children or other family members may also be included in the program. The use of TV as a medium for nutrition education of the elderly may also be important for nutrition educators.     

Arthritis disability, depression, and life satisfaction among black elderly people

This study examined the correlates of arthritis disorder in a sample of black elderly people in Nashville, Tennessee. More specifically, both the presence of arthritis and its severity were examined with regard to level of depression and life satisfaction, particularly in the areas of family life, social support, and leisure activities. Data were collected through face-to-face interviews with 600 black elderly people residing in the community. The sample had more females (70 percent) than males (30 percent) and majorities who were not married (75 percent) and who were living alone (56 percent). The authors' analyses indicated significant differences between arthritic and nonarthritic black elderly people in that arthritic elderly people were more depressed and experienced lower levels of life satisfaction. Further, levels of depression and life dissatisfaction were higher among those experiencing disability associated with the illness and those who were currently in treatment.     

Occupational stress and job satisfaction among physicians: sex differences.

The present study provides empirical findings from a national survey of physicians and addresses issues of sex differences in the nature of occupational stress experienced by physicians, and the sources of satisfaction in medical practice. Data were collected using questionnaires from 2584 physicians. The sample was randomly selected to represent physicians in all Canadian provinces. About 10% of the respondents were female. Measures included self-reports of stress and satisfaction, demographic variables, practice characteristics, and attitudes about health care. Major sources of stress indicated by female and male physicians were time pressures on the job, and major sources of satisfaction were relationships with patients and colleagues. Sex differences were found in terms of the specific variables that predicted job stress and satisfaction. However, for both women and men, various work setting variables positively predicted occupational stress and negatively predicted job satisfaction. Significant sex differences were present in both demographic and situational variables as well as measures of occupational stress and attitudes about health care. Correlations indicate that for both female and male physicians, high levels of occupational stress was associated with less satisfaction with medical practice and more negative attitudes about the medicare system and health care in general, and high job satisfaction was related to fewer specific work stressors and more positive attitudes about health care. Several methodological limitations necessitates caution in interpreting the findings. Nevertheless, the results may have some implications for future health care policies and procedures.     

Racial differences in hospital discharge disposition among stroke patients in Maryland.

OBJECTIVE: The objective of this retrospective study was to assess the evidence for racial differences in discharge disposition among patients hospitalized for stroke. DATA: Hospital discharge data from the Maryland Health Services Cost Review Commission were used in the analysis. The data covered the period from January 2000 to September 2003. STUDY DESIGN: Discharge-disposition categories were ordered such that higher numbers corresponded to less desirable outcomes: 1 = discharge to home; 2 = discharge to any medical care facility; 3 = death. We analyzed the influence of black race on the discharge disposition by estimating a partial proportional odds logit regression model that included demographic and clinical covariates. DATA EXTRACTION: The study inclusion criteria were 1) stroke (ICD9 431-434; 436-438) as a primary admission diagnosis and 2) patient race identified as black or white. Patients discharged against medical advice were excluded. The sample contained 51,564 stroke hospitalizations. PRINCIPAL FINDINGS: Based on the relative odds ratios (OR; 95% confidence interval [CI]), black males were more likely to be discharged to higher ranked (i.e., less desirable) discharge categories (OR = 1.66; CI 1.55-1.77) compared to white males. Black females were more likely to die (OR = 1.14; CI 1.02-1.28) and more likely either to die or to be discharged to medical care (OR = 1.38; CI 1.24-1.54) compared to white males. CONCLUSIONS: Blacks are at greater mortality risk following stroke hospitalizations and face less desirable discharge dispositions if they survive. These results are consistent with prior reports of lower survival rates among blacks and are robust to adjustments for various confounding factors.     

HIV/AIDS knowledge and the implications for health promotion programs among Chinese college students: geographic, gender and age differences

Data were collected in 2000 from 1081 students from eight colleges in China to assess the overall level of AIDS knowledge, and to explore regional, gender and grade differences in AIDS knowledge. The data indicate an inconsistent level of AIDS knowledge among students, with a significant gender and grade difference. More than one-third of the students perceived themselves as having limited knowledge of AIDS. While the students could identify transmission modes, they were less knowledgeable about symptoms, activities that did not transmit the virus, treatment and preventive measures. The majority of the students reported having discussed AIDS issues with their peers and friends, but few of them had done so with their parents or teachers. AIDS knowledge varied among students by site of residence, with the highest knowledge among students from the urban areas and the lowest among those from rural areas. The data underscore the urgent need for HIV/AIDS-related health promotion and prevention efforts targeting college students as well as younger age groups in China.     

Socioeconomic position,resilience, and health behaviour among elderly people

Objectives  

Healthy psychological functioning, the ability to respond rapidly to environmental changes, has been associated with better health outcomes. Less work has examined the association with health behaviour. This study explores whether resilience (a specific expression of healthy psychological functioning) is positively associated with health behaviour in an elderly population aged ≥65 years and whether this association differs in different socioeconomic groups.     

2014年某综合性医院老年患者3 485株病原菌分布及耐药性分析

目的 了解2014年四川大学华西医院65岁以上老年患者感染病原菌分布情况及耐药特点。 方法 使用VITEK2-compact全自动微生物分析仪对分离菌株进行鉴定及药敏试验,结果按美国实验室标准化协会(CLSI)2014年标准判断。 结果 3 485株病原菌中革兰阴性菌2 916株(83.7%),革兰阳性菌464株(13.3%),真菌105株(3.0%)。分离前5位为鲍曼不动杆菌(18.8%)、大肠埃希菌(15.0%)、肺炎克雷伯菌(13.4%)、铜绿假单胞菌(13.3%)、嗜麦芽窄食单胞菌(6.9%)。大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶(ESBLs)的检出率为56.8%和27.7%。鲍曼不动杆菌和铜绿假单胞菌对阿米卡星的耐药率为4.0%~28.1%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为34.3%、88.7%,未发现万古霉素耐药的葡萄球菌,仅凝固酶阴性葡萄球菌出现利奈唑胺耐药(2.0%)。除屎肠球菌对万古霉素耐药率为14.1%外,肠球菌对万古霉素、利奈唑胺的耐药率在2.2%以下。 结论 老年患者感染以革兰阴性菌为主,且耐药现象严重。加强细菌耐药监测,可指导临床治疗、有效预防及控制耐药菌株的产生和传播。     

Responses to the institution among elderly patients in hospital long-stay care.

The theory of the 'total institution' argues that institutions deliberately create dependency in individuals who would otherwise be self-determining. We examine the significance of this concept for patients in long-stay geriatric wards. All such patients in the South West Thames Region (808) were located and assessed for levels of physical dependency and mental confusion. 87% were profoundly disabled, 53% were severely confused and 23% were seriously ill or unable to communicate. Those capable of responding (291) were interviewed. Three quarters or more were satisfied with 'staff relations', 'autonomy', 'amenities' and 'privacy' and three fifths were satisfied with the 'social environment'. Results suggest that: (a) patients in long-stay geriatric wards who were not severely confused were able to make realistic assessments of their situation and (b) the majority were not passively institutionalized. In terms of institutionalization theory, it is their physical frailty that appears to differentiate this group from other categories of 'inmates'. We conclude that appropriate policy for the long-term ill necessitates consideration of the actual as well as the attributed needs of patients.     

Nurses and hospital infection control: knowledge, attitudes and behaviour of Italian operating theatre staff.

This study examined the disinfection and sterilization practices used by hospital operating theatres and evaluated the knowledge, attitude and behaviour of nursing staff with regard to infection control. Of the 216 nurses responding, knowledge concerning such practices was not consistent since 10% did not believe that items should be rinsed in water after contact with glutaraldehyde and more than 25% thought that 10 min contact time provided sterilization. Almost all were aware that improper practices increased the risk of nosocomial infections in patients. Nurses in orthopaedic surgery had a significantly lower level of knowledge compared with others. The great majority of nurses agreed that guidelines for disinfection and sterilization practice should be maintained and applied. With regard to the use of surgical instruments, the majority used steam or dry heat sterilizers for the appropriate time and temperature. Glutaraldehyde was used by 95% to sterilize endoscopes, but at different temperatures and times of exposure. Similar procedures were reported as used for laryngoscopes, though a higher percentage used heat sterilization. Only 38% routinely used all barrier techniques (gloves, masks, and protective eye-wear). Predictors for the routine use of all barrier techniques included attendance at continuing education courses on nosocomial infections, and nurses who were male and those involved in orthopaedic operations. Data support the need for finding and implementing interventions related to the prevention of hospital infection activities, in order to motivate nurses to use the correct procedures as a routine.