广东省医疗机构突发公共卫生事件监测与预警能力的初步评估

目的 了解广东省医疗机构对突发公共卫生事件的监测与预警能力.方法 以目的抽样方法对广东省209家医院进行问卷调查.结果 80%以上医院对发热、不明原因肺炎、不明原因的死亡、流感样疾病和急诊入院人数实行了监测并能及时上报异常情况;对败血症/感染性休克监测和报告的比例分别仅为51.3%和63.7%;对病原生物和中毒的检测能力较低;对各类突发公共卫生事件没有预警能力.结论 广东省医疗机构突发公共卫生事件监测能力尚有待提高,应尽早开展预警研究.     

影响死亡报告卡疾病信息准确性的分析

目的从编码角度探讨提高死亡报告卡疾病信息准确性的方法。方法采用回顾性调查方法对456份死亡报告卡进行列表统计。结果死亡科别、新生儿体重、就诊情况、诊断书写等均可影响报告卡疾病信息的准确性。结论提高医生对死亡报告卡的书写能力．同时将编码与病案同步,可以降低报告卡疾病信息的失误率。     

如皋市1995～1999年婴儿死亡监测分析

分析婴儿死亡监测报告对指导优生优育和开展计划生育工作具有一定的指导意义。现将我市近 5年婴儿死亡监测分析报道如下。1 资料与方法资料来源　资料为 1 995～ 1 999年如皋市婴儿生命监测上报的婴儿死亡登记表及死亡报告卡 ,全市总人口为 1 4 6万 ,平均每年活产数为 1 0 71 3名。方法　按《江苏省城乡婴儿死亡报告实施方法》具体要求进行监测调查 ,每年对各级儿保人员进行婴儿死亡填报方面的专业培训、复训 ,每月由基层儿保医生填写上报婴儿死亡报告及死亡登记表 ,市妇幼保健所每半年复核上报的死亡卡和死亡登记表 ,删去重卡、纠正错卡 ,…     

病案首页质量监测上报系统的开发与应用

目的实现医院病案首页信息的自动准确上报。方法分析病案首页数据上报需求,设置数据规则校验引擎,开发病案首页上报数据对接程序。结果基于医院数据平台开发的数据对接程序实现了病案首页信息的自动准确上报,并实现了上报数据对应84项指标的自动汇总分析、提取信息的规则引擎校验及展示。结论医院数据对接程序上报的病案首页信息符合卫生计生委的相关要求,并能有效的提高医院病案质量管理水平。     

信息化在多重耐药菌监测中的应用

目的:及时有效预防多重耐药菌(MDRO)的院内传播,进一步提高多重耐药菌感染监测效果。方法:对比2013年、2014年和2015年同期多重耐药菌开出隔离医嘱时间及疑似医院感染暴发数据比较。结果:利用MDRO网络预警与手机短信平台发送短信报告相结合,使医生作出判断进行干预时间明显缩短,有效减少多重耐药菌疑似医院感染暴发。结论:多重耐药菌的信息化监测,可以提高工作效率,有效预防多重耐药菌院内传播。     

强化病案回收确保病案及时归档

开滦(集团)有限责任公司医院是一所具有百年历史的"三级甲等"医院,现有688张病床.1999年8月,为了加强病案回收,确保病案及时归档,院信息科协同有关部门在认真、全面调查分析病案回收各环节的基础上,大胆提出24h回收制,即要求病案在患者出院后24h内完成书写整理和质检,病案室及时回收,并完成装订、编码、上机等工作.经过3年的实践,病案回收工作取得了满意的效果.     

医院质量监测系统上报数据问题分析及改进研究

目的 分析某院HQMS病案信息上报数据存在的问题,探寻改进措施以提高上报数据质量.方法 对某三甲综合医院HQMS近期上报的数据及问题进行统计分析.结果 HQMS月报数据显示住院重返、患者安全、治疗质量等方面的数据出现异常,发生压疮的出院患者例数、发生新生儿产伤例数、发生输血反应的出院患者例数与实际情况不符;另外HQMS上报数据的日报错误信息中89%的为疾病编码错误.结论 HQMS系统功能还需不断完善,信息提取时应给予相应判断功能,减少逻辑错误的发生;同时医院应采取有效措施,加强病案质量管理、病案回收管理和疾病字典库管理,保证病案信息的及时、完整、准确、真实上报.     

死亡病例网络报告质量分析

目的 通过某医院死亡病例网络报告资料分析,进一步规范死亡病例上报质量,为促进死亡病例网报管理工作提供依据.方法 搜集某医院2009-2013年上报的死亡病例自查资料,对死亡病例网络上报情况进行及时性、一致性、准确性的分析.结果 急诊科(不包含急诊病房)2009年-2013年报卡数量最多,共2826例,占报卡总数的47.13％(2826/5996).在2010年、2011年、2012年、2013年急诊科报卡及时率分别为95.38％、98.32％、95.94％、95.74％,均低于年度报卡及时率,及时率有待提高.填写与网报不一致项目主要是诊断依据,达到1004例.根本死因填写错误最多的是肺炎/肺部感染,达到379例.结论 死亡病例上报主要问题是根本死因填写和报卡时限,应通过加强培训、定期自查、健全管理制度以逐步提高上报质量.     

事前介入对医院信息上报质量的对策研究

目的 探寻提高医院信息上报质量的有效事前介入对策。方法 采用对比法、卡方检验、柏拉图等方法分析信息上报事前介入之前和介入之后的信息质量改进效果。结果 2013 年6 月-10 月信息总体报错率较1 月-5 月显著下降,其中因血型值、主要诊断编码等错误的报错率显著降低;因门急诊诊断、其他诊断编码等错误的报错率前后无显著差异;因病理诊断编码错误、婴儿信息丢失的报错率显著提升。信息的主要错误项得到了有效改善,个别错误已杜绝。结论 制定并细化考核制度、维护编码库、加强系统判断功能、建立院内分级培训机制等事前介入对策,信息上报质量明显提高,但还需持续改进。     

纸质病案的数字化管理

目的由于病案利用范围和法律作用不断扩大,而基础设施薄弱,管理滞后,病案的数字化管理为提高这一领域的科技含量提供了的一种方法。方法应用纸质病案数字化管理系统软件,通过数码相机拍摄获得标准的图文格式,将纸质病案转化为能被计算机所识别的数字化信息。结果保证了纸质病案的原文原貌,应用现行的编码系统和编码规则,使所有的纸质病案信息资料具有连贯性和完整性。利用现有的HIS网络,最大限度地满足各方的需求。结论病案的数字化管理是信息技术和网络技术在医疗领域应用的必然产物,是医院病案现代化管理的必然趋势。纸质病案的数字化管理,减少了病案存储空间,提高病案资料的利用率。     

Does informed consent exempt Japanese doctors from reporting therapeutic deaths?

The Japanese Medical Act section 21 states that doctors must report unnatural deaths to the police, even though the term "unnatural death" is not defined by law. However, many doctors are reluctant to report potential therapeutic deaths (PTDs). The Japanese Society of Legal Medicine has submitted guidelines for unnatural death, including PTD. These define a PTD as an unexpected death, the cause of which is unknown, but which is potentially related to medical practice. Such deaths are "reportable" to the coroner in the UK. In this study, we addressed the question of whether physicians would report each of eight hypothetical PTDs. Although the clinical societies (the Japan Society of Internal Medicine and the Japan Surgical Society) declare that doctors must report deaths due to gross negligence, 60% of the participants said that they would not report gross negligence involving an overdose in cases where they had obtained informed consent or had provided an explanation after the death occurred. This can be accounted for by the mistaken belief on the part of the participants that obtaining informed consent exempts Japanese physicians from the duty of reporting PTDs. The attitude of Japanese physicians is caused by the death investigation system, which is designed to discover whether a crime has been committed rather than focusing on the cause of death. Accordingly, the Japanese Government has decided to commission a pilot study from an independent organisation in which medical specialists will investigate PTDs in order to prevent deaths occurring as a result of gross negligence.     

Accuracy of asthma statistics from death certificates in South Australia.

OBJECTIVE: To assess the accuracy of asthma statistics from death certificates in South Australia. DESIGN: Comparison of death certificate coding with expert panel assessments of causes of death after interviews with certifying doctors, regular medical practitioners and close acquaintances of the deceased. SUBJECTS: 261 subjects for whom the term "asthma", "asthmatic" or "asthmaticus" was recorded in Part I or Part II of death certificates lodged in the 24-month period from May 1988. MAIN OUTCOME MEASURES: Sensitivity, specificity and predictive value of death certificate coding, with expert panel assessments as the reference standard. RESULTS: About 95% of deaths assessed as definitely due to asthma were so coded from death certificates, but only 69% of deaths assessed by the panel as not due to asthma were coded to a "non-asthmatic" cause. Of the 129 deaths coded to asthma, the percentage assessed as definitely or likely to be due to asthma was 56%. For ages under 65 years, this figure was 84% compared with only 38% for older subjects. CONCLUSION: The accuracy of death certificate data on asthma for the age group 65 years and over would be too low at present for most epidemiological purposes.     

孕产妇死亡案例的法医病理学分析

目的：探讨孕产妇死亡案例的特点、死亡原因及其医疗纠纷产生的原因并提出相应预防措施．方法对昆明医科大学司法鉴定中心2002年1月至2012年12月鉴定的35例孕产妇死亡案例进行回顾性分析．结果35例孕产妇死亡案例中：（1）30岁以上多见（14例,40%）,17～19岁也较常见（6例,17.1%）;农村人口为主（25例,71.4%）;（2）围产期的孕产妇死亡24例（68.5%）;（3）县级、乡镇医院及非正规医疗机构死亡26例（74.3%）,家中分娩和途中分娩死亡5例（14.3%）;（4）因产科出血引起的失血性休克死亡17例（48.6%）,羊水栓塞死亡11例（31.4%）,羊水栓塞合并产科出血死亡2例（5.7%）;（5）30例孕产妇死亡引发的医疗纠纷中临床诊断与病理诊断不相符20例（误诊漏诊率为66.7%）;（6）医疗纠纷产生的原因：临床诊断不明11例（36.7%）,怀疑抢救不及时、处理不当11例（36.7%）,怀疑误诊漏诊8例（26.6%）．结论产科出血、肺羊水栓塞是导致孕产妇死亡的主要原因;提高基层产科人员对产科出血、肺羊水栓塞的诊断和救治能力,可减少孕产妇死亡和医疗纠纷的发生．同时,还应提高妇女的自我保健意识,减少早婚早孕,提高住院分娩率．     

Natural deaths while driving: would screening for risk be ethically justified?

OBJECTIVES: To determine the epidemiology and the underlying pathological conditions of natural deaths among motor vehicle drivers. Sudden death while driving may cause damage to properties, other vehicles or road users. Although the Medical Commission on Accident Prevention recommended restrictions to drivers at risk of sudden death due to their medical conditions, these restrictions are useless if they do not result in greater safety to the public. DESIGN: A retrospective study of natural deaths of motor vehicle drivers. SETTING: Natural deaths of motor vehicle drivers reported to the coroner for Birmingham and Solihull. SUBJECTS: 86 consecutive natural deaths of motor vehicle drivers in a five-year period between 1984 and 1988. RESULTS: Of the 86 fatalities reviewed, 80 (93%) sudden deaths were caused by ischaemic heart disease. Fifty vehicles were involved in collision with 32 properties, 20 other vehicles and six pedestrians. Fifty-one out of 80 cardiac deaths had past cardiac history and three had reported chest pain prior to the sudden death. CONCLUSION: An applied normative ethical assessment based on the basic moral principles of autonomy, justice, beneficence and non-maleficence are discussed. We conclude that medical screening of drivers has little benefit for the drivers or other persons.     

Mortality at the medical wards of a university teaching hospital in Papua New Guinea: a study of 1242 admissions

The records of all patients who died in the medical wards of the University Teaching Hospital in Papua New Guinea during a 6-month period between 1st January and 1st July 1984 were reviewed. Deaths were classified as early or late and subclassified as preventable, treatable, untreatable or undetermined. There were 120 deaths among 1242 adult patients admitted to the medical wards during the period under study (overall case fatality rate 10%). 35 patients died within 24 hours after admission (early death), 2 of preventable, 7 of treatable, 8 of untreatable and 18 of undetermined causes. Of patients who stayed alive in the hospital for more than one day, 5 died of preventable, 28 of treatable, 23 of untreatable and 29 of undetermined causes. Autopsy was performed on 3 patients (2.5%). Age of the deceased patients ranged from 13 to 67 years (median: 37). Male to female ratio was 1.86. The length of hospital stay ranged from 1 to 77 days (median: 4). Infectious diseases were found to be the major cause of death with pneumonia and tuberculosis leading the list. The emergency procedures, laboratory facilities and autopsy rate need to be improved to reduce the number of deaths from undetermined and preventable causes in Papua New Guinea.     

Deaths in children with a diagnosis of acute appendicitis in England and Wales 1980-4

Thirty five children died of acute appendicitis in England and Wales in 1980-4 compared with 204 in 1963-7. Thirteen of the 35 deaths in 1980-4 took place at home or on the day of admission to hospital before operation and a further 18 on the day of operation or the first day after it. Thirty one of the children had peritonitis. A third of the deaths were in children aged 0-4 years, and the hospital fatality rate in this age group was one death in 320 cases compared with one death in 4760 cases in children aged 5-14 years. The fall in the number of deaths between the 1960s and the 1980s was due to improvements in medical care, a reduction in the incidence of appendicitis, and changes in the age structure of the child population. Difficulty and delay in diagnosis and inadequate intravenous therapy are now the main factors contributing to death.     

Problems for clinical judgement: 4. Surviving in the report card era

HEALTH CARE REPORT CARDS INVOLVE COMPARISONS of health care systems, hospitals or clinicians on performance measures. They are going to be an important feature of medical care in Canada in the new millennium as patients demand more information about their medical care. Although many clinicians are aware of this growing trend, they may not be prepared for all of its implications. In this article, we provide some historical background on health care report cards and describe a number of strategies to help clinicians survive and thrive in the report card era. We offer a number of tips ranging from knowing your outcomes first to proactively getting involved in developing report cards.     

院前RTS评分促进早期医疗介入提高院前急救质量的探讨

目的通过胸部创伤早期伤情特点的分析,探讨在院前急救中应用RTS评分法提高院前急救质量。方法 按是否运用院前RTS将早期胸伤163例分为1998年前、1999年后两组,评分量化早期伤情和生存概率。分组比较两组伤情,考察1999年后组的院前时间、院前出诊率和死亡率。结果163例早期伤情评分和生存概率均降低、运用院前RTS评分的1999年后组院前时间缩短,院前出诊率提高,虽然严重伤情比例高但死亡率较低。结论 胸伤早期的生理紊乱以RTS<7为重度损伤,可导致生存概率改变,院前急救中以RTS评分结果作为分拣转送和提前医学介入的依据,尽早纠正生理紊乱可降低重度胸外伤死亡率。作者建议在院前急救中用RTS评估伤情指导分拣转运,为早期医学干预提供客观指标,可提高急救医学质量和胸伤救治水平。     

3296例住院死亡患者死亡病因及死亡时间分析

目的:探讨我院十年来住院死亡病例的死因和死亡时间的规律,以及与年龄,性别的关系。方法:对3296例死亡患者进行统计学分析。结果:首位死因为恶性肿瘤,其次是消化系统疾病。前五种致死疾病男性均高于女性,死亡年龄高峰为60-69岁,各病种死亡高峰有明显的季节差异,死亡时间以农历朔,望期最多。结论:十年来,我院住院死亡患者前五位死因无变化,但有性别、年龄、时间差异。     

Enhanced surveillance for pregnancy-associated mortality--Maryland, 1993-1998

CONTEXT: Deaths occurring among women who are pregnant or who have had a recent pregnancy have a devastating impact on the family and community. It is important to understand the magnitude and causes of pregnancy-associated mortality so that comprehensive strategies can be formulated to prevent such deaths. OBJECTIVE: To ascertain the number and causes of pregnancy-associated deaths using enhanced surveillance techniques. DESIGN, SETTING, AND SUBJECTS: Retrospective, cross-sectional analysis of death certificate data of reproductive-age women, live birth and fetal death records, and medical examiner records in Maryland during 1993-1998. MAIN OUTCOME MEASURE: Number of pregnancy-associated deaths, defined as death from any cause during pregnancy or within 1 year of delivery or pregnancy termination, by source of data and cause of death. RESULTS: A total of 247 pregnancy-associated deaths were ascertained. Twenty-seven percent (n = 67) were identified through cause-of-death information obtained from death certificates, 70% (n = 174) through linkage of death records with birth and fetal death records, and 47% (n = 116) through review of medical examiner records. Homicide was the leading cause of pregnancy-associated death (n = 50; 20%), and cardiovascular disorders were the second-leading cause (n = 48; 19%). CONCLUSIONS: In this Maryland sample, comprehensive identification of pregnancy-associated deaths was accomplished only after collecting information from multiple sources and including all deaths occurring up to 1 year after delivery or pregnancy termination. This enhanced pregnancy mortality surveillance led to the disturbing finding that a pregnant or recently pregnant woman is more likely to be a victim of homicide than to die of any other cause. By broadening pregnancy mortality to include all possible causes, previously neglected factors may assume increased importance in prenatal and postpartum care.