论圆形分布法在监控老年肿瘤住院病人医院感染的应用

本文用圆形分布法对老年肿瘤住院病人医院感染发生的季节性特征做了分析,即以一年365天相当于360度来计算。将医院感染发生时间转换成角度计算平均角,用平均角来表示医院感染发生时间的集中方向,用平均角加减角标准差来估计医院感染发生的高峰期,发现老年肿瘤住院病人医院感染发生的高峰时点为6月4～5日,高峰时期为2月28日～9月9日。     

应用圆形分布法探讨手足口病发病高峰期

目的了解商丘市手足口病的发病季节性特征,为更有效地预防和控制该病提供科学依据。方法对2008-2010年商丘市手足口病的监测数据进行圆形分布法分析。结果手足口病发病的高峰时点为4月26日,高峰时期为3月2日至6月21日。结论手足口病在发病时间上存在明显的季节性集中趋势,在手足口病发病高峰期到来之前,开展手足口病的防控工作。     

应用圆形分布分析脑血管病患者昼夜死亡时间的集中趋势

应用圆形分布方法对南京市某三级综合医院 16 0例脑血管病患者昼夜死亡时间进行统计分析 ,进而估算出脑血管病患者死亡时间昼夜分布中的高峰时点及高峰时区     

应用圆形分布法探讨建德市病媒生物季节性消长规律

目的 掌握建德市病媒生物的季节性消长规律,为制定防制规划及控制相关传染病提供科学依据。方法 应用圆形分布法统计分析建德市2008-2012年鼠类、蚊类、蝇类、蜚蠊密度监测数据。结果 建德市2008-2012年鼠类季节性消长的高峰时点为6月25日,高峰时期为2月14日至11月3日;蚊类的高峰时点为7月5日,高峰时期为5月21日至8月18日;蝇类的高峰时点为7月5日,高峰时期为5月1日至9月7日;蜚蠊的高峰时点为9月8日,高峰时期为6月30日至11月16日。结论 圆形分布法能定量掌握病媒生物的季节消长规律,从而为预防相关传染病的传播和流行提供科学依据。     

圆形分布法在传染病监测工作中的初步应用

本文介绍了圆形分布法的基本原理及其在检疫工作中的初步应用。经实例分析证实该方法在传染病高峰时点计算与预测,传染病流行各时期估计以及病媒昆虫季节消长和高峰预测中的应用均有实际意义.     

急危入院病人发病季节规律分析

目的：寻找急危重病人发病规律。方法：以5年急危重入院病人资料为依据，按疾病分类办法对各病种入院时间进行统计学分析，运用频数分布拟合优度法检验各病种入院时间分布是否均匀。结果：损伤和中毒、循环系统疾病急危重病人、呼吸系统疾病、妊娠分娩和产褥期、传染病和寄生虫病、起源于围生期情况的6类疾病急危病人发病在各月呈不均匀分布。结论：医院和科室管理者可根据疾病发病规律合理安排人力，做好预防准备，同时，疾病预防部门可根据发病规律进行宣传和预防。     

圆形分布法在儿科门急诊管理中的应用

目的 了解儿科门急诊病人就诊集中时点及高峰期规律.方法 采用圆形分布法,找出儿科门急诊病人的就诊时间集中度,求出平均角和标准差,从而推算出集中时间和高峰期.结果 2007-2011年各年度及5年合计的儿科门急诊病人就诊集中时间圆形分析平均角依次为195.61°、167.46°、205.07°、176.58°、171.58°和185.12°,对应的高峰日分别为7月18日、6月19日、7月26日、6月28日、6月20日和7月6日.圆形分析角度离散程度指标r ＝0.094 7、0.085 0、0.100 2、0.062 5、0.093 5和0.085 5.各年度及5年合计的平均角假设检验,P值均小于0.001,说明平均角存在.各年平均角经Watson-William检验,P〉0.05,说明各年就诊高峰期比较恒定.结论 儿科门急诊病人就诊时间上存在明显的季节集中趋势,就诊高峰日在7月6日,高峰期为2月28日～10月12日.应用圆形分布法可以了解到儿科门急诊病人的就诊时间规律,可为医院管理提供可靠的参考依据.     

绍兴市麻疹发病时间聚集性分析

目的 探讨绍兴市麻疹发病的季节性及其变动趋势。方法 采用集中度和图形分布法对该市1955－1964年，1965－1983年，1984－2001年3个阶段的麻疹发病资料进行时间聚集性分析。结果 两种分析方法获一致的统计分析结果，即麻疹发病具有一定的季节性。用圆形分布法求得3个阶段发病高峰时点分别为3月12日，3月24日及4月25日，高峰时期分别为12月29日－5月23日（148天），1月7日－6月12日（155天）和2月27日－6月26日（120天）。3个阶段高峰时点经Watson与Williams检验差异有显著性。结论 绍兴市麻疹发病高峰点后移，自1965年使用麻疹疫苗后，高峰时期缩短，发病季节性增强。     

用圆形分布构成比法分析计算霍乱发病季节高峰月日

[目的]为预防和控制霍乱发生提供理论依据。[方法]应用圆形分布构成比法对广州市海珠区1996-2005年霍乱发病季节高峰月日进行计算分析。[结果]海珠区霍乱发病高峰时点在7月18日,95%病例所在累计时区为：3月28日～11月7日。[结论]在霍乱发病高峰阶段应更好地做好防治措施,有效地防止发病。     

用园形分布法分析钩端螺旋体病发病的季节性

钩端螺旋体病有季节性分布规律。本文采用园形分布法分析，结果表明，安徽省钩体病发病的高峰时点１９８４年前在８月中、下旬，１９８５年后，移至９月上、中旬；高峰期在８月至１０月份。发病数较多的沿江江南与全省比较，高峰时点与高峰期基本吻合。因此，采用园形分布法，可作为流行病学分析手段之一。     

Air particulate pollution due to bushfires and respiratory hospital admissions in Brisbane, Australia

To examine the impact of bushfire smoke on hospital admission rates for respiratory disease, a time series study was conducted in Brisbane, Australia. Data on particles of 10 microns or less in aerodynamic diameter (PM10) per cubic metre, bushfire events, meteorological conditions, and daily respiratory hospital admissions were obtained for the period of 1 July 1997 to 31 December 2000. A generalized linear model with the negative binomial distribution was used to estimate the effects of bushfire smoke on respiratory hospital admissions. The results of this study show that daily respiratory hospital admission rates consistently increased with increasing levels of PM10 for both bushfire and non-bushfire periods. This relationship appeared stronger during bushfire periods than non-bushfire periods, especially for the current day. The findings suggest that bushfire smoke was statistically significantly associated with an increased risk of respiratory hospital admissions in Brisbane (p < 0.05). The health impact assessment needs to be considered in the control and management of bushfires.     

临床护理路径对腹腔镜胆囊切除术后患者康复效果评价

目的 评价临床护理路径对肝胆外科经腹腔镜胆囊切除患者术后临床效果的影响。方法 选取在本院肝胆外科行经腹腔镜胆囊切除术的48例患者,根据入院顺序随机分为治疗组、对照组。其中,治疗组24例患者围手术期采用临床护理路径配合肝胆外科常规护理,对照组24例仅采用肝胆外科常规护理。观察2组患者临床护理效果、日常生活能力(下床、排尿、排气、进食、排便)恢复的时间、患者及护理人员满意度的差异。结果 2组在患者临床护理效果、日常生活能力(下床、排尿、排气、进食、排便)恢复的时间方面差异有统计学意义,在患者及护理人员满意度方面,治疗组优于对照组(P<0.05)。结论 对肝胆外科经腹腔镜胆囊切除患者围手术期实施临床护理路径,促进患者日常生活能力的恢复,有利于提高护理人员和患者的满意度。     

Do psychiatric patients know what is good for them?

The paper reports the findings of a medical audit exercise which monitored 192 consecutive psychiatric admissions. Approximately two-thirds of patients, consultants and referrers provided information on admission objectives and the degree to which they were attained. One-third of the patients furnished information on social problems and satisfaction with treatment. Sanctuary was rated as an important admission objective by patients but neglected by consultants and referrers. Patient satisfaction with treatment was significantly correlated with attainment of patient as well as consultant objectives, and negatively correlated with social problems. Agreement between consultant and patient on admission objectives was inversely related to both duration of contact with psychiatric services and number of previous admissions suggesting that congruence with consultants may be lost over time. The limitations imposed by variable response rates are acknowledged. It is concluded that serious note should be taken of psychiatric patients' own treatment objectives.     

Consultation between family physicians and specialists about the hospital admission of patients]

Consultation between GPs and specialists about patients' in-hospital treatment is to be expected from the claim of Dutch GPs that they are responsible for continuous care for the patients on their lists. Data were gathered in the Dutch National Survey of General Practice: registration concerning all patients hospitalized during a three-month period (n = 7815) by 161 GPs. GPs consult specialists most frequently about the decision to admit patients (15% of all admissions). Consultation during patient's stay in hospital (5%) and about the discharge decision and possible aftercare (4%) is less usual. Consultation results from practical circumstances, such as the GP's initiative in the admission and a contact between patient and GP about the admission. The results leave GPs to answer the question whether the little actual consultation about the patient's stay in hospital, discharge and aftercare accords with their task to provide continuous care.     

Potential for bias in waiting time studies: events between enrolment and admission

STUDY OBJECTIVE: To demonstrate the effect of exclusion of data on delays in scheduling operations in calculating difference in admission rates between two enrolment periods. DESIGN: A prospective cohort study; outcome measure-waiting time for elective admission; study variables-enrolment periods, before 31 March 1997 and after that date; the time of scheduling delay; gender; age; urgency, and type of surgery. SETTING: An acute care hospital in Ontario, Canada. PARTICIPANTS: 1173 consecutive cases accepted for elective vascular surgery between 1 July 1994 and 31 March 1999. MAIN RESULTS: Before adjustment for scheduling delays, a 20% lower admission rate was associated with period 2, rate ratio (RR) = 0.8 (95% confidence intervals (CI)= 0.7, 0.9). The difference between the periods became only marginally significant after the adjustment, RR = 0.9 (95% CI=0.8, 1.0). No difference between the periods was found when admission rates were compared before a delay occurred, RR = 0.9 (95% CI=0.8, 1.1). In delayed patients, those enrolled in period 1 and 2 had, respectively, a 40% and a 60% lower admission rate than the period 1 patients admitted without scheduling delays, RR = 0.6 (95% CI=0.4, 0.8) for period 1 and RR = 0.4 (95%CI=0.3, 0.5) for period 2. CONCLUSIONS: The results provide evidence that patients experiencing a delay in scheduling operation have a lower admission rate after the event. Thus, potential for bias exists when between group comparison of waiting time is done without adjustment for an intermediate event that may occur before elective admission.     

Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days

OBJECTIVE: To assess the association between changes in nutritional status in hospitalized patients and the occurrence of infections, complications, length of stay in hospital, and hospital charges. DESIGN: A prospective observational study with a retrospective component was conducted over a 7-month interval at a university hospital. SUBJECTS: A total of 404 adults (> or = 18 years old) admitted to the inpatient service for more than 7 days who were not pregnant or lactating and not a psychiatric patient were included. MAIN OUTCOME MEASURES: Major outcome variables included changes in nutritional status as assessed by subjective global assessment (SGA) at hospital admission and discharge, length of stay, hospital charges, complications, and infections. STATISTICAL ANALYSIS PERFORMED: Analysis of variance with a Tukey adjustment for multiple comparisons was used to examine the impact of changes in nutritional status between nutrition change categories for continuous variables (charges and length of stay). Discrete variables were assessed using chi 2 analysis. Logistic regression was used to calculate odds ratios with 95% confidence intervals for the development of complications and infections when compared with the reference group. RESULTS: Compared with the reference group (normally nourished at admission and discharge), patients who declined nutritionally, regardless of nutritional status at admission, had significantly higher hospital charges ($28,631 +/- 1,835 vs $45,762 +/- 4,021). Odds of complications were significantly greater for patients who declined nutritionally, regardless of nutritional status at admission, compared with the reference group. APPLICATIONS/CONCLUSIONS: Declines in patients' nutritional status while they are hospitalized, regardless of their nutritional status at admission, were associated with significantly higher hospital charges and a higher likelihood of complications. Practicing clinicians should make reducing declines in patients' nutritional status a priority regardless of patients' nutritional status at admission.     

Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons – A National Multicentre Prospective Cohort Study

ObjectiveFrailty is associated with morbidity and mortality in older injured patients. However, for older blunt-trauma patients, increased frailty may not manifest in longer length of stay at index admission. We hypothesized that owing to time spent in hospital from readmissions, frailty would be associated with less total time at home in the 1-year postinjury period.DesignProspective, nationwide, multicenter cohort study.Setting and ParticipantsAll Singaporean residents aged ≥55 years admitted for blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS) ≥10 from March 2016 to July 2018.MethodsFrailty (by modified Fried criteria) was assessed at index admission, based on questions on preinjury weight loss, slowness, exhaustion, physical activity, and grip strength at the time of recruitment. Low time at home was defined as >14 hospitalized days within 1 year postinjury. The contribution of planned and unplanned readmission to time at home postinjury was explored. Functional trajectory (by Barthel Index) over 1 year was compared by frailty.ResultsOf the 218 patients recruited, 125 (57.3%) were male, median age was 72 years, and 48 (22.0%) were frail. On univariate analysis, frailty [relative to nonfrail: odds ratio (OR) 3.45, 95% confidence interval (CI) 1.33–8.97, P = .01] was associated with low time at home. On multivariable analysis, after inclusion of age, gender, ISS, intensive care unit admission, and surgery at index admission, frailty (OR 5.21, 95% CI 1.77–15.34, P < .01) remained significantly associated with low time at home in the 1-year postinjury period. Unplanned readmissions were the main reason for frail participants having low time at home. Frail participants had poorer function in the 1-year postinjury period.Conclusions and ImplicationsIn the year following blunt trauma, frail older patients experience lower time at home compared to patients who were not frail at baseline. Screening for frailty should be considered in all older blunt-trauma patients, with a view to being prioritized for postdischarge support.     

Burden of delayed admission to psychogeriatric nursing homes on patients and their informal caregivers

OBJECTIVE: To assess the deleterious effects of waiting for admission to a nursing home on the state of health of patients and their informal caregivers, and on the burden of caring. DESIGN AND PARTICIPANTS: Prospective longitudinal study consisting of interviews with informal caregivers during the period on the waiting list and after admission of the patient to a nursing home. Analysis of patients' files on diagnosis, date of registration on the waiting list, and date of admission to nursing home. SETTING: Ninety three patients registered on waiting lists for admission to a psychogeriatric nursing home in two regions of Amsterdam. RESULTS: Seventy eight of the 93 patients were admitted to a nursing home. The burden on the caregivers declined after admission of the patient but depressive symptoms did not. After 6 months a subgroup of 19 caregivers whose relatives were still waiting to be admitted were interviewed. The health of these patients remained stable during this waiting period and only problems in activities of daily living increased. The burden on these 19 informal caregivers and their state of health remained stable during the waiting period. CONCLUSIONS:A decline in the state of health and a rise in the burden on caregivers during the waiting period did not occur. However, a decrease in the burden and an improvement in mental health could have started earlier if patients had been admitted earlier.     

Socioeconomic inequalities in the diffusion of health technology: Uptake of coronary procedures as an example

This paper examines socioeconomic lags in the diffusion of high technology health care, focusing on the diffusion of coronary procedures in people with ischaemic heart disease. Using linked hospital and mortality data, we studied patients admitted to Western Australian hospitals with a first admission for acute myocardial infarction between 1989 and 2003 (n = 27,209). An outcome event was the receipt, within a year, of a coronary procedure—angiography, angioplasty and/or coronary artery bypass surgery (CABG). Socioeconomic status (SES) was assigned to each individual using the SEIFA Index of Disadvantage. Cox regression was used to model the association between SES and procedure rates in five consecutive three-year time periods. Angiography and CABG showed socioeconomic lags in diffusion, with rates peaking earlier in higher SES patients, such that the inequality patterns were consistent with the inverse equity hypothesis. The evidence for a lag in diffusion for angioplasty was weaker. Overall, that there is some evidence for a lag in diffusion of health technology indicates that it is essential to consider trends over time when examining the equity impact of health technologies.