Health care marketing: lots of talk, any action?

Although health care managers pay a great deal of attention to marketing, there appears to be limited substantive action. As more organizations successfully implement the marketing concept, other organizations will follow suit and marketing will become more prevalent throughout the health care industry.     

ICU与非ICU感染患者病原菌分布及耐药性对比分析

目的分析重症监护室（ICU）与非ICU患者感染病原菌的分布和耐药情况，为临床抗感染治疗提供依据。方法对2006年5月-2007年5月临床各科室送检标本进行细菌分离培养与鉴定，并对ICU与非ICU患者感染病原菌分布及耐药性进行对比分析。结果从ICU患者标本中分离培养出病原菌150株，其中非发酵菌总构成比为40.67％（61/150）；非ICU患者标本分离培养出病原菌495株，非发酵菌总构成比为17.98％（89/495）。ICU患者非发酵菌检出率高于非ICU患者（χ2 ＝33.20，P＜0.01）。ICU患者分离的主要病原菌依次为真菌（21.33％）、铜绿假单胞菌（17.33％）、大肠埃希菌（12.67％）；非ICU患者分离的主要病原菌依次为真菌（20.61％）、大肠埃希菌（17.98％）、金黄色葡萄球菌（10.30％）。ICU患者感染的鲍曼不动杆菌和金黄色葡萄球菌耐药较严重；第三代头孢菌素在治疗革兰阴性杆菌感染时，ICU与非ICU患者耐药差异较大。结论ICU患者非发酵菌检出率高，其感染的病原菌耐药严重，应加强管理与监测。     

Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units

OBJECTIVES: This multisite study sought to identify (1) any differences in admission risk (defined by gestational age and illness severity) among neonatal intensive care units (NICUs) and (2) obstetric antecedents of newborn illness severity. METHODS: Data on 1476 babies born at a gestational age of less than 32 weeks in 6 perinatal centers were abstracted prospectively. Newborn illness severity was measured with the Score for Neonatal Acute Physiology. Regression models were constructed to predict scores as a function of perinatal risk factors. RESULTS: The sites differed by several obstetric case-mix characteristics. Of these, only gestational age, small for gestational age. White race, and severe congenital anomalies were associated with higher scores. Antenatal corticosteroids, low Apgar scores, and neonatal hypothermia also affected illness severity. At 2 sites, higher mean severity could not be explained by case mix. CONCLUSIONS: Obstetric events and perinatal practices affect newborn illness severity. These risk factors differ among perinatal centers and are associated with elevated illness severity at some sites. Outcomes of NICU care may be affected by antecedent events and perinatal practices.     

新生儿重症监护室医院感染管理现状

目的了解河北省各综合医院新生儿重症监护室(NICU)的医院感染及医疗安全管理工作现状。方法以《医院感染管理办法》和《河北省新生儿室医院感染管理考核标准》为依据,对河北省A、B两市的5所三级医院和6所二级医院NICU的医院感染管理现状进行考核评估。结果发现各级医院普遍存在NICU环境布局不合理、手卫生设施不符合要求、治疗室和沐浴问管理不规范、未严格执行消毒隔离等规章制度的问题,且在二级医院这些问题更加明显。结论应加强NICU环境布局和工作流程及手卫生设施的合理化建设,提高医院感染管理的执行力,推进NICU的规范化管理进程。     

Neonatal mortality in intensive care units of Central Brazil

OBJECTIVE: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. METHODS: A live-birth cohort study was carried out in Goiania, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatal-based mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. RESULTS: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500 g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. CONCLUSIONS: This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.     

Prevalence of healthcare-associated infection in Scottish intensive care units

A national point prevalence survey of healthcare-associated infection (HCAI) in all acute hospitals, including intensive care units (ICUs), was carried out in Scotland from October 2005 to October 2006. The survey measured the prevalence of HCAIs to determine the burden on ICU resources. HCAI prevalence in ICUs was compared with HCAI prevalence in patients outside ICU. The prevalence of HCAI in ICU patients was 27.1%, significantly higher than HCAI prevalence in patients outside ICU, which was 9.3%. The prevalence of specific infections, namely pneumonia and lower respiratory tract, bloodstream and surgical site infections, was also significantly higher in ICU patients compared with non-ICU patients. These results highlight the burden on ICU resources from all HCAIs, regardless of site of infection. High HCAI prevalence in Scottish ICUs has major implications for patient safety and ICU resources and emphasises the need for continuing strong collaboration between intensivists and infection control teams.     

Discourse and practice of care to newborns at risk: reflecting about humanized care

This study identifies nurses' opinions on humanized care for newborn at risk and their families, using Paterson and Zderad's theory (1976) as a theoretical-methodological reference framework. It was carried out at the Neonatal Intensive Care Unit of a maternity in Fortaleza-CE, between April and July 2003. Data were collected through interviews with 6 nurses. They approached the following themes: humanization, sensitiveness, conscience and care. There is a need to unite discourse with practice in humanized care for newborns at risk.     

Family members' needs at intensive care units: comparative analysis between a public and a private hospital

This cross-sectional study proposed to analyze the needs of adult ICU patients' family members at a public and a private hospital, regarding their level of importance and satisfaction. Ninety-one family members were interviewed, 47 from the public hospital and 44 from the private one, using the Brazilian adaptation of the Critical Care Family Need Inventory (INEFTI). There was no significant difference between the groups in the total score of importance attributed to the needs (p=0.410). The satisfaction score was higher in the private hospital than in the public one (p=0.002). Multiple linear regression analysis allowed us to establish a hierarchy of importance and satisfaction of the family members' needs in each group. The differences observed between the groups suggest that the fulfillment of their needs requires interventions directed at the specificity of each type of hospital.     

Identifying congestion levels,sources and determinants on intensive care units: the Portuguese case

Healthcare systems are facing a resources scarcity so they must be efficiently managed. On the other hand, it is commonly accepted that the higher the consumed resources, the higher the hospital production, although this is not true in practice. Congestion on inputs is an economic concept dealing with such situation and it is defined as the decreasing of outputs due to some resources overuse. This scenario gets worse when inpatients’ high severity requires a strict and effective resources management, as happens in Intensive Care Units (ICU). The present paper employs a set of nonparametric models to evaluate congestion levels, sources and determinants in Portuguese Intensive Care Units. Nonparametric models based on Data Envelopment Analysis are employed to assess both radial and non-radial (in)efficiency levels and sources. The environment adjustment models and bootstrapping are used to correct possible bias, to remove the deterministic nature of nonparametric models and to get a statistical background on results. Considerable inefficiency and congestion levels were identified, as well as the congestion determinants, including the ICU specialty and complexity, the hospital differentiation degree and population demography. Both the costs associated with staff and the length of stay are the main sources of (weak) congestion in ICUs. ICUs management shall make some efforts towards resource allocation to prevent the congestion effect. Those efforts shall, in general, be focused on costs with staff and hospital days, although these congestion sources may vary across hospitals and ICU services, once several congestion determinants were identified.     

Analysis of the activity of neurologic intensive care units]

The authors analysed six-year activity of the intensive Care Unit of Department of Neurology, Medical University of Pécs (POTEI), and two-year activity of the Intensive Care Unit of Department of Neurology, Semmelweis University of Medicine, Budapest (SOTEI). Mortality at POTEI and SOTEI was 33.9% and 32.2%, respectively. Mean duration of stay of survivors at POTEI was 10 +/- 12.8 days, and 7 +/- 6.8 days at SOTEI; mean duration of care of the deceased patients at POTEI was 6.3 +/- 10.5 days, and 10 +/- 13.7 days at SOTEI. At POTEI 60.7%, at SOTEI 63% of the patients was admitted because of cerebrovascular insult. Mortality of patients with brain haemorrhage at POTEI and SOTEI was 53.4% and 57.7% respectively. Mortality of the ischaemic group was 40.6% (POTEI) and 35.3% (SOTEI). In the group of intracranial tumours 44.4% mortality was recorded at POTEI and 47.6% at SOTEI. At POTEI 240 patients (15.9%), while at SOTEI 94 patients (21%) were admitted to treat epileptic seizures. Among the 510 patients, who died within one month 284 patients (55.6%) were unconscious at admission. From those with coma due to severe structural lesion of the brain (brain ischaemia, bleeding, meningitis) only 15 patients survived. Among the 184 patients, who were comatose and survived, the most frequent diagnosis was suicidal attempt with hypnotics (n = 67), metabolic encephalopathy (n = 19) and epilepsy (n = 12). At SOTEI among the 144 deceased patients 102 (70.8%) were unconscious at admission. Coma at admission proved to be a strong predictor of mortality. Mortality of the ventilated patients was 83% at POTEI and of those having subclavian catheter (n = 592) was 47.1%. In the acute phase of brain ischaemia at POTEI 39%, at SOTEI 10.7% of the patients received heparin. At SOTEI the cost of medication of patients who died after two weeks of care was 65.2% higher than that of the survived patients.     

Candiduria in intensive care units: association with heavy colonization and candidaemia

Candiduria is increasingly detected in intensive care unit (ICU) patients and often coexists with candidal colonization at other anatomical sites. Studies involving surgical and medical ICU patients have consistently reported a relationship between candiduria and heavy colonization. This suggests that candiduria could be considered as a marker for heavy colonization. Risk factors that predispose to heavy colonization are generally similar to those predisposing to candidaemia. Candiduria in ICU patients is characterized by a high mortality, largely through a significant relationship with candidaemia, which in some patients may reach 50%. Therapeutic interventions should be strongly considered in the critically ill patient who presents with candiduria and concurrent clinical risk factors predisposing to dissemination.     

Parameters of bed occupancy of intensive care units in Hungary

According to the Semmelweis Plan for Saving Health Care, "the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present". Author shows on the basis of data reported to the health insurance that not on a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary because patients occupying these beds were discharged to their homes directly from the intensive care unit. The data indicate that on the whole bed capacity is not low, only in some institutions insufficient. Thus, in order to improve emergency care in Hungary, the rearrangement of existing beds, rather than an increase of bed capacity is needed.