Communicating information on cardiopulmonary resuscitation to hospitalised patients

AIM: The primary aim of the study was to evaluate two different methods of communicating information on cardiopulmonary resuscitation (CPR) to patients admitted to general medical and elderly care wards. The information was either in the form of a detailed information leaflet (appendix I) or a summary document (appendix II). The study examined the willingness of patients in seeking detailed information on cardiopulmonary issues. SETTING: The study was conducted over three months on a general medical ward and an acute elderly care ward in two district general hospitals. METHODS: A detailed information leaflet on CPR was provided to the nursing staff on the wards. An A4 summary document summarising the CPR decision making process and basic information on cardiopulmonary issues was placed in a folder at the foot of each bed on the elderly care ward. On the general medical ward it was displayed prominently over the head of all beds. RESULTS: Out of the 274 patients admitted to the general medical ward only two requests were received for the detailed information leaflet. On the elderly care ward there were 182 admissions but no patients or their relatives requested the leaflet. CONCLUSIONS: Availability of basic information on cardiopulmonary resuscitation to all patients is practical and does not lead to unnecessary distress or offence to patients or their carers. It makes the decision making process more transparent. Detailed information leaflets are of value for a minority of hospitalised patients.     

Attitudes to a hospital based terminal care scheme

Two years after the establishment of a terminal care support team, the team perceived that a number of patients were not being referred to them, and many of those seen were referred at a very late stage in their illness. We sent a questionnaire to all clinicians and ward sisters in the district to elicit their knowledge of the team and attitudes to their role. Although most respondents had cared for terminal patients in the previous 6 months, over a quarter were not aware of the existence of the team. The lack of awareness was most common among junior medical staff, many of whom were spending relatively short times in the district. The study indicated a requirement for good communication between terminal care teams and other professionals and a need to inform junior staff about available facilities. A requirement for training in terminal care was also identified.     

Can short hospital admissions be avoided? A review of admissions of less than 24 hours' duration in a paediatric teaching hospital

OBJECTIVE: To review the records of children admitted to hospital for less than 24 hours to assess the appropriateness of the admission and subsequent discharge, and the suitability of these patients for admission to a short stay area rather than the hospital wards. DESIGN: Retrospective study consisting of a one in three sample of all children admitted to the hospital's general medical units over one year. All admissions were listed sequentially, and every third patient was included in the study. SETTING: Royal Children's Hospital, Melbourne; a tertiary paediatric hospital with a major primary care role. PARTICIPANTS: There were a total of 660 patients eligible for inclusion in the study; 220 were selected, and all records were reviewed. RESULTS: It was found that although 87.7% of admissions could be justified on medical grounds alone, the children quickly recovered with at least 65% being fit for discharge within 12 hours of admission. In spite of this the mean duration of admission was 17.0 hours. The majority of patients were suffering from easily diagnosed and treated disorders, with 78.9% falling into four diagnostic groups (asthma, ingestions, infections, and convulsions). Criteria for admission to a short stay observation area were satisfied in 65% of patients (at the time of the study no such area existed in the hospital). No patients were discharged inappropriately early. CONCLUSIONS: A significant number of children require brief hospitalisation for relatively minor illness, but unnecessary delays caused by administrative aspects of hospital admission and relatively infrequent inpatient review by medical staff often lengthen the period of admission. Significant cost savings are possible with the use of a short stay facility, and a large number of patients are suitable for this form of care.     

孤独症谱系障碍儿童家庭喘息服务的研究进展

孤独症谱系障碍（ASD）是一种较为严重的神经系统发育障碍性疾病,以社会互动缺陷、语言交流障碍、兴趣限制或重复刻板行为为主要表现,但目前该病尚不能根治,只能通过康复而改善症状。ASD儿童的主要照顾者是家长,长期繁重的照护压力严重影响照顾者的生活质量,为此国外提出了喘息服务的概念,以缓解照顾者照顾压力。本文结合喘息服务的模式及内容、ASD儿童家庭接受喘息服务的影响因素、喘息服务效果评价指标等分析了国外ASD儿童家庭喘息服务研究现状,强调ASD儿童家庭喘息服务应以家庭需求为导向,考虑家庭结构,融合家庭康复,提供个性化服务项目;同时分析了我国ASD儿童家庭机构性喘息服务现状,提出应以社会支持理论为依据,完善喘息服务政策及信息支持,加强喘息服务提供者队伍建设,通过多学科融合为ASD儿童提供涵盖教育、康复训练的综合性喘息服务,提高喘息服务质量。     

深圳特区内、外儿童保健服务现状调查

目的：全面了解特区内与特区外儿童社区服务状况，有针对性地开展社区儿童健康服务工作。方法：询问法。结果：儿童保健指导不够，特区外稍好于特区内；儿童定期体检率较高，但视力、牙齿检查率较低；调查对象对现有开展的多种保健服务满意度均达到85%以上；儿童心理日趋增多，特区内尤为突出。结论：加强社区儿童眼力保护、口腔卫生、心理保健等工作；开展多种形式的健康教育，加大宣传力度，才能提高儿童的健康素质。     

新疆某综合医院儿童保健一体化服务模式满意度调查

目的：了解新疆某综合医院儿童保健一体化服务满意度情况,为改善儿童保健服务提供意见.方法：通过随机抽样,采用自制问卷对489名儿童家长进行调查.结果：运用模糊综合评判,发现儿童家长对调查医院儿童保健服务满意度为81.74％,其中满意度最高的是医护人员的技术水平（91.82％）,育儿知识宣传的满意度最低（64.42％）.数据包络分析显示整体环境及设备、就诊等候时间和育儿知识宣传需要优先改善.结论：要进一步完善儿童保健服务模式,加强多部门的合作,满足不同儿童保健对象的需求,提高儿童保健服务工作质量.     

浙江省基层医疗机构老年无陪护病房护理员队伍现状的相关分析

目的：了解浙江省基层医院老年患者无陪护病房中护理员队伍的人员结构配置、专业素质、队伍稳定情况等。方法自行设计调查表,对浙江省3家基层医疗机构的老年病房护理员进行问卷调查。结果3家老年病房护理员队伍中55岁以下人员占26.8%、初中以上文化占7.22%、从业时间6个月以内人员占69.07%,全部人员均属无证上岗。结论设立护理员队伍认证资质,规范培训,同时提高人员待遇,建立绩效考核机制等措施亟待落实,这样才有利于老年病房无陪护护理模式的开展。     

Conductive education for physically handicapped children: parental expectations and experience.

Conductive education, an educational approach devised by Andras Petö in Hungary after the second world war, has attracted considerable media attention. Eight Northern Ireland families who recently had treatment for their disabled child at the Petö Institute in Budapest were identified. Six families returned postal questionnaires designed to look at parental experience of conductive education. An improvement in existing local services, as opposed to the wholesale introduction of this facility was the commonest parental hope for future provision for physically handicapped children.     

感控督导员的质量管理对新型冠状病毒肺炎院内感染防控工作的影响

目的探讨感控督导员制度在新型冠状病毒肺炎（新冠肺炎）医院感染防控质量持续改进中的作用。方法在荆州市第一人民医院新冠肺炎重症救治中心实施感控督导员制度,并比较实施前后新冠肺炎病区医务和保洁人员的医院感染防控能力。结果实施感控督导员制度后,医务人员和保洁人员在手卫生依从性、穿脱防护用品步骤、护目镜穿戴、口罩穿戴、医疗废物处理和物表消毒合格率等方面均高于实施前,差异有统计学意义(P＜0.05)。结论在新冠肺炎隔离病区实施感控督导员制度,能明显提高工作人员的医院感染防控能力,对降低一线人员感染风险,实现医务人员零感染目标,发挥了重要作用。     

鞍钢医疗卫生保健水平评价：Ⅱ文化卫生保健状况抽样调查分析

本文系鞍钢医疗卫生保健水平评价之一部分。我们通过对鞍钢职工进行的１／１０比例的抽样调查及对主要卫生指标的监测，获得了反映鞍钢文化卫生保健状况的有关指标。结果表明，鞍钢文化卫生保健工作状况良好，成人识字率、自来水普及率、产前检查率、新法接生率、疫苗接种率等主要指标已接近我国２０００年卫生事业的发展目标。     

南阳市3～13岁儿童睡眠障碍流行病学调查

目的了解南阳市3～13岁儿童睡眠障碍的发生情况和影响该年龄段儿童睡眠的主要因素。方法采用随机抽样的方法抽取南阳市3城区1878例儿童，对其家长或看护人进行睡眠状况的问卷调查。结果南阳市3～13岁儿童睡眠障碍发生率较高，为41％，影响睡眠障碍的相关因素包括儿童年龄、白天是否容易哭吵或发脾气、睡前安慰物、喘鸣、家庭人口数、主要看护人身份、儿童生病、母亲学历、母亲怀孕期间或产后情绪低落等。结论目前南阳市3-13岁儿童睡眠障碍发生率较高，需引起儿科医生、儿童保健医务人员以及广大家长的重视。     

Change in infection control practices and awareness of hospital medical staff in the aftermath of SARS

Severe Acute Respiratory Syndrome (SARS) epidemic illustrated the crucial role of infection surveillance and control measures in the combat of any highly transmissible disease. We conducted an interview survey of 121 medical staff 145 doctors, 46 staff nurses and 30 medical assistants) in a state hospital in Malaysia three months after the end of SARS epidemic (from October to December 2003). Staff was grouped according to those directly involved in the care of suspected SARS patients [S+ group n=41] and those who were not [S- group; n=80]. On hand washing following sneezing, coughing and touching patients, the proportions of medical staff that reported an increase after the SARS crisis were 22.3%, 16.5% and 45.5% respectively. On wearing masks, gloves, and aprons when meeting potentially infectious patients, the proportions that reported an increase were 39.7%, 47.1% and 32.2% respectively. Significantly more staff in S+ than S- group reported these increases. Sixty percent of staff was aware of changes in hospital infection control policies after SARS; 93.4% was aware of notifying procedures, and 81.8% was aware of whom to notify in the hospital. Regarding infection isolation ward, Infectious Control Nurse and Infection Control Committee Chairman in the hospital, the proportions of staff that could correctly name them were 39.7%, 38.3% and 15.7% respectively. Significantly more in S+ than S- group could do so. However, more than half the staff claimed ignorance on the knowledge of infection isolation ward (56.2%), Infection Control Nurse (57.9%) and Chairman (65.3%). Our findings demonstrated that SARS crisis had some positive impact on the infection control practices and awareness of medical staff especially on those with direct SARS involvement. Implications for future control of infectious diseases are obvious.     

Distribution of variable vs fixed costs of hospital care

CONTEXT: Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. OBJECTIVE: To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. DESIGN: Cost analysis. SETTING: A large urban public teaching hospital. MAIN OUTCOME MEASURES: All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. RESULTS: In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. CONCLUSIONS: The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.     

Hospice approach to the treatment of patients with advanced dementia of the Alzheimer type

A program that limits the extent of medical treatment in patients with advanced dementia of the Alzheimer type was initiated on an intermediate medical ward. Five levels of care were designed to define options that stress maintenance of patient comfort without striving for a maximal period of survival (hospice approach). An optimal care level for each patient recommended by the staff correlated highly with the severity of dementia, but care levels assigned during meetings of family members with the multidisciplinary team for 40 patients correlated poorly with the staff recommendations and the severity of dementia. Intensive nursing care and comfort measures, which included antipyretics, analgesics, and (if necessary) oxygen and anticholinergics, were provided during the terminal phase. Preliminary results indicate that the mortality did not increase significantly during the first year of this program, although the extent of medical care was limited in all patients, and 62% were not treated with antibiotics if they developed symptoms of pneumonia or urinary tract infection.     

Guidelines for stabilizing the condition of the critically ill child before transfer to a tertiary care facility.

The initial resuscitation and stabilization provided to a critically ill or injured child is often an important determinant of outcome. Before transfer to a tertiary care facility the initial care may be provided by physicians unaccustomed to managing critically ill children. The authors outline the unique aspects of resuscitation and stabilization of the critically ill child and give guidelines for the initial management of diseases affecting the central nervous system and respiratory tract (the most frequent indications for transfer to a tertiary care facility) and other, less frequent but important problems. In many situations it is worth while to enlist the expertise of the tertiary care centre, either by telephone consultation or by dispatch of a specially trained transport team.     

绩效考核在示范病房护理管理中的应用探讨

目的：对示范病房护理管理工作中应用绩效考核的效果进行探讨。方法：在优质护理示范病房的护理管理中应用绩效考核方法,根据护理工作特点,将护士薪酬和工作质量相结合,对示范病房应用绩效管理前后2年间的护理质量、医护患者满意度等方面进行对比分析。结果：应用绩效管理前后,该示范病房护理质量、医护患者满意度等方面均有显著提升,差异有统计学意义（P〈0.05）。结论：绩效考核管理能够提高护理人员的主观能动性,使示范病房的护理质量得到有效提高,最大化地推动优质护理活动的开展。     

Comparison of malocclusions and orthodontic treatment needs of handicapped and normal children in Ibadan using the Dental Aesthetic Index (DAI)

This study compared the prevalences of malocclusion and Orthodontic needs between normal Nigerian children and their handicapped counterparts using the Dental Aesthetic Index. The samples consisted of 1,010 children -614 normal (321 males; 294 females) and 396 handicapped (199 males;197 females) aged 12-18 years with mean ages for normal and handicapped children as 14.8+/-1.9 and 15.0+/- 2.2 respectively. They were drawn randomly from their respective schools in Ibadan, Nigeria. Although some differences were observed in the ten malocclusion traits of DAI between the normal and the handicapped children, none was found statistially significant (P> 0.05). Missing teeth were noted in 1.9% of the normal children as against 4.8% of the handicapped. Crowding of incisal segments was observed in 20.0% of the normal and in 21.7% of the disabled children. Spacing of incisal segments was recorded in 47% and 55.5% of normal and handicapped children respectively. Others in that order were: Disatema-31.7% and 32.3%; Anterior maxillary irregularity - 55.5% and 40.9%; Anterior mandibular irregularity- 50.2% and 34.3%; Overjet - 20.7% and 13.1 %; Reversed overjet - 1.9% and 2.3%; Open bite - 7.5% and 9.8% and total deviations from normal molar relation in 23.8% and 31.3%. Also, although higher proportions of handicapped children than the normal group were noted having DAI scores indicative of treatment needs ranging from elective to mandatory, no significant differences were noted (P>0.05). About 13% of the normal and 16% of the handicapped children in the study sample deserved publicly funded orthodontic care.     

Do the ward notes reflect the quality of end-of-life care?

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged.     

上海市“瑞金-卢湾医疗联合体”运行模式的现状调查和对策研究

目的了解上海市"瑞金-卢湾医疗联合体"成员单位的医务工作者对其的知晓、认同情况,并探索其试行过程中遇到的瓶颈问题及对策。方法采用问卷调查方法,对"瑞金-卢湾医疗联合体"内的7家成员单位的医院管理者及医护人员进行分层抽样调查。结果 57.0%的调查对象对医疗联合体的基本情况比较了解。56.3%的调查对象认同医疗联合体的存在,认为有必要进行区域医疗资源整合。对于医疗联合体工作的开展是否可以缓解老百姓"看病难、看病贵"现状的信心分值为(3.85±0.52)分。双向转诊不顺畅是医疗联合体运行过程中面临的主要障碍,影响医疗联合体运行的瓶颈问题主要是管理体制不健全和信息化建设有所欠缺。结论医务工作者对医疗联合体的知晓情况不佳,认同感不强,但是对"瑞金-卢湾医疗联合体"有信心,其面临的瓶颈问题和主要障碍不容忽视,需要通过加强宣传、建立层级医疗和统一的转诊标准、进一步提升医疗联合体的医疗水平、进一步加强和完善医疗联合体内信息化建设等方面来找到突破点。     

Needs assessment of caregivers of children with disabilities in resource-limited settings

Objective: This study aimed to identify and classify the needs of caregivers of children with disabilities living in resource-limited settings and develop a framework for need assessment.Participants and Methods: This study was conducted in the Maha Sarakham Province, Thailand, with 15 caregivers caring for children with disabilities recruited from hospitals, the Association for the Disabled, and primary health centers. Semi-structured interviews were conducted in local dialects, recorded, transcribed, converted into standard Thai, and then into English for thematic analysis. Meaning units corresponding to caregivers’ needs were extracted, interpreted, coded, and hierarchically organized into subcategories by comparing similarities and differences among the extracted codes. The subcategories were further grouped and abstracted into categories, and then domains of caregivers’ needs were formed.Results: Nineteen categories were identified across five domains of caregivers’ needs: health and medical, welfare, educational, social, and informational. Although basic medical treatment was covered, specific support, such as referral to a specialist, rehabilitation, or psychological support, was limited. Financial support and relief from the care burden are the main welfare needs. Educational needs were identified to provide knowledge to children and to offer respite to their caregivers. Social needs revealed ethical problems that arose because of strong rural community ties, making it difficult to maintain privacy. Informational needs were intertwined with the other four domains. In rural areas, where parents of children with disabilities migrate to cities to find work, the special needs of grandparents who were primary caregivers of the children needed to be addressed.Conclusion: This study provides a conceptual framework for comprehensive needs assessment and policy development for caregivers of children with disabilities living in resource-limited settings.