Streptococcus pneumoniae Serotypes Associated with Death,South Africa, 2012–2018

The Streptococcus pneumoniae polysaccharide capsule plays a role in disease severity. We assessed the association of serotype with case-fatality ratio (CFR) in invasive pneumococcal disease (IPD) and meningitis in South Africa, 2012–2018 (vaccine era), using multivariable logistic regression by manual backward elimination. The most common serotypes causing IPD were 8 and 19A. In patients <15 years of age, serotypes associated with increased CFR in IPD, compared with serotype 8 and controlling for confounding factors, were 11A, 13, 19F, 15A, and 6A. None of these serotypes were associated with increased CFR in meningitis. Among IPD patients >15 years of age, serotype 15B/C was associated with increased CFR. Among meningitis patients of all ages, serotype 1 was associated with increased CFR. PCV13 serotypes 1, 3, 6A, 19A, and 19F should be monitored, and serotypes 8, 12F, 15A, and 15B/C should be considered for inclusion in vaccines to reduce deaths caused by S. pneumoniae.     

Forty-one pediatric cases of non-typhoidal salmonellosis

Non-typhoidal Salmonella (NTS) infections are a major cause of infantile death in developing countries. OBJECTIVE: The aim of this study was to determine the epidemiologic and therapeutic data, as well as the evolution of NTS in Morocco. METHOD: This retrospective study was made on 41 patients hospitalized for NTS between 1994 and 2002 in the Casablanca University Hospital Pediatric ward. RESULTS: Twenty cases of digestive salmonellosis were diagnosed, 16 cases of septicemia, and 10 cases of meningitis. Ten patients were hospitalized after an outbreak of resistant Salmonella typhimurium in a nursery. Fifty percent of the patients were less than 3 months of age. The three patients between 1 and 3 years of age presented with primary immunodeficiency. Fever, vomiting, and diarrhea were noted in 97% of the cases. The stools were watery in 89% and severe dehydration in 55% of the cases. Salmonella strains were identified in blood in 25 cases, from stools in 10 cases, and from CSF in nine cases. The following Salmonella serotypes were identified: S. typhimurium (53.6%), S. enteritidis (44%), and S. agona (2.4%). Resistance to antibiotics was noted, especially for Salmonella typhimurium (34%) in the nursery outbreak. The evolution was favorable in 80%, but two children with meningitis developed severe neurological sequels, and six hypotrophic infants under 3 years of age died after septicemia.     

National surveillance for meningococcal disease in Japan, 1999–2014

We summarize the epidemiology of Japanese meningococcal disease with serogroup distribution. One hundred seventy-eight meningococcal meningitis cases were reported from April 1999 to March 2013 to the national surveillance system. From April 2013, bacteremia was added to the condition of reporting invasive meningococcal disease (IMD). Since then, 59 IMD cases were reported by the end of 2014. Approximately two thirds of the cases were male and the median age was 56 years (range: 0–93 years). Only 3% of the cases were <5 years old. One third of reported cases were meningitis and the others were bacteremia. The annual incidence (2014) for IMD was 0.028 per 100,000 and case fatality rate (CFR) was 19%. Serogroup Y (42%) was the most dominant serogroup, followed by C (12%), B (7%) and W (3%). Even though the number of reported cases has increased after the amendment of reporting requirements, the incidence of IMD is still low in Japan. Underreporting may play a role in this low incidence. Improving on the limitations of the surveillance system is necessary to capture the true epidemiology and accurate serogroup distribution of IMD cases in Japan, which is essential for making effective recommendations on newly licensed vaccine.     

Sex-differential effects of diphtheria-tetanus-pertussis vaccine for the outcome of paediatric admissions? A hospital based observational study from Guinea-Bissau

BackgroundIn spite of protection against the targeted infections, a large volume of observational data indicates that diphtheria-tetanus-pertussis (DTP) vaccine may have a negative impact on overall childhood mortality in low-income countries, especially in girls.MethodsIn an observational study using data from Bandim Health Project’s continuous registration of all admissions to the paediatric ward at the National Hospital Simão Mendes in Bissau, we investigated whether DTP was associated with higher female than male in-hospital mortality (female/male case fatality ratio (F/M CFR)) and whether the CFR comparing DTP-vaccinated and DTP-unvaccinated children differed by sex. We included children aged 6 weeks to 8 months (274 days) admitted to the paediatric ward with a vaccination card seen during admission.ResultsFrom May 2001 to January 2008, 4230 children aged 6 weeks to 8 months were admitted and 3450 (82%; 1997 boys, 1453 girls) presented a vaccination card. The proportion presenting a vaccination card and DTP coverage did not differ by sex. During admission, 16% (200/1250) of the girls and 13% (220/1694) of the boys who had received DTP died. The F/M CFR among the 2944 DTP-vaccinated children was 1.23 (1.03–1.46); while it was 0.95 (0.66–1.38) among the 506 children who had not received DTP. DTP-vaccinated children were older and had better socioeconomic status. Adjusted for age, BCG-vaccination, residence, and maternal education the CFR comparing DTP-vaccinated boys with DTP-unvaccinated boys was 0.84 (0.63–1.11), while the CFR comparing DTP-vaccinated girls with DTP-unvaccinated girls was 1.28 (0.90–1.83) (p = .07 for same effect in boys and girls).ConclusionAmong DTP-vaccinated children, female in-hospital mortality was higher than male in-hospital mortality and DTP-vaccination tended to be associated with higher mortality in girls. The data are consistent with DTP having negative effects on mortality for girls. Further studies are necessary to design the optimal vaccination programme for both sexes.     

某院2009—2019年住院患者死因统计分析

目的 分析近11年某院住院死亡病例情况,为合理配置医疗资源提供决策依据.方法 按ICD-10疾病分类,采用描述性流行病学方法,对某院2009—2019年住院死亡病例进行分析.结果 某院住院患者病死率为1.12％,呈现逐年降低趋势(χ2=237,P<0.001).经多因素logistic回归分析显示,65岁以上年龄组病例...     

急诊观察室患者滞留原因分析及对策

  目的  通过分析急诊临时观察室患者滞留时间的相关影响因素,为解决急诊室拥挤问题提供实践依据。
  方法  收集2019年1—12月上海市某三级甲等医院急诊临时观察室所有出观患者基本信息,根据留观时间不同,分为两组:A组患者留观时间≤ 7 d,B组患者留观时间> 7 d;调查两组患者年龄、性别、来源、疾病分类、医疗费用支付方式、转归等情况;采用二分类多因素logistic回归分析患者留观时间的影响因素,总结留观患者长期滞留的原因。
  结果  研究期间,出观患者共2 211例,年龄10~101岁,平均（67.81±18.87）岁,留观时间1~2 002 d,平均M（P₂₅,P₇₅）为2.5（1,9）d,急诊临观滞留时间≥ 72 h共计1 076例（占48.67%）。≥ 60岁患者平均留观时间多于 < 60岁患者,差异有统计学意义（P < 0.01）;出观患者中,病情缓解、出观离院1 183例,收入病房806例,转回抢救室97例,死亡125例。不同出观结局患者留观时间不同,收入病房患者留观时间最短,死亡患者留观时间最长（P < 0.01）。A组出观患者以神经系统疾病最多,B组出观患者以呼吸系统疾病最多。多因素logistic回归分析结果显示:患者年龄每增加一岁,留观时间 > 7 d的可能性是原来的1.293倍;以死亡患者为对照,缓解出院患者留观时间 > 7 d的可能性是其0.301倍,收入病房患者留观时间 > 7 d的可能性是其0.026倍,转送抢救室患者留观时间 > 7 d的可能性是其0.183倍。以来自诊室为对照,来自抢救室的患者留观时间 > 7 d的可能性是前者的0.754倍。
  结论  急诊留观患者滞留时间与患者年龄、疾病危重性、分类和临床预后密切相关。急诊留观患者滞留时间过长可导致急诊室拥挤,影响急诊资源的有效利用,应通过调整国家卫生政策、加强医院管理和服务能力,合理配置医疗资源,引导患者理性就医,改善公立三甲医院急诊室拥挤现象。
     

Case-fatality ratio of bacterial meningitis in the African meningitis belt: we can do better

In the African meningitis belt, reported case-fatality ratio (CFR) for meningitis are usually calculated on the basis of presumed cases. We reviewed 3509 presumed cases of bacterial meningitis reported in Niger for which a cerebrospinal fluid (CSF) sample had been tested later at the reference laboratory. The main aetiologies were Neisseria meningitidis (1496 cases), Streptococcus pneumoniae (303 cases) and Haemophilus influenzae (105 cases). The CFR of meningococcal meningitis was lower for serogroup A (5.5%) than for serogroups X (12%) and W135 (12.7%). With a CFR of 49.8%, pneumococcal meningitis, albeit representing only 20.7% of confirmed cases, accounted for 50% of the deaths. The disease burden of pneumococcal meningitis must be better taken into consideration in the future. As most treatments are presumptive, there is a urgent need for an easy-to-administer, cheap first-line treatment effective on N. meningitidis as well as on S. pneumoniae and H. influenzae that would replace the single-dose oily chloramphenicol treatment which is the most frequent treatment administered today, independent of microbial aetiology and season. The development of diagnostic tools really suitable for remote health facilities also is an urgent challenge.     

Current status of cerebrospinal meningitis and impact of the 2015 meningococcal C vaccination in Kebbi,Northwest Nigeria

IntroductionFollowing the significant reduction of Neisseria meningitidis A (NmA) in most parts of northern Nigeria, a new strain of Neisseria meningitidis C (NmC) emerged in 2013 causing outbreaks in the north and recently spreading to southern parts of the Nigeria. This study provides detailed epidemiological investigation in the last four years.MethodsAnalysis of confirmed and suspected cases of meningitis in Kebbi, Nigeria from 2014 to June 2017 detected through Integrated Disease Surveillance and Response.ResultsOf the 2776 cases, 1568 were males, and 1208 females. The median age of males and females was 10 and 11 years (Interquartile range of ages is 9 years) respectively. The attack rate (AR) per 100,000 in the state between 2014 and 2017 was 13.2, 46.7, 2.2 and 3.2 respectively. Case fatality rate (CFR) in 2014 was highest in the 4 years analysed at 13.8%. Binary logistic regression analysis suggests that the odds of confirmation of meningitis was 3.6 (Odds ratio, OR 3.60, 95% CI 1.58–8.2; p = 0.002) times as high in the age group 6–10 years and 2.4 times in the age group 11–19 years compared to the age group 0–5 years (OR 2.44, 95% CI 1.09–5.48; p = 0.03). An epidemic of NmC in 2015, led to a reactive vaccination campaign in selected wards in Aliero and Jega targeting age groups 1–29 years old, with a coverage of 72% and 51% respectively. In 2016–2017 Aliero and Jega local government areas (LGA) had no recorded deaths due to meningitis, a significant improvement over 2015 mortality rates (MR) per 100,000 of 33.4 and 12.2 respectively.ConclusionThe CFR in the state is still very high, suggesting the need for a more coordinated approach aimed at improving disease notification and early treatment. Vaccination in Aliero and Jega LGAs have demonstrated the usefulness of meningococcal C vaccine in reduction of morbidity and mortality.     

PDCA循环质量管理方法对提高患儿家属满意度的效果研究

目的在儿科病房中应用PDCA循环质量管理方法进行护理,观察该方法对患儿家属的影响。方法本次试验在2018年10月-2019年3月本院儿科住院部就诊的患儿中选取100例作为观察对象,根据管理模式的不同将其平均分为观察组与对照组两组,对照组接受常规病房护理,观察组接受PDCA循环质量管理,观察儿科患者家属对科室的满意度情况。结果观察组患儿家属对于儿科病房的服务态度、病房健康教育以及护患有效沟通的满意度显著高于对照组患儿家属,两组对比差异有统计学意义(P <0.05)。结论在儿科病房中应用PDCA循环质量管理方法对患儿进行护理,可有效缓解患儿的病情,提高生活质量,改善患儿预后,提升患儿及其家属的护理满意度。     

小儿外科伤口感染原因调查分析

目的 调查分析小儿外科手术伤口感染的原因,探讨小儿外科手术伤口感染的防治措施.方法 对医院小儿外科2009年2月-2010年2月进行外科手术治疗的1567例患儿中发生外科手术伤口感染的78例治疗护理资料进行整理.结果 年幼、体轻患儿较易发生伤口感染,其中＞3岁患儿发生伤口感染率为4.2％,＜3岁患儿发生伤口感染率为6.9％;体轻、正常体重、超重患儿伤口感染率分别为6.1％、4.8％、4.8％;年资＞5年的较＜5年手术者对患儿伤口感染发生率分别为:5.5％、8.5％,差异有统计学意义;年资＞3年较＜3年责任护士的患儿伤口感染率分别为3.1％、8.3％,差异有统计学意义;手术切口类别不同,患儿发生伤口感染的概率亦不同,Ⅲ类切口手术后感染率为7.7％,Ⅱ类切口为5.3％,Ⅰ类切口为2.2％;单独病房患儿发生伤口感染的概率明显低于双人病房及多人病房患儿,分别为6.2％、3.3％、2.0％.结论 加强医疗护理人员的无菌操作意识,做好患儿围术期的各项准备工作,术后做好患儿伤口护理、营养支持、病房环境管理等,是降低小儿外科伤口感染的有效措施.     

Adolescent girls' anxieties -- role of stressful life events

The study aim was to examine stressful events among 300 adolescent girls 11-17 years old enrolled in school in India. 50.33% had illiterate mothers. 22.33% had mothers who had a primary education and 25.34% who had a secondary education. 82.33% (247) were from nuclear families, and 17.67% (53) were from joint families. The largest proportions reported financial problems (38.67%) followed by household moves (30.33%) and a close relative's death (27.33%). Other concerns reported were parental frequent change or loss of job (12.33%), involvement in a court case (4.67%), death of one or both parents (4.33%), and frequent parental arguments (1.33%) and serious family accidents (1.33%). No stressful events were reported by 31.69% (95 girls); 68.34% reported stressful family events. A significant correlation was found between anxiety and life in a nuclear family (p 0.001). Anxiety was also higher, but not statistically significantly so, among families with an illiterate mother and lower socioeconomic status. More anxieties were reported among girls with working mothers (68%) than non-working mothers (32%). A significant correlation was found between the score of life events and the number of girls reporting anxieties. Individual anxieties were reported for inadequate height (15.66%), fear of boys' teasing (12.33%), losing hair (11.60%), menstrual tensions (10.33%), weak eyesight (9.66%), pimples (9.33%), weakness (8.88%), lack of study time (5.67%), excessive weight (3.67%), dark complexion (2.66%), and bad teeth (2.00%); 55.34% reported these anxieties.     

An investigation of the family background of acute Haemophilus infections of children.

Nose and throat swabs, for culture of Haemophilus influenza type b, and blood samples, for measurement of antibodies specific for that serotype, were collected from members of 28 families from which children had been admitted to hospital with acute H. influenzae type b infections (mainly meningitis or epiglottitis). The patients with meningitis were younger than those with epiglottitis and had more siblings, with a marked predominance of sisters. Investigations within a few days of admission of the affected children to hospital detected carriers of H. influenzae type b (19 altogether) in 13 of the 28 families, including 9 of the 13 families with 3 or more children. Members with raised antibody titres for H. influenzae type b (suggesting the presence of the organism for at least a few weeks) were found in 17 of the 25 families from which blood samples were obtained, including all 11 families with 3 or more children. Most of the patients probably acquired their infections from within their own families, and siblings under 11 years old were of predominant importance both as carriers and as potential sources of the patients'' infections. Persistence of the organism within families for up to 6 months was demonstrated. Possible reasons for the difference in age-incidence between haemophilus meningitis and epiglottitis and for the occurrence of the former in babies with older sisters are suggested, and also a possible connection between the results of this survey and the likely value of immunization against H. influenzae type b.     

Etiology and clinical course of meningitis in children

The aim of the paper was to pinpoint the etiological factors which caused meningitis, and to describe the course of the illness in the patients hospitalized in the years 1991-2000 at the observation ward of the Paediatrics Propaedeutics Clinic of the Paediatrics Institute. Etiological factors were determined in 42 of 80 cases included in the study: in 32 out of 62 purulent meningitis cases and 10 out of 18 aseptic meningitis cases. In purulent meningitis the most commonly isolated pathogens were N. meningitidis (16%), S. pneumoniae (8.1%), K. pneumoniae (4.9%) and H. influenzae type B (4.9%), where as in aseptic meningitis--mumps and herpes viruses. Despite appropriate treatment in 47% of cases there were observed complications such as hydrocephalus, brain oedema, ependymitis as well as hearing or vision impairment and failure to thrive.     

儿科病房医院感染的危险因素分析及管理探讨

目的 探讨儿科病房发生医院感染的危险因素及预防管理措施.方法 回顾性分析医院小儿科2008年1月-2011年5月住院的4249例患儿的临床特征,同时对发生医院感染患儿的相关危险因素进行统计分析.结果 4249例住院患儿中发生医院感染162例,感染率为3.8％,10 d～2岁患儿发生医院感染率最高为68.5％;医院感染部位以呼吸道、消化道为主分别占46.3％、43.2％,季节与感染发生率相关,多发于夏、秋季节.结论 儿科病房中应注意空气的消毒,加强医院感染防治知识的培训,强化对患儿及家长的健康教育,预防医院感染的发生.     

Age and sexwise child mortality and the influencing socio-economic factors in a rural and tribal population in western India

The study was a part of the survey conducted under the USAID-assisted Integrated Child Development Services impact evaluation project in Panchmahals district of Gujarat State, western India, where data of the same population were collected during 1985-86 for the baseline and during 1989-90 for the final evaluation. A minimum of 3 and a maximum of 7 villages were randomly selected from all the 11 blocks of Panchmahals. The entire child population of the selected villages was surveyed. Data were collected by means of a questionnaire by interviewing the head of the family. The families were categorized as below or above poverty line. The mothers were categorized as illiterate or literate. The children were weighed to the nearest 0.1 Kg. The association between age/sex and child deaths that occurred over the 5-year period demonstrated that the number of deaths were highest (70/1000 children) among children who were in the age category of 0-6 months at the baseline evaluation and lowest (8/1000 children) among those in the age category of over 37 months. More male than female children had died in the 7-12 months age group and more females than males had died in the 13-24 months age group. Deaths were 4-fold among the children under 3 as compared to those over 3 years of age. The number of deaths were higher among children of illiterate mothers. Male deaths were higher than female deaths when the birth order was over 4. Among children over 3 years of age birth order seemed to be positively related to male as well as female deaths. More children died when their birth interval was less than 24 months, particularly those under 3 years old. Deaths were higher among children with poor nutritional status ( 70% weight/age, NCHS median) especially among females. A significantly higher number of deaths occurred in females over 36 months of age who had poor nutritional status.     

北京市某医院456例急性心肌梗死患者五年吸烟及戒烟现状调查

目的 了解急性心肌梗死(AMI)患者吸烟及出院后自主戒烟现状.方法 分析2003年10月至2008年10月北京复兴医院CCU病房所有因首次AMI入院共456例西城区患者的个人资料及吸烟现状.统一对吸烟患者出院后戒烟情况、戒烟失败原因进行电话随访.结果 (1)AMI吸烟患者中以男性为主(96.3%),平均吸烟率为55.9%,其中29～50岁患者吸烟率高达87.5%.(2)正在吸烟的AMI患者平均发病年龄(58.0±12.3)岁,吸烟患者AMI平均发病年龄较戒烟组和从不吸烟组提前约16年.(3)吸烟的AMI患者出院后成功戒烟率为42.5%,不同年龄段对出院后成功戒烟率影响有统计学意义,29～50岁年龄段成功戒烟率最高,而51～65岁患者成功戒烟率最低.(4)自主戒烟失败率为40.9%,戒烟失败的主要原因为习惯性因素、戒断症状、工作压力及同事吸烟影响等.其中51～65岁患者主要受习惯性因素和戒断症状影响.结论 北京市西城区成年AMI患者吸烟率及自主戒烟失败率均较高,吸烟致AMI平均发病年龄明显提前.积极倡导戒烟对减少AMI发病率及改善预后有重要意义.

Abstract：

Objective To explore the smoking and smoking cessation status in patients with acute myocardial infarction.Methods 456 hospitalized patients with acute myocardial infarction in Xicheng district were recorded in CCU ward between October 2003 and October 2008.Personal data and smoking status were collected.The smoking cessation status after discharge was investigated by telephone.Results (1) Patients who smoked were still male-dominated (96.3%).The average smoking rate in male patients was 55.9%,and even as high as 87.5% in patients at 29-50 years of age.(2) The average age in patients who smoked and with acute myocardial infarction was 58.0±12.3 years old,16 years advanced the age compared to the groups who never smoked or after stopped smoking.(3) The successful smoking cessation rate in patients with acute myocardial infarction after discharge was 42.5%,and 29-50 years old group having the highest rate of successful cessation,while the lowest rate seen in 51-65 years old group.(4) The failure rate of smoking cessation was 40.9% with the main reasons as:radical habit on smoking,withdrawal symptoms,stress in work and peer influence etc.The 51-65 year-old group was mainly suffered from habitual factors and withdrawal symptoms.Conclusion The smoking rate and smoking cessation failure rate in adult patients with acute myocardial infarction in Xicheng district in Beijing remained high.The onset age of acute myocardial infarction was significantly in advance among patients who smoked.To actively advocate on smoking cessation was still vital for reducing the occurrence of acute myocardial infarction and to improve the prognosis in patients with myocardial infarction.     

乡镇企业农民工健康知识、行为与健康教育现状调查分析

目的 调查乡镇企业农民工的健康相关知识掌握情况和健康相关行为形成情况及在该群体中开展的健康教育和健康促进活动的现状.方法 采用随机整群抽样方法选择浙江省湖州市南浔区408名15岁以上农民工为研究对象,进行问卷调查.结果 被调查对象中40岁以下的占74.5%;小学文化程度的占43.4%,初中文化程度的占36.8%,文盲的占18.1%.68.3%的人在砖瓦厂上班,22.6%在纺织企业上班.69.6%的人和家属住在一起;79.2%的人居住在企业提供的集体宿舍,20.8%的人租房.健康知识知晓率男性为43.2%,女性为40.5%.文盲、小学文化程度、初中文化程度、高中文化程度的人健康知识知晓率分别为25.6%、36.6%、55.5%、60.3%.被调查的农民工有41.4%的人吸烟.有16.7%的人和家人共用一块毛巾.有14.0%的人经常喝生水.有40.9%的人生病了不去医院.农民工的业余生活比较单调,76.0%的人仅仅喜欢和老乡聊天交流.90.7%的人表示会积极参与企业组织的健康教育活动.文化程度越高,对健康教育的需求越高.结论 农民工的健康知信行水平处于比较低的水平.应该根据农民工的需求开展健康教育和健康促进工作.     

中国儿童肺炎链球菌疾病研究回顾

肺炎链球菌(Streptococcus pneumoniae,S.p)又名肺炎(双)球菌,是儿童社区获得性感染的首位致病病原。适当的疫苗可有效预防其感染,并可以降低儿童人群鼻咽部S.p携带率。20世纪60年代中期以前,国内对S.p疾病的研究表明,S.p性脑膜炎占化脓性脑膜炎(化脑)的11.1%~22.1%,是仅次于流行性脑脊髓膜炎的第2种常见化脑(不计入结核性脑膜炎)。S.p是小儿肺炎的重要病原之一,其所致的大叶性肺炎在小儿并不少见。S.p还是小儿脓胸与败血症的重要病原之一。1980年后的病原学和流行病学研究表明,S.p是8.0%~21.0%化脑的病原。以合肥市为例,<5岁的儿童S.p脑膜炎的发生率为1.5/10万。S.p仍然是儿童肺炎的常见且重要的病原。中国儿童中S.p血清型分布与国外不同,上呼吸道感染儿童中分离的菌株血清型<50%包括在欧美已推广应用的7价S.p结合疫苗内,开发适合中国国情的S.p疫苗还需要进一步研究血清型分布情况。中国儿童人群中S.p的耐药形势已经非常严峻,S.p的多重耐药状况也很常见。总之,中国儿童中S.p的疾病负担尚缺乏足够的确切资料,为了证明S.p在儿童感染中的作用,还有很多工作要做。     

探讨护士分层管理在儿科病房中的应用价值

目的探讨分析在儿科病房护理管理中应用分层管理的临床应用效果。方法选取86例在该院儿科病房接受治疗的患儿作为研究对象,分为常规管理组(n=43例)以及分层管理组(n=43例),对比两组患儿护理质量等情况。结果分层管理组患儿家属的护理总满意率为97.61%,常规管理组患儿家属的护理总满意率为74.42%,组间对比差异有统计学意义(P<0.05);分层管理组患儿的临床护理综合评分为(86.34±7.04)分,常规管理组患儿的临床护理综合评分为(78.01±5.13)分,组间对比差异有统计学意义(P<0.05)。结论在儿科病房护理管理中应用分层管理能够有效提高对患儿的护理质量,使患儿的家属能够对护理更加的认可,具有明显临床应用价值。     

高等病房医疗服务分析

目的分析和总结高等病房的运行模式、患者的平均住院时间、病房的床位利用率和需求情况以及在高等病房住院患者的年龄、病种分布和病情情况，提出高等病房医生的工作要求。方法对2002年1月至2008年12月在华山医院挑和高等病房（22病房）住院治疗的3153例患者和固定在此病房工作的医生的情况进行总结、分析。结果7年患者平均住院天数为9．73d，平均床位利用率为91．13％，住院患者平均年龄为50．3岁，其中40—59岁年龄段患者所占比例最高，病种分属21个科室，神经外科最多、普外科次之，固定在高等病房的医生必须有丰富的临床经验，有大量的全科知识。结论高等病房患者的平均住院时间短，高等病房的床位利用率能达到80％以上，收治的患肯数每年都有所增加，收治的患者年龄范围广，病种多样。在高等病房工作的医生需要有丰富的临床经验，大量的全科知识、良好的沟通能力和合作精神。