Pocket book of hospital care for children

This pocket book is for use by doctors, senior nurses and other senior health workers who are responsible for the care of young children at the first referral level in developing countries. It presents up-to-date clinical guidelines which are based on a review of the available published evidence by subject experts, for both inpatient and outpatient care in small hospitals where basic laboratory facilities and essential drugs and inexpensive medicines are available. In some settings, these guid…     

社区卫生服务信息系统建立的影响因素分析

结合社区卫生服务管理信息系统的开发和应用,分析了政府行政管理部门、社区卫生服务机构和软件开发商等对社区卫生服务管理信息系统建立的影响因素。建议系统开发应由卫生管理人员、计算机工程人员和社区卫生服务工作者共同参与,加强信息标准化建设,注重产品质量和功能,以及售后服务、产品升级等。     

Viewpoint: A Pragmatic Approach to Constructing a Minimum Data Set for Care of Patients with HIV in Developing Countries

Providing quality health care requires access to continuous patient data that developing countries often lack. A panel of medical informatics specialists, clinical human immunodeficiency virus (HIV) specialists, and program managers suggests a minimum data set for supporting the management and monitoring of patients with HIV and their care programs in developing countries. The proposed minimum data set consists of data for registration and scheduling, monitoring and improving practice management, and describing clinical encounters and clinical care. Data should be numeric or coded using standard definitions and minimal free text. To enhance accuracy, efficiency, and availability, data should be recorded electronically by those generating them. Data elements must be sufficiently detailed to support clinical algorithms/guidelines and aggregation into broader categories for consumption by higher level users (e.g., national and international health care agencies). The proposed minimum data set will evolve over time as funding increases, care protocols change, and additional tests and treatments become available for HIV-infected patients in developing countries.     

新型冠状病毒肺炎疫情期间北京协和医院手术室内医护人员头面部防护情况问卷调查

目的 调查新型冠状病毒肺炎(COVID-19)疫情期间北京协和医院手术室内医护人员头面部防护相关知识的掌握及执行情况。方法 通过匿名在线回答调查问卷的方式,对北京协和医院手术室内医护人员头面部防护的知识掌握程度及执行情况进行评估。结果 调查问卷分2次发放。第1次为疫情全国爆发阶段,共回收问卷153份。第2次为北京市防控响应级别降为三级后,疫情防控常态化阶段,共回收问卷101份。98%被调查人员在疫情工作期间均使用过任何一种形式的头面部防护用具。其中,麻醉医师在挂耳式防溅面屏式口罩的使用率最高(93.0%)。在疫情期间,对发热患者的诊疗,被调查人员主要以护目镜(71.2%)进行防护为主;对非发热患者的诊疗,被调查人员主要以挂耳式防溅面屏式口罩(56.2%)进行防护为主。在两次调查问卷中,43%及68%被调查人员仍持续进行头面部防护,其中以防溅面屏(50.0%及56.5%)及防溅面屏式口罩(56.1%及68.1%)为主。结论 此次疫情期间北京协和医院手术室内医护人员对头面部防护的认识水平可达90%以上,手术室内不同医务人员对头面部防护的选择各有不同,40%以上的人员将在疫情常态化防控阶段继续进行头面部防护。     

中西医结合治疗更年期和电脑工作者干眼症临床效果分析比较

目的探讨二冬玉竹汤联合人工泪液对更年期和电脑工作者干眼症的治疗效果。方法应用前瞻性研究方法对15例更年期干眼症患者和15例电脑工作者干眼症患者,采用二冬玉竹汤联合人工泪液（爱丽）的中西医结合方法进行治疗,用药1个月后,观察二冬玉竹汤联合人工泪液对两者治疗的临床效果。结果更年期干眼症和电脑工作者干眼症在应用中西医结合方法治疗1个月后,两组干眼症患者的泪液分泌量（Schirmer Ⅰ）明显增多、泪膜破裂时间（BUT）均延长、荧光素染色明显好转。二冬玉竹汤联合人工泪液对两组干眼症的治疗效果经统计学检验无明显差异（P〉0．05）。结论采用二冬玉竹汤口服联合人工泪液（爱丽）滴眼是一种治疗更年期干眼症和电脑工作者干眼症的个体化治疗手段,既可以明显改善患者的临床症状,又能够增加泪液的分泌量．延长患者的泪膜破裂时间,值得临床推广。     

角膜金属异物310例临床分析

目的：分析讨论角膜金属异物的病因及预后,提出对角膜异物的处理方法。方法：对310例角膜金属异物患者从病因、职业、发病率、处理方法、预后等方面进行分析,得出结论。结果：角膜金属异物对视力和眼球危害性较大,遗留角膜薄翳、斑翳或角膜白斑者92例,占复诊病例的35.52%。结论：角膜金属异物在工业发达地区发病率高,需要高度重视对角膜异物的预防和保健。主张患者增强眼的保健意识,发生角膜异物尽早就诊,尽量减少并发症的发生; 企业和工厂加强工人的安全生产意识,定期进行眼保健知识的培训。     

HIV prevention research and global inequality: steps towards improved standards of care

Intensification of poverty and degradation of health infrastructure over recent decades in countries most affected by HIV/AIDS present formidable challenges to clinical research. This paper addresses the overall standard of health care (SOC) that should be provided to research participants in developing countries, rather than the narrow definition of SOC that has characterised the international debate on standards of health care. It argues that contributing to sustainable improvements in health by progressively ratcheting the standard of care upwards for research participants and their communities is an ethical obligation of those in resource-rich countries who sponsor and implement research in poorer ones.     

Social health insurance: A knowledge-do gap in eastern Nepal

Health care costs, and those for inpatient care in particular, pose a barrier to seeking health care, and cost be a major cause of indebtedness and impoverishment, particularly among the poor. The Ministry of Health in Nepal intends to initiate alternative financing schemes such as community and social health insurance schemes as a means to supplement the government health sector financing source. Social Health Insurance (SHI) is a mechanism for financing and purchasing / delivering health care to workers in the formal sector regulated by the government. Considering all these facts BP Koirala Institute of Health Sciences (BPKIHS) has introduced SHI scheme in 2000 as an alternative health care financing mechanism to the community people of Sunsari and Morang districts. In the beginning small area was elected as a pilot project to launch the scheme. A major objective of SHI is to reduce poverty caused by paying for health care and to prevent already vulnerable families from falling into deeper poverty when facing health problems. A total of 26 organizations with 19799 populations are at present in SHI scheme. Sixteen rural based organizations with 14,047 populations and 10 urban based organizations with 5752 people are the beneficiaries in this scheme. BPKIHS SHI Scheme is the outcome of the visionary thinking on social solidarity and as an alternative health care financing mechanism to the community. BPKIHS is mobilizing people's organizations and is offering health services through its health insurance scheme at subsidized expenses. This has helped people to avail with health facilities who otherwise would have been left vulnerable because of their penetrating health needs. There is huge gap between premium collection and expenditures. The expenditures are more and this may be due to knowledge - do gap in the program. If conditions are unsuitable, SHI can lead to higher costs of care, inefficient allocation of health care resources, inequitable provision and dissatisfied patients. It can also be more difficult to realize the potential advantages of SHI in future. The future challenges confronting the scheme are to give the continuity and sustainability of the program to its catchments areas. This might entail a shift in its program operation mechanism. People's active involvement is required, which will further provide a sense of ownership in the scheme amongst the people.     

无针输液系统研究应用进展

无针输液系统是一种新型现代化输液技术.该系统从根本上实现了静脉输液的无针化,能避免针刺伤的发生,有效降低针刺伤引发的血源性感染,同时职业暴露问题亦得到改善,为医护人员和患者提供了医疗安全双保障,因此无针输液系统受到广泛关注.在国外,该系统在临床工作中已得到普遍应用.本文就无针输液系统的研究应用进展做一综述.     

Benign Prostatic Hyperplasia: Cost and Effectiveness of Three Alternative Surgical Treatment Methods Used in a Turkish Hospital

The purpose of this study was to compare three alternative surgical therapies for Benign prostatic hyperplasia (BPH) in terms of their cost and effectiveness in a general hospital setting in Turkey. BPH is an important potential burden on health care resources in developing countries like Turkey, not only because of the increasing incidence of the disease, but also because of the differences in cost and effectiveness that exist among the various available treatment technologies. In this study, three alternative surgical treatments for BPH, namely open prostatectomy, transurethral resection of the prostate (TURP), and laser prostatectomy were compared in terms of their cost and effectiveness. Effectiveness was measured through the use of the International Prostate Symptom Score (IPSS) before the operation and at 3 months after. Laser prostatectomy was found to be the most costly and least effective way of treating BPH. This conclusion was valid both in terms of cost per prostate symptom score and cost per improvement of quality of life index. This study shows how a rough estimate can be made of the potential burdens that alternative treatment methods would impose on a country's health budget.     

The roles and responsibilities of physicians in Pre-Hospital Emergency Medical Services: A Caribbean perspective

A Pre-hospital Emergency Medical Service (PHEMS) is a vital component of a country's health service because it provides early medical care to critically ill and injured persons in the field There is evidence to show that early care reduces mortality and morbidity and offers the patient the best chance of survival and improved quality of life. Caribbean territories have been developing their PHEMS as part of a programme of health sector reform. In a study of PHEMS in 12 Caribbean countries, the Pan American Health Organization reported that there were no clear guidelines with respect to the roles and responsibilities of the physician in PHEMS in the majority of countries. In fact, a few countries had services where there was no direct physician involvement. We present a brief review of the internationally recognized roles and responsibilities of physicians in PHEMS, and make recommendations with particular reference to the Caribbean. We suggest that there is a need for direct and active involvement of physicians in the development of PHEMS because the Emergency Medical Technician is recognized as an extension of the physician in the field and is supposed to be protected by the physician's licence to deliver medical care.     

How to balance between carotid endarterectomy and carotid artery stenting

Stroke is one of the most common causes of permanent disability in industrialized countries and become increasingly prevalent in developing countries.Management of stroke consumes $45 billion annually,and is responsible for greater than one million hospital admissions each year in the U.S.Neurologic sequelae related to cerebral vascular accidents (CVA) severely limit a patient's ability to carry out activities of daily living and invariably create an enormous burden on health care costs.As a result,the prevention of CVA with safe treatment of extra-cranial carotid occlusive disease remains an important health care goal.     

SARS防治一线医护人员心理行为的研究

目的 研究医护人员在SARS防治工作一线期间的心理行为状况。方法 从3家SARS定点医院和7家发热门诊随机抽取545名医护人员进行问卷调查。结果 545名调查对象中62．75％的医护人员感觉紧张。61．47％的人感觉目前压力比平时大得多；另有5．87％的人感觉压力大到令人崩溃。压力主要来自工作强度大(33．9l％)。与病人零距离接触(27．43％)及防护服太笨重(22．46％)。许多医护人员出现疲劳(35．96％)。失眠(26．62％)。孤独(62．57％)。担心自己(32．84％)及家人(53．94％)感染SARS等心理行为问题。一半以上的医护人员基本上不和病人交谈(54．50％)。结论 在SARS防治一线从事治疗护理工作的医护人员存在广泛的负面心理和行为。这些同题的出现与担心本人被感染以及人际交流的减少有关。     

脑出血行气管切开术后患者的治疗效果及护理

目的:探讨脑出血行气管切开术后患者的治疗效果及护理措施。方法:选取于2009年8月至2010年8月入我院治疗的脑出血行气管切开术患者40例,针对各患者的病情制订抢救方案,认真观察患者病情变化,行气管切开术后按照预定的护理方案对患者加强护理,然后统计和观察患者术后的临床治疗效果和护理效果。结果:患者在行气管切开术后并按照预定的护理方案对患者加强护理后,患者在治愈、有无变化、并发症、感染率、死亡率等方面均取得了理想的治疗效果。结论:对患者实施严格的护理措施有助于脑出血行气管切开术的治疗,通过实行各种护理措施,密切有效的配合临床治疗,可以减少并发症的发生、降低死亡率、降低感染率,提高患者术后生存质量,值得医护人员推广和使用     

Training appropriate laboratory workers for rural health centres in Papua New Guinea

Many rural health centres in developing countries continue to treat patients without the help of any laboratory tests. The result is often inaccurate diagnosis, wasteful use of multiple drugs, and increasing drug resistance of pathogens. It is unlikely that there will ever be sufficient funds to employ a full-time laboratory worker at each of the many small remote health centres in Papua New Guinea. It is also doubtful whether staff and health extension officers who run such centres have the appropriate knowledge to adequately utilize full-time laboratory personnel. It is feasible, however, to train selected health workers in courses of three to four months' duration to perform a few simple laboratory tests part-time, in addition to their clinical duties. Suitable tests are those where the result does not require skilled interpretation. For most such tests, the result is the diagnosis. After the clinical staff have received the laboratory diagnosis, they are free to decide whether it fits the clinical picture. If so, they can then find the appropriate treatment to prescribe in standard treatment books. The present paper describes the experience in setting up and operating laboratory training for health centre staff in Milne Bay Province, Papua New Guinea. Costs and initial results of the program are discussed.     

A method for selecting data subsets from large medical data bases

Because of the exponential increase in health care expenditures, attention has been drawn to the cost and effectiveness of health care delivered. The use of electronic data bases as a means for assessing health care effectiveness has been advocated as powerful computer systems have become commonplace. The need to work efficiently with extremely large data bases presents difficult challenges to researchers who wish to focus on specific aspects of the data. This paper describes a computer program written to facilitate the analysis of large medical data sets by providing a straightforward way to specify and select data subsets from the aggregate data base.     

National surveillance of AIDS in health care workers

Information obtained for all persons with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control, Atlanta, includes a question about employment in a health care or clinical laboratory setting. As of May 1, 1986, a total of 922 (5.5%) of 16,748 adults with AIDS reported employment in such settings. Ninety-five percent of these health care workers belonged to recognized high-risk groups for AIDS; the proportion with "no identified risk" has not increased with time. All AIDS patients (including health care workers) who do not belong to high-risk groups are referred for further investigation. Of 88 health care workers initially reported with no identified risk, ten were from countries where heterosexual transmission is believed to play a major role; additional information was unobtainable or incomplete for 17 individuals. Of 61 persons on whom interviews or other follow-up information was obtained, 44 (73%) were reclassified. Specific occupational exposures that could be implicated as the source of human immunodeficiency virus infection were not identified for any health care workers with AIDS. A review of surveillance data supports other studies indicating that the risk of human immunodeficiency virus transmission in the occupational setting is low.     

Detecting bacteriuria in a primary maternal and child health care programme

Urinary tract infection in pregnancy has not been adequately dealt with in developing countries, though its consequences are well recognised. This is primarily because of constraints on resources coupled with a lack of technological infrastructure. An evaluation of the Griess test for the mass screening of urinary tract infection among antenatal women was carried out prospectively using a case-control method. The Griess test was found to be a valid, reliable, and economical screening test for urinary tract infection which can be integrated into a primary maternal and child health care programme.     

Low cost methods for secondary prevention of cervical cancer in developing countries

BACKGROUND: Cervical cancer is both a preventable and a curable disease- preventable because the pre-invasive stage can be detected by screening and curable because the very early stage can be cured. It is the commonest genital cancer among females in Nigeria. The incidence and mortality from this disease in developing countries is very high. This is due to the unavailability of organised screening programmes. To address this problem, effective and practical alternatives to cytology are being investigated in many studies. OBJECTIVE: To examine the strengths and limitations of new methods currently undergoing evaluation for secondary prevention of cervical cancer in developing countries. MATERIAL AND METHODS: We conducted a computerised literature search for published articles. Mesh phrases used for the search were cervical cancer screening, cervical cancer screening in developing countries, cervical cancer screening- new techniques. Hand searches of journals and the proceedings of major conferences were also done. RESULTS: The visual tests for screening for cervical cancer was found to be highly sensitive and can be performed by not only physician but also other trained health care providers. The "single visit approach" to prevention of cervical cancer also referred to as "see and treat" has been tried in some countries in Asia and Africa and found to be effective and acceptable to women and their partners. CONCLUSION: Several studies conducted in many developing countries have shown that low cost methods for cervical cancer prevention do have a place in reducing the incidence of this deadly disease.