Partnership for preparedness: a model of academic public health.

The New York City Department of Health and Mental Hygiene and the Columbia University Mailman School of Public Health's National Center for Disaster Preparedness undertook a collaborative project to establish a model academic health department. The goals were to increase student participation at the health department, increase faculty participation in health department activities, and facilitate health department faculty appointments at the school. As a result, 17 students were placed in full-time summer research projects designed by health department staff specifically for the project, 154 health department staff attended a series of six lectures presented by faculty, and five health department professionals applied for academic appointments at the school. The benefits of the efforts toward establishing an academic health department extend to all areas of public health practice, including those of preparedness.     

谈如何加强科主任管理

目的 探索科主任管理的途径与方法。方法 采用科主任责任书和制定一系列的规范核制度。结果 比较规范并具有个体化，有操作性。结论 科主任责任书和规范的考核制度是当前科主在管理的有效措施。     

Hospital charges for colorectal cancer patients first admitted through an emergency department

Some 11,023 colorectal cancer patients diagnosed in 1992-96 in Connecticut first were admitted to a hospital through a hospital emergency department. The average hospital inpatient charges and average length of stay were about 60 percent higher for emergency department versus nonemergency department first admissions. Emergency department status was an important predictor of charges independent of age at diagnosis and length of stay. Applying these data to the approximately 131,000 colorectal cancers diagnosed in 1998 in the U.S., estimated excess hospital costs due to emergency department versus nonemergency department first admissions for colorectal cancer were about $328 million.     

医院检验科的管理刍议

本文就医院检验科的科室设置、人员分工、质量管理以及同临床各科室的关系、仪器设备和人员的配备，将竞争机制引入检验科管理作了较为全面的论述。根据作者多年从事检验工作的经验，提出了较新的关于医院检验科管理的思维方式。     

59例误诊的痛风患者初诊就医科室的分析

目的:分析被误诊的59例痛风患者临床特点,探讨其初诊就医科室的状况.方法:回顾性分析我院2010年1月~2015年12月来风湿科门诊就诊前被误诊的59例痛风患者的临床资料及初诊就医科室进行分析.结果:59例痛风性关节炎患者中,误诊为蜂窝组织炎31例,误诊率为52.5%;误诊为骨关节炎13例,误诊率为22%;误诊为类风湿关节炎12例,误诊率为20.3%;误诊为化脓性关节炎3例,误诊率为5.1%;首次就诊科室依次为急诊科(38.9%),骨科(32.2%),普外科(15.2%),中医科(8.4%),社区医院(5%).结论:加强痛风疾病的知识普及教育,减少痛风患者错误就医,减少误诊误治.     

住院患者抗菌药物临床应用横断面调查

目的了解某医院住院患者抗菌药物临床应用现状。方法采用横断面调查的方法,调查1d的全院住院患者中抗菌药物的使用种类、给药途径、用药量。结果1347例住院患者中,689例使用抗菌药物,使用率为51.15%;总DDD为1377.73,使用指数为102.28;抗菌药物使用指数排在前5位的科室为呼吸科(272.58)、口腔科(193.86)、泌尿外科(158.15)、普外科(157.82)、神经外科(155.69)。结论使用指数能较准确反映抗菌药物利用情况,口腔科、泌尿外科、普外科的抗菌药物使用过多。     

基于DEA模型评价手术科室运营效率的研究

目的探讨DEA模型评价手术科室运营效率的效果和路径。方法回顾性分析中山市某二甲医院2015年1月—2018年12月手术科室运营的一般资料,运用数据包络分析方法(data envelopment analysis,DEA),以出院人次、门诊人次、业务收入作为产出变量,以医生人数、开放床位数作为投入变量,评价各手术科室的运营效率。结果各手术科室综合效率为0.29~1.00,其中效率值为1的单位共7个,占比为25.00%;有效性为“有效”和“弱有效”的单位共15个,占比为53.57%。外二科(普通外科)、外三科(泌尿外科、神经外科)、五官科3个科室的运营效率有待改进。结论通过DEA模型评价手术科室的运营效率,能够直观分析出非有效科室投入、产出指标的改进空间,为进一步提升手术科室的运营效率,并对整合各种要素提出了一些可行性建议。     

Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect?

OBJECTIVES: The goal was to describe the use of the medical emergency department as a source of non-urgent medical care in order to assess unmet health care needs among its users. The specific objectives were thus to assess the proportion of emergency department visits for non-urgent medical care and to describe those who used the department for this reason. DESIGN: A cross sectional study was performed at the emergency department in two hospitals (around 12,000 visits per year each). Subjects were interviewed before and after the visit using a standardised questionnaire. SETTING: The medical emergency department of two university hospitals, one in Paris and one in Besançon (France). SUBJECTS: Each patient aged 15 and more attending the emergency department for a visit during 40 randomly selected periods of 12 hours was included. MAIN OUTCOME MEASURES: A definition of urgent care was adopted before the beginning of the study. Four expert judgments were then used for each case to determine whether the reason for the visit was urgent or not. RESULTS: Altogether 594 patients in the Paris emergency department and 614 in the Besançon one were included. In Besançon, the patients were older, a general practitioner was more often cited as the regular source of care, and the percentage of subsequent hospital admission was higher than in Paris (71% versus 34%). The non-urgent visits were estimated to account for 35% and 29% of the visits in Paris and Besançon respectively. Patients using the emergency department for a non-urgent visit were younger than other patients. More of them were unemployed, homeless, born outside of France, and without health insurance. CONCLUSIONS: Non-urgent use of the emergency department was observed in about one third of the visits. Groups using the department for primary care and/or non-urgent care were mostly young and socially fragile, with no regular source of health care. Their poor health condition suggests that there is a need for a structure providing primary care both inside and outside 'normal' working hours.     

The effect of the doctor-patient relationship on emergency department use among the elderly

OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician. METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician. CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.     

影响胸痛患者分诊准确率的因素与对策

目的总结胸痛患者分诊失误的经验,提高胸痛分诊准确率。方法回顾性研究532例胸痛患者的分诊资料,分析导致分诊失误的原因。结果分诊失误54例,其中心内科分诊失误4例、呼吸内科分诊失误15例、消化科分诊失误12例、胸外科分诊失误11例、皮肤科分诊失误7例、康复科分诊失误5例。结论加强对患者的宣教、制定规范的分诊流程和提高分诊护士对病例的综合分析和鉴别诊断能力是提高胸痛分诊准确率的有效措施。     

Primary care and public emergency department overcrowding.

OBJECTIVES. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. METHODS. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. RESULTS. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. CONCLUSIONS. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations.     

急诊科护士心理评估与分析

目的了解急诊科护士心理状况。方法应用自评量表(SCL-90)及自制压力源调查表对58名急诊科护士及60名普通病房护士进行问卷调查,并进行对比分析。结果急诊科护士SCL-90量表中的躯体化、强迫、抑郁、焦虑因子分显著高于普通病房护士(P<0.05)。结论与普通病房护士比较,急诊科护士显示出较多的身心问题,主要与急诊的工作性质和工作环境有关,使急诊科护士长期处于应激状态。     

The Impact of Immunization Record Aggregation on Up-to-date Rates–Implications for Immunization Registries in Rural Areas

Problems with poorly documented immunization records may be especially important in rural areas. To evaluate the potential impact of a regional registry in a rural region, this study quantified the change in documented immunization rates for nine primary care sites in rural Colorado resulting from the addition of public health department immunization clinic records. Manual chart reviews of immunization data were conducted at both private primary care and public health department sites in two geographic areas in rural Colorado. Data from private primary care sites were matched to data from the public health department sites. Immunization up-to-date (UTD) rates at each primary care site were then recalculated for 12- and 24-month-olds after including data from public health department sites. Of 1,533 children, 469 (31 percent) were given immunizations at both a private primary care and a public health department site. The UTD rate (3:2:3:2) of 12-month-olds using only data from primary care sites ranged from 32 to 79 percent. Including the public health department data increased the rates by 0 to 26 percent (mean = 11 percent) for 12-month-old children. The UTD rate of 24-month-olds (4:3:1:3 and any Hib on/after 12 months) ranged from 6 to 54 percent at the primary care sites. These rates increased by 6 to 21 percent (mean = 12 percent) when public health department data were added. This "virtual" registry combining primary care and public health department data increased calculated immunization rates at primary care sites substantially, with a range of 0 to 26 percent.     

儿童医院住院患儿铜绿假单胞菌的同源性

目的了解某儿童专科医院临床分离的铜绿假单胞菌(PA)感染流行趋势,观察PA的科室分布特征、耐药性及基因型。方法收集该儿童专科医院住院患儿送检标本分离的56株PA进行耐药性分析,并应用脉冲场凝胶电泳(PFGE)分型技术对其进行基因分型。结果56株PA对氨苄西林耐药率为100.00%,对阿米卡星、环丙沙星耐药率为0.00%,对其他抗菌药物表现为不同的耐药率（1.79%～96.43%）;共被分为18个PFGE型别,其中A型26株（均分离于呼吸科）,B型12株（11株分离于内分泌科）, C型3株,D～R型各1 株。不同科室分离的菌株数量不同,其中呼吸科分离最多,达27株（48.21%）;其次为内分泌科13株（23.21%）。结论该儿童医院呼吸科和内分泌科分别存在PA的2种不同克隆菌株流行。PFGE具有特异性高、重复性好、结果容易判断等优点,是目前细菌基因分型较为可靠的技术。     

Use of advance directives for nursing home residents in the emergency department

Documented requests can ensure that patients' end-of-life care preferences are implemented, particularly in emergent circumstances. This study a) compared information on advance directives found in different sources of documentation in the hospital record of nursing home patients admitted through the emergency department and b) assessed emergency department clinicians' perceptions of how end-of-life care requests are communicated to them. Seven potential sources of documentation were reviewed in the medical records of 40 patients, and semistructured interviews were conducted with 10 emergency department clinicians. We found little concordance among sources of advance directive documentation. Our results suggest variability in documentation for nursing home patients on transfer to the emergency department, and that emergency department clinicians experience substantial difficulty in reliably obtaining information about advance directives. As treatment may vary based solely on available documentation, such information gaps may decrease the likelihood of adherence in the emergency department to patients' previously expressed care preferences.     

Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,518 decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.     

急诊护士遭受工作场所暴力后应激障碍情况的调查分析

目的探讨急诊护士遭受工作场所暴力后应激障碍的发生情况。方法采用自行设计的一般资料调查问卷、工作场所暴力情况问卷及创伤后应激障碍测量量表平民版(PCL-C)对广州市5所三级甲等综合性医院急诊科护士进行问卷调查;运用SPSS17.0软件对数据进行统计分析。结果急诊护士遭受工作场所暴力后存在应激障碍的情况,过去1年内曾经遭受暴力的急诊护士(暴力组)的PCL-C得分明显高于过去1年内未遭受暴力的急诊护士(非暴力组),差异具显著统计学意义;在过去1年内曾经遭受暴力的急诊护士中,21.8%出现了一定程度的创伤后应激障碍症状,12.1%出现了明显的创伤后应激障碍症状。结论遭受工作场所暴力的急诊护士的心理健康状况较未遭受暴力的急诊护士差,存在创伤后应激障碍。     

Risk of unplanned emergency department readmission after an acute-care hospital discharge among geriatric inpatients: Results from the geriatric EDEN cohort study

Objectives

The study aims 1) to examine whether items of the brief geriatric assessment (BGA) or their combinations predicted the risk of unplanned emergency department readmission after an acute care hospital discharge among geriatric inpatients, and 2) to determine whether BGA could be used as a prognostic tool for unplanned emergency department readmission.

Methods

A total of 312 older patients (mean age, 84.6 ± 5.4 years; 64.1% female) hospitalized in acute care wards after an emergency department visit were recruited in this observational prospective cohort study and separated into 2 groups based on the occurrence or not of an unplanned emergency department readmission during a 12-month follow-up period after their hospital discharge. A 6-item BGA was performed at emergency department admission before the discharge to acute care wards. Information on incident unplanned emergency department readmission was prospectively collected by phone call and by consulting the hospital registry. Several combinations of items of BGA identifying three levels of risk of unplanned emergency department readmission (i.e., low risk, intermediate risk and high risk) were examined.

Results

The unplanned emergency department readmission was more frequently associated with a temporal disorientation (P=0.004). Area under receiver operating characteristic curves of unplanned emergency department readmission based on BGA items and their combinations ranged from 0.53 to 0.61. The best predictor of unplanned emergency department readmission was the temporal disorientation (hazard ratio>1.65, P<0.035), which defined the high-risk group. Inpatients classified in high-risk group of unplanned emergency department readmission were more frequently readmitted to emergency department than those in intermediate- and low-risk groups (P log Rank <0.004). Prognostic values for unplanned emergency department readmission of items and their combinations were poor with sensitivity below 67%, specificity ranging from 36.4 to 53.7, and positive likelihood ratio below 1.4.

Conclusions

The items of BGA and their combinations were significant risk factors for unplanned emergency department readmission, but their prognostic value was poor.

     

慢性病医疗保险门诊与普通门诊治疗冠心病效果比较

目的通过对慢性病医疗保险门诊与普通门诊冠心病患者治疗后有关项目指标的综合观察对比,探讨慢性病医疗保险门诊在冠心病治疗中的作用。方法对定点于山东省泰山慢性病医院慢性病医疗保险门诊治疗的92例冠心病患者1a来的就诊次数、医嘱遵从性、血压、血脂、血糖控制情况以及基于临床症状和心电图判断的疗效进行观察,并与同期随机抽取的能获取1a来完整资料的92例普通门诊冠心病患者进行比较。结果医疗保险门诊冠心病患者医嘱遵从性以及血脂、血压控制情况均优于普通门诊患者,差别均有统计学意义（P〈0.05）。医疗保险门诊冠心病患者治疗后临床症状及心电图理想者分别占45.6%和48.9%,普通门诊患者该构成比分别为29.3%和34.7%,差别均有统计学意义（P〈0.05）。结论慢性病医疗保险门诊对冠心病患者有较好疗效,值得推广。