某院近5年门诊量动态发展趋势简析

门诊是医院的前沿窗口,是与患者面对面交流的一个和谐桥梁,门诊担负着接诊、急救、体检等任务,随着医学科技的发展,门诊已成为医院医疗服务的重要工作。探讨医院门诊工作动态趋势对推动门诊科学管理具有重要意义,某院在近几年跨越式发展过程中,采取了各种积极的政策和措施,门诊量不断攀升。现将某院近五年来门诊量季节动态发展变化情况进行回顾和分析,为医院进一步加强门诊管理工作提供参考依据。     

10年间住院妇科恶性肿瘤患者的回顾性分析

目的 了解四川大学华西第二医院10年间住院妇科恶性肿瘤患者的发病情况,为妇科恶性肿瘤的流行病学及临床诊治提供一定的依据。方法 收集2003~2012年在我院住院的妇科恶性肿瘤病例,对其临床病理资料进行回顾性分析。结果 10年间妇科恶性肿瘤的发病人数呈上升趋势,构成比前3位为宫颈、宫体、卵巢恶性肿瘤,共占92.13%。妇科恶性肿瘤总的高发年龄段为40~49岁,占34.02%（3132/9207）。其次为50~59岁,占26.64%（2453/9207）;但各类型妇科恶性肿瘤的高发年龄段存在一定差异。宫颈恶性肿瘤高发年龄段30~49岁,占72.46%（3 062/4226）;宫体恶性肿瘤高发年龄段40~59岁,占69.77%（1768/2534）;卵巢恶性肿瘤高发年龄段40~59岁,占58.30%（1004/1722）。患者年龄20~29岁组占本组恶性肿瘤患者的4.43%（408/9207）,以宫颈、卵巢恶性肿瘤常见;＜20岁组仅占0.98%（90/9207）,以卵巢恶性肿瘤最常见;≥60岁组占12.90%（1188/9207）,以宫体、卵巢恶性肿瘤常见。大部分妇科恶性肿瘤患者就诊时处于早期阶段。结论 10年间妇科恶性肿瘤的患病人数呈上升趋势,各类型妇科恶性肿瘤的高发年龄段存在一定差异,宫颈、宫体及卵巢恶性肿瘤仍为防治重点。     

双源CT大螺距扫描技术在小儿先天性心脏病诊断的临床应用

目的 探讨二代双源炫速CT大螺距心电门控低剂量扫描方案(Advanced prospective ECG-triggering high pitch dual-source computed tomography, FLASH-DSCT)在小儿先天性心脏病（先心病）诊断中的临床应用价值。方法 收集2013年2~6月于我院行CT血管扫描的小儿先心病患者78例,随机分为两组,FLASH-DSCT组40例,采用FLASH-DSCT扫描方案;对照组38例,采用常规心电门控螺旋扫描方式。记录两组患者的容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP）,并计算有效辐射剂量（ED）,由2位经验丰富的放射医师独立诊断并采用5分法对图像质量进行评估,对结果一致性评价采用kappa检验,客观评价两组的对比度噪声比（CNR）。以手术结果或数字减影血管造影（digital substraction angiography, DSA)作为金标准,比较两种扫描方法的诊断价值。结果 FLASH-DSCT组患儿行DSCT低剂量扫描方案的ED为（0.238±0.178） mSv,与对照组ED〔（1.897±1.071） mSv〕差异有统计学意义（\P<0.05）;FLASH-DSCT组图像质量平均评分为（4.22±0.73）分,稍优于对照组〔（3.82±0.61）分〕,但差异无统计学意义,两组图像均符合诊断要求;两组降主动脉和左室CNR差异无统计学意义。FLASH-DSCT组与对照组的敏感度（96.4% vs. 97.4%)、特异度（99.8% vs. 99.5%)和诊断准确率（99.1% vs. 99.0%）差异无统计学意义。结论 FLASH-DSCT可有效地降低婴幼儿患者的辐射剂量,提高图像质量,具有重要的临床应用价值。     

2000—2011年豫东地区某市HIV感染流行趋势及新动向

目的分析豫东地区某市人群HIV感染的流行趋势及新动向,为艾滋病的综合防治和科学干预提供信息和依据。方法分析2000—2011年该市人群HIV感染监测报告。结果 2011年该市新增HIV感染者218例,新增发病者285例,新增死亡者105例。HIV感染途径中血液传播途径构成比逐年下降,而性传播途径构成比逐年上升,母婴传播途径构成比变化不大。与2010年相比,2011年A区HIV感染者占全市感染者的构成比增幅为13.29%,M县为10.91%,R县为9.25%,N县为8.25%,B区为5.46%,Y县为5.44%,Z县、S县、X县增幅均<3.00%。该市全部HIV感染者中,男2 946例,占56.60%;女2 259例,占43.40%,男女比例为1∶0.77;31～60岁者共4 379例,占84.13%;职业主要以农民居多,共4 801例,占92.40%。结论近年来,性传播途径逐渐取代血液传播途径而成为主要传播途径,男男性行为者(MSM)HIV感染率明显升高。全市各县区均有HIV感染者报告,分布仍较为广泛,呈灶状聚集分布。男性HIV感染者构成比高于同期女性。感染者职业种类有所增多,部分长期以来被认为与HIV感染相关性较小的职业人群新增例数有所增加,如工人、无业人员及长途司机等,流行范围在不断扩大。     

Trends of Mortality Rates During the Last Thirty Years in Greece

General mortality rates and specific mortality rates by major causes of death (coronary disease, cancer, tuberculosis, traffic accidents, suicide, vascular disorders of central neural system) in Greece have been studied throughout the 30-year period 1967–1996 and time trends have being calculated by nonlinear models of trend analysis. The results confirm the general pattern of decrease of mortality in Greece during the particular period of time as a result of the combination of the impact of two controversial trends: on one hand the decrease of infant mortality and mortality from infectious disorders and on the other the relatively slower and more gradual increase in mortality rates by disorders related to the western lifestyle culture, such as cardiovascular disorders and cancer. During the period under study in Greece the impact of the second trend seems to inflict less severe implication in the formulation of the pattern of general mortality especially as women are concerned. This statistically significant and gradually increasing difference in mortality between men and women in Greece has been confirmed in general mortality time trends as well as in the evaluation of the relatively better pattern of mortality trends of women from particular western lifestyle disorders.     

综合性医院五年来的传染病变化趋势

目的：分析传染病流行的趋势,为及时制定、调整防控措施,减少和防止传染病的进一步蔓延,提供参考的依据。方法：利用2008—2012年法定报告传染病数据,采取描述性统计分析,掌握5年传染病流行变化趋势。结果：5年法定传染病发病总体呈下降趋势并伴有小幅增长,疾病谱的排序有所变化;15岁以下青少年仍然是呼吸道和消化道疾病的高发人群,20～50岁的中青年人群是病毒性肝炎、肺结核及性病的高发人群。结论：对高危人群采取有针对性的防控措施,可有效降低相关传染病的发病趋势。但病毒性肝炎、肺结核及性病的防控形势依然严峻。     

气温对定西市农村居民心血管疾病住院人数的影响

目的 探讨气温对定西市农村居民心血管疾病住院人数的影响及其滞后效应。方法 利用定西市2018至2019年气象资料、空气污染资料以及农村居民每日因心血管疾病住院人数数据,采用分布滞后非线性模型,分析日均气温与心血管疾病住院人数的关系,并按性别、年龄和疾病种类进行分层分析。结果 定西市气温与农村居民心血管疾病住院人数之间存在非线性关系,暴露反应曲线近似一个倒“U”形,不同类型心血管疾病的暴露反应曲线形状基本类似,但气温阈值各不相同。低温(-7 ℃)和较低温(0 ℃)对心血管疾病住院人数存在累计滞后效应。低温(-7 ℃)累积滞后7 d时,RR值最大,为1.121(95% CI=1.002~1.255);较低温(0 ℃)累积滞后14 d时,RR值最大,为1.198(95% CI=1.123~1.278);较低温(0 ℃)在累积滞后14 d时对缺血性心脏病和心律失常住院人数的RR值分别为1.034(95% CI=1.003~1.077)和1.039(95% CI=1.004~1.066);较高温(17 ℃)和高温(21 ℃)对缺血性心脏病均在当天RR值最大,分别为1.148(95% CI=1.092~1.206)和1.176(95% CI=1.096~1.261);较高温(17 ℃)和高温(21 ℃)对心律失常累积滞后效应均在当天最大,RR值分别为1.071(95% CI=1.001~1.147)和1.112(95% CI=1.011~1.223);较高温(17 ℃)和高温(21 ℃)对脑血管疾病累积滞后效应在当天最大,RR值分别为1.084(95% CI=1.025~1.145)和1.094(95%CI=1.013~1.182);未发现气温对心力衰竭住院人数的累积滞后效应。分层分析显示低温(-7 ℃)和较低温(0 ℃)对女性心血管疾病住院人数有影响,但仅较低温(0 ℃)对男性有影响;高温对女性的累积效应高于男性,相比于男性,气温对女性的影响更大,<65岁人群较≥65岁人群对低温和高温更敏感。结论 气温变化会增加定西市农村居民心血管疾病住院风险,且存在滞后效应;温度对不同病因、性别及年龄心血管疾病住院患者的影响有差异,居民应注意气温变化对健康的影响,尤其是女性、<65岁和缺血性心脏病等重点人群在气温发生变化时应加强防范。     

2001～2003年我院麻醉药品应用情况分析

目的了解我院麻醉药品的应用情况，为临床合理用药提供参考。方法对我院药库微机管理系统提供的2001—2003年麻醉药品各品种的用量进行统计和分析。结果芬太尼用药频度居各年度首位；吗啡制剂用量逐年递减；哌替啶注射液用量仍居高不下。结论癌症止痛治疗中存在不合理用药现象。     

我院2007～2009年住院患者麻醉药品用药分析

目的:了解我院住院患者麻醉药品的应用情况.方法:收集我院2007～2009年住院药房麻醉药品品种、用量,运用药物频度分析法(DDDS)和排序对麻醉药品应用情况进行回顾性统计分析与评价.结果:我院麻醉药品的使用量,芬太尼注射液用量最大,并呈逐年递增趋势,吗啡制剂有减少的趋势,而新型口服镇痛药羟考酮及芬太尼透皮给药贴剂的使用频度呈逐渐提高趋势.结论:我院麻醉药品使用基本合理,符合WHO推荐的癌痛治疗原则.     

农村地区暗娼特征及低档场所艾滋病流行的控制

目的了解农村地区暗娼的分布情况以及人群特点,为有效的控制艾滋病的流行提供参考依据。方法对涉县、唐县、平山县域内从事性交易的暗娼活动场所及暗娼进行摸底调查。结果此次共调查暗娼活动场所307家,暗娼1184人。农村地区低档场所具有暗娼人群数量大、地处偏僻、隐蔽分散、场地多变换、流动性强的特点,预防艾滋病的措施难以覆盖。结论根据调查我们总结出了5种发现农村地区暗娼低档场所的方法:相关人物引见法、自我观察法、自身体验法、表明身份法、滚雪球法,根据此法可及时有效的发现暗娼活动场所,为艾滋病的宣传教育提供便利。     

Prevalence of Kaposi Sarcoma-Associated Herpesvirus Infection in Homosexual Men at Beginning of and During the HIV Epidemic

Context  Some studies have inferred that an epidemic of Kaposi sarcoma–associated herpesvirus (KSHV) infection in homosexual men in the United States occurred concurrently with that of human immunodeficiency virus (HIV), but there have been no direct measurements of KSHV prevalence at the beginning of the HIV epidemic. Objectives  To determine the prevalence of KSHV infection in homosexual men in San Francisco, Calif, at the beginning of the HIV epidemic in 1978 and 1979 and to examine changes in prevalence of KSHV at time points from 1978 through 1996 in light of changes in sexual behavior. Design, Setting, and Participants  Analysis of a clinic-based sample (n = 398) derived from the San Francisco City Clinic Cohort (ages 18-66 years) (n = 2666 for analyses herein) and from population-based samples from the San Francisco Men's Health Study (MHS) (ages 25-54 years) (n = 825 and 252) and the San Francisco Young Men's Health Study (YMHS) (ages 18-29 years) (n = 428-976, and 557); behavioral studies were longitudinal and KSHV prevalence studies were cross-sectional. Main Outcome Measures  Antibodies against KSHV and HIV; sexual behaviors. Results  The prevalence of KSHV infection in 1978 and 1979 was 26.5% of 235 (a random sample) overall (weighted for HIV infection) vs 6.9% (128/1842) for HIV in the San Francisco City Clinic Cohort sample. The prevalence of KSHV infection remained essentially unchanged between an MHS sample of 252 in 1984 and 1985 (29.6%) and a YMHS sample of 557 in 1995 and 1996 (26.4%), while HIV prevalence dropped from 49.5% of 825 in 1984 and 1985 (MHS) to 17.6% of 428 in 1992 and 1993 (YMHS). The proportion of men practicing unprotected receptive anal intercourse with 1 or more partners declined from 54% to 11% during the 1984 through 1993 period (MHS) with similar though slightly higher values in the YMHS in 1992 and 1993; whereas for unprotected oral intercourse it ranged between 60% and 90% in the 1984 through 1996 period (MHS and YMHS). Conclusions  Infection with KSHV was already highly prevalent in homosexual men when the HIV epidemic began in San Francisco, and its prevalence has been maintained at a nearly constant level. Any declines in the incidence of Kaposi sarcoma do not appear to be caused by a decline in KSHV transmission.      

Appropriateness of Admission and Length of Stay in a Turkish Military Hospital

The purpose of this study was to determine the extent of inappropriate days of stay in a Turkish military hospital, and to explore the variables correlated with these. A review was made of the medical records of surgery patients admitted to the hospital of Gülhane Military Medical Academy. To determine the appropriateness of lengths of hospitalization, a Turkish version of the Appropriateness Evaluation Protocol (AEP) was applied retrospectively. A total of 375 patients'files were reviewed; and 21.3% of the hospital admissions were evaluated as inappropriate. Multiple logistic regression analysis showed that inappropriate length of stay was significantly increased with relation to age, emergency status, military rank, and distance from the hospital to the patient's home. The results of the study suggest that changes in physicians' behavior and in the organization of hospital activities may be effective in improving the quality and efficiency of hospital care.     

Challenges in the provision of ICU services to HIV infected children in resource poor settings: a South African case study

The HIV/AIDS epidemic has placed increasing demands on limited paediatric intensive care services in developing countries. The decision to admit HIV infected children with Pneumocystis carinii pneumonia (PCP) into the paediatric intensive care unit (PICU) has to be made on the best available evidence of outcome and the ethical principles guiding appropriate use of scarce resources. The difficulty in confirming the diagnosis of HIV infection and PCP in infancy, issues around HIV counselling, and the variance in the outcome of HIV infected children with PCP admitted to the PICU in African studies compound this process. Pragmatic decision making will require evaluation of at least three ethical questions: are there clinical and moral reasons for admitting HIV positive children with PCP to the PICU, should more resources be committed to caring for HIV children who require the PICU, and how can we morally choose candidates for the PICU? Those working in the PICU in HIV endemic regions need to make difficult personal decisions on effective triage of admissions of HIV infected children with PCP based on individual case presentation, availability of resources, and applicable ethical principles.     

新型冠状病毒肺炎疫情下医院高频接触物体表面消毒及手卫生行为

目的 了解新型冠状病毒肺炎(COVID-19)疫情对定点医院公众手卫生行为及高频接触物体表面消毒效果的影响.方法 分别在河南省COVID-19疫情前(2019年10月1日至12月31日)和疫情期间(2020年1月1日至3月31日)对某院公共区域高频接触物体表面(各电梯间按钮、诊疗区域计算机键盘按钮、自助机键盘表面和洗手...