提高住院病历及时归档率

1选题理由1)《病历书写基本规范》中要求,病历资料必须在住院病人出院后3天之内交病案室,病案管理人员应及时进行归档。2)2005年是医院管理年,提高住院病历及时归档率是医教科的管理目标。基于以上理由我们选择了"提高住院病历及时归档率"为我们QC小组的活动课题。     

Measuring the Quality of Healthcare

Recently, enormous efforts to measure the quality of healthcare have been made to attain information on ways to improve the quality of healthcare. However, this area of research is still at an early stage of development and more research is required. This article outlines a framework by which the quality of healthcare can be analyzed on the basis of the three quality dimensions introduced by Donabedian. The article then goes on to test the validity of this (theoretical) framework within an empirical analysis.Because of increasing financial shortages within health systems, this article focuses on the treatment of myocardial infarction, which is one of the costliest and most prevalent diseases. This approach establishes a link between medical and economic problems. The variables for structure quality (i.e. number of cardiologists, number of catheterization facilities) were sourced and evaluated from the ‘Herzberichte der Jahrgänge’ (‘heart reports’) compiled by Bruckenberger for the period 1994–2004 for the 16 German federal states. Data from the Federation of Quality Assurance (BQS) were used for the evaluation of process quality (i.e. adequacy of indication for coronary angiography). Finally, administrative data from the German Federal Statistical office for 1994–2004 were used to determine the variables of outcome quality (i.e. standardized mortality rate due to myocardial infarction, potential years of life lost <70 years due to myocardial infarction).Three hypotheses were tested using panel data: (i) a better structure and/or process quality increases the probability of getting a better outcome quality for the clinical picture under observation; (ii) by employing additional input factors (such as additional catheterization facilities), the probability of getting a good outcome quality is increased; and (iii) in addition to structure quality and process quality, factors lying outside of the sphere of influence of the health system have an additional influence on outcome quality (marginal gains would decrease in this case). Three models were used to test these hypotheses using fixed effects estimation.The empirical analysis produced three results. First, the analysis confirms the predicted causality between the different dimensions of quality of care for the German federal states. Notably, the number of catheterization facilities has a highly significant positive influence on the outcome quality. Second, support is found for decreasing marginal gain of inputs. Third, a good structure and a good process quality alone cannot guarantee good outcome quality. However, the analysis also showed that, in addition to healthcare provided, there are other determinants that also affect the outcome quality of healthcare. Further empirical investigation regarding the influence of these factors on the outcome dimension could elaborate on our findings and deliver additional insights.     

低血糖症误诊探讨

目的 通过病例分析，探讨低血糖症的误诊原因，为提高糖尿病的早期诊断提供参考资料。方法 对误诊17例低血糖患者的临床体征、确诊方法、误诊疾病进行分析研究。结果 低血糖症因与某些常见病或共存病症状相似、表现不典型而误诊。医生询问病史、查体不全面、习惯性思维、未充分利用辅助检查，等确诊时，病情已十分严重。结论 低血糖症误诊率高。提高对低血糖症的认识和警惕性，综合分析病史，详细地检查，是减少误诊的关键。     

Controlling for occasion-specific effects when assessing the test–retest reliability of self-report health questionnaires

OBJECTIVE: This study proposes a method for self-report health questionnaires to adjust test-retest reliability for changes during the test-retest interval based on an external measure, and to distinguish such changes from random response errors. METHODS: In our application, eighty participants completed the Symptoms of Illness Checklist (SIC) on two occasions, two weeks apart, immediately before interviews given on each occasion by one of two physicians in a crossover design. The physician interview scores served as external measures, and structural equation modeling was used to estimate the parameters of a model that corrected for the occasion-specific effect of participants' responses using information from the interviews. RESULTS: Correcting for changes in symptoms during the test-retest interval increased SIC test-retest reliability from .744 to .804 and significantly improved model fit (chi2(diff)(1) = 30.78, p < .001). CONCLUSIONS: The results suggest methods that can improve the evaluation of self-report health questionnaire test-retest reliability by identifying changes using an external measure, and distinguishing these from random response errors; these increased the estimated SIC test-retest reliability and indicated that the SIC was indeed able to measure changes over the studied time interval. This method can be applied across a broad range of questionnaires.     

随机应答技术在大学生婚前性行为调查中的应用

目的了解大学生中婚前性行为的发生率，为开展大学生的性教育提供依据。方法应用问卷调查以及随机应答技术中的“三个无关联问题技术模型”，结合“多重试验模型”两种方式调查婚前性行为的发生率，并使用X^2方检验对两样本率进行比较。结果随机应答技术和问卷调查得到的婚前性行为发生率分别为0．1338和0．0864，有统计学差异（x^2=8．105，P=0．004）。结论随机应答技术可显著降低无应答率和误答率，得到高质量的调查结果。当前大学生婚前性行为发生率很高，应当引起高校教育工作者的注意，加强大学生的性道德和性健康教育。     

Chronic toxicology and carcinogenesis studies of Telone II by gavage in Fischer-344 rats and B6C3F1 mice

Telone II (technical grade, 1,3-dichloropropene), a soil fumigant, was evaluated in chronic toxicology/carcinogenicity studies using Fischer-344 (F344) rats and B6C3F1 mice of both sexes. Doses administered were 0, 25, or 50 mg/kg to rats and 0, 50, or 100 mg/kg to mice. Telone II was given in corn oil by gavage 3 times per week for 104 wk. Ancillary studies were conducted to determine time-related effects, in which dose groups containing 5 male and 5 females rats were killed after receiving Telone II for 9, 16, 21, 24, or 27 mo. The primary organs affected were the forestomach (rats and mice), urinary bladder (mice), lung (mice), and liver (rats). Compound-related non-neoplastic lesions included basal-cell or epithelial hyperplasia of the forestomach (rats and mice), epithelial hyperplasia of the urinary bladder (mice), and hydronephrosis (mice). Neoplastic lesions associated with administration of Telone II included squamous-cell papillomas of the forestomach (male and female rats, female mice), squamous-cell carcinomas of the forestomach (Male rats, female mice), transitional-cell carcinomas of the urinary bladder (female mice), alveolar/bronchiolar adenomas (female mice), and neoplastic nodules of the liver (male rats). Although cis- and trans-1,3-dichloropropene are the principal components of Telone II, the presence of 1% epichlorohydrin, a direct-acting mutagen and carcinogen added as stabilizer, may have influenced the development of forestomach lesions. The results of the ancillary studies supported the findings of the carcinogenesis studies and demonstrated the time-dependent development of lesions in the forestomach (basal-cell hyperplasia and squamous-cell papilloma). Under the conditions of these gavage studies, Telone II was shown to be carcinogenic in male and female F344 rats and female B6C3F1 mice. Although the study in male B6C3F1 mice was considered inadequate because of the low survival resulting from suppurative inflammation of the heart (myocarditis) in the control group, there was some indication of Telone II-related increases of transitional-cell carcinomas of the urinary bladder, squamous-cell papillomas of the forestomach, and alveolar/bronchiolar adenomas and carcinomas of the lung.     

Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey

Background  

Travel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data.     

一起幼儿园内空肠弯曲菌高感染情况的调查

作者报道了一起幼儿园内空肠弯曲菌高感染的传播。该幼儿园儿童空肠弯曲菌阳性率为23.0％(43/187)。腹泻病例空肠弯曲菌阳性率为18.6％(8/43),健康儿童带菌率为24.3％(35/144)。同期另一幼儿园健康儿童和门诊非腹泻患儿带菌率分别为11.3％(27/238)和7.5％(15/201),三者间差异显著(P<0.005)。通过流行病学调查及菌株的生物分型表明,传染源可能是两名患空肠弯曲菌肠炎的炊事员,他们与儿童的菌株为同一生物型。其传播可能是通过污染的食物或人与人接触而引起的。     

竹黄颗粒剂Ⅱ号对应激小鼠皮肤肥大细胞影响的实验研究

目的：阐明竹黄颗粒剂Ⅱ号治疗现的作用机制。方法：应用形态学方法观察竹黄Ⅱ号对应激小鼠皮肤肥大细胞的影响。结果：束缚应激诱导小鼠皮肤肥大细胞脱颗粒，竹黄Ⅱ号抑制了此效应。结论：提示竹黄颗粒剂Ⅱ号可抑制心理应激诱导的皮肤肥大细胞脱颗粒，可能是其治疗银屑病的疗效机制之一。     

温针灸为主治疗前列腺增生症疗效观察

笔者于1998年2月～1999年12月应用温针灸为主治疗前列腺增生症51例,效果理想.现报道如下. 1临床资料 1.1病例选择全部98例观察病例均来自男科门诊.按随机法分为治疗组和对照组.其中治疗组51例,年龄最小49岁,最大72岁,平均56.3岁;病程最短2年,最长5年,平均4.1年.对照组47例,年龄最小48岁,最大71岁,平均57.1岁;病程最短3年,最长7年,平均5.0年.两组具有可比性.