The Impact of Hospital Quality on Profits,Volume, and Length of Stay

Using 2006–2007 data from a sample of 6,082 U.S. hospitals, quality of care measures developed by the Hospital Quality Alliance (HQA) are applied to heart attack, heart failure, pneumonia, and surgery. Quality of care for these was related to both higher profits per case and increased number of cases. Length of stay was inversely related to quality of care for preventative (surgical and heart attack) care.     

ALIS‐FLP: Amplified ligation selected fragment‐length polymorphism method for microbial genotyping

A DNA fingerprinting method known as ALIS‐FLP (amplified ligation selected fragment‐length polymorphism) has been developed for selective and specific amplification of restriction fragments from TspRI restriction endonuclease digested genomic DNA. The method is similar to AFLP, but differs in that only one specific restriction enzyme (TspRI) is used. The cohesive ends of the DNA fragments are ligated with two types of oligonucleotide. A long oligonucleotide containing the primer site and the specific 9 nt 3 prime end, which is complementary to specific 9 nt, cohesive 3 prime end of the TspRI genomic DNA fragment, and a short, degenerated, oligonucleotide covering the remaining TspRI cohesive ends. Other cohesive ends are covered by a short degenerated oligonucleotide lacking the primer site. The ligation mixture is used as a template for amplification using a single primer corresponding to the 5 prime end of the long, specific oligonucleotide. The selection of TspRI digested genomic DNA fragments for amplification is achieved by sequence selective ligation of the specific long oligonucleotide carrying the primer site to both ends of the specific target fragment. This technique allows for differentiation of the organisms without previous knowledge of their DNA sequence. The usefulness of the method is confirmed by genotyping of 70 previously characterized clinical E. coli isolates. The grouping obtained was identical to the results of REA‐PFGE. Versatility of the method is highlighted, i.e. its combining the advantages of the AFLP technique with a simple, rapid and cheap polymerase chain reaction product detection method.     

The relationship between the levels of nurses’ competence and the length of their clinical experience: a tentative model for nursing competence development

Aims and objectives. To explore the relationship between the levels of nurses’ competence and the length of their clinical experience, in order to provide a tentative model of the continuing competence of nurses. Background. The professional development of employees has attracted great interest. This interest has led to the development of various models that illustrate how employees develop their competence throughout their careers. However, little is known of how nurses maintain and develop their competence throughout their career pathways. Design. A cross‐sectional design was used. Methods. Using a survey method, five dimensions of self‐assessed nursing competence and the length of the nurses’ clinical practice were measured (n = 325). Each dimension of competence was plotted against the length of their clinical experience using locally weighted scatterplot smoothing. Then, the shapes of the plots were analysed by fractional polynomial regression analysis. Results. Overall, the relationships between the levels of nursing competence and the length of clinical experience were illustrated by curves with a rapid increase in competence levels at the early stage of the nursing career and a slower increase later. These curves were modelled by either a logarithmic, square‐root function or its reciprocal. The results supported the learning curve model. Conclusions. The competence development of nurses may be characterised by two distinctive periods: a rapid growth period followed by stable periods. However, the modality of the growth may be different depending on which dimension of nursing competence is in focus. Relevance to clinical practice. The level of nursing competence directly affects the quality of care provided to patients. The findings of the study enable healthcare organisations to take proactive approaches to enhance nurses’ competence by identifying when and how to assist nurses.     

Shortening the course of antibiotic treatment in the intensive care unit

Effective antimicrobial stewardship is an increasingly important concern for healthcare providers globally. Antibiotics are frequently prescribed for patients who develop sepsis in the intensive care unit and traditionally courses are prolonged, with uncertain benefit and probable harm. There is little evidence to support many guidelines recommending between 10 and 14 days, and a number of studies suggest substantially shorter courses of less than 7 days may suffice. Safely reducing course length is likely to depend on a number of preconditions, including thorough eradication of any septic foci; optimization of serum antibiotic concentrations, particularly when there is physiological derangement; and use of novel biomarkers such as procalcitonin. The critical care environment is well suited to this aim as patients are closely monitored. With these measures in place, it is reasonable to believe short antibiotic courses can safely be used for the majority of intensive care infections.     

三种方法联合测量根管工作长度的准确性评价

目的:评价手感法、X线法和电测法联合应用测量根管工作长度的准确性.方法:选择离体牙123颗,216个根管按照牙根有无明显吸收分成两组,用三种方法分别测量两组的根管工作长度,将三种方法测量的结果平均得出三种方法联合应用的根管工作长度和准确率,并与电测法的准确率进行比较.结果:三联法在正常离体牙组的准确率(93.6%)略高于电测法(90.3%和89.5%).但无显著性差异(P＞0.05),而在牙根吸收组三联法的准确率(90.2%)则明显高于电测法(78.3%和73.9%).有显著性差差异(P＜0.05).根管预备前后电测法的准确率在两组中皆无显著性差异(P＞0.05).结论:手感法、X线法和电测法联合应用能提高牙根有明显吸收的牙齿根管长度测量的准确性.     

麻醉蒸发器进样管径、管长对于七氟醚气体输出浓度的影响探讨

目的 对可变旁路蒸发器的进样管径、管长对于七氟醚输出浓度的影响情况进行分析和探讨。 方法 以氧气为载气,在温、湿度等条件相同的情况下,通过对不同管径、不同管长的麻醉蒸发器的七氟醚气体输出浓度进行检测,将其与控制标准浓度进行比较,探讨进样管径、管长对于麻醉气体输出稳定性影响因素。 结果 随着进样管径和长度的增加,七氟醚的实际输出浓度也逐渐增大,且不同管径和管长的平均实际输出浓度与控制浓度(1%、2%、4%、8%)相比差异有统计学意义(P<0.05)。 结论 在同一条件下,可变旁路麻醉蒸发器的进样管径、进样管长的变化可对七氟醚输出浓度可以产生较大影响,如何选择最佳进样管径和进样管长度对于控制麻醉气体的准确输出、提高麻醉的稳定性和可控性具有重大意义,本研究中的数据也为临床麻醉仪器部件参数的选择提供了参考。     

用基团贡献法估算聚乙二醇单甲醚-聚乳酸两亲嵌段共聚物的HLB值

采用水数法测定了聚乙二醇单甲醚-聚乳酸两亲嵌段共聚物系列样品的HLB（Hydrophile-Lipophile Balance）值,其数值与分子中亲水基团的体积分数（φ_EO）呈线性变化规律。以Γ-分布概率密度函数描述聚乳酸链中单个聚乳酸链节对HLB的贡献,则聚乳酸链的有效链长可由Γ-分布概率密度函数的积分求得,由此得到了用基团贡献法估算此类共聚物HLB的方法,HLB计算方法的平均绝对误差小于0.97,与其实验测定误差相当,比常用的Griffin方法更为准确。     

烧伤患者精神障碍与重返社会工作的相关因素分析

目的　分析烧伤患者精神障碍的影响因素以及精神障碍与患者重返社会工作的相关性。方法　对年龄大于 7岁的 5 6 0例烧伤患者 ,采用焦虑自评量表 (SAS)和抑郁自评量表 (SDS)及 90项症状清单 (Symptomchecklist 90 ,SCL 90 ) ,测量其精神障碍情况 ;在烧伤康复期 1个月～ 2年间 ,采用大体评定量表 (globalassessmentscale,GAS)对其精神障碍严重程度、社会功能进行评定。出院后采用信函随访及电话联系方式对其愈后工作能力进行调查。　结果　严重烧伤、颜面部烧伤患者焦虑、抑郁发生早 ,持续时间长 ,程度重 ;患者对于重返工作岗位、家庭的关系维系、社会活动能力的担心 ,使其心理障碍加重。经心理治疗后 ,精神障碍得到改善 (P <0 .0 5 )。　结论　烧伤患者精神障碍越重 ,重返社会工作时间相对延长 ,原岗位工作受到影响