2009-2011年湖南省计划外生育孕产妇死亡相关特征分析

目的分析2009-2011年湖南省计划外生育孕产妇死亡相关特征,寻找减少计划外生育孕产妇死亡的可控因素,为制定计划外生育人群系统保健工作策略及政策提供理论依据。方法通过湖南省三级妇幼保健网络收集湖南省2009-2011年的孕产妇死亡资料共572例。依据计划生育情况,将其中有记录569例孕产妇死亡个案分为计划生育内、外组,分析指标包括:孕产妇的人口社会学因素、孕期保健相关因素、分娩相关特征、死亡相关特征。结果计划外生育组与计划内生育组组间比较:计划外生育组孕产妇死亡中高龄(35岁及以上)和低龄(小于20岁)构成比显著增高(χ2=78.828,P=0.000);妊娠次数(χ2=60.319,P=0.000)和分娩次数明显增多(χ2=56.887,P=0.000);产检次数明显减少,尤其是孕期从未做过产前检查者明显增加(χ2=43.793,P=0.000);分娩地点级别低,尤其是在家中及其他非法接生机构分娩者增多(χ2=29.351,P=0.000);计划外组剖宫产终止妊娠者明显减少(χ2=16.624,P=0.000);死于产科出血等直接产科原因者明显增多(χ2=23.096,P=0.000);可避免死亡构成比明显增多(χ2=13.735,P=0.001)。二组间死亡孕产妇的城乡分布、家庭年人均收入、死亡地点分布等构成比差异无统计学意义(P0.05)。结论计划外生育死亡孕产妇特点是妊娠和分娩次数多、高龄或低龄妊娠、孕产期服务较差,产检次数少、分娩地点级别较低、产科出血等直接产科死因及可避免死亡构成比高。     

Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

IntroductionThe incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous ‘baby-boomer’ generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.MethodsMajor trauma patients admitted to ICU over a 5 year period to June 2011 after ladder falls >1 m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.ResultsThere were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n = 58) fell >1 m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3 m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p = 0.02), higher AIS head code (p = 0.01), higher heart rate and lower mean arterial pressure (p < 0.01) in the initial 24 h period in ICU, and were ≥55 years of age (p = 0.05). Only 46% of patients available for follow-up were living at home at 12 months without requiring additional care.ConclusionsThe incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12 months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.     

Evolving classification of intensive care patients from event data

ObjectiveThis work aims at predicting the patient discharge outcome on each hospitalization day by introducing a new paradigm—evolving classification of event data streams. Most classification algorithms implicitly assume the values of all predictive features to be available at the time of making the prediction. This assumption does not necessarily hold in the evolving classification setting (such as intensive care patient monitoring), where we may be interested in classifying the monitored entities as early as possible, based on the attributes initially available to the classifier, and then keep refining our classification model at each time step (e.g., on daily basis) with the arrival of additional attributes.Materials and methodsAn oblivious read-once decision-tree algorithm, called information network (IN), is extended to deal with evolving classification. The new algorithm, named incremental information network (IIN), restricts the order of selected features by the temporal order of feature arrival. The IIN algorithm is compared to six other evolving classification approaches on an 8-year dataset of adult patients admitted to two Intensive Care Units (ICUs) in the United Kingdom.ResultsRetrospective study of 3452 episodes of adult patients (≥ 16 years of age) admitted to the ICUs of Guy’s and St. Thomas’ hospitals in London between 2002 and 2009. Random partition (66:34) into a development (training) set n = 2287 and validation set n = 1165. Episode-related time steps: Day 0—time of ICU admission, Day x—end of the x-th day at ICU. The most accurate decision-tree models, based on the area under curve (AUC): Day 0: IN (AUC = 0.652), Day 1: IIN (AUC = 0.660), Day 2: J48 decision-tree algorithm (AUC = 0.678), Days 3–7: regenerative IN (AUC = 0.717–0.772). Logistic regression AUC: 0.582 (Day 0)—0.827 (Day 7).ConclusionsOur experimental results have not identified a single optimal approach for evolving classification of ICU episodes. On Days 0 and 1, the IIN algorithm has produced the simplest and the most accurate models, which incorporate the temporal order of feature arrival. However, starting with Day 2, regenerative approaches have reached better performance in terms of predictive accuracy.     

Rôle du périnato-sexologue dans une équipe interdisciplinaire périnatale au Canada

Interdisciplinary health care teams are models of health care that are the way of the future. In this model, the sexologist has a unique and important role, particularly in perinatal health care where sexuality is a central component of health. Perinatal sexuality is a newly emerging discipline in which the perinatal sexologist has a double role to play: 1) to train other perinatal health professionals in sexuality; and 2) to educate and to intervene with future and new parenting couples by answering their multiple intimate and sexual questions and concerns during the transition to parenthood.     

The use of preventable hospitalization for monitoring the performance of local health authorities in long-term care

ObjectiveThe objective of the study was to examine whether there are differences in the performance of long-term care programs between local health authorities, using preventable hospitalization as an indicator.MethodsA retrospective cohort study compared the rate of preventable hospitalization for local health authorities in Tuscany (Italy) between January 2012 and September 2016. Several administrative datasets for the patients in long-term care programs were linked at the individual (patient) level. Elderly disabled patients 65 years of age and older in long-term care programs in Tuscany from both types of programs: nursing homes (n = 4 196) and home care (n = 15 659) were included in the study.ResultsThe rate of preventable hospitalization differed considerably between local health authorities. Three out twelve local health authorities had a significantly lower and one had a significantly higher preventable hospitalization rate than the regional average.ConclusionThere was a large variation in the rate of preventable hospitalization among the local health authorities. Applying preventable hospitalization as an indicator for quality, with implications for periodical audit can be used for monitoring the performance of a long-term care program.     

The knowledge desired by emergency medical service managers of their ambulance clinicians – A modified Delphi study

AimThe aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians.BackgroundEmergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers’ approach to this knowledge.DesignA modified Delphi method in three rounds.MethodsIn total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round.ResultsFive categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category ‘Knowledge to assess the patient’s situation from a holistic perspective’ was the highest ranked, followed by ‘Medical knowledge to assess and care for different diseases’ and ‘Knowledge to be able to care for critically ill patients’.ConclusionsTaken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge.