专科医院住院部各科医疗质量综合评价的初步探讨

目的：探讨专科医院住院各科工作情况综合评价方法,向临床科室提供医疗质量信息,促进医疗质量的提高。方法：以医院工作报表为数据来源,用秩和比法从诊疗质量,工作强度和经济效益三方面量化科室医疗质量考核指标。结果：综合数能更全面、有效、合理地评价住部各科医疗质量优劣等级,提出科室改进的指标。结论：此评价方法简便,实用,有利于深化院内改革,强化行政部门管理。     

295例外科感染患者抗菌药物应用调查分析

目的：探讨医院外科感染病例抗菌药物应用情况.方法：对抗菌药物使用的种类、用药频度、联用、致病菌分离菌株的耐药情况等进行统计分析.结果：阿米卡星、氧氟沙星、甲硝唑、庆大霉素、青霉素、头孢噻肟、环丙沙星、头孢唑林、诺氟沙星、替硝唑的使用频度位居前10位；不合理用药类型主要有选药不当、给药时间不当等.结论：合理应用抗菌药物有利于整体医疗水平的提高,减少耐药菌株的产生.     

药物不良事件的防范研究

目的：探讨心内科病房药物不良事件(ADE)的防范特征。方法：由药师深入心内科病房，集中监测药物不良事件。主要监测内容是药物不良事件的存在与否，可否防范及严重程度。结果：5个月研究期间共鉴定ADE64次，其中28％可以防范。在重度ADE中，50．0％可防范；在中度ADE中，33．3％可防范；在轻度ADE中，可防范的比例最少，为13．6％。结论：药物不良事件中有相当一部分可以防范，而且越是严重的ADE就越有可能被防范。应该采取有效的措施来防范药物不良事件。     

知识管理在我院药学部的应用

目的:探讨知识管理在医院药学部(药剂科)的应用。方法:总结近年来我院药学部关于知识管理的数种模式。结果:我院药学部知识管理已基本成型。结论:通过知识管理,增强了药学部的应变能力和创新能力。     

精神科医院感染的临床调查

目的了解我院精神科医院感染发病率,分析发生医院感染相关因素,减少医院感染的发生。方法采用回顾性调查分析,对我院精神科2000年1月~2004年12月的住院病历进行分析,计量资料进行均数计算,计数资料用χ2检验。结果9 089例精神科住院患者发生医院感染313例次,医院感染率为3.44%,总感染率呈逐年下降趋势(P<0.05);感染部位以上呼吸道(34.82%)、胃肠道(20.45%)、泌尿道(18.53%)为主;女病区医院感染率(3.83%)高于男病区医院感染率(3.07%)P<0.05;重管室医院感染构成比(57.51%)高于康复室医院感染构成比(42.49%)P<0.05。结论根据精神科医院感染的特点,必须加强医生、护士的防护意识和医院感染的重点监控,减少医院感染的发生。     

神经外科手术患者医院感染目标性监测及感染相关危险因素分析

目的研究神经外科手术患者医院感染危险因素,为制定医院感染控制措施提供理论依据。方法采用目标性监测方法,对神经外科手术后患者医院感染率及相关危险因素进行调查。结果267例神经外科手术患者共发生医院感染100例(37.45%),136例次(50.94%);住院时间>30 d,手术时间>2 h,意识障碍,脑室外引流,气管切开是其医院感染重要危险因素。结论神经外科手术患者医院感染危险因素多,需采取综合措施才能有效控制医院感染。     

注重人才培养促进学科建设

介绍了温州医学院附属第二医院加强学科建设的具体举措,引进和培育技术骨干,创造人才成长环境,加强国内外技术联合,整合多种学科资源,坚持科研与临床和市场相结合,树立良好形象。经过上述努力,使科研总体实力明显增强,教学工作跃上了新台阶,学科队伍整体素质迅速提升,社会效益和经济效益显著提高。     

优势专科建设的效应

通过本院优势专科第一周期建设中取得的绩效,重点阐述了科研、人才培养、社会效应和经济效应等几个方面,充分体现了优势专科建设的必要性和优越性,明确了今后的目标和任务,重视优势专科建设,促进医院医疗水平再上新台阶.     

Lower rates of emergency department injury visits among Latino children in the USA: no association with health insurance.

BACKGROUND AND OBJECTIVE: Latino children have lower rates of injury visits to emergency departments (EDs) than non-Latino white and African American children. This study tests the hypothesis that this difference reflects health insurance status. DESIGN: Secondary analysis. Patients/ SETTING: Children under 19 years of age visiting EDs in the USA, sampled in the National Hospital Ambulatory Medical Care Survey of EDs (NHAMCS-ED) from 1997 to 2001. MAIN OUTCOME MEASURES: Rates of ED injury visits; ED injury visit rates by race/ethnicity stratified by health insurance and adjusted for other covariates; subtypes of injury visits; and procedures and hospital admissions by race/ethnicity. RESULTS: Injuries accounted for >56 million, or 40.5%, of total ED visits among pediatric patients. Injury visits occurred at lower rates for Latino children (9.9 per 100 person years) than non-Latino white and African American children (16.2 and 18.3, respectively), although total ED visit rates were similar. Regardless of health insurance status, Latino children had lower rates of injury visits than non-Latino white and African American children. Latino children had lower rates of the three major subtypes of injury visits (sports, accidental falls, struck by/between objects). Latino children had similar rates of procedures and hospital admissions to non-Latino white children. CONCLUSIONS: Irrespective of their insurance status, Latino children have lower rates of ED injury visits in the USA than non-Latino white children. Possible reasons for this difference include different healthcare seeking behavior or different injury patterns by race/ethnicity, but not differences in health insurance status or barriers to accessing ED care.     

The Evaluation of Suspected Pediatric Sexual Abuse

Children with suspected sexual abuse often present to the ED, not infrequently like those in the 2 cases described. Most children who are sexually abused have normal genital examinations, which should be explained in discussions with caretakers and investigators. Interviewing of the child should be avoided by the physician, except to establish current symptoms that may impact examination or testing. Exams should not be forced on children. The hymen is extremely sensitive in the unestrogenized female and should not be touched. Speculum examination is never performed in the prepubertal child, except under anesthesia by a practitioner experienced in child sexual abuse evaluation or gynecology. Examination under anesthesia by a physician experienced in surgical repair is indicated with active vaginal or rectal bleeding. In cases in which the examination is abnormal or inadequate, the subspecialist should be consulted. Patients with contact less than 72 hours before presentation may need forensic evidence collection, which should be coordinated with the subspecialist. Prepubertal females with vaginal discharge seen on examination should have testing sent not only for STDs, but also for non-STD etiologies including group A streptococcus and enterics. Postexposure prophylaxis (pregnancy, STD, HIV) should be considered when appropriate. There are many conditions that may be mistaken for sexual abuse. Detailed documentation of the history and the physical examination (written, drawings, and ideally photographs) is essential.