纤维支气管镜在急危重病人气道管理中的应用

目的 探讨纤支镜在急危重病人气道管理中的作用。方法 回顾性总结支气管镜对34例重症病人进行气道管理中的清理作用及治疗咯血，肺炎及肺不张等临床经验。结果 10例肺部感染患者，经纤维支气管镜治疗后感染均得到不同程度的控制，其中6例痊愈出院；7例肺不张者，4例行纤支镜1次肺复张，1例行纤支镜2次后复张，余2例配合其它治疗措施后复张；大咯血9例患者，经纤支镜局部应用肾上腺素及凝血酶，6例咯血立即停止，3例明显减轻；机械通气患者4例，2例痰栓致肺不张，其中1例左肺不张纤支镜吸引冲洗后复张2例诊断气管插管球囊滑脱／破裂，指导换管成功。困难气管插管患者均因常规方法失败后经纤支镜引导插管成功。结论 支气管镜是对急危重症病人进行气道管理的极有价值的工具，即可用于协助气管插管，又可胜任气道的清理作用及诊治大咯血，难治性肺部感染及急性肺不张等。     

干部门诊就诊质量的影响因素与对策

对900例干部门诊中的就诊患者进行问卷调查分析,探讨干部门诊就诊质量的各种影响因素,提出干预措施,在提高患者就诊质量的前提下节省卫生资源.     

"托管制"条件下医疗服务质量监控的实践

无锡市卫生局在"托管制"条件下,转变政府职能,加强医疗服务质量监控,在依法管理的基础上,严把"导、评、赛、奖"四个控制环节.     

What methods do stakeholders prefer for feeding back performance data: a qualitative study in palliative care.

OBJECTIVE: To investigate the opinions of stakeholders (service commissioners and providers) on how performance data should be presented, in order to develop effective feedback methods to facilitate the use of these data in decision making. DESIGN: A qualitative analysis of semi-structured face-to-face and telephone interviews. League tables and fictional box plots were presented as an illustrative guide. The themes covered in the interviews were the effectiveness of these two feedback formats, their positive and negative characteristics, and ideas for new and improved feedback mechanisms. PARTICIPANTS: Thirty-six stakeholders representing a range of clinical and non-clinical roles within palliative care and the wider health care system across a variety of statutory and non-statutory organizations from London and the West Midlands. RESULTS: Box plots were received more positively than league tables, and qualitative information was considered more appropriate than pictorial feedback. Conventional methods such as league tables and box plots were judged to lack essential information on which important decisions could be based, such as additional contextual information and the methodological assumptions of the instrument. Both feedback methods were considered useful as an impetus to further discussion. There was a consensus that feedback should be constructive and able to be adapted to the organizational realities in which UK health services function. CONCLUSION: Qualitative research was viewed as the right evidence for gaining an understanding of the quality of end of life care. Stakeholders highlighted the importance of the lay perspective, which requires approaches that illuminate the subjective meanings of patient experience.     

新生儿红臀的病原学监测及治疗护理对策

目的探讨新生儿红臀继发感染的主要病原和合适的临床治疗护理方法,评价红臀患儿局部使用抗菌药物的价值.方法对2002年1月～2004年12月收治的132例新生儿的红臀进行病原学监测,并分为观察组和对照组,观察组在传统护理基础上加用含制霉菌素和氯霉素的激素软膏局部使用.比较2组红臀愈合时间.结果132例红臀患儿中,共获取细菌137株,真菌19株;122例(92.4%)存在合并感染的病原学证据;肺炎克雷伯氏菌和大肠杆菌是主要病原,分别占47.4%和19.2%;86例在传统护理基础上经应用含制霉菌素和氯霉素的激素软膏,愈合时间为(4.5±1.8)d,较传护理愈合时间(6.2±3.5)d明显缩短(t=3.083,p＜0.01).结论新生儿红臀常继发各种细菌和真菌感染,局部使用抗菌药物和合理适当的护理可加快红臀的愈合.     

实施责任护士竞聘制的做法与成效

目的 :营造良性竞争的机制和氛围 ,全面提高护理质量。方法 :通过资格认定、理论技术考试、民主测评及双项选择 ,由护理部聘任。结果 :较好地进行了人力资源的开发 ,竞聘上岗后的护士有责任感和使命感 ,工作积极主动 ,自觉地成为科室各项工作的带头人。加之岗位工资的兑现 ,更有利于护士长在科室开展工作 ,使科室各项护理工作质量显著提高。结论 :良性的竞争运行机制 ,使优秀护理人才脱颖而出 ,体现能级对应的原则 ,从而使护理质量不断提高。     

The Effect of Cuts in Medicare Reimbursement on Hospital Mortality

Objective. To determine if patients treated at hospitals under different levels of financial strain from the Balanced Budget Act (BBA) of 1997 had differential changes in 30-day mortality, and whether vulnerable patient populations such as the uninsured were disproportionately affected.
Data Source. Hospital discharge data from all general acute care hospitals in Pennsylvania from 1997 to 2001.
Study Design. A multivariate regression analysis was performed retrospectively on 30-day mortality rates, using hospital discharge data, hospital financial data, and death certificate information from Pennsylvania.
Data Collection. We used 370,017 hospital episodes with one of four conditions identified by the Agency for Healthcare Research and Quality as inpatient quality indicators were extracted.
Principal Findings. The average magnitude of Medicare payment reduction on overall net revenues was estimated at 1.8 percent for hospitals with low BBA impact and 3.6 percent for hospitals with a high impact in 1998, worsening to 2 and 4.8 percent, respectively, by 2001. Operating margins decreased significantly over the time period for all hospitals ( p <.05). While unadjusted mortality rates demonstrated a disproportionate rise in mortality for patients from high impact hospitals from 1997 to 2000, adjusted analyses show no consistent, significant difference in the rate of change in mortality between high-impact and low-impact hospitals ( p =.04–.94). Similarly, uninsured patients did not experience greater increases in mortality in high-impact hospitals relative to low-impact hospitals.
Conclusions. An analysis of hospitalizations in the Commonwealth of Pennsylvania did not find an adverse impact of increased financial strain from the BBA on patient mortality either among all patients or among the uninsured.     

SCL-25 and recognition of mental disorders reported by primary health care physicians

A marked proportion of primary care patients have mental disorders and problems that remain unrecognized by the patients and their general practitioners. There is furthermore a great variation in the physicians’ ability to detect mental disorders. The aim of the present study was to find out the overall prevalence of mental disorders among patients receiving primary health care. The material consisted of 1000 randomly selected adult patients attending primary care facilities in Turku. The mental disorders were assessed by using the Symptom Checklist (SCL-25) and by general practitioners. According to the SCL-25, one fourth of the sample had a mental disorder. Only two fifths of them could be identified by the general practitioners.     

Paediatric admissions to a district general hospital intensive care unit

The characteristics of all the paediatric admissions made to a district general hospital over a three-year period were analysed in this study. Paediatric admissions averaged 23 per year (10% of the total admissions to the unit over that time). The mean age was six years, median age was four years. Sixty-two per cent were medical admissions and 38% surgical. Forty-seven per cent of the surgical admissions involved head injuries. Seventy-four per cent of medical admissions were directly related to upper and lower airway problems. Mean total admission time was six days, with a median of two days. Fifty-nine per cent (40) of all cases required intubation for a mean period of five days (median = three days). All cases were PRISM scored (Pollack, Ruttimann & Getson 1988). The mean score was 8. Ninety-four percent of admissions surviving to go home. There were a total of four deaths over the three-year period. The PRISM scores of those who died had a mean of 30, which was significantly different (P < 0.05) from the survivors who had a mean PRISM score of six and a median of four. The organs of one of the nonsurvivors were transplanted. Currently there is considerable interest in the feasibility of transferring all paediatric intensive care patients to a regional centre, the consequences of such a policy must be carefully assessed if its implementation is to be a success.     

Economic perspectives on diagnosis and treatment planning in periodontology

Abstract Economic factors in diagnosis and treatment planning in periodontology may be considered from several points of view. A first perspective is that of government responsibility. Because of the explosion in health care expenditure in the last decade, public funding of dental care programmes may become static or even reduced. Most governments try to curb the ever growing public health expenditure. Consequently, terms like effectiveness, efficiency and accountability are now becoming common words also in relation to periodontal health care. Moreover, private insurance companies, which have entered this area, may be individual patient who, explicitly or implicitly, would like to consider the services individual patient, who explicitly or implicitly, would like to consider the sendees rendered in periodontal therapy and prevention as cost-effective. Features of supply of and demand for care on an individual basis should also be considered. Finally, the periodontist or general practitioner has to consider economic factors. In professional life, there should be a balance between good working conditions providing satisfactory care, and the demands and priorities of individual patients and the community at large.