Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals

OBJECTIVE: To examine the seroprevalence of undiagnosed HIV and variation by season among patients admitted to the general internal medicine (GIM) and trauma services of two urban hospitals. DESIGN: A cross-sectional blinded HIV-1 seroprevalence survey. SETTING: A 725-bed academic medical center's hospital and an affiliated 324-bed tertiary care hospital. PARTICIPANTS: Residual serological specimens were obtained for unique patients aged 17 to 65 to study services in summer (June 16 to September 4, 2001) and fall to winter (November 1, 2001 to January 8, 2002). METHODS: Hospital files provided data on demographics, service type, and discharge clinical categories (fall-winter group only). HIV ELISA (enzyme-linked immunosorbent assay) tests with confirmatory Western blot were linked to subjects' de-identified files. We excluded 34 subjects with known HIV. Of the remaining unique admissions in summer (n=604) and fall-winter (n=978), 60% and 55% were tested, respectively. Predictors of undiagnosed HIV infection were examined using multivariate analysis. RESULTS: The summer cohort (n=362) had significantly lower unadjusted seroprevalence of undiagnosed HIV infection (1.4%; 95% confidence interval [CI], 0.4% to 3.2%) than the fall-winter cohort (n=539; 3.7%; 95% CI, 2.3% to 5.7%; P=.04). Overall, undiagnosed HIV was somewhat less likely in women (adjusted odds ratio [AOR], 0.45; 95% CI, 0.19 to 1.07) but more likely in black patients (AOR, 3.46; 95% CI, 0.70 to 17.06). In the fall-winter cohort, undiagnosed HIV was more likely for discharges with the following clinical categories versus those with a cardiac condition: dermatologic/breast (AOR, 14.90; 95% CI, 1.20 to 184.77), renal/urological (AOR, 22.43; 95% CI, 2.12 to 236.75), or infectious (AOR, 31.08; 95% CI, 2.40 to 402.98). CONCLUSIONS: The higher seroprevalence of undiagnosed HIV in the fall-winter admissions to GIM and trauma services supports especially targeting HIV testing in these months.     

Narrative review of inpatient nutritional management of anorexia nervosa with management recommendations for Australian tertiary health services

Background

Patients with anorexia nervosa (AN) may experience life-threatening malnutrition-related complications requiring inpatient medical stabilisation. Several management guidelines have been developed but discrepancies exist because of limited high-level evidence.

Aims

To review the evidence base for recommendations contained in Victorian health services guidelines for the nutritional management of inpatients with AN.

Methods

MEDLINE and Embase databases were searched for published studies on the nutritional management of inpatients with AN, combined with a manual search through citations. Studies including patients with AN aged 16 years and older were included. Case reports, small case series of <10 patients, studies of nonmedical management and studies with an exclusive paediatric population were excluded. The search results were compared with AN inpatient medical management guidelines sourced from large tertiary health services across Victoria, Australia.

Results

The search yielded 584 studies, subsequently reduced to nine studies using the inclusion and exclusion criteria. The results suggest that commencing refeeding at a higher caloric value allows faster weight gain and shorter hospitalisation. Enteral tube feeding is preferential to parenteral nutrition because of infrequent and milder complications. Zinc supplementation showed a doubled rate of body mass index increase compared with placebo. Comparison with Victorian health services guidelines revealed inconsistent recommendations for high-calorie refeeding and micronutrient supplementation.

Conclusion

The evidence supports high-calorie refeeding of 2000 kcal/day in AN inpatient medical management and zinc supplementation in improving the rate of weight restoration. This is inconsistently reflected in different Victorian health services guidelines. Updated national consensus guidelines could assist in improving consistency of evidence-based health care.     

某院住院病人抗微生物药物应用分析

【目的】了解本院住院病人抗微生物药物应用情况,分析用药的合理性,为临床合理用药提供参考。【方法】从本院药品管理系统提取2008年度住院病人用药信息数据,应用限定日剂量法分析抗微生物药物的使用情况,采用Excel进行统计分析。【结果】本院住院病人抗微生物药物的应用中,注射剂品种占到近50％;医保药品品种占到87．91％;最常用的抗微生物药物分别是头孢菌素类、大环内酯类、青霉素类、喹诺酮类。【结论】本院住院病人抗微生物药物用药结构相对合理,并逐步规范化,但仍存在问题,应进一步规范抗菌药物的应用,使用药更加安全、有效、经济。     

对住院老年高血压患者实施健康教育路径的效果观察

目的 探讨健康教育路径在住院老年高血压患者中的实施效果.方法 随机将200例住院老年高血压患者分为观察组和对照组各100例,对照组采用一般常规宣教,对观察组患者根据健康教育路径图实施健康教育.并对两组患者进行书面测试、自我护理操作考核、服药依从性、血压的控制等方面的比较.结果 观察组患者书面测试、自我护理操作考核及护理满意度得分明显高于对照组,差异有显著性(P<0.001);观察组患者服药依从性、血压的控制率及健康教育达标率明显高于对照组,差异有显著性(P<0.005).结论 实施健康教育路径能够提高患者对高血压健康教育知识及服药依从性,从而使患者的血压得到有效的控制,减少患者的并发症,同时促进了护患沟通,提高了患者及家属对护理工作的满意度,获得良好的护理效果.     

不同性别老年住院患者的口腔健康状况

目的了解不同性别的老年住院患者口腔健康状况的差异。方法 2015年1月,采用便利抽样法选取重庆某三级甲等医院的住院患者1073例,采用汉化版简明口腔健康筛查表(Kayser-Jones brief oral health status examination,BOHSE)进行口腔健康调查。结果老年男性住院患者的BOHSE得分为8(6,9)分,女性患者为7(6,9)分,两者差异有统计学意义(P0.01);其中在舌、颊、口底及上腭粘膜、口腔卫生状况等方面老年男性与女性患者间的差异有统计学意义(P0.01或P0.05)。结论老年男性住院患者口腔健康状况较老年女性住院患者差,具体体现在舌、颊、口底及上腭黏膜和口腔卫生状况等方面,可为临床护理工作提供参考。     

住院患者关怀体验的质性研究

目的了解患者在住院期间对护理人员提供关怀服务的体验,帮助护理管理者更好地认识患者的需要和护理服务的效果,为提高护理服务质量提供依据。方法 2011年12月至2012年5月,采用目的抽样法选取某三级甲等医院内科、外科、妇产科、肿瘤科的住院患者24例,运用现象学研究方法对其进行观察和深度访谈,将记录的资料按Colaizzi步骤进行分析。结果对访谈结果进行分析,提炼出的5个主题为:护患人文关怀认知不足、护士服务态度良好、护理关怀服务质量参差不齐、护士对患者心理支持不足、服务硬环境有欠缺。结论护理管理者应加强培养护士的人文关怀意识,提高护士的关怀能力,同时重视对护士的人文关怀,从而使护士更好地为患者提供关怀性服务。     

家长焦虑水平对择期手术患儿合作程度的影响

目的探讨家长焦虑水平对择期手术患儿合作程度的影响。方法采用焦虑自评量表（SAS）对64名患儿家长焦虑水平进行测评;采用合作量表测量64例患儿手术合作程度。并分析家长SAS评分与患儿合作程度的相关性。结果患儿家长焦虑水平与常模比较,t=8.62,P〈0.01,差异有统计学意义。患儿手术合作程度：完全合作6例（9.4%）,轻度抵触35例（54.7%）,极度抵触和逃避23例（35.9%）。患儿家长焦虑水平与患儿合作程度成正相关（r=0.75,P〈0.01）。结论择期手术患儿家长在患儿术前存在明显焦虑情绪,并直接影响患儿对手术的合作程度,需采取针对性护理干预减轻其焦虑情绪,提高患儿手术的适应性。     

家庭化管理模式对慢性精神分裂症患者的疗效观察

目的：探讨家庭化管理模式对住院慢性精神病患者的康复疗效。方法：2组患者均按常规使用精神科药物治疗。家庭组给予家庭化生活模式训练,对照组只开展日常康复训练,采用传统封闭式管理方式。治疗前及治疗后第3、6、12月末分别采用阳性和阴性症状量表（PANSS）、生活技能训练评估表（SST）、日常生活能力量表（ADL）进行评定。结果：治疗3个月后,家庭组PANSS评分中阴性症状、精神病理症状和总分及ADL各项评分和总分均较治疗前及对照组明显下降（均P〈0．05）,且治疗6及12个月时呈持续下降趋势（均P〈0．01）;家庭组PANSS评分中阳性症状评分及对照组PANSS各项评分及总分治疗后各时间点与治疗前比较差异均无统计学意义。治疗3个月后,家庭组SST评分均较治疗前及对照组治疗后明显提高（均P〈0．05）,且治疗6及12个月时呈持续上升趋势（均P〈0．01）;对照组治疗后各时间点与治疗前比较差异无统计学意义。结论：家庭化管理模式能有效改善慢性精神分裂症患者社会功能,提高自我管理能力,减轻衰退症状。