大理白族自治州青少年对艾滋病认知度调查分析

目的:调查大理白族自治州的青少年对艾滋病的认知程度,为预防和控制该地区艾滋病提供参考。方法:随机抽样方法选取大理白族自治州的1500名青少年作为调查对象,采取自行设计的艾滋病认知调查表进行对其艾滋病认知度的调查,包括艾滋病相关知识、相关行为和性行为等情况。结果:男性青少年对艾滋病的知晓率为61.5%,女性青少年对艾滋病的知晓率为61.1%,两性差异无统计学意义(P0.05)。认为艾滋病是传染性疾病占58.7%,害怕或者恐惧艾滋病占50.0%,愿意与艾滋病感染患者交往占46.7%,了解艾滋病的病原体占40.0%,知道艾滋病病毒入侵人体哪个系统占26.7%,知道世界艾滋病日占50.0%,愿意接受艾滋病病毒检测占60.0%。发生性行为占58.7%,性行为时采取保护措施中使用安全套占26.7%,口服避孕药占26.7%,阴道冲洗占6.6%。性行为安全套使用情况中每次使用占13.3%,经常使用占7.3%,偶尔使用占6.0%,不使用占73.3%。结论:大理白族自治州的青少年对艾滋病的认知程度普遍较低,并对艾滋病存在认识不足的情况,应采取针对性的控制措施和加强健康知识的教育。     

从金秀县医疗卫生调查窥见农村地区烧伤快速反应机制的现状与对策

目的:通过研究金秀瑶族自治县烧伤快速反应机制所存在的问题,提高我国农村地区整体烧伤防治水平.方法:采用问卷调查方式,由调查员统一发放填写,然后将调查表汇总统计并分析.结果:广西壮族自治区金秀瑶族自治县交通不便,消防知识认识不到位,医务人员缺乏烧伤的急救与后送知识;96.3%以上患者对医疗条件不满意;在对各级医师关于烧伤急救与后送的调查中,有83%的医师缺乏正确的急救与后送治疗经验,其中乡村医师高达100%,不及格者高达67%.结论:在广大农村地区完善烧伤监控体系,建立统一协调、分工明确的烧伤快速反应机制,保证快速反应,提高预警能力,建立包括救护、消防、伤员运送等各部门在内的处理紧急事故一体化机制和体系势在必行.     

三甲医院与基层医疗卫生机构的患者信任模式比较：基于访谈与调查实验法的混合研究

目的：基于访谈与调查实验法的混合研究设计,比较三甲医院与基层医疗卫生机构的患者信任模式差异。方法：对38名居民进行半结构式访谈,通过内容分析法进行分析;调查实验法部分设置“三甲医院”和“基层医疗卫生机构”两个实验组,回收有效问卷648份,通过方差分析进行差异性检验。结果：患者对三甲医院的体系信任高于基层医疗卫生机构,而对基层医疗卫生机构的人际信任则高于三甲医院。建议：应有针对性地增强患者对基层的体系信任水平,并进一步巩固和突显基层的人际信任优势。同时,也要采取针对性措施以重塑患者对三甲医院的人际信任。     

Drug shortages may compromise patient safety: Results of a survey of the reference pharmacies of the Drug Commission of German Pharmacists

Drug shortages are a complex problem and of growing concern. To evaluate implications of drug shortages in terms of outpatient and inpatient safety, the Drug Commission of German Pharmacists surveyed its two nationwide reference pharmacy networks: 865 community and 54 hospital pharmacies.Participants were asked to complete a six-question online survey, covering relevance and challenges of drug shortages in everyday practice as well as consequences for patient safety. Answers were given in the context of the last three months prior to the survey. In total, 482 community (55.7%) and 36 hospital pharmacies (66.7%) participated.Occurrence of drug shortages were confirmed by 88.6% of community and 80.6% of hospital pharmacies. Thus, for example, a substitute was dispensed more than 15 times (60.7% of community, 44.8% of hospital pharmacies) during the 3-month-period. Comparing community and hospital pharmacies, differences in the incidence or severity of consequences for patient safety were apparent. Community pharmacies mainly confirmed adverse effects on patients’ medication adherence (60.4%) and treatment discontinuation (25.8%). A delay or deny of a life-saving treatment (39.4%) was largely reported by hospital pharmacies. Medication errors were reported by 20.1% of the community and 21.2% of the hospital pharmacies, respectively.Taken together, sustainable solutions are needed to counteract drug shortages and to ensure adequate treatment for patients.     

Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy

ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.     

Primera encuesta nacional sobre el diagnóstico de la infección por Helicobacter pylori en los laboratorios de microbiología clínica en España

IntroductionThe aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data.MethodsThe survey requested information about the diagnostic methods performed for Hp detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October-December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain.ResultsOverall, 51 centers from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%).ConclusionCulture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to ‘first-line’ antibiotics.     

The use of gadolinium-based contrast agents in Ghana with a focus on residual intracranial gadolinium deposition

IntroductionThe aim of the survey was to identify current practice of the use of gadolinium-based contrast agents (GBCAs) in the wake of recent reports on gadolinium deposition in the brain following repeated administration of GBCAs.MethodA total of 13 facilities in Ghana with magnetic resonance imaging (MRI) departments were contacted via email with a two-page questionnaire.ResultsA response rate of 69.2% (n = 9) was achieved. Gadodiamide (Omniscan) was the most commonly used GBCA. Slightly more than half of respondents were aware of residual deposition of GBCAs in the brain. Majority of the respondents were aware of GBCA deposition in individuals with abnormal renal function, but not aware of its deposition in those with normal renal function. A great majority of the respondents do not record the type and dose of GBCA after each intravenous administration, and such information is not provided in MRI reports. More than half of the respondents do not check eGFR prior to the administration of GBCA even when a high-risk agent is used.ConclusionGadodiamide (Omniscan) a high-risk agent remains the most commonly used GBCA in Ghana. Awareness of current findings of GBCA deposition in the brain following repeated doses are not encouraging as revealed in this study. The need to adopt international standard guidelines into practice cannot be overemphasized in order to reduce the potential long-term effect of this deposition.     

门诊高血压病患者的认知行为调查和分析

目的 了解门诊高血压病患者的认知及自我管理水平.方法 自行设计调查表,包括高血压病相关知识10条目、自我管理行为7条目.对本院门诊高血压病患者500例进行问卷调查.结果 回收有效问卷474份,门诊高血压病患者对高血压病相关知识的知晓率为20.04％～89.03％,自我管理行为能做到的为16.24％～81.01％.结论 ...