Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced.Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients.MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment).ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway.ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services.Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.     

医疗器械灭菌包灭菌参数验证与研究

目的：研究医疗器械灭菌包的灭菌参数与验证。方法：将体积为30cm×40cm×60cm、质量为20kg的120个灭菌包用Belimed灭菌器进行灭菌参数验证。结果：120个灭菌包中的600支快速阅读生物指示剂，有155支阳性，445支阴性；细菌检测有53包阳性；1243指示卡失败9例；湿包52个。结论：灭菌参数为负压脉，中3次，正压脉冲5次，灭菌温度134℃，灭菌时间11min，干燥时间11min，达到《消毒技术规范》的灭菌要求。     

碘化钠（铊）晶体生产劳动卫生学调查

对含铊固体闪烁体生产现场的劳动卫生学调查表明,车间空气中铊浓度在0.01mg/m~3以下,绝大多数接触者的尿铊含量在正常水平,无明显阳性体症,说明在该条件下生产是安全的,0.01mg/m~3可作车间空气中无害水平上限。接触者的尿铊含量与接触空气铊水平呈正相关,尿铊含量可作为生物接触监测指标。     

运动性骨骼肌损伤评价指标——血清CK、LDH、Mb的比较

目的:探讨不同类型运动中更为适用的评价运动性骨骼肌损伤的敏感指标。方法:15名体育学院男生(年龄23.40±1.06岁,身高180.03±3.51cm,体重75.93±6.70kg)分别进行大强度离心运动及耐力运动,测试运动前后血清CK、LDH和Mb。结果:大强度离心运动后,各指标在运动后48~72小时达最高,耐力训练后则在6~24小时达峰值。血清Mb在离心运动及耐力运动后产生变化的时间均早于CK、LDH。结论:血清Mb是最敏感的指标,而血清CK则在测试简便性方面有优势,同时敏感性也较高,是评价运动性骨骼肌损伤最实用的指标。     

如何防止灭菌化学指示卡监测中的失误

压力蒸气灭菌化学指示卡监测是常规使用的灭菌效果监测措施之一，但有其限局性，如指示卡安放位置或监测方法不正确，会产生假性结果，导致判断失误。作者对此进行了试验研究，结果表明：只有在工艺、化学、生物三种监测结果均合格时，方能判定为无菌物品     

A case of primary multidrug-resistant pulmonary tuberculosis with high minimum inhibitory concentration value for bedaquiline

Bedaquiline is a new ATP synthesis inhibitor developed as an anti-tuberculosis agent. It has resistance-associated variants (RAV), regardless of preceding bedaquiline exposure. Herein, we describe the case of a patient with multidrug-resistant tuberculosis (MDR-TB) who had no history of bedaquiline therapy but presented a relatively high minimum inhibitory concentration (MIC) of bedaquiline (1 μg/mL). Whole genome sequencing revealed a mutation in the resistance-associated gene Rv0678. The patient was first treated with a five-drug regimen (bedaquiline, delamanid, levofloxacin, cycloserine, and amikacin), which induced negative sputum culture conversion. Despite the successful treatment outcome, several questions remain regarding the efficacy of bedaquiline in this patient. Bedaquiline is an indispensable drug for MDR-TB treatment, but its clinical efficiency in the presence of Rv0678 mutations remains unclear. Therefore, evaluating the MIC of bedaquiline even in patients without a history of bedaquiline use is important for therapeutic regimen selection and may emphasize the importance of therapeutic drug monitoring in cases of bedaquiline RAV.     

Hypoalbuminemia: Pathogenesis and Clinical Significance

Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half‐life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin “from the shelf” is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.     

青浦区三家二级医院抗菌药物临床应用情况评价指标的建立与实践

目的建立合适的抗菌药物(AMD)评价指标,快速、可靠地评价青浦区二级医院内AMD使用的主要问题。方法依据16项国际抗菌药物使用调研指标,以及联合用药调研指标,采用回顾性数据收集和分析方法对该地区三家二级医院的住院患者进行抽样调研。结果医院基本药物目录中有62种AMD,但缺乏成文的药物治疗指南性文件,住院处方中有≥应用1种AMD的住院患者数占住院患者总数的69.59%;处方平均2.49种AMD;每位患者的使用AMD平均费用是879.74元;AMD治疗患者非预防Ⅰ、Ⅱ类切口感染的平均天数是6.33d;77.39%手术患者接受AMD预防感染,平均次数为14.27次;26.08%的肺炎病例按照指导原则治疗;以通用名开AMD处方的百分率为89.91%;仅有17.38%的AMD治疗患者进行了病原体药敏试验。结论医院决策层及药事管理委员会对AMD监管力度仍嫌不足,处方者对AMD的规范性使用意识薄弱,药师仍需发挥更大的合理用药促进作用。