The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population

A survey was carried out using the Canterbury Alcohol Screening Test (CAST) and clinical criteria for risk of alcohol withdrawal of 2000 randomly selected hospital in-patients in order to determine the prevalence of alcohol-related problems, the work-load for a specialist alcohol withdrawal service and the target group for early intervention. Patients at risk of alcohol withdrawal were followed prospectively.

The major findings were: 14.3% of patients had a positive CAST and 8% were at risk of alcohol withdrawal; the prevalence of positive clinical criteria was greatest in men under the age of 30 years (OR 3.6) and very low (OR 0.34) in women over 60 years. In addition, patients who were too sick or refused to complete the questionnaire had high rates of being at risk for alcohol withdrawal. The prevalence of CAST positivity was greatest in men under the age of 40 years (OR 3.7) and lowest in women over 70 years (OR 0.2).

It is concluded that 15-20% of in-patients have alcohol problems and 8% are at risk of withdrawal; questionnaires will produce underestimates of the order of 25%; and female in-patients over the age of 60 years are extremely unlikely to have problems with alcohol.     

河南省乡镇卫生院人力资源配置研究

该文在对河南省卫生院人力资源现状调查研究的基础上,分析了乡镇卫生院人力资源配置中存在的主要问题及成困,并从理论与实际相结合的角度,提出了实现卫生院人力资源合理配置的可行性对策。     

Data sources, bed supply and performance in hospital systems: An Anglo-Czechoslovak comparison

Background: There were a number of similarities, except fortheir effectiveness, in the health care systems of Czechoslovakiaand England and Wales between the Second World War and the late1980s. In a comparison of Czechoslovakia with England and Wales,the objectives of this study were to examine data sources andto report time trends and regional distributions in hospitalbed supply, hospital doctor supply and hospital utilisation.Methods: For the specialties of general medicine and generalsurgery in both countries from 1960 to 1986, data were collatedon bed supply, hospital doctor supply, discharge rates and lengthof stay. Issues concerning the comparability of the data wereaddressed, for example those of the definitions of specialty,length of stay and casemix. Results: In the period 1960 to 1986,in the specialties of general medicine and general surgery,there was a relative excess in the supply of hospital doctorsand beds in Czechoslovakia compared with England and Wales.Hospital performance in terms of discharge rates, dischargesper bed and length of stay remained relatively static in Czechoslovakiaduring this period compared to marked increases in dischargerates and reduced length of stay in England and Wales. Bothcountries recorded reductions in the regional variation of bedand doctor supply and hospital utilisation. Conclusions: Internationalstudies of hospital utilisation need to be interpreted carefullyin the light of definitions of hospital stay, casemix, the useof day cases and the availability of other services. Subjectto these caveats, discharge rates were high and duration ofstay long In Czechoslovakia compared with England and Wales;however, both countries achieved important improvements in regionalequity.     

河南省胸科医院院内感染调查分析

目的： 了解胸科医院院内感染疾病发生情况,加强院内感染的控制。方法： 按照国家卫生部制定的《院内感染监测管理规范》实施,对１９９５ ～１９９７ 年院内感染监测资料进行了统计分析。结果： 本院严格按照《院内感染监测管理规范》要求实施后,院内感染率明显降低（２６ ％ ） 。院内感染疾病以上、下呼吸道感染为主（８９ ％ ） ;结核和呼吸内科前两位为上呼吸道和下呼吸道院内感染,分别为７０ ％ ～７０４ ％ 和２０ ％ ～２２４ ％ ;外科为上呼吸道和外科手术切口感染,分别为５０ ％ 和３２４ ％ ;感染细菌菌株中Ｇ－ 菌占９４９ ％ ,主要菌株为绿脓杆菌（３０９ ％ ） 、肺炎克雷白氏菌（１２５ ％ ） ,真菌感染菌珠主要为白色念珠菌（４５７ ％ ） 、热带念珠菌（１７５ ％ ） ,混合两种以上菌株感染占２０５ ％ 。结论： 胸科医院应加强呼吸道院内感染的控制,即加强空气消毒工作,外科同时应重视手术切口感染的控制工作,使院内感染率降到最低水平。同时院内感染以抗Ｇ－ 菌治疗的同时及时根据药敏结果选用敏感药物治疗,达到最好治疗效果     

性病防治所和综合医院皮肤性病科性病患者求医行为研究

目的　比较性病患者选择性病防治所和综合医院皮肤性病科求医行为差别,探讨患者采取不同求医行为因素和丰富求医行为研究内容。方法　按事先拟定的结构式问卷,在知情同意前提下,对北京３９０例性防所性病患者、５５例综合医院性病患者进行个人访谈。结果　性病知识得分越高、首诊知道设有性病防治所者,倾向于选择性防所,就近就医倾向于选择综合医院皮肤性病科。结论　性病防治所、综合医院皮肤性病科在性病高危人群及一般人群中的知晓度是影响患者就诊不可忽视的因素,性病防治所由于它们在治疗和控制性病中的特殊地位,是确定卫生资源的重要条件之一。     

Medical students in ENT outpatient clinics: appointment times, patient satisfaction and student satisfaction

OBJECTIVES: Outpatient clinics are increasingly important in medical education. The effect of students on clinic times and patient satisfaction, as well as their own satisfaction, were studied. DESIGN: A prospective, non-randomized, controlled study using adult patient questionnaires, medical student questionnaires and clinic time sheets. SETTING: Two teaching hospital ENT clinics. SUBJECTS: Medical students and adult patients. RESULTS: Three hundred and twenty-five patient questionnaires were collected (77% response), including 135 student encounters. Students did not affect appointment durations (19 min +/- 0.48 (standard error)) except at centre B (35 min +/- 1.1, P < 0.0001) where patient numbers were cut for teaching. Patient satisfaction, generally high, was not affected by students, appointment duration or gender of doctor or patient. It was slightly higher in the lower social classes (rs = 0.20, P = 0. 003) and older patients (rs = 0.17, P = 0.002). Student acceptability scores were not affected by student numbers (up to four), social class or time spent alone with students. They were higher if time was spent alone with the doctor (75.3% +/- 4.9) than not (63.0% +/- 1.8, P = 0.024). Thirty-six per cent of patients preferred to have a student present; only 9% preferred not. Student satisfaction was higher at centre B (73.7% +/- 2.3) where appointments were longer and students spent more time alone with patients than centre A (64.3% +/- 2.3, P = 0.0052). CONCLUSIONS: Clinic appointments are not necessarily longer in the presence of students. When students have the chance to see patients alone during longer consultations, student satisfaction is higher. Patient satisfaction, generally high, is not altered by the presence of students, but patients given time alone with their doctor are more accepting of students. These findings have resource implications for the planning of NHS clinics in teaching hospitals.     

适应新形势 加快我市妇幼保健院的改革与发展

对市妇幼保健院的现状及存在的问题进行了分析。提出了在社会主义市场经济体制下,妇幼保健院要以改革为动力,更新观念,建立适应妇幼保健事业发展的管理机制;加强成本管理,降低医疗成本;依靠科技进步,建设具有特色的妇幼保健院;改善服务,树立良好的妇幼群体形象;以队伍为保证,启动人才工程的妇幼保健院建设与发展的思路。     

国内关于缩短平均住院日的影响因素及对策研究

平均住院日是衡量医院医疗质量与管理水平的综合指标。医院合理提速运行的基础是控制平均住院日的影响因素,这些因素可分为可控因素和不可控因素。相应可通过宏观协调转化不可控因素,引入的新的管理思想,制定适宜的平均住院日标准,配以微观措施以降低医院的平均住院日。     

试论提高乡镇医院效益

通常乡镇医院的经济效益是由病人的经济支付能力,医院提供卫生服务的可及性和医生的作用三方面因素决定的。对此从理论和实践方面进行了探讨,得出”减轻病人负担,上门为群众提供多功能医疗服务,优势的医疗服务是提高乡镇医院效益的有效途径。     

从部分贫困县住院分娩资料分析看农村地区围产保健对策

利用１９９６年在四川省和陕西省４个卫－Ⅵ项目县县乡两级医院,采用前瞻性研究方法收集的住院分娩资料,着重分析了产科床位使用率、产科接生工作负荷、产妇住院天数、剖腹产比例。结果显示：产科床位使用率不高,绝大多数医院都有５０％以上的产科床位日没有利用;接生工作负荷亦不高,各医院从事接生人员的１周平均接生数在０．５￣２．６之间;在一些乡卫生院产妇住院时间短,５０％以上的产妇住院不满１天;陕西的两县剖腹产比