The Impact of Hospital Quality on Profits,Volume, and Length of Stay

Using 2006–2007 data from a sample of 6,082 U.S. hospitals, quality of care measures developed by the Hospital Quality Alliance (HQA) are applied to heart attack, heart failure, pneumonia, and surgery. Quality of care for these was related to both higher profits per case and increased number of cases. Length of stay was inversely related to quality of care for preventative (surgical and heart attack) care.     

Transient loss of consciousness with and without injuries

Objectives: Transient loss of consciousness (LOC) is a fairly common phenomenon and frequently carries a risk of injury. The aim was to study the occurrence of injuries and causes of emergency referrals versus later specialist consultation in association with LOC in the primary healthcare setting.

Methods: A four-month survey was carried out in the Primary Healthcare Emergency Department of the City of Tampere, Finland (198,000 inhabitants). The subjects comprised consecutive patients aged at least 15 years, attending a primary healthcare emergency department because of LOC. The type of LOC was determined (seizure, syncope and uncertain) and the type and site of all injuries associated with LOC were registered. All referrals to hospital or specialist consultation because of LOC were also registered and the predictors of admission were analysed by logistic regression modelling.

Results: Injury was associated with 43 (20%) out of 220 visits because of LOC; in 12/72 (17%) cases with syncope, in 24/118 (20%) with seizures and in 7/30 (23%) with an uncertain cause of LOC. Most of the injuries were minor. Emergency referral was required in 45/220 (20%) cases of LOC. Coronary heart disease and injury were the main predictors of emergency referral to hospital.

Conclusions: Injuries are as frequent in patients with syncope as in those suffering seizures. Most patients with LOC in primary healthcare emergency departments do not seem to require emergency admission to hospital.     

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

Background: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established.

Objective: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF.

Methods: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed.

Results: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001–1.04), and (OR: 1.09, 95% CI: 1.03–1.15), respectively.

Conclusion: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode.     

加快转型转变 推动全面发展 为能打胜仗提供强有力的卫勤保障

本文回顾总结军区医院疗养院十年来的建设成绩和问题,分析建设发展形势,提出到2020年医院建设目标任务,探讨加快军区医院疗养院建设发展的对策措施。     

Impotence: Etiology and Management

There has never been a more favorable outlook for the patient with impotence. In the current climate of growing interest and candor regarding human sexuality, patients Eire more inclined to seek help, and physicians and other therapists are better informed. Improved understanding of pathophysiology and psychosexuality has enhanced the effectiveness of new approaches to treatment.     

Development of Acute Pain Service in an Indian Cancer Hospital

ABSTRACT

Postoperative pain relief continues to be a major challenge for all health care professionals caring for such patients in India. Acute pain services are almost nonexistent, even in large private and university hospitals. As per our estimate not more than 10 such services are available. Tata Memorial Hospital is a tertiary care cancer center that started one of the first Acute Pain Services (APS) in India in 2002 to provide safe and effective postoperative pain management. APS guidelines and protocols have since been implemented and patients are monitored by a team of a consultant physician, a nurse, and a medical resident. Audits are done at regular intervals to evaluate the efficacy of service and patient satisfaction. Pain scores declined yet the patient satisfaction has not improved. Postoperative outcome studies are yet to be undertaken. The development and current activities of the APS that can be implemented in a country that does not have sophisticated acute pain management teams are described.     

规范化培训对基础医院脓毒症集束化治疗依从性的影响

目的：探讨规范化培训对基层医院脓毒症集束化治疗依从性的影响。方法采用定点理论培训和对口支援的方法对郴州市7个县级医院重症医学科医护人员进行培训。回顾性调查培训前所有脓毒症患者388例和前瞻性收集培训后423例的一般资料,分析医护人员对脓毒症集束化治疗的依从性。结果培训前调查结果显示,2h内放置深静脉依从性最好,双上肢同时留取病原菌标本和液体复苏6h内EGDT达标依从性最差,其余依次为1h内完成乳酸测定、12h内乳酸下降、晶体液复苏为主、3h使用抗生素、3h内留取病原菌标本、使用抗生素之前留取病原菌标本、使用碳青霉烯类抗生素。培训后调查结果显示,1h内完成乳酸测定依从性最好,双上肢同时留取病原菌标本,依从性最差,其余依次为2h内放置深静脉、3h内留取病原菌标本、3 h使用抗生素、12 h内乳酸下降或原乳酸≤2 mmol/L、在使用抗生素前留取病原菌标本、使用碳青霉烯类抗生素、液体复苏6 h内EGDT达标。培训前后比较,1h内完成乳酸测定、2h内放置深静脉、12h内乳酸下降、双上肢同时留取病原菌标本等方面差异无统计学意义,3h使用抗生素、使用碳青霉烯类抗生素、3 h内留取病原菌标本、使用抗生素之前留取病原菌标本、液体复苏6 h内EGDT达标、晶体液复苏为主等方面培训前后比较均有显著提高（P<0.05）。结论规范化培训能有效提高基层医院医护人员对脓毒症集束化治疗的依从性。     

一家新建公管私立医院护理人员对技术操作的认识调查

目的 对一家新建公管私立医院护理人员进行50项技术操作认识情况的调查. 方法 采用自行设计的问卷,对143 名护士进行操作认识调查. 结果 护士对50项护理技术操作在常用性、重要性、熟练度(自评)三方面认识的比较;急救操作各项在常用性、重要性、熟练度(自评)三方面认识的比较,均有统计学意义( P＜0. 05 ). 结论 新建公管私立医院护理人员对50项技术操作认识存在的薄弱环节,需要进行强化和改进.     

运用精益生产管理理念稳定发展护理队伍初探

分析目前国内护理队伍组织管理方面存在的不足,总结目前医院日常管理存在的关键问题,提出了运用精益生产管理理念来实施"禀议制度"、"轮调制度"、"年功序列制"等7条具体措施以稳定发展护理队伍并取得了较好效果,提高了护士积极性和主动性,稳定了护理队伍发展。