结合新型冠状病毒肺炎疫情议“三山医院”的建设要领

新型冠状病毒肺炎疫情引起全球关注,病毒的高度传染性致使疫情迅速蔓延和大规模暴发。在应对突发的迅速蔓延的疫情过程中,快速建设一个安全性能高的应急传染病专科医院,对于患者治疗、医护人员防护和疫情的控制十分重要。笔者结合“三山医院”建设的经验和温州医科大学附属第一医院应急传染病治疗中心改造的实际经验,系统地对医院选址、医院规划和设计、暖通系统、给排水系统、医用气体要求及医疗废物处置进行阐述,并对关键环节进行探讨。     

Positive Distraction in Pediatric Healthcare Waiting Spaces: Sharing Play Not Germs through Inclusive,Hands-Free Interactive Media

ABSTRACT

Purpose: To investigate the value of shared opportunities for positive distraction in pediatric healthcare environments.

Methods: Self-selected activities of 271 young people (5–19 years) with diverse neurodevelopmental conditions were observed in an ambulatory pediatric rehabilitation clinic. Shared opportunities included hands-free media (nature video or interactive media) and an aquarium. Anxiety was self-reported on the State Trait Anxiety Scale upon arrival and after 10 minutes in the waiting space.

Results: Young people engaged more with shared opportunities for distraction (n = 170/271) than personal items brought from home (n = 119/271), p = 0.02. Personal electronic devices were used by 67 young people, but did not positively impact anxiety. Interactive media and the aquarium significantly reduced anxiety (p < 0.04) while the nature video appeared to increase anxiety (p = 0.036). Age influenced activity preference and anxiety. Shared, hands-free interactive media engaged individuals of diverse age and mobility.

Conclusion: Shared opportunities for positive distraction in healthcare facilities are valuable, particularly hands-free interactive media.     

Out‐of‐pocket costs for paediatric admissions in district hospitals in Kenya

Objective To describe out‐of‐pocket costs of inpatient care for children under 5 years of age in district hospitals in Kenya. Methods A total of 256 caretakers of admitted children were interviewed in 2‐week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to report care seeking behaviour and expenditure related to accessing inpatient care. Family socio‐economic status was assessed through reported expenditure in the previous month. Results Seventy eight percent of caretakers were required to pay user charges to access inpatient care for children. User charges (mean, US$ 8.1; 95% CI, 6.4–9.7) were 59% of total out‐of‐pocket costs, while transport costs (mean, US$ 4.9; 95% CI, 3.9–6.0) and medicine costs (mean, US$ 0.7; 95% CI, 0.5–1.0) were 36% and 5%, respectively. The mean total out‐of‐pocket cost per paediatric admission was US$ 14.1 (95% CI, 11.9–16.2). Out‐of‐pocket expenditures on health were catastrophic for 25.4% (95% CI, 18.4–33.3) of caretakers interviewed. Out‐of‐pocket expenditures were regressive, with a greater burden being experienced by households with lower socio‐economic status. Conclusion Despite a policy of user fee exemption for children under 5 years of age in Kenya, our findings show that high unofficial user fees are still charged in district hospitals. Financing mechanisms that will offer financial risk protection to children seeking care need to be developed to remove barriers to child survival.     

陕西省乡镇卫生院全科医生对抗生素使用的知识-态度-行为研究

目的：调查乡镇卫生院全科医生对抗生素的用药知识、态度和行为现状,为规范临床抗生素合理使用提供理论依据。方法：采用自行设计的"全科医生对抗生素合理使用的知识-态度-行为"问卷,于2016年3月到6月期间对陕西省乡镇卫生院全科医生进行问卷调查。问卷包括个人信息、知识、态度和行为4个部分。结果：共发放问卷250份,得到有效问卷234份,有效回收率93.6%。受访者对抗生素相关知识得分的中位数为6（6-7）,获得相关知识的主要途径是教材和培训,不同性别受访者对抗生素的认知水平存在统计学差异;受访者对抗生素用药的总体态度和行为得分分别为31.71±3.93和26.97±3.17;抗生素相关知识与态度、态度与行为的相关系数分别为0.139和0.146（p<0.05）。结论：全科医生对抗生素相关专业知识掌握不够牢固,存在滥用倾向,有超过1/3的全科医生会经常经验性地使用抗生素。建议政府继续加大对乡镇卫生院的卫生资源投入和配置;加强对社区医生,尤其是全科医生抗生素用药的岗位培训和继续教育。     

美国医院如何控制细菌对抗菌药物的耐药性?

“如何控制细菌对抗菌药物的耐药性”在关国医院内是一个热门话题,医生们基于临床经验所建立的一些临床治疗“指南”,其中之一是合理和正确指导使用抗菌药物。为此,对该“指南”中关国医院对抗菌药物的使用现状（主要以上呼吸道疾病为例）和成人合理使用抗菌药物的指导原则,以及合理和正确使用抗茵药物的处方指南作一介绍。     

Assessing Community-Based Injury Prevention Services in U.S. Children's Hospitals

ObjectiveNot-for-profit hospitals are required to meet federal reporting requirements detailing their community benefit activities, which support their tax-exempt status. Children''s hospitals have long provided community injury prevention (IP) programming and thus can inform public health outreach work in other areas. This work describes IP programming as a community service offered by children''s hospitals in the U.S.MethodsThe IP specialist at 232 US-based member institutions of the Children''s Hospital Association were invited to complete an assessment of their hospital''s IP outreach programming.Results47.7 percent of hospitals request financial data from IP programming for tax reporting purposes. Almost all offer injury prevention (IP) services; the majority are in the community (60.3%) and 34.5% are hospital-based. Most IP units are independent (60.3%) and 71.8% are responsible for their own budgets.ConclusionsBy integrating dissemination and implementation sciences and community health needs assessments, these findings can help advance community services provided by hospitals to impact public health.