灾难及突发事件住院信息管理系统研究现状及趋势

信息工作是决策的依据和先导,如何准确、及时、高效地收集、整理、分析灾难及突发事件信息、伤病员基本信息、救治信息等,已成为医院管理信息学的研究热点问题,也是医院在灾难和突发事件大量伤员信息管理中面临的难点问题。本文就灾难及突发事件住院信息管理系统研究现状及趋势进行综述。     

Surprise Realistic Mock Disasters—The Most Effective Means of Disaster Training

Realism introduced in several large scale surprise mock-disaster tests proved to be a real challenge to a disaster-conscious hospital staff that had previously undergone fairly extensive disaster training and testing, utilizing conventional methods.Serious weaknesses, flaws, omissions and deficiencies in disaster capability were dramatically and conclusively revealed by use of what appeared to be a “live” disaster setting with smoke, fire, explosions; adverse weather and light conditions; realistically-simulated “casualites” especially prepared not only to look but to act the part; selected harassment incidents from well-documented disasters, such as utility failures, automobile accident on the main access route, overload of telephone switchboard, and invasion of hospital and disaster site by distraught relatives and the morbidly curious.     

Prevalence of hepatitis B antibodies in hospital personnel.

Of 426 hospital staff tested for hepatitis B surface antibody (anti-HBS) by the radioimmunoassay method 57 (13.4%) had positive results. Laboratory staff had the highest prevalence, followed by nurses, and both values were significantly higher than that of administrative staff. Clerical staff working in laboratories were at the same risk for hepatitis B as general-duty nurses. Significantly more staff with anti-HBS had a history of hepatitis (19.3%) compared with staff without anti-HBS (79%), and significantly more staff with a history of hepatitis had anti-HBS (25.6%) compared with staff without such a history (12.0%). History of blood transfusions was not related to prevalence of anti-HBS. The risk for hepatitis B is greater in hospital staff who are in direct contact with patients or handle patients'' blood and other specimens. However, contact with patients is less important than contact with patients'' blood and other specimens.     

Ward meetings: a forum for patients' concerns.

A series of meetings between patients and staff were held on two general medical wards to discuss the concerns of patients. Issues ranged from the quality of hospital food, ward facilities, and visiting arrangements to the medical and nursing care provided and patients'' views on medical students. Most issues were raised by the patients themselves and the outcome was either acceptance or rejection of a suggestion, an explanation by the staff, or a general discussion if a specific decision was inappropriate. Most staff and patients considered the meetings to be valuable. Ward meetings thus seem to provide a way of making hospitals more responsive to patients'' concerns.     

The Great Plague of 1665 as a Study in Human Reactions to Disaster

Daniel Defoe''s “A Journal of The Plague Year” is reviewed in the light of disaster studies some three centuries later. Familiar disaster phenomena are described, as well as events that were different or perhaps unique. Leadership by civic authorities is noted. The conclusion is one that is familiar in this nuclear age, viz. survivors “should stand stock-still... and not shift”.     

区域综合生态风险评价框架——以雄安新区为例

构建区域生态风险评价框架有助于清晰地识别、评估、模拟、预测与管理区域生态风险,进而为区域生态安全网络构建和生态安全格局保障提供支撑。雄安新区的建设,使该区域面临巨大的土地利用变化,对区域生态系统的结构和功能产生不可忽视的影响,洪涝和干旱灾害对雄安新区及其周边区域生态系统具有显著的威胁。以雄安新区为例,构建包含暴露-响应关系、人为源和自然源相结合的区域综合生态风险评价框架,分别对城市化和气候变化背景下的雄安新区土地利用变化、洪涝灾害、干旱灾害三类胁迫引起的区域生态风险进行了评价和预测,确定其生态风险空间分布特征及变化趋势。结果表明：(1)从时间序列上来看,由于气候变化导致洪涝、干旱等自然灾害的影响,加上雄安新区的土地利用变化,雄安新区的生态风险在2025年后有所上升,但有序的规划和良好的地类配置使得雄安新区起步区在2025年后生态风险程度下降;(2)从空间上看,雄安新区风险高值区主要集中在白洋淀区以西和以南,以及新区东北部部分区域。最后,从土地利用管理、洪涝和干旱灾害预防等角度提出了生态风险防控对策：(1)雄安新区应坚持对土地利用的合理规划和严格管理,切实防止土地的无序利用,密切关注景观...     

Use of hospital beds: a cohort study of admissions to a provincial teaching hospital.

An instrument was developed to study the use of hospital beds and discharge arrangements of a cohort of 847 admissions to the John Radcliffe Hospital, Oxford, for a three week period during February-March 1986. For only 38% of bed days were patients considered to have medical, nursing, or life support reasons for requiring a provincial teaching hospital bed. The requirements for a bed in the hospital decreased with the patient''s age and length of stay in hospital. For only a tenth of patients was the general practitioner concerned in discussions with hospital staff about the patient''s discharge and less than one third of patients had been given more than 24 hours'' notice of discharge. Several features might increase the proportion of bed days that are occupied by patients with positive reasons for being in hospital. Among these are an increased frequency of ward rounds by consultants, or delegating discharge decisions by consultants to other staff; providing diagnostic related protocols for planning the length of stay in hospital; planned discharges; and providing liaison nurses to help with communication with primary care staff.     

The failure of DNA forensic testing: a case study of the 2009 Australian bushfire disaster

Different constructions of the fetus lie at the centre of reproductive, abortion and disability politics. Recent developments mean that, within the same hospital, a fetus may be perceived in contrasting and potentially conflicting ways. It is also argued that the status given to the fetus is directly relevant to the status given to pregnant women. During group discussions facilitated by an ethicist, health-care staff highlighted various perceptions of the fetus which included: person; patient; 'nobody'; commodity. Perhaps not surprisingly in view of the current legal situation, staff tended to claim that it is usually the pregnant woman who decides how her fetus will be constructed, and the practitioner who responds to this. However, various ways in which practitioners might influence women's perceptions of their fetus are highlighted, as are some ways in which the perceptions of staff might be influenced. This paper illustrates how sensitive health-care staff will need to be if they are indeed to respond to, rather than shape, women's constructions of their fetus.     

Challenges of maintaining research protocol fidelity in a clinical care setting: A qualitative study of the experiences and views of patients and staff participating in a randomized controlled trial

Background

Trial research has predominantly focused on patient and staff understandings of trial concepts and/or motivations for taking part, rather than why treatment recommendations may or may not be followed during trial delivery. This study sought to understand why there was limited attainment of the glycaemic target (HbA_1c ≤6.5%) among patients who participated in the Treating to Target in Type 2 Diabetes Trial (4-T). The objective was to inform interpretation of trial outcomes and provide recommendations for future trial delivery.

Methods

In-depth interviews were conducted with 45 patients and 21 health professionals recruited from 11 of 58 trial centres in the UK. Patients were broadly representative of those in the main trial in terms of treatment allocation, demographics and glycaemic control. Both physicians and research nurses were interviewed.

Results

Most patients were committed to taking insulin as recommended by 4-T staff. To avoid hypoglycaemia, patients occasionally altered or skipped insulin doses, normally in consultation with staff. Patients were usually unaware of the trial's glycaemic target. Positive staff feedback could lead patients to believe they had been 'successful' trial participants even when their HbA_1c exceeded 6.5%. While some staff felt that the 4-T automated insulin dose adjustment algorithm had increased their confidence to prescribe larger insulin doses than in routine clinical practice, all described situations where they had not followed its recommendations. Staff regarded the application of a 'one size fits all' glycaemic target during the trial as contradicting routine clinical practice where they would tailor treatments to individuals. Staff also expressed concerns that 'tight' glycaemic control might impose an unacceptably high risk of hypoglycaemia, thus compromising trust and safety, especially amongst older patients. To address these concerns, staff tended to adapt the trial protocol to align it with their clinical practices and experiences.

Conclusions

To understand trial findings, foster attainment of endpoints, and promote protocol fidelity, it may be necessary to look beyond individual patient characteristics and experiences. Specifically, the context of trial delivery, the impact of staff involvement, and the difficulties staff may encounter in balancing competing 'clinical' and 'research' roles and responsibilities may need to be considered and addressed.

     

REPORT FROM OTTAWA

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada''s 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada''s 6396 dentists could supply 30% reinforcement. The dentist''s training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.     

Web Information and Social Impacts of Disasters in China

Understanding disasters' social impacts is a key issue for efficient disaster management. This article proposes a framework to assess disasters' social impacts based on network information resources. The proposed approach is validated using statistical analysis. Key factors that change social impacts are also identified for useful decision-making.     

Long before Krever's report,blood scare had changed face of medicine

The disaster involving blood-borne pathogens and Canada''s blood system was in the spotlight in November with the release of the Krever inquiry report. Many physicians consider the report anticlimactic because action has already been taken on several fronts and the use of donated bloods has declined, but it will still have a far-reaching impact.     

Problems of care in a private nursing home.

To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged 62-90. During the second month a consultant physician visited the home weekly to hold case conferences and assess each patient''s functional ability and drug regimen. Various problems in medical, nursing, and bureaucratic matters were identified--for example, staff failed to understand the appropriate response to various medical symptoms; no clear policy existed for managing pressure sores; and one patient''s anticoagulant state could not be assessed when industrial action meant that transport to take him to hospital was not available--and several changes in drug treatments were recommended. The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes.     

Clinicians and the coronial system: ability of clinicians to recognise reportable deaths.

OBJECTIVE--To assess the ability of clinicians to recognise deaths which require referral to the coroner. DESIGN--Postal questionnaire consisting of 16 fictitious case histories, 14 of which contained a clear indication for referral to the coroner. SETTING--Large teaching hospital. Coroner''s office. SUBJECTS--200 clinicians from general medical and surgical firms and senior staff of the local coroner''s office (two coroner''s officers and the two deputy coroners). MAIN OUTCOME MEASURES--Number of correct assessments on questionnaire. RESULTS--The mean recognition score for the clinicians was 9.11 (range 3-14) with no difference between the clinical grades. All of the coroner''s senior staff recorded maximum recognition scores of 16. CONCLUSIONS--The study highlights several features of the coronial system which are poorly understood by clinicians and provides the basis for an initiative to improve the medicolegal education of all clinicians.     

Ready or Not: Evacuating an Animal Shelter During a Mock Emergency

ABSTRACT

The signing of the Pets Evacuation and Transportation Act into law will require states to include companion and service animals in their disaster response plans. Consequently, animal stakeholders across the United States are or will be involved in assessing their response capabilities as a part of developing or improving plans to evacuate and house animals. This paper reports on a mock disaster response exercise involving the evacuation of an urban animal shelter. A simulated emergency provided the opportunity to test the shelter's disaster evacuation capabilities and to illuminate issues that animal stakeholders should address when creating and refining emergency response plans. The participants successfully evacuated all animals from the building in good time, but the exercise highlighted two pitfalls. The first concerns the use of volunteers who have no training in disaster response but who nevertheless want to help. In situations involving animals, large numbers of well-meaning but untrained people will volunteer, and animal stakeholders should anticipate and manage their arrival. The second concerns the inevitable presence of the media and the need for a single point of contact for information about the incident.     

MEDICAL PREPAREDNESS FOR DISASTER

The Federal Civil Defense Administration has been consolidated under the President''s Reorganization Plan No. 1 of 1958 with the Office of Defense Mobilization. The new organization, the Office of Civil and Defense Mobilization, should be able to deal more efficiently with the problem of mobilization and management of all resources and production of the nation in time of disaster. As preparation for possible enemy attack, organized plans entailing training, supplies, equipment and communications for use in major peacetime disasters—floods, earthquakes, tornado damage—should be carried forward vigorously. Apathy must be overcome. From the local to the highest level all civil defense and disaster plans must be developed and kept flexible enough to be operable during any kind of emergency.Physicians must learn as much as they can about the mass care of casualties, how to survive under the most trying of circumstances. Drills in dealing with simulated disaster are of utmost importance for finding out ahead of time what must be done and the personnel and supplies needed for doing it.     

The impact of a new geriatric program in a hospital for the chronically ill.

Reports of the rapidly increasing proportion of persons aged 65 years and more in Canada and the resultant need for changes in the country''s health care system prompted experimental changes in the operation and training procedures at St. Mary''s of the Lake Hospital, Kingston, Ont. Aimed at better patient care and at better education of medical house staff in geriatrics and long-term care, the revised program is permeated with the philosophy of rehabilitation. It includes full-time staff, a geriatric outpatient clinic, a day hospital, a team approach to patient care (with regular team audits), problem-oriented medical records, a formal physical medicine section with a district inpatient unit, and an intensive inservice education program. After the first year of the program patient outcome had improved and more efficient use was being made of continuing care beds because of larger numbers of patinets being discharged home after shorter stays. This may be one avenue for deceleration of our country''s dismal rate of institutionalization.     

Informal complaints procedure in general practice: first year's experience.

OBJECTIVE--To evaluate the first year''s experience of an informal patient complaints system that encourages extensive patient participation. DESIGN--Audit of an informal complaints procedure. SETTING--The Marylebone Health Centre, London. SUBJECTS--39 complaints received over the audit period. MAIN OUTCOME MEASURES--Types of complaints (administrative, about doctors or medical care or both, staff about patients, mixed, other) and resolution of complaints (how complaints were dealt with and their resolution). RESULTS--37 of the 39 complaints were resolved within two weeks. Two complaints sent direct to the family health services authority were resolved (with patients'' agreement) by the informal complaints procedure. CONCLUSIONS--The informal complaints procedure was more cost effective than the family health services authority system and was comparatively straightforward to implement within the practice without major organisational restructuring. The two way process of the procedure ensured patients received a quick response to complaints and helped morale of health centre staff.     

Postoccupancy evaluation of staff,visitors, and three species of animals in a zoo setting

Postoccupancy evaluation (POE) was used to assess newly constructed zoo exhibits from the perspective of three user groups: zoo staff, zoo visitors, and the animals. Staff represents a generally understudied user group in zoo-based POEs. We asked staff to rate the animals' space, the visitors' space, and the staff's space at previous and new exhibits. We also compared zoo visitors' ratings of the animals' behavior and environments, overall exhibit impressions, and the time visitors spent viewing previous and new exhibits. Lastly, we compared activity and space use of a Komodo dragon (Varanus komodoensis), two red pandas (Ailurus fulgens), and one rhinoceros (Rhinoceros unicornis) in their previous and new exhibits. Staff rated animal, visitor, and staff areas higher at the new exhibits compared to the previous exhibits. Visitors also rated several factors higher and spent more time at the new exhibits. The most naturalistic exhibit received the most favorable ratings in all categories and animal activity increased visitor stay time. We found that red pandas were less active in their new exhibit, and the Komodo dragon and rhino showed no difference in activity. The red pandas and the Komodo dragon used more available space in their new exhibits; however, we recommend using Electivity index to examine resource preferences for these species, whose enclosure use has been less studied than large mammals. We emphasize the importance of including staff in zoo-based POE, make other recommendations for future POE studies, and discuss various factors that could have influenced our results.     

Dying in hospital: the residents' viewpoint

A survey of residents'' (junior house officers'') experiences and attitudes to the terminal care part of their work in four Glasgow teaching hospitals showed that even a month after starting work one-fifth of the respondents had not actively managed a dying patient. Sixty-four per cent thought that they had received inadequate teaching in terminal care. Depression and anxiety had been the most difficult symptoms encountered. The residents thought that the ward nursing staff contributed much more than their senior medical colleagues to both the medical and psychological aspects of terminal care. The results indicate a need for more undergraduate education in the most relevant areas, such as coping with the psychological problems of dying patients and their relatives. Newly qualified residents require more support from senior medical staff in looking after the terminally ill.