Suicide in General Hospitals

Of 14 medical and surgical patients who committed suicide in a general hospital, there were ten men and four women, ranging in age from 19 to 82. The patients had not made statements of suicidal intent; however, their hospital records showed there had been symptoms of depression and contained indirect references to a preoccupation with suicide. Most of the patients had been depressed because of their illnesses or distressing symptoms.It is important to keep in mind that there are clues that help anticipate suicide. Awareness by hospital staffs of symptoms and subtle signs of depression and of suicidal thoughts in patients is important in reducing the number of suicides in general hospitals. Of preventive and treatment measures, warmth, compassion and commitment to the care of patients by hospital staffs are most important.     

纤支镜导致呼吸机相关肺炎感染暴发的调查研究

目的调查分析疑似纤支镜清洗消毒不规范引起的医院感染暴发事件,为采取针对性控制措施提供依据。方法采用流行病学调查和病例对照研究的方法对医院感染病例进行分析,并提出综合干预措施。结果综合ICU使用呼吸机支持治疗患者,14天内发生的4例呼吸机相关肺炎患者均经纤支镜检查,4例患者痰标本中均培养出铜绿假单胞菌,纤支镜采样细菌培养出铜绿假单胞菌。结论使用不规范清洗消毒的纤支镜进行检查是引起综合ICU住院患者呼吸机相关肺炎感染的主要危险因素。重视医院感染控制,采取有效的消毒隔离措施,严格消毒灭菌技术操作,是预防和控制医院感染爆发的有效措施和途径。     

Fungal colonization in patients with cancer of the upper respiratory tract

Fungal opportunistic infections are a danger for immunocompromised hosts, such as patients with malignancies, especially in a hospital environment. We studied a group of patients with solid tumors of the respiratory tract on admission and after twenty days of hospitalization. Colonization by moulds and/or yeasts was frequently found.Preventive measures should be applied to avoid colonization inside the hospital. The importance of overcrowding, sanitation and diet is pointed out.     

感控干预在控制多重耐药定植菌医院感染的临床研究

目的研究多重耐药定植菌与医院感染的关系以及去定植措施的效果。方法对入住ICU的患者进行多重耐药定植菌筛查,观察阳性患者和阴性患者医院感染发生率;将阳性患者随机分为对照组和试验组,对照组采用常规的预防控制措施,试验组加上安尔碘Ⅲ去鼻腔MRSA、口服金双歧去肠道产ESBLs肠杆菌措施,观察两组患者医院感染发生率以及定植菌与医院感染的关系,对比两组去定植效果。结果ICU多重耐药菌定植率为31. 16% ;多重耐药定植菌筛查阴性患者医院感染率为7. 56%,阳性患者医院感染率为15.47% （P 〈0.01）;对照组医院感染率为20.79%,试验组医院感染率为22. 22% （P 〉0. 05）;对照组定植菌医院感染率为4. 95% ,试验组定植菌医院感染为0（ P 〈0.01）;对照组产ESBLs大肠埃希菌定植自行清除率为26. 31% ,试验组产ESBLs大肠埃希菌去定植率为80. 95% （P 〈 0. 01）。结论ICU患者多重耐药菌定植率高,多重耐药菌定植患者医院感染率高,口服金双歧去肠道产ESBLs细菌干预措施有效,安尔碘Ⅲ去鼻腔MRSA效果需继续研究。     

Application of control measures for infections caused by multi-resistant gram-negative bacteria in intensive care unit patients

Multi-resistant gram-negative rods are important pathogens in intensive care units (ICU), cause high rates of mortality, and need infection control measures to avoid spread to another patients. This study was undertaken prospectively with all of the patients hospitalized at ICU, Anesthesiology of the Hospital S?o Paulo, using the ICU component of the National Nosocomial Infection Surveillance System (NNIS) methodology, between March 1, 1997 and June 30, 1998. Hospital infections occurring during the first three months after the establishment of prevention and control measures (3/1/97 to 5/31/97) were compared to those of the last three months (3/1/98 to 5/31/98). In this period, 933 NNIS patients were studied, with 139 during the first period and 211 in the second period. The overall rates of infection by multi-resistant microorganisms in the first and second periods were, respectively, urinary tract infection: 3.28/1000 patients/day; 2.5/1000 patients/day; pneumonia: 2.10/1000 patients/day; 5.0/1000 patients/day; bloodstream infection: 1.09/1000 patients/day; 2.5/1000 patients/day. A comparison between overall infection rates of both periods (Wilcoxon test) showed no statistical significance (p = 0.067). The use of intervention measures effectively decreased the hospital bloodstream infection rate (p < 0.001), which shows that control measures in ICU can contribute to preventing hospital infections.     

Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care.

OBJECTIVE--To evaluate the effectiveness and acceptability of centrally organised prompting for coordinating community care of non-insulin dependent diabetic patients. DESIGN--Randomised single centre trial. Patients allocated to prompted care in the community or to continued attendance at hospital diabetic clinic (controls). Median follow up two years. SETTING--Two hospital outpatient clinics, 38 general practices, and 11 optometrists in the catchment area of a district general hospital in Islington. PATIENTS--181 patients attending hospital outpatient clinics. NULL HYPOTHESIS--There is no difference in process of medical care measures and medical outcome between prompted community care and hospital clinic care. RESULTS--14 hospital patients failed to receive a single review in the clinic as compared with three patients in the prompted group (chi 2 = 6.1, df = 1; p = 0.013). Follow up for retinal screening was better in prompted patients than in controls; two prompted patients defaulted as against 12 controls (chi 2 = 6.9, df = 1; p = 0.008). Three measures per patient yearly were more frequent in prompted patients: tests for albuminuria (median 3.0 v 2.3; p = 0.03), plasma glucose estimations (3.1 v 2.5; p = 0.003), and glycated haemoglobin estimations (2.4 v 0.9; p < 0.001). Continuity of care was better in the prompted group (3.2 v 2.2 reviews by each doctor seen; p < 0.001). The study ended with no significant differences between the groups in last recorded random plasma glucose concentration, glycated haemoglobin value, numbers admitted to hospital for a diabetes related reason, and number of deaths. Questionnaires revealed a high level of patient, general practitioner, and optometrist satisfaction. CONCLUSIONS--Six monthly prompting of non-insulin treated diabetic patients for care by inner city general practitioners and by optometrists is effective and acceptable.     

神经内科患者跌倒相关因素分析及护理对策

目的：探讨影响神经内科患者跌倒的原圜及影响因素,以便医护人员采取有效的护理措施预防患者跌倒,为神经内科防控住院患者跌倒提供切实可行的依据。方法：本研究采用回顾性调查分析的方法,对我院2009年10月-2010年10神经内科住院患者跌倒原因进行调查分析。结果：研究显示,调查的2307例患者中,发生跌倒79例,跌倒发生率为3．42％,影响神经内科患者跌倒的危险因素包括患者自身的疾病、年龄、药物原因、运动能力障碍、视听力障碍和认知能力障碍。患者自身的疾病、年龄和药物原因为主要影响因素。结论：神经内科患者发生跌倒与其年龄、基础疾病严重程度及使用药物等有关,护理人员可依据致使患者发生跌倒的危险因素,有针对性的采取防控措施,降低神经内科患者跌倒发生率,有效保障患者安全,提高护理质量。     

Implementation of the Abortion Act: Report on a Year's Working of Abortion Clinics and Operating Sessions

The results of the first year''s working of abortion clinics and operating sessions are reported. Seventy-eight per cent. of patients were managed on the basis of day admission and 20% were able to leave the hospital within four hours, operation having been carried out by either Karman catheter or by Bierer suction curette under paracervical block. These results were possible because of quick reference of patients to the clinics and the absence of delay in admission for operation.The measures detailed go some way towards managing the abortion problem within the hospital service; similar arrangements could be instituted elsewhere by the responsible regional hospital boards.     

神阙穴帖敷治疗骨科骨折患者术后便秘的疗效观察

目的探讨大黄水蜜贴敷"神阙"穴对骨折术后便秘的治疗效果。方法选取我院骨科骨折术后发生便秘的患者100例,随机分成治疗组和对照组各50例。对照组采用传统的治疗方法,即在骨科常规护理措施上指导患者多饮水,多进食水果、蔬菜,必要时给予缓泻药或开塞露纳肛。治疗组在对照组的基础上加用大黄水蜜贴敷"神阙"穴治疗,并对两组患者的便秘情况和相关症状进行比较。结果治疗组的治疗有效率为90%,对照组为60%,两组比较差异有统计学意义(P0.05);观察组发生便秘的相关症状少于对照组,差异有统计学意义(P0.05)。结论大黄水蜜贴敷"神阙"穴治疗骨科骨折术后便秘的疗效显著,值得临床推广应用。     

Organization of work with nursing staff in Central City Hospital of Verkhnyaya Pyshma town during mass hospitalization of patients with pneumonia caused by Legionella

Data on organization and carrying out of preventive and antiepidemic measures in hospital during hospitalization of more than 197 patients with Pontiac fever and pneumonia caused by Legionella were presented. Directions and formats of work with medical personnel, including those invited from other medical institutions, as well as their information support were determined. Optimal choice of organizational, and educational technologies, as well as ways to control of compliance with implemented measures by the staff allowed to prevent cases of nosocomial infections in patients and medical personnel.     

毒蛇咬伤对患者凝血功能的影响及诊疗分析

目的观察毒蛇咬伤对患者凝血功能的影响,并探讨有效的诊疗方法。方法对2014年9月~2015年9月我院收治的200例毒蛇咬伤患者凝血功能的变化情况进行研究,主要包括变化的类型、变化种类数量、出现异常的时间和好转时间,并分析诊疗过程及诊疗效果。结果毒蛇咬伤患者的凝血功能会受到不同程度的影响,其中纤维蛋白原(Fib)减少较明显,异常持续时间一般在72h以内,少数患者超过72h;患者入院后立即实施伤口清理、注射抗蛇毒血清、连续肾脏替代(CRRT治疗)等诊疗措施。经治疗后,患者均恢复出院。结论毒蛇咬伤可引起明显的凝血功能异常,及时采取有效的治疗措施,可明显提高治疗效果,促进康复。     

Organizational support of investigation of Legionnaires' disease outbreak in town Verkhnyaya Pyshma

Materials on organizational support of preventive and antiepidemic measures during outbreak of Legionnaires' disease in town Verkhnyaya Pyshma (Sverdlovsk region) in July-August 2007 are presented. Thanks to collaborative efforts of Federal Service for Surveillance for Protection of Consumers Rights and Human Welfare, Ministry of Health of Sverdlovsk region, health-care services in Verkhnyaya Pyshma, near located municipalities, and others it was able to establish in short term the hospital for treatment, identify source of the infection and factor of its transmission, and terminate the outbreak. Operative implementation of the mentioned measures both allowed to provide good quality medical care to all patients and to prevent occurrence of such situations on other towns of Sverdlovsk region.     

Randomised controlled trial comparing effectiveness and acceptability of an early discharge,hospital at home scheme with acute hospital care

Objective: To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital. Design: Pragmatic randomised controlled trial. Setting: Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people. Subjects: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate. Interventions: Patients’ received hospital at home care or routine hospital care. Main outcome measures: Patients’ quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months. Results: There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme. Conclusions: The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services.

Key messages

• Pressure on hospital beds, the increasing age of the population, and high costs associated with acute hospital care have fuelled the search for alternatives to inpatient hospital care
• There were no significant differences between early discharge to hospital at home scheme and routine hospital care in terms of patient quality of life, physical functioning, and most measures of patient satisfaction
• Length of stay for hospital patients was significantly shorter than that of hospital at home patients, but, owing to qualitative differences between the two interventions, this does not necessarily mean differences in effectiveness
• Early discharge to hospital at home provides an acceptable alternative to routine hospital care in terms of effectiveness and patient acceptability

     

心内科住院患者心理问题分析与护理对策研究

目的:了解心内科住院患者的心理问题,找出心内科住院患者常见的心理问题以及产生心理问题的原因,探讨改善心内科住院患者心理问题的有效护理措施。方法:对我院2011年1月-2011年4月心内科802例住院患者采取问卷调查及深入访谈相结合的方式进行调查。结果:对802例目标患者进行数据分析,心内科患者常见的心理问题为:焦虑与抑郁、多疑、恐惧紧张、绝望与悲哀;产生心理障碍的原因在于患者自身疾病、经济状况、环境等。结论:心内科住院患者心理问较为严重,通过实行有针对性的护理措施,有效治疗心内科患者的心理问题,减轻患者心理压力,促进患者的健康,保护患者安全。     

神经内科患者跌倒相关因素分析及护理对策

目的:探讨影响神经内科患者跌倒的原因及影响因素,以便医护人员采取有效的护理措施预防患者跌倒,为神经内科防控住院患者跌倒提供切实可行的依据。方法:本研究采用回顾性调查分析的方法,对我院2009年10月-2010年10神经内科住院患者跌倒原因进行调查分析。结果:研究显示,调查的2307例患者中,发生跌倒79例,跌倒发生率为3.42%,影响神经内科患者跌倒的危险因素包括患者自身的疾病、年龄、药物原因、运动能力障碍、视听力障碍和认知能力障碍。患者自身的疾病、年龄和药物原因为主要影响因素。结论:神经内科患者发生跌倒与其年龄、基础疾病严重程度及使用药物等有关,护理人员可依据致使患者发生跌倒的危险因素,有针对性的采取防控措施,降低神经内科患者跌倒发生率,有效保障患者安全,提高护理质量。     

Resuscitation from cardiac arrest: assessment of a system providing only basic life support outside of hospital

Resuscitation outside of hospital of victims of cardiac arrest is a major challenge to our emergency care system. Most cities in Canada do not have a mobile advanced life support service; instead they rely on basic life support outside of hospital. The outcome in such cases and the factors affecting the outcome are largely unknown. Thus, it is difficult to estimate the lifesaving potential of adding advanced life support to the existing measures available for care outside of hospital.A prospective study of all resuscitation attempts begun outside of hospital was conducted during 18 consecutive months in 1977-78 in Winnipeg; at that time only basic life support was available outside of hospital. Resuscitation was attempted 849 times, and 33 patients (4%) survived to be discharged from hospital. Data analysis revealed that: (a) none of the 58% of patients in asystole at the time of arrival at a hospital survived to be discharged, but 11% of the patients with ventricular fibrillation or tachycardia (27% of the entire group) survived; (b) the survival rate was lower when the interval from the emergency telephone call to the patient''s arrival at the hospital exceeded 10 minutes; and (c) basic life support was begun immediately in 29% of the patients with ventricular fibrillation or tachycardia, and increased the survival rate fivefold.The training of private citizens in basic life support is a vital component of total emergency cardiac care. A mobile advanced life support service will be effective in saving lives if it reduces the delay before definitive care is instituted, preferably to less than 10 minutes.     

Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial.

STUDY OBJECTIVE--To compare a community support scheme using care attendants with standard aftercare for their effects on independence and morale of elderly patients discharged from hospital and on their use of health and social services. DESIGN--Randomised controlled study of cohort of patients over 75 discharged to their own homes. SETTING--District general hospital and community. PATIENTS--Total of 903 patients (mean age 82, 25% over 85). INTERVENTIONS--Total of 464 patients received support from care attendants on first day at home and for up to 12 hours a week for two weeks. Support comprised practical care, help with rehabilitation, and organising social help. The remaining 439 patients received standard aftercare. END POINT--Difference between two groups of 7% in hospital readmission rates or one point on activities of daily living scale (power 80%, significance level 5%). MEASUREMENTS AND MAIN RESULTS--Three months after the initial discharge 763 patients were interviewed (84%). There were no significant differences between the two groups in physical independence (activities of daily living scale), in measures of morale (Philadelphia scale), or in death rates. Hospital readmission rates within 18 months of discharge, however, were significantly higher in the control group and they spent more days in hospital (mean; control group 30.6 days, support group 17.1 days; p = 0.014). Of the patients living alone who were followed up for 18 months 21 (15%) receiving standard aftercare were readmitted more than twice compared with 6 (5%) supported by care attendants (p less than 0.01). CONCLUSIONS--If the findings are confirmed, and the policy extended to all patients over the age of 75 living alone, an average health district might expect either to save about 23 hospital beds at a net annual saving of about pounds 220,000 in the short term or to increase available beds by this number.     

通过患者满意度调查评价护理质量

目的:通过患者满意度调查,进一步了解我院护理工作中的成效及存在问题,评价护理工作的质量,探索医院管理中护理科学管理方法。方法:①住院病人:采用问卷调查法;②出院病人:采用电话或上门随访方法;两种方法共对568例进行满意度调查,针对病人反馈的问题进行原因分析,提出改进措施并落实。结果:在疾病宣教及护理质量方面存在问题。结论:以医院管理年及创建优质护理服务为契机,以病人为中心,以质量为核心,逐步完善各项护理规章制度,加强护理安全管理,强化"三基三严"的训练,努力改善护理管理,提高护理服务质量。     

Impact of COVID-19 on the performance of a radiation oncology department at a major comprehensive cancer centre in Poland during the first ten weeks of the epidemic

The outbreak of SARS-CoV-2 coronavirus rapidly altered radiotherapy service delivery around the world.AimThe main objective of this study was to assess the impact of precautionary measures implemented in response to the COVID-19 pandemic on the performance of a radiation oncology departments and on mitigation the risk of COVID-19 contagion between and among patients and staff.MethodsThe study period was from March 15 until May 22, 2020. We evaluated total number of patients irradiated and those who initiated treatments, taking into account tumours localisations. We assessed the relationship of potential risk of contagion with patients’ domiciles locations in regions with high number of COVID19 case.Results and conclusionsThe number of patients treated with radiotherapy during the study period decreased due to precautionary measures. After five weeks, the number of radiotherapy treatments began to increase. Just over half of the radiotherapy patients (53.5%) treated at the GPCC reside in the city of Poznan or in one of the ten surrounding counties where COVID19 incidence was low and reached at the end of the study period cumulative number of cases n = 204. The precautionary measures were effective qRT-PCR tests were performed in 1545 individuals (patients and hospital staff) revealing four staff members and none patient with a positive PCR result. Immunoglobulin testing was performed in 1132 individuals (patients and hospital staff). A total of 63 individuals were positive for antibodies.     

The use of data on the composition and drug resistance of the causative agents of suppuration in a retrospective analysis of the epidemiological situation in a hospital

The analysis of bacterial 16,530 strains, dynamically isolated from 6,157 patients with purulent septic processes (PSP) in surgical, traumatological, burn, toxicological and resuscitation departments, was made. The computer processing of data on the spread of the causative agents of PSP, depending on their taxonomic classification and drug resistance spectra, was carried out, which made in possible to obtain information on the outbreaks of hospital infections. Correlation of the number of PSP cases and the spread of hospital resistovars was analyzed. The data on the composition and drug resistance of pyogenic microorganisms could be used in the retrospective analysis of the epidemiological situation in a hospital. 3-year observations revealed the tendency to a decrease in the spread of the hospital variants of the causative agents of PSP, multiresistant to antibacterial preparations, which was indicative of the effectiveness of the antiepidemic measures carried out during this period.