非计划再手术对平均住院费用及平均住院日影响研究

以某综合性三甲医院2007—2008年全部住院手术患者为研究对象,通过分析非计划再手术病例,探讨非计划再手术病例的平均住院日和平均住院费用。 共分析2007—2008年非计划再手术病例共432例,平均住院日42.83天,平均住院费用68 810元。 非计划再手术延长了住院天数,增加了住院费用。     

非计划再次手术关键环节管理与效果分析

目的 探索有效降低非计划再次手术发生率的管理方法。方法 对2012年1月—2016年12月住院并进行手术的患者进行主动监测,加强管理,发现非计划再次手术病例,统计发生率及引发原因。结果 225 944例手术共发生非计划再次手术914例,平均发生率为0.40%且五年呈显著下降趋势。引发原因以手术部位感染、切口裂开、切口疝或愈合不良,术后出血,出现漏或瘘为主,共占73.9%。结论 完善主动监测与报告系统、加强院科两级管理、注重原因分析与改进可有效降低非计划再次手术的发生率。     

Characterizing a tropical deforestation wave: a dynamic spatial analysis of a deforestation hotspot in the Colombian Amazon

Tropical deforestation is the major contemporary threat to global biodiversity, because a diminishing extent of tropical forests supports the majority of the Earth's biodiversity. Forest clearing is often spatially concentrated in regions where human land use pressures, either planned or unplanned, increase the likelihood of deforestation. However, it is not a random process, but often moves in waves originating from settled areas. We investigate the spatial dynamics of land cover change in a tropical deforestation hotspot in the Colombian Amazon. We apply a forest cover zoning approach which permitted: calculation of colonization speed; comparative spatial analysis of patterns of deforestation and regeneration; analysis of spatial patterns of mature and recently regenerated forests; and the identification of local‐level hotspots experiencing the fastest deforestation or regeneration. The colonization frontline moved at an average of 0.84 km yr^?1 from 1989 to 2002, resulting in the clearing of 3400 ha yr^?1 of forests beyond the 90% forest cover line. The dynamics of forest clearing varied across the colonization front according to the amount of forest in the landscape, but was spatially concentrated in well‐defined ‘local hotspots’ of deforestation and forest regeneration. Behind the deforestation front, the transformed landscape mosaic is composed of cropping and grazing lands interspersed with mature forest fragments and patches of recently regenerated forests. We discuss the implications of the patterns of forest loss and fragmentation for biodiversity conservation within a framework of dynamic conservation planning.     

Unintended pregnancies and exposure to potential human teratogens

BACKGROUND: We aimed to investigate the risk factors associated with unintended pregnancies as well as the association between unintended pregnancies and potential teratogenic exposures. METHODS: A cross-sectional survey was performed among women attending the Maternity School of the Samsung Cheil Hospital and Women's Health Care Center in Seoul, Korea. Demographic data, obstetric history, socioeconomic status, intention to become pregnant, and exposure to potential teratogens were obtained. RESULTS: A total of 1354 women with median age of 29 years and median gestational age of 29 weeks were included. Of these, an educational level above high school was 74.2%, primigravida was 77.3% and unintended pregnancy was 48%. In the logistic regression analysis, women younger than 24 years of age had a relative risk (RR) of 2.5 (95% confidence interval [CI], 1.3-4.7) of having an unintended pregnancy and women with lower household monthly income level had a RR of 1.3 (95% CI, 1.0-1.6). Women with unintended pregnancies had an RR of 1.9 (95% CI, 1.5-2.5), 3.0 (95% CI, 2.0-4.5), 1.5 (95% CI, 1.0-2.3), 2.9 (95% CI, 1.1-7.2), and 2.0 (95% CI, 1.62.4) of being exposed to alcohol, medications, cigarette smoking, X-rays, or to any of these, respectively, during the first trimester of pregnancy. CONCLUSIONS: Unintended pregnancies are more likely to occur among young women with a lower household monthly income level. Prenatal counseling should be especially recommended for women with unintended pregnancies in order to evaluate whether they have been exposed to potential teratogenic agents.     

品管圈降低肝胆外科非计划再手术发生率的应用研究

??????? 目的 降低肝胆二科非计划再次手术发生率。方法 综合运用品管圈的管理方法,分析影响非计划再次手术的主要原因,制定针对性措施实施过程改进。结果 实施改进措施后,非计划再次手术发生率由1.12%降低至0.21%,达到目标值＜0.5%（P=0.045）,月平均住院日由14.32天缩短至10.52天（P<0.001）。结论 品管圈管理方法的应用显著降低非计划再次手术发生率,缩短患者平均住院日,有利于提升手术质量,减少不良事件发生,保障患者生命安全。     

北京市某医院非计划再手术原因分析

以某综合性三甲医院2007—2008年全部住院手术患者为研究对象,通过分析非计划再手术病例,探讨非计划再手术发生原因。共分析2007—2008年非计划再手术病例共432例,未达预期效果手术再调整、切口问题、手术后出血、手术部位感染、手术损伤是导致二次或多次手术发生的主要原因。医院应该监测非计划再手术事件,寻找其发生的原因,发现围手术期存在的质量问题,以提高医疗质量。     

基于故障树方法的非计划再次手术风险评估

目的 探索一种适合于在过程复杂、环境多变、风险多样的手术治疗系统中,对术前准备、术中操作、术后医疗护理及管理等贯穿围手术期全过程进行风险评估的方法。方法 通过危险事件的风险影响因子识别、定性分析与定量分析、基本事件综合风险等级评价,绘制具有实践操作意义的风险矩阵图,全面识别手术治疗系统风险、科学分析危险事件与风险影响因子,有效评价风险等级与可容忍度。结果 构建包括7个中间事件、29个基本事件、9个逻辑或门和1个逻辑与门的非计划再次手术故障树模型,故障树由8个一阶割集和104个二阶割集组成。当所有最小割集均存在时,被调查医院非计划再次手术的发生概率为0.950 10,同时确定25个基本事件在该医院的综合风险重要性等级,并根据绘制的风险图谱进一步确定风险应对的优先顺序。结论 基于故障树的手术治疗系统风险评估方法,可以全面识别手术治疗系统风险,科学分析风险影响因子,有效评价风险等级。     

基于PDCA循环的非计划再次手术管理方法设计与实现

目的 针对非计划再次手术管理需求设计了一种管理方法。为医院非计划再次手术的管理以及医疗质量改进提供参考。方法 参考国家对非计划再次手术管理的相关规范及标准文件,遵循 PDCA 循环的思想,结合信息技术,最终建立一个“非计划再次手术”专用的管理方法。结果 方法实施前后非计划再次手术的发生率有了显著的下降,发生率从方法实施前（2014年下半年）的1.02%降低到方法实施后（2015年7—12月）的0.71%。结论 方法有效降低了非计划再次手术发生率,符合医疗管理的需求,有利于提升手术质量,以实现医疗质量的持续性改进。

     

北京市某三甲医院31天内非计划性再入院研究

目的 了解北京市某三甲综合性医院住院患者出院31天内非计划再入院的现状及其影响因素。方法 对北京市某三甲综合性医院2008年1月1日—12月31日之间出院后31天内非计划性再入院的患者进行描述性分析，通过t 检验和χ²检验进行单因素分析，选择有统计学意义的危险因素用向后逐步回归法进行非条件Logistic分析。结果 患者性别、患者年龄、出院—再入院的间隔天数、前次入院时入院状况和前次入院疾病是否治愈是31天内非计划性再入院的主要影响因素。结论 患者特征和医院相关因素均与患者出院31天内非计划性再入院相关。