各级医院非肾脏病科医生对慢性肾脏病知晓率的调查分析

目的调查社区医院、二级医院、三级医院非肾脏病科临床医生对慢性肾脏病的概念、临床表现、诊断方法、治疗原则、可逆因素、用药注意事项的知晓情况,为探索慢性肾脏病管理模式提供帮助。方法对北京市12家社区医院、10家二级医院、8家三级医院的共304名非肾脏病科临床医生进行问卷调查,从慢性肾脏病的概念与分期、诊断、防治、加重因素和可逆因素四个方面进行调查,答对80%以上为知晓,答对40-80%为部分知晓,答对40%以下为不知晓,数据进行统计分析。结果社区医院全科医生完成问卷97份,慢性肾脏病的概念与分期,知晓25%,部分知晓47%,不知晓28%;慢性肾脏病的诊断,知晓22%,部分知晓43%,不知晓35%;慢性肾脏病的防治,知晓20%,部分知晓45%,不知晓35%;慢性肾脏病的加重因素与可逆因素,知晓17%,部分知晓43%,不知晓40%。二级医院非肾脏病科临床医生完成问卷98份,慢性肾脏病的概念与分期,知晓38%,部分知晓51%,不知晓11%;慢性肾脏病的诊断,知晓25%,部分知晓43%,不知晓32%;慢性肾脏病的防治,知晓22%,部分知晓46%,不知晓32%;慢性肾脏病的加重因素与可逆因素,知晓16%,部分知晓47%,不知晓37%。三级医院非肾脏病科临床医生完成问卷109份,慢性肾脏病的概念与分期,知晓39%,部分知晓50%,不知晓11%;慢性肾脏病的诊断,知晓25%,部分知晓46%,不知晓29%;慢性肾脏病的防治,知晓25%,部分知晓48%,不知晓27%;慢性肾脏病的加重因素与可逆因素,知晓16%,部分知晓51%,不知晓33%。对于慢性肾脏病的概念与分期,二级医院非肾脏病科临床医生较社区医院全科医生知晓率高,χ~2=9.669,P=0.008,差异有统计学意义;三级医院非肾脏病科临床医生较社区医院全科医生知晓率高,χ~2=10.818,P=0.004,差异有统计学意义;二级医院非肾脏病科临床医生与三级医院非肾脏病科临床医生比较无显著差异。对于慢性肾脏病的诊断、防治、加重因素和可逆因素,各组间比较无显著差异。结论对于慢性肾脏病的概念与分期,二级医院和三级医院非肾脏病科临床医生的知晓率不高,社区医院全科医生的知晓率更低,对慢性肾脏病的防治、加重因素和可逆因素的知晓率就更低,不利于患者慢性肾脏病的防治和延缓病情进展,因此应加强慢性肾脏病知识的普及。     

临床医务人员输血相关知识知晓状况调查分析

目的了解医务人员对输血相关知识的知晓及需求情况,为进行输血相关知识继续教育提供依据。方法采用自制问卷调查表对2019年7～8月来本院参加会议、进修培训和学习的医务人员(陕西省各市县/区),共计652人员进行输血相关知识的知晓现状的调查。结果医务人员对输血和献血相关知识缺乏深入了解,部分知识甚至空缺。医生群体对相关知识的知晓率高于检验人员和护士,其中护士群体知晓率最低。结论医务人员输血相关知识知晓率较低,有必要加强输血相关知识培训。     

湖南省3个县乡村医务人员对新发传染病认知水平调查

目的了解湖南省3个县乡村医生对新发传染病认知水平,为农村新发传染病防治提供科学依据。方法应用自行设计的调查表,采用多级抽样的方法,抽取湖南省3个县(长沙县、平江县、邵东县)9个乡卫生院的乡村医生共209名作为调查对象,了解乡村医生基本情况、对新发传染病相关知识的知晓情况、对几种常见和不常见新发传染病知识知晓情况、对新发传染病政策相关知识知晓情况、新发传染病知识知晓主要途径等。结果本组调查对象对严重急性呼吸综合征(severe acute respiratory syndromes,SARS)、甲型H1N1流感等常见新发传染病的相关知识有一定程度的了解,尤其是SARS和甲型H1N1流感的传播途径知晓率达80.9%;对不常见的新发传染病,如埃博拉出血热病毒、莱姆病的相关知识知晓率偏低;对于新发传染病政策相关知识正确率较低,最低的是"甲类传染病未实行网络直报报告时间"一项,知晓率仅为4.3%。对新发传染病知识知晓途径通过培训获得的仅占5.3%。结论应加大乡村医生新发传染病防治相关知识、政策及操作技能的培训力度,扩大培训方式,提高其新发传染病防治能力。     

江西省部分医疗机构口腔门诊医护人员医院感染控制相关知识调查

摘要 目的 〖HT5"SS〗了解江西省口腔门诊医务人员医院感染控制的相关知识、态度和行为情况,分析影响因素并提出改进对策。方法 通过分层随机抽样调查的方式,对江西省部分医疗机构口腔门诊医务人员就医院感染相关情况进行问卷调查。结果 共调查59家医院口腔门诊医护人员849名,均对医院感染控制较为重视;598名医生对“喷溅性操作时为患者防护”和“喷溅性操作时使用隔离衣”两项内容的知晓率分别为18.6%和14.3%;251名护士对上述两项知晓率分别为33.8%和34.7%。医护人员对牙科手机、洁牙机和调拌刀消毒行为的依从率低,其中调拌刀消毒的行为依从率最低,医、护人员分别为29.6%和29.5%。结论 纳入调查的江西省部分医院口腔门诊医务人员均较重视医院感染控制工作,有较强的感染控制意识,但对医院感染的部分控制措施执行率较低,尚有待加强。     

飞行检查在新生儿重症监护室医院感染管理中的应用

[目的]探讨飞行检查在新生儿重症监护室医院感染管理中的应用。[方法]成立飞行检查小组,检查组依据三级妇产医院、三级儿童医院评审标准制定飞行检查内容和考核表,对新生儿重症监护室的环境卫生与保洁质量、医务人员手卫生依从与质量及医院感染知识知晓情况等方面进行现场抽查、考核,并将检查结果及时反馈科室进行针对性的整改。[结果]飞行检查实施1年后,新生儿重症监护室医院感染发生率由5.55%下降至2.91%。环境物表微生物抽查合格率上升了26.6%;环境物表清洁率(荧光标记法)提高至81.3%;医务人员手部微生物抽查合格率升高到90.9%,带菌率下降至42.2%;医务人员手卫生依从性、洗手正确性及手卫生知识知晓率分别升高到88.2%、87.5%和78.3%;医务人员对医院感染防控相关知识知晓率上升至86.1%。[结论]对新生儿重症监护室环境卫生、医务人员手卫生规范、医院感染防控知识知晓等方面进行飞行检查,可改善重症监护室环境物表的卫生状况和保洁质量,提高医务人员手卫生执行力度和医院感染防控知识知晓率,降低医院感染的发生率。     

瘢痕子宫再次妊娠孕产妇选择分娩方式的影响因素

[目的]探讨瘢痕子宫再次妊娠孕产妇选择分娩方式的影响因素分析.[方法]制定问卷,选择2016年1月至2016年12月深圳市10个医院产科产检、住院待产、分娩的瘢痕子宫再次妊娠的孕产妇、家属及各级医院的妇产科医务人员为调查对象.分别发放问卷调查表,调查孕产妇及家属对瘢痕子宫再次妊娠顺产、剖宫产知识的知晓情况及妇产科医务人员的剖宫产后阴道分娩(VBAC)的知晓情况,采用Logistic回归分析影响孕产妇选择分娩方式的因素.[结果]993例孕产妇选择VBAC,其中648例试产成功(占65.26％),其比例明显高于选择再次剖宫产在待产期自然分娩的孕产妇(占11.01％)(χ2=31.22,P=0.000);孕妇居住地、对顺产及剖宫产知识的认知、对顺产的紧张度、既往有阴道分娩史、家属建议阴道分娩等对孕产妇分娩方式的选择均有影响(P<0.05);在回收的738份有效调查问卷中,医生认为可以阴道分娩的知晓率为61.65％(328/532),明显高于护士21.19％(50/236),其差异有统计学意义(χ2=93.37,P=0.000);三级医院医生对VBAC的知晓率为68.46％,明显高于二级(46.62％)和一级医院(20.69％),其差异有统计学意义(χ2=45.26,P=0.000),其中专科医院医生和护士的知晓率均高于综合医院(P<0.05);具有高级职称的医务人员对VBAC的认知率明显高于初、中级职称的医务人员(P=0.000).[结论]对瘢痕子宫再次妊娠阴道分娩知识及再次剖宫产史知识的认知对分娩方式的选择有影响,需加强此方面知识的宣传.     

关于医务人员手卫生质量管理调查报告

目的调查我院医务人员洗手消毒情况,加强医院感染的预防和控制措施。方法随机问卷调查40名医生和60名护士,对医护人员手卫生现状及影响洗手的因素进行调查,要求被调查对象对手卫生概念、标准隔离措施、自我防护原则和洗手方法的掌握等问题进行回答,并对是否按标准执行、不能执行的原因给予解释。结果临床医生对手卫生各调查项目知晓率最高为32.4%,最低为21.6%;医生对手卫生措施平均执行率为19.0%。临床护士对手卫生各项调查项目知晓率最高为61.0%,最低为44.06%;护士对手卫生措施平均执行率为34.0%,知晓人数和执行人数护士明显高于医生。多数人是因工作忙忽视手的卫生或洗手设施不足所致;部分是因为操作时要戴手套,认为不必洗手;少数人惧怕长期洗手消毒会损伤皮肤,部分医护人员认为手卫生与临床医疗质量无关。结论医院医务人员存在对手卫生的重要性认识不足的问题,医院存在洗手设备不足,必须加强专项培训,减少医院感染。     

某三甲医院医务人员疼痛诊疗现状及疼痛相关知识的调查

目的:调查重庆市某三甲医院医务人员疼痛诊疗现状及疼痛相关知识的掌握程度,以期提高医务人员疼痛诊疗水平,提高患者满意度。方法:于2013年7月23日~7月25日对该院医务人员进行问卷调查。结果:有53.1%的手术科室医生经常接诊疼痛患者,非手术科室医生为41.6%。镇痛效果不佳时,向疼痛专业医师进行咨询的医疗人员较护理人员、医技人员多。97.5%的医务人员知晓用口服药物进行镇痛,放疗镇痛的知晓率为27.8%;医务人员评价疼痛的方法中以病人主诉和视觉模拟评分知晓率较高,痛阈测定法知晓率较低。结论:疼痛是患者前来就诊的主要原因之一。该院医务人员疼痛相关的基础知识普及较高,但疼痛相关的专业知识普及较低。护理人员和医技人员对疼痛诊疗相关认知相对较差,尚需加强。     

三级甲等医院医务人员脑卒中认知情况调查

[目的]调查了解三级甲等医院医务人员对脑卒中相关知识的认知情况,并分析其相关影响因素,为进一步开展和加强医务人员对脑卒中病人筛查和预防提供科学依据。[方法]采用自行设计的调查表对某三级甲等医院1 142名临床医务人员进行脑卒中相关知识问卷调查。[结果]该院医务人员对脑卒中相关知识总分为86.00分±23.77分;370名(32.4%)被调查者参加过脑卒中筛查相关知识培训;33.7%的调查对象不清楚脑卒中筛查的绿色通道流程,31.9%的调查对象不清楚脑卒中的叶酸药物干预;知晓率最高的是与脑卒中有关的基础疾病(88.7%)。影响医务人员脑卒中认知水平的因素主要有专业、学历、工龄、职称以及是否参加脑卒中筛查相关知识培训(P0.05)。[结论]三级甲等医院医务人员脑卒中认知水平总体较高,医院应鼓励和组织临床医务人员学习和掌握国内外最新的研究动态,全面把握脑卒中各类危险因素,将先进的研究成果自觉应用到脑卒中的临床筛查与预防中去。     

医务人员对医疗废物分类的知晓率及存在问题

目的：调查分析临床医务人员对医疗废物分类知识的知晓程度及存在问题。方法：随机抽查我院临床医务人员210人,填写医疗废物分类知识调查问卷。结果：我院临床医务人员对医疗废物分类知晓程度较低,其中护士对多数问题的知晓率高于医生和护工,医生和护工之间其知晓率没有统计学差异。结论：医疗废物管理的首要环节是医疗废物的分类收集,提高临床医务人员对相关知识的知晓率至关重要。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.