Study on the Prevalence of Leptospirosis among Fever Cases Reported from Private Clinics in the Urban areas of Villupuram District,Tamil Nadu,India

Objectives

To know the prevalence of leptospirosis cases reported in private clinics among fever cases in Villupuram District, Tamil Nadu, India to know its real magnitude of the problem and to diagnose Leptospirosis among fever cases from differential diagnosis.

Methods

1502 Blood serum samples collected from three urban towns namely Kallakurichi (Latitude: 11° 73′ N; Longitude: 78° 97′ E), Villupuram (Latitude: 11° 75′ N; Longitude: 79° 92′ E) and Thindivanam (Latitude: 12° 25′ N; Longitude: 79° 65′ E) in fifteen clinics based on case definition of leptospirosis delineated by the National Vector Borne Disease Control Programme (NVBDCP), Government of India. Samples were tested in the laboratory of the Zonal Entomological Team (ZET), Cuddalore with Macroscopic Slide Agglutination Test (MSAT) and Ig-M ELISA.

Result

There were 65 positive cases detected from 1502 blood serum samples in both MSAT and Ig-M ELISA. It could be known that there was 4% cases contributed from private clinics among fever cases. From this study, further it was known that all age groups of people affected irrespective of sexes based on their living condition associated with the environment prevailed of the disease.

Conclusion

From this study, it was quantified that 4% of cases reported in private clinics among fever cases and its findings ascertained both the importance of differential diagnosis as well as reports that should be included to the Government for knowing its real magnitude for planning.     

2011-2013年包头市个体诊所消毒监测结果分析

目的对包头市个体诊所(包括村卫生室)的消毒卫生状况进行调查研究,为改进基层医疗单位消毒卫生质量和预防医源性感染提供参考。方法采取现场随机抽样检测的方法对包头市个体诊所空气卫生质量、物体表面、医护人员手、使用中的消毒液、紫外线灯辐照强度等进行消毒质量监测。结果 2011-2013年消毒灭菌监测总合格率呈逐年上升趁势:2011年77.63%,2012年79.10%,2013年80.94%。结论个人诊所存在消毒不严格、医护人员消毒意识不强等问题,为院内感染及医源性传染病的发生埋下了隐患。因此,应加大个人诊所消毒监测管理力度,增强医护人员规范消毒意识。     

门诊处方中抗生素不合理用药分析

目的 考察我院门诊病房中抗生素使用现状,通过分析抗生素处方不合理开具的原因,指导今后工作中的正确使用.方法 随机选取2010年9月-2012年4月我院门诊每月5、15和25日的处方,排除节假日,共计8266张处方.对其抗生素处方开具的合理性进行统计分析.结果 8266张处方中涉及抗生素的处方共2904张,占35.13%.2904张涉及抗生素的处方中属于不合理使用的有1260张,占43.39%.排名前三位的原因分别是溶媒选择不当（30.63%）、选药不当（29.52%）和无用药指征（21.19%）;排名前三位的药物分别是氨基糖苷类（33.22%）、头孢菌素类（30.82%）和青霉素类（16.09%）.结论 今后应进一步加强抗生素使用管理,提高医务人员职业道德和用药规范知识.     

Optimizing management and financial performance of the teaching ambulatory care clinic

OBJECTIVE: To examine how to optimize teaching ambulatory care clinics performance with regard to access to care, access to teaching, and financial viability. DESIGN: Optimization analysis using computer simulation. METHODS: A discrete-event simulation model of the teaching ambulatory clinic setting was developed. This method captures flow time, waiting time, competition for resources, and the interdependency of events, providing insight into system dynamics. Sensitivity analyses were performed on staffing levels, room availability, patient characteristics such as "new" versus "established" status, and clinical complexity and pertinent probabilities. MAIN RESULTS: In the base-case, 4 trainees:preceptor, patient flow time (registration to check out) was 148 minutes (SD 5), wait time was 20.6 minutes (SD 4.4), the wait for precepting was 6.2 minutes (SD 1.2), and average daily net clinic income was $1,413. Utilization rates were preceptors (59%), trainees (61%), medical assistants (64%), and room (68%). Flow time and the wait times remained relatively constant for strategies with trainee:preceptor ratios <4:1 but increased with number of trainees steadily thereafter. Maximum revenue occurred with 3 preceptors and 5 trainees per preceptor. The model was relatively insensitive to the proportion of patients presenting who were new, and relatively sensitive to average evaluation and management (E/M) level. Flow and wait times rose on average by 0.05 minutes and 0.01 minutes per percent new patient, respectively. For each increase in average E/M level, flow time increased 8.4 minutes, wait time 1.2 minutes, wait for precepting 0.8 minutes, and net income increased by $490. CONCLUSION: Teaching ambulatory care clinics appear to operate optimally, minimizing flow time and waiting time while maximizing revenue, with trainee-to-preceptor ratios between 3 and 7 to 1.     

某三甲医院门诊手卫生工作干预效果研究

目的 评价某三甲医院门诊手卫生干预措施的效果.方法 采用手卫生集中培训、建立质控护士管理制度、改善手卫生设施等措施实施干预,评价干预前后门诊医务人员洗手依从性、手卫生理论与操作考核评分以及门诊患者对手卫生工作满意度的变化.结果 门诊医务人员7～9月洗手的平均不依从率较前6个月降低了31.4％;与培训前相比,培训后的理论考核成绩95.0(IQR=91.3 ～96.0,Z=-6.04,P＜0.001)与操作考核成绩98.0(IQR=97.0 ～100.0,Z=-5.45,P＜0.001)均有所上升,门诊患者对手卫生工作的满意度也从56.0％上升至78.0％(x2 =5.47,P=0.019).结论 实施手卫生系列干预措施可有效地提高门诊医务人员对手卫生知识的认识,增强洗手操作规范性,提高洗手的依从性.     

2014年山东省性病门诊男性就诊者艾滋病哨点监测分析

目的了解性病门诊男性就诊者艾滋病知识、行为及艾滋病、梅毒、丙肝感染状况,为制定艾滋病干预措施提供依据。方法 2014年4~7月根据全国艾滋病哨点监测实施方案操作手册的要求,对山东省性病门诊男性就诊者进行问卷调查,并采集静脉血进行艾滋病病毒、梅毒、丙肝血清学检测。结果共调查性病门诊男性就诊者6 163人,平均年龄为（33.95±10.71）岁,艾滋病知识知晓率为81.29%。最近3个月,37.98%（2 341/6 163）与暗娼发生过性行为,29.19%（1 799/6 163）与临时性伴发生过性行为,最近1年,调查对象获得过免费安全套发放及艾滋病咨询检测的占28.88%,HIV、梅毒、HCV抗体阳性率分别为0.58%、6.83%、0.21%。结论山东省性病门诊男性就诊者的梅毒感染率较高,接受艾滋病服务率低,应加强对性病门诊男性就诊者健康教育和行为干预,有效控制艾滋病经性途径传播。     

Do mobile family planning clinics facilitate vasectomy use in Nepal?

Background

Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy.

Study design

A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages.

Results

The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21–2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters.

Conclusion

Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning.

Implications

Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.     

A national survey of intensive care follow-up clinics in Australia

BackgroundIntensive care follow-up clinics (ICFCs) have been implemented internationally with the aim to address the growing number of patients living with sequalae of critical illness and intensive care. However, data on Australian intensive care follow-up practice are rare.ObjectivesThe primary objective was to determine the proportion of Australian intensive care units (ICUs) that offer a dedicated ICFC to ICU survivors, with the intention of improving long-term outcomes of critical illness. Secondary objectives were to identify models of ICU follow-up and barriers to the implementation of ICFCs.MethodsA custom-designed, pilot-tested 12-question online survey was sent to the nurse unit managers and medical directors of all 167 Australian ICUs listed in the database of the Australian and New Zealand Intensive Care Society. Outcome measures included proportion of ICUs offering ICFCs, details on types of follow-up services with staffing, funding source, and reasons for not providing ICU follow-up.ResultsOne hundred seven of the 167 ICUs contacted responded to the survey. Of these, two (2%) operated a dedicated ICFC. Both ICFCs were nursing-led, with one receiving dedicated funding and the other being unfunded. Three units (3%) conducted routine outpatient follow-up by telephone; one of these services was doctor-led, and two were nurse-led. Four units (4%) were performing outpatient follow-up as part of research studies only. Among the units not operating an ICFC, the main reason given for not doing so were financial constraints (58%), followed by lack of clinical need (19%) and perceived lack of evidence (11%).ConclusionIn Australia, only two ICUs operated an ICFC. Only one outpatient follow-up service received dedicated funding, and financial constraints were the main reason given for units not offering outpatient follow-up services.