广州市番禺区妇幼保健院(番禺区何贤纪念医院)

广州市番禺区妇幼保健院(番禺区何贤纪念医院)始建于1965年。核定病床650张,开放床位800张,职工1463人,副高以上职称专业技术人员207名,硕博士118名。2015年12月广州市卫计委《关于番禺区妇幼保健院调整为三级妇幼保健机构的批复》明确调整为三级妇幼保健院。番禺区妇幼保健院以妇科、产科、儿科以及生殖医学为特色,妇幼保健体系健全的三级妇幼保健院和综合性医院;是南方医科大学非直属附属医院。     

深圳地区9569例妊娠期妇女血红蛋白电泳结果分析

目的：评估全自动毛细管血红蛋白（Hb）电泳技术在深圳地区妊娠妇女产前珠蛋白生成障碍性贫血（地贫）筛查及异常 Hb 检查的临床应用价值。方法采用 Sebia capillary2flex 型全自动毛细管电泳仪对深圳市龙岗区妇幼保健院产前门诊孕妇进行 Hb 电泳检测,分析 HbA2水平及异常 Hb 电泳条带及水平。结果检出951例异常 Hb 电泳结果（异常率9．9％）包括 HbA2＞3．5％;HbA2＜2．5％;HbF ＞10％及其他异常 Hb（包括 HbCS 、HbE 、HbD 、Hb NewYork 和 Hb Q-Tailand 等）。结论全自动毛细管 Hb 电泳在地贫产前筛查及异常 Hb 检测中具有重要意义,可为进一步分子确诊及产前诊断提供指导。     

孕妇维生素D的调查分析

目的：调查昆明地区孕前及不同孕期、不同季节孕妇25-羟维生素D[25-（OH）D]水平分布情况,为指导育龄妇女及孕妇补充维生素D提供依据。方法：选择2013年6月至2015年6月在昆明市妇幼保健院进行检查的育龄妇女及正常妊娠孕妇21692例,按不同孕龄分成孕前699例、孕早期（孕1—12周）1180例、孕中期（孕13—27周）19108例和孕晚期（孕28—40周）705例。采用化学发光法（CLIA）检测血清中的25-（OH）D浓度,并对结果进行统计学分析。结果：（1）孕前育龄妇女血清25-（OH）D平均为（44．5±16．7）nmol／L,孕早期为（39．5±15．2）nmol／L,孕中期为（41．0±17．0）nmol／L,孕晚期为（37．0±16．7）nmol／L。四组孕妇血清25-（O）D水平有统计学差异（F=26．224,P〈0．001）。（2）孕前育龄妇女血清25-（OH）D缺乏和不足的发生率分别为10．7％和84．7％,孕早期分别为15．4％和82．1％,孕中期分别为15．1％和80．8％,孕晚期分别为25．0％和71．2％,差异有统计学意义（2=52．911,P〈0．001）。（3）不同季节25-（OH）D含量比较,差异有统计学差异（2=5．009,P〈0．001）,孕产妇维生素D含量夏秋最高,春季次之,冬季最低。结论：昆明地区不同孕期及季节孕妇普遍存在25-（OH）D缺乏或不足,孕晚期较显著,冬春季孕妇尤其要注意维生素D的补充。     

产前心理指导对分娩方式的影响

目的：探讨产前心理指导对分娩方式的影响。方法对梁平县妇幼保健院2012年和2013年同一时段年龄在18～32岁无任何并发症的足月妊娠单胎头位孕妇入院时分别分为对阴道分娩有信心（A组）、对分娩方式无主见（B组）、对阴道分娩无信心要求剖宫产（C组），每组各100例观察其最终分娩方式。结果2012年A组孕妇顺产率为84．00％，B组经过心理疏导的孕妇顺产率为62．00％，C组经过心理疏导勉强接受阴道试产的孕妇顺产率为23．00％；2013年A组孕妇顺产率为86．00％，B组孕妇顺产率达83．00％，C组孕妇顺产率达64．0％。2年同一时段C组经过心理疏导接受阴道试产的产妇顺产率比较，2013年顺产率明显提高，顺产和剖宫产发生率差异有统计学意义（P＜0．05）。结论加强孕期宣传及产前产时心理指导对促进阴道分娩有显著作用，产前适当的心理干预能促进阴道分娩，降低剖宫产率。     

1587例孕妇血清碱性磷酸酶水平观察

目的调查中、晚期孕妇血清碱性磷酸酶（ALP）水平的变化，探讨其正常参考值范围及意义。方法对2008年1～12月到龙川县妇幼保健院保健科行产前检查的中、晚期孕妇的ALP检测结果进行回顾性分析。结果ALP参考范围：中期孕妇为（153．84±18．91）U／L，晚期孕妇为（167．51±16．10）U／L，健康未妊娠妇女为（103．42±16．07）U／L。中、晚期孕妇ALP含量与健康未妊娠妇女比较差异有统计学意义（P〈0．05）。结论ALP水平正常中、晚期孕妇高于健康未妊娠妇女，可以作为孕妇胎盘、胎儿动态观察指标。     

孕期保健对产妇的影响

目的调查研究孕期保健对孕妇的影响及其作用方式。方法以江安县妇幼保健院近5年接诊孕妇为研究对象,将孕妇分为实验组及对照组,实验组孕妇给予孕期保健,未接受孕期保健者设为对照组,综合分析孕期保健对难产率及其相关危险因素如胎儿、产妇体质量,运动锻炼,饮食,心理状况及血糖水平的影响。结果5年间接诊产妇共2695例,实验组2096例,难产236例,难产发病率为11．26％;对照组599例,难产302例,难产发病率为50．42％。实验组胎儿及孕妇体质量较轻,孕妇坚持锻炼、饮食合理、心理稳定、血糖控制良好（P〈0．05）。结论孕期保健有利于孕妇安全分娩。     

2015年某医院儿童呼吸道感染病原学特征分析

目的：比较并分析甘肃省妇幼保健院儿童呼吸道感染常见病原体的检出情况,为临床准确诊断、合理治疗提供依据。方法收集2015年1～12月甘肃省妇幼保健院6032例急性呼吸道感染的患儿标本,采用免疫斑点试验技术检测其血清中6种常见呼吸道病原体早期特异性抗体IgM：腺病毒（ADV）、流感病毒（IV）、副流感病毒（PIV）、呼吸道合胞病毒（RSV）、肺炎支原体（MP）、肺炎衣原体（CP）。分析患儿感染模式,以及不同年龄、季节、性别等感染情况的差异。结果6032例感染的标本中有2279例阳性,阳性率为37．8％。6种呼吸道病原体的阳性率依次为：ADV12．2％、IV9．6％、CP7．9％、MP4．6％、RSV3．0％、PIV0．3％。呼吸道病原体检出率在春、夏季节较高;1～3岁和4～6岁组阳性率高。结论该院儿童呼吸道感染常见病原体以ADV为主,其次是IV,其感染具有明显的季节性;支原体和衣原体也是呼吸道感染常见病原体,主要有MP和CP。     

四所县级综合医院护理管理队伍的现状调查

四所县级综合医院护理管理队伍的现状调查匡学衡，吴光莉广州市辖番禺市、花都市、增城市（均为县级市）及从化县４所县级综合医院，共有病床１４２６张，护理人员７２３人，其中护理管理人员（含护理部主任或总护士长、科护士长、病区护士长）７０人。为了解这４所医院护...     

北京市丰台区孕妇妊娠期运动知识认知情况的调查

目的：了解丰台区孕妇对妊娠期运动的认知情况,通过护理干预后提高孕妇对妊娠期运动重要性的认知,增强孕妇的自我保健意识,为进一步指导孕妇孕期进行科学健康运动提供依据。方法采用便利抽样的方法,选取2013年6-7月在北京市丰台区妇幼保健院产科门诊建档的孕晚期（≥28周）孕妇117名,采用自行设计的妊娠期运动相关知识问卷对孕妇认知情况进行调查。结果117名孕妇妊娠期运动知识得分为0-15分,平均（8．99±1．41）分,平均正确认知率为60．3％;仅13．68％的孕妇经过正规的孕期运动相关知识培训,86．32％的孕妇表示没有参加过相关知识的培训。结论应重视低文化程度孕妇的培训,考虑孕妇的学习与接受能力,进行弹性教学,以取得更好的教学效果。     

妇幼保健院在出生缺陷护理干预中的效果研究

目的探讨妇幼保健院通过对孕妇进行出生缺陷的三级预防，评价其对出生缺陷护理干预的效果。方法回顾性分析2011年1月至2013年1月我市妇幼保健院产妇（及新生儿）1000例的临床病例资料，按照随机的方法，将所有产妇分为观察组与对照组，每组500例，观察组产妇给予全面的孕期指导及对婴儿出生缺陷的三级预防，对照组仅给予常规的普通护理干预。对比分析两组新生儿出生缺陷的发生率。结果观察组新生儿的出生缺陷率达2．0％，500例孕妇中，有400例孕妇接受羊水染色体检查，其中4例出现染色体异常，经B超检查，2例出现神经管缺损，1例出现脑积水，3例出现先天性心脏病，所有异常的产妇均行引产术，引产率达100％。对照组新生儿的出生缺陷率达9．0％，500例孕妇中，有412例孕妇接受羊水染色体检查，其中14例出现染色体异常，经B超检查，13例出现神经管缺损，10例出现脑积水，8例出现先天性心脏病，所有异常的产妇均行引产术，引产率达100％。两组间差异（P〈0．05），两组间差异具有统计学意义。结论整体、全面的孕期指导及对婴儿出生缺陷_的三级预防可有效减少新生儿出生缺陷的概率，优生优育，加强婚前保健和孕期指导及宣传对我国的计划生育国策极为重要。     

专科层次医学教育临床教学质量的影响因素分析与对策

目的探讨专科层次医学教育临床教学质量的影响因素及有效对策。方法对2006-2007年在27所医院实习的268名专科层次医学毕业实习学生和106名带教老师采用问卷法进行调查,对影响临床教学质量的因素进行统计、归纳和分析。结果影响临床教学质量的因素依次为：学生的学习主动性,带教老师的职业素质、带教意识和带教方法,学生的“三基”水平,教学医院的管理水平,实习操作机会,学校管理及院校沟通,学生择业就业,实习管理制度、考核制度,医患关系,教学医院环境条件。结论专科层次医学教育教学质量受到学生、实习医院、学校和社会众多因素的影响。其中主要影响因素是学生的学习主动性“三基”水平,其次是医院因素。     

Hospital Nurses' Perceptions of Patient Teaching

Patient teaching in general hospitals is becoming increasingly important both due to higher patient turnover and the principles of self-care. This study focuses on how hospital nurses describe ideals and realities in teaching adult patients in a general hospital, and how they describe the factors affecting their teaching function. The study has a qualitative approach. Fourteen registered nurses, working in a general hospital, are interviewed. The interviews are semistructured. The four stages adapted from Glaser & Strauss' grounded theory approach are used as a support in the elaboration and the analysis of the data. The study shows that the ideals about patient teaching are rather weakly articulated. The realities are, however, more distinctly described. Empirical findings reveal two different ‘teaching processes’ articulated by the informants. Both processes are novel and different from the traditional teaching process mentioned in the literature. Which processes the nurses are applying in the clinic seem to depend on the objective and content of the patient teaching. This evidence has so far not been reported in previous studies. Regarding the factors affecting their patient teaching, the nurses emphasize the following three; The nurses' qualifications, training in the teaching function and the organizational setting.     

Comparing the demographic data and outcomes of septic shock patients presenting to teaching or non-teaching metropolitan hospitals in the United States

BACKGROUND: Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking. The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States.     

三种类型医院抗精神病药物使用情况比较

目的：比较三种不同类型医院抗精神病药物使用情况，为临床用药提供参考。方法：采用全国精神科药物使用调查表同时对一所教学医院精神科门诊患者94例（13－84岁）、住院患者119例（12－76岁）一所市级精神病院门诊患者95例（17－77岁）、住院患者142例（14－77岁）；和一所区级精神病院门诊患者34例（19－72岁）、住院患者117例（20－70岁）在连续5天内抗精神病药物使用情况进行调查。结果：不同类型医院患者的人口学资料和一般情况有差异；在教学医院，患者的首次入院和诊断抑郁症的比例较高；住院时间较短；非典型抗精神病药的应用比例较其他类型的医院高，以维思通和氯氮平的应用为主；在联合用药方面，联合应用氯氮平的比例最高；在不同类型的医院，典型抗精神病药舒必利的应用比例均居首位。结论：不同类型医院使用抗精神病药物情况不同，教学医院使用非典型抗精神病药的比例较高。     

A qualitative study of factors influencing antimicrobial prescribing by non-consultant hospital doctors

OBJECTIVES: To determine the factors that influence non-consultant hospital doctors (NCHDs) in their decision to prescribe antimicrobial agents. METHODS: A qualitative study using semi-structured interviews centred on a life grid tracking the medical career of 22 NCHDs employed by a university teaching hospital in the west of Ireland. RESULTS: Early in their careers NCHD prescribing is based primarily on the immediate influence of more senior colleagues. Recollection of formalized undergraduate teaching and hospital guidelines are a very minor influence. As their career progressed and they exercise greater autonomy, personal experience becomes the major influence on prescribing decisions. Hospital guidelines are a minor influence. Participants consider that undergraduate teaching needs to be more practical and taught in a way that is easier to apply to on-ward situations and that hospital prescribing guidelines need to be presented in a 'user-friendly' format and adherence to the guidelines needs to be promoted. CONCLUSIONS: The key influences on antimicrobial prescribing by NCHDs are informal. New approaches are required to ensure that formal training and hospital guidelines on antimicrobial prescribing are more influential in shaping antimicrobial prescribing practice.     

THE USE OF NARCOTIC ANALGESICS IN HOSPITAL PRACTICE

A survey on the use of parenteral analgesics was carried out in three teaching hospitals and one non-teaching hospital in the Mersey Region. A comparison of the use of narcotics in one teaching hospital and one non-teaching hospital was carried out over a 5 year period (1972 to 1976). A second comparison of narcotic supply in three teaching hospitals was conducted during the period 1974 to 1976 inclusive. Results indicated that over the 5 year period 73,608 doses were used in teaching hospital A and 49,448 doses in the non-teaching hospital. The synthetic group was used most frequently (52.3% and 62.3% of the total in the teaching and the non-teaching hospital respectively). The most popular individual narcotic was the synthetic analgesic pethidine (44.5% in the teaching hospital and 57.1% in the non-teaching hospital). The majority of the total narcotics were used in the surgical wards, which accounted for 28.0% of all narcotics used in the teaching hospital, where the preferred group was the morphine alkaloids. However, in the non-teaching hospital, the synthetic group was preferred of the 55.5% of the total narcotics used in the surgical wards. Comparing the data over the 3 year period (1974 to 1976) it was found that the total number of doses of parenteral narcotics used in the three teaching hospitals A, B and C was 52300,74,737 and 51,153 respectively. The synthetic group was used most frequently in hospitals A and B (49.2% and 45.7% respectively), whilst the morphine alkaloids were preferred in hospital C (52.7% of the total narcotic use). Pethidine, the synthetic analgesic, was the most popular individual narcotic (42.4%) in hospital A, whilst morphine was preferred in hospital B and C (39.3% and 50.8% respectively). The greatest use of narcotics was in surgical wards, which accounted for 26.5%, 32.1% and 39% of all narcotics used in teaching hospitals A, B and C respectively. In hospitals A and C the main group used in these wards was the morphine alkaloids, but the synthetic group was the most popular in hospital B. This and the previous survey show that pethidine, the synthetic analogue, is the most popular drug in both the Mersey and the West Midland regions. However, morphine (including papaveretum) and diamorphine are also widely used. The pattern of use is influenced by the size of the hospital, the percentage of occupancy of hospital beds, the surgical speciality of the hospital and the prescribing habits of clinicians. In order t o substantiate the present findings, the survey should be carried out in many more regions in the country and over a longer period of time. Studies on factors which influence clinicians' prescribinghabits should be included in future surveys.     

院校融通教学做一体化护理人才培养模式的应用

目的探讨"院校融通,教学做一体化"护理人才培养模式的应用效果。方法选取我校2009级、2010级、2011级本科护理专业学生作为研究对象,在整个培养过程中采用"院校融通、教学做一体化"护理人才培养模式。结果采用"院校融通,教学做一体化"护理人才培养模式后护理人才培养质量提高,护生工作能力增强。结论应用"院校融通,教学做一体化"人才培养模式能增强教学效果,提高护生学生的综合素质,包括创新能力、科研能力、分析解决问题能力、临床操作能力等。     

医院驻点教学模式下高职诊断学教学质量均一性探索研究

目的 探索产教融合的医院驻点教学模式下如何控制高职诊断学教学质量均一性。方法 2017年9月至2019年2月选取江苏卫生健康职业学院临床医学专业2016级、2017级学生开展医院驻点教学。在严格筛选教学医院基础上，同级学生随机分配到2个驻点班（高淳班、昆山班）和校内班里。通过制定院校合作的驻点教学诊断学课程标准、做好医院教师全课程的培训服务工作、充分发挥学生质量控制角色作用、合理运用移动设备和信息化教学手段、校内主导各驻点医院的课程考核这5项具体措施后，对两个年级校内班和驻点班学生考核成绩和教学满意度进行统计分析。结果 同级校内班和各驻点班学生之间的考核成绩差异均无统计学意义（P＞0.05）；同级校内班和各驻点班学生教学满意度差异无统计学意义（P＞0.05）。结论 严格筛选教学医院并做好全课程的教学服务、管理和诊改，在医院驻点教学模式下能够保证高职诊断学教学质量均一性。     

Incidence of 24-hour faculty coverage in teaching EDs

There is growing concern in academic emergency medicine as to the appropriateness of 24-hour faculty coverage in the teaching emergency department. We surveyed 170 teaching emergency departments, 49 of which had approved emergency medicine residencies, asking for information regarding 24-hour faculty coverage. We were able to separate each department into one of 15 profiles based on the two variables of average ED yearly census and hospital type. Seventy-three percent of university teaching hospital EDs and 65% of those with emergency medicine residencies have 24-hour faculty coverage; 83% of private teaching hospital EDs and 100% of those with emergency medicine residencies have 24-hour faculty coverage; and 79% of city/county teaching hospital EDs and 80% of those with emergency medicine residencies have 24-hour faculty coverage.     

Do postoperative complications vary by hospital teaching status?

OBJECTIVE: The purpose of this paper is to assess postoperative patient safety outcomes across teaching and nonteaching hospitals and to examine the relation of hospital and patient factors to patient safety outcomes. RESEARCH DESIGN AND METHODS: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. Patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ) were used to identify 6 postoperative PSIs. The study sample consisted of 646 acute care hospitals, divided into nonteaching (n = 400), minor teaching (n = 207), and major teaching hospitals (n = 39). The unit of analysis was the patient. Associations between hospital teaching status and patient and hospital characteristics were determined using one-way analysis of variance and Pearson chi test. Multivariable analysis using generalized estimating equation regression models assessed the relationship between teaching status and PSIs. RESULTS: Bivariate results showed higher observed PSI rates at major teaching hospitals. Results from multivariable analyses, after adjusting for hospital size, staffing variables, patient case mix, and other risk factors, showed that major teaching hospitals had significantly higher odds of postoperative pulmonary embolism or deep vein thrombosis and postoperative sepsis, lower odds of postoperative respiratory failure, and showed no difference for postoperative hip fracture, postoperative hematoma or hemorrhage, and postoperative physio-metabolic derangement. CONCLUSIONS: The present analysis found an inconsistent relationship between teaching status and postoperative patient safety event rates. Teaching status of the hospital was associated with numerous hospital and patient characteristics which mediate the relationship between teaching status and PSIs.