Teaching hospital

教学医院
  • 文章类型: Journal Article
    医护人员面临尖锐和针刺伤害的重大风险,这会增加传播乙型肝炎等疾病的可能性,丙型肝炎,和艾滋病毒。目前,在埃塞俄比亚南部的医院中,没有关于针刺和锐器伤(NSSI)的患病率或影响因素的可用信息.
    这项研究旨在评估BHUTH医护人员的针刺和锐器伤害,埃塞俄比亚南部。
    该研究是2023年10月在一家机构进行的横断面研究,随机选择了164名参与者。使用自我管理的问卷来收集有关社会人口统计学因素和暴露状况的信息。使用Epi-Data和SPSS输入和分析数据。通过二元和多变量逻辑回归分析确定危险因素。P值小于0.05被认为有统计学意义。
    在过去12个月中,至少一次针刺和锐器伤的总患病率为46.4%(95%CI为39.3%至53.6%)。45.8%的伤害是由于注射器针头造成的。针重述等因素(AOR=3.73,95%CI:1.07-12.19),用两只手(AOR=2.78,95%CI:1.36-10.02),每周工作40小时(AOR=2.18,95%CI:0.98-6.86),缺乏职业安全实践培训(AOR=4.01,95%CI:2.60-9.91),是与针刺和锐器伤患病率显着相关的因素。
    这项研究发现,近一半的受访者在前一年至少经历过一次尖锐的针刺和受伤;然而,研究区域的NSSI量仍然很高。医护人员应该接受在职培训,医院高管应该留出时间讨论如何解决问题。
    UNASSIGNED: Healthcare workers face a significant risk of sharp and needle-stick injuries, which can increase the likelihood of spreading illnesses like hepatitis B, hepatitis C, and HIV. Currently, there is no available information on the prevalence or contributing factors of needle sticks and sharp injuries (NSSI) in hospitals in southern Ethiopia.
    UNASSIGNED: This study aimed to assess the needle sticks and sharp injuries among health care workers at the BHUTH, Southern Ethiopia.
    UNASSIGNED: The study was a cross-sectional study conducted at an institution in October 2023, with 164 randomly selected participants. A self-administered questionnaire was used to gather information on sociodemographic factors and exposure status. The data was entered and analyzed using Epi-Data and SPSS. The risk factors were identified by binary and multivariate logistic regression analyses. A P-value less than .05 was considered statistical significance.
    UNASSIGNED: The overall prevalence of at least one Needle sticks and sharp injuries in the last 12 months was 46.4% (95% CI of 39.3% to 53.6%). The majority of injuries 45.8% were due to the syringe needle. Factors such as needle recap (AOR = 3.73, 95% CI: 1.07-12.19), Recapping with two hands (AOR = 2.78, 95% CI: 1.36-10.02), working 40 hours per week (AOR = 2.18, 95% CI: 0.98-6.86), and lack of training in occupational safety practices (AOR = 4.01, 95% CI: 2.60-9.91), were factors significantly associated with the prevalence of needle stick and sharp injuries.
    UNASSIGNED: This study found that nearly half of the respondents experienced a sharp needle poke and injury at least once in the previous year; however, the volume of NSSI remains high in the study area. Healthcare workers should receive on-the-job training, and hospital executives should set aside time for discussions on how to solve the problem.
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  • 文章类型: Journal Article
    对静脉输液治疗的认识不足是导致住院患者发病率和死亡率的重大挑战。护士在评估患者的液体和电解质平衡以及恢复液体水平方面发挥着关键作用。各种研究表明,护士对静脉治疗的知识不足,然而,这在许多环境中仍然没有得到充分研究,包括纳米比亚。
    评估纳米比亚一家教学医院护士对静脉输液治疗的知识,并描述与静脉输液治疗知识相关的变量。
    一项横断面在线调查,涉及164名护士,他们是使用总人口抽样招募的。数据是在2021年9月至11月之间收集的,使用自我管理的14项验证工具(α=0.8)。采用SPSSv28.0软件进行数据分析。
    这项研究中的大多数护士(84%)表现出关于静脉治疗的知识水平不足,只有少数人(16%)对静脉输液治疗有适度的了解。教育资格与静脉治疗知识之间存在显着正相关(r=0.21;p=0.01)。
    这项研究的结果表明,护士对静脉治疗知识的了解有一个令人担忧的轨迹。这些发现强调了医院需要为护士建立全面的培训计划,以确保提供安全有效的静脉治疗。需要更多的研究来调查教育资格如何影响患者与静脉治疗相关的结果。
    UNASSIGNED: Insufficient knowledge of intravenous fluid therapy is a significant challenge contributing to morbidity and mortality in hospitalized patients. Nurses play a critical role in evaluating patients\' fluid and electrolyte balance as well as in restoring fluid levels. Various studies have indicated a deficiency in nurses\' knowledge of intravenous therapy, yet this remains understudied in many settings, including Namibia.
    UNASSIGNED: To assess nurses\' knowledge of intravenous fluid therapy and to describe the variables associated with knowledge of intravenous fluid therapy at a teaching hospital in Namibia.
    UNASSIGNED: A cross-sectional online survey involving 164 nurses who were recruited using total population sampling. Data were collected between September and November 2021, using a self-administered 14-item validated tool (α = 0.8). Data analysis was conducted using SPSSv28.0 software.
    UNASSIGNED: The majority of nurses (84%) in this study exhibited an insufficient level of knowledge regarding intravenous therapy, with only a minority (16%) demonstrating a moderately adequate understanding of intravenous fluid therapy. A significant positive correlation was found between educational qualification and knowledge of intravenous therapy (r = 0.21; p = .01).
    UNASSIGNED: The study\'s results indicate a worrying trajectory in nurses\' knowledge of intravenous therapy. These findings underscore the need for hospitals to establish comprehensive training programs for nurses to guarantee the provision of secure and efficient intravenous therapy. Additional research is needed to investigate how educational qualifications impact patient outcomes related to intravenous therapy.
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  • 文章类型: Journal Article
    使用三角测量工具评估乳腺癌(BC)患者的生活质量(QoL)对于了解他们的健康状况和定制特定干预措施以改善他们的整体体验至关重要。该研究使用通用和疾病特异性验证问卷的组合来评估BC患者的QoL。该研究在尼日利亚教学医院的肿瘤学诊所就诊的BC患者中使用了基于自我管理问卷的横断面设计。向同意的合格受访者提供了23项EORTC-BR23问卷和15项HRQoL15D问卷,以进行数据收集。描述性(例如,频率,百分比,意思是,中位数,等。)和对清洗后的数据进行推断(T检验和单因素方差分析)统计分析,显著的p值设置为小于0.05。共有60名女性BC患者参与该研究。年龄在41-50岁和50-60岁的受访者分别为20(33.3%)和19(31.7%)。在研究前一年被诊断为BC的患者为22例(39.3%),其中51例(85%)报告无阳性BC家族史。接受过手术的病人,放射治疗,激素治疗,化疗52例(86.7%),27(45.0%),14(24.1%),和54(90%)。患者对未来观点和身体形象的评分为30.00±4.67%和72.36±2.93%,分别,在EORTC-BR23的功能量表中,最大可能得分为100%。在症状量表上,他们在治疗副作用和脱发方面得分47.46±2.52%和63.40±5.03%,分别。15-D工具中患者的生活质量效用评分为0.79±0.02。p值小于0.005,年龄,自诊断以来的时间,和癌症分期是影响患者生活质量的决定因素。基于HRQoL-15D的参与者的QoL被确定为高。对于EORTC-BR23,受访者报告说,身体形象和性功能的生活质量很高,但就功能量表而言,性享受和未来前景的生活质量都很低。EORTC-BR23的症状量表仅在脱发引起的不适领域显示出高症状,导致QoL低。影响BC患者QoL的社会人口统计学因素是年龄,自BC诊断以来的年数和分期。
    Assessing the quality of life (QoL) of breast cancer (BC) patients using a triangulation of tools is crucial for understanding their well-being and tailoring specific interventions to improve their overall experience. The study assessed the QoL of BC patients using a combination of generic and disease-specific validated questionnaires. The study utilized a self-administered questionnaire-based cross-sectional design among BC patients attending the Oncology clinic in a Nigerian teaching hospital. The 23-item EORTC-BR23 questionnaire and the 15-item HRQoL 15D questionnaire were provided to consenting eligible respondents for data collection. Descriptive (e.g., frequency, percentages, mean, median, etc.) and inferential (T-test and one-way ANOVA) statistical analyses were conducted on the cleaned data, with significant p values set at less than 0.05. A total of 60 female BC patients participated in the study. Respondents that were aged 41-50 years and 50-60 years were 20 (33.3%) and 19 (31.7%) respectively. Patients who were diagnosed with BC one year ago before the study were 22 (39.3%) with 51 (85%) reporting no positive family history of BC. Patients who had undergone surgery, radiotherapy, hormonal therapy, and chemotherapy were 52 (86.7%), 27 (45.0%), 14 (24.1%), and 54 (90%) respectively. The patients scored 30.00 ± 4.67% and 72.36 ± 2.93% for future perspective and body image, respectively, in the functional scales of the EORTC-BR23 with a maximum possible score of 100%. On the symptom scale, they scored 47.46 ± 2.52% and 63.40 ± 5.03% for side effects of therapy and being upset about hair loss, respectively. The patients\' quality of life utility score in the 15-D tool was 0.79 ± 0.02. With p values less than 0.005, age, time since diagnosis, and cancer stage were influential determinants of patients\' QoL. The QoL of the participants based on the HRQoL-15D was determined to be high. For the EORTC-BR23, respondents reported high quality of life for body image and sexual function but low quality of life for both sexual enjoyment and future perspective in terms of the functional scale. The symptom scale of EORTC-BR23 showed high symptoms for only the domain of upset by hair loss resulting in low QoL. Socio-demographic factor that affects the QoL of BC patients were age, number of years since diagnosis and stage of BC.
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  • 文章类型: Journal Article
    全球范围内的医护人员遭受工作场所暴力的风险增加。身体伤害等不良影响,降低了对患者的护理质量,降低了生产率,并给雇主带来了相关的成本。不报告妨碍了有效预防的实施。这项研究旨在评估患病率,不报告工作场所暴力的原因,以及在研究地点设计干预策略之前的预防知识,在这个问题上缺乏研究。
    这项横断面研究是在阿巴卡利基的教学医院进行的,Ebonyi州,2020年,205名员工为期4周。医院被分层为临床,护理服务,药房,实验室,和行政区划;按比例分配和随机抽样用于选择分配的样本。使用结构化问卷收集数据。描述性统计确定了中心趋势和分散的衡量标准,而变量的双变量分析采用Pearson卡方检验。统计学显著性设定为p≤0.05,置信水平为95%。
    参与者的平均年龄为39.1±7.8岁。工作场所暴力的发生率为70%。不报告的最常见原因是报告程序的复杂性和耗时(26.5%),其次是对职业报复的恐惧(22.4%)。对工作场所暴力预防策略具有良好知识的受访者比例很高(69.8%)。性别(p=0.03),工作设置(p=0.006),以前的工作场所暴力培训(p=0.005)和工作场所暴力预防策略知识(p=0.04)与工作场所暴力经历有统计学意义的关联.
    工作场所暴力的高流行率表明,需要一个工作场所暴力预防计划,该计划应包括一个简单的报告和培训过程。以前的培训提高了认识,这可能是与工作场所暴力密切相关的原因。
    UNASSIGNED: Healthcare workers globally are at an increased risk of workplace violence. Adverse effects such as physical injury, reduced quality of care to patients and lower productivity with associated costs to employers occur. Non-reporting hinders the implementation of effective prevention. This study aimed to assess the prevalence, reasons for non-reporting of workplace violence, and knowledge of prevention prior to designing intervention strategies in the study location where there is a paucity of research on this issue.
    UNASSIGNED: This cross-sectional study was conducted at a Teaching Hospital in Abakaliki, Ebonyi State, for 4 weeks in 2020 among 205 employees. The hospital was stratified into Clinical, Nursing Services, Pharmacy, Laboratory, and administrative divisions; proportionate allocation and random sampling were used to select the allocated samples. A structured questionnaire was used to collect data. Descriptive statistics determined the measures of central tendencies and dispersion, while bivariate analysis of the variables was done using Pearson\'s Chi-Square test. Statistical significance was set at p ≤ 0.05 with a confidence level of 95%.
    UNASSIGNED: The mean age of the participants was 39.1 ± 7.8 years. The prevalence of workplace violence was 70%. The most common reason for non-reporting was complexities and time-consuming reporting procedures (26.5%) followed by fear of reprisal on career (22.4%). The proportion of respondents with good knowledge of workplace violence prevention strategies was high (69.8%). Gender (p = 0.03), work setting (p = 0.006), previous workplace violence training (p = 0.005) and knowledge of workplace violence preventive strategies (p = 0.04) had statistically significant associations with experience of workplace violence.
    UNASSIGNED: The high prevalence of workplace violence suggests a need for a workplace violence prevention program which should include a simple process of reporting and training. The improved awareness from previous training may account for the significant association with workplace violence.
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  • 文章类型: Journal Article
    背景:低收入和中等收入国家的研究成果和作者身份存在巨大差距。研究传播事件有可能通过知识转移来帮助弥合这一差距,机构合作,和利益相关者的参与。这些事件也可能对临床服务交付和政策制定产生影响。卢旺达国王费萨尔医院(KFH)是位于基加利的三级教学医院,卢旺达。加强其研究传播,KFH举行了首届研究日(RD)来传播其研究活动,表彰KFH的工作人员和学生研究人员,定义医院的研究议程,并在KFH和卢旺达促进研究文化。
    方法:RD由KFH的临床和非临床工作人员组成的跨学科委员会协调。鼓励研究人员将他们的研究传播到所有学科。使用加权标题对摘要进行盲目审查,并按总分进行排名。顶尖的研究人员也因他们的工作而获奖和认可,公平和包容是研发规划的最前沿。
    结果:RD有来自KFH和其他公众的100多名与会者,私人,和学术机构。摘要征集中提交了47份摘要,研究癌症(17.02%)和性健康和生殖健康(10.64%)的比例最高。37名研究人员提交了摘要,大部分主要调查人员是医生(35.14%),专职医疗专业人员(27.03%),以及护士和助产士(16.22%)。此外,30%的主要调查人员是女性,其中护士和助产士比例最高(36.36%)。
    结论:RD是在医院环境中传播研究的有效方法。RD有可能加强该机构的研究议程,让社区参与正在进行的项目,并为研究人员提供内容领域支持。公平和包容应该是研究传播的前沿,包括性别平等,作者代表,并纳入跨学科卫生专业人员。利益相关者的参与也可以用来加强机构研究合作,以产生更大的影响。
    BACKGROUND: There are significant gaps in research output and authorship in low- and middle-income countries. Research dissemination events have the potential to help bridge this gap through knowledge transfer, institutional collaboration, and stakeholder engagement. These events may also have an impact on both clinical service delivery and policy development. King Faisal Hospital Rwanda (KFH) is a tertiary-level teaching hospital located in Kigali, Rwanda. To strengthen its research dissemination, KFH conducted an inaugural Research Day (RD) to disseminate its research activities, recognize staff and student researchers at KFH, define a research agenda for the hospital, and promote a culture of research both at KFH and in Rwanda.
    METHODS: RD was coordinated by an interdisciplinary committee of clinical and non-clinical staff at KFH. Researchers were encouraged to disseminate their research across all disciplines. Abstracts were blind reviewed using a weighted rubric and ranked by overall score. Top researchers were also awarded and recognized for their work, and equity and inclusion was at the forefront of RD programming.
    RESULTS: RD had over 100 attendees from KFH and other public, private, and academic institutions. Forty-seven abstracts were submitted from the call for abstracts, with the highest proportion studying cancer (17.02%) and sexual and reproductive health (10.64%). Thirty-seven researchers submitted abstracts, and most of the principal investigators were medical doctors (35.14%), allied health professionals (27.03%), and nurses and midwives (16.22%). Furthermore, 30% of principal investigators were female, with the highest proportion of them being nurses and midwives (36.36%).
    CONCLUSIONS: RD is an effective way to disseminate research in a hospital setting. RD has the potential to strengthen the institution\'s research agenda, engage the community in ongoing projects, and provide content-area support to researchers. Equity and inclusion should be at the forefront of research dissemination, including gender equity, authorship representation, and the inclusion of interdisciplinary health professionals. Stakeholder engagement can also be utilized to strengthen institutional research collaboration for greater impact.
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  • 文章类型: Journal Article
    背景:斯里兰卡妊娠期糖尿病(GDM)的患病率为5.5%至11.5%。它与孕产妇和围产期并发症有关,强调早期筛查和干预的必要性。本研究旨在确定妊娠早期血脂和空腹血糖对GDM的预测作用。
    方法:这是一项前瞻性队列研究,对贾夫纳一家三级医院的172名孕妇进行了产前检查,斯里兰卡。预测是通过计算多变量逻辑回归中的比值比(ORs)和95%置信区间(CIs)得出的,评估脂质和葡萄糖对GDM风险的影响。
    结果:该研究包括172名参与者(平均年龄:29.84±5.38)。GDM的患病率为16.9%,57.14%的母亲肥胖。在首次就诊和24-28周之间观察到空腹血糖(FPG)值的显着差异。GDM母亲的总胆固醇和低密度脂蛋白(LDL)水平升高。在评估点(POA),甘油三酯(TG)水平与FPG显着相关,鉴定0.945mmol/L的截止值,具有75%的灵敏度和77.1%的特异性。Logistic回归证实了显著的TG-GDM关系。在妊娠早期测量的FPG水平与以后发展为GDM的可能性之间存在关联。具体来说,当妊娠早期FPG水平超过3.94mmol/L的临界值时,GDM的风险增加,OR为3.81。结论:妊娠早期FPG和TG水平是预测GDM的潜在标志物。FPG显示出比TG更高的预测功效。总胆固醇,LDL,高密度脂蛋白(HDL)缺乏预测能力。
    BACKGROUND: Gestational diabetes mellitus\'s (GDM\'s) prevalence in Sri Lanka ranges from 5.5% to 11.5%. It is associated with maternal and perinatal complications, emphasizing the need for early screening and intervention. This study aims to determine the predictive effect of early pregnancy lipid profile and fasting plasma glucose for GDM.
    METHODS: It is a prospective cohort study of 172 pregnant women attending antenatal clinics at a tertiary hospital in Jaffna, Sri Lanka. Prediction was derived by calculating odds ratios (ORs) and 95% confidence intervals (CIs) in multivariable logistic regression, assessing lipid and glucose effects on GDM risk.
    RESULTS: The study included 172 participants (mean age: 29.84±5.38). GDM\'s prevalence was 16.9%, and 57.14% of these mothers were obese. Significant differences in fasting plasma glucose (FPG) values were observed between the first visit and at 24-28 weeks. GDM mothers showed elevated total cholesterol and low-density lipoprotein (LDL) levels. Triglyceride (TG) levels correlated significantly with FPG at the Point of Assessment (POA), identifying a 0.945 mmol/L cutoff with 75% sensitivity and 77.1% specificity. Logistic regression confirmed a significant TG-GDM relationship. There is an association between FPG levels measured in early pregnancy and the likelihood of developing GDM later on. Specifically, when FPG levels in early pregnancy surpass a cutoff value of 3.94 mmol/L, there is an increased risk of GDM, indicated by an OR of 3.81 Conclusion: Early pregnancy FPG and TG levels are potential markers for predicting GDM. FPG shows higher predictive efficacy than TG. Total cholesterol, LDL, and high-density lipoprotein (HDL) lack predictive ability.
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  • 文章类型: Journal Article
    背景:风湿性疾病会严重影响儿童的整体健康,发展,和增长。然而,由于缺乏资源,在许多非洲国家,小儿风湿病在很大程度上是不发达的专业。患有风湿性疾病的儿童在获得专门医疗护理方面面临障碍,包括缺乏专家,护理中心,药物接入,以及有限的研究和教育,以增加医疗保健从业者对小儿风湿性疾病的理解。这项研究描述了疾病的特点,患病率,以及在阿克拉的教学医院接受护理的小儿风湿性疾病患者所面临的挑战,加纳。
    方法:对2011年1月至2021年12月在KorleBu教学医院风湿病诊所就诊的所有儿科病例进行了一项基于记录的回顾性研究。收集的数据包括临床特征,疾病表现的实验室发现,根据标准指南和经验规定的治疗方案。
    结果:截至2021年,共确定121例,点患病率为0.0011%。大多数(73%)是女性,平均年龄为13.4±3.2岁。患者在成功转诊至风湿病学家之前经历的平均症状持续时间为18个月。转诊诊断和确诊诊断之间存在显着差异,特别是在涉及混合性结缔组织疾病(MCTD)的病例中,系统性红斑狼疮(SLE),和青少年皮肌炎(JDM),这表明这些条件可能被低估了。关节痛和关节炎是最常见的症状。研究的病例中有四分之三以上(86.8%)接受了类固醇(口服或静脉注射)治疗。在需要免疫抑制治疗的病例中,在33.9%的病例中,甲氨蝶呤是最常用的处方。死亡率为8.3%,大多数涉及SLE病例。大多数(95.7%)的主要护理人员对成人风湿病诊所接受的护理表示了积极的经验。
    结论:小儿风湿性疾病(PRD)患者的诊断和诊断准确性明显延迟。这凸显了加强非洲儿科风湿病服务的迫切需要,包括提高公众和医疗保健提供者对这些疾病的认识,以改善患有这些疾病的儿童的早期诊断和生活质量。
    BACKGROUND: Rheumatic diseases can seriously impact children\'s general health, development, and growth. However, due to a lack of resources, paediatric rheumatology is a largely underdeveloped speciality in many African nations. Children with rheumatic disorders face obstacles in accessing specialized medical care, including lack of specialists, care centres, medication access, and limited research and education to increase understanding of paediatric rheumatic disease among healthcare practitioners. This study described the disease characteristics, prevalence, and challenges faced by paediatric rheumatic disease patients receiving care at a teaching hospital in Accra, Ghana.
    METHODS: A retrospective record-based study was conducted among all paediatric cases presenting to the rheumatology clinic of the Korle Bu Teaching Hospital (KBTH) from January 2011 to December 2021. Data collected include clinical features, laboratory findings at disease presentation, andtherapeutic regimens prescribed per standard guidelines and experiences.
    RESULTS: A total of 121 cases were identified as of 2021, indicating a point prevalence of 0.0011%. The majority (73%) were females with a mean age of 13.4 ± 3.2 years. The mean duration of symptoms in months experienced by patients before being successfully referred to a rheumatologist was 18 months. There were significant differences between referred and confirmed diagnoses, especially in cases involving mixed connective tissue diseases (MCTD), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), suggesting that these conditions may be under-recognised. Arthralgia and arthritis were the most common presenting symptoms. More than three-quarters (86.8%) of the cases studied were treated with steroids (oral or intravenous). In cases requiring immunosuppressive therapy, methotrexate was the most commonly prescribed in 33.9% of instances. Mortality was recorded at 8.3%, with the majority involving SLE cases. Most (95.7%) of the primary caregivers expressed positive experiences regarding care received at the adult rheumatology clinic.
    CONCLUSIONS: There were significant delays in diagnosis and diagnostic accuracy for patients with paediatric rheumatic disease (PRD). This highlights the pressing need for strengthening paediatric rheumatology services in Africa, including increasing awareness about these conditions among the public and healthcare providers to improve early diagnosis and quality of life for children with these conditions.
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  • 文章类型: Observational Study
    背景:不适当的抗生素使用导致了全球抗生素耐药性的上升,在低收入和中等收入国家,包括印度。尽管手术部位感染的风险相当大,印度缺乏抗生素处方指南和关于外科部门抗生素处方的长期研究。因此,本研究旨在分析印度中部两家三级医院的外科部门10年抗生素处方趋势。
    方法:前瞻性收集了2008年至2017年在教学(TH-15,016)和非教学医院(NTH-14,499)的手术住院患者的数据。根据世界卫生组织(WHO)获取观察储备系统对抗生素进行分类,并根据诊断和遵守印度国家基本药物清单(NLEMI)和世卫组织基本药物模式清单(WHOMLEM)进行分析。总抗生素使用按DDD/1000患者天数计算。通过多项式和线性回归分析抗生素处方的时间趋势。
    结果:最常见的手术适应症是腹股沟疝(TH-12%)以及肾脏和输尿管结石(NTH-13%)。处方最多的抗生素是氟喹诺酮类(TH-20%)和第三代头孢菌素类(NTH-41%),作为抗生素预防,诺氟沙星(TH-19%)和头孢曲松(NTH-24%)。TH中主要开有访问抗生素(57%),NTH中主要开有观察抗生素(66%)。很少进行培养和药敏试验(TH-2%;NTH-1%)。坚持NLEMI(TH-80%;NTH-69%)高于坚持WHOMLEM(TH-77%;NTH-66%)。NTH的平均DDD/1000患者天数比TH高两倍(185vs90)。直到2012年,TH(β1=13.7)和NTH(β2=0.96)的总体抗生素处方显着增加,直到2014年,此后下降(TH,β2=-0.01;NTH,β3=-0.0005)。两家医院的观察抗生素使用比例显著增加(TH,β=0.16;NTH,β=0.96)。
    结论:在过去的三年(NTH)和五年(TH)中,抗生素的使用总量有所下降,而两家医院的观察抗生素消费量在10年内都有所增加。围手术期抗生素预防的选择通常是不合适的,抗生素处方大多是经验性的。这项研究的结果证实了抗生素处方指南和实施抗菌药物管理计划的必要性。
    BACKGROUND: Inappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years\' antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India.
    METHODS: Data was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions.
    RESULTS: The most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3rd generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (β1 =13.7) until 2012, and in the NTH (β2 =0.96) until 2014, and after that decreased (TH, β2= -0.01; NTH, β3= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, β=0.16; NTH, β=0.96).
    CONCLUSIONS: Total antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs.
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  • 文章类型: Journal Article
    目的:本研究旨在探讨护士压疮风险评估量表实施的障碍。
    方法:定性描述性现象学研究。
    方法:研究参与者由10名护士组成,他们来自纳米比亚东北部一家教学医院的各个内科和外科部门。数据是在2022年8月至9月之间通过深入收集的,半结构化面对面的个人访谈,并使用Colaizzi的7步方法进行分析。
    结果:对护士的访谈,导致发现两个主要主题:(1)阻碍有效预防压疮的因素;(2)改善风险评估量表使用的建议。与会者指出,他们对正式的风险评估量表了解不足;资源不足,人员不足;没有关于压疮管理的政策或准则,所有这些都影响了他们对压力风险评估量表的使用。教育和培训,提供设备,因此,雇用新员工和制定政策/准则将提高护士对量表的利用率。
    结论:这项研究的结果揭示了对护士使用风险评估量表有不利影响的三个主要因素,这是他们缺乏压疮风险评估量表的知识;人员和设备短缺;以及缺乏政策/指南。这项研究的结果为指导旨在提高纳米比亚和其他资源有限环境中的护理标准的质量改进计划提供了宝贵的启示。
    OBJECTIVE: The aim of the study was to explore nurses\' barriers to the pressure ulcer risk assessment scales implementation.
    METHODS: A qualitative descriptive phenomenological study.
    METHODS: The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi\'s 7-step method.
    RESULTS: The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses\' utilization of the scales.
    CONCLUSIONS: The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.
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  • 文章类型: Journal Article
    背景:转移性前列腺癌(MPC)的脊髓压迫(SCC)是一种严重的并发症,多种因素会影响最佳治疗策略。我们调查了美国教学医院(TH)和非教学医院(NTH)之间的实践模式差异。
    方法:使用国家住院患者样本数据库(NIS),我们对2016年至2020年美国MPC和SCC住院情况进行了回顾性研究.我们比较了人口因素,合并症,治疗方式,住院时间,财政支出,和死亡率在TH和NTH之间。我们还根据患者选择的治疗策略检查了患者的TH和NTH的特征和结果。
    结果:我们确定了11,380例转移性前列腺癌和SCC入院;TH为9610,NTH为1770。TH的平均住院费用为21,922美元,NTH为15,141美元。尽管两组的中位年龄和Charlson合并症评分没有差异,与NTH相比,TH患者更有可能接受干预(放射或手术)(手术:TH患者占28.2%NTH和辐射为23.0%:TH为12.1%在NTH中为8.2%)。TH的死亡率低于NTH(4.5%vs.7.9%)。在TH和NTH,私人保险患者接受手术的比例更高(TH:手术25.1%vs.辐射18.8%和NTH:手术27.0%与6.9%)。在TH中,黑人患者比手术更有可能接受放射治疗(34.2%vs.26.8%)。
    结论:这项研究表明,与NTH相比,在TH接受手术干预的患者比例更高。此外,保险类型和种族背景与独特的治疗方法相关.
    BACKGROUND: Spinal cord compression (SCC) in metastatic prostate cancer (MPC) is a critical complication and multiple factors influence the optimal therapeutic strategy. We investigated the differences in practice patterns between teaching hospitals (TH) and non-teaching hospitals (NTH) across the United States.
    METHODS: Using the National Inpatient Sample Database (NIS), we performed a retrospective study on hospitalizations with MPC and SCC between 2016 and 2020 in US. We compared demographic factors, comorbidities, treatment modalities, duration of hospitalization, financial expenditures, and mortality between TH and NTH. We also examined the patients\' characteristics and outcomes in TH and NTH based on their chosen therapeutic strategy.
    RESULTS: We identified 11,380 admissions with metastatic prostate cancer and SCC; 9610 in TH and 1770 in NTH. The median cost of hospitalization was $21,922 in TH and $15,141 in NTH. Although the median age and Charlson comorbidity score did not differ between two groups, patients in TH were more likely to receive intervention (radiation or surgery) compared to NTH (Surgery: 28.2% in TH vs. 23.0% in NTH & Radiation: 12.1% in TH vs. 8.2% in NTH). Mortality was lower in TH than NTH (4.5% vs. 7.9%). In both TH and NTH, a higher proportion of patients with private insurance underwent surgery (TH: Surgery 25.1% vs. Radiation 18.8% & NTH: Surgery 27.0% vs. 6.9%). Black patients were more likely to receive radiation than surgery in TH (34.2% vs. 26.8%).
    CONCLUSIONS: This study showed a greater percentage of patients underwent surgical intervention at TH compared to NTH. Additionally, the type of insurance and racial background were associated with distinctive treatment approaches.
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