加强重点环节管理 提升医院感染控制质量

目的分析如何加强医院重点环节感染管理,探索预防和控制医院重点环节感染的有效措施。方法将某医院分为常规管理和重点环节管理两个阶段,将两个阶段的患者分为A组和B组,在重点环节管理阶段通过宣传教育及完善规章制度及考核方式,紧抓医院重点部门和环节中的感染预防与控制,针对医院特殊时期、特殊事件、重点人群关键预防和处理。进行相应的感染预防和控制3个月后,分别对A、B两组患者的院内感染率进行统计比较。结果 A组孕产妇感染4例,新生儿感染6例,手术感染6例,其他治疗感染0例,总感染率1.57%;B组孕产妇感染63例,新生儿感染75例,手术感染56例,其他治疗感染58例,总感染率24.71%。A组采用重点环节感染管理的效果明显优于B组,P<0.05,差异有统计学意义。结论完善医院对感染预防和控制的规章制度,加强对各部门、各环节及医务人员感染防控的考核,全面提升医务人员感染防控意识和防控技术是有效管控医院感染的主要方法和途径。     

中西医结合防治小儿反复呼吸道感染临床观察

目的对采用中西医结合疗法针对小儿反复呼吸道感染的预防和临床治疗效果进行分析。方法对本医院收治的60例患有小儿反复呼吸道感染的患者临床资料进行回顾性分析与总结。将其分为对照组与治疗组,治疗组采用中西医结合的方法,对照组采用西医进行治疗。结果中西医结合的方法很大程度上提高了小儿反复呼吸道感染的治疗效果,也从很大程度上预防和控制了小儿反复呼吸道感染的发生。结论中西医结合的方法是一种针对小儿反复呼吸道感染的预防和治疗的较为有效和科学的方法,用于预防和治疗小儿反复呼吸道感染。     

老年糖尿病患者烧伤后的综合护理

目的探讨老年糖尿病患者烧伤治疗的综合护理措施与效果。方法根据老年糖尿病患者临床特点及烧伤后创面易感染、愈合能力低下等因素,对51例老年糖尿病患者烧伤后在治疗的同时积极做好全方位综合护理和出院指导。结果非手术治疗治愈46例,经手术治疗治愈5例,治疗期间空腹血糖控制在7~9 mmol/L。结论严格控制血糖与感染的全方位综合护理,是老年糖尿病烧伤患者预防感染、促进愈合的关键。     

ICU老年肺部感染患者的临床特征及预防分析

目的探讨 ICU 老年肺部感染的临床特征以及对其的有效预防分析研究。方法从我院抽样选择2009年11月～2012年7月诊治的ICU老年肺部感染患者64例，对这些患者均采用回顾性的历史病况研究。结果64例患者通过我院专业医师的合理医治，痊愈的患者高达53例（占总数的82.81%），感染得到缓解的患者7例（占总数的10.94%），感染恶化的患者3例（占总数的4.69%），感染死亡的患者1例（占总数的1.56%）。结论通过分析可知，掌握ICU老年肺部感染的临床特征是相当有其必要，能够为日后的治疗及其预防起到极其重要的作用。     

脑梗死合并肺部感染临床分析

目的分析探讨急性脑梗死合并肺部感染的危险因素,以便积极预防及治疗,提高疗效,降低死亡风险。方法回顾性分析2006年12月～2013年8月本院收治的180例急性脑梗死患者,分为肺部感染组90例和非感染组90例,对相关危险因素进行对照分析。结果肺部感染组合并吞咽困难、意识障碍、大面积脑梗死以及慢性阻塞性肺疾病、冠心病、糖尿病等基础疾病较非感染组明显升高。结论年龄、COPD病史、吞咽困难、意识障碍、大面积脑梗死以及基础疾病冠心病、糖尿病是脑梗死合并肺部感染的危险因素,临床应高度重视,并积极预防及治疗。     

肾内科住院患者抗菌药物应用临床分析

目的：探讨肾内科住院患者应用抗菌药物的具体情况,提升药物的临床治疗效果。方法选取舒兰矿业（集团）总医院2012年5月至2014年5月在肾内科住院的550例患者,对其应用抗菌药物的情况进行分析。结果550例患者在住院期间应用抗菌药物的比例达到79.3%（436/550）,其中治疗性用药196例,预防性用药198例,预防+治疗联合用药42例;对196例治疗性应用抗生素的患者出现感染部位分析发现,尿路感染102例,呼吸道感染50例,皮肤感染及深静脉留置导管感染20例;对436例应用抗菌药物治疗的患者进行用药评价,220（50.5%）例用药合理,174例（39.9%）基本合理,42例（9.6%）不合理。结论通过对肾内科住院患者应用抗菌药物进行分析,促使抗菌药物应用更加合理、安全、有效和经济。     

急性化脓性阑尾炎切口感染分析

目的分析与探讨急性化脓性阑尾炎切口感染的发生原因及防治办法。方法选取本院2009年7月至2011年7月期间收治的急性化脓性阑尾炎患者共66例,对其临床资料进行回顾性分析发现其中共4例患者发生切口感染,分析与探讨其感染原因与防治方法。结果发生切口感染的患者其中1例为高龄患者,2例患者具有慢性疾病,1例患者因医疗操作过程中消毒不严谨造成感染。结论在进行急性化脓性阑尾炎手术治疗的过程中,需严格进行消毒,防止切口感染,除此之外,对感染高危人群要采取相应的措施进行预防,以降低并发症的发生。     

骨科老年患者预防压疮的护理分析

目的观察骨科手术后患者出现压疮的临床症状,探讨对压疮的防御措施以及护理方法。方法选择我院骨科术后的老年患者143例,进行回顾性研究,将未进行预防压疮系统护理的41例患者分为OG组,将进行预防压疮系统护理的102患者分为TG组。比较两组患者出现压疮以及治疗状况。结果 TG组患者未发生压疮例数为40例,占39.22%,OG组患者为8例占19.51%。两组护理有效率分别为94.12%和46.34%,存在明显差异(P<0.01)。结论老年患者压疮重在预防,临床治疗主要是防止感染。临床工作中必须对受压皮肤进行系统护理,防止压疮出现和进展,降低并发症和感染发生率。     

老年科患者医院感染原因分析及护理干预

目的探讨老年科患者医院感染原因及护理干预的效果。方法分析2012年4月-12月所在老年科住院患者201例的院内感染情况。结果发生院内感染19例,以呼吸道、血流相关性导管、泌尿道为主,与老年患者年龄大、基础疾病多、抵抗力差、抗生素使用、病区管理、手卫生落实不到位有关。结论加强病区管理,严格无菌操作,合理使用抗生素,注重手卫生,积极治疗基础疾病,减少探视,加强营养,提高机体抵抗力是预防老年科患者医院感染的有效护理干预措施。     

造血干细胞移植患者中抗真菌预防治疗的成本-效果分析

背景：米卡芬净已经被批准用于对造血干细胞移植患者中念珠菌感染的预防治疗。一项临床Ⅲ期、多中心的随机双盲对比试验入组了882例成年及儿童患者,该试验发现米卡芬净能预防系统性真菌感染使其发生率显著降低,并在经验性抗真菌治疗方面优于氟康唑在造血干细胞移植后的中性粒细胞减少期内作为抗真菌预防治疗的效果。尽管米卡芬净比氟康唑的药品费用高,但它可以降低相关治疗费用。目的：对米卡芬净与氟康唑在接受造血干细胞移植患者中的预防治疗作用进行成本-效果分析。方法：从医院角度出发,费用计算从患者入院开始至出院结束,效果基于临床试验取得的临床转归数据。采用已经发表的文献估算与造血干细胞移植和预防治疗、经验性抗真菌治疗和一次可能或确诊的念珠菌或曲霉感染的治疗相关的费用。每个治疗组都进行了平均成本-效果比的计算。为了检验分析结果的变化采用了重复抽样,还使用Bootstrap法对从每个治疗组随机抽取的100例患者进行了1000次模拟分析。计算了增量成本-效果比,并对不同成本进行了敏感度分析。结果：本研究分析的数据来自882例患者[527例男性,355例女性;使用米卡芬净患者425例,平均年龄43.2岁（年龄0.6-73.0岁）;使用氟康唑患者457例,平均年龄41.9岁（年龄0.6-71.0岁）]。米卡芬净治疗组和氟康唑治疗组每例患者的总住院费用分别是121098美元和124957美元,相差3859美元。Bootstrap分析表明米卡芬净预防治疗真菌感染在72.4％的样本中节省了费用,而氟康唑预防治疗仅在9.2％的样本中节省了费用。对住院费用的敏感度分析表明米卡芬净是一种具有良好成本-效果的治疗方法。结论：本研究通过对一项接受造血干细胞移植的成年和儿童患者进行的临床试验获得的数据分析发现,米卡芬净与?     

妇产科手术致泌尿系统损伤案例分析

目的本文对27例泌尿系统损伤案例进行统计,分析了导致泌尿系统损伤的原因及损伤后的处理方法,并提出了预防泌尿系统损伤的措施。方法对11734例手术引起的27例泌尿系统损伤患者资料进行分析。结果 27例病例中,输尿管损伤10例,膀胱损伤11例,尿道损伤6例,输尿管和膀胱损伤是较多见的症状。结论妇科手术致泌尿系统损伤是较少见但较严重的并发症,术前明确诊断、熟悉盆腔解剖结构、严格手术操作规范是预防损伤的关键,输尿管插管吻合及膀胱修补是其主要治疗措施。     

头孢米诺治疗尿路感染的疗效及安全性分析

目的探讨头孢米诺治疗尿路感染的疗效和安全性。方法对我院在2011年1月至2013年1月收治的100例尿路感染患者随机分为观察组和对照组,观察组患者给予头孢米诺治疗,对照组患者给予左氧氟沙星治疗,对比观察两组治疗方法的临床疗效。结果观察组临床疗效总有效率为96.0%,对照组临床疗效总有效率为88.0%,两组在临床疗效上具有明显差异性（P〈0.05）;两组患者在不良反应发生率上存在显著差异性（P〈0.05）。结论头孢米诺治疗尿路感染疗效显著,具有安全、可靠性,值得在临床上广泛推广和使用。     

Economic impact of onabotulinumtoxinA for overactive bladder with urinary incontinence in Europe

Background: Overactive bladder (OAB) is a common condition that has a significant impact on patients’ health-related quality-of-life and is associated with a substantial economic burden to healthcare systems. OnabotulinumtoxinA has a well-established efficacy and safety profile as a treatment for OAB; however, the economic impact of using onabotulinumtoxinA has not been well described.

Methods: An economic model was developed to assess the budget impact associated with OAB treatment in France, Germany, Italy, Spain and the UK, using onabotulinumtoxinA alongside best supportive care (BSC)—comprising incontinence pads and/or anticholinergic use and/or clean intermittent catheterisation (CIC)—vs BSC alone. The model time horizon spanned 5 years, and included direct costs associated with treatment, BSC, and adverse events.

Results: Per 100,000 patients in each country, the use of onabotulinumtoxinA resulted in estimated cost savings of €97,200 (Italy), €71,580 (Spain), and €19,710 (UK), and cost increases of €23,840 in France and €284,760 in Germany, largely due to day-case and inpatient administration, respectively. Projecting these results to the population of individuals aged 18 years and above gave national budget saving estimates of €9,924,790, €27,458,290, and €48,270,760, for the UK, Spain, and Italy, respectively, compared to cost increases of €12,160,020 and €196,086,530 for France and Germany, respectively. Anticholinergic treatment and incontinence pads were the largest contributors to overall spending on OAB management when onabotulinumtoxinA use was not increased, and remained so in four of five scenarios where onabotulinumtoxinA use was increased. This decreased resource use was equivalent to cost offsets ranging from €106,110 to €176,600 per 100,000 population.

Conclusions: In three of five countries investigated, the use of onabotulinumtoxinA, in addition to BSC, was shown to result in healthcare budget cost savings over 5 years. Scenario analyses showed increased costs in Germany and France were largely attributable to the treatment setting rather than onabotulinumtoxinA acquisition costs.     

Economic evaluation of human urinary kallindinogenase for patients with acute ischemic stroke in China

Objectives: In China, both human urinary kallindinogenase (HUK) and 3-n-butylphthalide (NBP) are recommended for clinical use to improve cerebral blood circulation during an acute ischemic stroke (AIS). The objective was to evaluate the economic value of HUK vs NBP for patients with AIS from a Chinese payer’s perspective.

Methods: An economic evaluation based on data of patients who have been treated with either HUK (n?=?488) or NBP (n?=?885) from a prospective, phase IV, multi-center, clinical registry study (Chinese Acute Ischemic Stroke Treatment Outcome Registry, CASTOR) was conducted to analyze the cost and effectiveness of HUK vs NBP for AIS in China. Before the analysis, the patients were matched using propensity score. Both a cost-minimization analysis and a cost-effectiveness analysis were conducted to compare the matched pairs. A bootstrapping exercise was conducted for the matched arms to demonstrate the probability of one intervention being cost-effective over another for a given willingness-to-pay for an extra quality-adjusted life-year (QALY).

Results: After propensity score matching, 463 pairs were matched. The overall medical cost in the HUK arm is USD 2,701.20, while the NBP arm is USD 3,436.83, indicating HUK is preferred with cost-minimization analysis. Although the QALY gained in the HUK arm (0.77176) compared with the NBP arm (0.76831) is statistically insignificant (p?=?.4862), the cost-effectiveness analysis as exploratory analysis found that, compared with NBP, HUK is a cost-saving strategy with the lower costs of USD 735.63 and greater QALYs gained of 0.00345. Among the 5,000 bootstrapping replications, 100% indicates that HUK is cost-effective compared with NBP under a 1-time-GDP threshold; and 97.12% indicates the same under a 3-time-GDP threshold.

Conclusion: This economic evaluation study indicates that administrating HUK is a cost-saving therapy compared with NBP for managing blood flow during AIS in the Chinese setting.     

The Hospital-Acquired Conditions (HAC) reduction program: using cranberry treatment to reduce catheter-associated urinary tract infections and avoid Medicare payment reduction penalties

Objective: The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals’ HAC scores and likelihood of avoiding the Medicare-reimbursement penalty.

Methods: A simulation model is developed and implemented using public data from the CMS’ Hospital Compare website to determine how hospitals’ unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals’ HAC scores.

Results: Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction.

Limitations: The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter patients would be able to consume cranberry in either juice or capsule form, but this may not be true in 100% of cases.

Conclusion: Most hospitals can improve their HAC scores and many can avoid Medicare reimbursement reductions if they are able to attain a percentage reduction in CAUTI comparable to that documented for cranberry-treatment regimes in the existing literature.     

Economic impact of using fesoterodine for the treatment of overactive bladder with urge urinary incontinence in a vulnerable elderly population in the United States

Objectives:

To assess the costs of treating overactive bladder (OAB) with fesoterodine compared to no OAB pharmacotherapy among vulnerable elderly from the US payer perspective.

Methods:

A decision analytic cost model was developed to estimate the 52-week costs of a cohort of vulnerable elderly with OAB initiating treatment with fesoterodine or no OAB pharmacotherapy. Vulnerable elderly OAB patients were defined as those aged ≥65 years with self-reported urge urinary incontinence (UUI) symptoms for ≥3 months, 2–15 UUI episodes/day, and at risk of deteriorating health by a score of ≥3 on the Vulnerable Elders Survey (VES)-13. Patients were evaluated for fesoterodine treatment response (defined as no UUI episodes) and persistence at weeks 12, 26, and 52. The model included a hypothetical health plan with 100,000 elderly members. A total of 7096 vulnerable elderly subjects were identified as the model target population based on the percentage of vulnerable elderly and annual prevalence of OAB among vulnerable elderly. OAB-related costs included fesoterodine drug acquisition costs, healthcare resource use (inpatient hospitalization, outpatient visits, and physician office visits), and OAB-related co-morbidities (falls/fractures, urinary tract infections, depression, and nursing home admissions). All costs were inflated to 2013 US$ using the medical care component of the consumer price index (CPI).

Results:

When 7096 vulnerable elderly OAB patients were treated with fesoterodine, US healthcare payers could save $11,463,981 per year, or $1616 per patient vs no OAB pharmacotherapy. Univariate one-way sensitivity analyses supported the robustness of the findings and showed results were most sensitive to changes in fesoterodine efficacy followed by annual costs of inpatient hospitalization.

Conclusions:

From a US payer perspective, treating vulnerable elderly OAB patients with fesoterodine was cost-saving compared to no OAB pharmacotherapy.     

Healthcare costs of urinary tract infections and genital mycotic infections among patients with type 2 diabetes mellitus initiated on canagliflozin: a retrospective cohort study

Objective: To assess the economic impact of urinary tract infections (UTIs) and genital mycotic infections (GMIs) among patients with type 2 diabetes mellitus (T2DM) initiated on canagliflozin.

Methods: Administrative claims data from April 2013 through June 2014 MarketScan^® databases were extracted. Adults with ≥1 claim for canagliflozin, T2DM diagnosis, and ≥90 days enrollment before and after canagliflozin initiation were propensity score matched to controls with T2DM initiated on other anti-hyperglycemic agents (AHAs). UTI and GMI healthcare costs were evaluated 90-days post-index and reported as cohort means.

Results: Rates of UTI claims 90 days post-index were similar in patients receiving canagliflozin for T2DM (n?=?31,257) and matched controls (2.7% vs 2.8%, p?=?.677). More canagliflozin than control patients had GMI claims (1.2% vs 0.6%, p?p?p?=?.150). GMI treatment costs were higher for the canagliflozin cohort ($3.68 vs $2.44, p?=?.041). Combined costs to treat either UTI and/or GMI averaged $31.29 per patient for the canagliflozin cohort v $39.77 for controls (p?=?.211). Rates and costs of UTIs and GMIs were higher for females than males, but the canagliflozin vs control trends observed for the overall sample were similar for both sexes. There were no significant cost differences between the canagliflozin and control cohorts among patients aged 18–64. Among patients aged 65 and above, GMI treatment costs were not significantly different, but costs to treat UTIs and either UTI and/or GMI were significantly lower for canagliflozin patients vs controls.

Conclusions: In a real-world setting, the costs to payers of treating UTIs and GMIs are generally similar for patients with T2DM initiated on canagliflozin vs other AHAs.     

Estimating the quality-of-life impact and cost-effectiveness of alpha-blocker and anti-muscarinic combination treatment in men with lower urinary tract symptoms related to benign prostatic hyperplasia and overactive bladder

Abstract

Objective:

A 12-week clinical trial (TIMES) demonstrated that therapy with tolterodine extended release (TOL)?+?tamsulosin (TAM) provides clinical benefits vs TOL or TAM monotherapy or placebo (PBO) in men with lower urinary tract symptoms (LUTS) including overactive bladder (OAB). The present analysis estimated the costs and quality-adjusted life-years (QALYs) associated with these therapies from the perspective of the UK healthcare system.

Methods:

TIMES cohorts receiving TOL, TAM, TOL?+?TAM, or PBO were followed from therapy initiation to 12 weeks. A decision-tree model was used to extrapolate the 12-week results to 1 year (including need for surgery owing to treatment failure at 12 weeks) and to track patients’ outcomes (symptoms, utility, and costs). Because TIMES did not include costs and QALYs, data from the EpiLUTS epidemiologic survey (12,796 males) were used to model a mathematical relationship between LUTS (daytime and nocturnal frequency, urgency episodes, urgency urinary incontinence episodes, and International Prostate Symptom Score [IPSS]), quality-of-life, and utility. This was used to convert improvements in TIMES patients’ LUTS into utility scores and QALYs. The model included drug and surgery procedure costs and hospital length of stay.

Results:

Incremental QALYs of TOL?+?TAM vs PBO, TAM, and TOL were 0.042, 0.021, and 0.013, and corresponding incremental costs were £189, £223, and ?£70, respectively, resulting in cost-utility ratios for TOL?+?TAM of £4508/QALY gained compared with PBO and £10,381/QALY gained compared with TAM. TOL?+?TAM combination therapy was both more effective and cost-saving compared with TOL. Univariate sensitivity analyses showed that patient utility was most responsive to changes in drug efficacy on IPSS and urgency episodes. Changing the percentage of patients undergoing surgery did not substantially affect model outcomes. The main limitation of the study was that the relation between LUTS and patient utility was based on an indirect association.

Conclusions:

TOL?+?TAM combination therapy appears to be cost-effective compared with TOL or TAM monotherapy or PBO in male patients with LUTS.