医院感染在儿科的隐患因素及干预措施

探讨医院感染在儿科存在的隐患并对其采取有效措施。运用有效措施降低感染的几率。通过控制可控因素大大减少儿科的医院感染。环境因素、抗菌素的不规范应用、患者家属和护士的感染意识淡漠都是发生医院感染的因素。     

浅析蒙药在儿科疾病中的应用

蒙药是指在蒙医理论指导下,辩证的分析病情,治疗疾病所应用的药物。蒙医用药是中国传统蒙医特有药物。蒙药是在蒙医理论辩证论治的指导下,结合赫依、协日和巴达干的"三根"学说,按照蒙医理论来源实践,结合分析望诊、问诊、闻诊和切诊获得的所有信息,注重整体,辨证用药。传统蒙药作为蒙医治疗疾病的主要载体,对儿科疾病显示出了神奇的治疗效果。     

安全管理在儿科护理中的应用

在儿科护理工作中安全管理有重要的意义及作用,通过在儿科护理工作中实施安全管理措施,可以减少护理工作中的医疗风险,提高护理质量,保障患儿住院护理的安全,减少了护患纠纷,为患儿提供良好的就医环境。     

PBL教学模式在儿科临床实习教学中的效果

目的探讨PBL教学法在儿科临床实践教学中的效果。方法收集2009级的医学生70名资料,将医学生随机分为试验组和对照组,各35名。对照组医学生采用传统教学法,观察组医学生采用PBL教学法,比较两种教学法的效果。结果试验组学生在理论考试、实践考核、案例分析等方面均优于对照组,差异均有统计学意义(均P<0.05)。结论 PBL教学模式有助于提高儿科实习医师学习积极性,提高教学质量,是临床教学改革的新方向。     

弹性排班在儿科优质护理中的应用

重庆市南川区人民医院在儿科优质护理中应用弹性排班,最大程度地发挥了护士的工作主动性和潜能,较好地缓解了临床护士因工作量大、编制不足所造成的矛盾。本文就弹性排班在儿科优质护理中的应用进行了较为深入的探讨,具有一定的参考价值。     

舒适护理在儿科发热患儿中的应用

目的探讨舒适护理在儿科发热患儿中的应用效果。方法将2011年1月至2012年7月在我科住院的发热患儿随机分为试验组和对照组。对照组采用常规护理,试验组采用舒适护理,观察并比较两组患儿的哭闹情况、体温下降情况、住院时间、静脉穿刺成功率及家属满意度等指标差异。结果试验组患儿主动配合情况、发热持续天数、静脉穿刺成功率及家属满意度与对照组比较,差异有统计学意义(P<0.05),住院时时间比较,差异无统计学意义(P>0.05)。结论发热患儿在临床护理中应用舒适护理效果满意。     

心理护理在儿科重症监护室中的应用

目的研究儿科重症监护室实施心理护理的临床作用。方法选择我院儿科重症监护室2011年8月至2013年8月收治的200例患儿,将其均分为两组。对照组患儿实施常规护理,观察组患儿在常规护理的基础上实施心理护理,比较两组患儿实施护理后的恐惧、焦虑程度及对医护人员的满意度。结果观察组患儿的恐惧、焦虑程度明显低于对照组,而对医护人员的满意度明显高于对照组,差异有统计学意义(P<0.05)。结论通过对儿科重症监护室患儿实施有效心理护理干预,能显著降低其恐惧及焦虑程度,促使患儿配合医护人员的操作及治疗,增强其战胜疾病的信心,提升患儿及家属对医护人员的满意度,缩短患儿的治疗时间。     

人文关怀在少数民族地区医院儿科护理中应用的策略

目的探讨人文关怀在儿科护理中的临床应用。方法我院于2010年2月开始于儿科实施人文关怀护理。以2010年8月~2012年8月于我院儿科就诊的109例患儿为观察组,另选取2008年2月~2010年2月于我院儿科就诊的110例患儿为对照组。比较两组患儿家长对护理服务的满意情况及投诉情况。结果观察组109例患儿家长中对护理服务非常满意者共67例,占61.5%,明显高于对照组38.2%(42/110)(χ2=11.88,P<0.01)。观察组患儿家长投诉率明显低于对照组(χ2=3.94,P<0.05)。结论人文关怀提高了患儿家长对护理服务的满意度并减少了投诉率,是一种有效的儿科护理方法与模式,值得临床进一步应用推广。     

风险防范护理在儿科护理管理中的应用效果

目的探讨风险防范护理在儿科护理管理中的应用效果。方法选取我院2012年9月至2013年8月儿科收治的患儿100例,随机将其分成观察组与对照组,对照组采用常规护理,观察组在其基础上实施风险防范护理,对两组患儿的护理效果进行观察比较。结果经过有效的治疗与护理后,对照组患儿总有效率为72.0%,观察组患儿总有效率为94.0%,差异有统计学意义(P<0.05)。结论在儿科护理管理中应用风险防范护理可有效的提高治疗效果,减少患儿病死率。     

干扰素联合炎琥宁治疗小儿手足口病的临床效果观察

目的分析研究干扰素联合炎琥宁治疗小儿手足口病的临床表现,观察临床中治疗效果。方法将来我院进行治疗小儿手足口病的150例患儿进行随机分配,分成A、B、C三组,各50例,A组50例患儿采用干扰素单一治疗;B组50例患儿采用炎琥宁的单一治疗;C组50例患儿采用干扰素联合炎琥宁治疗。通过对比三组患儿的退烧时间、口腔溃烂愈合时间、住院时间及用药后的疗效。结果单独用药的临床效果和临床表现相比较无明显差异;而联合用药与单独用药的临床效果和临床表现相对比有明显差异(P<0.05),具有统计学意义。结论干扰素联合炎琥宁治疗小儿手足口病的临床效果显著,是治疗小儿手足口病的最佳方法之一。     

聚乙二醇干扰素a-2a 与普通干扰素联合利巴韦林治疗慢性丙型肝炎的经济学评价

目的 评估聚乙二醇干扰素a-2a联合利巴韦林与普通干扰素联合利巴韦林治疗慢性丙型肝炎患者的健康效果、成本及其成本效果.方法 运用文献资料和Delphi专家咨询的数据,采用Markov 模型对聚乙二醇干扰素a-2a 与普通干扰素联合利巴韦林治疗慢性丙型肝炎进行经济学评价.结果 与普通干扰素相比,使用聚乙二醇干扰素a-2a48周治疗慢性丙型肝炎患者,人均延长2.19个质量调整生命年,同时减少终身医疗费用支出15296元.结论 使用聚乙二醇干扰素a-2a联合利巴韦林较普通干扰素联合利巴韦林治疗慢性丙型肝炎48周更具成本效果.     

Modeling hard clinical end-point data in economic analyses

Abstract

Objective:

The availability of hard clinical end-point data, such as that on cardiovascular (CV) events among patients with type 2 diabetes mellitus, is increasing, and as a result there is growing interest in using hard end-point data of this type in economic analyses. This study investigated published approaches for modeling hard end-points from clinical trials and evaluated their applicability in health economic models with different disease features.

Methods:

A review of cost-effectiveness models of interventions in clinically significant therapeutic areas (CV diseases, cancer, and chronic lower respiratory diseases) was conducted in PubMed and Embase using a defined search strategy. Only studies integrating hard end-point data from randomized clinical trials were considered. For each study included, clinical input characteristics and modeling approach were summarized and evaluated.

Results:

A total of 33 articles (23 CV, eight cancer, two respiratory) were accepted for detailed analysis. Decision trees, Markov models, discrete event simulations, and hybrids were used. Event rates were incorporated either as constant rates, time-dependent risks, or risk equations based on patient characteristics. Risks dependent on time and/or patient characteristics were used where major event rates were >1%/year in models with fewer health states (<7). Models of infrequent events or with numerous health states generally preferred constant event rates.

Limitations:

The detailed modeling information and terminology varied, sometimes requiring interpretation.

Conclusions:

Key considerations for cost-effectiveness models incorporating hard end-point data include the frequency and characteristics of the relevant clinical events and how the trial data is reported. When event risk is low, simplification of both the model structure and event rate modeling is recommended. When event risk is common, such as in high risk populations, more detailed modeling approaches, including individual simulations or explicitly time-dependent event rates, are more appropriate to accurately reflect the trial data.     

脐带脱垂的护理与临床分析

目的 探讨脐带脱垂的护理与防治措施,降低围产儿死亡率.方法 回顾分析2009 年2 月～2012 年2 月我院收治的5 例脐带脱垂患者,密切观察产程进展,对产时和产后进行护理,分析影响脐带脱垂的因素.结果 脐带脱垂的发生率0.02%,与胎位异常、胎产次、脐带长度有关.结论 重视产前检查,加强孕期保健,做好相应的护理措施,可降低脐带脱垂的发生率.     

Economic impact of industry-sponsored clinical trials of pharmaceutical products in Austria

Abstract

Aims: Modern pharmaceutical product development is a long and complex process associated with significant investments by pharmaceutical companies. The innovative pharmaceutical industry accounts for the vast majority of expenditures in clinical trials of potential new pharmaceuticals and therefore generates economic activity within a country. The aim was to assess the far-reaching economic impact of industry-sponsored clinical-trials (ISCTs) of pharmaceutical products for the healthcare system and the national economy.

Materials and methods: The study approach was based on three analytical steps. First, a survey among 15 pharmaceutical companies in Austria was conducted to evaluate the annual number of ISCTs subdivided according to trial phase, therapeutic areas and associated employees. Second, the monetary value of treatments performed in ISCTs was calculated based on a sample of clinical-trial protocols. Finally, the macroeconomic impact, measured in terms of value-added and jobs created by the conducted ISCTs, was calculated using Input–Output analysis by applying an extended Leontief-model.

Results: The study demonstrated that €116.22 million spent in ISCTs generated a total value added of €144 million, €74 million direct, in 2018. Each year a medical treatment value of €100 million was financed through 463 ISCTs, with an average value of medical treatment of €37,068 per recruited patient. This represents a significant 0.3% of annual current health-expenditures. In summary, each Euro invested by the pharmaceutical industry in ISCTs generates €1.95 for the Austrian economy. ISCTs also created and secured employment in the extent of 2,021 full-time-equivalents, thus resulting in an employment multiplier of 1.66.

Conclusions: In conclusion, conducting clinical-trials by pharmaceutical industry—beside its importance in its own domain—results in tangible benefits and a positive macroeconomic impact that contribute to the sustainability of the Austrian healthcare system by complementing its limited resources. Furthermore, it is a non-negligible factor in locational and industrial policy.     

静脉留置针在临床中的应用及健康教育

目的 探讨静脉留置针在临床中的应用及健康教育.方法 通过对不同年龄阶段患者进行健康宣教.结果 健康教育使患者及家属对静脉留置针有一定了解并配合治疗.结论 采用多种形式健康教育,减少患者对疼痛的刺激,改善护患关系.     

Composite outcome measurement in clinical research: the triumph of illusion over reality?

Abstract

Composite measures that combine different types of indicators are widely used in medical research; to evaluate health systems, as outcomes in clinical trials and patient-reported outcome measurement. The potential advantages of such indices are clear. They are used to summarise complex data and to overcome the problem of evaluating new interventions when the most important outcome is rare or likely to occur far in the future. However, many scientists question the value of composite measures, primarily due to inadequate development methodology, lack of transparency or the likelihood of producing misleading results. It is argued that the real problems with composite measurement are related to their failure to take account of measurement theory and the absence of coherent theoretical models that justify the addition of the individual indicators that are combined into the composite index. All outcome measures must be unidimensional if they are to provide meaningful data. They should also have dimensional homogeneity. Ideally, a specification equation should be developed that can predict accurately how organisations or individuals will score on an index, based on their scores on the individual indicators that make up the measure. The article concludes that composite measures should not be used as they fail to apply measurement theory and, consequently, produce invalid and misleading scores.     

On the analogy between field experiments in economics and clinical trials in medicine

Randomized experiments, as developed by Esther Duflo and Abhijit Banerjee at the Abdul Latif Jameel Poverty Action Lab (J-PAL), offer a novel, evidence-based approach to fighting poverty. This approach is original, in that it imports the methodology of clinical trials for application in development economics. This paper examines the analogy between J-PAL’s field experiments in development economics and randomized controlled trials (RCTs) in medicine. RCTs and randomized field experiments are commonly treated as identical, but such treatment neglects some of the major distinguishing features that make each experiment specifically apt for use in its respective field. The central claim of this paper is that the analogy between medicine and development economics is incomplete because the central dimensions of RCTs are not simply different but altogether lacking in J-PAL’s approach. This weakens both the political and the theoretical power of such experiments in development economics.     

多层螺旋CT主动脉血管造影在主动脉夹层动脉瘤的临床应用

目的探讨多层螺旋CT血管造影(MSCTA)及其三维重建在主动脉夹层动脉瘤的CT表现及诊断价值。方法收集72例行主动脉64排螺旋CT增强扫描的主动脉夹层动脉瘤病例,将MSCTA原始数据在ADW4.4工作站进行最大密度投影(MIP)、多平面重建(MPR)、曲面重建(CPR)、容积再现(VR)的主动脉血管重建处理,并将获取的资料进行综合分析,完成诊断。结果全部病例均很好地显示了主动脉全程及其主要分支血管,清晰地显示夹层动脉瘤的部位、范围、真腔、假腔、内膜片等,其中主动脉壁增厚钙化51例及附壁血栓39例也清晰显示。6例主动脉夹层患者经内支架置入术后复查,其支架位置、形态、膨胀程度及真假腔情况也得到满意显示。结论 MSCTA可清晰地显示主动脉夹层及主要分支血管的改变,为临床选择合理的治疗提供有价值的依据,是诊断夹层动脉瘤有效的检查方法,具有较高的临床应用价值。     

A cost utility model of interferon beta-1b in the treatment of relapsing-remitting multiple sclerosis

SUMMARY

This study estimates the long-term cost effectiveness of Betaferon®, (interferon beta-1b) in the treatment of relapsing-remitting multiple sclerosis (RRMS). Clinical trial data, natural disease history information, and costs and quality of life (EQ-5D) data, are linked using disease severity levels, via a model that accounts for the number, severity and duration of relapses, and the probability and speed of disease progression. Previous attempts at modeling the cost effectiveness of beta interferon have produced very estimates of costs per QALY gained (CQG). Increasing data availability enables the modification or replacement of many of the assumptions underlying these models. In particular, longer term modeling and the consideration of wider societal costs is appropriate in the context of this chronic disease. The evidence presented here provides much lower, and more precise, estimates of CQG. The base case 20-year model estimates a CQG of £8,100. These new estimates are in line with other recent estimates and demonstrate the cost effectiveness of beta interferon.