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A prospective study of surgical site infections in a pediatric hospital in Mexico City

AMERICAN JOURNAL OF INFECTION CONTROL 2003年第5期31卷 302-308页

作者： Porras-Hernández, JD Vilar-Compte, D Cashat-Cruz, M Ordorica-Flores, RM Bracho-Blanchet, E Avila-Figueroa, C Hosp Infantil Mexico Feder Gomez Dept Cirugia Mexico City DF Mexico Inst Nacl Cancerol Dept Infectol Mexico City DF Mexico Hosp Infantil Mexico Feder Gomez Dept Epidemiol Mexico City DF Mexico

Background: Pediatric surgical site infection (SSI) rates in the United States range from 2.5% to 4.4%. There is little data regarding their risk factors among children. We quantified SSI rates and identified risk factors of SSI in a tertiary care pediatric teaching hospital in Mexico City. Methods: All neurosurgical, cardiovascular, and general surgical patients who underwent operation between Aug 1, 1998, and Jan 31, 1999, were followed-up daily during hospitalization. On postoperative day 30, a full review of microbiology reports and medical records was performed. Univariate and multivariate analyses were done to identify risk factors. Results: Four hundred twenty-eight of 530 children completed follow-up. The overall SSI rate was 18.7%. Forty percent of SSI were superficial incisional, 21 % were deep incisional, and 39% were organ/space infections. For clean, clean-contaminated, contaminated, and dirty procedures, SSI infection rates were 12.4 %, 24.4 %, 14.3 %, and 32.4 %, respectively. Open drains (OR = 2.3;95 % CI = 1.34.2;P < .005) and surgery that lasted 90 or more minutes (OR = 2.9;95% CI = 1.6-5.1;P < .001) were associated with infection. Conclusions: Our rates are greater than comparable reported data among children. Duration of surgery and use of open drains were associated with SSI.

关键词：交叉感染/流行病学医院儿科/标准医院儿科/统计学和数值数据医院教学/标准医院教学/统计学和数值数据医院市区/标准医院市区/统计学和数值数据墨西哥/流行病学前瞻性研究哨点监测外科伤口感染/流行病学外科伤口感染/预防和控制儿童学龄前女(雌)性人类婴儿男(雄)性

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EFFECT OF POSTDISCHARGE SURVEILLANCE ON RATES OF INFECTIOUS COMPLICATIONS AFTER CESAREAN-SECTION

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AMERICAN JOURNAL OF INFECTION CONTROL 1992年第4期20卷 198-201页

作者： HULTON, LJ OLMSTED, RN TRESTONAURAND, J CRAIG, CP CATHERINE MCAULEY HLTH SYST INFECT CONTROL SERVPOB 992ANN ARBORMI 48106

Decreases in length of stay for surgical procedures and increased outpatient surgery affect accuracy of surgical wound infection rates. To assess accuracy of rates for infectious complications after delivery by cesarean section, we implemented postdischarge surveillance at our hospital (4800 annual deliveries). Physician questionnaires were used. Response rate was greater than 90%. During the 5 months before postdischarge surveillance the overall infection rate was 1.6%;afterward the rate increased to 6.3% (p = 0.0003). Approximately 59% of infectious complications would have gone undetected with only inpatient surveillance. We conclude that postdischarge surveillance is necessary for an accurate determination of rates of infectious complications. The need among this population reflects relatively short postpartum hospitalization and emphasis on outpatient management of postoperative complications.

关键词：出院后医疗/标准交叉感染/流行病学交叉感染/病因学医院病床数 500张以上医院社区/统计学和数值数据医院教学/统计学和数值数据发病率感染控制/方法住院时间/统计学和数值数据密执安/流行病学病人出院人群监测手术后并发症/流行病学手术后并发症/病因学方案评价问卷调查危险因素季节女(雌)性人类

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Complications of gynecologic laparoscopy

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JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999年第3期6卷 317-321页

作者： Quasarano, RT Kashef, M Sherman, SJ Hagglund, KH St John Hosp & Med Ctr Dept Obstet & Gynecol Detroit MI 48236 USA

Study Objective. To examine the frequency of gynecologic laparoscopy complications from January 1996 to June 1996. Design. Prospective review (Canadian Task Force classification II-1). Setting. Tertiary center teaching hospital with 607 beds. Patients. Two hundred thirty-four patients (age 15-70 yrs). Interventions. Gynecologic laparoscopy. Measurements and Main Results. The overall number of complications was 23 (9.8%). They were principally infection, extraperitoneal insufflation, and injury to blood vessels. Complication rates were examined by service (private, clinic, staff) and by type of laparoscopy (operative, diagnostic, laparoscopic-assisted vaginal hysterectomy). Of 11 (47.8%) complications that occurred during laparoscopic-assisted vaginal hysterectomy, 5 involved postoperative infection. Conclusion. The complication rate in this review was similar to that published in the literature, with the exception of ileus and infection, which occurred at higher rates in our institution.

关键词：置信区间数据收集妇科外科手术/方法医院教学/统计学和数值数据发病率腹腔镜检查/方法密执安手术后并发症/流行病学前瞻性研究危险因素软件青少年成年人老年人女(雌)性人类中年人

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Surgical wound infection surveillance in general surgery procedures at a teaching hospital in Pakistan

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AMERICAN JOURNAL OF INFECTION CONTROL 2003年第5期31卷 296-301页

作者： Pishori, T Siddiqui, AR Ahmed, M Aga Khan Univ Dept Surg Karachi Pakistan Aga Khan Univ Dept Community Hlth Sci Karachi Pakistan

Background: A surveillance system was established at the Aga Khan University Hospital in Karachi, Pakistan, to determine surgical wound infection (SWI) rates, trends, and risk factors;and to compare rates with those reported by the National Nosocomial Infection Surveillance (NNIS) system of the Centers for Disease Control and Prevention. Methods: Surveillance was performed from January 1997 to December 1999. Risk categorization was on the basis of the NNIS system. P < .05 was set for statistically significant difference between groups. Data were analyzed using the Epi-Info software (version 6.04, CDC, Atlanta, Ga). Results: Overall SWI rates for the NNIS risk categories 0, 1, 2, and 3 were 1.9%, 3.7%, 6.7%, and 5.1 %, respectively. SWI rate in 0 risk category decreased from 3 % in 1997 to 1.1 % in 1999 (P =.06). Multivariate analysis showed that SWI rates were higher after mastectomy (odds ratio [OR] 4.28, 95% confidence interval [CI] 1.8-10), hernia repair (OR 3.28, 95% CI 1.6-6.7), gastrointestinal resection (OR 2.2, 95% CI 0.88-5.9), skin procedures (OR 1.97, 95% CI 0.89-4.3), appendectomy OR 0.57, 95% CI 0.20-1.60, and miscellaneous procedures (OR 3.6, 95 % CI 1.6-7.7), as compared with cholecystectomy. Other risk factors were contaminated type of operation'(OR 2.6, 95% CI 1.2-5.5), and duration of operation exceeding the NNIS standard of "T" hours (OR 2.6, 95% CI 1.7-4). Conclusion: The SWI rates at the Aga Khan University Hospital are higher than the NNIS standards. There was a downward trend in the SWI rates during the surveillance period. A decrease in the duration of surgical procedures could further reduce the risk.

关键词：交叉感染/流行病学医院信息系统医院教学/标准医院教学/统计学和数值数据医学审核巴基斯坦/流行病学危险因素哨点监测外科手术/分类外科伤口感染/流行病学人类

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Trends in the use and capacity of California's emergency departments, 1990-1999

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ANNALS OF EMERGENCY MEDICINE 2002年第4期39卷 389-396页

作者： Lambe, S Washington, DL Fink, A Herbst, K Liu, HH Fosse, JS Asch, SM VA Greater Los Angeles Helathcare Syst Dept Med Robert Wood Johnson Clin Scholars Program Los Angeles CA USA Univ Calif Los Angeles Dept Publ Hlth Los Angeles CA USA Univ Calif Los Angeles Div Gen Internal Med Los Angeles CA USA Herbst Med Geog Haddam CT USA

Study Objective: Concerns over the ability of the nation's emergency departments to meet current demands are growing among the public and health care professionals. Data supporting perceptions of inadequate capacity are sparse and conflicting. We describe changes in the use and capacity of California's EDs between 1990 and 1999, as well as trends in severity of patient illness or injury. Methods: Data from California's Office of Statewide Health Planning and Development (OSHPD), which describe all hospital and health service use in the state, were analyzed and later verified using a telephone survey of all 320 open EDs in California. Six variables were analyzed: hospital's ownership type (public or private), total number of annual ED visits, severity of patient illness or injury (percentage of visits categorized as critical, urgent, or nonurgent), number of ED beds, proximity to a closed ED, and teaching status. We tested 2 main hypotheses: (1) Have statewide ED visits, ED beds, visits per ED, and visits per bed increased or decreased between 1990 and 1999? and (2) Has severity of patient illness or injury, as reported to OSHPD, changed over the past decade? State level data were analyzed using ordinary least-squares regression. Hospital level data were analyzed using repeated measures analyses. Results: The number of EDs in California decreased by 12% (P<.0001). The number of ED treatment stations (ie, physical spaces for the treatment of patients) increased by 687 (16%) statewide (P=.0001), or an average of 79 beds per year. The average annual change in ED visits was not statistically significant (P=.5), whereas visits per ED increased by 27% for all EDs (P<.0001), although with differing trends noted at public and private hospitals. At private hospitals, the average increase was 512 visits/ED each year, whereas at public hospitals, visits decreased by an average of 1,085 visits/ED each year (P<.0001). Overall, critical visits per ED increased by 59% (P<.0001), an

关键词：急性病/流行病学加利福尼亚/流行病学危重病/流行病学急症/流行病学急诊室医院/统计学和数值数据卫生保健调查卫生设施关闭/统计学和数值数据卫生服务需求/发展趋势医院病床数医院教学/统计学和数值数据多元分析州卫生计划和开发署时间因素美国人类

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ESTIMATING THE INDIRECT COSTS OF TEACHING

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JOURNAL OF HEALTH ECONOMICS 1992年第2期11卷 153-171页

作者： ROGOWSKI, JA NEWHOUSE, JP HARVARD UNIV CAMBRIDGEMA 02138

Medicare's Prospective Payment System pays teaching hospitals using a regression coefficient in a log-log cost function. Previous literature showed that this coefficient is sensitive to the covariates included in the function, but specified teaching intensity as the logarithm of one plus the intern and resident-to-bed ratio. Provided the true relationship is log-log, adding one biases the coefficient substantially but not predicted cost. In a re-specified equation that makes this bias negligible, the coefficient is not nearly as sensitive to the inclusion of other covariates. Because further issues remain to be explored, it is premature to use our results for policy purposes.

关键词： Medicare与Medicaid服务中心(美国) 费用分配/方法费用分配/统计学和数值数据卫生设施规模卫生服务研究医院教学/经济学医院教学/立法和法学医院教学/统计学和数值数据实习医师和住院医师职务/经济学实习医师和住院医师职务/统计学和数值数据 Medicare/经济学模型经济计量学预期支付系统/经济学支付标准制定和审核/方法支付标准制定和审核/统计学和数值数据回归分析美国

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The use of gaming in a dental hygiene review course.

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Journal of dental education 2000年第4期64卷 294-297页

作者： Peterson, C.A. Mauriello, S.M. Caplan, D.J. Dental Hygiene Program Catawba Valley Community College Hickory 28602-9699 NC United States

Evaluated the effectiveness of gaming to create an interactive, stimulating learning environment as a review format for the Dental Hygiene National Board examination. Students (n=28) participated in either the gaming or a lecture review format. The gaming group scored higher on the exam on eight of 12 topics as well as on the case-based learning section. (DB)

关键词：卡方分布教育考核/统计学和数值数据策略实验性北卡罗来纳口腔卫生/教育问卷调查统计学非参数教学/方法教学/统计学和数值数据

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Effects of sex composition by class and instructor's sex on physical self-efficacy of college men

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PERCEPTUAL AND MOTOR SKILLS 2000年第1期90卷 105-110页

作者： Gibbons, ES Rust, DM Blassingame, CL Reed, JL Texas A&M Univ Dept Hlth & Kinesiol College Stn TX 77843 USA Gardner Webb Univ Boiling Springs NC USA Stephen F Austin State Univ Nacogdoches TX 75962 USA Sam Houston State Univ Huntsville TX 77341 USA

The relationship of sex composition of class and instructor's sex to Physical Self-efficacy has yielded conflicting results in several studies. This study examined the relationship of sex composition of class and instructor's sex to scores on Physical Self-efficacy, Perceived Physical Ability, and Physical Self-presentation Confidence of 80 male students enrolled in one of four sections of a strength training class. Analysis indicated no significant difference on Physical Self-efficacy between male students who were enrolled in all male classes or in coeducational classes;improvements in scores on Physical Self-efficacy were not specific to the sex composition of the class or sex of the instructor and no significant difference on Perceived Physical Ability and Physical Self-presentation Confidence between male students who joined an all male class or a coeducational class. Perceived Physical Ability improved from the pretest to the posttest in all classes;and no improvement in scores for Physical Self-presentation Confidence was found in all classes. Ln conclusion, the analysis showed that sex composition of the class and sex of the instructor were not significantly related to scores for self-efficacy.

关键词：用力/生理学肌收缩/生理学个性量表体育和训练/统计学和数值数据身体素质问卷调查自我效验性别分布性别因素学生/心理学学生/统计学和数值数据教学/统计学和数值数据女(雌)性人类男(雄)性

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Expertise in women's gymnastic judging: An observational approach

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PERCEPTUAL AND MOTOR SKILLS 2000年第2期90卷 543-546页

作者： Ste-Marie, DM Univ Ottawa Sch Human Kinet Ottawa ON K1N 6N5 Canada

Observation was used to study expertise in gymnastic judging. 10 expert and 10 novice gymnastic judges were videotaped while judging at actual competitions. Analyses showed that novice judges, as compared to expert judges, spent less time looking at the gymnast perform, spent more time looking at the scoring paper, and were less able to engage in the dual-task demands required in gymnastic judging.

关键词：成就注意力竞争行为/分类注视眼体操/标准判断记忆作业完成和分析教学/统计学和数值数据录像磁带女(雌)性人类

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Prosthodontic Olympics: gaming to aid students gain proficiency.

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Journal of dental education 2000年第4期64卷 302-305页

作者： Loney, R.W. Murphy, H.J. Miller, V.J. Dept. of Dental Clinical Sciences Faculty of Dentistry Dalhousie University Halifax NS Canada.

Evaluated the effectiveness of an educational game, "The Prosthodontic Olympics," to improve the speed of dental students in their performance of selected laboratory procedures. The students race to complete a procedure which is then judged for quality. Evaluation indicated participants increased their speed by as much as 50 percent without sacrificing quality and responded positively to the activity. (DB)

关键词：教育考核/方法教育考核/统计学和数值数据策略实验性义齿修复术/教育教学/方法教学/统计学和数值数据时间因素

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