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Burns

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BRITISH MEDICAL BULLETIN 1999年第4期55卷 885-894页

作者： Clarke, J Chelsea & Westminster Hosp Dept Plast Surg London SW10 9NH England

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Maximizing use of the emergency department observation unit: A novel hybrid design

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ANNALS OF EMERGENCY MEDICINE 2001年第3期37卷 267-274页

作者： Ross, MA Naylor, S Compton, S Gibb, KA Wilson, AG William Beaumont Hosp Dept Emergency Med Royal Oak MI 48072 USA

Study objective: We sought to determine whether sharing an observation unit with scheduled procedure patients would maintain a more consistent unit census and patient/nurse ratio. A secondary objective was to determine the effect of this model on patient length of stay and discharge rates. Methods: This retrospective, descriptive study was conducted in a high-volume suburban teaching hospital, using a "before-and-after" study design, A "pure" postprocedure unit became a "hybrid" observation postprocedure unit by displacing specific postprocedure patients to inpatient locations. Subsequently, the displaced patients were returned to the unit. On weekends, the unit operated as a pure observation unit. Hourly unit occupancy and census data were prospectively collected, and hourly patient/ nurse ratios were calculated. Patient length of stay and dis charge data were collected and compared in different settings. Results: The 2 services showed a complementary census pattern that allowed the hybrid unit to maintain an average hourly patient/nurse ratio of 3.7 compared with the ratio of 2.5 for a pure observation unit. There was no difference in observation patient length of stay(14.8 hours versus 14.7 hours) or discharge rate (20.4% versus 18.1%) between weekdays and weekends. However, scheduled procedure patients experienced significantly shorter lengths of stay in the hybrid unit setting (4.3 hours) than in alternative inpatient locations (9.4 hours). Conclusion: The hybrid model showed better hourly census and nurse resource use rates, with no adverse effect on observation patients. However, scheduled procedure patient length of stay was shorter in this setting.

关键词：病床利用率/经济学费用节省效率急诊室医院/经济学急诊室医院/组织和管理医院教学住院时间/经济学观察病人医疗小组/经济学病人医疗小组/组织和管理病人出院/经济学前瞻性研究回顾性研究人类

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Rehabilitation after traumatic brain injury

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BRITISH MEDICAL BULLETIN 1999年第4期55卷 927-943页

作者： Barnes, MP Univ Newcastle Upon Tyne Hunters Moor Reg Neurorehabil Ctr Acad Unit Neurol Rehabil Newcastle Upon Tyne NE2 4NR Tyne & Wear England

Head injury is a common disabling condition but regrettably facilities for rehabilitation are sparse. There is now increasing evidence of the efficacy of a comprehensive multidisciplinary rehabilitation team compared to natural recovery following brain injury. This chapter outlines some basic concepts of rehabilitation and emphasises the importance of valid and reliable outcome measures. The evidence of the efficacy of a rehabilitation programme is discussed in some detail. A number of specific rehabilitation problems are outlined including the management of spasticity, nutrition, pressure sores and urinary continence. The increasingly important role of assistive technology is illustrated, particularly in terms of communication aids and environmental control equipment. However, the major long-term difficulties after head injury focus around the cognitive, intellectual, behavioural and emotional problems. The complex management of these disorders is briefly addressed and the evidence of the efficacy of some techniques discussed. The importance of recognition of the vegetative state and avoidance of misdiagnosis is emphasised. Finally, the important, but often neglected, area of employment rehabilitation is covered.

关键词：出院后医疗/组织和管理行为疗法脑损伤/心理学脑损伤/康复社区和机构的关系残疾鉴定病人医疗小组/组织和管理康复职业性/利用可重复性结果治疗结果人类

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MULTIMEDIA COMMUNICATIONS IN HEALTH-CARE

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 257-268页

作者： REIS, H BRENNER, D ROBINSON, J NYNEX SCI & TECHNOL INC CAMBRIDGE MA 02139 USA

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Community mental health teams: evidence or belief?

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BRITISH JOURNAL OF PSYCHIATRY 1999年第6期175卷 508-513页

作者： Thornicroft, G Becker, T Holloway, F Johnson, S Leese, M McCrone, P Szmukler, G Taylor, R Wykes, T Inst Psychiat Sect Community Psychiat London SE5 8AF England Maudsley Hosp & Inst Psychiat London SE5 8AZ England UCL Sch Med Dept Psychiat & Behav Sci London W1N 8AA England Inst Psychiat Dept Psychiat London SE5 8AF England Inst Psychiat Dept Psychol London SE5 8AF England

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PRiSM psychosis study - Design limitations, questionable conclusions

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BRITISH JOURNAL OF PSYCHIATRY 1999年第6期175卷 501-503页

作者： Marshall, M Bond, G Stein, LI Shepherd, G McGrew, J Hoult, J Rosen, A Huxley, P Diamond, RJ Warner, R Olsen, M Latimer, E Goering, P Craig, TKJ Meisler, N Test, MA Univ Manchester Dept Community Psychiat Manchester M13 9PL Lancs England Indiana Univ Purdue Univ Indianapolis IN 46202 USA Univ Wisconsin Sch Med Dept Psychiat Madison WI 53792 USA Guys & St Thomas Med Sch London England Camden & Islington Natl Hlth Serv Trust London England Royal N Shore Hosp Sydney NSW Australia Community Mental Hlth Serv Sydney NSW Australia Univ Wollongong Wollongong NSW 2500 Australia Univ Sydney Sydney NSW 2006 Australia Univ Manchester Dept Psychiat Manchester M13 9PL Lancs England Mental Hlth Ctr Dane Cty Madison WI USA Univ Colorado Boulder CO 80309 USA Texas Dept Mental Hlth & Mental Retardat Austin TX USA McGill Univ Douglas Hosp Res Ctr Montreal PQ Canada McGill Univ Dept Psychiat Montreal PQ Canada Univ Toronto Dept Psychiat Toronto ON Canada Ctr Addict & Mental Hlth Hlth Syst Res Unit Clarke Div Toronto ON Canada Guys Kings & St Thomas Sch Med Dent & Biomed Sci London England St Thomas Hosp Lambeth Healthcare Natl Hlth Serv Trust London England Med Univ S Carolina Dept Psychiat & Behav Sci Charleston SC USA Univ Wisconsin Sch Social Work Madison WI 53706 USA

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Resuscitation after high energy polytrauma

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BRITISH MEDICAL BULLETIN 1999年第4期55卷 785-805页

作者： Dollery, W Driscoll, P Hope Hosp Dept Emergency Med Salford M6 8HD Lancs England

The majority of patients with polytrauma seen in the UK are victims of blunt injury. The trauma reception team approach, using a predetermined plan for initial assessment and urgent resuscitation, can improve outcome. It is important, therefore, that each member of the team is familiar with both their own role and that of their colleagues. This chapter reviews the immediate management of the patient with polytrauma, focusing on the importance of the 'ABC' approach. Optimal management of the trauma airway is essential and the benefits of early intubation and alternative techniques for securing the difficult airway are discussed. The early identification and management of life-threatening respiratory and circulatory complications is emphasised. Accurate assessment of shock in the victim of trauma is difficult, as the simple clinical indicators are not ideal. Some of the techniques available for advanced assessment of tissue perfusion are discussed in detail. The management of polytrauma provides a considerable clinical challenge, and this chapter emphasises the importance of a team approach.

关键词：血液循环超声心动描记术经食管急诊室医院/组织和管理多处创伤/诊断多处创伤/治疗病人医疗小组/组织和管理体格检查/标准呼吸复苏术/方法休克/诊断创伤非贯通性/诊断创伤非贯通性/治疗人类

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Critical care bug team: A multidisciplinary team approach to reducing ventilator-associated pneumonia

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第2期28卷 197-201页

作者： Kaye, J Ashline, V Erickson, D Zeiler, K Gavigan, D Gannon, L Wynne, P Cooper, J Kittle, W Sharma, K Morton, J Univ Hosp Patient Care Adm Augusta GA 30901 USA

Background: Ventilator-associated pneumonia rates in me medical-surgical intensive care unit first exceeded the 90th percentile in September 1997 and were significantly (P < .05) higher than National Nosocomial Infections Surveillance System pooled mean data. In January 1998, a multidisciplinary "Critical Care Bug Team" was developed by the Infection Control Committee to review 1997 National Nosocomial Infections Surveillance System data for four adult intensive care units in a 583-bed tertiary care hospital. Methods: Membership included clinical nurse specialists, a dietitian, a pharmacist, a respiratory therapist, an infection control professional, a research specialist, and a physician adviser. Having the team report directly to the hospital's Infection Control and Adult Critical Care Committees maximized support for recommendations and provided a direct link from patient care to hospital administration. By identifying issues, evaluating patient care processes, performing literature searches, and monitoring compliance, the team implemented numerous interventions, including policy and procedure changes, purchasing of equipment, and implementation of various education tools. Results: Each member of the Critical Care Bug Team contributed to a synergized effort that may have produced the desired outcome of decreasing ventilator-associated pneumonia rates. Except for August 1998, ventilator-associated pneumonia rates have been below the 75th percentile since May 1998. Conclusion: This study illustrates the effectiveness of a multidisciplinary team approach devised to reduce and stabilize ventilator-associated pneumonia rates in a medical-surgical intensive care unit.

关键词：危重病人医疗/组织和管理交叉感染/流行病学交叉感染/病因学交叉感染/预防和控制佐治亚医院大学感染控制/组织和管理重症监护病房组织改革组织方针结果与过程评价(卫生保健)/组织和管理病人医疗小组/组织和管理人员医院/教育肺炎/流行病学肺炎/病因学肺炎/预防和控制人群监测规划制订方案评价危险因素成年人人类

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Department of pediatric hematology-oncology in Crete

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PEDIATRIC HEMATOLOGY AND ONCOLOGY 1996年第5期13卷 397-399页

作者： Kalmanti, M Department of Pediatric Hematology/Oncology University Hospital of Heraklion University of Crete Medical School Heraklion Crete Greece

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关键词：病人医疗小组/组织和管理人员医院/统计学和数值数据研究/组织和管理研究人员/统计学和数值数据

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Hematology and oncology at the hospital for sick children

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PEDIATRIC HEMATOLOGY AND ONCOLOGY 1996年第5期13卷 391-395页

作者： Zipursky, A UNIV TORONTO TORONTOONCANADA

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关键词：安大略门诊部医院病人医疗小组/组织和管理人员医院/统计学和数值数据研究/组织和管理研究人员/统计学和数值数据

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