目的 探讨医院消毒供应中心清洗全程质量控制用于院内感染风险预防价值。方法 选取2019年1月—2021年6月期间医院消毒供应中心待清洗消毒的1 000件手术器械（观察组）,采用全程质量控制;另选取1 000件手术器械（对照组）,常规流程清洗;比较2组患者器械清洗质量,统计清洗后因术中器械的院内感染率。结果 观察组清洗消毒后器械血渍、污垢、锈斑总发生率0.20%,低于对照组的1.50%,器械清洗、消毒、灭菌合格率高于对照组（P<0.05）。观察组器械操作流程与标准、科室管理、安全管理、综合质量管理高于对照组,院内感染率0.10%低于对照组的1.00%,医护人员满意度95.00%高于对照组的75.00%（P<0.05）。结论 医院消毒供应中心清洗质量控制,可增加手术器械清洗质量,减少院内感染的发生。

Objective To explore the value of whole process cleaning quality control in hospital disinfection supply center for risk prevention of hospital infection．Methods From January 2019 to June 2021,1000 surgical instruments to be cleaned and disinfected in the hospital disinfection supply center（observation group）were selected,and the whole process quality control was applied;another 1000 surgical instruments（control group）were selected for routine cleaning．The quality of instrument cleaning in the two groups was compared,and the hospital infection rate after the application of cleaned instrument was calculated．Results After cleaning and disinfecting instruments,the total incidence of blood stains,dirt and rust was 0.20% in the observation group,lower than that in the control group,which was 1.50%,and the qualified rate of instrument cleaning,disinfecting and sterilizing was higher than that in the control group（P<0.05）．The equipment operation procedures and standards,department management,safety management,and comprehensive quality management of the observation group were higher than those of the control group,the hospital infection rate was 0.10%,lower than that of the control group（1.00%）,and the satisfaction rate of medical staff was 95.00% in the observation group,higher than that of the control group（75.00%,P<0.05）．Conclusions The cleaning quality control of hospital disinfection supply center can improve the cleaning quality of surgical instruments and reduce the occurrence of hospital infection.

目的 从社会组织网络嵌入性的角度,探讨公立医院医务人员工作内外匹配（包括组织匹配和区域匹配）在人际信任与隐性医学知识共享行为之间的中介效应,完善公立医院医务人员隐性医学知识共享机制的研究。方法 采用问卷调查方式对公立医院医务人员进行调查,运用SPSS 17.0软件进行数据分析,采用AMOS 22.0建立公立医院医务人员工作内外匹配在人际信任与隐性医学知识共享行为之间的中介效应回归方程。结果 公立医院医务人员人际信任与隐性医学知识共享行为之间有显著的正相关关系,标准化回归系数为0.446（P <0.001）。加入工作内外匹配变量后,公立医务人员人际信任对隐性医学知识共享行为的标准化回归系数由0.446（P <0.001）降到0.189（P<0.01）。结论 公立医务人员人际信任正向预测隐性医学知识共享行为;组织匹配、区域匹配在公立医务人员人际信任与隐性医学知识共享行为之间具有部分中介效应。

Objective To explore a new path of interpersonal trust impact on knowledge sharing behavior-being from the perspective of job embeddedness．Methods Questionnaire survey was used to investigate the medical staff in public hospitals．SPSS 17.0 software was used to analyze the data．AMOS 22.0 was used to establish the regression equation of intermediary effect between interpersonal trust and tacit medical knowledge sharing behavior of medical staff in public hospitals．Results There was a significant positive correlation between interpersonal trust and tacit medical knowledge sharing behavior．The standardized regression coefficient was 0.446（P <0.001）．When added the fitting to organization and community,the standardized regression coefficient decreased from 0.446（P <0.001）to 0.189（P <0.01）．Conclusions The interpersonal trust of public medical staffs positively predicts the tacit medical knowledge sharing behavior．Organizational matching and regional matching have partial mediating effect between interpersonal trust and tacit medical knowledge sharing behavior of public medical staff.

目的 通过静脉输液批次决策的自动化、标准化以及个体化,实现静脉用药调配中心（PIVAS）工作同质化和高效化,进而促进临床安全合理用药。方法 根据药物使用的时辰药理学,调查分析人工决策输液批次存在的问题,建立批次时间划分表和制定批次决策规则,基于医院信息系统构建自动输液批次决策系统。由药师维护自动输液批次决策系统,针对该系统的应用效果评价分析。结果 应用自动批次决策软件后,PIVAS 批次不合格率下降,输液时间合理性提高。审方药师用于决策输液批次的时间减少,大幅度提高 PIVAS 和病区护士工作效率,同时降低 PIVAS输液配送出错频率。结论 自动输液批次决策系统构建完成之后,用药时间更合理,提高药物治疗效果;PIVAS工作效率明显提高,工作质量显著提升,输液批次不合格率降低,患者输液批次真正做到编排一致性,提高用药时间合理性,进而使临床用药更合理、更安全,实现个体化治疗。

ObjectiveThrough the automation, standardization and individualization of intravenous（IV）fluid batch decision-making, to realize the homogenization and high efficiency of Pharmacy Intravenous Admixture Services（PIVAS）, to promot safe and rational clinical drug use．Methods According to the pharmacology of drug use, the problems existing in manual IV fluid batch decision were investigated and analyzed, and an automatic IV fluid batch decision system was constructed based on hospital information system．Batch time division table and batch decision rules were established, automatic IV fluid batch decision system was maintained by pharmacists, the application effect of the system were evaluated and analyzed．Results The unqualified rate of PIVAS batch decreased, and the rationality of IV transfusion time increased．The time for prescription checking pharmacists to make IV fluid batch decisions was shortened, which greatly improved the work efficiency of PIVAS and nurses, and reduced the error frequency of PIVAS IV fluid distribution．Conclusions After the completion of the automatic IV fluid batch decision system, the medication time is more reasonable and the drug treatment effect is improved．The work efficiency and quality of PIVAS are significantly improved, and the unqualified rate of IV fluid batches is reduced．The IV fluid batches of patients are really arranged in a consistent way, and the rationality of medication time is improved, so that clinical medication is more reasonable and safer, and individualized treatment is realized．

目的 了解门诊老年患者补充与替代医学（CAM）使用现状及影响因素。方法 采用便利抽样法,选取2020年11月—2021年2月广东省某三甲医院老年科门诊就诊的老年患者作为研究对象,调查方法采用一般资料调查表和CAM使用情况调查表进行横断面调查。应用二元Logistics回归分析探讨门诊老年患者使用CAM的影响因素。结果 参与调查的123例老年患者中,有75例（61.0%）老年患者使用CAM,使用CAM的项目主要为中草药、药膳等中国传统医学项目。支付方式是门诊老年患者是否使用CAM的影响因素,使用医保支付的患者较公费、自费患者更愿意使用CAM（OR=5.054,95%CI：1.452~17.590,P<0.05）。结论 CAM在门诊应用广泛,我们应充分发挥我国传统医学优势,为老年人疾病防治提供更多的思路。政府层面也可进一步提高医保覆盖范围,让更多的患者有经济能力可以接受安全、有效的治疗。

Objective To investigate the current status of complementary and alternative medicine（CAM）use and the influencing factors of elderly patients in outpatient clinic．Methods Using the convenience sampling method,the elderly patients treated in the geriatric outpatient department of a Class A tertiary Hospital in Guangdong from November 2020 to February 2021 were selected．General data and the CAM usage questionnaire were collected．Binary logistics regression analysis was used to explore the factors influencing CAM use in elderly patients．Results Seventy-five（61.0%）of 123 elderly patients used CAM．Chinese herbal medicine and medicinal diet were the most common CAM．Payment method was a factor affecting whether elderly outpatient patients use CAM．Insured patients were more willing to use CAM than self-funded patients（OR=5.054,95%CI：1.452-17.590,P<0.05）．Conclusions CAM is widely used in outpatient clinics．We should make full use of our country’s traditional medicine,to provide different thoughts of diseases prevention and treatment in elderly patients．The government can also further enlarge the coverage of health insurance,so that more patients can afford safe and effective treatment．

目的 了解广州市某三甲综合医院2016—2022年住院病例的疾病分布特征,探究新型冠状病毒感染（新冠）疫情对疾病谱的影响,为医院合理配置医疗资源、提高医院医疗水平提供参考。方法 回顾性收集广州市某三甲综合医院2016—2022年间住院病例的病例数据,按照ICD-10国际统计分类标准进行分类,建立Joinpoint回归模型对不同类别疾病构成比的时间变化趋势进行分析。结果 2016—2022年间,前12顺位的疾病种类不变,构成比呈上升趋势的有4种,分别是循环系统疾病、肿瘤、消化系统疾病以及眼和附器疾病,构成比呈下降趋势的有3种,分别是呼吸系统疾病、肌肉骨骼系统和结缔组织疾病以及妊娠、分娩和产褥期。对这7类系统疾病进行不同性别、不同年龄段和不同居住地（广州市内/市外）的亚组分析,结果显示,除眼和附器疾病与妊娠、分娩和产褥期外,其余5种系统疾病在男性和女性中变化趋势比较差异无统计学意义（均P>0.05）。25岁以上人群循环系统疾病、肿瘤和消化系统疾病比例呈上升趋势。45岁以上人群眼和附器疾病的住院比例逐年上升。呼吸系统疾病的下降趋势集中出现在0~5岁和65岁以上人群,肌肉骨骼系统和结缔组织疾病的下降趋势可在45岁以上人群中被观测到,妊娠、分娩和产褥期的下降趋势则可在45岁以下人群中被观测到。总体和市内来源的住院病例的各系统疾病构成比变化趋势均未发现有2019年的连接拐点。但对于居住地在广州市外的病例,有6种系统疾病均存在一个2019年的连接拐点,与2016—2019年相比,2020—2022年增长趋势普遍减弱或者略有降低,但均无统计学意义,2022年市外来源住院病例的多种疾病占比低于2019年。≤24岁年龄组的病例因妊娠、分娩和产褥期住院的比例在2019年以后降低趋势加快,但也无统计学意义,2020—2022年≤24岁人群因妊娠、分娩和产褥期住院的比例低于2019年水平。结论 2016—2022年期间住院病例疾病谱有较大变化,这种变化趋势在不同性别、不同年龄段和居住地间效应存在差异。2020—2022年的新冠疫情流行主要降低了居住地在广州市外的住院病例多个系统疾病的比例以及24岁及以下患者因妊娠、分娩和产褥期住院的比例。

Objective To understand the disease distribution characteristics of inpatients in a 3-A-grade general hospital in Guangzhou from 2016 to 2022,to explore the impact of the COVID-19 on the disease spectrum,and to provide reference for hospitals to reasonably allocate medical resources and improve medical level. Methods Inpatient case data of a 3-A-grade general hospital from 2016 to 2022 were retrospectively collected and were classified according to the ICD-10 international statistical classification standard. A Joinpoint regression model was established to analyze the temporal trend of disease composition ratios in different categories. Results From 2016 to 2022,the type of top 12 diseases remained unchanged. There were 4 diseases showing an upward trend in composition,namely circulatory system diseases,tumors,digestive system diseases and eye and accessory organ diseases. There were 3 diseases showing a downward trend in composition,namely respiratory system diseases,musculoskeletal system and connective tissue diseases,as well as pregnancy,childbirth and postpartum period. A subgroup analysis was conducted on these 7 types of systemic diseases by gender,age group and place of residence(within/outside Guangzhou). The results showed that except for eye and accessory organ diseases and pregnancy,childbirth and postpartum period,there was no significant difference in the trend of changes in the other 5 systemic diseases between males and females(all P>0. 05). The upward trend of circulatory system diseases,tumors and digestive system diseases could be observed in people over the age of 25. The hospitalization rate of eye and accessory organ diseases among people over 45 years old was increasing year by year. The downward trend of respiratory diseases was concentrated in people aged 0~5 and over 65 years old,while the downward trend of musculoskeletal and connective tissue diseases could be observed in people aged 45 and above. The downward trend of pregnancy,childbirth and postpartum period could be observed in people under 45 years old. The trend of changes in the proportion of systemic diseases among inpatient cases from both overall and within Guangzhou had not been found to have a joinpoint in 2019. However,for cases residing outside of Guangzhou,there were six systemic diseases that all had a joinpoint in 2019. Compared with the growth trend from 2016 to 2019,the growth trend from 2020 to 2022 generally weakened or showed a slightly downward trend,but none of them were statistically significant. In 2022,the proportion of multiple diseases in hospitalized cases from outside Guangzhou was lower than that in 2019. The proportion of cases in the age group ≤24 years old who are hospitalized due to pregnancy,childbirth and postpartum period has been decreasing rapidly since 2019,but there was no statistical significance. The proportion of cases hospitalized due to pregnancy,childbirth and postpartum period in the population ≤24 years old from 2020 to 2022 was significantly lower than the level in 2019. Conclusions The disease spectrum of inpatients had undergone significant changes between 2016 and 2022,and these trends of changes were different among different genders,age groups and places of residence. The prevalence of the COVID-19 from 2020 to 2022 mainly reduced the proportion of inpatients with multiple systemic diseases living outside Guangzhou,and the proportion of inpatients aged 24 and under hospitalized for pregnancy,childbirth and puerperium.

目的 探讨脑卒中患者多重耐药菌（MDROs）医院感染风险因素,并进行病原学特点分析。方法 选择2020年1月—2022年12月福建中医药大学附属福鼎医院神经内科病房收治的160例脑卒中患者为研究对象,评估患者的MDROs医院感染发生状况,调查患者的一般资料并进行多因素分析。结果 在160例患者中,发生医院感染20例,分离到病原体26株,其中8例样本为MDROs（研究组,其他归为对照组）,来源于8例患者,占比5.00%,包括耐甲氧西林金黄色葡萄球菌（MRSA）3株,耐碳青霉烯大肠埃希菌（E.coli）2株、耐碳青霉烯肺炎克雷伯菌（KP）1株、全耐药KP1株、耐碳青霉烯PA1株。研究组的美国国立卫生院神经功能缺损（NIHSS）评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、糖尿病、低蛋白血症、置管留置时间、住院时间等与对照组对比差异有统计学意义（P<0.05）。二分类Logistic回归分析显示,上述指标均为导致MDROs医院感染发生的重要因素（P<0.05）。结论 脑卒中患者MDROs医院感染的发生率依然比较高,病原菌多为耐甲氧西林MRSA、耐碳青霉烯E.coli,患者的NIHSS评分、APACHEⅡ评分、糖尿病、低蛋白血症、置管留置时间、住院时间为主要的MDROs感染风险因素。

介绍了欧洲标准评估框架(CAF)的具体内涵。从国家三级公立医院绩效考核、现代医院管理制度构建、医院高质量发展实现和全面推进健康中国建设四个方面对我国三级公立医院实施卓越绩效管理的必要性进行了分析。在此基础上,提出基于CAF的我国三级公立医院卓越绩效管理实现策略:将卓越绩效管理理念贯穿医院管理全过程;构建基于CAF的三级公立医院内部卓越绩效考核指标体系;构筑基于CAF的卓越绩效考核医院内部运行机制;打造符合院情的卓越绩效考核自评模式。

目的 分析区级医院甲型流行性感冒患者的临床特征,为基层医院甲型流感的早期诊断及防控工作提供科学依据。方法 对2019年12月广州市番禺区中心医院发热门诊就诊的具有流感样症状的发热患者共628例,进行咽拭子甲型流感病毒核酸检测,收集患者临床资料,包括性别、年龄、体温、症状、血常规,根据核酸检测结果分为阴性组及阳性组,2组结果进行比较。结果 甲型流感病毒核酸检测阳性患者共116例,阳性率为18.5%。阳性组发病年龄以14～19岁所占比例最大,共91例(78.4%)。阳性组平均年龄小于阴性组(P＜0.05)。阳性组发病体温以38.1～39 ℃所占比例最大,共47例(46.5%)。阳性者平均体温高于阴性组(P＜0.01)。症状方面,阳性组仅鼻塞流涕比例较阴性组高(P＜0.05)。阳性组白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值、淋巴细胞百分比均低于阴性组(P＜0.01)。结论 2019年冬季甲型流感患者以青少年为主,单纯症状较难区分甲型流感及普通感冒,需结合血常规特别是白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值的降低进行分析。

Objective The clinical characteristics of patients with influenza A in district hospital were analyzed to provide scientific basis for early diagnosis, prevention and control of influenza A in primary hospital. Methods A total of 628 patients with influenza-like symptoms from Guangzhou Panyu Central Hospital in December 2019 were enrolled, and the clinical data was collected, including gender, age, body temperature, symptoms, and blood test results. According to the result of influenza A nucleic acid detection, patients were divided into negative group and positive group, and the clinical data of these two groups were compared. Results A total of 116 patients were positive in influenza A virus nucleic acid detection, which positive rate was 18.5%. In the positive group, patients aged 14-19 accounted for the largest proportion, with 91 patients (78.4%). The mean age of the positive group was significantly lower than that of the negative group (P＜0.05). Body temperature ranged from 38.1 to 39 ℃ accounted for the largest proportion in the positive group, with 47 patients (46.5%). The mean body temperature of the positive group was significantly higher than that of the negative group (P＜0.01). In terms of symptoms, only the proportion of nasal congestion in positive group was higher than that in negative group (P＜0.05). In terms of blood test results, WBC count, neutrophil absolute value, lymphocyte absolute value and lymphocyte percentage in the positive group were significantly lower than those in the negative group (P＜0.01). Conclusions The majority of patients with influenza A in the winter of 2019 were teenagers, and it was difficult to distinguish influenza A from the common cold only by symptoms. The differential diagnosis should be carried out in combination with the blood routine analysis, especially the decrease in the white blood cell count, the absolute value of neutrophil and the absolute value of lymphocytes.

目的 了解疫情期间医护人员代谢综合征(MS)、高同型半胱氨酸血症(HHcy)的患病率、二者关系及靶器官损害。方法 选取2020年1月—2021年11月在天津市某三级综合医院的1 544名医护人员作为研究对象。测量人体指标,测定血液生化、免疫等指标。分析MS及其组分的患病率、HHcy的患病率及靶器官损害。采用χ²检验,比较MS组、HHcy组与对照组靶器官损害的差异。采用Logistic回归模型分析MS与HHcy的关系。结果 三级综合医院医护人员疫情期间MS患病率为23.7%,MS组分:中心性肥胖、高血压/高血压病、高甘油三酯、低高密度脂蛋白和高空腹葡萄糖/糖尿病的患病率分别为49.4%、19.3%、24.3%、0.5%和37%。HHcy的患病率为29.7%。MS组、HHcy组与对照组靶器官损害程度差异有统计学意义(P<0.001)。HHcy与MS无直接相关性。结论 疫情期间医护人员MS和HHcy患病率较高,与对照组相比有明显的靶器官损害,HHcy不是MS的独立危险因素。

Objective To explore the prevalence of metabolic syndrome (MS) and hyperhomocysteinemia (HHcy), their relationship and target organ damage among medical staff during the pandemic. Methods A total of 1 544 medical staff in a third-class general hospital in Tianjin from January 2020 to November 2021 were selected as the object of study. The indexes of human body were measured, and the indexes of blood biochemistry and immunity were detected. The prevalence of MS and its components, the prevalence of HHcy and target organ damage were analyzed. χ² test was used to analyze the difference of target organ damage among MS group, HHcy group and control group. The relationship between HHcy and MS was analyzed by Logistic regression model. Results The prevalence of MS among medical staff in the third-class general hospital during the pandemic was 23.7%. The prevalence of central obesity, hypertension / hypertension disease, high triglyceride, low high density lipoprotein cholesterol and high fasting plasma glucose/diabetes were 49.4%, 19.3%, 24.3%, 0.5% and 37%, respectively. The prevalence of HHcy was 29.7%. There was significant difference in target organ damage among MS group, HHcy group and control group (P<0.001). There was no direct correlation between HHcy and MS. Conclusions During the pandemic period, the prevalence of MS and HHcy in medical staff were high, and there was obvious target organ damage in those staff compared with the control staff. HHcy is not an independent risk factor of MS.

目的 回顾分析2017—2018年汕头中心医院50例腹泻儿童鼠伤寒沙门菌的标本信息及药敏结果, 得出汕头地区这两年鼠伤寒沙门菌感染特性及指导临床合理用药。方法 从腹泻儿童粪便标本中分离沙门氏菌, 采用纸片扩散法检测其对抗菌药物的敏感性, 采用血清学凝集试验沙门氏菌血清型, 记录鉴定为鼠伤寒沙门菌的标本数据进行分析。结果 50例腹泻儿童鼠伤寒沙门氏菌中,易感时间多为夏秋季节;0～1岁为易感人群;感染后多出现发热、腹泻症状,可出现血便症状,较少出现呕吐;鼠伤寒沙门菌对亚胺培南、替加环素、厄他培南有100%的敏感率,对呱啦西林/他唑巴坦、头孢呱酮/舒巴坦有96%和92.68%的敏感率,队阿莫西林/克拉维酸有80.48%的敏感率,对阿米卡星、头孢呋辛酯、头孢呋辛、头孢西丁都为100%耐药,对其他抗生素有不同程度的敏感性及耐药性。结论 在夏秋季节,0～1岁儿童应加强对鼠伤寒沙门菌感染的预防,若出现发热、腹泻症状需及时就医,医生需向鼠伤寒沙门菌的方向考虑治疗,鼠伤寒沙门菌对多抗生素产生耐药性,临床上需根据药敏结果合理使用抗生素。

Objective To retrospectively analyze information and drug susceptibility of 50 cases of Salmonella typhimurium isolated from children with diarrhea in Shantou Central Hospital from 2017 to 2018, and to obtain the characteristics of Salmonella typhimurium infection in Shantou area in the past two years and to guide rational drug use in clinic. Methods Salmonella was isolated from fecal specimens of children with diarrhea. The susceptibility of Salmonella to antimicrobial agents was detected by disk diffusion method. Serological agglutination test was used to determine the serotype of salmonella. Sample data identified as Salmonella typhimurium were recorded and analyzed. Results Among the 50 children with diarrhea, the susceptibility time of Salmonella typhimurium was summer and autumn; the age of 0～1 was susceptible population; fever and diarrhea were common after infection, and hematochezia and vomiting were rare; Salmonella typhimurium had 100% susceptibility to imipenem, tegacycline and ertapenem, 96% and 92.68% to guacillin/tazobactam, cefotaxone/sulbactam. The sensitivity rate of amoxicillin/clavulanic acid was 80.48%. It was 100% resistant to amikacin, cefuroxime axetil, cefuroxime and cefoxitin. It had different sensitivity and resistance to other antibiotics. Conclusion In summer and autumn, children aged 0～1 should strengthen prevention of Salmonella typhimurium infection. If symptoms of fever and diarrhea occur, doctors should consider the direction of Salmonella typhimurium treatment. Salmonella typhimurium is resistant to multi-antibiotics, and rational use of antibiotics in clinic should be based on the results of drug sensitivity.