BACKGROUND & AIMS: :It is well reported in the epilepsy literature that use of antiepileptic drugs (AEDs) leads to bone loss. Validated instruments were administered to assess knowledge, health behavior, quality of life, and stigma, to determine their effects on self-efficacy for osteoprotective and self-management behaviors. This adult epilepsy population had a mean age of 45, with 20 years of AED exposure. Fifty subjects were Caucasian and 44 were non-Caucasian. By one-way ANOVA, there were significant differences in self-efficacy based on ethnicity, medical assistance, status, and seizure frequency. Differences in knowledge based on ethnicity, education, and income were also noted. Regression analysis revealed that the factors that most predict self-efficacy for calcium, exercise, and self-management do not parallel each other. Age and ethnicity were predictive of self-efficacy for epilepsy self-management only. Medical management factors varied among the models. Overall quality of life was a positive predictor for both calcium and exercise self-efficacy.

背景与目标： ：在癫痫文献中有充分的报道指出，使用抗癫痫药（AED）会导致骨质流失。使用经过验证的工具来评估知识，健康行为，生活质量和污名，以确定它们对自我保护对骨保护和自我管理行为的影响。该成人癫痫患者的平均年龄为45岁，暴露于AED的时间为20年。五十名受试者是高加索人，四十四名非高加索人。通过单因素方差分析，根据种族，医疗救助，身份和癫痫发作频率，自我效能有显着差异。还指出了基于种族，教育和收入的知识差异。回归分析显示，最能预测钙的自我效能，运动和自我管理的因素并不相互平行。年龄和种族仅能预测癫痫自我管理的自我效能。医疗管理因素因模型而异。总体生活质量是钙和运动自我效能的积极预测指标。

BACKGROUND & AIMS: :Health care workers' perceptions of patient suffering have not been well studied. Patients and health care workers were invited to answer a single, open-ended question. To develop a survey tool that could be validated and used for future research, what health care workers thought causes or caused the most suffering for patients was compared with what patients actually identified as the cause of their worst suffering. Health care workers underestimated loss and significantly underestimated physical nonpainful symptoms as causes of maximal suffering. Communication, emotional, and systems issues were often overestimated by health care workers. Health care workers may not accurately perceive what causes the worst suffering for patients. More studies are needed.

背景与目标： ：医护人员对患者痛苦的看法尚未得到很好的研究。邀请患者和医护人员回答一个开放性问题。为了开发一种可以验证并用于未来研究的调查工具，将医护人员认为造成或造成患者最大痛苦的原因与实际确定为造成其最严重痛苦的原因进行了比较。医护人员低估了损失，严重低估了身体无痛的症状，这是造成最大痛苦的原因。沟通，情感和系统问题经常被医护人员高估。医护人员可能无法准确地了解是什么导致患者遭受最严重的痛苦。需要更多的研究。

BACKGROUND & AIMS: BACKGROUND:Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case-by-case review, they could be targeted for specific interventions to improve their use of medical care. OBJECTIVE:We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity. DESIGN:Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables. SUBJECTS:We studied consecutive adults attending 2 primary care practices on randomly chosen days. MEASURES:The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital's automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients. RESULTS:Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%). CONCLUSIONS:We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.

背景与目标： 背景：躯体化患者适应不良，医疗利用率更高。如果有一种常规识别此类患者的方法，而无需进行深入的个案审查，则可以针对他们采取特定的干预措施，以改善他们对医疗的使用。
目的：我们试图确定可以利用可接受的敏感性和特异性来区分躯体化和非躯体化门诊患者的医疗利用模式。
设计：受试者完成问卷调查，评估躯体化和社会人口统计学特征。在索引访问之前的12个月中获得了他们的医疗保健利用率。然后，我们使用多变量logistic回归和递归分区来确定患有躯体形式疾病的临时诊断的患者。这些探索性模型使用了各种医疗保健利用模式和社会人口统计学特征作为自变量。
受试者：我们研究了在随机选择的日子里连续参加2种初级保健实践的成年人。
措施：用15个项目的自我报告调查表对躯体形式障碍的临时诊断进行了评估。在索引访问之前的12个月中，从我们医院的自动医疗记录中获得了初级保健就诊，专科就诊，心理健康就诊，急诊就诊以及住院和门诊费用的数量，还提供了总的发病率。我们从患者子样本中获得了我们医院系统外部的自我报告利用率。
结果：获得了1440例患者的完整数据。躯体化患者比初级保健就诊者拥有更多的专科护理，门诊患者比住院费用更高，并且急诊就诊者比非躯体化患者更多。包含7个使用率度量标准和4个社会人口统计学特征的回归模型以c统计量= 0.73区分了躯体化和非躯体化的患者。递归分区确定了10个终端节点，它们的特异性很高（99％），但敏感性很低（15％）。
结论：我们确定了7种离散的医疗服务利用模式，分别区分了躯体化和非躯体化的患者。但是，他们这样做只是出于适度的特异性和敏感性。该算法可以有效地用作两步筛查程序中的第一步，该步骤的第二步将需要进行更深入的筛查，或者进行逐项个案审查，以识别初级保健实践中的躯体化患者。

BACKGROUND & AIMS: OBJECTIVE:This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure. METHOD:This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior. SETTING AND SUBJECT:A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB. RESULTS:Two thirds of the total sample of participants (n=111) sought help for their continence problem. Approximately 70.3% (n=78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people. CONCLUSIONS:These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

背景与目标： 目的：本研究回顾了参加者的节制教育包，其中包括节制教育手册（CEB），并指出他们因节制失禁症状而受到困扰，从而改变了他们对失禁问题的健康寻求行为，因为他们获得了手册。
方法：本研究采用描述性和探索性设计。参加者获得了CEB的邀请，并要求阅读信息。还要求他们填写节制问卷并将其邮寄回研究团队。 2至3个月后打电话给表示自己受到节制问题困扰并同意接受采访的参与者。他们被问到问题，以确定他们在处理自控问题方面的行动和进展，以及CEB是否影响了他们的行为。
地点和主题：来自澳大利亚维多利亚州4个农村和地区性地区的631名参与者（352名女性，占55.8％； 279名男性，占44.2％）参加了该项目。在该样本中，有111名参与者报告他们受到节制问题困扰，其中有78名女性，占70.3％； 33名男性，占29.7％，在接受CEB后三个月进行了访谈。
结果：参与者（n = 111）的总样本的三分之二寻求帮助，以解决他们的节制问题。大约70.3％（n = 78）仍然存在尿失禁问题。在这一组中，仍有84.6％的人患有尿失禁问题，还有65.4％的人已经采取了行动来治疗他们的尿失禁。 49名参与者（44.1％）表示，由于该研究或小册子中包含的信息，他们直接与某人讨论了膀胱或肠道问题。记得CEB的参与者中，超过94％的参与者表示，他们认为该手册对其他人有帮助。
结论：这些发现表明，CEB促使个人讨论他们的节制问题，并在较少的情况下寻求专业帮助。鉴于这些发现，提倡分发节制教育一揽子计划作为节制健康促进策略。

BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

背景与目标： ：这项研究旨在阐明消化道手术后口腔护理的有效性，包括刷牙，义齿清洁和舌头清洁。受试者包括接受消化道手术的30位年龄在60-98岁（74.9 /-7.8岁）的老年患者。将受试者随机分为干预组和对照组。在干预组中，每天从基线（手术日）开始，在每天的5分钟内，每天进行以下口腔护理，并持续5天：用聚维酮碘漱口，刷牙，使用专用刷子清洁义齿和使用舌刷清洁舌头。在对照组中，受试者仅含聚维酮碘。我们在基线和5天后比较了两组之间的以下变量：口干的感觉，口内气体浓度，肺音，体温和细菌菌群。在干预组中，肺音异常（干音或湿音）的患者数量从1增加到2，在对照组中从0增加到4（P <0.05）。对照组术前平均细菌种类为3.64 /-1.34，术后为3.50 /-1.74，而干预组术前为3.08 /-0.95，术后为2.62 /-0.65。操作上。在干预组中，细菌种类的数量显着减少（P <0.05）。这些发现表明，接受消化道手术的老年患者的术后口腔护理降低了在口腔中发现的细菌种类的数量。反过来，这种效果可能会改善呼吸功能。

BACKGROUND & AIMS: INTRODUCTION:Adverse drug reactions (ADRs) occur frequently in hospitals and increase costs of health care; however, few studies have quantified the clinical and economic impact of ADRs in Colombia. OBJECTIVES:These impacts were evaluated by calculating costs associated with ADRs in patients hospitalized in the internal medicine ward of a Level 3 hospital located in Bogotá, Colombia. In addition, salient clinical features of ADRs were identified and characterized. MATERIAL AND METHODS:Intensive follow-ups for a cohort of patients were conducted for a five month period in order to detect ADRs; different ways to classify them, according to literature, were considered as well. Information was collected using the INVIMA reporting format, and causal probability was evaluated with the Naranjo algorithm. Direct costs were calculated from the perspective of payer, based on the following costs: additional hospital stay, medications, paraclinical tests, additional procedures, patient displacement to intermediate or intensive care units, and other costs. RESULTS:Of 836 patients admitted to the service, 268 adverse drug reactions were detected in 208 patients (incidence proportion 25.1%, occurence rate 0.32). About the ADRs found, 74.3% were classified as probable, 92.5% were type A, and 81.3% were moderate. The body system most often affected was the circulatory system (33.9%). Drugs acting on the blood were most frequently those ones associated with adverse reactions (37.6%). The costs resulting from medical care of adverse drug reactions varied from COL dollar 93,633,422 (USD dollar 35,014.92) to COL dollar 122,155,406 (USD dollar 45,680.94), according to insurance type, during the study period. CONCLUSIONS:Adverse drug reactions have a significant negative health and financial impact on patient welfare. Because of the substantial resources required for their medical care and the significant proportion of preventable adverse reactions, active programs of institutional pharmacovigilance are highly recommended.

背景与目标： 简介：药物不良反应（ADR）在医院中经常发生，并增加了医疗保健费用；但是，很少有研究能够量化ADR在哥伦比亚的临床和经济影响。
目的：通过计算在哥伦比亚波哥大三级医院内科病房住院的患者与ADR相关的费用来评估这些影响。此外，ADR的显着临床特征已得到鉴定和表征。
材料与方法：对一组患者进行了为期五个月的强化随访，以检测ADR。根据文献，还考虑了不同的分类方法。使用INVIMA报告格式收集信息，并使用Naranjo算法评估因果概率。直接费用是根据以下费用从付款人的角度计算的：额外的住院时间，药物，辅助临床检查，其他程序，将患者转移到中级或重症监护室以及其他费用。
结果：836例入院患者中，208例患者发生了268例药物不良反应（发生率25.1％，发生率0.32）。关于发现的ADR，有74.3％被归为可能，A型为92.5％，中度为81.3％。受影响最严重的身体系统是循环系统（33.9％）。作用于血液的药物最常见于那些与不良反应有关的药物（37.6％）。根据保险类型，在研究期间，药物不良反应的医疗费用从93,633,422美元（35,014.92美元）到122,155,406美元（45,680.94美元）不等。
结论：药物不良反应会对患者的健康产生重大的负面健康和财务影响。由于其医疗服务所需的大量资源以及可预防的不良反应的比例很大，因此强烈建议积极进行机构药物警戒计划。

BACKGROUND & AIMS: BACKGROUND:Despite increasing numbers of morbidly obese patients admitted to acute care facilities for surgery or treatment of nonsurgical conditions, there is little evidence of the problems nurses face in providing care to these patients. Anecdotal evidence suggests that the care of these patients is more demanding than the care of nonobese patients. The objective of this study was to describe nurses' perceptions of the challenges that they face when caring for morbidly obese patients. METHODS:Focus groups of nurses from a tertiary care facility were convened. A trained facilitator posed questions to the group concerning various aspects of care for morbidly obese patients. Comments of respondents were categorized using NVIVO software. RESULTS:Nurses reported concerns about the increased staffing needs required for care of these patients and the particular challenges of the physical care. Concerns also included the availability, placement, and use of specialized equipment. Room size and the absence of some equipment were also problematic. Finally, nurses perceived safety issues, both for themselves and their patients. CONCLUSIONS:Morbidly obese patients in the acute care setting require specialized nursing care in terms of techniques, levels of staffing required, and the use of specialized equipment.

背景与目标： 背景：尽管进入急性护理机构接受外科手术或非手术条件治疗的病态肥胖患者的人数不断增加，但几乎没有证据表明护士在为这些患者提供护理方面面临的问题。轶事证据表明，与非肥胖患者相比，这些患者的护理要求更高。这项研究的目的是描述护士对照顾病态肥胖患者时面临的挑战的看法。
方法：召集三级护理机构的护士重点小组。一位训练有素的主持人向小组提出了有关病态肥胖患者护理各个方面的问题。使用NVIVO软件对受访者的评论进行了分类。
结果：护士报告担心护理这些患者所需的人员增加以及身体护理的特殊挑战。问题还包括专用设备的可用性，放置和使用。房间的大小和缺少一些设备也是有问题的。最后，护士们意识到了自己和病人的安全问题。
结论：急性护理环境中的病态肥胖患者需要在技术，所需人员配备和使用专用设备方面进行专门护理。

BACKGROUND & AIMS: :Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. They tend to use heuristic or intuitive approaches to simplify complexity, and in the process, important information is ignored. Next, policy makers may select interventions for only political motives. This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health--that tend to focus on single criteria--towards transparent and systematic approaches that take into account all relevant criteria simultaneously.

背景与目标： ：卫生干预措施的优先级设置通常是临时的，资源没有得到最佳利用。潜在的问题是多个标准起着作用，并且决策很复杂。可以选择干预措施，以最大程度地提高总体人口健康，减少弱势或弱势群体的健康不平等，广告/或应对危及生命的情况，所有这些都涉及实际和预算方面的限制。这是决策者通常无助于理性解决的典型问题。他们倾向于使用启发式或直观的方法来简化复杂性，并且在此过程中，重要的信息将被忽略。接下来，政策制定者可能只出于政治动机选择干预措施。这表明需要采取合理和透明的方法来确定优先事项。在过去的几十年中，已经开发出许多方法，包括循证医学，疾病负担分析，成本效益分析和公平性分析。但是，这些方法仅集中于单个标准，而实际上，决策者需要在选择时同时考虑多个标准。此外，它们并未涵盖与决策者相关的所有标准。因此，有必要开发一种确定优先级的多标准方法，并且最近确实将其确定为卫生系统研究中最重要的问题之一。在其他科学学科中，多准则决策分析已经得到了很好的发展，已经得到了广泛的认可并被常规使用。本文介绍了多准则决策分析的主要原理。只有很少的应用程序可以指导健康状况中的资源分配决策。我们呼吁从目前卫生领域的优先重点设定工具（倾向于只关注单一标准）转变为同时考虑所有相关标准的透明，系统的方法。

BACKGROUND & AIMS: PURPOSE:Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. DESIGN AND METHODS:We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we asked the professional to recommend the appropriate forms of long-term care. RESULTS:Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favor the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favored rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favored day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. IMPLICATIONS:Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment-but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.

背景与目标： 目的：做出正确的消费者决定需要掌握良好的信息。这项研究比较了各种类型的卫生专业人员之间的长期护理建议。
设计与方法：我们为来自不同学科和工作地点的211名专业人员提供了随机变化的情景，以方便他们在全国范围内进行抽样。对于每种情况，我们都要求专业人员推荐适当的长期护理形式。
结果：尽管专业受访者使用了提供给他们的所有选择，但一些专业人士倾向于偏爱他们工作的部门。高级执业护士建议日托和家庭护理更多，而成人寄养则更少。老年学家更加积极地使用熟练的护理设施，而康复，家庭装修和家庭保健的活动则较少。老年医生和初级保健医生都偏爱康复和熟练的护理设施护理，对辅助生活，家庭制作和非正式护理的热情都较低，但是老年医生比初级保健医生更喜欢日托。注册护士高度支持辅助生活，成人寄养，家庭护理和家庭保健，并且他们反对熟练的护理设施护理。与其他参与者相比，社会工作者认可康复和成人寄养服务的可能性较小。
含义：由于消费者的偏好应该是做出长期护理决定的主要因素，因此许多消费者需要有关哪种选择最适合其情况的信息。在缺乏关于哪种类型的长期护理最适合谁的经验数据的情况下，消费者必须依靠专家的判断，但这种判断会有所不同。客户应注意，专家的背景（由学科和工作情况所定义）可能会影响其建议。每个学科似乎都有自己的经验和信念，可能会影响建议。

BACKGROUND & AIMS: :In the last few decades, the importance of selenium in human health has been the subject of numerous studies. It is believed that the physiological effects of selenium occur mainly through the function of selenoproteins, which incorporate selenium in the form of one or more selenocysteine residues. Recent advances in understanding the complex regulation of selenoprotein synthesis and functional characterization of several members of the selenoprotein family have contributed to an improved comprehension of the role(s) of selenium in human health and the great diversity of physiological pathways influenced by this trace element.

背景与目标： ：在过去的几十年中，硒在人类健康中的重要性一直是众多研究的主题。相信硒的生理作用主要通过硒蛋白的功能而发生，硒蛋白以一种或多种硒代半胱氨酸残基的形式掺入硒。在了解硒蛋白合成的复杂调控和硒蛋白家族几个成员的功能表征方面的最新进展有助于人们更好地理解硒在人体健康中的作用以及受该微量元素影响的多种生理途径。

BACKGROUND & AIMS: :A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.

背景与目标： ：在癌症医院的医疗重症监护室连续12个月进行了前瞻性抗菌药物阳性培养。在528例入院病例中，总共记录了144例感染和163种病原体。肺，尿，耳鼻喉（耳，鼻和喉）感染和菌血症的记录最频繁。葡萄球菌，链球菌，大肠杆菌，克雷伯菌和假单胞菌是最常见的病原体。革兰氏阳性菌株主要在单微生物菌血症期间观察到（48.9％）。分别在58％和92％的分离菌株中发现了耐甲氧西林的金黄色葡萄球菌（MRSA）和表皮葡萄球菌（MRSE）。没有发现特定的爆发。有必要进行进一步的前瞻性研究，以评估抗生素使用对我们ICU中耐药菌株选择的影响。

BACKGROUND & AIMS: :The health issues of young adulthood have received relatively little attention compared with those of adolescence, although the critical issues in young adulthood parallel those of adolescence. Young adults often fare worse than adolescents on health indicators, with many measures of negative outcomes--including rates of injury, homicide, and substance use--peaking during the young adult years. The contextual factors shaping health status and access to care in young adulthood differ significantly from the context of adolescence. This article synthesizes national data to present a health profile of young adults, reviewing social indicators that describe the context of young adulthood and presenting measures of health status. We examine mortality, morbidity, risky behaviors, and health care access and utilization, identifying the most significant gender and racial/ethnic disparities. The article also identifies limitations of existing data and offers suggestions for future research and health monitoring in this area. We conclude with a discussion of current efforts to address the health and well-being of young adults and argue for creating a national health agenda for young adults that includes research, programs and policies to address health issues during this period of the lifespan.

背景与目标： ：与青春期相比，青年期的健康问题受到的关注相对较少，尽管青年期的关键问题与青春期的问题平行。在健康指标上，年轻人通常比青少年情况更糟，在年轻人成年时期，有很多负面结果的衡量指标，包括伤害率，杀人率和药物使用率。决定健康状况和成年后获得医疗服务的情境因素与青春期有很大不同。本文综合了国家数据，以介绍年轻人的健康状况，回顾了描述年轻人成年背景的社会指标，并提出了健康状况的衡量指标。我们检查了死亡率，发病率，危险行为以及医疗保健的获取和利用，确定了最重要的性别和种族/族裔差异。本文还指出了现有数据的局限性，并为该领域的未来研究和健康监测提供了建议。最后，我们讨论了当前为解决年轻人的健康和福祉所做的努力，并争辩了制定一项针对年轻人的国家健康议程，其中包括研究，计划和政策，以解决这一时期的健康问题。

BACKGROUND & AIMS: OBJECTIVE:To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program. DATA SOURCE:Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995. STUDY DESIGN:The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects. PRINCIPAL FINDINGS:Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects. CONCLUSIONS:Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.

背景与目标： 目的：调查当地劳动力市场状况以及雇主赞助的医疗保险对医疗补助计划退出的影响。
数据来源：该项目的数据来自一个独特的管理数据库，该数据库包含1987年加利福尼亚州医疗补助计划所有病例的2％样本，以及从1987年至1995年每年开始的所有新病例的2％样本。
研究设计：使用离散持续时间模型估算结果，其中每月退出概率是人口统计学特征，当地劳动力市场变量，拥有雇主赞助的保险的概率以及固定的年度和县级影响的函数。
主要发现：劳动力市场机会的增加（即就业增长，工资增长以及雇主赞助的健康保险的增加）促使人们退出了医疗补助计划。雇主赞助的保险的可用性增加2.5个百分点，则完整的持续时间不超过2年的概率将增加6％。失业率降低2个百分点或平均季度收入提高10％，才能在2年内退出医疗补助计划。这些效应对于将县级固定效应和时间效应包括在内是有力的。
结论：医疗补助支出和病案量对当地经济波动和健康保险可及性的长期趋势很敏感。基于雇主的健康保险覆盖率的持续下降将大大增加对公共保险覆盖率的需求以及州政府的财务压力。

BACKGROUND & AIMS: :Spiritual issues arise frequently in the care of dying patients, yet health care professionals may not recognize them, may not believe they have a duty to address these issues, and may not understand how best to respond to their patients' spiritual needs. The case of a patient with a strong religious belief in a miraculous cure of metastatic pancreatic cancer is used to explore how better understanding of this belief and more explicitly spiritual conversation with the patient by his treating team might have provided opportunities for an improved plan of care. This article distinguishes spirituality from religion; describes the salient spiritual needs of patients at the end of life as encompassing questions of meaning, value, and relationship; delineates the role physicians ought to play in ascertaining and responding to those needs; and discusses the particular issue of miracles, arguing that expectations of miraculous cure ought not preclude referral to hospice care.

背景与目标： 精神问题经常出现在垂死患者的护理中，但是医疗保健专业人员可能不认识他们，可能不相信他们有责任解决这些问题，并且可能不了解如何最好地满足患者的精神需求。以强烈信仰宗教信仰的患者奇迹般地治疗转移性胰腺癌的案例为例，探讨了如何更好地理解这一信仰，以及治疗团队与患者进行更明确的精神对话，可能会为改善护理计划提供机会。本文将灵性与宗教区分开来；描述生命终了时患者的主要精神需求，包括意义，价值和关系问题；描述医生在确定和响应这些需求中应发挥的作用；并讨论了奇迹的特殊问题，认为奇迹疗法的期望不应排除转诊临终关怀的可能性。