BACKGROUND & AIMS: INTRODUCTION:The epidemiology of Clostridium difficile infection (CDI) has changed in the last two decades. There is a lack of information regarding incidence and severity of CDI, especially in the developing world. METHODS:This was a retrospective and observational study from four hospitals of three Mexican cities. Patients were diagnosed with CDI when presented with loose stools and had at least one of the following tests positive: toxins assay, real-time PCR, or an endoscopic image compatible with pseudomembranous colitis. CDI was classified according to international guidelines. Demographic and clinical data as well as information regarding total hospital admissions, total length-of-hospital stay, and other variables related to hospitalization were gathered from the epidemiology and administration departments of each hospital. RESULTS:A total of 2050 hospital beds were analyzed with 288,171 patients hospitalized accumulating 1,576,446 days of hospitalization during the study period. The average rate of CDI per 1000 hospital-days was lower than the rates reported in the US and Europe, although in 2015 CDI rates were almost persistently above the mean rate for the study period. More than half of PCR positive patients were ribotype 027. CONCLUSION:Hospital rates of CDI are increasing in Mexican hospitals with a predominance of infections caused by ribotype 027.

背景与目标： 简介：最近二十年来，艰难梭菌感染（CDI）的流行病学发生了变化。缺乏关于CDI发生率和严重程度的信息，尤其是在发展中国家。
方法：这是来自墨西哥三个城市的四家医院的回顾性观察研究。当患者出现稀便时被诊断为CDI，并且至少接受以下一项阳性检查：毒素测定，实时PCR或与伪膜性结肠炎兼容的内窥镜检查。 CDI是根据国际准则进行分类的。从每家医院的流行病学和行政管理部门收集了人口统计学和临床​​数据，以及有关总住院人数，总住院时间以及其他与住院相关的变量的信息。
结果：共分析了2050张病床，其中288,171名患者入院，在研究期间累计住院1,576,446天。每千个住院日的平均CDI率低于美国和欧洲的报告率，尽管2015年CDI率几乎持续高于研究期的平均率。超过一半的PCR阳性患者为027型核糖体。
结论：墨西哥医院的CDI率正在上升，其中主要是由027型核糖体引起的感染。

BACKGROUND & AIMS: :This paper describes part of a multicenter study sponsored by the Pan American Health Organization to assess health care reforms and their implications for nursing in several countries. The objective of this research was to learn the views of nurses working in philanthropic hospitals in Ribeirão Preto, in the state of São Paulo, Brazil, regarding the changes in nursing practice coming from Brazil's health care reform and implementation of the Unified Health System (UHS). Data were obtained through structured interviews with seven nurses who met the selection criteria, from the three philanthropic hospitals in Ribeirão Preto. The nurses reported a decline in the quality of care and in the number of beds for UHS patients. The nurses reported that UHS implementation initially led to infrastructure improvements in the philanthropic hospitals. However, the reforms eventually shifted toward improving the care of private and privately insured patients. In addition, the nurses emphasized their heavy work loads and low pay. The nurses' reports indicated that Brazil's UHS is going through a crisis. In general, the nurses linked this crisis to problems in funding and allocation of resources.

背景与目标： ：本文描述了由泛美卫生组织赞助的一项多中心研究的一部分，该研究旨在评估医疗保健改革及其在几个国家对护理的影响。这项研究的目的是了解在巴西圣保罗州里贝朗·普雷图（RibeirãoPreto）慈善医院工作的护士对巴西医疗改革和统一医疗体系（UHS）实施带来的护理实践的看法）。数据是通过对RibeirãoPreto的三家慈善医院中符合selection选标准的七名护士进行结构化访谈而获得的。护士们报告说，UHS患者的护理质量和床位数下降。护士们报告说，实施UHS最初可以改善慈善医院的基础设施。但是，这些改革最终转向改善私人和私人参保患者的护理。此外，护士们强调他们的繁重工作和低薪水。护士们的报告表明，巴西的UHS正在经历一场危机。通常，护士将这场危机与资金和资源分配问题联系在一起。

BACKGROUND & AIMS: BACKGROUND:In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. METHODS:The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. RESULTS:Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). CONCLUSIONS:Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

背景与目标： 背景：在2011年美国医院针对医疗保健相关感染和抗菌药物使用的患病率调查中，有50％的患者在调查日期或前一天接受了抗菌药物治疗。此后，更多的医院建立了抗菌素管理计划。我们在2015年重复了这项调查，以确定抗菌药物的使用率并描述自2011年以来的变化。
方法：美国疾病控制和预防中心的新发感染项目站点分别招募了≤25家普通医院和妇女儿童医院。医院从2015年5月至9月选择了一个调查日期。在调查日期对随机患者样本的病历进行了审查，以收集有关在调查日期或前一天施用的抗菌药物的数据。比较了使用抗菌药物的患者百分比；多变量对数二项式回归模型用于评估与抗菌药物使用相关的因素。
结果：在199家医院的12至299名患者中，有6084名患者（49.5％； 95％CI，48.6-50.4％）接受了抗菌药物治疗。在两项调查的148家医院中，尽管2015年新生儿重症监护患者使用抗菌药物的比例较低，但总体抗菌药物使用率在2011年和2015年相似（22.8％vs 32.0％[2011]； P = .006）。 2015年氟喹诺酮类药物的使用率较低（10.1％的患者对11.9％的患者[2011]； P <0.001）。第三或第四代头孢菌素的使用率较高（12.2％比10.7％[2011]； P = .002），碳青霉烯的使用率也较高（3.7％比2.7％[2011]； P <0.001）。
结论：2011年和2015年医院总体抗菌药物使用率无差异。但是，在选定的患者或抗菌药物组中观察到的差异可能会提供管理影响的证据。

BACKGROUND & AIMS: BACKGROUND:Whether safety-net hospitals (SNHs) provide patient-centered care has important implications both for patient outcomes and for how these hospitals will fare under value-based purchasing (VBP). We sought to determine performance and improvement on measures of patient-reported hospital experience among SNHs compared with non-SNHs. METHODS:Our sample consisted of 3096 US hospitals. We defined safety-net hospitals as those hospitals in the highest quartile of the Disproportionate Share Hospital (DSH) index, and we used national data on patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in 2007 and 2010 to examine overall hospital performance and improvement over time. RESULTS:Safety-net hospitals had lower performance than non-SNHs on nearly all measures of patient experience. The greatest differences were in overall hospital rating, where patients in SNHs were less likely to rate the hospital a 9 or 10 on a 10-point scale compared with patients in non-SNHs (63.9% vs 69.5%; P < .001). Gaps were also sizeable for the proportion of patients who reported receiving discharge information (2.6 percentage point difference; P < .001) and who thought they always communicated well with physicians (2.2 percentage point difference; P < .001). Although both groups of hospitals improved from 2007 through 2010, the gap between SNHs and non-SNHs increased (3.8% in 2007 vs 5.6% in 2010; P = .08). Finally, SNHs had a 60% lower odds of meeting VBP performance benchmarks for hospital payments (odds ratio, 0.4; 95% CI, 0.3-0.5; P < .001) compared with non-SNHs. CONCLUSIONS:Safety-net hospitals have lower performance than non-SNHs on metrics of patient-reported experience, improved somewhat more slowly under public reporting, and are likely to fare poorly under VBP.

背景与目标： 背景：安全网医院（SNHs）是否提供以患者为中心的护理，对患者的结局以及这些医院在基于价值的购买（VBP）下的收费方式都具有重要意义。我们试图确定与非SNH相比，SNH中患者报告的医院经验指标的性能和改进情况。
方法：我们的样本包括3096家美国医院。我们将安全网医院定义为在不成比例共享医院（DSH）指数中排名最高的四分之一的医院，并且我们使用了2007年和2010年《医院医疗保健提供者和系统消费者评估》（HCAHPS）调查中有关患者经验的国家数据，检查医院的整体绩效并随着时间的推移进行改进。
结果：在几乎所有患者体验指标上，安全网医院的绩效均低于非SNH。最大的差异在于医院的整体评分，与非SNH的患者相比，SNH的患者在10分制上对医院的评分为9分或10分的可能性较小（63.9％对69.5％； P <.001）。对于报告接受出院信息的患者比例（2.6个百分点差异； P <.001），并认为他们与医生的沟通始终很好（2.2个百分点差异； P <.001），这部分患者的差距也很大。尽管从2007年到2010年两组医院都有所改善，但SNH与非SNH之间的差距有所增加（2007年为3.8％，2010年为5.6％； P = 0.08）。最后，与非SNH相比，SNH满足医院付款的VBP绩效基准的几率要低60％（赔率，0.4； 95％CI，0.3-0.5； P <.001）。
结论：就患者报告的经验而言，安全网医院的绩效要比非SNH医院低，在公共报告中的改善速度较慢，在VBP的情况下收费可能很差。

BACKGROUND & AIMS: :Purpose: Direct obstetric causes have a significant contribution for severe maternal morbidities and mortalities, although the effect of grand multiparity on adverse obstetric outcomes remains controversial across studies. This study aimed to compare obstetric outcomes in grand multiparous and low multiparous women in two hospitals of southern Ethiopia.Materials and methods: A comparative cross-sectional study was conducted in one general and one comprehensive specialized hospitals in 2018. Four hundred and sixty-one mothers were included in the study. Data were collected by structured questionnaire and extraction sheets from clinical documents, and were analyzed using STATA version 14 (StataCorp, College Station, TX, USA).Results: About 39% of the included mothers had at least one adverse obstetric outcome. Hypertensive disorders of pregnancy, antepartum hemorrhage, and premature rupture of membrane and were higher in the grand multiparous mothers. However, obstructed labor and risk of cesarean delivery were higher in low multiparous women. History of medical illnesses, previous cesarean delivery, and high birth weight were independent predictors of adverse maternal outcomes regardless of parity. However, parity did not show statistically significant difference in obstetric outcomes.Conclusion: Parity did not show statistically significant difference in experiencing adverse obstetric outcomes in women. Early identification and treatment of high-risk mothers is recommended regardless of parity.

背景与目标： 目的：直接产科病因对严重的产妇发病和死亡有重大贡献，尽管在整个研究中，巨大的产妇对不良产科预后的影响仍然存在争议。这项研究旨在比较埃塞俄比亚南部两所医院的多产和低多产妇女的产科结局。材料和方法：2018年在一家综合性医院和一家综合性专科医院进行了比较横断面研究。461例母亲被纳入研究。通过结构化问卷和临床文献摘录收集数据，并使用STATA 14版（StataCorp，美国德克萨斯州大学城，StataCorp）进行分析。结果：约39％的母亲至少有一项不良产科预后。妊娠高血压疾病，产前出血和胎膜早破，在多产母亲中较高。但是，低分娩妇女的产程受阻和剖宫产的风险较高。医学疾病史，既往剖腹产和高出生体重是孕产妇不良后果的独立预测因子，无论其是否均等。但是，均等在产科预后方面没有统计学上的显着性差异。结论：均等在女性经历不良产科预后上没有显着性上的差异。建议不分性别，尽早识别和治疗高危母亲。

BACKGROUND & AIMS: BACKGROUND:Hospitals have been one of the major targets for phishing attacks. Despite efforts to improve information security compliance, hospitals still significantly suffer from such attacks, impacting the quality of care and the safety of patients. OBJECTIVE:This study aimed to investigate why hospital employees decide to click on phishing emails by analyzing actual clicking data. METHODS:We first gauged the factors that influence clicking behavior using the theory of planned behavior (TPB) and integrating trust theories. We then conducted a survey in hospitals and used structural equation modeling to investigate the components of compliance intention. We matched employees' survey results with their actual clicking data from phishing campaigns. RESULTS:Our analysis (N=397) reveals that TPB factors (attitude, subjective norms, and perceived behavioral control), as well as collective felt trust and trust in information security technology, are positively related to compliance intention. However, compliance intention is not significantly related to compliance behavior. Only the level of employees' workload is positively associated with the likelihood of employees clicking on a phishing link. CONCLUSIONS:This is one of the few studies in information security and decision making that observed compliance behavior by analyzing clicking data rather than using self-reported data. We show that, in the context of phishing emails, intention and compliance might not be as strongly linked as previously assumed; hence, hospitals must remain vigilant with vulnerabilities that cannot be easily managed. Importantly, given the significant association between workload and noncompliance behavior (ie, clicking on phishing links), hospitals should better manage employees' workload to increase information security. Our findings can help health care organizations augment employees' compliance with their cybersecurity policies and reduce the likelihood of clicking on phishing links.

背景与目标： 背景：医院已成为网络钓鱼攻击的主要目标之一。尽管努力改善信息安全合规性，但医院仍然遭受此类攻击的严重影响，从而影响了护理质量和患者的安全。
目的：本研究旨在通过分析实际点击数据来调查为什么医院员工决定点击网络钓鱼电子邮件。
方法：我们首先使用计划行为理论（TPB）并整合了信任理论，评估了影响点击行为的因素。然后，我们在医院进行了一项调查，并使用结构方程模型来研究合规意图的组成部分。我们将员工的调查结果与网络钓鱼活动中的实际点击数据进行了匹配。
结果：我们的分析（N = 397）表明，TPB因素（态度，主观规范和感知的行为控制）以及集体对信息安全技术的信任和信任与合规意图成正相关。但是，合规意图与合规行为没有显着关系。只有员工的工作量水平与员工点击网络钓鱼链接的可能性呈正相关。
结论：这是信息安全和决策研究中为数不多的研究之一，这些研究通过分析点击数据而不是使用自我报告的数据来观察合规性行为。我们表明，在网络钓鱼电子邮件的上下文中，意图和合规性可能不像以前所假设的那样紧密地联系在一起。因此，医院必须对无法轻易管理的漏洞保持警惕。重要的是，考虑到工作量和违规行为之间存在显着关联（即，单击网络钓鱼链接），医院应更好地管理员工的工作量以提高信息安全性。我们的发现可以帮助医疗保健组织提高员工对网络安全政策的遵从性，并减少点击网络钓鱼链接的可能性。

BACKGROUND & AIMS: :Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p < 0.0001), brucellosis (OR = 1.84, p = 0.005), CCHF (OR = 4.35, p = 0.001), TBE (OR = 2.78, p < 0.0001), and HEV (OR = 1.94, p = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.

背景与目标： ：有关病原体流行率的数据对于告知暴露和疾病风险至关重要。我们评估了1033例表现为tick传性脑炎（TBE），西尼罗河（WN），戊型肝炎病毒（HEV），克里米亚-刚果出血热（CCHF），耶尔森病，莱姆病（LD）和布鲁氏菌病的血清学证据来自肯尼亚不同生态区的9个医疗机构的急性发热性疾病：干旱和半干旱（加里萨斯区医院，罗德瓦尔区医院，马里加特区医院，吉尔吉尔区医院），维多利亚湖盆地（基苏木区医院，阿卢佩区医院，科姆贝瓦苏维埃-县医院），Kisii高地（Kisii地区医院）和沿海地区（马林迪地区医院）。分析患者的流行病学信息，例如地理，年龄，性别和饲养动物等，作为潜在的危险因素。在1033个样本中，有619个（59.9％）通过IgM（当前暴露），IgG / IgM（最近暴露）和IgG（过去暴露）对至少一种病原体呈血清阳性。 LD的当前，最近和过去的集体血清阳性率为LD的9.4％，5.1％和21.1％； WN为3.6％，0.5％和12.4％； HEV的0.9％，0.5％和16.9％；布氏杆菌病分别为5.8％，1.3％和3.9％；耶尔氏菌病分别为5.7％，0.2％和2.3％； TBE为1.7％，0％和6.2％； CCHF分别为0.4％，0％和1.9％。在Garissa地区医院招募的布鲁氏菌病风险较高（赔率[OR] = 3.41），在Lodwar District Hospital中的HEV（OR = 2.45）和CCHF（OR = 5.46），在Alupe地区医院的LD（OR = 5.73）， Kombewa街道医院（OR = 8.17）和马林迪区医院（OR = 3.3）。 LD暴露在年轻人群中最高，而耶尔森菌病并没有随年龄而变化。年龄是WN，布鲁氏菌病，CCHF，TBE和HEV的重大风险，而年龄大于14岁的人群中WN（OR = 2.30，p <0.0001），布鲁氏菌病（OR = 1.84，p = 0.005）的风险增加。 ，CCHF（OR ＝ 4.35，p ＝ 0.001），TBE（OR ＝ 2.78，p ＜0.0001）和HEV（OR ＝ 1.94，p ＝ 0.0001）。我们得出的结论是，LD无处不在，对研究人群构成重大的健康负担，而耶尔氏菌病和CCHF则不是重大威胁。展望未来，将需要进行基于社区的研究，以获取真实的血清阳性率和相关的危险因素。

BACKGROUND & AIMS: OBJECTIVE:To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model. DESIGN:The study was a facility-based, cross-sectional study. SETTING:Two public and tertiary hospitals in Addis Ababa. PARTICIPANTS:All pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model. RESULTS:A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays. CONCLUSION AND RECOMMENDATION:This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals' set-up and readiness to manage obstetric emergencies.

背景与目标： 目的：基于三延迟模型，评估埃塞俄比亚亚的斯亚贝巴大多数孕产妇健康结局转诊链中的延误发生位置。
设计：该研究是一项基于设施的横断面研究。
地点：亚的斯亚贝巴的两家公立和三级医院。
参加者：所有孕妇在2018年12月至2019年2月期间在Zewditu和Gandhi Memorial Hospital的妊娠28周后仅接受分娩和分娩服务。
主要和次要指标：主要成果是三延迟模型中的延误类型，该延迟满足了运营规定的时间。次要结果是基于三延迟模型的孕产妇健康结果。
结果：共有403名孕妇被分派到研究医院进行了研究。被转诊的孕妇中有四分之三（301，74.7％）经历了第三次延误（延迟获得适当的护理）； 211人（52.4％）经历了第一次延误（决定寻求护理的延迟）。总共366名（90.8％）孕妇经历了这三种延误中的至少一种，而71名（17.6％）的孕妇经历了这三种延误中的至少一种。有29名（7.2％）推荐的妇女有严重的孕产妇结局。严重孕妇预后的主要原因/诊断是输血（17，58.6％），其次是产后出血（15，52％）和子痫（9，31％）。此外，经历严重孕产妇结局的妇女发生三种延误中至少一种的可能性要高2.9倍。
结论和建议：本研究强调了各级延迟的持续存在，尤其是第三次延迟及其对严重孕产妇结局的影响。我们建议加强卫生转诊系统，并解决分娩和分娩期间特定的卫生系统瓶颈，以确保没有母亲受到威胁。我们还建议进行定性研究（焦点小组讨论和深入访谈），并观察三级医院的设置和准备处理产科急症的准备情况。

BACKGROUND & AIMS: PURPOSE:To define organizational culture in hospitals that have received quality certificates and to identify attitudes of healthcare personnel toward change. METHODS:The population was all physicians and nurses (N=3,067) employed at four private hospitals that have received accreditation or the "ISO" certificate, and four public hospitals, all of which were located within Istanbul city limits. A proportional sample of 570 participants were selected from the eight hospitals. Data-gathering tools were information form, culture scale, and Attitude Against Change Scale (AACS). Data were evaluated by using descriptive statistics, Cronbach alpha coefficient, Chi-square test, and by t test for dependent groups, one-way variance analysis (ANOVA), and Tukey test. FINDINGS:The lowest score averages on the AACS were found in those employed in public hospitals, in those who perceived top executives as autocrats, and in those who were unwilling to participate in quality studies. Participants in a power culture were least open to change. CONCLUSIONS:A collaborative culture was the most evident culture in private hospitals, but in public hospitals the most dominant culture was a power culture.

背景与目标： 目的：定义已获得质量证书的医院的组织文化，并确定医护人员对变革的态度。
方法：人口为在四家获得认证或“ ISO”证书的私立医院和四家公立医院（均位于伊斯坦布尔市范围内）雇用的所有医生和护士（N = 3,067）。从八家医院中按比例抽取了570名参与者。数据收集工具包括信息表，文化量表和抵制态度量表（AACS）。通过使用描述性统计数据，Cronbachα系数，卡方检验和相关组的t检验，单向方差分析（ANOVA）和Tukey检验来评估数据。
结果：在AACS中得分最低的是在公立医院工作的人，那些将高级管理人员视为独裁者的人以及不愿参加质量研究的人。权力文化的参与者最不愿意改变。
结论：合作文化是私立医院中最明显的文化，但在公立医院中，最主要的文化是权力文化。

BACKGROUND & AIMS: :In Japan, long-term-care hospitals and facilities face the problem of quality of care, and providing adequate pressure ulcer care is one of the most urgent quality issues. Purpose of the present study was to explore the prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan, and to identify factors associated with them. An anonymous questionnaire was sent to 720 randomly sampled, long-term-care hospitals all over Japan. The prevalence and incidence of pressure ulcers and their factors, including organizational strategies for pressure ulcer prevention and management, were examined. The mean prevalence and incidence of pressure ulcers was 9.6 and 1.9% per month, respectively. Almost all hospitals had established an interdisciplinary team for pressure ulcer prevention, developed a clinical protocol for pressure ulcers, and implemented education for staff. However, 35% of the interdisciplinary teams were not useful, more than half of the clinical protocols were not used frequently, and about half of the wards did not have sufficient pressure-relieving mattresses. In multiple regression analyses, a low prevalence of pressure ulcers was associated with a lower ratio of clients with a high medical severity level (p=0.034), the use of a clinical protocol including the management of preventive devices (p=0.023), the standardized pressure ulcer assessment tool (DESIGN-R; p=0.017), and staff education (p=0.003). This study demonstrated a higher prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan as compared to regular acute-care hospitals, as well as poor organizational strategies for managing pressure ulcers.

背景与目标： ：在日本，长期护理医院和设施面临护理质量问题，提供足够的压疮治疗是最紧迫的质量问题之一。本研究的目的是探讨日本长期护理医院中压疮的患病率和发生率，并找出与之相关的因素。匿名调查表发送给了全日本720家随机抽样的长期护理医院。检查了压疮的患病率和发生率及其因素，包括预防和管理压疮的组织策略。压疮的平均患病率和发病率每月分别为9.6％和1.9％。几乎所有医院都建立了预防压疮的跨学科团队，制定了压疮临床方案，并对员工进行了教育。但是，35％的跨学科团队没有用，一半以上的临床方案不经常使用，并且大约一半的病房没有足够的减压床垫。在多元回归分析中，压疮的患病率较低与较高的医疗严重度水平的患者比例较低（p = 0.034），使用包括预防性装置管理的临床方案（p = 0.023），标准化的压疮评估工具（DESIGN-R; p = 0.017）和员工培训（p = 0.003）。这项研究表明，与常规的急性护理医院相比，日本的长期护理医院中压疮的患病率和发病率更高，而且管理压疮的组织策略较差。

BACKGROUND & AIMS: :Professional health workers need continuous update of knowledge in blood transfusion practice. To fulfill this expectation, the "Etablissement français du sang (E.F.S) Auvergne-Loire", in cooperation with the Department of Regional Affairs in Health Services in the Auvergne region, has set up a proximity-based and a dedicated continuous education course, for more than three years. The content of this update course was based upon regulatory recommendations. The course is one day long; an evaluation of the course by the teachers as well as an evaluation of the teachers' level after the course is carried out. Each course attendant is given a CD-ROM which comprises all of the presentations of the day, along with relevant law texts. We now report on our experience in teaching 127 individual professionals in eight sessions: 95% gave full appreciation. This experience reached - up to now - 53% of the public and private hospitals with transfusion services in the Auvergne region and the Loire district and 90% of structures having remote blood banks. This experience can easily be extended to other regional E.F.S. settings.

背景与目标： ：专业卫生工作者需要不断更新有关输血实践的知识。为了实现这一期望，“奥弗涅-卢瓦尔地区法语教育”与奥弗涅地区卫生服务区域事务部合作，为近距离学习和专门的持续教育课程，三年多了。此更新课程的内容基于监管建议。该课程为期一天；教师对课程的评估以及课程结束后对教师水平的评估。每位课程参与者都会获得一张CD-ROM，其中包含当天的所有演讲以及相关的法律文本。现在，我们报告我们在八次会议中对127位个人专业人员进行教学的经验：95％的人表示完全赞赏。到目前为止，这种经验达到了在奥弗涅地区和卢瓦尔河地区提供输血服务的53％的公立和私立医院，以及90％具有偏远血库的建筑物。这种经验可以很容易地扩展到其他地区的E.F.S.设置。

BACKGROUND & AIMS: ISSUE ADDRESSED:Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. METHODS:A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. RESULTS:The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P < .001). The majority (79.5%) of the 2394 surveyed supported SSB removal, with nearly half (48.4%) reporting it would improve people's health. A minority (13.4%) did not support SSB removal, more than half (61.4%) of those said individuals should have free choice. More staff than visitors were aware of the change (61.9% vs 31.2%; P < .0001). CONCLUSIONS:Availability of SSBs in NSW hospitals was significantly reduced after implementation of a policy to remove them from sale. There was strong staff and visitor support for the initiative. SO WHAT?: This study provides clear evidence that a policy designed to provide a healthy hospital retail drink environment can be successfully implemented at scale with high levels of support from staff and visitors. SUMMARY:A state-wide policy initiative to remove SSBs from sale in NSW hospital food outlets in 2017 was successfully implemented, with a sample of outlets having nearly 100% compliance. The majority of staff and visitors (80%) supported the removal of SSBs, mostly because they believed it would improve individual and population health.

背景与目标： 已解决的问题：政策和环境措施可减少获取和购买含糖饮料（SSB）的可能性，从而有可能减少超重和肥胖症。这项研究研究了一项州级政策对从新南威尔士州公立医院出售中去除SSB的影响（2017年7月推出），并探讨了消费者的意识和支持。
方法：在26个医院的81家食品零售店的便利性样本抽取SSB的目标日期之前和之后（2017年12月31日）进行了SSB可用性审核。一项由访调员管理的拦截调查在10家随机选择的医院中进行（2018年3月至5月），评估了工作人员和访客对去除SSB的了解和支持。描述性分析和χ2分析评估了以下方面的差异：SSB可用性；员工和访客的意识和支持。对开放式调查的答复进行了主题分析。
结果：去除SSB的网点比例从58.0％增加到96.3％（P <.001）。接受调查的2394人中，大多数（79.5％）支持移除SSB，近一半（48.4％）的报告称这样做可以改善人们的健康。少数人（13.4％）不支持删除SSB，其中一半以上（61.4％）的人说个人应该有自由选择的权利。知道此变化的员工人数超过访问者（61.9％vs 31.2％; P <.0001）。
结论：实施一项将其出售的政策后，新南威尔士州医院中SSB的可用性大大降低。该计划得到了强大的员工和访客支持。怎么办？：这项研究提供了明确的证据，证明可以通过在工作人员和访客的大力支持下成功地大规模实施旨在提供健康的医院零售饮料环境的政策。
摘要：成功实施了一项全州范围的政策举措，以于2017年在新南威尔士州的医院食品销售网点中取消SSB的销售，样本网点的符合率接近100％。大多数工作人员和访客（80％）支持取消SSB，主要是因为他们认为这会改善个人和人群的健康。

BACKGROUND & AIMS: :We describe the trends in the incidence of methicillin-resistant Staphylococcus aureus nosocomial infection in intensive care units in Lyon hospitals from January 1, 2003, through December 31, 2006. The incidence rate decreased from 1.77 cases per 100 ICU patients in 2003 to 1.16 cases per 100 ICU patients in 2006, a reduction of 38.0% (P = .05).

背景与目标： ：我们描述了2003年1月1日至2006年12月31日里昂医院重症监护室耐甲氧西林金黄色葡萄球菌医院感染的发生趋势。发病率从2003年的每100 ICU患者1.77例下降到2003年的1.16 2006年，每100 ICU患者中有50例病例减少了38.0％（P = 0.05）。

BACKGROUND & AIMS: INTRODUCTION:The quality of health care significantly depends on the satisfaction of the employees. OBJECTIVE:The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. METHOD:Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. RESULTS:This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. CONCLUSION:There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

背景与目标： 简介：医疗保健的质量在很大程度上取决于员工的满意度。
目的：本研究的目的是确定塞尔维亚贝尔格莱德州立医院中医护人员的专业满意度水平，并确定影响其满意度或不满意度的因素并对其进行排名。
方法：设计专业满意度调查，并于2008年进行横断面研究。完整的问卷由贝尔格莱德医院的6595名医护人员返回。使用学生t检验，χ2检验和ANOVA进行统计分析。应用因素分析来定义专业满意度（即不满意）的决定因素。
结果：本研究表明塞尔维亚医疗专业人员的职业满意度较低。专业人员不满意的主要原因是工资，设备，继续接受医学教育/培训的可能性以及职业发展的机会。具有大学学历的医疗保健专业人员对工作满意度的各个方面都比具有中学和大学学历的医疗保健专业人员更满意。
结论：在年龄在50-59岁，具有管理职能，服务30年或以上的男性中，年龄在60岁以上，年龄在60岁以上的男性中，医疗保健专业人员的满意度明显提高。塞尔维亚卫生保健系统中的人力资源开发战略将大大提高所提供卫生保健的专业满意度和质量。

BACKGROUND & AIMS: :This study reports an opinion survey of 211 nonpsychiatrist physicians in two general hospitals who estimated that 16.1% of their patients have psychiatric disorders and that they spent 13.8% of their time in treating the psychiatric components of their patients' illnesses. Physicians indicated that anxiety and psychosomatic and depressive illness were the most frequent psychiatric disorders and that one-third of them would personally treat such disorders without referral to psychiatric consultation. The findings also suggest that adequate undergraduate psychiatric education was associated with increased recognition of psychiatric disorders and more preference for their personal treatment. In addition, it provides a possible explanation for the discrepancy between the high prevalence of psychiatric disorders in general hospital patients and the low referral rate to psychiatric consultation.

背景与目标： ：这项研究报告了对两家综合医院的211名非精神科医生的意见调查，他们估计他们的患者中有16.1％患有精神疾病，并且他们花费了13.8％的时间来治疗患者疾病中的精神疾病。医师表示，焦虑症，心身疾病和抑郁症是最常见的精神疾病，其中三分之一将亲自治疗此类疾病，而无需转诊精神科。研究结果还表明，适当的大学生心理教育与对精神障碍的认识增加以及对他们的个人治疗的偏爱有关。此外，它为综合医院患者精神病患病率高与精神科咨询转诊率低之间的差异提供了可能的解释。