Objective. To evaluate early neonatal mortality at the University Teaching Hospital and assess changes in the rate and causes during the last ten years. Material and method. We performed a retrospective analysis of ne...Objective. To evaluate early neonatal mortality at the University Teaching Hospital and assess changes in the rate and causes during the last ten years. Material and method. We performed a retrospective analysis of neonatal deaths recorded at the Neonatal and Premature Unit (NPU) in 2003. The results were compared with earlier evaluations. Comparison of proportions was used for statistical analysis to eliminate the random element in rate variations. The significance threshold was ≤ 5% . Results. We registered 364 neonatal deaths: 243 among 4853 newborns in our maternity ward and 121 among 213 newborns transferred from a referring maternity. Early neonatal mortality rate 45.5 per 1,000 live births. Mortality particularly concerned newborns with a birth weight ≤ 2,500 grams (66% ) and Apgar scores ≤ 6. Early neonatal mortality fell significantly since 1994, while overall mortality remained high among newborns transferred from referring maternities. The most frequent causes were premature birth (49% ), acute fetal distress (23% ) and neonatal infection (18% ). Conclusion. Early neonatal mortality has decreased remains at a high level. It could be improved by limiting the number of premature births, neonatal suffering and neonatal infection. In a parallel direction we recommend organizing a perinatal network in Dakar.展开更多
目的本文以大学附属教学医院的卒中急救绿色通道培训医师为主要研究对象,旨在提高新进医疗岗位医师的学习效率,改善临床工作的多种质控指标。方法设计多元化教学方法,包括临床案例式协作教学法、基于问题教学法、翻转课堂、一带一学习...目的本文以大学附属教学医院的卒中急救绿色通道培训医师为主要研究对象,旨在提高新进医疗岗位医师的学习效率,改善临床工作的多种质控指标。方法设计多元化教学方法,包括临床案例式协作教学法、基于问题教学法、翻转课堂、一带一学习、情景模拟及临床疗效反馈等,以一家教学医院区域性高级卒中中心的绿色通道患者和医师为调查对象,收集多环节时间点的质控指标以及教学互评反馈来评价教学效果。结果纳入2021年6月—2023年7月急诊卒中绿色通道诊疗环节中符合条件的患者194例,其中接受单纯静脉溶栓治疗者171例(88.14%),桥接治疗或者直接机械取栓者23例(11.86%),纳入观察学员为低年资住院医师10名,高年资住院医师5名。培训前收治患者88例(45.36%),培训后收治患者106例(54.64%),人口学基线特征差异无统计学意义。中位入院至静脉溶栓时间(door-to-needle time,DNT)缩短了4 min(44 min vs.48 min,P=0.150),DNT≤60 min比例分别为73.86%、65.09%(P=0.188)。培训后,中位知情同意谈话时间缩短了3.5 min(6.5 mi n vs.10 min,P=0.001);溶栓相关出血事件减少(培训前:牙龈出血1例,硬膜下血肿1例,消化道出血1例;培训后:无相关事件);大血管闭塞患者血管内治疗比例提升(16.98%vs.5.68%,P=0.015)。高年资与低年资住院医师对多元化教学模式绿色通道教学方法的认可度、对绿色通道学习方式的兴趣程度、病例质控环节提升满意度、影像库对解决问题适配度、文献指南库对解决问题适配度和自我学习能力提升6个方面的满意度相当,差异均无统计学意义。结论多元化培训方案可以提高绿色通道医师的卒中急救应对能力、谈话沟通技能及诊疗水平,改善工作质量和教学满意度,而且对低年资和高年资住院医师的临床学习均有帮助。展开更多
文摘Objective. To evaluate early neonatal mortality at the University Teaching Hospital and assess changes in the rate and causes during the last ten years. Material and method. We performed a retrospective analysis of neonatal deaths recorded at the Neonatal and Premature Unit (NPU) in 2003. The results were compared with earlier evaluations. Comparison of proportions was used for statistical analysis to eliminate the random element in rate variations. The significance threshold was ≤ 5% . Results. We registered 364 neonatal deaths: 243 among 4853 newborns in our maternity ward and 121 among 213 newborns transferred from a referring maternity. Early neonatal mortality rate 45.5 per 1,000 live births. Mortality particularly concerned newborns with a birth weight ≤ 2,500 grams (66% ) and Apgar scores ≤ 6. Early neonatal mortality fell significantly since 1994, while overall mortality remained high among newborns transferred from referring maternities. The most frequent causes were premature birth (49% ), acute fetal distress (23% ) and neonatal infection (18% ). Conclusion. Early neonatal mortality has decreased remains at a high level. It could be improved by limiting the number of premature births, neonatal suffering and neonatal infection. In a parallel direction we recommend organizing a perinatal network in Dakar.
文摘目的本文以大学附属教学医院的卒中急救绿色通道培训医师为主要研究对象,旨在提高新进医疗岗位医师的学习效率,改善临床工作的多种质控指标。方法设计多元化教学方法,包括临床案例式协作教学法、基于问题教学法、翻转课堂、一带一学习、情景模拟及临床疗效反馈等,以一家教学医院区域性高级卒中中心的绿色通道患者和医师为调查对象,收集多环节时间点的质控指标以及教学互评反馈来评价教学效果。结果纳入2021年6月—2023年7月急诊卒中绿色通道诊疗环节中符合条件的患者194例,其中接受单纯静脉溶栓治疗者171例(88.14%),桥接治疗或者直接机械取栓者23例(11.86%),纳入观察学员为低年资住院医师10名,高年资住院医师5名。培训前收治患者88例(45.36%),培训后收治患者106例(54.64%),人口学基线特征差异无统计学意义。中位入院至静脉溶栓时间(door-to-needle time,DNT)缩短了4 min(44 min vs.48 min,P=0.150),DNT≤60 min比例分别为73.86%、65.09%(P=0.188)。培训后,中位知情同意谈话时间缩短了3.5 min(6.5 mi n vs.10 min,P=0.001);溶栓相关出血事件减少(培训前:牙龈出血1例,硬膜下血肿1例,消化道出血1例;培训后:无相关事件);大血管闭塞患者血管内治疗比例提升(16.98%vs.5.68%,P=0.015)。高年资与低年资住院医师对多元化教学模式绿色通道教学方法的认可度、对绿色通道学习方式的兴趣程度、病例质控环节提升满意度、影像库对解决问题适配度、文献指南库对解决问题适配度和自我学习能力提升6个方面的满意度相当,差异均无统计学意义。结论多元化培训方案可以提高绿色通道医师的卒中急救应对能力、谈话沟通技能及诊疗水平,改善工作质量和教学满意度,而且对低年资和高年资住院医师的临床学习均有帮助。
