Analysis of Monitoring,Early Warning and Emergency Response System for New Major Infectious Diseases in China and Overseas

In recent years,the impact of new major infectious diseases on people’s normal life is becoming more and more frequent,which has brought great impact on people’s life safety and social economy,especially the corona virus disease 2019,which has been sweeping the globe.Public health and disease prevention and control systems in different countries have different performances in response to the pandemic,but they all have exposed many shortcomings.Countries around the world urgently need to improve the monitoring,early warning and emergency response systems for new major infectious diseases.As the outpost and main part of medical rescue,the hospital urgently needs to establish a set of scientifically advanced emergency response mechanism that is suitable for the business process of the medical system and unified standards in order to improve the response efficiency and quality of emergency treatment.

Probabilistic Antibiotic Therapy in the Infectious Diseases Department of the Yalgado Ouédraogo University Hospital (CHU-YO) in Ouagadougou, Burkina Faso

Introduction: In Burkina Faso, as in most developing countries, limited access to biological tests forces practitioners to resort very often to probabilistic antibiotic therapy. The objective of this study is to determine the extent of this prescription. Patients and Methods: This was a cross-sectional study with retrospective data collection of patients hospitalized in the infectious diseases department in the period from January 1, 2005 to December 31, 2020. The records of patients who received probabilistic antibiotic therapy were included. Results: During the study period, 330 patients had received probabilistic antibiotic therapy. The majority of patients were male (53%), with a sex ratio of 1.12. The mean age of the patients was 33 years ± 14. The age range of 20 to 40 years was the most represented (42%). Fifteen percent (15%) of patients were living with HIV. The majority of patients were from urban areas (56.4%). Forty-nine percent (49%) of the patients worked in the informal sector. Clinically, the reasons for consultation were dominated by fever, alteration of general condition, neurological disorders, digestive disorders, respiratory signs, urinary signs and diffuse pain. The physical examination showed that 48.1% of the patients had meningeal irritation syndrome, 10% had convulsions and 10% had focal signs, trismus was present in 4% of the patients and facial paralysis in 3%. In the digestive system, hepatomegaly was present in 29% of patients and digestive candidiasis in 31%. Respiratory examination showed crepitus and fluid effusion syndrome in 26.83% and 20.62% of patients respectively. The presumptive diagnosis was dominated by bacterial meningitis, salmonellosis and bronchopneumonia with banal germs. In terms of treatment, the beta-lactam family of drugs was the most prescribed. They were followed by aminoglycosides and fluoroquinolones. The evolution was marked by the death of 50 patients (15%). Conclusion: The most prescribed molecules belong to the family of Beta-lactam. And this prescription improved the outcome of patients. Bacterial susceptibility studies will allow better orientation of probabilistic antibiotic therapy in order to limit the emergence of multi-resistant bacteria.

Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

Medical errors, infection-control breaches and the use of adulterated and misbranded medical devices

Several well-publicized cases of improper cleaning,disinfection or sterilization of contaminated reusable medical equipment that posed an increased risk of patientto-patient disease transmission were reported within the past few years,resulting in the notification of approximately 20 000 patients.These medical errors,the specific infection-control standards they breached,and assessments of the risk of infection associated with each are discussed.Other topics discussed include the Food and Drug Administration’s(FDA)regulation of medical devices and infection-control products;the use of adulterated,misbranded,and investigational devices;consent decrees and associated Certificates of Medical Necessity;and informed patient consent.Focus is placed on liquid chemical sterilization,its history,and the FDA’s recent censure and discontinuation of a medical device labeled with this claim,namely,the STERIS System 1 processor.Recommendations are provided for healthcare facilities,regulatory agencies,manufacturers of reusable medical devices,and professional healthcare organizations and administrations to improve public health and prevent healthcareassociated infections.

Rare case of brucellosis misdiagnosed as prostate carcinoma with lumbar vertebra metastasis:A case report

BACKGROUND Prostatitis caused by Brucella infection is rare and usually lacks typical lower urinary tract symptoms.However,Brucella infection can cause serum prostatespecific antigen levels to become abnormally elevated.When concurrent with lumbar vertebra infection and erosion,brucellosis can easily be misdiagnosed as prostate cancer with bone metastasis.CASE SUMMARY A 45-year-old man complained of recurrent low back pain and fever for 2 wk.Magnetic resonance imaging of the lumbar vertebrae showed abnormal signs at the rear of the L4–5 vertebral body.Serum prostate-specific antigen level was 17.64 ng/mL,and positron emission tomography/computed tomography suggested the possibility of prostate cancer with liver and lumbar metastases.The patient was transferred to our department for further treatment.He experienced repeated bouts of fever and low back pain during hospitalization.Biopsy results indicated prostatitis.There was no significant increase in white blood cell count or procalcitonin levels.The Mycobacterium tuberculosis smear and antibody detection results were negative.Cefoperazone sulbactam was not effective.Blood culture test results were positive for brucellosis,confirming the diagnosis of brucellosis.After oral anti-infection treatment with doxycycline and rifampicin,the body temperature gradually returned to normal,and lumbago improved.After continuous treatment for 6 mo,the patient recovered.CONCLUSION In patients with low back pain and fever accompanied by elevated prostatespecific antigen levels and lesions of the prostate and lumbar spine,a detailed medical history and blood and urine cultures should be obtained,and attention should be given to the local epidemic infectious disease situation.

Co-infection of Chlamydia psittaci and Tropheryma whipplei: A case report

BACKGROUND The co-infection of Chlamydia psittaci(C.psittaci)and Tropheryma whipplei(T.whipplei)is unusual,and the detection of pathogenic microorganisms is particularly important for patients with severe diseases or poor experience in treatment.Early identification of pathogens can significantly improve the prognosis of the patients.Targeted next-generation sequencing(tNGS)is currently widely used in clinical practice for various infectious diseases,including respiratory infections,to achieve early,accurate,and rapid microbial diagnosis.CASE SUMMARY We report a case of a 40-year-old female patient with a history of contact with parrots who was diagnosed with C.psittaci and T.whipplei infection through bronchial lavage fluid targeted next generation sequencing.After moxifloxacin treatment,the patient's symptoms improved significantly,and the imaging changes were obviously resolved.CONCLUSION Coinfection with C.psittaci and T.whipplei is not common.In this case,timely and accurate identification of both pathogens was achieved using tNGS.Moreover,the efficacy of monotherapy with moxifloxacin was confirmed.

Evaluating Hospital Utilization Late in the Epidemic

This study evaluated present and future impact of the coronavirus on hospitalization as the virus winds down in the metropolitan area of Syracuse, New York. The study compared adult medicine and adult surgery discharges between January-May 2019 and 2022. The data indicated that 69 percent of the reduction in medical-surgical discharges that occurred since 2019 was offset during 2022. The remaining 31 percent remained at levels experienced in 2020 and 2021. The study clearly demonstrated that medical and surgical discharges increased significantly since 2019. An important question is whether these will continue or if they will level off.

我国三级医院急诊病人激增应对方式调查

目的:了解我国三级医院急诊病人激增应对方式。方法:于2023年1月—3月选取我国54所三级医院急诊科作为研究对象,其中,东部地区26所(48.1%),中部地区10所(18.5%),西部地区18所(33.3%)。采用自行编制的中国不同地区医院急诊病人激增应对方式调查问卷进行调查。结果:三级医院急诊病人激增后日均急诊量增幅达87.5%,急诊日均候诊时间整体延长(Z=-5.560,P<0.001),东部地区三级医院急诊病人激增后72 h出抢救室病人比例较激增前下降(P<0.05)。面对急诊病人激增,各三级医院采取的应对措施包括增加急诊床位数和出诊医生诊位、增设专门收治新型冠状病毒感染病人的病房、增加重点设备投入、调配医护人员支援急诊等。东部地区三级医院急诊候诊时间变化率与医患比变化率(r=-0.418,P=0.034)、护患比变化率(r=-0.469,P=0.016)、互联网诊疗变化率(r=-0.684,P=0.020)均呈负相关,东部地区三级医院抢救室滞留时间变化率与护患比变化率呈负相关(r=-0.422,P=0.032),中西部地区三级医院抢救室滞留时间变化率与留观室床位变化率呈正相关(r=0.405,P=0.036)。结论:急诊科应不断优化人力、床位、仪器设备等医疗资源配置,探索急危重症病人“互联网+”新模式,进一步提升重大传染病的应对能力。

北京市临床医生新发传染病报告知信行调查

目的了解北京市临床医生对新发传染病报告的知信行情况,为将来更好地报告新发传染病提供参考依据。方法采用多阶段抽样方法,对呼吸科、感染科临床医生进行线上问卷调查,收集其人口学信息、传染病报告相关知识素养、新型冠状病毒感染(以下简称新冠感染)诊疗及报告行为等相关信息,组间比较采用χ^(2)检验。结果抽取152家医疗机构,实际完成调查148家。共收回问卷495份,其中491份有效,问卷有效率为99.2%。调查对象以30~<50岁(74.1%)、本硕学历(89.2%)、中高级职称(83.7%)、女性(67.8%)为主,对传染病报告工作感到不厌烦的占60.1%,认为传染病报告工作非常重要、传染病报告相关培训非常有必要的占比均≥80.0%。临床医生认为传染病报告卡中难以收集的项目包括现住址、人群分类、病人属于、工作单位、发病日期、联系方式;其中前3项被认为不必要收集项目;患者不配合、传染病报告卡内容理解问题、工作忙没时间、单位系统问题是传染病报告卡填写不顺利的主要原因。有新冠感染报告的医疗机构调查对象中高学历(χ^(2)=5.526,P<0.001)、高职称(χ^(2)=6.136,P=0.047)、填写过传染病报告卡(χ^(2)=8.384,P=0.004)及接到过新冠感染相关通知文件(χ^(2)=4.696,P=0.030)的占比均高于无新冠感染报告组,前者的传染病报告知识储备考试优秀占比高于后者(χ^(2)=14.166,P<0.001)。结论临床医生具备依法依规及时报告法定传染病的意识,传染病报告卡中的项目亟待梳理,临床医生填卡不顺利涉及患者、自身、系统三方面原因,需采取不同的改进措施。新发传染病的报告,受政策影响容易集中在高级别或定点医疗机构,非定点医疗机构的传染病报告工作需政策支持并提升诊疗能力。

基于熵增和耗散结构理论的传染病医院管理研究

热力学中的熵增定律指出任何封闭系统在无外力维持的情况下,总是自发趋于混乱和无序。系统对抗熵增,需要形成开放的耗散结构。熵增定律在企业和组织管理中得到广泛应用。文章将熵增理论运用到传染病医院的管理分析中,探讨传染病医院构建耗散结构、形成熵减的4个要素和主要途径,结合传染病医院发展面临的主要困局,提出传染病医院应从以患者为中心,全面提升对利益相关方的开放性、持续打破既有格局远离稳定的平衡态、加强内部协作提升非线性机制、充分利用涨落因素激励医院变革,为传染病医院的组织管理优化和可持续发展提供参考。

基于SIRS模型的核电事故致因传播机制研究

文章用自然语言处理技术对152起核电厂执照运行事件报告(Licensed Operation Event Report,LOER)进行风险致因分析,得出风险致因复杂网络的相关数据,借助改进SIR传染病模型,结合核电运行事件风险传播的特征,构建了适用于核电领域的改进传播模型。文章对核电运行事件致因传播过程进行动态仿真,对比了不同因素对传播风险的影响差异,对当前的核电安全管理工作进行优化。

综合医院应对呼吸道传染病医院监测预警体系的构建

呼吸道传染病监测体系的建立是现阶段综合医院在实践中对突发性的呼吸道传染病疫情予以快速应对、及早发现可能导致传染性疾病流行风险、研判疫情趋势、及时预警风险、评估医疗系统负荷的基础。特别是在呼吸道传染病暴发流行期间,该体系的建立能够使得综合医院的医院感染风险显著降低,保障医院医疗环境安全。本研究以房山区第一医院为例,着重围绕呼吸道传染病感染防控的相关临床实践经验,严格遵照官方文件、标准以及规范的相关要求,充分结合风险评估内容,初步探讨并着力构建综合医院应对呼吸道传染病医院监测预警体系,包括传染病信息报告系统、流感监测系统、症状监测系统、发热门诊监测系统、实验室监测系统等多维度监测系统。医院设立监测领导小组,由医院领导担任组长,并由领导小组统一开展相关协调指挥工作,将各部门责权展开清晰划分,以此全面建立整体医院监测预警机制。医院根据预警迅速响应,人力、物资、设备等相关部门联动,防止院感发生,做好诊疗准备,确保院内的日常诊疗工作可以有序开展,以此为综合医院关于呼吸道传染病防控管理工作提供有效经验参考。

2019—2021年某中医医院传染病报告分析与管理

目的分析某中医医院法定和其他重点监测传染病报告情况,为规范开展医院传染病报告和制定医院传染病报告管理策略提供参考。方法对2019—2021年某中医医院传染病报告数据进行描述性分析。结果2019—2021年某中医医院共报告法定和其他重点监测传染病6865例次,无甲类传染病报告,其中乙类传染病668例次(9.73%),丙类传染病5356例次(78.02%),其他重点监测传染病841例次(12.25%)。排名前5位的传染病分别是流行性感冒、水痘、梅毒、其他感染性腹泻病和肺结核,其中报告病例最多的流行性感冒,在报告时间上每年传染病报告例次数居首位的是第一季度。2019—2021年某中医医院法定和其他重点监测传染病报告例次数呈下降趋势。结论2019—2021年某中医医院法定和其他重点监测传染病报告以呼吸道传染病为主,应根据不同季节、疾病流行趋势,采取有针对性的传染病监测、防控策略。

基于PPRR理论的精神专科医院传染病防控能力评价指标体系构建

目的构建精神专科医院传染病防控能力评价指标,为提升精神专科医院传染病防控能力建设提供参考依据。方法基于PPRR危机管理理论,综合运用文献法、半结构式访谈法、德尔菲法、层次分析法构建精神专科医院传染病防控能力评价指标体系。结果经过2轮专家函询,专家咨询积极系数均为100%,专家平均权威系数为0.88,协调系数较好,构建了一套包括4个一级指标,20个二级指标,85个三级指标的精神专科医院传染病防控能力评价指标体系,经层次法分析各级评价指标均符合一致性检验要求。结论该评价指标体系有一定的科学性和可靠性,为精神专科医院传染病防控提供了可行性标准。

基于主题框架分析的浙江省公立医院传染病医防融合案例研究

目的结合浙江省典型实践,分析公立医院传染病医防融合现状。方法通过焦点小组访谈收集各医院传染病医防融合相关材料,采用主题框架分析的方法对访谈材料进行分析。结果浙江省公立医院传染病医防融合做法主要包括组织融合、管理融合、服务融合、资源融合四个方面,目前存在缺乏顶层设计、医院内部公共卫生职责履行不到位、资源共享不足等问题。结论浙江省公立医院传染病医防融合工作有序开展但存在不足,建议进一步加强传染病医防融合管理体制,探索多种形式的医防融合模式,改革医防融合人才培养机制,建立信息共享平台。

高质量发展视域下三级公立医院重大传染病救治能力评价指标体系构建

文章综合运用定性和定量相结合的研究方法,通过文献研究初步拟定评价指标集后,采用德尔菲法进行两轮专家咨询,并利用层次分析法计算各项指标权重,旨在构建安徽省三级公立医院重大传染病救治能力评价指标体系。结果显示,两轮咨询的专家积极系数分别为100%、90%,专家权威系数分别为0.825、0.831,肯德尔和谐系数分别为0.123、0.124(P<0.001),表明专家咨询的可信度高。最终构建的安徽省三级公立医院重大传染病救治能力评价指标体系包含6个一级指标、15个二级指标、50个三级指标,且具有较高的科学性和可靠性。在公立医院高质量发展视域下,该指标体系可为三级公立医院重大传染病救治能力的考核评估与质量提升提供理论依据。

安徽省某传染病专科医院人才队伍建设情况调查分析及应对措施

目的:探讨传染病医院人才队伍建设问题,分析改进的措施和方案。方法:统计分析某省传染病医院近五年专业人才队伍建设情况和存在的不足及解决办法。结果:某院在2018年-2022年期间专业技术人员和职工总人数呈逐年增加的趋势,总人数平均年增长速度为3.22%,截止2022年12月某医院共有职工336人,其中卫生技术人员为268人,占总职工人数的79.76%,本科及以上学历人数、副高及以上职称人数分别占卫生技术人员的73.13%、18.65%;医护比为1:1.74,床护比为1:0.74,床位与医护比为1:1.17。结论:某医院本科及以上学历人数呈逐年增长趋势,高级职称人才占比有待提高。传染病医院应通过优化卫生专业人才薪酬分配、晋升途径等措施提高医院专业人才队伍的质量。

边疆少数民族地区教学医院医护人员传染病健康素养现状分析

目的了解边疆少数民族地区教学医院医护人员传染病健康素养现状,为制定相关卫生健康政策提供科学依据。方法采用整群随机抽样的方法,抽取广西百色市、河池市、崇左市各1家教学医院(三级甲等综合医院)作为调查对象,填写《个人基本信息自制问卷》和《中国居民传染病健康素养测评量表》。结果边疆少数民族地区教学医院医护人员传染病健康素养评分情况为(31.62±4.34)分,传染病健康素养具备率为59.40%。分析结果显示:随着年龄、文化程度、月收入、院龄、从事教学工作的时间和职称的增长,研究对象的传染病健康素养具备率呈现提高趋势(P<0.001);从事过传染病工作或接受过传染病知识等相关培训者的传染病健康素养具备率更高(P<0.05);医师的传染病健康素养具备率高于护士(P<0.05)。结论边疆少数民族地区教学医院医护人员传染病健康素养水平有待提高,因不同群体医护人员的传染病健康素养水平不同,应有针对性开展健康宣教等干预措施。

综合医院应对突发公共卫生事件能力建设的SWOT分析

采用SWOT分析方法对我国综合型医院应对突发公共卫生事件的应急管理能力进行内部优势(strength)、劣势(weakness)、外部机会(opportunity)、威胁(threat)的系统性分析和概括讨论。综合医院作为突发公共卫生应急事件的主要防控及救治基础,充分利用医院在应急预案、应急物资、救治能力、实验室检测能力、远程医疗等方面具备的优势,进一步加快综合医院对突发公共卫生事件管理体系的建设,提高早期识别应急事件能力、完善应对响应机制,加强应急体系及人才梯队建设,不断推进信息化建设。为综合医院应对突发公共卫生事件的应急管理能力和重大传染病诊治能力提高科学决策依据。

突发公共卫生事件“平战结合”应急医疗体系建立与实践

基于天津市某三甲医院的突发公共卫生事件定点医院运行经历,总结该医院实行“平战结合”模式的经验,进而探索和分析为应对突发呼吸道传染病定点医院的收治工作模式。认为建立定点医院平战结合应急医疗体系,一是细化应急流程,组建应急医疗队,做好平时制度、人员、物资储备;二是战时应急机制及时启动,人力资源统筹规划,严格把控医疗质量。本文对平战结合模式下的应急医疗体系的构建进行经验分享,并分析在应对突发公共卫生事件实践中发现的问题,为定点医院医疗应急体系的完善提供参考依据。