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目的了解新疆维吾尔自治区(新疆)南疆五地区伤寒监测系统报告病例的准确性,以及基层医疗机构对伤寒、副伤寒的诊断能力和水平。方法将南疆五地区所有医院报告的发病日期为2016年1月1日至8月31日的伤寒、副伤寒的临床和确诊病例的流行病学个案调查表与国家伤寒、副伤寒诊断标准进行比较,核实病例诊断的准确性。抽取部分医院,通过访谈检验科医生,了解被抽中医院开展伤寒、副伤寒的实验室检测情况。对临床医生采用自行设计的调查问卷以面对面访谈的方式,询问医生对伤寒、副伤寒疾病的认知以及参加相关培训的情况。结果调查结果显示南疆五地区2016年1月1日至8月31日上报的伤寒、副伤寒49例病例中,临床病例诊断正确率为6.67%(1/15),确诊病例诊断正确率为14.71%(5/34)。共调查32家医疗机构,乡镇级医院仅有5.88%(1/17)可开展细菌培养,100%均未开展肥达试验。调查的105名医生中对临床诊断病例定义的正确回答率只有7.62%,对确诊病例定义的正确回答率仅为11.43%。参加过培训的人员中对诊断标准的回答正确率高于未参加过培训的人员。结论本次调查发现基层医疗机构开展细菌培养和肥达试验的比例均不高,而且医生对伤寒、副伤寒的诊断标准掌握不规范。建议县级疾病预防控制中心承担伤寒、副伤寒的核实和免费检测任务,对县(乡)级医院的医务人员应加强伤寒、副伤寒的培训,保证基层医生能及时做出疑似诊断报告,以保持发现疫情的敏感性。
Objective To understand the accuracy of reported cases of typhoid fever surveillance system in five areas of southern Xinjiang in the Xinjiang Uygur Autonomous Region (Xinjiang) and the diagnosis ability and level of typhoid and paratyphoid in primary medical institutions. Methods The epidemiological questionnaires of clinical and confirmed cases of typhoid fever and paratyphoid fever which were reported by all the hospitals in the five districts in southern Xinjiang from January 1 to August 31, 2016 were compared with the national diagnostic criteria of typhoid fever and paratyphoid fever Compare and verify the accuracy of the case diagnosis. Selected part of the hospital, through interviews with the doctor to understand the hospital was drawn in the typhoid fever, paratyphoid laboratory testing. To clinicians using self-designed questionnaires to face-to-face interviews, doctors were asked about the typhoid and paratyphoid disease awareness and attend the relevant training. Results The survey results showed that in 49 cases of typhoid and paratyphoid reported from January 1, 2016 to August 31, 2016, the correct rate of clinical diagnosis was 6.67% (1/15) in all five areas in South Xinjiang. The diagnostic accuracy rate of confirmed cases was 14.71% (5/34). A total of 32 medical institutions were surveyed. Only 5.88% (1/17) of township hospitals were allowed to carry out bacterial culture, and 100% of them did not carry out the test. Of the 105 surveyed physicians, the correct rate of answers to the definition of a clinically diagnosed case was 7.62% and the correct answer to the definition of a confirmed case was only 11.43%. Among the trained personnel, the correct answers to the diagnostic criteria were higher than those who did not participate in the training. Conclusion The survey found that primary medical institutions to carry out bacterial culture and the proportion of trials are not high, and the doctor of typhoid fever, paratyphoid diagnosis standard non-standard. It is suggested that the county-level CDC should undertake the tasks of verification and free testing of typhoid fever and paratyphoid fever and strengthen the training of typhoid and paratyphoid among medical staff at county (township) level hospitals so as to ensure that primary-level doctors can make timely and suspected diagnosis reports Maintain the sensitivity of the epidemic.