Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Determinants of High Blood Pressure and Quality of Management in Three Regions of Benin

Objective: The aim of this work was to determine the prevalence, associated factors and quality of high blood pressure (HBP) management in three regions of Benin in 2015. Methodology: This was a cross-sectional study, with two components. The first component included adults aged from 18 to 69 years, selected using a three-stage random sampling within the households. Data were collected thanks to the French version of the WHO STEPS instrument. Anthropometric data, including blood pressure, capillary fasting glucose and total cholesterol were measured according to standard procedures. The second component included Public Health Centers (PHC) selected by a random stratified multi-stage sampling. Data were collected on the structures and the processes of HBP management using the standardized tool for assessing the capacities of management of non-communicable diseases in peripheral health centers provided by the World Health Organization. Results: A total of 4816 participants were included in the first component. The mean age was 35.8 ± 12.7 years. The weighted prevalence of HBP was 27.9% (95% Confidence Interval (CI) [25.6 - 30.2]). It was higher in the 60 - 69 years compared to the lower age groups (Adjusted Odd-ratio (ORa) = 5;95% CI [3.9 - 6.5)]). HBP was positively associated with urban residence (ORa = 1.26;95% CI [1.24 - 1.28]), obesity (ORa = 1.46;95% CI [1.43 - 1.50]), hyperglycemia (ORa = 1.13;95% CI [1.10 - 1.15)]) and hypercholesterolemia (ORa = 1.64;95% CI [1.59 - 1.70)]). A total of 27 PHC were included in the second component. Taking blood pressure and other anthropometric measurements was not routine in PHC. Several essential medicines were not available in the PHC. A low level of community involvement in the management of HBP was noted. Conclusion: This study confirms the high prevalence of HBP and shows inadequacies in its management in the targeted PHC. More appropriate prevention and control measures for HBP should be implemented.

Aging and Life Management System of Reactor Pressure Vessel

Reactor pressure vessel (RPV), the only key component that can not be replaced in nuclear power plants (NPPs), is the main barrier against the radioactive leakage. The lifetime of NPPs is dependent heavily on the life of RPV, and thus, the aging and life research on a RPV is a key factor in determining the life extension of NPPs. The purpose of this paper is to introduce an aging and life management system for an operating RPV which can be used as a reference of the lifetime extension. In order to realize the objective, an aging and life management system was developed. It is an comprehensive knowledge management system that integrates decentralized information and serves as a valuable data center. Based on the storage and management of RPV state information and operation data, this system provides real-time monitoring of important operating parameters, evaluation of irradiation embrittlement, and RPV aging assessment. Therefore, it is anticipated that the developed system can be used as an efficient tool for aging and life estimation of RPV.

Management of Perioperative Target Blood Pressure in Bridging Therapy for Acute Ischemic Stroke

Objective:To investigate the management of perioperative target blood pressure in the treatment of acute ischemic stroke with intravenous thrombolytic bridging.Methods:Retrospective analysis of the blood pressure management and nursing experience of 36 patients with acute ischemic stroke who received endovascular treatment with bridge mode from November 2017 to January 2019 in our hospital.Through correct monitoring of basic blood pressure,rapid and stable blood pressure reduction before the bridge treatment,close cooperation during the operation,and close observation and treatment of postoperative blood pressure fluctuations,the patient’s blood pressure can be controlled within the target range.Results:The blood vessels of 36 patients were partially or completely recanalized after treatment.Clinical outcomes:Two cases died.After 90 days,29 patients with good clinical outcomes were followed up,and 5 patients with poor clinical prognosis.Conclusion:Effective blood pressure management is a necessary measure in the perioperative period of bridging therapy for patients with acute ischemic stroke,which can reduce the postoperative complications of patients treated with bridging therapy,obtain good therapeutic effect and improve the prognosis of patients.

Managed Pressure Drilling Technology,As the Lost Piece of the Drilling Puzzle,Results in More Economical Benefits

The economics of drilling wells is important as we drill deeper wells whether offshore or onshore. Drilling-related problems,including stuck pipe,lost circulation,and excessive mud cost,show the need for better drilling technology.If we can solve these problems,the economics of drilling the wells will improve,thus enabling the industry to drill wells that were previously uneconomical.Managed pressure drilling techniques,at one time,having

A dynamic managed pressure well-control method for rapid treatment of gas kick in deepwater managed pressure drilling

During deepwater managed pressure drilling(MPD),the gas kick may occur in abnormally high-pressure formations.If the traditional well control method is adopted,the treatment time is long and the advantage of early gas kick detection of MPD is lost.The dynamic managed pressure well-control(MPWC)method can be used to rapidly treat gas kick in deepwater MPD.In this paper,considering the effect of large-variable-diameter annulus and complex wellbore temperature in deepwater drilling,a simplified model of non-isothermal gas-liquid two-phase flow was established for dynamic deepwater MPWC simulation.Using this model,the response characteristics of outlet flow and wellhead backpressure were investigated.The results indicated that the gas fraction,outlet liquid flow rate,pit gain and wellhead backpressure presented complex alternating characteristics when gas moved upwards in the wellbore due to the large-variable-diameter annulus.The outlet liquid flow rate would be lower than the inlet flow rate and the pit gain would decrease before the gas moved to the wellhead.The variation trend of the wellhead backpressure was consistent with that of the pit gain.When the gas-liquid mixture passed through the choke,the expansion or compression of the gas caused part of the choke pressure drop to be supplemented or unloaded,delaying the response rate of the wellhead backpressure.The wellbore temperature,borehole diameter and seawater depth had different effects on outlet flow rate,pit gain and wellhead backpressure.This research could provide a new idea for well control methods in deepwater managed pressure drilling.

Pressure Solution and Happiness Promotion in Young University Teachers based on EAP

This paper investigates and analyzes the current situation of young teachers in ten universities in Shaanxi via questionnaire survey and random interview. It is shown that the main source of pressure include the following aspects ： heavy burden of education and research, high-pressure in economy and life, high expectations of personal development, lack of physical exercise, mechanization of college evaluation system. On the basis of the above analysis, this paper puts forward the specific EAP model which is suitable to young teachers in NWPU Furtherly, the program impact assessment method is constructed to ensure the effective implementation of the program

Population Ecology of the Endangered Himalayan Yew in Khokhan Wildlife Sanctuary of North Western Himalaya for Conservation Management

The Himalayan Yew (Taxus baccata subsp. wallichiana) is an endangered native high value medicinal plant of the Himalayan Region. The several medicinal properties of the bark and leaves of this species have increased its risk of extinction due to pressures for utilization. It is also subjected to harvest for fuelwood. The species does not regenerate well from seed and that is another risk factor. The objective of this research was to investigate the population ecology of the species as a foundation for its conservation. Six forest communities in the Khokhan Wildlife Sanctuary where the species is present were sampled. The abundance of the species, impacts of harvesting and its current regeneration patterns indicate that it may soon be extirpated from the Sanctuary. A plan for conserving the remaining sub-populations is presented. It could provide a template for conservation in other locations where the species is at risk.

Targeted temperature management in neurological intensive care unit

Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit(ICU).The most common cause of HIE is cardiac arrest.Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest.Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies.Several methods of TTM have been reported in the literature.TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.

Management of non-alcoholic fatty liver disease patients with sleep apnea syndrome

Nonalcoholic fatty liver disease(NAFLD)is strongly associated with sleep apnea syndrome(SAS).Many NAFLD patients have SAS,and obstructive sleep apnea hypopnea syndrome is also considered to be an independent risk factor for NAFLD,as it contributes to the progression of NAFLD via oxidative stress,lipid peroxidation,inflammation,and insulin resistance.This review aims to provide some recommendations for the management of NAFLD patients with SAS,including diet,exercise,weight loss,and continuous positive airway pressure.This review also highlights the importance of effective strategies in NAFLD prevention and treatment.

Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic:A case report

BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.

Oxytocin versus Methylergometrine in the Active Management of Third Stage of Labour

Objective: To compare the efficacy of Oxytocin versus Methylergometrine in active management of third stage of labour in reducing risk of postpartum hemorrhage. Methods: This study was carried out by randomly assigning into two groups with 150 women in each group.?Group 1 included patients who received injection Oxytocin 10 IU intramuscular within one minute of the birth of the baby. Injection?Methylergometrine?(0.2 mg) was given intravenously at the delivery of anterior shoulder of the baby to women in Group 2. Outcome measures were the duration of third stage, blood loss, pre and post-delivery hematocrit, side effects and incidence of PPH. Statistical analysis was done using Chi square test, Fischers test, Mann Whitney test, and t test. p < 0.05 was considered significant. Results: Mean duration of third stage of labour, mean blood loss, post-delivery fall in hematocrit and need for additional uterotonics were significantly less in the Group 2. However side effects like nausea, vomiting and rise in blood pressure were significantly higher in women in Group 2 (p = 0.000). Conclusion: Methylergometrine is more effective than Oxytocin in reducing the duration of third stage of labour and blood loss but has significant side effects like nausea, vomiting and rise in blood pressure.

Role of proning and positive end-expiratory pressure in COVID-19

The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.

Epidural Blood Patches Performed with Miethke Sensor Reservoir for Continuous Intracranial Pressure Monitoring

An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.

Treating extended stage IV ischial pressure ulcer in patient with spinal cord injury utilizing a multidisciplinary approach:a case report

Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This report examines a case of complicated stage-4 pressure ulcers in a young adult who had gunshot injury in his spine above T-11 level treated following a multidisciplinary approach.A multidisciplinary team formulated a multifaceted program that includes meticulous pressure relief program,wound care and flap reconstructive surgery,osteomyelitis treatment,nutrition optimization,post-operative physiotherapy,patient education,and psychological support,that recruited for this patient over the course of his stay at our unit.Results:During the third day postoperatively showed good blood circulation without necrosis or hematoma and site of ulcer completely has healed.Conclusion:Implementation of a multidisciplinary approach was key to optimizing surgical outcomes in spinal cord injury patients who have pressure sores,achieving a low recurrence rate and reducing readmissions.

医院压力管理的有效手段——EAP

目的研究在医院压力管理中推行EAP计划的效果。方法为自愿接受EAP的医护人员提供服务,采用测量工具对干预人群做前后测调查并对结果进行对比分析。结果EAP实施后医护人员生活质量及工作满意度有所改善。结论EAP计划的推广和实施,有利于减轻医护人员的压力,改善职业倦怠的状况,提高生活质量和工作满意度。

EAP在矿工压力管理中的应用

为探讨员工援助计划(EAP)在矿工压力管理中的应用,概述了EAP主要内容以及其在中国的应用,从矿工的特殊工作环境,工作时间、劳动强度,家庭因素以及社会因素说明矿工压力管理的迫切性,并分析了目前中国矿工压力管理过程存在的问题。最后提出了EAP在煤矿企业压力管理中的工作流程,并根据EAP的核心思想提出了压力管理应用方案。

企业员工援助计划(EAP)的应用效果及导入

首先介绍了员工援助计划的涵义及内容,然后从提高员工工作生活质量、降低单位管理成本、增加员工投资回报等角度,分析了员工援助计划在西方发达国家的应用效果,最后提出了中国企业导入员工援助计划的思路。

基于改进的Diameter/EAP-MD5的SWIM认证方法

广域信息管理(SWIM,system wide information management)采用面向服务的体系结构(SOA,service oriented architecture)提供民航信息交互与数据共享功能。在分析SWIM体系结构和基于Diameter协议的EAP-MD5应用子协议基础上,给出标准Diameter/EAP-MD5认证过程中存在的安全隐患,改进了EAP-MD5认证协议,提出基于改进的Diameter/EAP-MD5协议的SWIM用户身份认证方法,研究基于Diameter的SWIM认证服务,并在模拟的SWIM环境中对改进方法进行仿真实验和安全性分析。实验结果表明,改进的Diameter/EAP-MD5认证方法可在计算性能相当的前提下提高SWIM认证系统的安全性,为SWIM安全服务框架的构建提供保障。

基于缓解高职院校教师心理压力的EAP策略探析

高职院校教师承担着重大的社会责任。面对教育教学改革、课程建设及学校生存发展提出的要求,教师源自社会、学校以及自身等方面的压力越来越大,心理负担日益加重。因此,有必要在高职院校中构建EAP体系,通过加强宣传、深化交流、开展培训等措施,缓解教师的心理压力,倡导并帮助教师健康快乐地教学。