Epidemiological and Clinical Aspects of Male Infertility in Patients Consulting at the Urology Department of the Yaounde Central Hospital

Introduction: About 10 to 15% of couples in the world and 20 to 30% in Cameroon consult for infertility problems. Infertility is of male origin in 40% of cases. Our objective was to evaluate the epidemiological and clinical aspects of male infertility in our setting. Methods: This was a cross-sectional and descriptive study, with retrospective data collection from the files of patients received for male infertility, over 5 years and 6 months (from January 1st, 2016 to April 30th, 2021) at the Urology Department of the Yaounde Central Hospital. Phone calls were made to patients with incomplete records for completion following a verbal consent. Data reported on data collection forms were entered into a data entry form designed on CSPro software version 7.2. The database was later exported for descriptive statistics using the IBM SPSS software version 23. Qualitative variables were summarized in frequencies and percentages while quantitative variables were summarized in means with their standard deviations for normally distributed data, or medians and interquartile ranges otherwise. Results: Out of 110 patients whose records were analyzed, the median age was 37.0 years, with an interquartile range of 8.3, with 55.5% in the age group 30 to 39 years. Of these 95 (86.4%) were married, 58 (52.7%) were from the West region, 76 (69.1%) were employed. Past history was dominated by mumps 40 (36.4%), varicocele surgery 25 (22.7%), alcoholism 87 (79.1%) and smoking 15 (13.6%). A disorder of spermatogenesis was found in all our patients: 37 (33.6%) azoospermia, 27 (24.6%) asthenospermia and 26 (23.7%) oligospermia patients. Paraclinical evidence of chlamydia and gonococcal infections were found respectively in 38 (34.5%) and 14 (12.7%) patients, varicocele and testicular dystrophy respectively in 95 (86.4%) and 38 (34.5%) patients. Infertility was primary in 67 (60.9%) patients. Conclusion: Most patients with infertility were in their thirties, had risky social habits and comorbidities. An early start of health promotion activities, comorbidities prevention and early detection of spermogram abnormalities would make it possible to reduce the frequency of male infertility.

Clandestine Abortions and Its Complications at the University Hospital Center of the Sino-Central African Friendship

Introduction: In developed countries in general and particularly in the Central African Republic, clandestine abortions constitute a real health problem. The aim of our work was to study the method of carrying out clandestine abortions, to describe the profile of the providers and the complications that result from it. Patients and Methods: This was a descriptive cross-sectional study of patients hospitalized at the University Hospital Center for Sino-Central African Friendship (CHUASC) from 2015 to 2019 on 236 cases. Results: We identified a total of 254 patients for 8039 live births in the same period, a frequency of 3.16%. The age of the patients was between 15 years old and 48 years old with an average of 25 years old. Singles accounted for 42.5%. Induced abortions were more performed among students (32.6%) and the unemployed 53.6%. Contraception was used in 11.5% of cases. The methods used were numerous: misoprostol (32%), the traditional method (18%), the mechanical method (50%). In this method, we note the dilation of the cervix by the cassava stem;Hegar’s candles;the probes, which are infusion tubes cut and introduced into the cervix, of which 2 cases had escaped at the level of the uterine muscles and emerged under the skin at the pubis part two years later. The practice of induced abortions in our series was done by medical students in 37.3% followed by unqualified staff in 49.7%. It took place either at home or in centers managed by Non-Governmental Organizations. The aseptic conditions were not perfect. Some patients (43.2%) were aware of the ensuing complications. All complications were present: hemorrhage (60.7%), pelviperitonitis (23.6%), uterine perforation (6.6%), peritonitis (2.8%) and death (2%) related to sepsis. Conclusion: Clandestine abortion remains a real health problem for young Central African women.

Management of Immediate Postpartum Hemorrhage at the University Hospital Center of the Sino-Central African Friendship

Introduction: Immediate postpartum hemorrhages constitute a frequent maternal complication and remain at the forefront of maternal death in our countries. Objective: Contribute to improving the management of immediate postpartum hemorrhage in our context with a view to reducing maternal mortality. Patients and Methods: We conducted a retrospective descriptive and analytical study over a period of 12 months from January 1st to December 31st 2020. Results: We collected a total of 109 files on a total of 4360 deliveries. The frequency of postpartum haemorrhages was of the order of 2.5%. The most represented age group was between 20 and 24 years old. Pauciparas represented the majority of our study population. 64.5% of patients were uneducated. These hemorrhages occurred in patients who often gave birth outside the department with 63.8%. The main causes of postpartum hemorrhage were cervical tears (51.2%) and partial placental retention (30.7%). The majority of these deliveries (48.8%) were carried out by midwives followed by assistant midwives (33.2%). Active management of the third period of delivery was systematic and immediate followed by the valve examination completed by the infusion of oxytocin in case of uterine atony, tranexamic acid ans misoprostol intrarectally. In the event of persistent hemorrhage, suture of the cervical lesions, ligation of the cervical vessels or even laparotomy either for the selective ligation of the blood vessels or for the hysterectomy for hemostasis were practiced. We do not have a Nalador, nor a Bakry balloon, nor an Interventional Radiology service for embolization of the uterine arteries. We deplore 1.3% of deaths from afibrinogenemia. Conclusion: The frequency of immediate postpartum hemorrhages is lower in our health facility. This is due to the rapid handling of cases. Improving the quality of services offered to women during childbirth can further help reduce the frequency of these hemorrhages.

Use of Chinese Herbal Medicine Therapies in Comprehensive Hospitals in Central China: A Parallel Survey in Cancer Patients and Clinicians

Summary： Chinese herbal medicine （CHM）, as the largest application category of traditional Chinese medicine （TCM）, is widely accepted among cancer patients in China. Herbal slice （HS） and Chinese patent drug （CPD） are commonly used CHM in China. This study aimed to investigate the utilization of CHM among clinicians and cancer patients in central China. Five hundred and twenty-five patients and 165 clinicians in 35 comprehensive hospitals in central China were asked to complete an anonymous questionnaire that was designed to evaluate the use of CHM. The results showed that 90.74% clinicians and 72.24% cancer patients used CHM during cancer treatment. The educational backgrounds of the clinicians and the age, education level, annual income, and cancer stage of the cancer patients were re- lated to use of CHM. More than 90% clinicians and cancer patients had used CPD. Comparatively, the percentage of HS use was 10% lower than that of CPD use among clinicians and cancer patients. More clinicians preferred to use CHM after surgery than cancer patients did （20.41% vs. 5.37%）. Enhancing physical fitness and improving performance status were regarded as the most potential effect of CHM on cancer treatment （85.71% among clinicians and 94.07% among cancer patients）, in comparison with directly killing tumor cells （24.49% among clinicians and 31.36% among patients）. As for refusal rea- sons, imprecise efficacy was the unanimous （100%） reason for clinicians＇ rejection of CHM, and 95.58% patients objected to using CHM also for this reason. Furthermore, the side effects of CHM were more concerned by clinicians than by patients （33.33% vs. 15.81%）. In conclusion, our survey revealed that CHM was popularly accepted by clinicians and cancer patients in central China. The reasons of use and rejection of CHM were different between clinicians and cancer patients.

Patterns of Mortality Occurrence in a Cardiology Unit of a Low-Income Country: A Critical Analysis at the YaoundéCentral Hospital

Background: In-hospital mortality is high in low-income countries. Currently, little is known in Cameroon concerning the characteristics of patients who die in cardiology units. Our objectives were to determine the in-hospital mortality rate;describe the general characteristics of death patients, and factors associated with mortality. Material and Methods: We conducted a retrospective cross-sectional study by reviewing the medical records of all patients admitted to the cardiology unit of the Yaoundé Central Hospital (CHY) between January 2018 andJanuary 2019. The files of all death patients were studied for socio-demographical, clinical and therapeutical variables. Bivariate analysis was conducted to order to check the association between independents variables and time of death. A p-value < 0.05 was considered statistically significant. Results: A total number of 860 patients were admitted in the cardiology unit of CHY during the study period. Amongst the 860 patients admitted 78 had a fatal outcome, hence, an in-hospital mortality rate of 9.06%. The male gender was predominant amongst the deceased patients (n = 45). The mean age at death was 69 ± 15.19 years. The median time before death was 6 days and they ranged between 1 to 25 days. Hypertension was the most frequent comorbidity (65.4%). Stroke was the principal cause of admission (40.3%), whereas the main presenting complaint was dyspnea (26.9%). Before being admitted to the cardiology department, the majority of the deceased patients were from the emergency department. The major clinical sign of death was respiratory distress (39.74%). Shock on admission was the sole factor found to be associated with the mean time of death (p = 0.012). The patients with deep venous thrombosis compared to other diagnoses were less like to die early (r = 16, p = 0.016). Conclusion: The patient admitted in the cardiology unit of Yaoundé Central Hospital died mainly from stroke and the death is earlier when the patient has signs of shock on admission. These results emphasize the need for a good primary evaluation at the emergency room, to better manage patients with cardiovascular diseases in the cardiology ward.

Analysis of Ornidazole Injection in Clinical Use at Post-marketing Stage by Centralized Hospital Monitoring System

This study aims to analyze the clinical use of ornidazole injection at the post-marketing stage by centralized hospital monitoring system method,and investigate its widespread use in patients,in order to regulate and guide the rational drug use,improve the drug specificity and provide a basis for drug therapy.The study adopts a prospective,multi-center,large sample size,centralized hospital monitoring system.We selected five leading hospitals in Hubei province,and observed the inpatients who received the ornidazole injection from July 1,2015 to October 31,2015.The basic information of patients was recorded,as well as the drug use and adverse events.The statistical analysis was performed based on these data.A total of 4396 individuals were enrolled in this study,most of them were middle-aged female patients and the ornidazole injection was mainly used as prophylactic prior to surgery to prevent the infections,and surgical treatment of anaerobic infections,abdominal infections and pelvic infections.The irrational drug use existed mainly in the prescribing and administration process,including unreasonable dosing frequency,rapid intravenous drip speed and extended duration of drug use.Eleven cases of adverse reactions were collected during the monitoring,incidence rate of adverse reactions was 2.5‰;adverse drug reactions occurred within 30 min.The study results fully reflected the usage of ornidazole injection in the real world.Based on the study,we calculated the adverse reaction incidence of ornidazole and identified the risk factors which may affect the safety of ornidazole injection.Study results strongly recommend that the manufacturers should publish standards for inpatient use and doctors should prescribe with caution accordingly.

Multidrug resistance Acinetobacter species at the intensive care unit,Aseer Central Hospital,Saudi Arabia:A one year analysis

Objective:To identify and to determine the antimicrobial susceptibility of Acinetobacter baumannii(A.baumannii) clinical isolates from ICU at Aseer Central Hospital.Methods:The study was conducted in the Intensive Care Unit,Aseer Central Hospital,Saudi Arabia over 13 months period(2014-2015).Acinetobacter species(n= 105) were isolated from various clinical samples.Isolates were identified using selected phenotypic criteria and confirmed using the Vitek 2 automated system.This system was used to determine the susceptibilities of 21 antimicrobial agents.Patients,isolates and drug data were analyzed using the SPSS statistical software package to determine some epidemiological and microbiological patterns.Results:Of the 105 stains,A.baumannii accounted for 49(46.67%),A.baumannii complex,19(18.09%),A.baumannii/haemolyticus 32(30.47),Acinetobacter haemolyticus 4(3.81%),Acinetobater lwoffii 1(0.95%) and unidentified Acinetobater species 2(1.3%).Of the 105 Acinetobacter strains,103(98.1%) were found multidrug resistant(MDR).A.baumannii strain were 100% sensitive to colistin and 74.5% to trimethoprim + sulfamethoxazole.The remaining 19 antimicrobial agents revealed low or no sensitivities:amikacin 16.3%; ampicillin 7.7%; ceftazidime 7.3%.Distribution of similar sensitivities was shown by other Acinetobacter species.Mean number of isolates from males and females indicates no statistical variation(P=0.867) whereas age groups showed significant differences(P= 0.008) as it is clear from the high percentage of infected individuals more than 60 years followed by those aged 20 to 29 years old(19.05%).Upper respiratory tract(30.48%),lower respiratory tract(47.65%) and subcutaneous tissue(9.5%) were the main sources of Acinetobacter spp.but mean numbers of isolates from these specimens indicate no discrepancy between specimens(P=0.731).Conclusions:Acinetobacterspecies including A.baumannii were found MDR(98.1%) according to the current Acinetobacter spp.antimicrobial categorization.Approximately half of these strains were A.baumannii.All Acinetobacter species were 100% sensitive to colistin and to some extent to trimethoprim + sulfamethoxazole(74.5%).ICU-acquired pneumonia among patients over 60 years of age who spend prolong times at artificial ventilations made up the majority of the cases.

Application and Exploration of BPR Theory in Hospital Financial Management under Informatization

In recent years,people's work and life have been unable to break away from the application of technology and information industry.However,the booming and huge influence of big data and information age has a greater impact on people.In this form,the traditional model of public hospitals has a huge collision with it,so it actively seeks a way out and actively develops it.In the subsequent development,it needs to abandon the financial management mode of inefficiency,energy consumption,etc.,advanced financial management model to improve the financial management of public hospitals.This paper mainly studies the application and exploration of BPR theory in hospital financial management under the informationization.Firstly,it discusses and analyzes the BPR theory in detail.Secondly,it combines the status quo of public hospitals to reconstruct the information management financial management plan.Before and after the comparison,the application is applied to the daily financial management of the hospital according to the actual situation.

Analysis of the Effect of Quality Control Circle on the Central Sterile Supply Department

Objective:To analyze the effect of quality control circle on the central sterile supply department(CSSD).Methods:The control group and the observation group each consisted of 180 instruments received by the sterilization supply center from January to March 2023 and 11 CSSD staff.The control group underwent routine management while quality control circle was implemented in the observation group.The quality of work,disinfection and sterilization qualification rates,disinfection and sterilization of various instruments,cleaning indicators,and management satisfaction of both groups were compared.Results:The observation group scored higher in terms of work quality,the qualification rate of disinfection and sterilization in each link,the disinfection and sterilization of instruments,and cleaning indicators compared to the control group.Besides,the management satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:A quality control circle ensures the quality of work,improves the cleaning,disinfection,and sterilization of instruments of the CSSD,and improves the management satisfaction of the CSSD staff.

Central bank digital currency,loan supply,and bank failure risk:a microeconomic approach

Central bank digital currencies(CBDCs),which are legal tenders in digital form,are expected to reduce currency issuance and circulation costs and broaden the scope of monetary policy.In addition,these currencies may also reduce consumers’need for conventional demand deposits,which,in turn,increases banks’loan provision costs because deposits require higher rates of return.We use a microeconomic banking model to investigate the effects of introducing an economy-wide,account-type CBDC on a bank’s loan supply and its failure risk.Given that a CBDC is expected to lower the cost of liquidity circulation and become a strong substitute for demand deposits,both the loan supply and the bank failure risk increase.These increases are countered by subsequent increases in the rates of return on term deposits and loans,which,in turn,reduce the loan supply and thus bank failure risk.These offsetting forces lead to no significant change in banking,as long as the rate of return on loans is below a certain threshold.However,once the rate is above the threshold,bank failure risk increases,thereby undermining banking stability.The problem is more pronounced when the degree of pass-through of funding costs to the loan rate is high and the profitability of a successful project is low.Our results imply that central banks wishing to introduce an economy-wide,account-type CBDC should first monitor yields on bank loans and consider policy measures that induce banks to maintain adequate liquidity reserve levels.

The Research on the Money Supply of Central Bank Digital Currency

Currently,the only central bank digital currencies(CBDC)in the world is Venezuela^currency^Petro.Nowadays,the IMF,BIS,and major countries have conducted a lot of research on CBDC.It's an urgent issue for the central bank to issue CBDC,determine and formulate the circulation of CBDC and the issuance speed,and supervise it.Therefore,establishing ARMA and VARs by sorting out literature,the paper uses the characteristics of CBDC—cash,and similarities with third-party payment in terms of payment to determine the circulation of CDBC by third-party payment users and currency in circulation.The model calculates and predicts the speed of circulation of digital currency.The issuance of CBDC will accelerate the circulation of money.In this regard,we will explore the impact of money supply on monetary policy and make relevant recommendations.

Measuring Global Supply Chain Vulnerabilities Using Trade Network Analysis Method

With the trade network analysis method and bilateral country-product level trade data of 2017-2020,this paper reveals the overall characteristics and intrinsic vulnerabilities of China’s global supply chains.Our research finds that first,most global supply-chain-vulnerable products are from technology-intensive sectors.For advanced economies,their supply chain vulnerabilities are primarily exposed to political and economic alliances.In comparison,developing economies are more dependent on regional communities.Second,China has a significant export advantage with over 80%of highly vulnerable intermediate inputs relying on imports of high-end electrical,mechanical and chemical products from advanced economies or their multinational companies.China also relies on developing economies for the import of some resource products.Third,during the trade frictions from 2018 to 2019 and the subsequent COVID-19 pandemic,there was a significant reduction in the supply chain vulnerabilities of China and the US for critical products compared with other products,which reflects a shift in the layout of critical product supply chains to ensure not just efficiency but security.China should address supply chain vulnerabilities by bolstering supply-side weaknesses,diversifying import sources,and promoting international coordination and cooperation.

人工关节集采对DRG IC29组病例住院费用的影响分析

[目的]研究集中带量采购对人工关节置换术患者住院费用的影响,为深化高值耗材持续改革提供依据。[方法]收集某三级医院集采前后DRG分组IC29组病例的DRG结算数据和医保信息系统的相关信息,进行倾向得分匹配后,采用描述性分析、非参数检验、结构变动度进行费用变化分析。[结果]集采政策实施后的各项费用中位数显示,IC29组病例次均费用下降了33445元,其中材料费下降了34835元;DRG统筹金额下降了13705元,个人自付金额下降了24550元。集采前后的结构变动度为60.52%,材料费呈负向变动,医疗服务费、检查化验费、药品费及其他费呈正向变动。结构变动贡献率前三位为材料费50.00%、医疗服务费26.04%、检查化验费16.36%。[结论]集采后IC29组病例的次均费用、材料费、医保支付和个人负担费用均明显降低,费用结构得到优化,人工关节集中带量采购成效明显。建议持续进行高值耗材集采工作,并协同推进医疗服务价格和医院薪酬制度等其他医改配套政策。

消毒供应中心护士岗位培训的态势分析及发展策略

消毒供应中心是医院内特殊的护理单元,消毒供应中心护士的岗位职责及其岗位培训与临床护士大相径庭。该文采用SWOT态势分析法,系统分析目前我国消毒供应中心护士岗位培训现状的内部优势、内部劣势和外部机会、外部威胁四个方面,并依据SWOT矩阵分析,给出相应的发展策略,旨在为消毒供应中心护士岗位培训提供一定参考。

集中式馈线自动化配电网供电可靠性评估

计及集中式馈线自动化的配电网可靠性评估尚存在较多研究空白,且多数研究仅计及故障停电的影响,在考虑预安排检修容量约束的情况下,计及负荷转供影响,结合馈线自动化的类型及运行逻辑,依据馈线自动化相关技术指标,对恢复供电过程中出现的负荷点进行详细分类,推导出不同类型负荷期望恢复供电时间和配电网供电可靠性指标计算公式。结合算例进行分析可知,不同终端配置下馈线系统平均停电持续时间SAIDI可减少0.95~1.08 h/(用户·a),说明了优化终端配置可有效提高配电网供电可靠性,证明了所提评估方法的准确性和实用性,并比较了不同终端配置对可靠性的影响。

公立医院医用耗材带量集采管理问题与对策研究

目的在医用耗材带量集采扩面提质的背景下,耗材集采的“一品一策”给公立医院耗材管理工作带来挑战,本研究通过探究广东省某公立三甲医院医用耗材带量集采过程中可能发生的管理问题,设计并实施相应管理对策并衡量其执行效果。方法应用鱼骨图分析法系统分析医用耗材带量集采执行过程中的潜在问题,并于2023年5月—7月在院内采取针对性措施。选取该医院2022年12月—2023年12月冠脉支架、起搏器、管型/端端吻合器以及脊柱产品的集采时序作为研究对象,衡量其干预前后的月度执行率、合同完成量变化,判断干预成效。结果鱼骨图分析结果显示影响集采执行的主要因素有内部制度不完善、人员管理无法满足需要、供货问题、信息系统欠缺等因素。干预后集采月度执行率(t=-4.19,P<0.05)、合同完成量(t=-2.38,P<0.05)均高于干预前,差异具有统计学意义。结论对医用耗材带量集采实施干预管理能有效促进科室带量集采执行效果。在带量集采的环境下,临床以及卫生管理人员需要进一步提升自身专业性,保障耗材集采管理的效率与质量;并深化对政策的理解并落实,完善生产配送环节的监督与惩戒机制,多部门联动落实供应保障;以及提升医院与集采平台信息系统。

纵向监管、地方选择性供地与产业结构绿色转型

地方政府的有效执行是中国式分权下提升中央发展战略实施绩效的关键,而中央政府对地方政府治理行为的有效监督则是其中至关重要的环节。本文基于2007—2019年中国微观工业用地供应以及中央环保督察的通报结果数据,采用广义双重差分法实证考察中央环保督察对地方政府选择性供地策略的影响及其机制。研究表明,中央环保督察促使地方政府降低污染密集型工业用地供应,增加清洁型工业用地供应,从而推动地区产业结构的绿色转型。机制分析发现,中央环保督察通过地方领导人职业发展激励机制以及产业转型能力机制对不同特征的城市工业土地供应结构策略产生异质性影响。本文结论对高质量发展背景下的央地互动关系与地方利用土地偏向性供给推动产业结构绿色转型具有政策启示。

量化积分绩效分配模式在消毒供应中心工勤人员中的应用研究

目的探讨量化积分在消毒供应中心工勤人员绩效分配中的应用效果,为消毒供应中心提供一种有效的绩效分配方法。方法采用前-后对照研究方法,选取2020年1月至12月本院消毒供应中心绩效分配模式为对照组,选取2021年1月至12月本院消毒供应中心绩效分配模式为试验组。对照组采用按工勤人员工龄绩效分配模式,试验组采用量化积分绩效分配模式,即从技术层级、工作质量、工作效率、工作量方面实施量化绩效分配模式。比较改进前后两组工勤人员工作效率、工作质量缺陷发生率(包装器械缺失、器械种类错误、包装标识错误、收送物品错误、信息系统操作错误)、临床科室满意度情况。结果实施量化积分绩效分配模式后,试验组工勤人员工作效率和临床科室满意度均高于对照组,工作缺陷发生率低于对照组,两组比较,差异具有统计学意义(均P<0.05)。结论量化积分绩效分配模式在消毒供应中心工勤人员中的应用,能够提高工勤人员的工作能动性,提高工作效率和工作质量。

隐私信息供需视域下央行数字货币与现金替换:模型与数值分析

本文从隐私信息供需分析出发,通过拆解CBDC与实物现金使用净效用差异阐明社会平均隐私偏好强度与CBDC使用情况的基本逻辑;将社会平均隐私偏好纳入货币搜寻框架构建含隐私因素的货币替代模型,考察社会平均隐私偏好与CBDC替代现金的关系;借助数值分析手段对强保密型、弱保密型和可控保密型CBDC技术进行情景模拟。研究发现,社会平均隐私偏好变化通过商家交易激励影响CBDC和现金的流动性,若商家(消费者)平均隐私偏好更强,CBDC相对现金的比例增加(下降);福利最大化的一种情形是CBDC-现金结构与社会平均隐私偏好强度相匹配且商品均匀分布;可控保密型CBDC在抵御强隐私偏好冲击和福利效应维度占有相对优势;引入可控保密型CBDC后中国情景的最大化社会福利水平最高,一般经济体次之,发达经济体最小。

FMEA在消毒供应中心口腔科器械管理中的应用效果

目的探讨失效模式与效应分析(FMEA)在消毒供应中心口腔科器械管理中的应用效果。方法自2019年12月起,医院消毒供应中心开始通过FMEA对口腔科器械实施管理。于FMEA实施前后所使用的口腔器械中随机选取1638件,对其展开FMEA分析,对比实施前后的失效模式危急值(Risk Priority Number,RPN)、器械管理效果及服务满意度。结果FMEA实施后的口腔器械交接数目不符合、器械损坏、器械包装名称错误、器械清洗、消毒与灭菌不合格的RPN值明显比实施前低(P<0.05);FMEA实施后的口腔科器械清洗、包装合格率比实施前高,器械耗损率、湿包发生率比实施前低,及时发放率比实施前高(P<0.05);实施后的服务满意度总分实施前高(P<0.05)。结论消毒供应中心对口腔科器械展开管理时,应用FMEA并针对分析结果制定相应措施可有效降低口腔科器械管理中的风险,提升器械管理效果,并且有助于提升服务满意度。