Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Hyperprolactinemia in Hospitals in Lomé: Diagnostic and Therapeutic Aspects

Introduction. Hyperprolactinemia represents a supraphysiological secretion of prolactin. In clinical practice, it is the most frequently encountered anterior pituitary disorder. However, its real prevalence is little known in Africa. The purpose of this study is to list all cases of hyperprolactinemia over the past four years and to make an inventory of the various etiologies found and their management. Methodology. This is a cross-sectional descriptive study on the files of patients who came for consultation in the internal medicine and endocrinology department with hyperprolactinemia retrospectively collected from January 2017 to December 2020. Included were patients followed or whose the diagnosis of hyperprolactinemia was established in endocrinological consultation during the study period. Results. This study recorded 26 cases of hyperprolactinemia. The female sex represented 73.08% (sex ratio M/F 0.37) and the average age was 33.92 years. The 40 - 50 age group was the most represented with 30.77%. In women, galactorrhea accounted for 73.07%, amenorrhea 57.69% of clinical pictures and infertility 23.08%. In men, infertility accounted for 7.69% of presentations, gynecomastia 11.54% and erectile dysfunction 15.38%. The duration of evolution of the signs was 4 months in 23.08% of the patients. The mean prolactinemia was 702.58 ng/ml. CT was performed in 80.85% of patients. The main etiologies were pituitary adenomas (77%). All our patients were treated with dopaminergic agonists. Cabergoline was prescribed in 77% of patients. The evolution was favorable in 96.25% of patients. Conclusion. Hyperprolactinemia is a pathology that exists in our regions. The main etiology remains pituitary adenomas and treatment with cabergoline.

Construction of competency evaluation system for infection control personnel in traditional Chinese medicine hospitals

Background:This study uses a literature review and the Delphi expert consultation method to construct a competency evaluation model for infection control personnel in traditional Chinese medicine(TCM)hospitals.The aim is to strengthen infection control management in TCM hospitals,assess the competency of infection control personnel in their positions,and assist them in identifying the competencies that need improvement.Methods:Based on the literature research method and the Delphi expert consultation method,a competency model for the position was constructed through two rounds of expert consultations,analyzing the relationships between various factors and establishing a hierarchical structure model.Pairwise comparisons were made among the elements at the same level to construct a judgment matrix.Through the analytic hierarchy process,the weight coefficients of the indicators at each level in the competency model were obtained.Results:This study conducted a comprehensive assessment of various capabilities and practices related to hospital infection control.The survey results indicate that participants excelled in multiple areas,with a high overall satisfaction rate.95.28%of participants were able to develop hospital infection monitoring plans based on national infection control policies,demonstrating a good understanding and execution of these policies.94.09%of participants were familiar with high-risk populations and key departments in the hospital.91.73%of participants were able to establish monitoring scopes based on the trends of multidrug-resistant bacteria and conduct information monitoring,reflecting strong response capabilities.92.91%of participants were able to collaborate with relevant departments to conduct bacterial resistance monitoring,showing a good team spirit.94.49%of participants were able to perform targeted monitoring,including surgical site infections,indicating that they have effective monitoring strategies.91.34%of participants were able to collect and organize monitoring data and establish a systematic database,demonstrating good data management skills.90.16%of participants were able to interpret laws and regulations related to hospital infection management,indicating a high level of legal knowledge.89.37%of participants generally possessed good communication skills.92.52%of participants were able to guide medical staff on occupational safety and protective knowledge,showing an emphasis on occupational health.Participants demonstrated a strong desire to learn and innovate,with 87.01%actively participating in continuing education and research activities,reflecting a pursuit of professional development.Conclusion:Based on the results of the two rounds of expert consultations,a competency evaluation model for infection control personnel in TCM hospitals was formed.Through the analytic hierarchy process,the weight coefficients of various indicators at different levels in the model were obtained,and the research results have good scientific validity and reliability.

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Management Measures for Preventing Postoperative Incision Infections in General Surgery at Primary Hospitals

Objective:To analyze the management measures and effects of preventing postoperative incision infections in the general surgery department of primary hospitals.Methods:Forty-nine surgical patients with 11 healthcare workers who were admitted to the general surgery department of the primary hospital between August 2021 and August 2022 were selected as the routine group for routine incision infection management.Forty-nine surgical patients with 11 healthcare workers admitted to the same department between September 2022 and September 2023 were selected as the prevention group for prophylactic management of postoperative incision infections.The incision infection rate,knowledge,attitude,and practice(KAP)scores,and management satisfaction of the patients as well as the management skill scores of healthcare workers were compared between the two groups.Results:The rate of postoperative incision infection in the prevention group was lower than that in the routine group;after implementing management measures,patients in the prevention group had higher KAP scores than those in the routine group;patients in the prevention group were more satisfied with the management than those in the routine group;and healthcare workers in the prevention group had higher scores than those in the routine group,with P<0.05 for the comparison between the groups.Conclusion:The implementation of preventive management for general surgery patients in primary hospitals can reduce the incidence of postoperative incision infection and improve the KAP of patients,with higher management satisfaction.It can also enhance the management skills of healthcare workers,thus improving their overall management level.

A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

Evaluating patients' perception of service quality at hospitals in nine Chinese cities by use of the ServQual scale

Objective: To investigate patients' perception of service quality at hospitals in nine Chinese cities and propose some measures for improvement. Methods: The ServQ ual scale method was used in a survey involving patients at out-patient and in-patient facilities in Shanghai, Chongqing, Chengdu, Nanning, Guilin and Laibin of Guangxi, Honghezhou of Yunnan, Wulumuqi of Xinjiang and Zhongshan of Guangdong. The data collected were entered and analyzed using SPSS 20.0. Statistical analyses included descriptive statistics, factor analyses, reliability analyses, product-moment correlations, independent-sample t-tests, One-way ANOVA and regression analyses. Results: The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.979. The Cronbach's α for the reliability analysis was 0.978. All the Pearson correlation coei cients were positive and statistically signii cant. Visitors to out-patient facilities reported more positive perception tacilities on tangibles(t = 4.168, P(t = 1.979, P <han visitors to in-patient f 0.05). Patients of 60 years of age and above reported mor< 0.001) and reliability e positive perception th<an those between 40 and 49 on reliability(F = 3.311, P = 0.010), assurances(F = 2.751, P 0.05) and empathy(F = 4.009, P = 0.003). For the i ve dimensions of the scale, patients in Laibin, Guangxi reported the most positive perceived service quality, followed by patients in Shanghai. On the other hand, patients in Chongqing and Nanning and Guilin of Guangxi reported relatively poor perceptions of service quality. Standardized regression coei cients showed statistically significant(P < 0.001) positive values for all Serv Qual dimensions. Empathy(β = 0.267) and reliability(β uality. = 0.239) most strongly predicted perception of service qConclusions: Chinese patients perceived service quality as satisfactory. Hospitals in various regions of China should enhance their awareness and ability to serve their patients.

Gastroenterology training in private hospitals:India vs South Africa

In South Africa,nurses and doctors are emigrating in significant numbers. Job satisfaction,safety and ensuring career progression are important in retaining doctors to make a career in Republic of South Africa (RSA). Due to budgetary constraints many hospitals have not been upgraded. Coming home after overseas training seems difficult. In RSA it takes a minimum of 13 years for a young specialist to become registered and 15 years for subspecialists. Career progression,creating more specialist trainees in public and private hospitals and shortening the period of professional training are potential solutions to the problem. India,which has a population of more than 1 billion people,is struggling with similar problems. For the past 10-15 years,private hospitals have assisted in manpower development for medical specialist and subspecialist careers. Currently their private sector trains 60% of their recognised (sub)specialities fellows. A national task force for specialist training in RSA should be instituted. It should discuss,based on the current status and projected specialist and subspecialist personnel requirements,thefuture structure and logistics of training needs. This is required in all subspecialities including gastroenterology,as has been done in India. It is hoped that as a consequence well-trained doctors,similar to those in India,might move to provincial hospitals in rural areas,upgrading the medical services and keeping medical power in South Africa. South Africa should become a model for Sub-Saharan Africa,as India already is for South-East Asia.

Evaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan------A comparison of lengths of hospital stay and medical payments among hospitals

Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future.

Is Nationwide Special Campaign on Antibiotic Stewardship Program Effective on Ameliorating Irrational Antibiotic Use in China? Study on the Antibiotic Use of Specialized Hospitals in China in 2011–2012

Summary： With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program （ASP） at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children＇s, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses （DDDs） per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient eases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days （P〈0.001）. The percentage of antibiotic use in outpatient prescriptions （range： 24.12%-18.71%, P=0.109） and inpatient cases （64.85%-60.10%, P=-0.006） also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

Features of colorectal cancer in China stratified by anatomic sites:A hospital-based study conducted in university-affiliated hospitals from 2014 to 2018

Objective:The clinical and biological characteristics of colorectal cancer have been found to differ depending on the anatomic site of the cancer.However,for Chinese patients,there is limited information on the proportion of cases at each site and the related features.In this study,we explored the location,distribution and other features of colorectal cancers at each anatomic site in Chinese patients.Methods:We conducted a hospital-based study using hospitalization summary reports from 10 Peking University-affiliated hospitals from 2014 to 2018;the reports covered a total of 2,097,347 hospitalizations.Incident cases were chosen as the study population,and their epidemiological features were further analyzed.Results:A total of 20,739 colorectal cancer patients were identified.Rectum was the most common location(48.3%)of the cancer,whereas the proportions of patients with distal and proximal colon cancer were 24.5%and18.6%,respectively.Patients with rectal cancer were predominantly male and were the youngest for all anatomical sites(each P<0.001).The highest proportion of emergency admissions,the longest hospital stays and the highest hospitalization costs were found in patients with proximal colon cancer(each P<0.001).The proximal colon cancer subgroup included the highest proportions of patients with medical histories of cholecystectomy,cholecystolithiasis and/or gallbladder polyps and appendectomy(P=0.009,P<0.001 and P<0.001,respectively).The distal colon cancer subgroup included the highest proportions of patients with medical histories of diabetes and hypertension(P<0.001,respectively).Conclusions:The patterns of colorectal cancer observed in this study differ from those reported for Western patients and show a significantly higher proportion of patients with rectal cancer.Different epidemiological features were also found based on anatomic sites.Further studies based on tumor location should be conducted to facilitate more accurate screening and treatment.

Bootstrapping Data Envelopment Analysis of Efficiency and Productivity of County Public Hospitals in Eastern, Central, and Western China after the Public Hospital Reform

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.

Research-training needs of clinical nurses: A nationwide study among tertiary hospitals in China

Objective: This study aimed to evaluate Chinese tertiary hospital nurses' research output,research ability,and their related training needs regarding scientific research methodology and analyze the relations among them.Methods: A nationwide survey was conducted in China on a large sample of tertiary hospital nurses (n =27,335) recruited from 22 provinces,autonomous regions,and municipalities.A validated,self-designed questionnaire,consisted of a common questionnaire,the Science Research Skills Self-Rating Questionnaire (SRSQ) and the Scientific Research Training Needs Questionnaire (SRTNQ) were used to assess nurses' research output,self-rated research skills and research-training needs.Results: The nurses' scientific research participation rates (with 4.13%,7.85%,5.35%,and 2.04% in research projects,research attendance,papers published,and patent,respectively) and their self-rated research skills 25.00 (12.50,37.50) were very low.However,the research training needs were relatively high 53.12(37.50,75.00).Significant differences in research participation rates (research projects,research attendance,papers published,and patent),scientific research skills,and research-training needs were determined by age,highest education level,nursing experience,employment,technical title,administrative post,and clinical tutoring experience (P< 0.05).Female and male nurses had different research participation rates (only research projects and studies published) and scientific research skills (P < 0.05).Positive correlations were observed among research output,scientific research skills,and researchtraining needs (P < 0.01).Conclusions: Nurses' scientific research participation and self-rated research ability were below the optimal despite that they had relatively high research-training needs.Nurses should be provided further research training with tailored content to their characteristics and capacity.

Analysis of Nosocomial Infections in Selected Teaching Hospitals, Qazvin, Iran

Introduction: Hospital infections prolong patient hospitalization, necessitate additional treatment, increase mortality rate, raise hospital expenses, and even reduce the level of health in the society. The purpose of this research was to study hospital infections in selected hospitals of Qazvin. Methods and Materials: This was an analytic-cross-sectional study. The research population consisted of 25,628 hospitalized patients in the first eight months of 2012 in three selected hospitals of the Qazvin Province. The algorithm of reporting hospital infections, the National Program of Controlling Hospital Infections, and 223 patient files hospitalized due to hospital-acquired infections were used to collect information. The collected information was analyzed using the SPSS V. 17 software;the descriptive statistics was used to analyze the qualitative variables;and the descriptive statistics together with chi-square and t-test were employed for the quantitative variables. Results: The ICU units had the most cases of hospital infections. Respiratory pneumonia and urinary infections topped the list of hospital infections. The most invasive treatments carried out on patients with hospital infections were surgery, urinary catheter, and venous catheter, respectively. More than 50 percent of patients with hospital infections were hospitalized for 2 to 21 days. Results and Conclusions: Because of the high rate of hospital infections, especially in the ICU ward, authorities must give top priority in their plans to designing suitable educational programs to inform hospital staff and patients of hospital infections and to provide suitable resources for dealing with this problem.

Healthcare waste management in selected government and private hospitals in Southeast Nigeria

Objective:To assess healthcare workers' involvement in healthcare waste management in public and private hospitals.Methods:Validated questionnaires(n = 660) were administered to randomly selected healthcare workers from selected private hospitals between April and July 2013.Results:Among the healthcare workers that participated in the study,187(28.33%) were medical doctors,44(6.67%) were pharmacists,77(11.67%) were medical laboratory scientist,35(5.30%) were waste handlers and 317(48.03%) were nurses.Generally,the number of workers that have heard about healthcare waste disposal system was above average 424(69.5%).More health-workers in the government(81.5%) than in private(57.3%) hospitals were aware of healthcare waste disposal system and more in government hospitals attended training on it.The level of waste generated by the two hospitals differed significantly(P=0.0086) with the generation level higher in government than private hospitals.The materials for healthcare waste disposal were significantly more available(P=0.001) in government than private hospitals.There was no significant difference(P = 0.285) in syringes and needles disposal practices in the two hospitals and they were exposed to equal risks(P =0.8510).Fifty-six(18.5%) and 140(45.5%) of the study participants in private and government hospitals respectively were aware of the existence of healthcare waste management committee with 134(44.4%) and 19(6.2%) workers confirming that it did not exist in their institutions.The existence of the committee was very low in the private hospitals.Conclusions:The availability of material for waste segregation at point of generation,compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.

Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals

INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.

A conceptual evolutionary aseismic decision support framework for hospitals

In this paper, aconceptual evolutionary framework for aseismic decision support for hospitalsthat attempts to integrate a range of engineering and sociotechnical models is presented. Genetic algorithms are applied to find the optimal decision sets. A case study is completed to demonstrate how the frameworkmay applytoa specific hospital.The simulations show that the proposed evolutionary decision support framework is able to discover robust policy sets in either uncertain or fixed environments. The framework also qualitatively identifies some of the characteristicbehavior of the critical care organization. Thus, by utilizing the proposedframework, the decision makers are able to make more informed decisions, especially toenhance the seismic safety of the hospitals.