Short-term effects of low-level PM_(2.5),PM_(10),O_(3),and tropical meteorological conditions on emergency department visits for respiratory diseases in Haikou,China

Objective:To assess the correlation between atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City.Methods:Daily data on atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City from 2018 to 2021 were collected.The Spearman rank correlation test was used to analyze the correlation,and a distributed lag non-linear model was employed to analyze the health effects and lag impacts of environmental factors.Subgroup analyses were conducted based on sex and age.Results:According to the criteria of International Classification of Diseases(ICD-10:J00-J99),a total of 221913 cases were included,accounting for 21.3%of the total emergency department visits in Haikou City.For every 1℃increase in temperature,the risk of emergency department visits increased by 1.029%(95%CI 1.016%-1.042%).Relative humidity greater than 80%reduced the risk of visits,while higher atmospheric pressure(>1010 hpa)also decreased the likelihood of daily emergency department visits.Higher concentrations of PM_(2.5)(30-50μg/m^(3)),PM10(>60μg/m^(3)),and O_(3)(75-125μg/m^(3))were associated with increased visits.Higher temperatures(>25℃)have a greater impact on females and children aged 0-14 years,while males are more sensitive to low atmospheric pressure.Individuals aged 65 and above exhibited increased sensitivity to O_(3)concentration,and the effects of PM2.5,PM10,and O_(3)are more pronounced in individuals over 14 years old.Conclusions:Short-term exposure to high temperatures,particulate matter pollutants(PM_(2.5)and PM_(10)),and ozone(O_(3))is associated with increased emergency department visits for respiratory diseases.

The Definition of Non-Urgent Visits to the Emergency Department and Validation of Criteria for Referrals

Background: The centers of disease control and prevention define a non-urgent Emergency Department (NU-ED) visit as a medical condition requiring treatment within more than 24 hours. These visits constitute one of the main reasons for emergency department (ED) overcrowding, which greatly affects healthcare workers’ wellbeing, health costs, patients’ satisfaction and treatment outcomes. Currently, there is no solid definition of non-urgent emergency visits, which is the first step towards dealing and potentially solving this issue. Having that, the aim of the current study is to define and validate the criteria for NU-ED visits in Israel. Methods: This qualitative study included twelve senior physicians and nurses working in Emergency Department and/or Health Maintenance Organizations (HMOs) across Israel. The study was performed using in-depth, semi-structured, open-ended interviews. Qualitative data analysis was performed by conventional content analysis. Results: The urgency of medical visits was defined based on these two questions: 1) Does the medical condition require an immediate treatment? 2) Is the emergency department the only place that can provide the required treatment at a certain timepoint? We found that non-urgent visits mostly occur during the nights and weekends, when medical treatments are not available in the HMOs. Visitors for non-urgent cases mostly complained about minor injuries or chronic conditions, fever, abdominal or chest pain. Most visits occurred based on referral from the family physician or the nurse from the call center. Participants reported a lack of awareness and knowledge about the roles of the EDs and the available options in the HMOs, which seem unable to provide patients with appropriate treatments. The usage of triage scales seems to ensure that patients are being treated based on the clinical urgency of their condition. Medical cases that score above 3 can be defined as non-urgent visits. Therefore, implementation of these scales in the community and their use in decision making of referrals to emergency department might greatly reduce non-urgent visits. Conclusions: Participants defined urgent ED visits as medical situations that need to be treated immediately, while there are no available treatment options in the HMOs. Participants identified many reasons behind NU referrals to the ED, mainly, low awareness about the role of ED, low availability of certain tests in the HMOs, and inability to provide adequate treatment in the community.

Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic:A hospitalbased study

BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency department(ED)visits and hospital admission among kidney transplant(KT)recipients.AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand.METHODS We conducted a retrospective study at a university hospital in Thailand.We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19(from January 2020 to December 2021).We used the previous 2 years as the control period in the analysis.We obtained baseline demographics and ED visit characteristics for each KT patient.The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1^(st)year following a KT.The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model.RESULTS A total of 263 patients were included in this study:112 during the COVID-19 period and 151 during the control period.There were 34 and 41 ED visits after KT in the COVID-19 and control periods,respectively.The rate of first ED visit at 1 year was not significantly different in the COVID-19 period,compared with the control period[hazard ratio(HR)=1.02,95%confidence interval(CI):0.54-1.92;P=0.96].The hospital admission rate was similar between periods(HR=0.92,95%CI:0.50-1.69;P=0.78).CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic.Despite these findings,we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions,particularly in post-KT patients.

Trends in hospital readmissions and emergency room visits 60 days after robotic-assisted and laparoscopic hysterectomy

Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.

Association between Fine Particulate Air Pollution and Outpatient Visits for Eczema in Beijing, China: A Time-series Analysis

Eczema is a very common inflammatory skin disease characterized by patches of erythematous,itchy, cracked, and scaly skin.According to the 2010 Global Burden of Disease Study, the global prevalence of eczema is 3.33% and the leading cause of skin condition-based disability-adjusted life years is eczema[1].The large health burden brought about by eczema suggests high direct medical costs and health care utilization[2].Thus, eczema prevention is of great importance in efforts to eliminate the public health burden of the disease.

Association between Ambient Air Pollution and Outpatient Visits for Acute Bronchitis in a Chinese City

Objective To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis,which is a rare subject of research in the mainland of China.Methods A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data（2010-2011）.Results Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai.The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants.For lag06,a 10 μg/m3 increase in the concentrations of PM10,SO2,and NO2 corresponded to 0.94%（95% CI：0.83%,1.05%）,11.12%（95% CI：10.76%,11.48%）,and 4.84%（95% CI：4.49%,5.18%） increases in hospital visits for acute bronchitis,respectively.These associations appeared to be stronger in females（P〈0.05）.Between-age differences were significant for SO2（P〈0.05）,and between-season differences were also significant for SO2（P〈0.05）.Conclusion Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.

Ambient Temperature and Outpatient Visits for Acute Exacerbation of Chronic Bronchitis in Shanghai: A Time Series Analysis

The association between ambient temperature and acute exacerbation of chronic bronchitis （AECB） was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the relationship about temperature and outpatient visit for AECB. We adopted a quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on AECB across multiple days. We found significant non-linear effects of cold temperature on hospital visits for AECB, and the potential effect of cold temperature might last more than 2 weeks. The relative risks of extreme cold （first percentiles of temperature throughout the study period） and cold （10th percentile of temperature） temperature over lags 0-14 d were 2.98 [95% confidence intervals （CI）： 1.77, 5.04] and 1.63 （95% Ch 1.21, 2.19）, compared with the 25th percentile of temperature. However, we found no positive association between hospital visits and hot weather. This study showed that exposure to both extreme cold and cold temperatures were associated with increased outpatient visits for AECB in a large hospital of Shanghai.

Effects of PM2.5 Exposure in Different Air Quality Grades on Daily Outpatient Visits for Childhood Asthma in Shijiazhuang, China

Asthma is a common chronic inflammatory disorder that is more prevalent in children than in adults.China has seen an increasing prevalence of childhood asthma in recentdecades[1].Earlier studies have shown that air particulate matter (PM),particularly fine particulate matter(PM2.5)[2],is an important factor triggering childhood asthma. Since nationalPM2.5data were nota vailabl euntil 2013,

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Trends and challenges of emergency and acute care in Chinese mainland:2005–2017

BACKGROUND:Emergency medical service system(EMSS)is essential in providing acute care services for health conditions.However,trends of emergency and acute care in China haven’t been studied systematically.METHODS:Relevant literature was carefully reviewed,including original and review articles,letters,government reports,yearbooks,both in Chinese and in English.Data on the number of emergency visits,physicians and beds in emergency departments(EDs),and the workforce of prehospital emergency care were summarized and analyzed from China Health and Family Planning Statistical Yearbooks(2006–2018).RESULTS:Over the past decade,the number of ED visits tripled from 51.9 million to 166.5 million;and utilization of pre-hospital emergency care increased from 3.2 million to 6.8 million.In response to rapid increases in demand,the number of licensed emergency physicians raised from 20,058 to 59,409;the beds’number increased from 10,783 to 42,367.For pre-hospital emergency care,the volume of health workforce increased from 3,687 to 8,671,with a 109%increase in the number of physicians from 1,774 to 3,712.However,overcrowding,the long length of stay in EDs,poor work environment,and work exhaustion were still the critical challenges faced by China’s EMSS.CONCLUSIONS:The number of emergency visits has grown with continual capability enhancement during the past decade.However,overcrowding,the long length of stay in EDs,poor work environment,and work exhaustion still need to be solved by China’s EMSS.These fi ndings and comparison with the USA could offer experiences and lessons to EMSS development worldwide,especially for developing countries.

The use of outcome feedback by emergency medicine physicians: Results of a physician survey

BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

The Outpatient Clinic Visit: Expectations and Fulfilment of Perceived Needs in Adolescents with Type 1 Diabetes

Background: To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. Aims: The aim is to investigate adolescents’ expectations of an outpatient diabetes clinic visit in comparison to what was deemed to be delivered and contrast this outcome in adolescents with self-reported high- and low-diabetes distress respectively. Methods: All adolescents in Sweden with type 1 diabetes, aged 15 to 18 years, were identified via The National Pediatric Diabetes Registry (SWEDIABKIDS) and asked to complete an online questionnaire regarding their expectations and the support received during the outpatient diabetes clinic visit. Results: 453 adolescents completed the survey. Boys’ expectations of discussion topics were mainly met while girls, especially those with diabetes distress, felt their discussion needs were not met regarding quality-of-life aspects. Conclusions: Although adolescents’ expectations are in general met during the diabetes outpatient clinic visit, aspects related to living with diabetes are not being met especially among female adolescents who reported diabetes distress. This study shows a gender difference both regarding expected discussion topics and what was deemed covered. Practice Implications: A multi-professional, individual person-centred care approach is needed at the diabetes outpatient clinic. This paper proposes that agenda setting performed by the adolescent, and agreed by the physician, prior to the outpatient clinic visit could facilitate individualized care and better meet the adolescents’ needs in a shared decision-making process.

Putin Visits China to Boost Sino-Russian Economic and Trade Ties

During June 5-7 of 2012, the Russian President Putin paid an state visit to China for the first time since his resuming

Association of emergency room visits for respiratory diseases with sources of ambient PM2.5

Previous studies have reported associations of short-term exposure to different sources of ambient fine particulate matter(PM2.5)and increased mortality or hospitalizations for respiratory diseases.Few studies,however,have focused on the short-term effects of source-specific PM2.5 on emergency room visits(ERVs)of respiratory diseases.Source apportionment for PM2.5 was performed with Positive Matrix Factorization(PMF)and generalized additive model was applied to estimate associations between source-specific PM2.5 and respiratory disease ERVs.The association of PM2.5 and total respiratory ERVs was found on lag4(RR=1.011,95%CI:1.002,1.020)per interquartile range(76μg/m3)increase.We found PM2.5 to be significantly associated with asthma,bronchitis and chronic obstructive pulmonary disease(COPD)ERVs,with the strongest effects on lag5(RR=1.072,95%CI:1.024,1.119),lag4(RR=1.104,95%CI:1.032,1.176)and lag3(RR=1.091,95%CI:1.047,1.135),respectively.The estimated effects of PM2.5 changed little after adjusting for different air pollutants.Six primary PM2.5 sources were identified using PMF analysis,including dust/soil(6.7%),industry emission(4.5%),secondary aerosols(30.3%),metal processing(3.2%),coal combustion(37.5%)and traffic-related source(17.8%).Some of the sources were identified to have effects on ERVs of total respiratory diseases(dust/soil,secondary aerosols,metal processing,coal combustion and traffic-related source),bronchitis ERVs(dust/soil)and COPD ERVs(traffic-related source,industry emission and secondary aerosols).Different sources of PM2.5 contribute to increased risk of respiratory ERVs to different extents,which may provide potential implications for the decision making of air quality related policies,rational emission control and public health welfare.

分时段预约胸外科门诊迟到患者特征的回顾性分析

目的分析在分时段预约中四川大学华西医院胸外科门诊患者迟到的特征。方法从四川大学华西医院HIS中提取2019年胸外科患者人口信息及预约就诊信息,共获得有效数据9378例。以正常患者为对照组,采用SPSS 24.0软件对迟到患者进行分析。结果年龄、性别、来源地、就诊类型、就诊时间、预约方式、专家级别、就诊时段是患者迟到的影响因素,差异均有统计学意义(P<0.05)。患者在周一迟到率最高,达到34.6%。每天上午时段的>08:30—09:00迟到率最高,达到78.1%;下午时段的>13:00—13:30迟到率最高,达到65.7%。结论在预约就诊时段内迟到的患者具有一定的特征,需根据相关特征提出解决方案,以提高患者在预约时间段内就诊的依从性。

儿科门急诊药房用药指导现状与患者需求调研

目的:对儿科门急诊药房的用药指导需求和现状进行深入调研与分析,并提出相应的规范化管理策略。方法:通过问卷对全国12家省市儿童医院进行调研,应用SPSS 25.0和R4.0.3软件进行统计。结果:18项用药指导的咨询条目中“经常咨询+偶尔咨询”的占比均超过了50%,显示出高度的需求。经常咨询占比排名前五的条目:用药时间注意事项(68.65%)、药品分剂量注意事项(57.24%)、药品贮藏注意事项(47.36%)、用药疗程(46.68%)、特殊剂型用法及注意事项(40.37%)。然而,儿科门急诊药师在实际工作中能够主动提供完全指导的比例相对较低,20项用药指导的各条目做到总能告知的平均占比只有42.19%。执行程度得分前5位的是药品贮藏注意事项(4.63分)、药品特殊使用条件(4.62分)、特殊剂型用法及注意事项(4.38分)、药品分剂量注意事项(4.36分)、用药时间注意事项(4.36分)。得分后五位的是药品的适应证(3.72分)、用药后的不良反应及处理措施(3.69分)、喂药技巧与对策(3.65分)、漏服或吐药后的处理措施(3.50分)、药品口味(3.49分)。初级职称比中级及以上职称做到总能执行的程度更高(OR=0.331~0.635,P<0.05),工作年限越长的药师做到总能执行的程度更高(OR=1.019~1.035,P<0.05)。职称是整体执行程度评分的影响因素(P<0.05),初级职称比中级及以上职称总体执行程度更高。门急诊工作中,在窗口配发药品时进行用药交代是最主要的用药指导形式,占比87.22%。药师未能做到全面指导的原因调查显示,高峰期患者量大,时间有限来不及做到全面指导(86.91%)占比最高。结论:当前儿科门急诊药房的用药指导状况并未满足患者的需求,需要在内容、形式及培训等方面实施规范化管理,以提高服务质量。

北京市某三级口腔专科医院门急诊处方不合理情况分析

目的 点评分析北京大学口腔医学院口腔医院门急诊处方,了解处方质量和临床用药存在的问题,为促进合理用药提供参考。方法 随机抽取2021年7—12月该院门急诊处方6 000张,利用美康合理用药软件进行用药合理性初步筛查,再由药师进行人工复审,采用Excel软件对不合理处方进行分类统计及分析。结果 6 000张处方中,软件初筛不合理处方798张(含药品不合理条目828条),不合理率为13.30%。药师人工复审后确认不合理处方214张(含药品不合理条目219条),不合理率为3.57%,不合理条目类型为用法用量不适宜(112条,51.14%)、诊断描述不全(59条,26.94%)、遴选药品不适宜(15条,6.85%)、书写不规范(14条,6.39%)。不合理条目分布最多的科室为口腔黏膜科,占比50.68%。不合理条目数最多的药品为他克莫司软膏,占比30.59%,主要问题为用药频次不合理(超过规定次数)。结论 医院门急诊处方基本合理,但需关注用法用量、诊断描述等问题。合理用药软件有助于处方点评初筛但无效提醒较多、需定期改进,点评结果需要药师结合医药进展及临床实际情况进行人工审核后最终判定。可通过软件初筛结合人工复审并及时反馈问题、加强超说明书用药管理等手段,加强临床合理用药。

某三级公立医院门急诊电子病历使用情况影响因素研究

目的:研究江苏某三级公立医院门急诊电子病历书写情况及其影响因素,为进一步推进门急诊电子病历的使用提供参考。方法:收集某三级公立医院2023年2-10月份门急诊相关数据,采用方差分析和多元线性回归分析影响门急诊医师电子病历使用的主要因素。结果:性别、年龄、科室差异、专科模板、每诊疗单元负荷是影响门急诊电子病历使用的关键因素(P<0.05)。结论:门急诊电子病历的使用情况受性别、年龄、科室分类、专科模板、每诊疗单元负荷的影响,医院应根据不同专科、不同人群制定差异化的措施,通过培养年轻医师临床思维、建立层级质控管理体系、完善电子病历模板、合理设置门诊号源等方式,切实提高门急诊电子病历的使用比例和书写质量。

医疗机构门急诊处方信息化审核专家共识

保证医疗机构的合理用药是国家卫生健康委为加强医疗卫生服务综合监管水平做出的重要指示。随着我国医疗水平的快速提升、门急诊就诊规模的不断扩大,处方数量急剧增长,基于合理用药数据库的处方信息化审核系统成为药学服务的重要工具。由北京药学会智慧药学与智能化管理专业委员会、中国老年保健医学研究会合理用药与综合评价分会、中国药师协会区域药学服务促进工作委员会、中国智慧药学联盟共同组织相关医疗机构专家撰写了《医疗机构门急诊处方信息化审核专家共识》。本共识旨在为各级医疗机构所开展的门急诊处方信息化审核工作的规范化提供参考,助力医疗机构构建标准统一、合理用药数据库完善的处方信息化审核系统,提升处方审核准确率和医患接受度,进一步提升我国医疗机构的合理用药水平,促进医院药学服务信息化和智慧化发展。

医院门、急诊中成药处方专项点评分析

目的 通过分析并汇总射阳县人民医院门、急诊中成药处方专项点评情况,以期为中成药的合理应用提供参考。方法 抽查2023年8月1日至2023年8月31日射阳县人民医院门、急诊处方中成药处方1000份,经点评其中不合理处方69份,因同一张处方可能存在2种及2种以上不合理情况,经统计不合理情况数量为86处。点评的依据包括《处方管理办法》《中成药临床应用指导原则》《中药处方格式及书写规范》《医院处方点评管理规范(试行)》,点评的内容包括不规范处方(临床诊断书写不全、临床诊断为健康查体),用药不适宜处方(外用制剂给药剂量不适宜、门诊处方超7日用量未说明情况、给药频次不适宜、给药途径不适宜、联合用药不适宜、适应证不适宜、药物用量不适宜、重复用药不适宜),超常处方(无适应证用药)等情况。结果 射阳县人民医院2023年8月份共点评处方1000份,不合理处方69份,因同一张处方可能存在2种及2种以上不合理情况,经统计不合理情况数量为86处,其中不规范处方共4处[临床诊断书写不全3处(3.49%)、临床诊断为健康查体1处(1.16%)],用药不适宜处方共80处[外用制剂给药剂量不适宜3处(3.49%)、门诊处方超7日用量未说明理由23处(26.74%)、给药频次不适宜10处(11.63%)、给药途径不适宜1处(1.16%)、联合用药不适宜3处(3.49%)、适应证不适宜19处(22.09%)、药物用量不适宜3处(3.49%)、重复用药不适宜18处(20.93%)],超常处方2处[无适应证用药2处(2.33%)]。结论 本院当月门、急诊中成药用药存在不合理现象,主要以门诊处方超7日用量未说明理由、适应证不适宜、重复用药不适宜为主。医院应当加以重视,严格落实相关制度和措施,加强中成药处方管理,促进中成药合理应用。