External Otitis: Epidemiological, Clinical, Etiological, and Therapeutic Aspects at the Oto-Rhino-Laryngology Department of Mamou Regional Hospital

Introduction: External otitis (OE) is an acute or chronic inflammation or infection of the external ear resulting from an imbalance in the external auditory canal secondary to microtrauma, maceration, eczema, or a foreign body in the external auditory canal. Objective: To study cases of external otitis at the Mamou Regional Hospital. Materials and Methods: This was a prospective descriptive study conducted over a period of six (6) months from July 1st to December 31st, 2016. It included all patients admitted to the ENT department of the Mamou Regional Hospital. Results: During the study period, 712 patients were admitted to the department for various pathologies, of which 103 met our selection criteria, representing a frequency of 14.46%. The mean age of the patients was 33.74 years with a range of 1 to 90 years. Males predominated in the sample, accounting for 59.22%. The vast majority of patients resided in urban areas, constituting 61.17% of the sample. In our study, all patients consulted for otalgia (100%), and over half (53.39%) for hypoacusis. We formally identified rhinitis in 66.66% of cases, while diabetes was found in only 4 patients (11.11%). Otomycosis was the most commonly identified condition (53.39%), followed by furuncles (33.98%). Ear drops containing antibiotics were administered to all patients, although 66.60% received antibiotic therapy. Conclusion: External otitis is a relatively common condition, particularly among children and the elderly. Diagnosis can be made based on pain upon traction of the pinna and pressure on the tragus.

Otorhinolaryngological (ORL) and Cervicofacial Injuries Resulting from Road Accidents within the Otorhinolaryngology (ORL) Department of the Regional Hospital of Mamou

Introduction: Otorhinolaryngological (ORL) and cervicofacial traumas encompass injuries affecting the neck, face, and ORL region, resulting from external influence. The objective of this study was to conduct an epidemiological and clinical analysis of ORL and cervicofacial injuries observed in victims of road accidents treated at the Otorhinolaryngology (ORL) department of the Regional Hospital of Mamou. Materials and Methods: This prospective and descriptive study was conducted over a period of 12 months, from January 1st to December 31st, 2021, within the Otorhinolaryngology (ORL) department of the Regional Hospital of Mamou. It included patients hospitalized for ORL and/or cervicofacial traumas resulting from road accidents during the study period. Results: A total of 348 cases were included, representing 36.22% of all traumas related to road accidents (AVP) within the Regional Hospital of Mamou. The average age of the patients was 26.44 years, with a sex ratio of 3.83, favoring males. The dominant socio-professional category was students, encompassing 32.47% of cases. Road accidents were mainly associated with motorcycle use (31.32% motorcycle-to-motorcycle, 24.43% motorcycle skidding, 13.51% motorcycle-pedestrian). Facial region injuries were the most common, accounting for 69.03% of cases, followed by rhinological injuries (17.28%) and otological injuries (13.69%). Associated injuries were predominantly closed head traumas (52.55%) and lower limb fractures (20.41%). Imaging was underutilized. Regarding surgical interventions, reconstructive surgery was the most predominant, accounting for 52.51% of cases, with a management timeframe of 30 minutes to 12 hours for 99.72% of patients. Conclusion: Road traffic accidents remain a serious public health issue, primarily affecting young males. Emphasis should be placed on road safety measures to reduce the frequency of these accidents.

Hand Hygiene by Ward Staff at Dapaong Regional Hospital in Togo

Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.

Epidemiological Aspect and Evaluation of the Management of Urologic Emergencies at the Urology Unit of Labe Regional Hospital

Aim: To contribute to improving the management of urological emergencies at Labé Regional Hospital. Patients and Method: This was a dynamic, descriptive study lasting six months from July 1 to December 31, 2017. Results: Urological emergencies represented 45.14% (n = 218) of all admissions to the urology unit. The mean age of our patients was 56.60 years with extremes of fifteen days and 93 years. The 71 - 80 age group was the most represented with 28.03% (n = 61) followed by 61 - 70 years with 24.31% (n = 53). Our patients’ activities were dominated by agriculture, with 35.77% (n = 88), and the city center was most affected by urological emergencies, with 39.44% of cases (n = 86). 70.18% (n = 153) of our patients had bladder retention on admission, and 53.21% (n = 116) underwent urethral catheterization, including 3 women. The etiology of bladder retention in these 3 women was dominated by two cases of bladder lithiasis and one case of neurological bladder. Conclusion: The management of urological emergencies requires specific material and human resources. Their knowledge will enable us to better understand this problem and could serve as a basis for a broad reflection on the organization of the management of urological emergencies in our region.

Fishbone-Type Pharyngeal Foreign Body with Cutaneous Migration in the ENT Department of the Mamou Regional Hospital: A Case Report

We report a case of pharyngeal foreign body with cutaneous migration in the form of a fishbone in a 24-year-old rural resident, presented with odynophagia, dysphagia, pain and left antero-latero-cervical swelling fistulated to the skin following ingestion of a fishbone during a meal that had been evolving for 2 weeks. Vital parameters were normal, with an unremarkable psychological examination. Clinical examination revealed a left antero-latero-cervical swelling that was painful to palpation, fistulous to the skin and draining frank pus, revealing a sharp fishbone. A standard X-ray showed that the foreign body had exited the pharynx and was located in the soft tissues of the lower neck. An exploratory cervicotomy was performed, allowing extraction of a serrated fishbone. The post-operative course was favorable.

Characteristics of Severely Anemic Pregnant Women and Perinatal Outcomes in Banfora Regional Hospital, Burkina Faso: An Epidemiological Study

Severe anemia during pregnancy remains an acute maternal health problem in low income countries and its management is a challenge. This study aimed to analyze the characteristics of hospitalized pregnant women with severe anemia and issue of the management in a regional hospital of a low income country. Material and Methods: This was a retrospective descriptive study from January 1, 2007 to December 31, 2008, at a regional hospital maternity. Data of the 283 pregnancy severe anemia cases have been analyzed using usual Pearson’s Chi square test or Fisher’s exact test. Results: Of the 283 women with pregnancy severe anemia, 98% were illiterate, 98% were household women;majority were in the third trimester (64%);41% had no previous delivery;49% did not had antenatal care. There were no statistics association between hemoglobin values stage and gestational age, gravidity and parity. During the hospitalization, from the 283 women with pregnancy severe anemia, deliveries occurred on 22.6%;abortion on 1%. From the 64 deliveries, 45.3% were alive preterm birth, 20.3% preterm stillbirth, 25.0% at term birth and 9.4% at term stillbirth. Between the 45 alive babies, 91% were low birth weight. In global, from the 283 women, mortality rate was 2.8%. Conclusion:?Severe anemia during pregnancy results in maternal mortality, preterm, low birth and stillbirth even between hospitalized women. As most of the pregnancy anemia risk factors are chronic poverty related factors, intervention must be focused on prevention including health pregnant women iron supplementation and adequate nutritional diet promoting at both health facilities and community level.

Maternal Mortality Risk Factors in Regional Hospital of Burkina Faso

Individual causes and community determinants are synergic in maternal death occurrence. This study aimed to identify maternal mortality risk factors in a regional hospital. Material and Methods: This was a retrospective cohort study from data of 1807 hospitalized women. To identify maternal mortality risks factors, mortality hazard ratio (HR CI95%) has been calculated in univariate analysis and Cox proportional hazard model. Results: During hospitalization, 30 maternal deaths occurred. From Cox regression, adjusted mortality HR confirmed that women age older than 35 (HR = 2.5, CI95%: [1.2-5.7] and younger than 19 (HR = 3.02, CI95%: [1.5-6.7]);distance to hospital ≥10 Km (HR = 4.1, CI95%: [1.8-9.4];multiple deliveries (HR = 2.4, CI95%: [1.1-7.3]), less ante natal care (<3 visits) (HR = 3.03, CI95%: [0.97-9.48]);obstetrical maternal mortality directs causes (HR = 2.31, CI95%: [1.7-6.21]) and emergently reference (HR = 3.5, CI95%: [1.8-8.32]) were maternal mortality risk factors. Conclusion: In this regional hospital of low income country, identified maternal mortality factors are related to women socio-economic determinants and quality prenatal or obstetric care access. Interventions to reduce maternal mortality rate should be conducted within both household and women socio-economic status development and in maternal health and obstetric care strengthening.

Injury Patterns and Treatment Outcome of Road Traffic Crash Victims at the Emergency Department of the Regional Hospital Limbe, Cameroon

Background: Traumatic injuries constitute a leading cause of mortality and morbidity worldwide with a global burden that is on the rise. The aim of this study is to analyse preliminary data of the Limbe trauma registry, to describe the injury patterns and determine the outcome of care of the injured who were treated in the emergency department of the regional hospital Limbe in Cameroon. Methodology: This was a descriptive secondary analysis of prospective data collected on injury at Limbe Regional Hospital in two years, between October 2008 and October 2010. All cases of injury presenting to the emergency department of Limbe Regional Hospital were included in a prospective trauma registry. Data was collected with a pre-tested data entry form and included the age, sex, mechanism of injury, delay before arrival to hospital, body part injured, description of lesions and outcome at the emergency. Descriptive analyses were done using STATA 14. Comparisons between groups were evaluated using Chi-squared test or Kruskal-Wallis and p-values <0.05 were considered statistically significant. Results: A total of 2400 cases of injury were recorded during the study period with more males (68%) than females. The ages ranged from 0 to 90 years with a peak between 20 to 39 years. Road traffic crash was the most common cause of injury representing 60.81% of the population (n = 1434);other causes were burns, falls, domestic injuries, assaults, and labour accidents. The accidents mostly involved motor cycle alone (42.03%). Concerning the outcome of care at the emergency department, 88.73% (n = 1260) were discharged. Conclusion: The burden of road traffic injuries in south west Cameroon is high. Motorcycles are mostly involved alone or with pedestrians and/or cars.

The Fluid Traditional and Indigenous Structure of Climatism in Physical Architecture and Its Role in Hospital Construction

The issue of climatism is a matter of concern today, given the growth of technology and the subject of globalization, which is defined and explained in many respects. The rapid advancement of technology makes communication and navigation readily available. This factor causes the challenge for human societies to discover more recent developments that in turn raise the issues of how can the climatism be compatible with the creation of an architectural work, taking into account that the countries’ conventional boundaries lose their importance. And, the factors affect climatism, in other words, the way that climatism, human societies with diverse cultures, and the surrounding environment interact with each other, is raised. And, in general, the way that an architecture work to interact with its environment is discussed. In this sense, the traditional and indigenous architecture, and the fluidity of the region in the architectural framework also address the characteristics of the physical and architectural features of each region from the architectural arena, introducing effective approaches to architecture and urban planning (objective and tactical approaches), using the rational-logical approach to regional review. Then, the discussion of regionalism and regional influences in the physical fabric of each traditional architectural structure’s region is presented, with the special look of traditional architecture that is expressed in consistency between the building and the nature, and to explain the arguments to the examples and characteristics.

First Hour Initiation of Breast Feeding &Associated Factors, among Mothers at Post Natal Ward in Fort Portal Referral Hospital, Uganda

Background: Breast milk is recommended as the best feeding option to neonates and infants for it confers immunological benefits that help to reduce neonatal and infant morbidities and mortalities. WHO recommends that all infants should start breast feeding within one hour of birth i.e. early initiation of breast feeding (EIBF). Unfortunately, studies show that less than 40% of infants in resource limited settings Uganda inclusive are initiated on breast feeding practice, with no documented study done in Kabarole district to assess the problem. This study therefore, set out to establish the prevalence and associated factors with the practice of first hour initiation of breast feeding at Fort Portal Regional Hospital, Kabarole district, Uganda. Methods: With a cross-sectional design, we collected data from 330 post natal mothers and their live-born infants at Fort Portal Regional Referral hospital from 5th-20th August 2019. With a standard interviewer administered tool, mothers who initiated breast feeding within the first hour after delivery of their newly born babies responded with yes and those that did not with a no. Prevalence of one hour initiation was got considering infants that were initiated on breast within one hour over the total live birth times 100 to get the percent prevalence. With Stata version 13 software, statistically significant relationships of the predisposing factors were determined at a p-value (p ≤ 0.05) at bivariate and at multivariate regression coefficient. Results: A total of 330 postnatal mothers targeted for this study, 100% response rate was covered. Mothers’ age ranged from 18 - 45 years with mean age 31 SD ± 6. The prevalence of initiation of breast feeding in the first hour of birth was 68%, a third of (32%) mothers had not initiated breast feeding in the first hour. A half (50%) of the direct predisposing factors for non-initiation of timely breastfeeding were due to birth asphyxia, almost a quarter 23% due to mother’s ill health and 7% due mother not being guided by the health worker on what to do. In this study mothers’ knowledge and awareness of the practice were very low at 20% while that of health workers was fair at 53%. Social demographic factors that influence 1st hour breast feeding practice were;young maternal age being less than 34 years, mothers occupation being self-employed (83%) or unemployed (73%) with 3 times higher odds of initiating breastfeeding within 1st (OR = 3, p = 0.003) than working class mothers (civil servants). Marital status of mothers being married (73%) significantly influenced early breastfeeding practice (p = 0.001). Health workers’ knowledge of the practice was significantly associated (OR = 2.7, X2 = 11.32, *p = 0.00078) with enforcement of mother initiation of breast feeding in first hour compared to the less knowledgeable ones. Conclusion: The practice of timely initiation of breastfeeding at Fort Portal Regional Referral hospital at 68.2% was sub-optimal against WHO universal practice recommendations. Mothers’ low knowledge on timely initiation of breast feeding practice was the most deterrent factor for first hour initiation of breastfeeding practice. Providing breastfeeding counselling to all mothers during ANC and training on best breastfeeding practices and counselling skills for health staff at Fort Portal Referral hospital are urgent recommendation in this study to improve the practice.

区域化党建格局下探索公立医院党建工作高质量发展研究

区域化党建是近年来创新基层党建的重要探索。在全面贯彻落实新时代党的建设总要求下,公立医院通过体制与机制的改革和创新,实现了医疗资源的共享和延伸,立足于区域化党建已成为探索公立医院党建工作新时代的必然要求,分析目前医院参与区域化党建工作的现实挑战,结合上海中医药大学附属曙光医院区域化党建工作的实践经验,推进党建引领深化党建联建共建、扩大医疗志愿服务范围、推动党建与业务工作深度融合等路径,进一步提高人民生活质量,最终以“资源共享”实现“双向受益”。

中医医院卫生技术人员配置水平空间差异及分布动态

目的:分析中医医院卫生技术人员配置的空间差异和分布动态演进,为制定中医医院卫生技术人员优化配置策略提供参考。方法:构建2012-2021年30个省份的中医医院卫生技术人员的面板数据,采用Dagum基尼系数和核密度估计探究中医医院卫生技术人员的空间差异及分布动态演进过程。结果:2012-2021年中医医院卫生技术人员配置水平存在空间差异,差异整体呈缩小态势。东部区域中医医院卫生技术人员的配置水平最高,增速最慢、区域内差异最大;中部区域的增速较慢、配置水平较低、区域内差异最小;西部区域增速最快、配置水平最低、区域内差异较大。东部与西部的区域间差异最大,东部与中部的区域间差异最小。总体差异的主要来源是超变密度。结论:中医医院卫生技术人员配置水平的总体差异在缩小,其非均衡性有所减弱,为此,建议完善体制机制,统筹区域协调发展,激活政策存量并兼顾政策创新。

大型公立医院评审全流程管理策略实践与应用

医院评审是促进大中型公立医院实现高质量发展的关键抓手,全流程管理策略则是推动大中型公立医院实现高质量发展的重要手段。通过全流程管理策略可以充分融合医院资源优势、技术优势、资金优势和人才优势,探索全流程管理新业态、新模式,深入开展现代医院精细化运营管理,以医院评审培育新动能,用新动能推动新发展,以评促建、以评促改、评建并举,完善医院运营管理模式,提升医疗服务效率,优化医疗资源配置,推动医院更快更好地实现高质量发展。

国家区域医疗中心创建老年友善医院实践探索

为积极应对人口老龄化,改善老年人就医体验,复旦大学附属中山医院厦门医院在探索国家区域医疗中心建设过程中,从加强老年友善管理、构建老年友善文化、提升老年友善服务和优化老年友善环境4个维度创建老年友善医院,并形成了独具复旦中山厦门医院特色的经验做法及成效。提出创建老年友善医院要“软硬”兼施、兼顾“外在”和“内涵”、健全可持续发展机制等建议,以期能为国内其他新建国家区域医疗中心创建老年友善医院并赋能医院高质量发展提供经验参考。

国家区域医疗中心协作医院同质化发展实践探索

促进优质医疗资源扩容和区域均衡布局,满足人民群众日益增长的高质量就医需求,是新医改的必备路径。本文以贵州省某国家区域医疗中心医院为例,通过输出医院与项目医院协同合作,引入发达地区医院优质资源,促进项目医院管理、人才、技术、学科、文化与输出医院同质化发展,为西南欠发达区域医疗卫生事业高质量发展蓄力赋能,并为新形势下国家区域医疗中心项目医院运行发展提供参考。

基于“四化”路径的公立医院健康科普实践研究

目的探讨基于“四化”路径的公立医院健康科普实践成效。方法以“华福科普”等主题共享体系的科普实践为依据,依托大数据、互联网+、多媒体等技术运用,打造“体系制度化”“主题分类化”“形式多样化”和“内容输出精准化”的“四化”路径的科普实践模式。结果经过样本医院的健康科普实践研究证明:“四化”路径下的健康科普实践中涌现出众多优秀的科普作品;荣获多项省级以上科普荣誉;参与科普竞赛人数增幅25%以上;线下科普讲堂1/3及以上为华山医院高级职称专家;增设多个专病门诊;特色门诊患者满意度95%以上等。结论基于“四化”路径的科普实践方法对彰显公立医院的“公益性”职能、提升专科声誉度等具有显著效果。

我国中医医院服务效率的地区差异及影响因素研究

目的测算我国中医医院服务效率水平,分析不同地区中医医院服务效率差异及影响因素,为优化中医药资源配置提供参考。方法采用超效率SBM模型测算2012年-2021年我国中医医院服务效率,运用Dagum基尼系数分析我国中医医院服务效率地区差异,借助空间杜宾模型探究其影响因素及溢出效应。结果2012年-2021年我国中医医院服务效率均值为0.907,东部、中部、西部及东北地区中医医院服务效率均值分别为0.955、0.886、0.947、0.669。中部地区中医医院服务效率基尼系数均值最大,为0.159;西部地区中医医院服务效率基尼系数均值最小,为0.107。中部地区与东北地区中医医院之间服务效率的差异最大。超变密度是我国中医医院服务效率总体差异的主要来源。空间自相关系数显著为负,人均受教育水平和人均地区生产总值的直接效应系数显著为正,城镇率和人口密度的溢出效应系数显著为负,床护比的直接效应系数和溢出效应系数均显著。结论我国中医医院服务效率有待进一步提升,应重点关注东北地区中医医院服务效率。不同地区间存在的交叉重叠问题是导致我国中医医院服务效率存在差异的关键因素。我国中医医院服务效率受人均受教育水平、人均地区生产总值、城镇率、人口密度、床护比等多种因素影响。

医院资源差异与区域政策效应——基于京津冀协同发展的实证检验

目的:分析京津冀医院资源的变化特征,识别京津冀协同发展战略对区域医院资源配置的政策效应。方法:基于2011—2019年30个省(区、市)的面板数据,采用合成控制法评估京津冀医院集聚度的政策效应。结果:北京、天津医院集聚度水平远高于河北,在政策影响下,北京医院集聚度下降幅度持续扩大,“非首都功能”疏解成效显著;河北医院集聚度水平上升,资源得到持续补充;天津医院集聚度的政策效应不稳定,但也一定程度上提升了医院配置公平性。结论:京津冀医院资源配置整体优化,但“中心化”特征仍旧明显,应通过加强顶层设计、创新服务模式、优化资源结构,进一步推动医疗卫生资源的合理配置。

互联网医院辐射区域可及性研究与提升路径浅探

目的:研究互联网医院区域医疗辐射可及性,探讨医疗辐射提升路径。方法:选取上海市某医院2022年度互联网医院就诊患者为研究对象,采取整体抽样的方式,分析互联网医院就诊患者居住区域与申请人手机号码关联区域在全国区域之占比,研究互联网医院医疗辐射可及区域。结果:2022年度,华东地区就诊人次占99.04%,华东以外地区就诊人次仅占0.96%,华东地区与其他区域存在显著差异。结论:互联网医疗辐射可及区域呈辐射渐弱趋势,华东地区较强,华东以外地区较弱,地区经济发展引起的人员流动对医疗辐射可及性呈加强效应。有序开放跨院复诊,开展合作共建,助推咨询就诊转化,是提升医疗辐射可及性的可选路径。

基于地域特征的医院建筑疗愈环境营造

探讨了在地域特征条件限定性下的医院建筑疗愈环境设计问题,从患者的安全属性、心理恢复属性以及医护工作的需求属性三个方面分析了医院建筑疗愈环境的积极康复属性,以地域环境中的气候条件、场地条件、人文特征为出发点,分析了疗愈环境建设中的限制条件,提出了医院建筑疗愈环境的营造策略。