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.

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.

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.

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.

Research misconduct in hospitals is spreading:A bibliometric analysis of retracted papers from Chinese university-affiliated hospitals

Purpose: The number of retracted papers from Chinese university-affiliated hospitals is increasing, which has raised much concern. The aim of this study is to analyze the retracted papers from university-affiliated hospitals in China’s mainland from 2000 to 2021. Design/methodology/approach: Data for 1,031 retracted papers were identified from the Web of Science Core collection database. The information of the hospitals involved was obtained from their official websites. We analyzed the chronological changes, journal distribution, discipline distribution and retraction reasons for the retracted papers. The grade and geographic locations of the hospitals involved were explored as well.Findings: We found a rapid increase in the number of retracted papers, while the retraction time interval is decreasing. The main reasons for retraction are plagiarism/self-plagiarism(n=255), invalid data/images/conclusions(n=212), fake peer review(n=175) and honesty error(n=163). The disciplines are mainly distributed in oncology(n=320), pharmacology & pharmacy(n=198) and research & experimental medicine(n=166). About 43.8% of the retracted papers were from hospitals affiliated with prestigious universities. Research limitations: This study fails to differentiate between retractions due to honest error and retractions due to research misconduct. We believe that there is a fundamental difference between honest error retractions and misconduct retractions. Another limitation is that authors of the retracted papers have not been analyzed in this study.Practical implications: This study provides a reference for addressing research misconduct in Chinese university-affiliated hospitals. It is our recommendation that universities and hospitals should educate all their staff about the basic norms of research integrity, punish authors of scientific misconduct retracted papers, and reform the unreasonable evaluation system.Originality/value: Based on the analysis of retracted papers, this study further analyzes the characteristics of institutions of retracted papers, which may deepen the research on retracted papers and provide a new perspective to understand the retraction phenomenon.

Prevalence of HCV Antibody and its Associated Factors: A Study from Sentinel Hospitals in China

Objective The prevalence and related factors of serum anti-HCV in different regions and hospitals have not been studied extensively in China. We used routine screening data to determine the prevalence of HCV antibody in hospital patients, evaluate the epidemic trend of hepatitis C and formulate screening strategies.Methods Patient information and HCV antibody testing results were collected from January 2017 to December 2019 in 77 HCV sentinel hospitals in China. Univariate and multivariate logistic regression was used to determine the characteristics and associations.Results HCV antibody prevalence rates were distinct among patients in different departments, with a range of 0.33%–6.93%. Patients who were admitted to the liver disease-related departments(aOR =10.76;95% CI, 10.27–11.28), Internal Medicine(aOR = 2.87;95% CI, 2.75–3.00), and Department of Surgery(aOR = 1.95;95% CI, 1.87–2.04), were more likely to be tested for HCV antibody positive. HCV antibody prevalence was associated with patients aged 45 years and older(aOR = 2.74;95% CI,2.69–2.80), testing in infetious disease hospitals(aOR = 2.33;95% CI, 2.26–2.40) and secondary hospitals(aOR = 1.72;95% CI, 1.69–1.75). Patients in sentinel hospitals of the Northeast(aOR = 12.75;95% CI,12.40–13.11), the Central(aOR = 1.65;95% CI, 1.61–1.70), and the West(aOR = 1.78;95% CI, 1.73–1.83)China had higher HCV prevalence than those who were in the Eastern coastal area. Conclusion Those who were over 45 years old and saw doctors for liver diseases, and invasive diagnosis and treatment should be referred to HCV antibody testing.

Hospital Stakeholders’ Perception on Environmental Effects Related to Biomedical Waste in Togo’s University Hospitals (UHC) in 2021

Introduction: Given its effects, hospital waste is an environmental concern and a threat to health personnel, users of health services and neighboring populations. Our objective was to assess the perception of health care stakeholders on the environmental effects related to biomedical waste produced in Teaching Hospitals (CHU) in Togo in 2021. Methods: This was a cross-sectional study held from June 24 to August 28, 2021. It targeted three university hospitals, 340 health care providers and services selected by a probabilistic method with a simple random technique in 25 services, 72 directors, deputy directors, supervisors and heads of services, 27 collection and incineration agents selected by a non-probabilistic method with a reasoned choice technique, 44 patients and attendants and 36 householders of neighboring residents selected by a non-probabilistic method with an accidental choice technique. Variables such as the spreading of disease vectors, soil, air and water contamination, the presence of unpleasant odors and unsightly living conditions were assessed. Results: According to the respondents, biomedical waste causes the proliferation of vectors (55.3%), an unsightly environment inside the hospital (47.1%), and unpleasant odors (61.2%). Incineration operations disturb hospital residents (52.8%), according to the householders of the residents. During observation, we note deposits of waste that have not been destroyed and wastewater flowing in some places. Conclusion: Biomedical waste in Togo’s university hospitals generates environmental effects and therefore potentially high risks for human health. Improving their management should be a concern for all hospital actors.

Prevalence of Uropathogenic Escherichia coli among Adult Male Patients 40 Years and above with Haematuria and Impaired Kidney Attending General Hospitals in Benue State

Haematuria is the presence of red blood cells in urine. It is most often caused by urinary tract infections of which Escherichia coli is frequently implicated. Impairment of kidney functions could occur as a result of infection or other complications of the kidney. The aim of the study was to determine the prevalence of uropathogenic Escherichia coli among adult male patients with haematuria and impaired kidneys attending a general hospital in Benue state. Three hundred and sixty-eight (368) samples of urine were collected from 368 male patients (≥ 40 years) attending the 23 general hospitals in Benue state. Each of the urine samples was divided into two parts for haematuria and isolation and identification of Escherichia coli. Blood samples (368) were also collected from the patients and used for quantitative determination of creatinine and estimation of glomerular filtration rate. The presence of haematuria was 45.1% and ranges from 12.5% to 100%. Prevalence of haematuria with respect to age shows that patients within the age group of 90 - 99 years had the highest rate (100%) and the least were those within the ages of 40 - 49 years (20.0%). Isolation rate of uropathogenic Escherichia coli was 16.3% and ranged from 6.3 to 37.5%. Patients within the age group of 90 - 99 years had the highest elevated impaired renal function of 4 (80%), followed by patients within the ages of 80 - 89 years [17 (77.3%)] and the lowest were those within the ages of 40 - 49 [6 (10.0%)]. The overall presence of haematuria in the patients was high (45.1%) with similar high Escherichia coli isolation rate and impaired renal function which could mean that acute or chronic kidney disease may set in.

Nurses’ Knowledge, Attitude, and Practice Regarding Personal Protective Equipment for the Prevention of COVID-19 in Public Hospitals Khartoum State Sudan 2022

Since December 2019, there had been a series of unexplained cases of pneumonia reported in Wuhan, China, and on 12 January 2020, the World Health Organization (WHO) named this new virus as the 2019 novel coronavirus (2019-nCoV). The Novel Coronavirus disease (COVID-19) is an emerging, rapidly changing global health challenge affecting all sectors, including the health sector. This study aimed to investigate nurses’ knowledge, attitudes, and practices regarding the prevention and control of COVID-19. Methods: This cross-sectional study was conducted among nurses in three public health hospitals in Khartoum state. A self-administered questionnaire was used. A total of 14 knowledge questions were adopted. There are 5 questions constructed for attitude. A total of 12 practice questions were used. Mean score of knowledge considers as follows when the mean more than 75% considers as good knowledge while this percent uses as good practice and poor practice respectively to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 101 nurses approached, a total of 100 nurses responded (99.0% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 1.01 (SD 0.100). The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 1.4176 (SD 1.4176). There was a negative correlation between knowledge and attitude scores (P < -0.014) and between knowledge and practice scores (P < -0.081). Conclusions: The overall levels of knowledge and practice and attitude were good.

Comparative study of self-compassion and sense of coherence in nurses of psychiatric hospitals

Objective:Nurses,due to the nature of their job,are subjected to various forms of stress and physical and psychological injuries.Self-compassion and a sense of coherence have attracted much attention in research in recent years as having high potential for improving the health and performance of people in the workplace.The present study aimed to compare self-compassion and the sense of coherence in nurses working in psychiatric hospitals and other hospitals of Kerman University of Medical Sciences.Methods:The present study was a descriptive-comparative study of applied type conducted on 100 nurses of Shahid Beheshti Psychiatric Hospital in Kerman by the census method and 100 nurses of other hospitals of Kerman University of Medical Sciences by the stratified random sampling method.The instruments included the self-compassion questionnaire and the sense of coherence questionnaire.Data were analyzed using the Statistical Package for Social Sciences software.Results:The results of the present study showed that self-compassion and sense of coherence were higher in psychiatric nurses(39.35±7.7 and 53.02±8.01)than among other nurses(36.03±5.81 and 49.76±6.30).There was a direct and moderate relationship between a sense of coherence and self-compassion(P-value<0.005).The higher the score of compassion for oneself,the higher was the score of sense of coherence.Furthermore,the sense of coherence had a direct and weak relationship with all dimensions of self-compassion,except for the extreme imitation dimension,which showed a direct and moderate relationship to other dimensions(P-value<0.001).Conclusions:Self-compassion and a sense of coherence,as a form of self-communication,increase nurses’satisfaction and reduce nurses’job stress and,as a result,job performance is improved.

Occupational Health and Safety Hazards Experienced by Healthcare Workers at Two Hospitals in Suyani, Bono Region, Ghana

INTRODUCTION Occupational safety and health (OSH) is generally the anticipation, recognition, evaluation, and control of hazards arising in or from the workplace. The study sought to assess and evaluate occupational health and safety hazards experienced among health workers in the Bono region of Ghana. METHODOLOGY The study was descriptive cross-sectional quantitative study. Data was from two hundred (200) health workers and was analyzed using the binary logistic regression analysis. RESULTS The findings from the study show that risk factors associated with biological hazards were clinical staff [OR = 2.487 (1.146 - 5.397), p = 0.021], poor maintenance of hospital items [OR = 0.446 (0.240 - 0.831), p = 0.011], assault (verbal) abuse [OR = 2.581 (1.317 - 5.059), p = 0.006] and extreme pressure from work [OR = 2.975 (1.519 - 5.829), p = 0.001]. Non-biological hazards were associated with being single [OR = 0.499 (0.263 - 0.947), p = 0.034], being verbally assaulted [OR = 3.581 (1.865 - 6.876), p CONCLUSION Risk factors related with biological hazards include poor maintenance of hospital items and extreme pressure from work whereas non-biological hazards were associated with being single, being verbally assaulted. Clinical healthcare providers are more vulnerable to occupational health and safety hazards. The study recommends the provision of strategic policies to promote and protect the workers’ health based on the development of the epidemiological profile of health, needs to be readjusted and strengthened.

省级医院优质医疗资源下沉实践与思考

全面深化医疗供给侧结构性改革,作为全周期医疗健康服务体系的重要一环,省级公立医院积极推进多形式医联体建设,促进优质医疗资源均衡布局和扩容下沉,构建分级诊疗服务格局。笔者以河南省人民医院“医院-政府”托管县级公立医院实践为案例,探析其经验做法,从体制机制、技术支撑、人才能力方面剖析存在的问题,并提出针对性建议。

Conflict among Saudi nurses in hospitals:a qualitative study

Background:Conflict among nurses often has an undesirable effect on their work.Thus,understanding the predictable causes of conflict helps in dealing with it at an early stage,preventing negative consequences that may impact nurses’performance,ultimately affecting the quality of care and patient safety.This study aimed to explore the sources of conflict and how Saudi nurses in Taif deal with conflicts in hospitals.Method:A descriptive qualitative approach was employed,using the semi-structured interview method to collect data from 17 Saudi nurses working in 3 hospitals in the city of Taif from September 2022 to January 2023.Ethical approval was obtained from the Research and Studies Department at the Directorate of Health Affairs in Taif(IRB registration number with King Abdulaziz City for Science and Technology,KSA:HAP-02-T-067,approval number:720 on 10/08/2022).Results:The data revealed two main themes:firstly,conflicts arising among nurses,which can be categorized into two sub-themes:lack of awareness in work policies and procedures,and lack of communication;secondly,preemptive strategies for dealing with conflicts.Three sub-themes emerged in this regard:identifying conflict sources in advance,conducting regular meetings to enhance communication,and increasing awareness of policies and regulations while adhering to them.Conclusion:Conflict negatively impacts the quality of nursing care.Therefore,it is crucial to implement preventive and early measures,such as improving communication among nurses and enhancing awareness of policies and procedures,to address the ambiguities that lead to workplace conflict.

农业生产托管对小麦种植户福利效应的实证分析

【目的】分析河南省小麦种植户的农业生产托管行为对农户家庭人均收入的影响,验证农业生产托管对农户的福利效应。【方法】在理论分析农业生产托管对农户福利效应影响的基础上,基于河南省918个小麦种植户调研数据,采用倾向得分匹配法实证分析了农业生产托管行为对农户的福利效应,并用农户受教育程度和经营规模两个特征变量对农户福利效应进行了分组分析。【结果】农业生产托管对农户福利效应具有显著的促进作用,但在不同群体间存在差异,受教育程度越高、生产规模越小的农户,其农业生产托管的福利效应水平越高。进一步分析影响农户选择农业生产托管驱动因素发现,家庭非农就业人口数量对农户农业生产托管选择有显著正向影响,家庭农业机械价值、地块数量和农户距中心城区距离对其选择农业生产托管有显著负向影响。【结论】为促进农户福利水平的提升,应当大力发展农业生产托管服务,多种渠道引导农户外出务工就业,适当调整当前农机补贴政策,采取适当方式开展地块整理合并。

基于合成控制法的DRG改革对住院费用的影响——以北京市三级公立医院为例

目的:分析DRG改革对北京市三级公立医院例均住院总费用及其增速、内部结构的短期效应与长期影响。方法:基于2009—2018年北京市三级公立医院住院费用的年度报表数据,采用合成控制法分析2011年的DRG改革对例均住院总费用及各项费用占比的影响。结果:与未试点的医院相比,短期内试点医院的例均住院总费用有所降低,药占比下降显著,耗材费用占比增速下降明显,手术、治疗、护理费用占比有所下降,检查、化验费用占比略有上升。长期看,试点医院例均住院总费用与增速超过非试点医院,药占比、手术、治疗、护理费用占比低于非试点医院,耗材费用占比大幅提高,检查、化验费用占比呈现较强的个体差异性。结论:DRG改革短期内对控制费用增长具有积极作用,长期效果有待改善,费用结构有待优化;未来应从发挥“双中心”的多元作用、与三级公立医院绩效考核结合、提高体现医生技术劳动价值的收入等方面完善DRG改革。

基于灾害脆弱性分析的精神专科医院感染风险评估研究

目的对某三级甲等精神专科医院的医院感染风险事件进行评估,明确需要优先干预的感染风险事件和关键点,为精准防控并降低感染风险提供依据。方法采用灾害脆弱性分析方法,通过头脑风暴和查阅文献,初步筛选出精神专科医院的医院感染风险评估指标23个,对51名院感专/兼职医生、护士进行问卷调查,并基于Kaiser模型计算风险值,采用矩阵分析法划定风险带。结果风险值前5位的是手卫生依从性差、感染控制建筑布局不达标、感染控制知识不知晓、工作人员职业防护不到位、清洁消毒不合格;矩阵分析结果显示,处于高风险带的指标有6项,中风险9项,低风险8项。结论精神专科医院的医院感染风险总体不高,基于灾害脆弱性分析明确风险事件,有利于管理者有针对性地采取高风险事件干预策略,以降低医院感染发生率。

中日友好医院党建引领高质量发展实践与思考

公立医院党建工作是实现高质量发展的重要保障。本文以中日友好医院为例,介绍把党的政治建设、思想建设、组织建设、作风建设、纪律建设、制度建设与医院高质量发展紧密结合的实践探索,逐步形成以高质量党建引领高质量发展的“六提升”工作法,为公立医院党建引领高质量发展提供参考。

基于生产托管服务的农业科技成果转化新模式探析——以安徽颍州农业社会化服务科技创新基地为例

加速农业科技创新成果转化是推进现代农业发展的主要动力,对推动乡村产业振兴具有重要现实意义。系统阐述了目前安徽省农业科技成果转化的主要模式,并综合分析了成果转化过程中存在的成果属性、转化动力、转化机制及农技推广模式等方面的问题。结合新阶段对科技创新和成果转化联动发展以及农业生产托管高质量发展的要求,提出了基于农业社会化服务的农业科技成果转化模式的理论框架,并以安徽颍州农业社会化服务科技创新基地为例,分析了农业生产托管服务在推进科技创新和促进成果高效转化方面的正向作用,阐述了农业科研院所、农技推广系统、托管组织等主体在科技创新与成果转化中的联动协作机制。提出了一条可行的农业科技成果转化新模式——基于生产托管的农业科技成果转化模式,以期为推动农业科技创新成果转化、助力农业新技术推广到位、助推乡村振兴提供参考依据。

公立医院党支部发挥战斗堡垒作用实践与思考

在推动公立医院高质量发展过程中,如何落实党建引领,如何牢固树立“大抓基层”的鲜明导向,如何健全机制强化公立医院基层党支部战斗堡垒作用,是当前公立医院面临的重要课题。分析了党支部战斗堡垒作用的内涵机制,并通过构建党支部标准化规范化建设体系、健全党员干部培训教育体系、构建“1+1+N”党建品牌体系,为更好激发党支部战斗堡垒作用提供借鉴参考。