Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Family resilience of cancer patients:a concept analysis

Objective:The concept of family resilience of cancer patients was discussed through literature review,which provided reference for nursing of cancer patients.Methods:China National Knowledge Infrastructure(CNKI),Wanfang Database,SinoMed,PubMed,Web of Science,and Embase were systematically searched,and the concept analysis method proposed by Walker and Avant was adopted.Results:In this study,we defined the concept of family resilience,identified attributes,and analyzed the antecedents and consequences.The proposed operational definition of family resilience was:After a family member is diagnosed with cancer,the whole family can actively explore its own unique internal and external resources and advantages,strengthen self-regulation,jointly cope with the crisis by establishing close family relationships,providing mutual support to family members,and interacting with the outside world.Conclusions:The definition of family resilience of cancer patients is conducive to the development of measurement tools and the improvement of family outcomes of adult cancer patients by intervening family resilience factors.

Target versus sub-target dose of renin–angiotensin system inhibitors on survival in elderly patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis

BACKGROUND The efficiency of the target versus sub-target dose of renin–angiotensin system inhibitors(RASIs)in elderly patients with heart failure(HF)with reduced ejection fraction(HErEF)remains unclear.METHODS PubMed,Embase,and the Cochrane Central Register of Controlled Trials were searched from database inception through March 2022 for randomized controlled trials(RCTs)and observational studies considering the effect of the target versus sub-target dose of RASIs on survival in elderly patients(≥60 years)with HErEF.The primary outcome was all-cause mortality.The secondary outcomes were cardiac mortality,HF hospitalization,and the composite endpoint of mortality or HF hospitalization.A meta-analysis was conducted to generate combined hazard ratio(HR)and 95%CI.RESULTS Seven studies(two RCTs and five observational studies)enrolling 16,634 patients were included.A pooled analysis suggested that the target versus sub-target dose of RASIs led to lower rates of all-cause mortality(HR=0.92,95%CI:0.87–0.98,I2=21%)and cardiac mortality(HR=0.93,95%CI:0.85–1.00,I2=15%)but not reduced rates of HF hospitalization(HR=0.94,95%CI:0.88–1.01,I2=0)and the composite endpoint(HR=1.03,95%CI:0.91–1.15,I2=51%).However,the target dose of RASIs was associated with a similar primary outcome(HR=0.85,95%CI:0.64–1.14,I2=0)in a subgroup of very elderly patients>75 years of age.CONCLUSIONS Our analysis suggests that the target dose of RASIs has a better survival benefit in elderly patients with HFrEF compared to the sub-target dose of RASIs.However,the sub-target dose of RASIs is associated with a similar mortality rate in very elderly patients>75 years of age.Future high-quality and adequately powered RCTs are warranted.

Correlation analysis of mental health conditions and personality of patients with alcohol addiction

BACKGROUND Alcohol addiction,or alcohol dependence,refers to a psychological state of strong craving for alcohol caused by drinking when both the drinking times and alcohol consumption reach a certain level.Alcohol addiction can cause irreversible damage,leading to mental illness or mental disorders,negative changes in their original personality,and a tendency to safety incidents such as committing suicide or violent attacks on others.Significant attention needs to be given to the mental health of alcohol addicts,which could reflect their abnormal personality traits.However,only a few papers on this issue have been reported in China.AIM To investigate the correlation between mental health and personality in patients with alcohol addiction.METHODS In this single-center observational study,we selected 80 patients with alcohol addiction as the research subjects,according to the criteria of the K10 scale to evaluate the mental health of patients with alcohol addiction,and divided these patients into four groups based on the evaluation results:Good,average,relatively poor and bad.And then analyzed the correlation between mental health conditions and personality characteristics from these four groups of patients.RESULTS The average score of the K10 scale(Kessler 10 Simple Psychological Status Assessment Scale)in 80 patients with alcohol addiction was 25.45 points,the median score was 25 points,the highest score was 50 points,and the lowest score was 11 points.Pearson's analysis showed that the K10 score was positively correlated with the scores of these two subscales,such as the P-subscale and the N-subscale(P<0.05).In contrast,the K10 score had no significant correlation with the scores from the E-subscale and the L-subscale(P>0.05).CONCLUSION The mental health conditions of patients with alcohol addiction are positively correlated with their personality characteristics.

Quality of life of hospitalized patients after lung cancer operation and analysis of influencing factors

Objective:To explore the current status and influencing factors of quality of life in patients with lung cancer after surgery in a tertiary hospital in Hainan province.Methods:To investigate the influencing factors of quality of life of lung cancer patients after surgery in a tertiary hospital in Hainan province by cross‑sectional survey method.Results:The scores of insomnia,appetite loss,constipation and pain in 186 lung cancer patients after surgery in a tertiary hospital in Hainan Province were significantly higher than the reference value.Multiple linear regression analysis showed that older patients(>60 years)had lower scores in physical function domain(β=-0.193),and female patients had more appetite loss symptoms(β=0.245).Compared with other minority ethnic groups,Han ethnic group had lower scores in role function domain(β=0.179),more severe fatigue symptoms(β=-0.162),and higher general health level(β=0.166).Patients with employee medical insurance had lower scores of emotional function(β=0.194),cognitive function(β=0.281),the lowest score in social function(β=0.188),and severe pain in other parts(β=-0.227).Smokers had less cough symptoms(β=0.175)and more arm and shoulder pain symptoms(β=-0.21)than non‑smokers.Patients with secondhand smoke exposure had lower cognitive function scores(β=-0.158)and more obvious symptoms of oral ulcer(β=0.185).Patients who drank alcohol frequently(drinking frequency>1 time/day)had more severe cough symptoms(β=0.27).Patients with small number of children(0‑1)had milder cough symptoms(β=0.178).Patients who did not understand the disease had obvious symptoms of arm and shoulder pain(β=0.151).Patients with early pathological stage(stageⅠ‑Ⅱ)had more severe shortness of breath(β=-0.159)and pain(β=-0.181).The symptoms of appetite loss were more obvious in patients living in cities(β=0.192).The symptoms of peripheral neuropathy were more obvious(β=0.174).Patients who often consumed pickulated food had severe pain symptoms(β=-0.219),and pain in other parts was obvious(β=-0.149).Male patients had obvious alopecia symptoms(β=-0.306).Conclusion:Age,ethnicity,residence,type of medical insurance,number of children,pathological stage of lung cancer,smoking,second‑hand smoke exposure,alcohol consumption,and frequent consumption of pickled food were related to the quality of life of lung cancer patients in hospital after surgery.Medical staff and family members should pay attention to the emotional communication of patients during the treatment of lung cancer patients in hospital after surgery.Patients should avoid exposure to smoking,alcohol and second‑hand smoke,and reduce consumption of pickled food.

Rate of Patient Delay among Students with Pulmonary Tuberculosis in China: A Meta-Analysis

Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library, CBM, CNKI, VIP, and WANFANG DATA were electronically searched to collect cross-sectional studies on the incidence of delayed consultation in students with PTB in China from January 1, 2000, to November 15, 2022. Two researchers independently screened studies, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 16.0 software. Results: In total, 60 cross-sectional studies with 260,707 cases involving 136,701 delayed consultation PTB patients were included. The results of meta-analysis showed that the rate of patient delay was 46.4% (95% CI 44.3% to 48.4%) among students with PTB in China. Results of subgroup analyses showed that: 1) The rates were 46.8% and 50.4% for male and female students, respectively. 2) The rates for the East, Central and West parts of China were 42.3%, 45.6% and 50.5%, respectively. 3) The rates were increased first and then decreased during 2007 to 2020. 4) The rates of students from primary school, junior high school, senior high school and university were 50.3%, 49.8%, 40.7% and 44.9%, respectively. 5) The rates for the Han and the other nationalities were 50.3% and 53.9%, respectively. 6) The rates for local and non-local students were 47.2% and 50.5%, respectively. 7) The rates of patients detected by consultation due to symptoms, recommendation due to symptoms, referral, tracking and healthy physical examination were 50.5%, 51.6%, 46.6%, 55.6% and 16.2%, respectively. 8) The rates of patients with initial PTB and retreatment PTB were 53.1% and 59.6%, respectively. 9) The rates of patients with positive etiology, negative etiology and without etiological results were 55.9%, 47.0% and 51.6%, respectively. 10) The rates of severe and non-severe patients were 59.4% and 52.9%, respectively. Conclusion: The patient delay rate for Chinese students with PTB is generally at a high level. There are substantial differences in the patient delay rate for students with PTB among different genders, regions, study stages, nationalities, household registration types, detection methods, and treatment classifications.

Prognostic analysis and comparison of colon cancer in Han and Hui patients

AIM: To investigate the relevant prognostic factors and their differences between colorectal cancer (CRC) patients of Chinese Han and Hui ethnicities in the Beijing region.

Analysis of risk factors for central venous port failure in cancer patients

AIM: To analyze the risk factors for central port failure in cancer patients administered chemotherapy, using univariate and multivariate analyses. METHODS: A total of 1348 totally implantable venous access devices (TIVADs) were implanted into 1280 cancer patients in this cohort study. A Cox proportional hazard model was applied to analyze risk factors for failure of TIVADs. Log-rank test was used to compare actuarial survival rates. Infection, thrombosis, and surgical complication rates (χ2 test or Fisher's exact test) were compared in relation to the risk factors. RESULTS: Increasing age, male gender and openended catheter use were signifi cant risk factors reducing survival of TIVADs as determined by univariate and multivariate analyses. Hematogenous malignancy decreased the survival time of TIVADs; this reduction was not statistically signifi cant by univariate analysis [hazard ratio (HR) = 1.336, 95% CI: 0.966-1.849, P = 0.080)]. However, it became a signifi cant risk factor by multivariate analysis (HR = 1.499, 95% CI: 1.079-2.083, P = 0.016) when correlated with variables of age, sex and catheter type. Close-ended (Groshong) catheters had a lower thrombosis rate than open-ended catheters (2.5% vs 5%, P = 0.015). Hematogenous malignancy had higher infection rates than solid malignancy (10.5% vs 2.5%, P < 0.001). CONCLUSION: Increasing age, male gender, openended catheters and hematogenous malignancy were risk factors for TIVAD failure. Close-ended catheters had lower thrombosis rates and hematogenous malignancy had higher infection rates.

Hepatocellular carcinoma in extremely elderly patients:An analysis of clinical characteristics,prognosis and patient survival

AIM： To identify the clinical and prognostic features of patients with hepatocellular carcinoma （HCC） aged 80 years or more. METHODS： A total of 1310 patients with HCC were included in this study. Ninety-one patients aged 80 years or more at the time of diagnosis of HCC were defined as the extremely elderly group. Two hundred and thirty-four patients aged 〉/ 50 years but less than 60 years were regarded as the non-elderly group. RESULTS： The sex ratio （male to female） was significantly lower in the extremely elderly group （0.90：1） than in the non-elderly group （3.9：1, P〈 0.001）. The positive rate for HBsAg was significantly lower in the extremely elderly group and the proportion of patients negative for HBsAg and HCVAb obviously increased in the extremely elderly group （P〈 0.001）. There were no significant differences in the following parameters： diameter and number of tumors, Child-Pugh grading, tumor staging, presence of portal thrombosis or ascites, and positive rate for HCVAb. Extremely elderly patients did not often receive surgical treatment （P 〈 0.001） and they were more likely to receive conservative treatment （P〈 0.01）. There were no significant differences in survival curves based on the Kaplan-Meier methods in comparison with the overall patients between the two groups. However, the survival curves were significantly worse in the extremely elderly patients with stage Ⅰ/Ⅱ, stage Ⅰ/Ⅱ and Child-Pugh grade A cirrhosis in comparison with the non-elderly group. The causes of death did not differ among the patients, and most cases died of liverrelated diseases even in the extremely elderly patients. CONCLUSION： In the patients with good liver functions and good performance status, aggressive treatment for HCC might improve the survival rate, even in extremely elderly patients.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

Patient outcomes in the field of nursing: A concept analysis

Purpose:This paper reports an analysis of the concept of patient outcomes.Methods:The Walker and Avant concept analysis approach was applied.Results:The attributes of patient outcomes include(1)patient functional status(maintained or improved),(2)patient safety(protected or unharmed),and(3)patient satisfaction(patient reporting of comfort and contentment).These attributes are influenced by the antecedents of individual patient characteristics and health problems,the structure of healthcare organizations and received health interventions.Additionally,patient outcomes do significantly impact the quality of nursing care,the cost of effective care and healthcare policy making formulation.Conclusion:Providing good nursing care to all patients is a central goal of nursing.Patient outcomes in nursing are primarily about the results for the patient receiving nursing care.This analysis provides nurses with a new perspective by helping them to understand all the components within the concept of patient outcomes.

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

Bibliometric Analysis of Patient Navigation Model Applied in Colorectal Cancer Care Based on Web of Science

Background: The mortality rate of colorectal cancer in China is on the rise, which has exceeded the global average rate, thus making the care of colorectal cancer widely concerned. As a comprehensive nursing model, the patient navigation model has shown its effectiveness in improving the quality of life among patients with chronic diseases and reducing the shortage of current healthcare resources in some area. This study aims to identify the current status and dilemma of the patient navigation model applied in colorectal cancer care in China. Methods: Bibliometric method was used to analyze published articles regarding the application of patient navigation model in colorectal cancer care retrieved from the Web of Science database. Statistics were presented using visualization method processed by the Bibliographic Items Co-occurrence Matrix Builder (BICOMB) software. Results: 124 articles, from 2006 to 2018, covering 14 countries, involving 931 researchers, 356 institutions and 60 publications were obtained;American research papers are the largest components of the aforementioned articles;only one of them is written by Chinese authors. The 3 leading institutions in this domain are University OF Rochester, Ohio State University, Icahn School of Medicine at Mount Sinai, yet the distribution of authors is relatively decentralized. “Cancer” is the main journal that publishes the researches in this domain. Research hotspots are on “cancer prevention and screening”, “health disparities”, “economic evaluation”, “patient navigators”, and “ethnicity”. Conclusion: In China, the research on the patient navigation is still in its infancy. Therefore, the Chinese government should provide more endorsement to this particular area and encourage the cooperation with other countries. China, having a long way to go, should further explore patient navigation on colorectal cancer care and establish a model that matches its cultural backgrounds.

Citation Classics in Patient Engagement Research: An Analysis of the 50 Most Cited Articles

Background: Patient engagement offers a promising pathway toward improved population health, better-quality care, and greater cost efficiency. The objective of the current study is to identify and analyze the characteristics of the 50 most frequently cited articles in patient engagement journals. Methods: The ISI Journal Citation Reports: Science Edition 2014 database was used to determine the most frequently cited published articles in Dec 2016. The most cited 50 articles were selected and assessed according to the published journal, origin of institutions, publication year, impact factor, topic, and type of study. Results: The 50 selected articles were published in 19 journals, the majority of which originated from the UK. The most common study design was quantitative study and reviews. The improvement of health care services quality and the construction of engagement model were the top two topics. And 2013 is the most published year receiving the most citations. Conclusions: Our findings provide a historical perspective on the scientific progress of patient engagement and allow for recognition of important developments and limitations in this field.

Systematic review and meta-analysis of Saccharomyces boulardii in adult patients

This article reviews the evidence for efficacy and safety of Saccharomyces boulardii(S.boulardii) for various disease indications in adults based on the peerreviewed,randomized clinical trials and pre-clinical studies from the published medical literature(Medline,Clinical Trial websites and meeting abstracts) between 1976 and 2009.For meta-analysis,only randomized,blinded controlled trials unrestricted by language were included.Pre-clinical studies,volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis,but included in the systematic review.Of 31 randomized,placebo-controlled treatment arms in 27 trials(encompassing 5029 study patients),S.boulardii was found to be significantly efficacious and safe in 84% of those treatment arms.A meta-analysis found a significant therapeutic efficacy for S.boulardii in the prevention of antibiotic-associated diarrhea(AAD)(RR = 0.47,95% CI:0.35-0.63,P < 0.001).In adults,S.boulardii can be strongly recommended for the prevention of AAD and the traveler's diarrhea.Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Heliobacter pylori treatment-related symptoms.S.boulardii shows promise for the prevention of C.difficile disease recurrences;treatment of irritable bowel syndrome,acute adult diarrhea,Crohn's disease,giardiasis,human immunodeficiency virus-related diarrhea;but more supporting evidence is recommended for these indications.The use of S.boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.

Effect of blood gas analysis in patients with bed rest and blood sampling through the dorsal artery:A meta-analysis

Objective:To systematic evaluation by the dorsalis pedis artery puncture for bed patients blood gas analysis of application effect of impact.Methods:A randomized controlled trial of the effect of arterial blood extraction on blood gas analysis in PubMed,CNKI,Wanfang database and VIP database.After selecting the literature,extracting the data and evaluating the quality of the literature.Meta- analysis was carried out by RevMan 5.3 software.Results:Twelve randomized controlled trials were included and 1696 patients were enrolled.After meta-analysis,the arterial puncture can effectively improve the success of arterial puncture in patients with bed [Z = 5.78,95%CI(1.90,3.66),P<0.001],reduce the occurrence of hematoma [Z = 4.27,95%CI(0.19,0.54),P<0.001],reduce the mistaken into the vein [Z = 4.60,95%CI(0.08,0.36),P<0.001],reduce cyanosis [Z = 2.84,95%CI(0.23,0.81),P<0.008],the difference was statistically significant.Conclusion:Dorsalis pedis artery puncture can improve the success rate of blood gas analysis in bedridden patients,reduce the incidence of hematoma and the incidence of venous leakage,and can be widely used in clinical practice.

Self-management A concept analysis of self-management for cancer patients’ home-based rehabilitation

Objective： To explore and clarify the concept of self-management in the context of cancer patients’ home-basedrehabilitation. This concept analysis will provide a theoretical lens for nurses to help cancer patients to developself-management strategies and enables them to improve their ability in symptom self-management of home-basedrehabilitation. Method： Walker and Avant’s framework （2011） was used to analyse the concept of self-management.Results： Self-management is defined as a dynamic process that involves perception of one’s needs, resource utilisation,problem solving and active participation. Antecedents of self-management include self-efficacy, disease knowledge andsocial support. Improving cancer patients’ ability in symptom self-management can improve their health outcomes andquality of life and reduce healthcare expenditures. Although Strategy and Effectiveness of Symptom Self-Managementscale is perceived as an ideal instrument to measure self-management and thus it is used worldwide, whether thisinstrument fits to measure this concept for cancer patients in Chinese context has still not yet been verified and thusfurther research is needed. Conclusion： According to the concept analysis, nurses should encourage cancer patients toinvolve actively in making a home-based rehabilitation plan and promote their ability in symptom self-management ofhome-based rehabilitation so as to improve their health outcomes and reduce healthcare expenditures.

Management of non-ST-segment elevation myocardial in-farction in patients aged≥80 years:a meta-analysis of ran-domized controlled trials

Coronary artery disease(CAD)is the major cause of morbidity and mortality in elderly patients.^([1])Despite this,elderly patients are under-represented in most trials of CAD.Non-ST-segment elevation myocardial infarction(NSTEMI)is a common cause of hospitalization among patients≥80 years of age,^([2])and with an aging global population,there is a pressing need to establish the optimal management strategy for these patients.Therefore,we conducted a meta-analysis of all randomized control trials(RCTs)performed to date in patients≥80 years of age,comparing an initial invasive versus conservative strategy to provide insights into their optimal initial management strategy.

Analysis on Immune Tolerance and Resistance Mechanism of <i>Cryptococcus albidus</i>of AIDS Patients with Opportunistic Cryptococci Infection

Objective: To explore more about the immune tolerance and drug resistance of white Cryptococci albidus in AIDS patients with opportunistic Cryptococcus infection. Methods: To analyze drug resistance of the samples of white Cryptococcus albidus extracted from opportunistic infection AIDS patients in the certain infection area from October 2011 to December 2014. Results: After analyzing two samples of Cryptococcus albidus from 885 cases with opportunistic infection, we found that one of the samples do resist to ten common antibiotics. They were fluconazole, flu-cytosine, fluconazole, caspofungin, amphotericin B, MI miconazole, terbinafine, ketoconazole and itraconazole. The other one was sensitive to voriconazole, but resistant to the rest of the drug. Two strains of bacteria were inoculated into the animals in vivo and their DNA was extracted to carry out the genotyping analysis. The results showed that different degrees of resistance gene amplification bands were found in the 10 kinds of antibiotics. Conclusion: Although there were few opportunistic infection Cryptococcus albidus in AIDS patients, it was easy to show its resistance to drugs. Therefore, great attention should be paid to it for the medical workers.

Views on patient safety by operations managers in somatic hospital care: a qualitative analysis

Healthcare outcome is to achieve optimal health for each patient. It is a well-known phenomenon that patients suffer from care injuries. Operations managers have difficulties in seeing that the relationship between safety culture, values and attitudes affects the medical care to the detriment of the patient. The aim was to describe the views on patient safety by operations managers and the establishment of patient safety and safety culture in somatic hospital care. Four open questions were answered by 29 operations managers in somatic hospital care. Data analysis was carried out by deductive qualitative content analysis. Operations managers found production to be the most important goal, and patient safety was linked to this basic mission. Safety work meant to achieve optimal health outcomes for each patient in a continuous development of operations. This was accomplished by pursuing a high level of competence among employees, having a functioning report system and preventing medical errors. Safety culture was mentioned to a smaller extent. The primary target of patient safety work by the operations managers was improving care quality which resulted in fewer complications and shorter care time. A change in emphasis to primary safety work is necessary. To accomplish this increased knowledge of communication, teamwork and clinical decision making are required.