小儿厌食的中医治疗

厌食是较严重的食欲不振,以较长时期原因不明的厌食、体重显著减轻为临床特征。可见于各个年龄阶段,小儿多见于1-6岁。小儿脾常不足,脏腑娇嫩,如饮食不节,喂养不当,久病多病,损伤脾胃,先天不足,后天失调,情绪变化,思虑伤脾,均可致厌食。

全南实行医务人员轮流下基层服务责任制

全南从1991年起,县直医疗卫生单位实行医务人员轮流下基层服务责任制,定点包片,一定三年。规定:凡在县级卫生单位工作的医师、主治医师都必须轮流下去。

Geriatric nursing competence of clinical nursing staff at different hospital levels in Chongqing,China:A cross-sectional study

Objectives:This study aimed to survey the geriatric nursing competencies of clinical nursing staff in Chongqing City,China,and provide suggestions to enhance these competencies.Methods:This study was conducted in 204 hospitals in Southwest China from December 24,2022 to January 7,2023.The“Geriatric Nursing Competence of Clinical Nurse Investigation Tool”was used to explore factors that influence geriatric nurses’competencies via stratified sampling.The survey was conducted by distributing and collecting questionnaires through the online platform Wenjuanxing.Results:A total of 10,692 nurses answered the questionnaires.Of these questionnaires,9,442 were valid.The total geriatric nursing competence score of the clinical nursing staff was 2.29±0.81,the secondary hospital score was 2.23±0.78,and the tertiary hospital’s overall mean score was 2.33±0.83.The factors that influenced secondary hospitals included the department of medicine,age of nurses and total length of career(P<0.05).The factors that influenced tertiary hospitals included the department of medicine,age of nurses,nurses’professional title,and geriatric practical advanced nurses’certification(P<0.05).Conclusions:Geriatric nursing competence among clinical nursing staff is imbalanced at a lower-middle level and is influenced by various factors.Thefindings highlight the need for further clinical training in geriatric nursing.The training of geriatric nurses should focus on necessary clinical skills and on preparing them to adequately manage comprehensive geriatric syndromes.

分级诊疗将重塑医疗体系

近年来,我国各级政府陆续出台《关于推进分级诊疗制度建设的指导意见》等重要文件,不断强调和推进分级诊疗改革。毫不夸张地说,分级诊疗将重塑我国的医疗卫生服务体系。但是,目前亟待明确分级诊疗的概念。英美发达国家是现代医院的发源地,但是这些国家并没有＂分级诊疗＂这个词。他们称之为Primary Care,国内一直翻译为＂基层诊疗＂或者＂初级诊疗＂。

Turning Hostility into Friendship——Heihe’s Frontier Cultural Exchange

HEIHE is a city of strategicimportance on the northeastem border of China on thebanks of the Heilong River.An openborder town since March 1992,ithas gradually made its entry into theworld and made contributions in cul-tural exchange with the people of Russia.Located in the center of

Second-order problem solving:Nurses'perspectives on learning from.near misses

Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes.This study aimed to explore frontline nurses’perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.Methods:A qualitative exploratory study design was employed.This study was conducted in three tertiary hospitals in east China from June to November 2015.Purposive sampling was used to recruit 19 frontline nurses.Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan’s 4I Framework of Organizational Learning as a coding framework.Results:Second-order problem solving behavior,based on the 4I Framework of Organizational Learning,was referred to as being a leader in exposing near misses,pushing forward the cause analysis within limited capacity,balancing the active and passive role during improvement project,and promoting the continuous improvement with passion while feeling low-powered.Conclusions:4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses’role in promoting organizations to learn from near misses.In this study,nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving.However,additional knowledge,skills,and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.

Secondary cardiovascular prevention in older adults： an evidence based review

1 BackgroundIn the United States, life expectancy is rising, particularly among the older population （〉 65 years）, with projected estimates approaching 20% by year 2050. Despite improved survival estimates, cardiovascular diseases remain the leading cause of morbidity and mortality resulting in substantial increase in health care cost. For younger adults, the evidence for secondary cardiovascular prevention is well established and corroborated by robust data. However, the application of risk reduction strategies in older populations remains an area of active debate. Many assume that vulnerability to chronic cardiovascular diseases is an inexorable part of aging such that the risks attributable to prevention outweigh potential benefits.

Possessions Ceded for the Benefit of the Hospitals and Churches From the Sighisoara County

Transilvania is a province of the actual state of Romania, geographically situated in the middle of the country, in the inner arch of the Carpathians. Starting with the 10th century, the territory of Transilvania became attractive for the neighboring Hungarian royalty and later on, in the 1 lth century it was annexed into Hungary. For a better control of the newly annexed territory and in order to convert the orthodox population to Catholicism, the Hungarian rulers brought the Szeklers to Transilvania and two centuries later, German originating populations, from Rhine, Luxemburg, and Saxony （the name of Sas people, or Saxon of Transilvania derives from ＂Saxony＂）. The aim of this paper is to focus on the Sighisoara County, namely on the easement of certain areas for temporary or permanent maintenance or use by the church and hospitals in the region. That was a common practice in Medieval Europe aimed at ensuring the survival means for these institutions. However, it was not the only one to serve this goal. There were also donations on behalf of various people or allocations of money by the county authorities. The documents attesting this are unpublished, unedited and are to be found in the archives of the Brasov County, Budapest, and Vienna. They are the stepping stone of this paper and hence, they grant its originality. The objectives of the paper are to bring arguments in favor of the thesis that community money was directed towards meeting the needs of the hospitals, as well as towards supporting the widows, the orphans, and the needy ones. Worth noting in this respect is the management of the funds ceded to the church and county hospitals and that actually benefitted the whole community. Moreover, the paper also emphasizes the role played by education, since the latter is an important landmark for a community＇s development level

Barriers to nurse-patient communication in primary healthcare centers in Bahrain:Patient perspective

Objectives:Effective and efficient communication is a core element in healthcare systems,especially between healthcare providers and patients.This study aimed to identify communication barriers be-tween nurses and patients in primary healthcare centers in Bahrain.Methods:This is a cross-sectional study conducted across primary healthcare centers in Bahrain.Four hundred and two patients were recruited using convenience sampling.A self-administered question-naire comprising 29 items on communication barriers was used.Results:A total of 402 patients consented to participate.The majority of participants reported the following statements had large effects on communication:“shortage in the number of nurses compared to the large number of patients”(254/401,63.3%),“lack of desire of nurse to communicate with patients”(246/402,61.2%),and“negative attitude of the nurse toward the patient”(238/401,59.4%).Further,“difference in language between nurses and patients,”“lack of self-confidence by nurses,”and“nurses overwhelmed by work”were ranked as top three statements with a significant influence on commu-nication between nurses and patients.Conclusions:Communication between healthcare providers and patients is pivotal for an optimal healthcare service.Based on the findings of this study and the literature,we recommend formal training of health care workers in improving communication skills and including this not only in medical cur-riculum but also in the form of continuing medical education(CMEs)1.

Thoughts on Grade Teaching of ＂University Computer Basis＂ in Medical College

Along with information technology in depth, The combined degree of computer and medical specialty is more closely, students in computer operation level has greatly improved, traditional teaching in basic computer has been seriously impacted, ？This paper discusses the effect of the university Computer Basis reform in Medical College.

联动整合 分级诊疗方能落地

分级诊疗要用医疗、医保、药品、价格、财政、绩效等6种方式,就像＂六味地黄丸＂,少一味药都不行。分级诊疗制度是一种结构性调整,通过按病种推进分级诊疗,采取联动改革和整合式改革,分级诊疗才能落地。分级诊疗是前几年改革不断总结、深化、认识的产物。2005年前,改革往往是单向的,而2006年、2007年制订医改方案时,大家意识到单向改革不行,必须是综合改革。

Missed Opportunities for Intermittent Preventive Treatment among Pregnant Women, in a Secondary Health Facility, Cross River State, Nigeria

The study determined the magnitude and contributory factors for missed opportunities for the administration of IPTp （intermittent preventive treatment for malaria prevention）, during pregnancy among pregnant women attending a secondary health facility in Calabar. This study was a descriptive survey. Exit interviews were carried out on all pregnant and post natal women who attended the antenatal clinic of a secondary health facility for two weeks in November 2008. Data were analyzed using descriptive and inferential statistics. The mean age of respondents was 27.0 ± 5.4, mean parity was 2.4 ± 1.5, mean clinic attendance 4.9 ± 4.0 while mean gestational age at booking was 18.6± 7.7. The prevalence of missed opportunity among the pregnant women was 59.1% for IPTpl ＆ 56.0% for IPTp2; among pregnant PLWHA （people living with HIV/AIDS）, it was 100% for IPTp3, 70% for IPTp2 ＆ 80.0% for IPTpl. Factors accountable for missed opportunity include non-availability of SP （sulfadoxine-pyrimethamine）, lack of supervision, failure to prescribe medication, late booking and lack of knowledge. More women significantly received IPTp2 compared to IPTpl （P = 0.001）. Discussion： The findings establish the need for making SP available in the ANC （antenatal clinic）, educating health workers about current schedule and procedures for administration and early mobilization of pregnant mothers for ANC.

Study on salary level of medical doctors in county-level public hospitals and related influencing factors

This study aimed to investigate the salary status of medical doctors who work in county-level hospitals, and analyze the existing problems. We collected the data from questionnaires and applied both EXCEL and SPSS to conduct analysis. Doctors working in county level-hospitals received relatively lower salaries, with 78.5% of the doctors making lower than 5000 RMB per month. Influencing factors for the salary levels included personal factors, attributes of the hospitals, workload and performance appraisal. Reasonable adjustment for the salary levels is needed to refine important elements of salary distribution, and to construct a rational performance appraisal system.

芝麻绿豆——成语药谈之八

＂芝麻绿豆＂,这是一条颇为流行的俗成语,常被用来比喻微不足道、不很重要的东西或事情。很显然,它的立足点是建立在芝麻、绿豆的形态上的,说的不是芝麻、绿豆的全部,多少有点欠公正和不全面的感觉。抓住芝麻丢了西瓜,固然不好;抓住西瓜丢了芝麻,也未必就是好事。矛盾有主有次,关键看怎么个抓法。芝麻个头不大,却有＂巨胜＂之称,可见小物体中寓有大内涵;绿豆虽是不起眼的小球,却与大得容纳百川的地球同形,说明物理不以大小为根据。从食用和药用的不同角度出发，芝麻、绿豆都有着较为重要的地位．不可因其形小而忽略之。

Comparison of the new injury severity score and the injury severity score in multiple trauma patients

Objective： To assess whether these characteristics of less misclassification and greater area under receiver operator characteristic （ROC） curve of the new injury severity score （NISS） are better than the injury severity score （ISS） as applying it to our multiple trauma patients registered into the emergency intensive care unit （EICU）. Methods： This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively registered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and multivariate logistic progression model. Results： Among the 2 286 patients, 176 （7.7%） were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 1 10 patients. Mean EICU length of stay （LOS） was 7.8 days ± 2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and head/neck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the penetrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups （4.01% versus 4.49%）. However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate （21.04% versus 15.55% for IS S, t=-3.310, P〈0.001）, resulting in an overall misclassification rate of 23.57% for NISS versus 18.79% for ISS （t=3.290, P〈0.001）. In the whole sample, NISS presented equivalent discrimination （area under ROC curve： NISS=0.938 versus ISS=0.943）. The H-L statistics showed poorer calibration （48.64 versus 32.11, t=3.305, P〈0.001） in the penetrating injury group. Conclusions： NISS should not replace ISS because Lhey share similar accuracy and calibration in predicting multiple blunt trauma patients. NISS may be more sensitive but less specific than ISS in predicting mortality in certain penetrating injury patients.

Impact of the zero-markup drug policy on volume of medical service:based on 57 county hospitals of China

In the present study,we aimed to assess the long-term impact of zero-markup drug policy on volume of medical service in county hospitals of China.This study used 57 county hospitals’records of medical service from 2011 to 2015,and a fixed effect model was applied to examine the impact of the zero-markup drug policy on volume of medical service.The outcome indicators included the number of patient visits,the number of prescriptions,the number of discharged patients,the length of stay,the number of patients who had surgeries and the number of patients who had CT or MRI,monthly.The number of hospitals which implemented the zero-markup drug policy was increased continuously.By the end of 2015,41 hospitals(71.9%)implemented this policy.The panel regression showed that most indicators were insignificantly decreased,including the number of patient visits(P<0.01),the length of stay(P<0.05),the number of patients who had surgeries(P<0.01)and the number of patients who had CT or MRI(P<0.01).However,the number of prescriptions and the number of discharged patients were not significantly changed.The implementation of the zero-markup drug policy might affect the reduction of the volume of medical service in county-level hospitals and the reason needs to be clarified in future studies.

Regional whole-course trauma care - Experiences from a county-level hospital

Fifty percent of the deaths caused by severe trauma occur within 1 h after injury. With the concepts ot ＂golden 1 h＂ and ＂platinum 10 rain＇, the professionals in the field of emergency trauma treatment have agreed on the necessity of establishing a rapid and efficient trauma rescue system. However, due to the size of the hospital, the population in the neighborhood, the local economic conditions and geographical features, how to establish an optimal trauma rescue system remains an issue. In this paper, we introduced our experiences in a county-level hospital located in middle-and high-income areas.

Antimicrobial stewardship program in China’s tertiary hospitals in 2018:a nationwide cross-sectional online survey

In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking.A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System(CARSS).The questionnaire included 5 sections regarding structure,technical support,antimicrobial use management,antimicrobial use surveillance,and education.Descriptive statistics were used for data analysis.Of the 1044 tertiary hospitals under CARSS,13.4%(140)hospitals participated in the study.Among them,99.3%(139/140)set up the AMS program.The hospital president(82.1%,115/140)and medical service department(59.3%,83/140)were responsible for AMS outcomes in most hospitals.Structured antimicrobial formulary restriction management was adopted by 99.3%(139/140)hospitals.Infectious disease department,infection control department,and microbiological laboratories were established in 87.1%(122/140),99.3%(139/140)and 100%(140/140)hospitals,respectively.Up to 85.6%(124/140)hospitals applied clinical pathways,and 33.6%(47/140)hospitals implemented hospital-specific guidelines for infectious diseases.Outpatient prescription auditing,inpatient prescription auditing,and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3%(139/140),98.6%(138/140)and 95.7%(134/140)hospitals,respectively.Up to 97.1%(136/140)hospitals participated in antimicrobial use surveillance network,and 99.3%(139/140)hospitals established the specialized management of carbapenem and tigecycline.Staff education and public education were provided with various ways and frequencies in 100%(140/140)and 90.0%(126/140)hospitals,respectively.AMS programs in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments.More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system.

Trauma care construction under the guidance of county-level trauma centers

Severe trauma has the characteristics of complicated condition, multiple organs involved, limitq auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to prima hospitals to receive treatments. But the traditional mode of separate discipline management can easi lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mc tality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospit~ （usually the top general hospital within the administrative region of a county）, can establish a sc entific and comprehensive trauma care system, the success rate of trauma rescue in this region can ] greatly improved. On March 1st, 2013, Tiantai People＇s Hospital of Zhejiang Province, China set up trauma care center, which integrated the pre-hospital and in-hospital trauma treatment procedur~ and has achieved good economic and social benefits. Till March 1st, 2017, 1265 severe trauma patier （injury severity score 〉16） have been treated in this trauma center. The rescue success rate reach~ 95~ and the delayed and]or missed diagnosis rate was less than 5%. Totally 86 severe cases of peK fractures with unstable hemodynamics were treated, and the success rate was 92%. The in-hospil emergency rescue response time is less than 3 min, and the time from definite diagnosis to surge is within 35 min.