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.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

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.

Construction of competency evaluation system for infection control personnel in traditional Chinese medicine hospitals

Background:This study uses a literature review and the Delphi expert consultation method to construct a competency evaluation model for infection control personnel in traditional Chinese medicine(TCM)hospitals.The aim is to strengthen infection control management in TCM hospitals,assess the competency of infection control personnel in their positions,and assist them in identifying the competencies that need improvement.Methods:Based on the literature research method and the Delphi expert consultation method,a competency model for the position was constructed through two rounds of expert consultations,analyzing the relationships between various factors and establishing a hierarchical structure model.Pairwise comparisons were made among the elements at the same level to construct a judgment matrix.Through the analytic hierarchy process,the weight coefficients of the indicators at each level in the competency model were obtained.Results:This study conducted a comprehensive assessment of various capabilities and practices related to hospital infection control.The survey results indicate that participants excelled in multiple areas,with a high overall satisfaction rate.95.28%of participants were able to develop hospital infection monitoring plans based on national infection control policies,demonstrating a good understanding and execution of these policies.94.09%of participants were familiar with high-risk populations and key departments in the hospital.91.73%of participants were able to establish monitoring scopes based on the trends of multidrug-resistant bacteria and conduct information monitoring,reflecting strong response capabilities.92.91%of participants were able to collaborate with relevant departments to conduct bacterial resistance monitoring,showing a good team spirit.94.49%of participants were able to perform targeted monitoring,including surgical site infections,indicating that they have effective monitoring strategies.91.34%of participants were able to collect and organize monitoring data and establish a systematic database,demonstrating good data management skills.90.16%of participants were able to interpret laws and regulations related to hospital infection management,indicating a high level of legal knowledge.89.37%of participants generally possessed good communication skills.92.52%of participants were able to guide medical staff on occupational safety and protective knowledge,showing an emphasis on occupational health.Participants demonstrated a strong desire to learn and innovate,with 87.01%actively participating in continuing education and research activities,reflecting a pursuit of professional development.Conclusion:Based on the results of the two rounds of expert consultations,a competency evaluation model for infection control personnel in TCM hospitals was formed.Through the analytic hierarchy process,the weight coefficients of various indicators at different levels in the model were obtained,and the research results have good scientific validity and reliability.

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.

Management Measures for Preventing Postoperative Incision Infections in General Surgery at Primary Hospitals

Objective:To analyze the management measures and effects of preventing postoperative incision infections in the general surgery department of primary hospitals.Methods:Forty-nine surgical patients with 11 healthcare workers who were admitted to the general surgery department of the primary hospital between August 2021 and August 2022 were selected as the routine group for routine incision infection management.Forty-nine surgical patients with 11 healthcare workers admitted to the same department between September 2022 and September 2023 were selected as the prevention group for prophylactic management of postoperative incision infections.The incision infection rate,knowledge,attitude,and practice(KAP)scores,and management satisfaction of the patients as well as the management skill scores of healthcare workers were compared between the two groups.Results:The rate of postoperative incision infection in the prevention group was lower than that in the routine group;after implementing management measures,patients in the prevention group had higher KAP scores than those in the routine group;patients in the prevention group were more satisfied with the management than those in the routine group;and healthcare workers in the prevention group had higher scores than those in the routine group,with P<0.05 for the comparison between the groups.Conclusion:The implementation of preventive management for general surgery patients in primary hospitals can reduce the incidence of postoperative incision infection and improve the KAP of patients,with higher management satisfaction.It can also enhance the management skills of healthcare workers,thus improving their overall management level.

A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

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.

快速城镇化地区生态环境质量时空格局演变及对土地利用变化响应——以廊坊市北三县为例

对生态环境质量时空格局及其对土地利用变化的响应进行研究可为区域制定生态保护修复政策提供参考。通过构建遥感生态指数,对廊坊市北三县2000-2020年生态环境质量分布格局分析评价,利用地理加权回归模型探索生态环境质量变化对土地利用变化的响应。结果表明,北三县2000-2020年生态环境质量等级以“良”和“一般”为主,整体呈下降趋势,等级“较差”面积呈快速增长趋势。建设用地变化、土地利用强度变化和生态环境质量变化呈负相关关系,回归系数在空间上呈现较大的异质性;生态用地变化与生态环境质量变化呈正相关关系,回归系数在空间上异质性不强。城镇快速扩张的区域生态环境质量变化对建设用地变化和土地利用强度变化响应最显著。大量耕地向建设用地转变是区域生态环境变化的最主要影响因素,在国土空间规划中应划定城市边界,严格控制建设用地规模,提高集约节约利用水平,确保区域可持续发展。

教育强国建设中县中文化生态重塑的理论意蕴与实践逻辑

基础教育是教育强国建设的基点。作为县域基础教育龙头的县中,其振兴对于推进教育强国建设具有重要的战略意义。“县中塌陷”背后的核心问题在于其教育文化生态的失衡,县中振兴的关键环节是其文化生态的重构。文化生态学有助于为教育强国建设中县中文化生态重构提供统筹全局的新视角。县中文化生态重构应基于文化生态系统的有机整体性,重构高质均衡的县中文化外生态;基于文化生态系统的多样平衡性,重构多样多元的县中文化中生态;基于文化生态系统的互动开放性,重构主体创新的县中文化内生态。

西南山区乡村贫困地域系统时空演化格局研究——以云南省镇沅县为例

在梳理总结国内外关于贫困地理与农村多维空间贫困、乡村地域系统与贫困地域系统理论前沿研究的基础上,提出“乡村贫困地域系统”研究视角,并对乡村贫困地域系统理论内涵进行了初步探析.以云南省镇沅县109个村域为评价分析单元,构建了乡村贫困地域系统演化发展评价指标体系,设计了乡村贫困地域系统演化发展指数测度模型和基于“时空立方体—新兴时空热点分析”的时空演化模式识别方法.研究显示:(1)镇沅县2013-2021年乡村贫困地域系统演化时序阶段性特征经历了“差异波动演化(2013-2015年)—快速演化(2016-2019年)—增长滞缓趋稳(2020-2021年)”3个主要阶段.(2)镇沅县乡村贫困地域系统时空演化模式以连续热点模式为主,加强的热点模式呈零星分布,表征2013-2021年镇沅县乡村贫困地域系统整体上经历了较快且连续稳定的减贫演化过程,是减贫政策普惠作用在时空演化模式上的具体表现;连续冷点模式和持续冷点模式呈现出县域东西两端集聚分布态势.(3)多维空间贫困陷阱主要集中在和平镇、者东镇、振太镇的部分村域,相关村域脱贫稳定性相对较差、返贫风险较高.乡村发展是乡村地域系统循环累积与动态演化的结果,深入刻画分析乡村贫困地域系统时空演化格局与特征,对于科学推动脱贫地区转型发展具有重要意义.

广东省县区级医院感染管理质量控制中心的现状调查

目的调研广东省县区级医院感染管理质量控制中心现实情况,为本省院感质控中心对县区级院感质量控制中心质控管理方案的制定提供参考依据,并探讨相应的管理对策。方法通过问卷星问卷调查平台对广东省2023年12月31日前成立的县区级质控中心进行调研,内容包括医院感染管理专业质控中心的成立时间、人员架构、信息化水平、管理、质控及培训工作情况等。结果广东省有68家县区级院感质控中心,覆盖率达50.37%,近五年成立的占95.59%。专家以临床和护理为主(分别占23.75%、62.97%),学历以本科为主(占71.06%)。仅13%有运行经费。39家已建医院感染信息化监测,23家未配备,6家在建。20家进行质控督导出具质控报告,占29.41%;41家举办培训,占60.29%。结论广东省医院感染管理质量控制组织体系县区级覆盖率正在稳步提升,但是未完全覆盖所有县区,缺乏政策、经费支持,人员配备、人员专业覆盖面不足。卫生健康行政部门及县区级院感质控中心需统一监测标准、质控规范及考核评价方案,提升院感质控能力,完善“四级”管理与培训体系,以有效推动提升基层医疗机构的质量安全管理水平。

高质量发展目标下脱贫县农业产业化与农地利用生态效率耦合协调分析:以江西省为例

探究脱贫县农业产业化与农地利用生态效率耦合协调关系,对促进农业高质量发展具有重要意义。基于新发展理念,以江西省25个脱贫县为研究对象,构建农业产业化与农地利用生态效率耦合评价体系,借助耦合协调模型和泰尔指数模型测度两者的耦合协调水平及其区域差异。结果表明:(1)2011—2020年,江西省脱贫县农地利用生态效率总体水平较高,年均值为0.738,赣南地区高于赣中和赣北地区;(2)2011—2020年,江西省脱贫县农业产业化发展指数总体水平较低,年均值为0.414,赣北地区最高,其次为赣中,赣南最低;(3)2011—2020年,脱贫县农业产业化与农地利用生态效率耦合协调指数由期初的0.321升至期末的0.342,总体处于中度失调和轻度失调阶段;(4)脱贫县地区内差异对泰尔指数总体贡献最大,县域农业发展协调性较弱。进一步分析可以发现,市场与政府的作用差异是导致农业产业化水平与农地利用生态效率存在差异的主要原因,综合运用行政和市场手段推动农业产业化发展是提高两者耦合协调水平的关键。

区县级医院学科发展竞争力指标体系研究

目的:构建一套科学实用的区县级医院学科发展竞争力评价指标。方法:基于PEST+SWOT分析法探索区县级医院学科发展关键要素及其运行机制,初筛学科发展竞争力指标体系;运用德尔菲法开展两轮专家咨询确定指标体系及权重。结果:该指标体系包括一级指标4个维度(医院管理及综合实力、人才队伍建设、科研创新、教育培训)、二级指标16个、三级指标38个。两轮专家咨询积极系数均为100%,各指标评分变异系数CV值均<0.2,专家协调程度较高,专家权威系数分别为0.94和0.91;各指标第二轮专家评分均值>3.8,大多数指标得分4以上。结论:经专家反馈和统计检验,该指标体系具备科学性和实用性。

元江县羊肠道寄生虫感染调查及危险性因素分析

采用饱和盐水漂浮法和流行病学的“病例-对照研究”对元江县羊肠道寄生虫感染现状进行调查和危险性因素分析。在元江县10个乡(镇)22个养殖场(户)所采集的339份羊新鲜粪便样本中,寄生虫卵囊总检出率为93.51%(317/339),其中线虫卵检出率为24.48%(83/339),球虫卵囊检出率为69.03%(234/339),混合感染虫卵囊检出率为20.06%(68/349),未检出吸虫虫卵;不同区域、品种羊肠道寄生虫卵囊检出率也有所差异。危险性因素分析显示,成年羊线虫、球虫及混合感染虫卵囊检出率分别是羔羊的2.47倍、2.84倍、2.31倍,表明元江县羊年龄因素与羊肠道寄生虫病流行有中等程度的关联;母羊线虫、球虫及混合感染虫卵囊检出率分别是公羊的1.11倍、1.09倍、1.21倍,表明元江县羊性别因素与羊肠道寄生虫病流行有弱程度的关联;高海拔球虫、线虫及混合感染虫卵囊检出率分别是低海拔的2.19倍、1.9倍、2.09倍,表明元江县海拔高度与羊肠道寄生虫病流行有中等程度的关联;温热气候条件下线虫、球虫及混合感染虫卵囊检出率分别是寒冷气候条件下的2.45倍、2.45倍、2.14倍,表明元江县气温与羊肠道寄生虫病流行有中等程度的关联。

“省直管县”财政改革与企业投融资期限错配

“省直管县”财政改革对企业投融资期限错配的影响没有引起研究重视。首次利用“省直管县”财政改革的准自然实验,借助“固定资产投资-流动负债”敏感度方程,实证评估了“省直管县”财政改革对企业投融资期限错配的影响。多期双重差分结果显示,“省直管县”财政改革显著增强了固定资产投资对流动负债的正向敏感度,表明“省直管县”财政改革加剧了企业投融资期限错配。该结论在经过排除同期政策影响、处理效应异质性讨论、其他稳健性检验与安慰剂检验等多种稳健性检验后依然成立。机制分析表明,“省直管县”财政改革加剧了政企融资竞争,显著降低了企业长期融资的可得性。异质性分析显示,影响效应在改革强度大与经济财政实力弱的地区以及融资约束严重的企业更为突出。结论的政策启示是推进“省直管县”财政改革要兼顾市县利益,处理好简化政府层级与微观经济运行风险的关系。

“乡财县管”背景下乡镇人大监督的优化路径

“乡财县管”背景下,乡镇人大监督存在人员虚位、权力虚置、监管虚化等问题。面对中国式现代化的目标要求以及新一轮财税体制改革的规划部署,应提升乡镇人大监督队伍履职能力,激发乡镇人大监督人员的履职内生动力,规范创新乡镇人大监督方式,切实加强乡镇人大监督的机制保障和现代化监督方式的应用,在发展全过程人民民主中促进基层财政监督提质增效。

“遇邪”与清代假命案的形成与处理——以《巴县档案》为中心的讨论

有清一代,凡最终确定并不构成关系人犯罪的命案称为假命案。在对假命案的处理过程中,涉案人及州县官员均有借用“遇邪”之类理据来促成案件和解的行为。虽然百姓以死者“遇邪”为由和解命案的背后多隐含金钱因素的推动,但知县为了顺利结案,对于这一结果往往乐见其成,甚至在审案过程中还存在一些主动引导涉案人确认死者遇邪身亡之举。然而,由于朝廷以儒家思想规范社会,总体上不容妖邪鬼怪之说,州县在上呈详文中又往往隐去“遇邪”的死因记录,以致档案记载的司法状况多呈混乱。在当时社会环境下,此类司法实践存在一定的合理性,但同时也必须看到,这种司法实践会造成案情中许多对社会生活史和法制史研究有重要意义的真实细节的遗失。

秀山县水稻病虫害防控成效植保贡献率评价试验

水稻病虫害防控是确保水稻产量的重要措施。为客观评价水稻病虫害防控成效,2023年秀山县组织开展水稻病虫害防控成效植保贡献率评价试验,试验设置完全不防治、严格防治、统防统治和农户自防区共4个处理。结果表明,统防统治区植保贡献率为53.49%,农户自防区为45.58%;按照严格防治区、统防统治区、农户自防区面积各占比15%、35%、50%测算,县域(水稻)植保贡献率为50.66%。2023年秀山县水稻病虫害防控共计挽回产量损失6.97万t,成效十分显著。