The Psychological Experience of the Nursing Staff of the Medical Oncology Department in Cameroon: Case of the YaoundéGeneral Hospital

Background: The world of cancer care is an emotional place, given the severity of the disease being treated, the heavy workload, the suffering of patients, and the high number of deaths. The nursing staff who work there may be exposed to constant stress from these factors. This study aimed to explore the psychological experience of the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Methods: We carried out a cross-sectional study, in June 2017, involving the nursing staff of the Medical Oncology Department of the Yaoundé General Hospital. Results: Sixteen out of 18 nurses were interviewed. All had worked in at least one other department prior to Oncology. The number of years of experience in Oncology ranged from less than one year to 13 years. The choice of the Oncology department was involuntary for 100% of the staff;of these, 62% had intentions of changing departments. Twenty-five percent had applied for a change of department, which was unsuccessful. Stress was expressed by 94% of the staff;93% thought that there was a solution to the stress experienced on a daily basis in the Oncology department. The main solutions proposed to manage this stress were: support for the staff, provision of work materials, and staff training. Conclusion: The nursing staff of the Medical Oncology Department of the Yaoundé General Hospital experiences a high level of stress and are in need of solutions.

Acute Fevers in the Medical Unit of the Medical-Surgical Emergency Department of the Donka National Hospital

Introduction: Fever is a high core temperature ≥ 37.5°C in the morning and 37.8°C in the evening. It is acute when it evolves from 0 to 20 days. Very common in clinical practice, the etiological diagnosis, particularly in developing and tropical countries, is often a challenge for clinicians due to their diversity and the limited availability of diagnostic tools. There is a wide spectrum of etiological diagnoses including infectious causes and non-infectious causes. The aim of this study was to investigate the etiology of fevers acute at the medical unit in the medico-surgical emergency department of the Donka National Hospital. Methods: This was a descriptive cross-sectional study lasting 03 months (January 01, 2022 to March 31, 2022). We included in this study all patients seen in the medical unit, whose age ≥ 18 years, without distinction of sex, from any origin, with an axillary temperature ≥ 37.5°C in the morning and 37.8°C in the evening, evolving from 0 to 20 days, hospitalized or followed on an outpatient basis, and having given verbal consent. Results: Of a total of 1087 patients seen, 466 had an acute fever. The mean age was 40.04 ± 18.91 years (18 and 96 years). The female sex (58.15%) was predominant with a sex ratio of 0.72. Malaria (50.86%) was the main diagnosis. The treatment consisted of compressed paracetamol (59.01%), arthemether + lumefantrine (50.85%). Conclusion: The incidence of acute fevers is high in the medical unit of the medico-surgical emergency department of the Donka National Hospital. Malaria was the main pathology. Treatment was etiological and symptomatic. This high incidence could be explained by the fact that Guinea is an endemic malaria zone. A study taking into account other etiological factors would be of great interest.

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.

Clinical profile of medication-related emergencies among patients presenting to the emergency department:An observational study

Objective:To determine the clinical profile of patients presenting with medication-related emergencies to the Emergency Department of our institute.Methods:This was an observational study conducted between November 2018 and September 2020 at Bangalore Baptist Hospital,Karnataka.A total of 138 subjects who satisfied the inclusion criteria were included in the study.The severity of adverse drug reactions(ADR)is assessed based on the Hurwitz severity assessment scale of ADR.Glasgow coma scale at the time of presentation and source of medication were noted.The type of drug overdose,requirement of advanced airway and vasopressors,and the outcome were also assessed.Results:Among medication-related emergencies(n=138)in our study,ADR contributed to 70.3%(n=97)of the study population,and drug overdose accounted for 29.7%(n=41).One-third of the ADR occurred in patients aged above 60 years.Most patients were hemodynamically stable and did not require vasopressors,or advanced airway in both groups.Most patients had Glasgow coma scale ranging from 13-15 in both groups.Nonsteroidal anti-inflammatory drugs were the most used medicine(17/41,41.5%)and most medications were over the counter drugs(25/41,61.0%)in the drug overdose group;meanwhile in the ADR group,anti-diabetic medication was the most used medicine(34/97,35.1%)and most medications were prescribed in the ADR group(93/97,95.9%).Conclusions:Our study shows that ADR is the most common type of medication-related emergency.

Rate of Inappropriate Imaging Utilization by the Emergency Department in Community Hospitals

Objective: To retrospectively analyse the use of imaging studies in the Emergency Department of community hospitals using evidence based guidelines and clinical judgement. Methods: Medical records of 661 patients who visited the Emergency Department (ED) in 2015 and underwent imaging studies were reviewed. The Canadian Association of Radiologists, American College of Radiologists and Choosing Wisely Canada guidelines were used to determine the appropriateness of imaging studies. The use of prior patient imaging, the rate at which studies were repeated and the respective impacts on patient management of the imaging studies were also examined. Results: Of the 1056 imaging studies reviewed, 228 (22%) were found to be clinical situations where no imaging study was indicated while 168 (16%) were considered a suboptimal choice of imaging study or modality. When no study was recommended, a positive impact on the diagnosis was noted in 105 (46%) cases and on patient management 83 (36%) times. Notably, 219 (21%) patients had a relevant examination performed in the last 30 days, and 147 (14%) reports noted that the results of the prior study also concurred with the imaging study evaluated. Conclusion: In this study, 228 (22%) radiographs and CT studies, excluding MVC related imaging and extremity imaging, were not indicated based on appropriateness criteria and consequently had a limited impact on patient management. This supports the need for increased clinical decision support for ED physicians, regional health information exchanges and consideration of Computerized Physician Order Entry in the ED with embedded appropriateness criteria at the point of ordering.

Probabilistic Antibiotic Therapy in the Infectious Diseases Department of the Yalgado Ouédraogo University Hospital (CHU-YO) in Ouagadougou, Burkina Faso

Introduction: In Burkina Faso, as in most developing countries, limited access to biological tests forces practitioners to resort very often to probabilistic antibiotic therapy. The objective of this study is to determine the extent of this prescription. Patients and Methods: This was a cross-sectional study with retrospective data collection of patients hospitalized in the infectious diseases department in the period from January 1, 2005 to December 31, 2020. The records of patients who received probabilistic antibiotic therapy were included. Results: During the study period, 330 patients had received probabilistic antibiotic therapy. The majority of patients were male (53%), with a sex ratio of 1.12. The mean age of the patients was 33 years ± 14. The age range of 20 to 40 years was the most represented (42%). Fifteen percent (15%) of patients were living with HIV. The majority of patients were from urban areas (56.4%). Forty-nine percent (49%) of the patients worked in the informal sector. Clinically, the reasons for consultation were dominated by fever, alteration of general condition, neurological disorders, digestive disorders, respiratory signs, urinary signs and diffuse pain. The physical examination showed that 48.1% of the patients had meningeal irritation syndrome, 10% had convulsions and 10% had focal signs, trismus was present in 4% of the patients and facial paralysis in 3%. In the digestive system, hepatomegaly was present in 29% of patients and digestive candidiasis in 31%. Respiratory examination showed crepitus and fluid effusion syndrome in 26.83% and 20.62% of patients respectively. The presumptive diagnosis was dominated by bacterial meningitis, salmonellosis and bronchopneumonia with banal germs. In terms of treatment, the beta-lactam family of drugs was the most prescribed. They were followed by aminoglycosides and fluoroquinolones. The evolution was marked by the death of 50 patients (15%). Conclusion: The most prescribed molecules belong to the family of Beta-lactam. And this prescription improved the outcome of patients. Bacterial susceptibility studies will allow better orientation of probabilistic antibiotic therapy in order to limit the emergence of multi-resistant bacteria.

The Department of Otolaryngology Head and Neck Surgery,PLA General Hospital (national key academic unit) The PLA Institute of Otolaryngology (PLA key laboratory for acoustic trauma) The PLA Medical College Department of Deafness Education Key Laboratory

Led by four generations of leadership from late Prof.JIANG Sichang(academician,Chinese Academy of Engineering),Prof.YANG Weiyan(Honorary President,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association),Prof.HAN Dongyi(President Elected,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association)to now Prof.YANG Shiming(President,Division of Otolaryngologists,

To Carry out Drug Consultation to Improve the Quality of Pharmacy Service in Outpatient Pharmacy

Objective:to explore the development of drug counseling service,strengthen the quality of pharmacy service in outpatient pharmacy,better service to patients,promote harmonious relations between doctors and patients.Methods:to analyze the necessity of drug consultation in outpatient pharmacy,in order to improve the quality of pharmacology service in outpatient pharmacy,we will discuss how to effectively provide drug counseling to improve the pharmacological service quality of outpatient pharmacy.Results:the implementation of the complete drug consultation process can effectively improve the quality of pharmaceutical work in outpatient pharmacy.Improve the patient's satisfaction with pharmaceutical work.Conclusion:with the perfection of the medical system,improving the quality of pharmaceutical service in outpatient service,and improving the quality of medical consultation,make it more systematic,normalization is important,only improving the quality of outpatient pharmacy service and strengthening the development of drug consultation work,to achieve the common progress of medical services.

The Application of the “3 + 1” Mode in the COVID-19 Epidemic Prevention and Control at the Infection Ward of a Designated Comprehensive Hospital for COVID-19 Treatment

Objective: We assess the application effect of the “3 + 1” mode in the COVID-19 epidemic prevention and control at the infection ward of a designated comprehensive hospital for COVID-19 treatment. Method: Based on the features of the inpatients of the infection ward and their relatives, a “3 + 1” mode for the COVID-19 prevention and control is developed to conform to the demands for epidemic prevention and control and the overall prevention and control scheme of the whole hospital. Here, “3” stands for the epidemic prevention and control system, personnel management, and prevention and control measures;“1” stands for COVID-19 testing. Result: From March 1, 2020 to March 31, 2021, a total of 3056 patients were hospitalized in the three infection wards. Among them, 265 patients had a fever, and 113 patients had respiratory symptoms. None of them were infected with COVID-19. The participation rate of the test about the knowledge related to COVID-19 and the knowledge mastery rate were both 100% among the medical staff. None of the inpatients and their companions or the medical staff was diagnosed with COVID-19. Conclusion: Thus the “3 + 1” mode proves successful for avoiding nosocomial infection and the spread of the epidemic.

Department of Otolaryngology Head and Neck Surgery of Chinese PLA General Hospital (National Key Discipline)

Institute of Otolaryngology of Chinese PLA ( Key Laboratory for the Prevention of Acoustic Trauma,PLA)Key Laboratory of Hearing Impairment Science(Chinese PLA Medical School)Ministry of Education Led by four generations of leadership from late Prof. JIANG Sichang (academician, Chinese Academy of Engineering), Prof.YANG Weiyan (Honorary President, Division of Otolaryngology

Application and Exploration of BPR Theory in Hospital Financial Management under Informatization

In recent years,people's work and life have been unable to break away from the application of technology and information industry.However,the booming and huge influence of big data and information age has a greater impact on people.In this form,the traditional model of public hospitals has a huge collision with it,so it actively seeks a way out and actively develops it.In the subsequent development,it needs to abandon the financial management mode of inefficiency,energy consumption,etc.,advanced financial management model to improve the financial management of public hospitals.This paper mainly studies the application and exploration of BPR theory in hospital financial management under the informationization.Firstly,it discusses and analyzes the BPR theory in detail.Secondly,it combines the status quo of public hospitals to reconstruct the information management financial management plan.Before and after the comparison,the application is applied to the daily financial management of the hospital according to the actual situation.

Training of clinical pharmacists in psychiatric pharmacy services during the prevention and treatment of COVID-19

A series of pharmacy services of clinical pharmacists at the Wuhan Mental Health Center during the prevention and treatment of Coronavirus disease 2019(COVID-19),such as participation in the formulation of COVID-19 prevention and treatment plans suitable for psychiatric departments,popular science of pharmacy,medical order review,real-time intervention,and medication education are summarized here.Due to the sudden public health incident,the service model of psychiatric clinical pharmacists should be addressed,as clinical pharmacists are an important part of the diagnosis and treatment of psychiatric diseases.Among the majors currently available in the clinical pharmacy training base curriculum,no psychiatry major has been set up in China yet;therefore,in this paper,we provide guidance in psychiatry pharmacy for those who wish to integrate clinical teams.

Trends in mortality of emergency departments patients in China

BACKGROUND: Emergency medical service system (EMSS) in China is becoming more important. However, studies on mortality of emergency departments (EDs) patients in tertiary hospitals and on the trends in mortality of ED patients all over China are stagnant. The objective of this study was to quantify and describe the trends in mortality of ED patients in China. METHODS: Nine tertiary teaching hospitals were selected from tertiary teaching hospitals in different regions. The annual numbers of ED visits and deaths of these hospitals in 2004, 2009 and 2014 were recorded and analyzed. Chi-square test was used to compare the mortality of the EDs’ visits. Moreover, data on the mortality of ED patients in China from 2005 to 2015 were summarized and analyzed from the China Health and Family Planning Statistical Yearbooks (2006–2016). RESULTS: From 2004 to 2014, the overall annual mortalities in EDs increased among the tertiary hospitals (P<0.001). However, the overall annual mortality in EDs all over China decreased from 0.12% in 2005 to 0.08% in 2015. And the mortalities of EDs patients in the eastern, central and western regions of China all decreased. In addition, the average mortality of EDs patients in northern China was obviously higher than that in southern China (P<0.05). CONCLUSION: The ED mortality was increased in tertiary hospitals while decreased all over China during the past decade, which may be partly caused by some critical challenges faced by China’s EMSS, such as overcrowding and long length of stay in EDs of tertiary hospitals.

Experiences of Occupational Stress among Emergency Nurses at Private Hospitals in Bangkok, Thailand

Introduction: Occupational stress has negative effects on employee’s health and organizational productivity. Nurses in emergency department are more exposed to stress than nurses in other departments. Aim: To explore nurses’ experiences of occupational stress in emergency departments in private hospitals in Bangkok, Thailand. Design: A descriptive qualitative design, with a deductive approach based on the Job Demand-Control-Support model was used. Methods: Fifteen emergency department nurses at two different hospitals were interviewed and the data were analyzed using a manifest content analysis. Results: Three main categories: “work context is an issue”, “consequences of reactions to stress”, and “coping with work stress”, including seven sub-categories emerged from the data analysis. Conclusion: The patients’ and their relatives’ behaviors were experienced as the primary stressor at the private hospital, in addition to excessive work tasks. Other important stressors were misunderstanding and conflicts between emergency department nurses and the other health care professionals, presumably related to hierarchy and power relations between health care professions. Creating a better working environment and a balance between the number of patients and nurses would reduce workload and stress, encourage ED nurses to stay in the profession and ultimately maintain patient safety.

Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition

Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%;n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81;p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care;and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00;n = 122;91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.

Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic:A hospitalbased study

BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency department(ED)visits and hospital admission among kidney transplant(KT)recipients.AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand.METHODS We conducted a retrospective study at a university hospital in Thailand.We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19(from January 2020 to December 2021).We used the previous 2 years as the control period in the analysis.We obtained baseline demographics and ED visit characteristics for each KT patient.The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1^(st)year following a KT.The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model.RESULTS A total of 263 patients were included in this study:112 during the COVID-19 period and 151 during the control period.There were 34 and 41 ED visits after KT in the COVID-19 and control periods,respectively.The rate of first ED visit at 1 year was not significantly different in the COVID-19 period,compared with the control period[hazard ratio(HR)=1.02,95%confidence interval(CI):0.54-1.92;P=0.96].The hospital admission rate was similar between periods(HR=0.92,95%CI:0.50-1.69;P=0.78).CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic.Despite these findings,we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions,particularly in post-KT patients.

Developing Additional Hospital Capacity at the Community Level

Hospitals in the United States are being challenged to provide the capacity for adult medicine and surgery care. The study suggested that the hospitals of Syracuse, New York have generated additional inpatient capacity through a number of efforts. One program involved moving some low severity of illness inpatient procedures to ambulatory care. A different approach has also avoided inpatient utilization by diverting incoming ambulances to different providers. The third program evaluated in the study, length of stay reduction, was a different type of initiative. It has generated additional inpatient capacity by reducing the amount of inpatient care provided. In effect, it has increased inpatient capacity by addressing the efficiency of care. These programs illustrate the potential for improving hospital capacity at the community level. Each of them was developed by acute care providers using local services.

Pharmacy Service in Private Hospitals: Problems and Countermeasures

Objective To improve the quality of pharmacy service in private hospitals on the background of the fact that hospital pharmacy service is an important guarantee to promote rational drug use and the government encourages social capital to enter the field of pharmacy and healthcare, therefore, private hospitals are facing a new stage of development. Methods Questionnaire survey was used to sample and analyze 10 representative private hospitals in local area, and comparisons were made with the status of pharmacy service in level 3 public hospitals. Results and Conclusion It can be found that private hospitals have many problems in pharmacy services, such as the low level of professional skills of pharmaceutical personnel, low recognition and trust from patients, and the imperfect pharmaceutical management system. Some countermeasures and suggestions are put forward to promote the level of pharmacy services in private hospitals on the basis of this study.

基于内容分析法的临床药师岗位胜任力指标构建

目的 对国内外临床药师胜任力评价指标进行内容分析,为临床药师岗位胜任力构建提供参考。方法 检索国内外临床药师岗位胜任力相关文献,采用内容分析法对符合标准的文献进行分析。结果 最终纳入22篇文献及14篇胜任力评估框架及模型,提取个人素质、知识、个人能力、药学服务、教研5个一级类目、15个二级类目及61个三级类目。结论 初步构建了临床药师岗位胜任力指标体系,为临床药师开展实践工作提供参考。