Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data

AIM： To assess the association of measured gait speed with hemodialysis （HD） patients’ hospitalization, in conjunction with, and apart from, recent fall history.METHODS： Gait speed was measured by a standard protocol and falls during the past 12 mo were ascertained for a prevalent multi-center HD cohort （n = 668） aged 20-92. Hospitalization during the past 12 mo was identified in the patient’s clinic records, and the first hospitalization after gait speed assessment （or the competing event of death） was identifed in the 2013 United States Renal Data System Standard Analysis Files.characterized 34.7% of the patients, and 27.1% had experienced a recent fall. Patients with slow gait speed but without a history of recent falls were 1.79 times more likely to have been hospitalized during the past 12 mo （OR = 1.79, 95%CI： 1.11-2.88, P = 0.02）, and patients with slow gait speed and a history of recent falls were over two times more likely to have been hospitalized （OR = 2.10, 95%CI： 1.19-3.73, P = 0.01）, compared with patients having faster gait speed and no recent fall history. Prospective examination of gait speed/fall history status in relation to frst hospitaliza-tion （or death） incurred by the end of follow-up Decem-ber 31, 2011 also showed that slow gait speed was as-sociated with these events in conjunction with a history of falls （HR = 1.54, 95%CI： 1.04-2.30, P = 0.03）.CONCLUSION： The International Task Force on Nutri-tion and Aging reported that gait speed is a powerful predictor for older adults of adverse outcomes such as hospitalization. In our data, gait speed-apart from, as well as in conjunction with, recent fall history-was as-sociated with HD patients’ hospitalization for multiple causes. Gait speed may be a sensitive health indicator among HD patients across the age spectrum.

Interdialytic Weight Gain in Hemodialysis Patients: Worse Hospital Admissions and Intradialytic Hypotension

Introduction: Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. Method: Prospective clinical-observational study to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH. Results: Of the 240 patients, those who had IDWG ≥ 4%, 81% had at least one hospital admission due to volume-overload or the need for extra HD-session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p < 0.001). Of those who were admitted (over 12 months) due to volume overload;74.1% had IDWG ≥ 4%, while 25.9% had IDWG < 4% (p < 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p < 0.001). When analyzing those who had at least one IDH episode/week;72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG < 4% (p < 0.001). Conclusion: In HD patients, the frequency of hospital admission due to volume-overload and the need for extra HD-sessions is strongly related to the amount of IDWG (>4% in our patients), the same stands for the frequency of IDH. Thus, control of IDWG in HD patients is of great importance, keeping in mind the importance of the nutrition status of HD patients that may also impact IDWG.

Usefulness of a Simple Protein-Energy Wasting Score for Predicting Hospitalization in Maintenance Hemodialysis Patients: A Prospective Cohort Study

Background: Malnutrition is a strong predictor of prognosis in maintenance hemodialysis patients (MHD). We previously proposed a new and simple protein-energy wasting (PEW) score that appears to be useful for assessing the risk of mortality in patients on MHD. Objectives: In the present study, we evaluated the reliability of this PEW score as a predictor of hospitalization in Japanese patients on MHD. Methods: In this single-center, prospective cohort study conducted in Japan, PEW score was calculated for 180 MHD patients. PEW score ranged from 0 (best: S1) to 4 (worst: S4) and was calculated based on nutritional indicators including serum albumin, body mass index, serum creatinine level, and protein intake. The outcome was the number of hospitalizations during the 2-year study period. Results: Thirty-six patients were hospitalized during the study period. Kaplan-Meier curves showed there were fewer hospitalizations in the group with a PEW score of 0/1 than in the group with a score of 3/4. Multivariate analysis revealed a hazard ratio for hospitalization of 3.109 for S3/4 versus S0, 2.777 for S3/4 versus S1, and 2.048 for S3/4 versus S2. Conclusion: The new and simple PEW score is a useful predictor of hospitalization in MHD patients and is also useful for identifying subgroups of MHD patients with a high risk of mortality.

Criteria for Determining the Need for Admission of People with Dementia to Dementia Nursing Wards of Psychiatric Hospitals in Japan

Purpose: This study aims to establish criteria to determine the need for admission of people with dementia to dementia nursing wards of psychiatric hospitals—based on the experience of nurses working in dementia nursing wards. Methods: Semi-structured interviews were conducted with nurses who had worked in dementia nursing wards of psychiatric hospitals for more than 3 years, to collect data related to the “condition at the time of admission and the process of hospitalization of dementia patients”. Data were analyzed using the content analysis approach. Focusing on “What is the condition of patients with dementia admitted to the dementia nursing ward?”, we created codes according to similarities in the meaning, and classified these into categories where they were evaluated to fully fit in. Results and Discussion: The analysis yielded 4 categories, and 44 codes. The four categories are as follows: [Appearance of a state where self-control is difficult] which expresses a state where behavioral and psychological symptoms of dementia (BPSD) have appeared, and the remaining three categories [Insufficient support provided], [Appearance of symptoms that make living difficult], and [Appearance of physical symptoms that require treatment] express the states that may trigger the appearance of BPSD. These show that the appearance of BPSD is a criterion for determining hospitalization. By providing support to prevent the states described in the 44 codes, nurses may help people with dementia avoid being hospitalized in dementia nursing wards in psychiatric hospitals.

Outcome of In-Hospital Cardiac Arrest in Adult General Wards

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.

The healthcare environment—The importance of aesthetic surroundings: Health professionals’ experiences from a surgical ward in Finland

There is a growing acceptance of the vital role patient centered design plays in shaping the environment. Art can be of use in every area of health care. It is within the power of each person to share and interpret experience by means of the arts, by viewing the work of others, and by using feelings and imagination. Health professionals [n = 24 of a total of n = 35], answered the Wheel Questionnaire test instrument. It measures structure, motivation/engagement, and degree of emotional investment in a situation. Participants were requested to describe, in their own words, their perception of the enrichment of the ward interiordesign and the double-sided photos with a short poetic text, and the photo-book placed at each patient room. The results demonstrate that participants are motivated, structured and emotionally engaged when describing the new enrichment. The domains and themes are: Social interaction domain;rising thoughts and conversations. Comfort domain;atmosphere. Aesthetic do main;enrichment of the working environment. It could be concluded that the surgical ward environmental enrichment stimulated conversations between health professionals and between health professionals and patients and should be regarded as an important aspect in hospital planning.

综合性医院病区分类管理评价指标体系构建

目的:构建综合性医院临床病区分类管理指标体系,为科学评价岗位价值奠定基础、对护理岗位管理提供理论依据。方法:对综合医院病区分类管理主要构成要素进行分析,根据专科属性结合各临床病区的工作量、护理难度等因素选择客观、可测量的指标,采用德尔菲专家咨询法构建临床病区分类管理指标体系。结果:2轮函询分别向15名专家发出函询表,回收率均为100%。2轮专家函询有12名专家提出修改意见,专家权威程度为0.89。最终形成包括护理工作量、护理工作难度、护理职业风险和工作压力负荷4个一级指标、11个二级指标、33个三级指标的评价体系。结论:构建的综合医院病区分类管理指标可为临床病区分类及临床护理管理实践提供理论基础。

An artificial intelligence diabetes management architecture based on 5G

Along with the development of 5G network and Internet of Things technologies,there has been an explosion in personalized healthcare systems.When the 5G and Artificial Intelligence(Al)is introduced into diabetes management architecture,it can increase the efficiency of existing systems and complications of diabetes can be handled more effectively by taking advantage of 5G.In this article,we propose a 5G-based Artificial Intelligence Diabetes Management architecture(AIDM),which can help physicians and patients to manage both acute complications and chronic complications.The AIDM contains five layers:the sensing layer,the transmission layer,the storage layer,the computing layer,and the application layer.We build a test bed for the transmission and application layers.Specifically,we apply a delay-aware RA optimization based on a double-queue model to improve access efficiency in smart hospital wards in the transmission layer.In application layer,we build a prediction model using a deep forest algorithm.Results on real-world data show that our AIDM can enhance the efficiency of diabetes management and improve the screening rate of diabetes as well.

广东省三级综合医院优质护理服务评价指标的构建

目的构建广东省三级综合医院优质护理服务评价指标,为促进优质护理服务评价工作和规范优质护理服务提供参考。方法基于文献检索的基础上,应用头脑风暴法并借鉴国内已有的相关制度、标准和政策构建出评价指标条目池和问卷初稿;采用德尔菲法对评价指标进行两轮专家函询。结果两轮专家函询的回收率分别为80.00%和91.67%;权威程度系数均为0.93,医院部分Kendall协调系数W分别为0.128和0.116,病区部分分别为0.193、0.107,差异具有统计学意义(均P<0.001)。第2轮函询医院各指标的重要性均数为(4.43~5.00)分。第2轮函询病区各指标的重要性均数为(4.59~5.00)分。构建的广东省三级综合医院优质护理服务评价指标包括医院和病区两个部分,其中医院部分包括一级指标8项、二级指标22项、三级指标65项,病区部分包括一级指标9项、二级指标23项、三级指标50项。结论本研究编制的广东省三级综合医院优质护理服务评价指标具有较好的科学性和可靠性,有利于完善优质护理服务管理制度,引导优质护理服务健康发展。

某大型公立医院医养结合模式实践探索

随着人口老龄化程度的加深以及医疗需求的增加,家庭病房作为一种医养结合服务模式逐渐受到重视,成为一种对医疗资源紧缺的重要补充手段。广东省第二人民医院建设智慧家庭病房,探索实践医养结合“互联网+养老”新模式。本文以广东省第二人民医院建设智慧家庭病房的医养结合实践为对象,探索分析公立医院医养结合“互联网+养老”模式在应用中存在的问题,并提出相应的对策建议。

多院区医院床位效能优化评测实践与探索

目的科学合理设置病房布局和规模,实现床位效能最优化。方法选取医院2022年住院统计报表及DRG相关数据,包括出院人次、实际占用床日数、床位使用率、病床周转次数等。运用指数分布图将全院病区分为四类,建立床位工作效率模型和病床产出效率模型,并引入CMI指标进行调整。结果医院有40%的病区位于“效率型”象限,5.3%位于“压床型”象限,28%位于“周转型”象限,26.7%位于“空置型”象限。经CMI调整后的病床产出效率、病区布局显著改善,实现了资源的优化配置。结论通过床位工作效率和病床产出效率进行床位合理区间估算,结合实际情况进行适时床位调整和人员调配,有效提升了医院运营效率。

社区血液透析中心临床决策支持系统的全流程构建与应用

目的:设计一种临床辅助决策支持系统用于社区血液透析中心的管理,并评价其应用效果。方法:构建临床辅助决策支持系统,该系统具备实时数据采集、智能预警、远程指导等技术特点。采用系统可用性问卷(PSSUQ)评价该系统的可用性及满意度,并比较实施该系统前后两组患者血液透析敏感质量指标。结果:在系统的评价中,PSSUQ单项题目平均得分及99%置信区间均低于平均数3.5分的分界点,单项题目平均得分和4个维度得分均低于PSSUQ最佳基准;实施后患者血液透析敏感指标均有不同程度的改善。结论:临床辅助决策系统具有较高的可用性及满意度,能够显著提升患者透析质量,减少不良事件的发生,具有良好的应用前景。

婴儿家庭病房对新生儿高胆红素血症结局影响的分析

目的分析新生儿高胆红素血症患儿在婴儿家庭病房和普通病房中治疗效果的异同,为推广婴儿家庭病房提供依据。方法选取2022年1—12月佛山市妇幼保健院婴儿家庭病房收治的183例新生儿高胆红素血症患儿为研究对象,随机抽取同期普通病房183例新生儿高胆红素血症患儿做对比,回顾性分析2种类型病房新生儿高胆红素血症的治疗效果。结果婴儿家庭病房收治患儿平均胎龄(38.22±1.21)周,出生体质量(3181±395)g,入院时的日龄(4.51±1.36)d,血清胆红素水平(266.87±35.16)μmol/L;普通病房患儿平均胎龄(38.17±1.39)周,出生体质量(3139±426)g,入院时的日龄(4.26±1.37)d,血清胆红素水平(262.86±37.55)μmol/L,2组比较,差异均无统计学意义(P>0.05)。婴儿家庭病房15 d再入院5例,普通病房12例,2组比较差异无统计学意义(P>0.05)。婴儿家庭病房母乳喂养181例,普通病房13例,2组比较差异有统计学意义(P<0.05)。婴儿家庭病房并发症(皮疹、腹泻)6例,普通病房并发症(皮疹、腹泻)22例,差异有统计学意义(P<0.05)。婴儿家庭病房非常满意179例,普通病房非常满意160例,差异有统计学意义(P<0.05)。结论婴儿家庭病房减少母婴分离,更有利于母乳喂养及母婴康复,可以缩短新生儿高胆红素血症患儿住院时间,减少并发症的发生,对家属满意度产生正性影响。

医院物流机器人洁净被服配送场景的探索与实践

目的 探索医院物流机器人配送洁净被服的适配性和应用价值。方法 分析院内日间病房洁物运输场景下传统物流运送的需求和痛点,通过试用机器人,对比、评估机器人与传统人工配送在主要效果评价指标方面的差异,及在洁净被服配送场景下的适配性和应用价值。结果 相较于传统人工配送模式在日间病房洁物配送任务中的主要表现,物流机器人均次配送时间缩短,送达准确率大幅提升,人力成本节约显著,感染风险较低,关键用户体验感更佳。结论 物流机器人在病房洁物配送中具有明显的优势,能够提高物流效率,减轻人员负担,提升服务质量,降低感染风险。

中医院病区院感管理指标体系构建研究

目的:构建适合三级中医院普通病区的医院感染管理质量评价指标体系,以全面、客观评价病区医院感染防控工作。方法:通过梳理病区医院感染管理相关标准规范、查阅文献及研究小组讨论,初步拟定病区医院感染管理指标内容与定义。采用2轮改良德尔菲专家咨询法,函询收集全国22家三级中医院院感专家意见,确立指标体系。用AHP层次分析法计算各级指标的权重,肯德尔协调系数(Kendall’s W)评价专家对指标设置意见的协调性。结果:构建了共包含11个一级指标、66个二级指标及定义的指标体系,AHP判断矩阵满足一致性检验(CR值=0.000)。一级指标中,“诊疗用品处理”“标准预防与职业暴露”“医院感染报告与监测”“医院感染高风险环节防控”“传染性病原体与多重耐药菌相关感染防控”5项权重度最高,均为0.0931。两轮函询后,Kendall’s W一级指标为0.225,二级指标为0.186,P值均<0.01。结论:研究构建的病区医院感染管理指标体系,专家意见协调一致性高,可作为中医院病区感染管理与防控工作开展与评价的参考。

智慧医院建设下“外科一张床”模式的构建与应用

目的:在保证诊疗质量的前提下,推行“外科一张床”模式,实现多科室跨病区收治患儿,提升床位利用率。方法:调研“外科一张床”模式下临床医护人员以及患者的痛点,综合考虑业务管理、绩效分配、临床操作等要素,设计符合浙大儿院的“外科一张床”创新服务模式。结果:“外科一张床”模式上线两月内,浙大儿院外科跨病区收治患者数量共计186例,平均入院等待时间下降25.34%,病床使用率由82.56%上升至88.10%。结论:“外科一张床”模式的推行,实现了医院床位的高效利用,降低了患者入院等待时间,提高了患者满意度。

PDCA循环在公立医院综合查房问题整改中的应用与成效

东莞市滨海湾中心医院将PDCA循环应用于综合查房问题整改,针对综合查房问题整改存在的缺陷,通过“分析问题,制定计划”“实施计划,解决问题”“持续检查,跟踪问效”“提炼标准,总结经验”四个阶段的持续循环改进,打通了跨组织、跨层级的业务协同壁垒,提高了领导决策力和部门执行力。应用后,查房问题的整改率显著提高,临床医技科室对查房问题整改平均满意度明显改善,查房工作取得较好实效;同时进一步健全了医院管理制度、规范了工作流程。做到以问题为导向,切实解决好影响人民群众的就医体验以及困扰医院持续发展的重点与难点问题,从根本上提高了服务品质,赋能医院高质量发展。

基于场景理论的病区物流机器人设计策略

为医院病区提供更好的物流配送服务效率和用户体验,助力病区服务实现智能化、数字化升级。利用场景化设计流程与方法,提出场景驱动下的病区物流机器人产品系统设计流程。在场景构成要素模型引导下挖掘和梳理病区物流场景设计需求,推导出产品系统设计定位。探索场景化视角下病区物流机器人需要从物流功能性,场景适应性,服务数字化以及人机交互体验四个维度展开的设计策略。为公共场景下智能设备的设计研究提供新思路。

“知信行控修”管理模式在病区医院感染中的应用研究

本文主要以《病区医院感染管理规范》作为研究的理论依据,引入健康教育“知信行控修”模式作为理论支撑,使用多种形式的宣传教育从而对医务人员起到培训的效果,最终加强病区医院感染管理工作。这种工作模式可以更好地提升病区医院感染管理的工作力度,让工作人员进一步巩固、推进落实感染管理质量。同时,这一管理模式目前也存在一定的优化与改进方向,在研究过程中,通过不断的优化与调整,提出“知信行控修”管理全新模式。文章主要的目的在于讨论这一模式对病区医院管理的实际效果以及应用策略,希望可以起到参考的作用与意义,为我国病区医院感染管理起到一定的参考作用。

终末期肾病新入血液透析患者再住院影响因素及其风险预测模型

目的探讨终末期肾病(ESRD)新入血液透析患者再住院的影响因素,据此构建风险预测模型。方法选取2015年1月—2020年5月ESRD新入血液透析194例,根据透析1年内有无再住院分为住院组(113例)与非住院组(81例)。收集2组临床资料,采用多因素Logistic和Lasso回归分析ESRD新入血液透析患者再住院的影响因素,利用列线图构建其风险预测模型,校正曲线和受试者工作特征(ROC)曲线对风险预测模型进行评估。结果住院组与非住院组年龄、体质量指数(BMI)、糖尿病肾病、血管通路、血尿素、血肌酐、血尿素下降率、肾小球滤过率(eGFR)、血红蛋白(Hb)、白蛋白(Alb)、B型脑钠肽(BNP)、C反应蛋白(CRP)、血清铁蛋白、尿素清除指数(KT/V)比较,差异有统计学意义(P<0.05,P<0.01)。将上述指标纳入Lasso回归分析,得出10个因素:年龄、BMI、糖尿病肾病、血管通路、eGFR、Hb、Alb、BNP、CRP、KT/V。年龄、糖尿病肾病、血管通路为导管、BNP、CRP是ESRD新入血液透析患者再住院的独立危险因素,BMI、eGFR、Hb、Alb、KT/V是其独立保护因素(P<0.05,P<0.01)。基于以上因素构建患者再住院的风险预测模型,校正曲线、ROC曲线评估该模型具有较高一致性和预测价值。结论ESRD新入血液透析患者再住院影响因素包括年龄、BMI、糖尿病肾病、血管通路、eGFR、Hb、Alb、BNP、CRP、KT/V,利用上述因素构建患者再住院风险预测模型,该模型具有较高预测价值。