Analysis of High Alert Medication Knowledge of Medical Staff in Tianjin:A Convenient Sampling Survey in China

The current situation of medical staff＇s awareness about high alert medication was investigated in order to promote safe medication and standardized management of the high alert medication in China. Twenty questions were designed concerning elementary knowledge of high alert medications, storage management, medication issues and risks. In order to understand the knowledge level and education status of high alert medication, a convenient survey was conducted among 300 medical staffs in Tianjin. Medical staff＇s average score of high alert medication knowledge was 12.43±0.27, and the average scores of elementary knowledge of high alert medication, storage management, medication issues and risks were 3.38±0.11, 2.46±0.14, 3.17±0.11 and 3.41±0.12 respectively. Occupation（F=4.86, P=0.003）, education background（F=5.57, P=0.019） and professional titles（F=13.44, P≤0.001） contributed to the high alert medications knowledge scores. Currently, the most important channel to obtain high alert medication knowledge was hospital files or administrative rules, and clinical pharmacist seminars were the most popular education form. It was suggested that the high alert medication knowledge level of the medical staff needs to increase, and it might benefit from targeted, systematic and diverse training to the medical staff working in the different circulation nodes of the medications. Further research to develop and validate the instrument is needed.

Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Long-term outcomes of high-risk elderly male patients with multivessel coronary disease： optimal medical therapy versus revascularization

Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

High Alert

THE threat of militant Islamist group Boko Haram in far north Cameroon is impacting many foreign-invested projects in the region. It has prompted the authorities to beef up security to protect foreign citizens and their work. which is vital in achieving the development goals of the country. Chinese workers and operations in Cameroon have been part of those affected by the security threats. In May 2014, Boko Haram militants kidnapped 10 Chinese road construction workers in Waza, about 20 km from the border with Nigeria. killing a soldier. The hostages were freed in October 2014,

高质量发展视角下灵活就业人员参加职工医疗保险的三重维度

灵活就业人员参加职工医疗保险是推动社会保险制度高质量发展的内在要求。从纳保维度来看,灵活就业人员参加职工医疗保险既是基于团体性社会保险“领薪就业”参保逻辑的法理考量,也是基本医疗保险参保扩面、保障灵活就业人员医保待遇权的必要之举。从缴费维度来看,职工医疗保险对灵活就业人员财产权的限制须置于比例原则框架内进行审查,未来在实现短期“各保其保”的基础上可通过降低缴费基数下限、确立灵活的缴费方式、强化保费补助以减轻灵活就业人员的缴费负担。从给付维度来看,应基于职工医疗保险法律关系的法定之债属性逐步取消医保待遇等待期,统一累计最低缴费年限以保障灵活就业人员的退休医保待遇,构建职工医疗保险疾病津贴制度填补灵活就业人员的因病收入损失。

高质量发展背景下公立医院医疗设备档案管理实践与思考

加强大型医疗设备档案管理对于优化医疗设备资源配置、提升医疗设备的社会效益和经济效益、有效推进公立医院高质量发展都具有重要意义。笔者系统分析当前公立医院档案管理现状,聚焦于医疗设备档案管理建设中存在的问题,包括:重视不足、制度执行不到位、信息化程度不高、档案功能没有得到充分应用等。针对上述问题,笔者建议应完善制度建设、建立考评机制、推进信息化建设、充分发挥档案价值以及加强人才培养助力医疗设备档案管理,有效防范和管控大型医疗设备相关的医疗质量风险、廉政风险和经济运营风险,有效提升公立医院服务效能,推动公立医院高质量发展。

面向不平衡医疗数据的多阶段混合特征选择算法

为解决医疗数据中存在的特征高维和类别不平衡问题,在基于简单、快速和有效高维特征选择算法SFE(simple,fast and effective high-dimensional feature selection)的基础上,提出了一种面向不平衡医疗数据的多阶段混合特征选择算法HFSIM(hybrid feature selection for imbalanced medical data)。HFSIM算法采用改进的自适应边界SMOTE过采样技术,生成符合边界条件的新少数类实例以解决医学数据中类不平衡问题。同时,为了改善搜索空间多样性不足的问题,优化了SFE算法中的非选择操作符率参数UR(unselected rate),有效避免了算法过早收敛及易陷入局部最优的问题。将过滤式Fisher Score方法与优化UR参数后的算法有效结合,使算法能以较低的计算成本获得较好寻优能力。经实验验证,相比于SFE算法,HFSIM算法在Ovarian数据集上准确率达到99.67%,提升了2.11个百分点,G-means和F1分别提升了5.13和2.30个百分点。此外,通过对比特征数量和运行时间,证明了HFSIM算法既能保证算法精度又有效降低了计算成本。

供应链视角下高值医用耗材集采执行问题分析和政策建议

目的:系统梳理我国高值医用耗材集采执行存在的问题,提出完善建议。方法:基于供应链视角,从生产、供应、使用、费用报销4个环节分析高值医用耗材集采执行存在的问题。结果:集采背景下,高值医用耗材在可获得性、产品使用、医保支付方面存在问题,影响了集采政策的落地。结论:在供应环节明确配送费用和配送标准,在使用环节探索中选产品医疗服务项目调整的绿色通道、建立医用耗材库存信息化系统,在报销环节加强医保支付标准协同,从而推动高值医用耗材集采执行工作的健康发展。

某大型综合公立医院运营管理模式构建与实践探索

提升运营管理精细化水平是推动医院高质量发展的内在要求。某大型综合公立医院创新管理机制,构建全方位系统化运营管理模式,在专题运营分析、精细成本核算、优化绩效考核等方面采取系列举措,关键运营指标持续向好,有效促进了医院运营管理科学化、规范化和精细化。介绍了其运营管理模式和实践探索举措,为公立医院提升运营管理水平提供参考。

优质医疗资源下沉基层现状及其对策研究

目的分析重庆市石柱县桥头镇优质医疗资源下沉基层现状及存在的问题,提出针对性的建议与对策,促进优质医疗资源下沉。方法随机抽取330名桥头镇村民开展问卷调查,选取5名桥头镇卫生院工作人员进行定性访谈,采用SPSS 26.0和MAXQDA软件对数据进行分析。结果桥头镇优质医疗资源下沉初见成效,但整体来说仍面临优质医疗资源下沉方式单一、地方财政资金投入不足、卫生院基础建设落后、人才匮乏且专科能力不强、村民就医选择行为固化等问题。结论要加大对桥头镇卫生院财政资金投入力度,强化机构人才队伍和医院信息化建设,完善下沉机制,做好村民医疗政策及健康教育宣传工作等,促进优质医疗资源下沉。

党建引领下医联体高质量发展实践探索与思考

医联体是构建我国优质医疗卫生服务体系、整合医疗资源、合理规划医疗资源配置的重要载体,党建则是引领医联体高质量发展的重要保障。在医联体建设工作广泛开展的时代背景下,深度剖析党建引领下医联体高质量发展的实践探索路径与主要成效,并结合实践经验提出建议,旨在为医联体建设与高质量发展提供参考。

1例京巴犬乳腺高级别导管内原位癌的诊治

[目的]对前来就诊的高龄京巴犬腹部肿物进行有效诊治,以期为类似病例的研究和诊治提供参考。[方法]采用临床检查、血常规检查、血液生化检查、病理组织学方法进行诊断,并结合诊断结果进行综合性治疗。[结果]该患犬诊断为乳腺肿瘤。通过手术成功切除乳腺肿瘤,病理学诊断为高级别导管内原位癌。术后进行系统治疗,3个月后复发,DR影像显示为癌转移。[结论]平时应多观察犬的身体状况,发现异样及时到正规动物医院就诊,乳腺肿瘤早发现、早治疗,才能得到良好的治疗效果和较高的治愈率。

High matrix metalloproteinase-9 expression induces angiogenesis and basement membrane degradation in stroke-prone spontaneously hypertensive rats after cerebral infarction

Basement membrane degradation and blood-brain barrier damage appear after cerebral infarc- tion, severely impacting neuronal and brain functioning; however, the underlying pathogenetic mechanisms remain poorly understood. In this study, we induced cerebral infarction in stroke- prone spontaneously hypertensive rats by intragastric administration of high-sodium water （1.3% NaC1） for 7 consecutive weeks. Immunohistochemical and immunofluorescence assays demonstrated that, compared with the non-infarcted contralateral hemisphere, stroke-prone spontaneously hypertensive rats on normal sodium intake and Wistar-Kyoto rats, matrix metalloproteinase-9 expression, the number of blood vessels with discontinuous collagen IV expression and microvessel density were significantly higher, and the number of continuous collagen IV-positive blood vessels was lower in the infarct border zones of stroke-prone sponta- neously hypertensive rats given high-sodium water. Linear correlation analysis showed matrix metalloproteinase-9 expression was positively correlated with the number of discontinuously collagen IV-labeled blood vessels and microvessel density in cerebral infarcts of stroke-prone spontaneously hypertensive rats. These results suggest that matrix metalloproteinase-9 upregula- tion is associated with increased regional angiogenesis and degradation of collagen IV, the major component of the basal lamina, in stroke-prone spontaneously hypertensive rats with high-sodi- um water-induced focal cerebral infarction.

Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home;discussions be made with patients on severity of non-adherence and importance of adherence;use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.

Patient and Health System Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Background: Non-adherence to hypertensive medication continues to become a contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure. Associated factors to non-adherence are complex, are both internal and external to the patient and are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. Objective: This study sought to explore the patient’s related factors that are associated with non-adherence to hypertension medication. Methods: This is a descriptive study design of (N = 575) people among them doctors, pharmacists, nurses, record officers and hypertension patients. Simple random sampling for patients (n = 81) and census sampling for health care workers was done and data collected using questionnaires and interview schedules between April 4th-May 30th 2019. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. Results: 64% of the patients stated that they had missed medication. A significant negative correlation (rpb = -0.23, p < 0.05) between age and non-adherence, significant positive correlation with monthly income (rpb = 0.24, p < 0.04), non-significant relationship between non-adherence and marital status (rpb = -0.13, p = 0.25) and patients’ level of education (rpb = -0.06, p = 0.57). The overall model of health system related factors were found to be significant (p < 0.05) and this included;quality of health service, physician patient relationship, stock out, health education, and availability of medicine (p = 0.012). Conclusion: Lacks of funds, unavailability of drugs are the leading factors to regimen completion. This could be easily be addressed by the government.

DESIGN AND FABRICATION OF A 20 MHz ANNULAR ARRAY FOR MEDICAL ULTRASOUND

Most high frequency(>15MHz)medical ultrasound systems are based on single element transducers mechanically scanned.These systems can provide images with excellent resolution.However,single element transducers are often limited by the fixed focal point and small depth of field.Annular arrays consisting of concentric rings of elements are focused electronically.These arrays are desirable to avoid the fixed focal point of the single element transducers and improve the depth of field.This paper reports the design,fabrication,and characterization of a 5-element equal-area annular array transducer.After electrical impedance matching,the average center frequency was 20MHz and-6 dB bandwidths ranged from 34 to 42%.The ILs for the matched annuli ranged from 6.1 to 26.5 dB.

护士高警示药品用药安全影响因素的质性研究

目的 :了解护士对高警示药品用药安全影响因素的认知体验,为护士更加安全有效地管理高警示药品提供参考。方法 :采用目的抽样法,选取不同科室的13名临床护士和护理管理者,以临床事件分析模型为理论框架,采用描述性质性研究方法对研究对象进行半结构式访谈和关键事件访谈,采用内容分析法对资料进行分析。结果 :构建了防止高警示药品错误实践的描述性模型——高警示药品用药安全:组织、护理与合作影响,提炼出组织因素、护士能力与责任、沟通合作3个主题和8个亚主题。结论 :护士高警示药品用药安全受到组织文化、自身知识与能力、医护患间沟通合作等因素影响。本研究为高警示药品用药安全管理实践提供了概念框架,同时也为医疗机构安全有效地管理高警示药品提供理论依据。

省级医院优质医疗资源下沉实践与思考

全面深化医疗供给侧结构性改革,作为全周期医疗健康服务体系的重要一环,省级公立医院积极推进多形式医联体建设,促进优质医疗资源均衡布局和扩容下沉,构建分级诊疗服务格局。笔者以河南省人民医院“医院-政府”托管县级公立医院实践为案例,探析其经验做法,从体制机制、技术支撑、人才能力方面剖析存在的问题,并提出针对性建议。

某三级专科医院DRG分组高倍率病例费用影响因素比较分析

[目的]基于天津市某三级专科医院DRG分组数据探讨专科医院DRG组高倍率病例影响因素,为医院进行有针对性的成本控制提供参考。[方法]收集某专科医院2022年10月1日-2023年9月30日上传的医保患者医保结算清单经分组器分组后正常入组数据,按照进入天津市医保局DRG分组器分组后的全市付费次均费用、平均住院天数计算入组病例费用的倍率,应用logistic回归分析高倍率病例的影响因素,采用灰色关联分析法分析高倍率病例各分项费用与住院总费用的关联度。[结果]入组病例总数为7829例,其中高倍率病例673例,占8.60%。Logistic回归结果显示,DRG合并并发症、15~60岁、非医嘱离院、实际住院天数长是高倍率病例产生的影响因素(P<0.05)。灰色关联结果显示,在10个高倍率的DRG组里,有5个DRG组的诊断费与其呈现最强的相关性,有3个DRG组的药品费与其呈现最强的相关性,有2个DRG组的综合服务费与其呈现最强的相关性。[结论]药品费、诊断费、综合服务费、合并并发症、15~60岁及住院天数长与高倍率住院费用的产生显著相关,是医院进行有指向性成本控制的重要因素。