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%.

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.

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

BackgroundMany 研究显示了那医药治疗和经皮的冠的干预与稳定的冠的动脉疾病以病人的长期的预后有类似的效果。这研究与高风险的 angina.MethodsIn 在老病人调查了最佳的医药治疗(OMT ) 和 revascularization-plus-OMT 的效果这未来的非使随机化的研究，有 angiographically 证实的 multivessel 疾病的 241 个连续高风险的老男病人(65-92 岁) 从 2004 年 1 月在登记被注册到 2005 年4月。这些， 98 个病人经历了 OMT ， 143 加后续的 OMT.ResultsAfter 6.5 年经历了 revascularization 治疗，我们发现长期的心脏的死亡的率在比在经历了 revascularization 的那些经历了 OMT 的病人是显著地更高的(6.5年的 unadjusted 死亡率，14.3%为 OMT 对7.0%为 revascularization 病人；木头等级 P = 0.04 ) 。然而，主要不利心脏的脑血管的事件(MACCE ) 的全面风险在所有病人之中是类似的(6.5 年的 unadjusted 死亡率， 29.6% 为 OMT 对 27.3% 为 revascularization 病人；木头等级 P = 0.67 ).ConclusionsOMT 与心脏的死亡的增加被联系但是 MACCE 的类似的 6.5 年的风险与在有冠的 multivessel 的高风险的老男病人的 revascularization 相比疾病。

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,

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。

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。

分析青年高血压患者药物治疗时的遵医嘱服药概率以及影响因素

目的研究和分析青年高血压患者药物治疗时的遵医嘱服药概率及影响因素。方法随机选取2022年1—12月滨州医学院附属医院就诊并接受降血压药物治疗的100例高血压患者为研究对象,根据服药时是否遵医嘱的调查结果分为研究组(遵医嘱服药,81例)和对照组(未遵医嘱服药,19例),对于两组之间的临床资料进行分析,以明确导致青年高血压患者在药物治疗中未遵医嘱服药的危险因素。结果经单因素分析,两组患者的文化程度、疾病认知度、药物不良反应、焦虑评分、抑郁评分对比,差异有统计学意义(P均<0.05)。经多因素分析显示,文化程度(OR=2.457,95%CI=1.193~3.107)、疾病认知度(OR=2.369,95%CI=1.207~3.114)、药物不良反应(OR=2.561,95%CI=1.489~3.082)、焦虑评分(OR=2.468,95%CI=1.347~3.119)、抑郁评分(OR=2.406,95%CI=1.352~3.069)是导致青年高血压患者在应用降血压药物治疗期间未遵医嘱服药的危险因素(P均<0.05)。结论青年高血压患者在应用降血压药物治疗时,存在不遵医嘱服药情况,患者是否遵医嘱服药主要与文化程度、疾病认知度、药物不良反应等因素有关。

大型公立医院构建三尺质控模型的实践探索

目的构建“三尺”质控模型,促进医疗质量全面内涵管理。方法构建由“标尺、量尺、戒尺”组成的“三尺”质控模型,具体包括:以各项质量指标的标准化保障质量的基础管理,形成“标尺”;以“标尺”为准绳,落实全面质控和监督机制,保障质量的环节管理,形成“量尺”;运用绩效奖惩等措施落实质量的终末管理,形成“戒尺”。结果“三尺”质控模型的构建形成了全方位医疗质量监督管理机制,强化了医疗质量全面内涵管理,夯实医院高质量发展根基。结论“三尺”质控模型的构建与推广,有助于医疗质量持续改进和医疗服务能力有效提升,为我国各级医院医疗质量持续改进提供参考。

三表汤“首剂大量”随证施量策略在外感发热治疗中的运用

通过分享仝小林院士应用三表汤为基础方治疗外感发热的一则病例,阐释其运用“首剂大量”随证施量策略治疗疾病的体会:此法多用于治疗急症或急重症,如外感急症早期,以求迅速起效;使用首剂大量必须重视“症靶”,作为及时调量的指征,中病即减/止;可采用调整服药间隔时间和每服量灵活控制方药用量,以保证用药安全。

基于全面质量管理理论的临床专科能力建设实践

临床专科能力建设是优质医疗资源扩容的基础。以全面质量管理理论的六要素为框架,从人才队伍建设(人)、设备耗材管理(机和料)、制度流程管理(法)、医院文化建设(环)、质量控制和系统评价(测)等6个方面阐述了临床专科能力建设的主要做法。实践后,临床专科能力持续提升,并提高了优质医疗服务可及性。还需进一步整合各类资源,注重分院区专科能力建设,促进专科同质化发展。

SPD助力手术室高值医用耗材精细化管理

对生产厂家、供应商、物流公司、设备物资科及手术室进行规范化管理,利用SPD医用耗材管理系统及智能感知柜管理系统,改变原有手术室高值医用耗材逆向物流的模式,建立院内手术室高值医用耗材的正向物流管理模式及追溯机制,以降低临床医用耗材管理工作强度,实现高值医用耗材可视化管理和精细化管理,为医院进行科学合理的宏观调控提供可靠准确的信息,在保证高值医用耗材使用快捷的同时,最大限度地保证手术室高值医用耗材在使用中的安全性及可追溯性。

三级公立医院绩效考核背景下医院运营管理的研究

国家三级公立医院绩效考核开始于2019年,运营效率作为考核的一部分,相关的国家监测指标有9个,包含收支结构和费用控制。绩效考核是医改工作的有力抓手,也是加快现代医院管理制度建立的强劲推手。通过分析某三级甲等口腔专科医院在绩效考核背景下运营效率指标的得分情况,找出原因;并通过加强党建引领,做好医院运营管理体系架构顶层设计,加强医疗质量管理,落实医改相关政策,加强能耗管理,不断提高员工福利待遇,强化公立医院功能定位,提高医疗服务收入占比,绩效分配体现医务人员的劳动技术价值,提高运营管理能力,助推医院高质量发展。

三级公立医院紧密型城市医疗集团建设的探索与思考

加强紧密型城市医疗集团一体化管理,助力分级诊疗政策落地,对提升基层医院医疗水平具有促进作用。以某市级三甲公立医院为例,对紧密型城市医疗集团成员单位在医、教、研、防及管理上实施一体化管理,通过责权协同、资源协同、业务协同等方法,以资源下沉共享为核心,搭建联盟平台,通过网格化布局,构建分级诊疗服务新格局。针对医疗集团基层单位,建立定期反馈机制,针对基层医疗集团运营中的难点,帮助基层单位找准定位,促进医疗集团内部协同发展,通过深化创新实践,推动医防融合。紧密型城市医疗集团实施一体化管理后,集团成员单位社会影响力扩大,医疗服务能力得到提升,医疗科研技术水平也得到不同程度的提高,基层医院获得百姓的认可。

新时代医学院校外语课程思政高质量发展路径探索

该文紧扣当前时代特征和国家高等教育的根本问题,以助力新医科人才培养为目标,从理论与实践两个方面探索大学外语课程思政高质量发展路径。医学院校外语课程思政高质量发展应遵循系统性、规律性、精准性、实践性原则,从教师素养提升、外语课程建设、课堂教学改革、第二课堂教育实践、保障机制建设五个方面推进。

数字化驱动优质医疗资源区域均衡的基本逻辑与实践路径

数字医疗凭借其智能化、便捷化、高效化等优势,为医疗服务的革新和转型提供机遇。研究构建了数字化驱动优质医疗资源区域均衡的理论逻辑框架,结合在此过程中面临的现实挑战,提出实践路径。主要结论如下:数字医疗可有效驱动医疗市场创新与变革、提升优质医疗资源供给与配置效率、促进优质医疗资源区域共享。然而,在医疗资源区域均衡的过程中,数字基础设施建设不足、数字鸿沟难以跨越、技术人才储备不足以及政策不完善等诸多问题仍束缚了数字化医疗的全面推广与应用。为有效应对这些挑战,需持续推进数字基础设施建设,推进医疗信息平台建设;构建数字医疗区域合作机制,完善配套政策支持;强化医疗人才队伍建设,加快互联网医疗服务普及。

DRG支付方式改革对公立医院高质量发展的影响及对策分析

DRG支付方式改革既是深入推进医药卫生体制改革的新举措,也是推动公立医院高质量发展、实施公立医院改革的重要途径。DRG支付方式改革不但可以平衡公立医院财务收支,还能协调“医保、医院、患者”三方之间的利益,对医院管控运行成本、规范医疗行为、医疗质量管理及就医流程优化等方面具有重要作用。为了更好地适应DRG支付方式改革的需要,公立医院要抢抓卫生体制改革发展机遇,迅速采取行动,制定出有效的对策,应对DRG支付方式改革带来的各种影响,以促进公立医院健康、可持续高质量发展。

城市医疗集团建设实践与思考

城市医疗集团是分级诊疗背景下持续深化卫生事业改革、促进优质医疗资源高效整合的重要载体之一。近年来,城市医疗集团由最初自主组合的单体探索发展到现下以政府为主导的规模化建设,不断深入且趋向多元化发展。本文对国内外典型案例进行讨论,从中提炼城市医疗集团建设和发展的经验启示,为促进城市医疗集团内部建设优化、运行机制完善和实现向高质量纵深发展提供参考。

广州市某三甲医院开展“疑难高风险患者谈话”的现状与效果分析

为进一步做细做实医疗投诉纠纷前端预防和源头化解工作,医院及时总结既往投诉纠纷事项中患者反映的突出问题和关心的焦点问题,结合医疗工作中存在的收治患者疾病类型较重、治疗方案复杂、风险高等特点,自2020年以来,积极在高风险科室开展疑难高风险患者谈话工作,形成了由医务管理部门、纠纷管理部门联合临床科室共同进行术前/治疗前谈话的工作机制。在医患沟通过程中充分贯彻以患者为中心的人文理念,促进沟通质量提升,使医疗安全更有保障,患者满意度高,取得了较好效果。