Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

Recommendations for Emergency Management of Rural Major Infectious Diseases in Non-epicenter Areas:Taking Village B during COVID-19 as an Example

This paper analyzed the key issues and challenges confronted in the governance of Village B in the non-epicenter area in rural areas of China during the COVID-19 pandemic.It clarified the weak points in the prevention and control of infectious diseases in Village B.A triple emergency management mechanism of"people-materials-environment"in rural areas should be established.It came up with constructive recommendations for scientifically and effectively responding to public health emergencies in rural non-epicenter areas,which is helpful to improve the rationality,legality and scientific effectiveness of the construction of emergency response mechanisms in rural areas.

Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic

Objective:To introduce the emergency management of nursing human resources and supplies of a large general hospital when facing the outbreak of coronavirus disease 2019(COVID-19).Method:The Nursing Department of the hospital fully executed its functional authority to establish a three-level echelon of sustainable support,allocate human recourses dynamically,organize pre-service training,supervise the key working steps,formulate positive incentive methods,and deploy medical supplies scientifically.Result:By taking these strategies,the hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID-19.Conclusion:The emergency management of nursing human resources and material resources for COVID-19 of the hospital is successful.But several deficiencies were identified as well,which indicated that the hospital needs to establish an efficient emergency management system,and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies.

Analysis of Monitoring,Early Warning and Emergency Response System for New Major Infectious Diseases in China and Overseas

In recent years,the impact of new major infectious diseases on people’s normal life is becoming more and more frequent,which has brought great impact on people’s life safety and social economy,especially the corona virus disease 2019,which has been sweeping the globe.Public health and disease prevention and control systems in different countries have different performances in response to the pandemic,but they all have exposed many shortcomings.Countries around the world urgently need to improve the monitoring,early warning and emergency response systems for new major infectious diseases.As the outpost and main part of medical rescue,the hospital urgently needs to establish a set of scientifically advanced emergency response mechanism that is suitable for the business process of the medical system and unified standards in order to improve the response efficiency and quality of emergency treatment.

Contingency management strategies of the Nursing Department in centralized rescue of patients with coronavirus disease 2019

Objectives:This article aims to summarize a series of contingency management strategies of the Nursing Department in the centralized treatment of patients with coronavirus disease 2019(COVID-19).Methods:The strategies of the Nursing Department included an early warning for prevention and control,taking functions of vertically commanding and horizontally coordinating,and reasonably allocating nursing workforce,to facilitate centralized treatment work in the in-hospital fever clinic,isolation wards and ICU,and referral and admission of critical patients.Five special groups were established in charge of training and examination,management and supervision,psychological support,logistical support,and reporting and publicity,respectively.Results:It was achieved that no deaths from critical patients and no medical staff,no other patients were infected.Conclusion:Through the implementation of these strategies,safe and efficient centralized treatment was ensured timely,orderly and sustainably.

Study on the Grouping of Patients with Chronic Infectious Diseases Based on Data Mining

Objective: According to RFM model theory of customer relationship management, data mining technology was used to group the chronic infectious disease patients to explore the effect of customer segmentation on the management of patients with different characteristics. Methods: 170,246 outpatient data was extracted from the hospital management information system (HIS) during January 2016 to July 2016, 43,448 data was formed after the data cleaning. K-Means clustering algorithm was used to classify patients with chronic infectious diseases, and then C5.0 decision tree algorithm was used to predict the situation of patients with chronic infectious diseases. Results: Male patients accounted for 58.7%, patients living in Shanghai accounted for 85.6%. The average age of patients is 45.88 years old, the high incidence age is 25 to 65 years old. Patients was gathered into three categories: 1) Clusters 1—Important patients (4786 people, 11.72%, R = 2.89, F = 11.72, M = 84,302.95);2) Clustering 2—Major patients (23,103, 53.2%, R = 5.22, F = 3.45, M = 9146.39);3) Cluster 3—Potential patients (15,559 people, 35.8%, R = 19.77, F = 1.55, M = 1739.09). C5.0 decision tree algorithm was used to predict the treatment situation of patients with chronic infectious diseases, the final treatment time (weeks) is an important predictor, the accuracy rate is 99.94% verified by the confusion model. Conclusion: Medical institutions should strengthen the adherence education for patients with chronic infectious diseases, establish the chronic infectious diseases and customer relationship management database, take the initiative to help them improve treatment adherence. Chinese governments at all levels should speed up the construction of hospital information, establish the chronic infectious disease database, strengthen the blocking of mother-to-child transmission, to effectively curb chronic infectious diseases, reduce disease burden and mortality.

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.

MANAGEMENT OF MENEERE'S DISEASE—THE BEIJING TIANTAN HOSPITAL EXPERIENCE

Objective To report outcomes of nonsurgical and surgical management of Menire＇s disease at Beijing Tiantan Hospital. Methods Patients with Menire＇s disease were categorized into groups based on hearing and quality of life. Individualized management was provided, including life style modification, drug therapies, endolymphatic sac decompression and labyrin- thectomy. Treatment outcomes were evaluated during up to 24 months follow up. Results Eighty seven patients underwent life style modification and drug therapies. The vertigo control rate of Grade A and B was 76.9% and 83.8% respectively. Six patients received surgical management, including endolymphatic sac decompression （n = 5） and labyrinthecto- my （n = 1）. For these patients, the vertigo control rate of Grade A and B was 80% and 100%, respectively. Conclu- lsions Management of Meni6re＇s disease depends on several factors, i.e. severities of vertigo and hearing loss, quality of life, surgical contraindications and patient subjective desire. The treatment is drug therapies for the majority of patients, as well as life style modification. Surgical indications are rare and the least invasive procedures should be considered first. The results of surgery are generally satisfying.

Clostridium difficile-associated disease:Adherence with current guidelines at a tertiary medical center

AIM:To assess adherence with the the Society for Healthcare Epidemiology of America(SHEA)/the Infectious Diseases Society of America(IDSA)guidelines for management of Clostridium difficile(C.difficile)-associated disease(CDAD)at a tertiary medical center.METHODS:All positive C.difficile stool toxin assays in adults between May 2010 and May 2011 at the University of Maryland Medical Center were identified.CDAD episodes were classified as guideline adherent or nonadherent and these two groups were compared to determine demographic and clinical factors predictive of adherence.Logistic regression analysis was performed to assess the effect of multiple predictors on guideline adherence.RESULTS:320 positive C.difficile stool tests were identified in 290 patients.Stratified by disease severity criteria set forth by the SHEA/IDSA guidelines,42.2%of cases were mild-moderate,48.1%severe,and 9.7%severe-complicated.Full adherence with the guidelines was observed in only 43.4%of cases.Adherence was65.9%for mild-moderate CDAD,which was significantly better than in severe cases(25.3%)or severe-complicated cases(35.5%)(P<0.001).There was no difference in demographics,hospitalization,ICU exposure,recurrence or 30-d mortality between adherent and non-adherent groups.A multivariate model revealed significantly decreased adherence for severe or severecomplicated episodes(OR=0.18,95%CI:0.11-0.30)and recurrent episodes(OR=0.46,95%CI:0.23-0.95).CONCLUSION:Overall adherence with the SHEA/IDSA guidelines for management of CDAD at a tertiary medical center was poor;this was most pronounced in severe,severe-complicated and recurrent cases.Educational interventions aimed at improving guideline adherence are warranted.

The application of feedforward control in the nursing emergency management of COVID-19

Objective:To explore the application of feedforward control in the nursing emergency management of COVID-19.Methods:The feedforward control theory was applied to the emergency management of COVID-19 nursing,including grasping the latest epidemic information,preparing for the early stage,formulating nursing workflow,implementing flexible management,standardizing isolation and protection measures,unifying nursing document record format,and implementing humanistic care.Results:During the period of support to Wuhan,the nursing work in the isolated area was orderly,the nursing staff's job satisfaction was high,no nursing errors and hospital infections occurred.Conclusion:Efficient feedforward control in the nursing emergency management that could avoid work blindness to a certain extent and play a guiding role in maintaining the normal operation of treatment and nursing work and protecting the safety of patients and medical staff in the ward during the epidemic period of COVID-19.

Methods of Domestic Solid Waste Management in Hohoe Urban in the Volta Region

Solid waste management has become the greatest public health problem facing many urban and semi-urban areas in Ghana. Great wealth can be generated from wastes if managed effectively but also has high probability of causing serious health and environmental problems if not effectively managed. The study sought to determine factors militating against domestic solid waste management in Hohoe, possible ways of curbing them and also to assess the methods of domestic solid waste management. This study used descriptive cross-sectional survey and structured questionnaire to obtain the required information from respondents. A total number of 403 respondents were recruited into the study. The data collected were entered and analyzed using Statistical Package for Social Sciences version 20. The relationships between socio-demographic characteristics of the respondents and their use or non-use of apt domestic solid waste disposal methods were examined using chi-square analysis. The study found that 44% of respondents disposed domestic waste into central skip over dustbins. Spilled over of skip over dustbin has caused 8% of respondents to practice open burning. 7% dumped on undeveloped building plots, 5% dumped elsewhere, and 3% dumped into the river course. About 78% of respondents reported that mobilization of cleanups was irregular. The result from the study also showed a statistical significant association between practice of domestic solid waste management and religion [χ2 (2, 403) = 60.9484, p α = 5%]. About 96% of Christians practiced good methods of domestic solid waste management compared to 4% of Muslims. The findings painted a gloomy picture of poor domestic solid waste management practice among the respondents in the study communities.

Focal Point of Nursing Management of PTSD Related to COVID-19 Infection, Quarantine, and Curfew

Background:Since the coronavirus outbreak(COVID-19)has been declared an emergency in public health and has drawn enormous attention worldwide,the number of infected cases and deaths increases.The psychological well-being of the citizens and the health team workers might be affected and lead to more anxiety and stress,such as Post Traumatic Stress Disorder.Aim:This paper aims to provide a holistic approach regarding nursing management of Post-Traumatic Stress Disorder concerning the COVID-19 outbreak and the consequences of lockdown,quarantine,or curfew.Methods:An extensive literature searchesCumulative Index of Nursing&Allied Health Literature(CINAHL),ProQuest Nursing&Allied Health Database,Google scholar PubMed,Ovid MEDLINE,Psych articles,and Psych Info,were conducted to achieve the objective of the study.Results:This paper highlights that the experiences of PTSD among patients in different age groups and health conditions,as well as health team workers as a result of the COVID-19 outbreak,can be affected by several factors including health and social stigmatization,media influences,and public health awareness.The result of this paper suggested that it is important for all nursing practices,concerning the treatment of patients with COVID-19 and its psychological symptoms,especially PTSD,to master their skills and knowledge to gather crucial information on the history of patient distress and to assess their existing levels of stress and anxiety-related the pandemic.Conclusion:The COVID-19 pandemic involves several possible causes of distress for particular people,such as experiencing a loved one's death or being terminally ill;this may lead to post-traumatic stress disorder(PTSD),which needs skilled and certified nurses to collaborate closely alongside other health.team members to identify,manage and support the health of such persons effectively.

科技创新应对健康挑战

随着全球化、人口老龄化趋势的加剧和全球气候变化,人类面临的健康挑战日益复杂。全球化带来了全球性健康问题的出现,传染病的传播速度和范围明显增加,影响更加深远;气候变化不仅直接影响着人类健康,还通过改变生态系统和病媒生物分布等方式间接增加传染病暴发风险;与此同时,人口老龄化使得慢性非传染性疾病负担持续攀升,共病等复杂健康问题日益凸显,给医疗卫生健康系统和社会服务保障系统均带来了巨大挑战。而科技创新为应对这些挑战提供了前所未有的机遇,从精准医学到人工智能(AI),科技的进步正重塑健康管理范式。科技创新不仅是现代医学发展的引擎,更是应对未来健康问题的关键。未来应加强卫生健康体系建设、创新医防协同及医防融合机制、加强科技攻关与创新、AI赋能基层能力提升,以更好地应对健康挑战,增进人类福祉。

我国三级医院急诊病人激增应对方式调查

目的:了解我国三级医院急诊病人激增应对方式。方法:于2023年1月—3月选取我国54所三级医院急诊科作为研究对象,其中,东部地区26所(48.1%),中部地区10所(18.5%),西部地区18所(33.3%)。采用自行编制的中国不同地区医院急诊病人激增应对方式调查问卷进行调查。结果:三级医院急诊病人激增后日均急诊量增幅达87.5%,急诊日均候诊时间整体延长(Z=-5.560,P<0.001),东部地区三级医院急诊病人激增后72 h出抢救室病人比例较激增前下降(P<0.05)。面对急诊病人激增,各三级医院采取的应对措施包括增加急诊床位数和出诊医生诊位、增设专门收治新型冠状病毒感染病人的病房、增加重点设备投入、调配医护人员支援急诊等。东部地区三级医院急诊候诊时间变化率与医患比变化率(r=-0.418,P=0.034)、护患比变化率(r=-0.469,P=0.016)、互联网诊疗变化率(r=-0.684,P=0.020)均呈负相关,东部地区三级医院抢救室滞留时间变化率与护患比变化率呈负相关(r=-0.422,P=0.032),中西部地区三级医院抢救室滞留时间变化率与留观室床位变化率呈正相关(r=0.405,P=0.036)。结论:急诊科应不断优化人力、床位、仪器设备等医疗资源配置,探索急危重症病人“互联网+”新模式,进一步提升重大传染病的应对能力。

三级甲等医院护士坐诊社区卫生服务中心的慢性病管理实践

目的:评价三级甲等医院护士坐诊社区卫生服务中心的慢性病管理实践效果,为促进优质护理资源下沉提供借鉴和参考。方法:合肥市某三级甲等医院选拔护士到医联体单位的4个社区服务中心,实施“1+1+1+N”管理团队的慢性病管理服务模式并开设专科护理门诊,对高血压、糖尿病、脑卒中3类慢性病患者进行规范管理。以开设专科护理门诊后第1次建档的513例患者为研究对象,比较实施前后患者的血压、血糖控制情况,生活质量,自我管理行为,自我效能和患者满意度。结果:三级甲等医院护士坐诊社区卫生服务中心后,患者的血压、血糖控制率,生活质量,自我管理行为,自我效能和满意度优于坐诊前,差异均有统计学意义(P<0.05)。结论:三级甲等医院护士坐诊社区服务中心的慢性病管理实践能够提高慢性病患者的管理质量,提高其生活质量和自我效能。

基于熵增和耗散结构理论的传染病医院管理研究

热力学中的熵增定律指出任何封闭系统在无外力维持的情况下,总是自发趋于混乱和无序。系统对抗熵增,需要形成开放的耗散结构。熵增定律在企业和组织管理中得到广泛应用。文章将熵增理论运用到传染病医院的管理分析中,探讨传染病医院构建耗散结构、形成熵减的4个要素和主要途径,结合传染病医院发展面临的主要困局,提出传染病医院应从以患者为中心,全面提升对利益相关方的开放性、持续打破既有格局远离稳定的平衡态、加强内部协作提升非线性机制、充分利用涨落因素激励医院变革,为传染病医院的组织管理优化和可持续发展提供参考。

北京佑安医院降低平均住院日的管理措施研究

目的探讨首都医科大学附属北京佑安医院实施平均住院日管理的效果。方法首都医科大学附属北京佑安医院在2022年1月起采取建立集中预约平台、成立住院服务中心、实时沟通机制、积极开展日间手术和微创手术、深入推进临床路径和单病种管理、优化多学科诊疗模式等多项措施综合管控平均住院日,比较2021年1—12月和2022年1—12月病案首页数据,对全院、重点科室、前20位疾病的平均住院日相关数据进行统计分析。结果采取多措并举后,2022年1—12月全院平均住院日、重点科室平均住院日和前20位疾病平均住院日均较2021年1—12月明显下降,2022年1—12月平均住院日由9.49 d降至8.50 d。结论多部门联动后优化措施可有效缩短平均住院日。

重大突发传染病疫情下护理应急队伍的构建与管理

在重大突发传染病疫情下,护理应急队伍的构建与管理至关重要。护理人员在传染病疫情救援团队中所占比例最大,其应急能力是影响重大传染病疫情救援质量的重要因素之一。护理应急队伍的存在可以迅速响应疫情,采取有效的控制措施,降低病情的扩散和传播。护理应急队伍的有效构建和管理能够提供关键的支持和保障,帮助应对突发疫情,保护公众的健康与安全。文章首先概述了重大突发传染病疫情下护理应急队伍的构建存在的问题,提出了重大突发传染病疫情下护理应急队伍的构建对策:加强人员配备和培训、组建整体性传染病护理应急队伍、加强护理应急物资准备等。

家庭医生签约服务与肺结核患者临床特征的关联性研究

目的:通过比较已签约家庭医生和未签约家庭医生的肺结核患者临床特征的相关数据,为社区结核病管理模式提供依据。方法:选取2022年1月至2023年12月在“结核病管理信息系统”中住址登记为广州市海珠区的肺结核患者作为研究对象,共1479例。其中,已签约并接受家庭医生服务者为管理组(844例,57.06%),未签约家庭医生服务者为对照组(635例,42.94%)。收集并比较两组研究对象的人口学特征和临床特征信息。结果:管理组平均年龄为(48.48±18.38)岁,明显低于对照组的平均年龄[(50.73±18.91)岁],差异有统计学意义(t=-2.303,P=0.021)。管理组流动人口、病灶范围≥3个肺野、有空洞、合并糖尿病、合并高尿酸血症者分别占54.27%(458/844)、58.65%(495/844)、32.11%(271/844)、12.56%(106/844)、8.18%(69/844),均明显高于对照组[分别占48.50%(308/635)、48.50%(308/635)、26.93%(171/635)、8.98%(57/635)、3.78%(24/635)],差异均有统计学意义(χ^(2)值分别为9.638、15.030、4.640、4.744、11.883,P值均<0.05)。管理组合并高血压、合并肿瘤、发生药物不良反应及首诊住院治疗者分别占6.40%(54/844)、3.32%(28/844)、10.90%(92/844)、27.49%(232/844),均明显低于对照组[分别为10.71%(68/635)、5.51%(35/635)、15.12%(96/635)、36.22%(230/635)],差异均有统计学意义(χ^(2)值分别为8.896、4.278、5.809、12.864,P值均<0.05)。结论:家庭医生签约服务与肺结核患者的临床特征之间存在着明显的关联性,这为进一步改善肺结核患者的医疗管理提供了重要的参考和指导。

综合医院应对呼吸道传染病医院监测预警体系的构建

呼吸道传染病监测体系的建立是现阶段综合医院在实践中对突发性的呼吸道传染病疫情予以快速应对、及早发现可能导致传染性疾病流行风险、研判疫情趋势、及时预警风险、评估医疗系统负荷的基础。特别是在呼吸道传染病暴发流行期间,该体系的建立能够使得综合医院的医院感染风险显著降低,保障医院医疗环境安全。本研究以房山区第一医院为例,着重围绕呼吸道传染病感染防控的相关临床实践经验,严格遵照官方文件、标准以及规范的相关要求,充分结合风险评估内容,初步探讨并着力构建综合医院应对呼吸道传染病医院监测预警体系,包括传染病信息报告系统、流感监测系统、症状监测系统、发热门诊监测系统、实验室监测系统等多维度监测系统。医院设立监测领导小组,由医院领导担任组长,并由领导小组统一开展相关协调指挥工作,将各部门责权展开清晰划分,以此全面建立整体医院监测预警机制。医院根据预警迅速响应,人力、物资、设备等相关部门联动,防止院感发生,做好诊疗准备,确保院内的日常诊疗工作可以有序开展,以此为综合医院关于呼吸道传染病防控管理工作提供有效经验参考。