Management and Reconfiguration of a Radiology Department under the Threat of Coronavirus Disease 2019:Experience from Wuhan

Summary:The corona virus disease 2019(COVID-19)is an emerging respiratory infectious disease caused by SARS-CoV-2,which first occurred in December 2019 in Wuhan,China.These days,in China,chest CT is used for diagnosis of COVID-19,as an important complement to the reverse-transcription polymerase chain reaction(RT-PCR)test.Because of contacting with a large number of suspected or probable cases closely during chest CT examination,radiographers are easily infected with COVID-19.This article included the rearrangement of CT examination room in fever clinic,the rearrangement of human resources in radiology department,and the drafting of new operating procedures for radiologists who carry out CT examination on COVID-19 patients.This article also introduced the emergency management procedures of the department of radiology during the outbreak,and the experience of infection prevention for the staff of the department of radiology.

Intranasal ketamine as an analgesic agent for acute pain management in emergency department: A literature review

Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using 'ketamine', 'pain or analgesia', and'intranasal' as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1204 papers extracted via primary search, 1088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics.

Implementation and evaluation of a pain management core competency education program for surgical nurses

Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain,pain assessment,pharmacological and nonpharmacological management,and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team.Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used.The Clinical Pain Knowledge Test(CPKT)was completed by 135 and 107 nurses from 17 surgical wards pre and post-program,respectively.Two hundred and three patients’medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention,respectively.Documentation of patients’postoperative pain management nursing practice behaviors and pain intensity scores were collected.Results:After the intervention,the CPKT scores of nurses significantly increased from 45.6%±12.3%to 54.2%±10.2%(t=5.786,P<0.001).Nurses’postoperative pain management nursing practice improved,with proportion of pain assessment documentation increased from 59.6%(121/203)to 74.9%(152/203)(χ^(2)=10.746,P=0.001),those using pain intensity assessment tools increased from 81.8%(99/121)to 95.4%(145/152)(χ^(2)=13.079,P<0.001),and intramuscular injection of nonopioids decreased from 12.6%(13/103)to 2.7%(3/111)(χ^(2)=7.598,P=0.006).Patients’average worst pain score on the operation day significantly decreased(Z=-2.486,P=0.013),and scores from the first to the third postoperative day also decreased(Z=-2.172,P=0.030).Conclusions:Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management,improve selected pain management practices,and decrease patients’postoperative pain intensity.

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

Building a Business and Strategic Intelligence Policy as a Strategy for Promoting Congolese Business Progress and Healthy Economic Development in Eastern DRC

The aim of this study was to verify the existence of business and strategic intelligence policies at the level of Congolese companies and at the state level, likely to foster progress and healthy development in the east of the DRC. The study was based on a mixed perspective consisting of objective analysis of quantitative data and interpretative analysis of qualitative data. The results showed that business and strategic intelligence policies have not been established at either company or state level, as this is an area of activity that is not known to the players in companies and public departments, and there are no units or offices in their organizational structures responsible for managing strategic information for competitiveness on the international market. In addition, there is a real need to establish strategic information management units within companies, upstream, and to set up a national strategic information management department or agency to help local companies compete in the marketplace, downstream. This reflects the importance and timeliness of building business and strategic intelligence policies to ensure economic progress and development in the eastern DRC. Business and strategic intelligence provides companies with an appropriate tool for researching, collecting, processing and disseminating information useful for decision-making among stakeholders, in order to cope with a crisis or competitive situation. The study suggests a number of key recommendations based on its findings. To the government, it is recommended to establish the national policy of business and strategic intelligence by setting up a national agency of strategic intelligence in favor of local companies;and to companies to establish business intelligence units in their organizational structures in favor of stakeholders to foster advantageous decision-making in the competitive market and achieve progress. Finally, the study suggests that studies be carried out to fully understand the opportunities and impact of business and strategic intelligence in African countries, particularly in the DRC.

On division management for environmental system of China: lessons from European local sustainable development

The concept of sustainable development, after being brousht forward, has become a shibboleth in the world, at national and local levels. In Europe, this concept is implemented from the local to tha nation, even to the Continent. The local sustainable development mainly consists in two factors： one is the renovating method continually invented by European Secretariot of ICLEI, and the other is that the local authorities towards sustainability are co-operated by the European Sustainable Cities and Towns Campaign. The coo-budget method is the outcome of tbese factors, For our country is a big country, on rapid progression of indastrialization and urbanization, with a large population and scarce resoarces per capita, it is practically significance to study us soon as possible the methodology. Experience from European local sustainable development may help us to resolve the handicap of departraent division in local a, tbority.

Self Evaluation in Department of Communicable Diseases, Faculty of Medicine, Tehran University of Medical Sciences

Introduction: Self evaluation is a process that defines and collects required data to judge about decision making issues at educational system on whether the educational department is fit to educate students? The objective of this study was determining the quality of the structural elements of the department of Communicable Diseases & determining the strengths, weaknesses, opportunities and threats to improve the quality of activities in the department under research. Materials and Methods: The employed method was Mixed methods (qualitative & quantitative research), on the basis of 10 procedural steps and within 8 sections dealing with evaluated factors;such as 1) organizational and management structure 2) scientific board members 3) students 4) Manpower 5) Space of educational research and health care 6) Equipment 7) curriculum 8) satisfaction of graduates, which were studied using 61 criteria and 172 indicators. Five-point Likert Scale was used for the responses in the questionnaire (1 - 1.75 = undesirable, to 4.2 - 5 completely desirable). Finally the data were analyzed using descriptive statistics indices and the assessment software of the Educational Development Center of TUMS. The instruments used in this method included assessment software, interview, observation and self-prepared questionnaire which consisted of 7 questionnaires and 2 check lists. Finding: The results of the research showed that general average of 8 investigating sections was 56.9% as a rather desirable research work. Conclusions: Therefore, it was concluded that function of the educational management in that group was directly in line with evaluation process, but continuing the process of evaluation seems necessary.

New Perspectives for Workflow Analysis in the Health Italian Sector through Discrete Event Simulation: The Case of a Department of Laboratory Medicine

The management systems currently used in the Italian healthcare sector provide fragmented and incomplete information on this system and are generally unlikely to give accurate information on the performances of the healthcare processes. The present paper introduces a combined discrete event simulation (DES)/business process management (BPM) approach as innovative means to study the workflow of the activities within the Department of Laboratory Medicine of the “San Paolo” Hospital in Naples (Italy). After a first “As-Is” analysis to identify the current workflows of the system and to gather information regarding its behaviour, a following DES-based “What-If” analysis is implemented to figure out alternative work hypotheses in order to highlight possible modifications to the system’s response under varying operating conditions and improve its overall performances. The structure of the simulation program is explained and the results of the scenario analysis are discussed. The paper starts with a brief exploration of the use of DES in healthcare and ends with general observations on the subject.

Value Based Purchasing and Nursing Case Management

The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid and private insurance plans are developing similar programs. These programs reflect a change in pay or incentives in the direction of primary and ambulatory care at the community level. This study described the use of nursing case management as a tool for monitoring and coordinating the impact of value based programs at the community level. It suggested that, under these programs, nursing case management can contribute to reduction of hospital admissions/discharges, emergency department visits, and hospital readmissions. This can be accomplished through monitoring of utilization levels for these indicators. These are major objectives of MACRA and related programs. The study also suggested that nursing case management can contribute to the development of new programs, such as Complex Care, as a means of reaching these objectives. The study included estimates of the costs and benefits of using case management to reduce hospital admissions for low severity of illness patients at the community level. It suggested that the service can provide important opportunities for health planning and development in this area.

Nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties: Study at Kenyatta National Hospital, Kenya

The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject’s inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including;assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.

An academic emergency department:residents' perspective

BACKGROUND:Since demographic changes have contributed to the growth of emergency medicine,a highly populous nation such as India needs to give physicians associated due credit and recognition.The management of knowledge source must also be conducted with due care as the work environment is completely different from that of any other clinicians.METHODS:The data were collected by direct interaction with residents of the department.Additional information was gathered by observation.The data were verified for validity.RESULTS:This study was to bring out the benefits of proactive decisions that could further enhance the emergency department.But such decisions did not always result in positive responses and improved morale.When such decisions were retracted as it causes misalignment with the existing system.An academic emergency department was expected and physicians should enrich their knowledge about emergency medicine.CONCLUSIONS:The problems faced by emergency department might be similar but the way in which one tackles the situation would be different.Decision making in this hospital may not be the best but it would've been the optimum one given the conditions available.

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.

公立骨科医院临床科室绩效综合评价——基于目标管理与加权TOPSIS法相结合的研究

目的对骨科医院临床科室绩效进行综合评价,考察科室绩效的差异。方法采用目标管理与加权TOPSIS相结合的方法,用各指标的月度绩效目标值对效率和效益指标作标化,从效率效益、质量和医德医风3个方面对骨科医院主要临床科室的月度绩效进行综合评价。结果足外科绩效水平最高,康复和3大手外科绩效水平位居前列,老年骨、ICU、和骨病科绩效水平较低。结论指标体系的构建有利于全面、动态地对医院临床科室进行综合评价;目标管理与加权TOPSIS相结合的方法所测量出的绩效水平与医院的实际发展情况相符,在骨科医院具有适用性。

SWOT分析法在感染科低年资护士管理中的评估与应用

目的:探讨SWOT分析法在感染科低年资护士管理中的实践应用效果。方法:通过对感染科低年资护理人员管理中的优势、劣势及外部环境的机遇和威胁进行综合评估,构建SWOT矩阵,依据分析结果,提出应对策略并组织实施。结果:通过对某三级甲等综合性医院感染科2015年8月至2018年8月≤3年注册的15名低年资护理人员进行S-O、W-O、S-T、W-T策略分析,并组织实施过程。SWOT分析管理前后护理人员自评结果分析,其沟通能力、操作能力、急救能力、应变能力以及被带教与培训能力均有明显提高(P<0.05),住院患者的满意度也得到明显改善。结论:感染科低年资护理人员管理中引入SWOT分析法,综合评估并组织实施,真正提高了护士个人能力与科室临床护理质量,降低了安全隐患,达到了提高护理风险应急实战能力的目的,为护理管理者和低年资护士做好职业规划提供了依据。

军队大型综合医院手术科室实施临床路径SWOT分析

临床路径管理模式是新医改的重要内容,通过规范医院服务水平,改善医患关系,调整医院经营策略促进医院市场竞争力的提升;临床路径的实施能够比较好地规范医疗行为,缩短平均住院日,降低医疗费用,并能保证医疗质量,提高患者满意度。临床路径管理模式将为医院发展带来新的机遇。手术科室作为医院的一个重要组成部分,既能反映医院的医疗、护理、医技能力,又能全面体现医院的经营管理水平。本文将介绍该模式的概念及发展过程,并对其在军队大型综合医院手术科室的实施进行SWOT分析。

ISO9000在CT室质量管理中的应用

目的进一步提高医院CT室的医疗服务质量,实现CT室的规范化管理。方法建立ISO9000:2000质量管理体系并持续改进。结果实施4年来,CT室各项指标逐年上升,患者满意度提高。结论CT室推行ISO9000:2000质量管理体系,提高了医疗质量,减少了医疗纠纷,提高了患者满意度,增强了市场竞争力。

基于MassMotion仿真的三甲医院急诊科感控管理优化研究

选取某三甲医院急诊科一层特定时间段所有患者就诊全过程的行为数据,将患者行为数据输入到Mass Moton行人模拟软件中,模拟三种不同管理策略下的急诊科状况,对比不同的模拟结果,对急诊科感控管理策略进行优化。

公立医院管理科室SWOT战略分析

从医院管理科室的组织资源、管理和目标导向3个方面入手,结合某省级公立三级甲等医院情况,从组织资源、管理及目标导向3方面入手,进行了管理科室的优势、劣势、机会、威胁分析,通过SWOT法分析其优势、劣势、机会、威胁,试图找出符合管理科室的改善之路。该研究应用现代管理理论SWOT分析办法,并从中探讨出一些用以解决存在问题的行动方案。

基于ASP.NET的网站系统研究——以教务管理系统为例

现在的"互联网+"技术发展的势头良好,而与"互联网+"相关联的计算机技术的软件也发展迅速.计算机软件的应用领域也从办公自动化到管理系统,给生活带来了更大的便利.基于以上应用中,本文设计了教务管理系统,该系统分别从学生层面、管理员层面和教师层面进行介绍.管理员界面能够实现比教师和学生界面更复杂的管理,比如说科目增加、专业增加、任课教师指定等.进入到学生层面,能够看到该学生对应科目的成绩,还可以对登录密码等进行更改;进到教师层面,能够实现教师信息添加和管理;部门信息管理能够实现学院、专业及班级信息的添加和管理;科目信息管理能够实现科目信息的添加和管理、科目状态管理、授课教师指定和课程指定;考试结果管理能够生成考试名单和进行成绩添加;进入到教师层面,可以实现教师密码更改,教师信息更改,以及更复杂的像科目增加、专业增加、班级增加等.该系统设计以ASP.NET应用开发技术和SQL Server数据为基础,采用C/S模式结构,该系统以教务系统作为参考,介绍了网站系统的建设全过程,系统在一定程度上为网站系统的开发提供一个参考依据.

基于SWOT分析的医务部门发展现状与对策思考

文章运用SWOT分析法,将医务管理自身发展的优势、劣势以及面临的机遇和挑战做出探究,并提出相应的对策建议,包括:明确医务部门的定位,合理划分行政职能;采用多学科合作思维,促成多部门联动机制;激发主体意识,形成质量文化传承;制定科学的评价体系,拓展职业前景。