Disease spectrum analysis of hospitalized children in China: A study of 18 tertiary children's hospitals

Importance: Morbidity and mortality of children are important indicators of the performance of the public health system in any country. In China, the children's disease spectrum has gradually changed in recent years. However, the gender- and age-specific disease spectrum for hospitalized children under 15 years old is still unclear. Objective: To explore the gender- and age-based distribution of diseases in hospitalized children under 15 years in China. Methods: Medical records home page data for 2016 to 2018 were collected from 18 tertiary children's hospitals in China. The gender- and age-specific disease spectrum was analyzed, using the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Results: The most common diseases were those of the respiratory system (25.7% of all 2232142 hospitalized children). The top three diseases for boys were diseases of the respiratory system (25.6%), diseases of the digestive system (11.4%) and certain conditions originating in the perinatal period (8.6%). The top three diseases for girls were diseases of the respiratory system (25.9%), certain conditions originating in the perinatal period (10.1%), and factors influencing health status and contact with health services (9.4%).The most common diseases for children under 1 year old were certain conditions originating in the perinatal period (38.1%). For all other age groups, the most common conditions were respiratory diseases (33.8% for those aged 1–3 years, 25.2% for those aged 4–6 years, and 12.2% for those aged 7–14 years). Interpretation: This study analyzed the medical records home pages of 18 children's hospitals to provide the first overview of the disease spectrum and its gender- and age-specific distribution among children in China.

Prevalence and Factors Associated with Musculoskeletal Disorders among Biomedical Analysis Laboratory Staff in Hospitals in Cotonou

Introduction: Musculoskeletal disorders (MSDs) are a real occupational health problem. Laboratory technicians appear to be among those most affected. Objective: To assess the prevalence and factors associated with MSDs among laboratory technicians in Cotonou. Study Method: A descriptive and analytical cross-sectional study was carried out on laboratory technicians at university hospitals and area hospitals in Cotonou. It took place over a three-month period from August 10 to November 10, 2021. The data collected were analyzed using SPSS version 25.0 software. Frequencies were compared using the chi2 test for qualitative variables and the ANOVA test for quantitative parametric variables. The significance level was 5%. Results: A total of 156 technicians were included in the study, 83 of them male, i.e. a M/F sex ratio of 1.14. The mean age was 36.70 ± 6.69 years. The overall prevalence of MSD was 91.03%. For back, neck, shoulder, elbow, wrist-hand, the prevalence was 83.56%, 50.68%, 08.21%, 14.38% and 20.54% respectively. Factors associated with MSD were the non-adjustable nature of the seats (p = 0.03), job strain (p Conclusion: The prevalence of MSD is high among laboratory technicians. The study confirms the multifactorial etiology of MSDs. The preventive approach must be comprehensive, including all risk factors.

Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Hyperprolactinemia in Hospitals in Lomé: Diagnostic and Therapeutic Aspects

Introduction. Hyperprolactinemia represents a supraphysiological secretion of prolactin. In clinical practice, it is the most frequently encountered anterior pituitary disorder. However, its real prevalence is little known in Africa. The purpose of this study is to list all cases of hyperprolactinemia over the past four years and to make an inventory of the various etiologies found and their management. Methodology. This is a cross-sectional descriptive study on the files of patients who came for consultation in the internal medicine and endocrinology department with hyperprolactinemia retrospectively collected from January 2017 to December 2020. Included were patients followed or whose the diagnosis of hyperprolactinemia was established in endocrinological consultation during the study period. Results. This study recorded 26 cases of hyperprolactinemia. The female sex represented 73.08% (sex ratio M/F 0.37) and the average age was 33.92 years. The 40 - 50 age group was the most represented with 30.77%. In women, galactorrhea accounted for 73.07%, amenorrhea 57.69% of clinical pictures and infertility 23.08%. In men, infertility accounted for 7.69% of presentations, gynecomastia 11.54% and erectile dysfunction 15.38%. The duration of evolution of the signs was 4 months in 23.08% of the patients. The mean prolactinemia was 702.58 ng/ml. CT was performed in 80.85% of patients. The main etiologies were pituitary adenomas (77%). All our patients were treated with dopaminergic agonists. Cabergoline was prescribed in 77% of patients. The evolution was favorable in 96.25% of patients. Conclusion. Hyperprolactinemia is a pathology that exists in our regions. The main etiology remains pituitary adenomas and treatment with cabergoline.

Construction of competency evaluation system for infection control personnel in traditional Chinese medicine hospitals

Background:This study uses a literature review and the Delphi expert consultation method to construct a competency evaluation model for infection control personnel in traditional Chinese medicine(TCM)hospitals.The aim is to strengthen infection control management in TCM hospitals,assess the competency of infection control personnel in their positions,and assist them in identifying the competencies that need improvement.Methods:Based on the literature research method and the Delphi expert consultation method,a competency model for the position was constructed through two rounds of expert consultations,analyzing the relationships between various factors and establishing a hierarchical structure model.Pairwise comparisons were made among the elements at the same level to construct a judgment matrix.Through the analytic hierarchy process,the weight coefficients of the indicators at each level in the competency model were obtained.Results:This study conducted a comprehensive assessment of various capabilities and practices related to hospital infection control.The survey results indicate that participants excelled in multiple areas,with a high overall satisfaction rate.95.28%of participants were able to develop hospital infection monitoring plans based on national infection control policies,demonstrating a good understanding and execution of these policies.94.09%of participants were familiar with high-risk populations and key departments in the hospital.91.73%of participants were able to establish monitoring scopes based on the trends of multidrug-resistant bacteria and conduct information monitoring,reflecting strong response capabilities.92.91%of participants were able to collaborate with relevant departments to conduct bacterial resistance monitoring,showing a good team spirit.94.49%of participants were able to perform targeted monitoring,including surgical site infections,indicating that they have effective monitoring strategies.91.34%of participants were able to collect and organize monitoring data and establish a systematic database,demonstrating good data management skills.90.16%of participants were able to interpret laws and regulations related to hospital infection management,indicating a high level of legal knowledge.89.37%of participants generally possessed good communication skills.92.52%of participants were able to guide medical staff on occupational safety and protective knowledge,showing an emphasis on occupational health.Participants demonstrated a strong desire to learn and innovate,with 87.01%actively participating in continuing education and research activities,reflecting a pursuit of professional development.Conclusion:Based on the results of the two rounds of expert consultations,a competency evaluation model for infection control personnel in TCM hospitals was formed.Through the analytic hierarchy process,the weight coefficients of various indicators at different levels in the model were obtained,and the research results have good scientific validity and reliability.

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Management Measures for Preventing Postoperative Incision Infections in General Surgery at Primary Hospitals

Objective:To analyze the management measures and effects of preventing postoperative incision infections in the general surgery department of primary hospitals.Methods:Forty-nine surgical patients with 11 healthcare workers who were admitted to the general surgery department of the primary hospital between August 2021 and August 2022 were selected as the routine group for routine incision infection management.Forty-nine surgical patients with 11 healthcare workers admitted to the same department between September 2022 and September 2023 were selected as the prevention group for prophylactic management of postoperative incision infections.The incision infection rate,knowledge,attitude,and practice(KAP)scores,and management satisfaction of the patients as well as the management skill scores of healthcare workers were compared between the two groups.Results:The rate of postoperative incision infection in the prevention group was lower than that in the routine group;after implementing management measures,patients in the prevention group had higher KAP scores than those in the routine group;patients in the prevention group were more satisfied with the management than those in the routine group;and healthcare workers in the prevention group had higher scores than those in the routine group,with P<0.05 for the comparison between the groups.Conclusion:The implementation of preventive management for general surgery patients in primary hospitals can reduce the incidence of postoperative incision infection and improve the KAP of patients,with higher management satisfaction.It can also enhance the management skills of healthcare workers,thus improving their overall management level.

A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

Formulation of a CITE metric for evaluating the clinical implications of medical studies and their originating hospitals in China

Background:The number of medical research publications by Chinese clinical investigators has risen substantially,contributing to 14.63%of the global total in 2019;however,their tangible impact on clinical decisionmaking remains limited.Various evaluation methods have been developed to measure hospital research competence in China,such as Fudan University's China hospital ranking and Science and Technology Evaluation Metrics(STEM)ranking,which predominantly focuses on factors such as academic reputation,volume of publications and patents,and research resources.However,composite indices may not fully capture the actual clinical value generated by medical research.To address this gap,we introduced the“Clinical Influence and Timeliness Evaluation(CITE)”metric to assess both the clinical importance of a given medical research study and the clinical influence of the hospital where it originated.The methodology used relies on the premise that influential medical research would be referenced in clinical guidelines,which serve as critical resources for clinicians.Methods:The CITE metric was applied for 78,636 medical studies concerning chronic obstructive pulmonary disease(COPD)published between 2000 and 2020 and referenced in both Chinese and international clinical guidelines for COPD.Specific indexes and formulas were derived to quantify the clinical weight of a medical research study(W)and its timeliness(T),enabling a dynamic assessment of the clinical value of each study and the overall contribution of a particular hospital.Results:In this analysis,we incorporated 499 hospitals in China and quantitatively identified their dynamic clinical influence in COPD from 2000 to 2020.Our findings offer objective and targeted evaluation metrics by focusing on clinical relevance and recognizing the collaborative nature of medical research.Conclusion:The CITE metric provides an innovative method to gauge the true impact of medical research in China,with potential applications across different medical specialties.CITE can serve as a useful tool for understanding the relationship between research input and practical clinical outcomes,ultimately promoting more clinically relevant research endeavors.

共情护理对肝硬化住院焦虑抑郁症状影响的研究

目的 探究共情护理对肝硬化住院患者焦虑抑郁症状的影响。方法 选取2023年1月至2024年1月本院收治的肝硬化住院患者60例,采用随机数字表均分为两组,对照组行常规健康教育和心理护理,观察组同步实施共情护理。比较两组的焦虑抑郁严重程度、自我管理行为水平、治疗依从性以及生活质量。结果 干预前,两组各项指标之间的评分均无显著性差异(P>0.05)。干预后,相较于对照组,观察组SAS、SDS评分均明显下降(P<0.05);自我管理行为评分、FCS评分、生活质量各维度评分均明显升高(P<0.05)。结论 在肝硬化住院患者中应用共情护理,可显著改善患者的焦虑抑郁严重程度和自我管理行为,有效提高患者的治疗依从性,明显提升患者的生活质量,值得临床推广。

替雷利珠单抗药物利用评价标准的建立与应用

目的针对替雷利珠单抗建立药物利用评价(drug use evaluation,DUE)标准,对南京医科大学附属南京医院替雷利珠单抗使用情况进行评价,为临床合理用药提供参考依据。方法根据替雷利单抗药品说明书、临床相关指导原则、诊疗指南和专家共识等,建立替雷利珠单抗DUE标准,依据标准回顾性分析评价2023年1—9月南京医科大学附属南京医院使用替雷利珠单抗的住院病人用药情况。结果替雷利珠单抗DUE标准包含14个指标。纳入96例病人,共使用替雷利珠单抗687次。体力评分、器官功能和实验室指标、给药剂量、给药途径、输注时间、给药频次和疗效评估合理率100%;禁忌证、溶媒种类和用量合理率98.96%;联合用药合理率97.92%;药物相互作用合理率96.88%;给药顺序和时间合理率84.38%;适应证合理率80.21%;不良反应监测与处理合理率39.58%。结论建立并应用替雷利珠单抗DUE标准可发现用药过程中的不合理现象,为临床安全用药提供参考依据。

肺移植受者术后医院感染病原学特点及药敏分析:一项单中心5年回顾性调查研究

目的分析单中心近5年肺移植受者术后医院感染特点及药物敏感性。方法选取无锡市人民医院2019年1月至2023年12月724例肺移植受者,依据医院感染判定原则,回顾性分析肺移植受者医院感染情况及感染部位,对医院感染病原菌分布及其药敏试验状况进行分析。结果724例肺移植受者中,275例发生医院感染,感染率为38.0%。感染例次率由2019年的54.2%降低至2023年的22.8%,呈逐年下降趋势(Z=30.98,P<0.001)。感染部位主要为下呼吸道,占73.6%。感染病原菌以革兰阴性菌为主,前4位为鲍曼不动杆菌(37.1%)、铜绿假单胞菌(17.3%)、肺炎克雷伯菌(13.7%)和嗜麦芽窄食单胞菌(13.4%),对亚胺培南的耐药率分别为89%、53%、58%和100%。革兰阳性菌以金黄色葡萄球菌为主(3.6%),对苯唑西林的耐药率为67%。结论近5年肺移植受者的医院感染呈下降趋势,主要以下呼吸道感染为主,感染病原菌主要为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌,对亚胺培南的耐药率均较高。

基于智能病案归档系统的医疗过程无纸化办公平台建设

目的设计一套基于智能病案归档系统的医疗过程无纸化办公平台,以实现医疗过程的无纸化办公。方法以某三级甲等医院为例,基于实验室信息系统、医院信息系统、影像归档和通信系统等信息系统,完成数字证书认证系统、信息集成平台、病案质控系统、病案数据库及索引库、数据灾难备份体系等的设计。在“病案可信归档系统V1.0”软件基础上引入AI全病案质控系统,升级为“病案可信归档系统V2.0”,建立一套无纸化办公的管理机制,实现病案全生命周期智能化管理。结果基于智能病案归档系统的医疗过程无纸化办公平台应用后,病案7 d内归档率由72.66%提高至96.87%,甲级病案占比由97.74%提高至99.14%,差异均有统计学意义(P<0.001)。借助无纸化办公平台,查询病案资料时间平均缩短了157.56 s,无纸化病案调取份数也有大量提高;危急值30 min内处置及时率由78.58%提高至88.86%,差异均有统计学意义(P<0.001);医院每年节省经济成本约496万元。结论基于智能病案归档系统的医疗过程无纸化办公平台的应用,切实提升了医院病案归档水平和医疗过程无纸化水平,实现了医院病案档案的高效管理和利用、充分发挥了无纸化管理优势,提高了工作效率,提升了患者体验,使病案更好地服务于医疗。

基于改进神经网络的医院通信安全态势感知方法

针对医院通信安全态势感知不及时,易导致医院信息系统重要信息受到损害的问题,提出基于改进神经网络的医院通信安全态势感知方法。使用基于小波消噪的通信信号去除噪声并保留关键信息,输入基于改进RBF神经网络的医院通信安全态势感知模型。利用花朵授粉算法完成改进RBF神经网络训练。通过径向基函数对输入数据进行非线性变换,将得到的权值进行加权求和,得到当前通信网络信号的安全态势预测结果。实验结果显示,应用该文方法的医院通信网络异常信息可在1 s内完成感知。

新医改背景下医院档案管理工作提质增效路径研究

随着医疗行业的改革发展,医院档案管理工作需适应新的行业环境,创新档案管理模式,提高档案管理效率和服务质量。文章基于医疗改革背景下,分析医疗改革对医院档案管理工作的影响,调查新医改背景下医院档案管理的现状并剖析存在的问题,从增强医院档案管理意识、完善医院档案管理制度、推进医院档案信息化建设、加强医院档案人员培训与考核等方面提出建议措施。

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。

公立医院护工服务质量评价指标体系构建

目的:构建一套用于评估公立医院护工服务质量评价指标体系,为进一步规范护工人员管理提供依据。方法:基于SERVQUAL模型,结合文献研究、追踪方法学现场调查及两轮德尔菲法专家咨询确定评价指标体系,结合专家决策法和熵值法为指标赋予权重。结果:最终构建的公立医院护工服务质量评价指标体系包含5个一级指标和23个二级指标。17名专家的积极系数均为100%,权威系数分别为0.841和0.842(P<0.001);肯德尔系数逐轮递增(0.218和0.343),专家意见一致性较高。结论:本研究构建的指标体系具备一定的系统性与科学性,能够作为有效评估工具,为护工的服务质量管理提供依据。