Effect analysis of applying high-quality service model to surgical nursing

BACKGROUND Surgical care of the hand plays a crucial role in the medical field,as problems with the hand can profoundly affect a patient's quality of life and function.In order to meet the needs of patients,improve patient satisfaction and improve treatment outcomes,high-quality service models have been introduced in the field of nursing.AIM To explore the effect analysis of applying high-quality service model to surgical nursing.METHODS We conducted a retrospective study of patients who underwent hand surgery at our hospital between 2019 and 2022,using a quality service model that included improved patient education,pain management,care team collaboration,and effective communication.Another group of patients received traditional care as a control group.We compared postoperative recovery,satisfaction,complication rate,and length of hospital stay between the two groups.Inferential statistics were used to compare the difference between the two groups by independent sample t test,Chi-square test and other methods to evaluate the effect of intervention measures.RESULTS Postoperative recovery time decreased from 17.8±2.3 d to 14.5±2.1 d,pain score decreased from 4.7±1.9 to 3.2±1.4,and hand function score increased from 78.4±7.1 to 88.5±6.2.In terms of patient satisfaction,the quality service model group scored 87.3±5.6 points,which was significantly higher than that of the traditional care group(74.6±6.3 points).At the same time,patients'understanding of medical information also improved from 6.9±1.4 to 8.6±1.2.In terms of postoperative complications,the application of the quality service model reduced the incidence of postoperative complications from 26%to 10%,the incidence of infection from 12%to 5%,and the incidence of bleeding from 10%to 3%.The reduction in these data indicates that the quality service model plays a positive role in reducing the risk of complications.In addition,the average hospital stay of patients in the quality service model group was shortened from 6.8±1.5 d to 5.2±1.3 d,and the hospitalization cost was also reduced from 2800±600 yuan to 2500±500 yuan.CONCLUSION Applying a quality service model to hand surgery care can significantly improve patient clinical outcomes,including faster recovery,less pain,greater satisfaction,and reduced complication rates.

The Effectiveness of Clinical Colloquium Established by the “Drawing Recall” Technique in University Counselling Services for Student Mental Health

An experimental assessment of the effectiveness of university counselling was conducted through the “Stress Drawing Recall” Technique applied before and after a clinical colloquium with 70 university students of both genders, aged 18 - 35 years, who had requested this service. Another 70 students waiting to undergo the colloquium were interviewed as a control group. Two parallel series of drawings depicting personal stress situations were collected and, after evaluation by three expert judges in “double-blind” conditions, led to establishing five forms of development of the graphic language from the first to second drawing, defined as follows: a) distension, with a reduction in stress indicators and increase in comfort indicators;b) explicit representation of conflict resolution;c) appearance of new elements, with persisting conflict;d) increase in stress indicators;e) invariant or equivalent repetition of the stress drawing. Results showed that students who underwent the clinical colloquium (experimental group) changed their stress drawings mainly in the direction of distension and conflict resolution, while the control group had more invariant or equivalent repetition of the stress situation (?= 62.77;p < 0.001). The events depicted in the stress drawings were divided into three categories: a) limited short-term stressful situations due to mainly external agents;b) externally induced stressful situations with intense emotional resonance;c) wide-ranging long-lasting stressful situations with great involvement of the self. The participants were divided into: a) very anxious subjects;b) averagely anxious subjects;c) not very anxious subjects, on the basis of their scores on two questionnaires: the MPI (1959) and the STAI (1970). There is a correspondence between the subjects’ level of conflict and extension of the depicted stress. This confirms the usefulness of the Stress Drawing Recall Technique in psychological counselling.

Training of clinical pharmacists in psychiatric pharmacy services during the prevention and treatment of COVID-19

A series of pharmacy services of clinical pharmacists at the Wuhan Mental Health Center during the prevention and treatment of Coronavirus disease 2019(COVID-19),such as participation in the formulation of COVID-19 prevention and treatment plans suitable for psychiatric departments,popular science of pharmacy,medical order review,real-time intervention,and medication education are summarized here.Due to the sudden public health incident,the service model of psychiatric clinical pharmacists should be addressed,as clinical pharmacists are an important part of the diagnosis and treatment of psychiatric diseases.Among the majors currently available in the clinical pharmacy training base curriculum,no psychiatry major has been set up in China yet;therefore,in this paper,we provide guidance in psychiatry pharmacy for those who wish to integrate clinical teams.

The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.

Psychological Complaints at Psychological Emergency Service Associated with Referral to Extended Screening in a Psychology School Clinic

The Psychological Emergency Service(PES)at psychology school clinics is an unscheduled and free psychological service to meet urgent demands.From this service,some patients whose complaints require more time for clinical work are referred to the Extended Screening(ES),a modality composed of six extra appointments.This study aims to analyze the sociodemographic profile of patients seen on PES in a Brazilian Psychology School Clinic,and to identify the demands that motivated referral to the ES,for better qualification of the care offered.This is a descriptive analysis research,carried out based on data from the medical records of 46 patients who went through the PES and were referred to the ES at the institution,between the years 2019 and 2021.Sociodemographic data were collected and,from the session reports,a content analysis of the thematic analysis modality was performed to identify the complaints.The participants’age ranged from 18 to 65 years,with a mean of 32.28 years(sd=10.95).There was a predominance of female participants(71.74%),that completed High School(39.14%)and had an income from one to two Brazilian minimum wages(32.61%).The most frequent complaints were depressive symptoms(56.52%)and difficulties in interpersonal relationships(32.61%).The results obtained,besides allowing the survey of the social and demographic profile of the clientele of the PES at the Psychology School Clinic,and demonstrating its social relevance by providing free psychological care,also show to be of great importance for the definition of more accurate criteria for referral to the ES of patients seen on PES.

基于Web Service的电子病历系统的设计与应用

建立区域医疗信息系统,实现电子病历的地全面共享已成为当前医药卫生体制改革和卫生信息化建设的重要内容。文中阐述了Web Service技术特点及优势,探讨了基于Web Service的电子病历系统体系结构以及运行支撑框架的设计。在此基础上,简要介绍了基于Web Service的电子病历系统在我院的实施和应用情况,并指出了进一步的研究方向。

基于Web Service的电子病例整合技术研究

为了提高医院电子病历信息的共享,使用Web Services构建以临床文件架构(Clinical Document Architecture,CDA)为标准的电子病历交换系统,CDA文件提供了标准化医疗文件,并可在医疗院所之间进行病历交换,它使用XML定义了完整的医疗信息。通过Web Services的技术可使HTTP协议在分布式架构中达到不同平台的系统整合,改善现有医疗信息环境封闭性架构的限制与缺点,构建出一个可移植性、可读性、交换性的电子病历交换系统以确保病历的完整性并提升医疗系统质量。

Integrated Services Platform of International Scientific Cooperation

Innoscience Research(Malaysia),which is global market oriented,was founded in 2016.Innoscience Research focuses on services based on scientific research.By cooperating with universities and scientific institutes all over the world,it performs medical researches to benefit human beings and promotes the interdisciplinary and international exchanges among researchers.Innoscience Research covers biology,chemistry,physics and many other disciplines.It mainly focuses on the improvement of human health.It aims to promote the cooperation,exploration and exchange among researchers from different countries.By establishing platforms,Innoscience integrates the demands from different fields to realize the combination of clinical research and basic research and to accelerate and deepen the international scientific cooperation.

The Impact of a Clinical Pharmacist in the Emergency Department of an Academic Hospital in the Kingdom of Saudi Arabia

Introduction： The department of emergency medicine （DEM） has a high-risk environment due to its unique and complex workflow. Many high-risk medications are ordered and administered at patients’ bedsides without being checked by a pharmacist first, which may lead to an increase in the incidence of patient medication errors （MEs）. Objective： The current study evaluated the needs of the clinical pharmacy service in the DEM at King Saud University Medical City （KSUMC）, Riyadh, Saudi Arabia. Methods： A cross-sectional retrospective study was conducted between Jan 2016 to Dec 2017 and the documentation of clinical pharmacist interventions was extracted from Esihi database. Results： A total of 2,255 interventions for 862 patients were documented. The recommended interventions were as follows： 645 （dose adjustments）, 108 （therapeutic substitutions）, and 354 interventions （initiating drug therapy）. Adverse drug reactions （ADRs） were reported in 16 patients, and drug interactions were managed in 26 patients. The DEM responded to 713 information inquires and 290 pharmacokinetic consultations. Drug discontinuations included 39 incidents （where unjustified drug prescription occurred）, 37 （where contraindications were involved）, and 19 （where duplicate therapy was involved）. The most common interventions were related to the following drugs： antibiotics （34%）, anticoagulants （15%）, and anticonvulsants （10%）. The acceptance rates for the EM clinical pharmacist recommendations increased from 93.9% in 2016 to 99% in 2017. The most common outcome for interventions was to optimize the therapeutic effects of the drugs that were administered （73%）. Reconciliation was done in 796 patients. Conclusions： The clinical pharmacy service plays a critical role in the management of patients in the emergency department （ED）.

Pharmacist-Managed Anticoagulation Services for Warfarin Management in Tertiary Hospitals:The Egyptian Experience

Background:Warfarin is widely regarded as the main anticoagulant in lowering the risk of thromboembolism.This study used indicators to compare pharmacist-managed anticoagulation services,using a well-prepared protocol,with physician-managed anticoagulation services・Methods:A retrospective prospective pilot study was conducted to compare patient outcomes before and after transitioning patients to phannacist-managed anticoagulation services,comparing the proportion of those with therapeutic international normalized ratio(INK),subtherapeutic INK,and supratherapeutic INR,as well as their bleeding occurrences as indicators of assuring quality care.Results:A significant improvement in anticoagulation management was noted in the transition to pharmacist-managed anticoagulation services.The proportion of those with subtherapeutic INR decreased from 61.8%to 11.8%(p<0.001),those with supratherapeutic INR decreased from 20.6%to 2.9%(p<0.001),those with therapeutic INR increased from 17.6%to 85.3%(p<0.001),and the occurrence of bleeding decreased from 11.8%to 0.0%,without significant difference in warfarin doses(median from 4 before the transition to 5 after);in addition,the time to reach therapeutic INR decreased from 12-24 weeks to 2-8 weeks after transitioning to pharmacist-managed anticoagulation services.Conclusion:Pharmacist-managed anticoagulation services are considered safer and more effective than physician-managed anticoagulation services alone in terms of patientsJ adherence and satisfaction,which provide an excellent opportunity for quality assurance care.

新时期我国结核病防治服务体系建设及展望

中国结核病防治服务体系是随着疫情水平的变化和经济社会的发展不断调整变化的。自2011年,中国逐步推行新型结核病防治服务体系。进入新时代,如何更好地健全和完善结核病防治服务体系,是结核病防治工作面临的重大问题。作者系统总结了中国结核病防治服务体系的演变沿革,阐述了结核病防治服务体系运行现状,分析了其中存在的问题和挑战,对结核病防治服务体系建设提出了工作意见和建议,并展示了未来发展前景。

呼吸与危重症医学科咳喘药学门诊的建设实践与效果评价

目的 回顾性总结呼吸与危重症医学科(PCCM)咳喘药学门诊实践成果,与综合药学门诊进行成效对比,评估其药学服务价值,为其他医疗机构药学门诊的规划建设提供参考。方法 选取黄石市中心医院药学综合门诊2020年11月至2021年5月及PCCM咳喘药学门诊2021年11月至2022年5月就诊的哮喘病例,通过药学门诊病人用药评估指导单、病人吸入装置操作评定表,对比评价药学综合门诊和PCCM药学门诊的药学服务效果。结果 以药学综合门诊哮喘病人为对照组,PCCM咳喘药学门诊哮喘病人为干预组,病人自我用药情况评估,在知晓用药原因、用法用量、不良反应应对措施、药物相互作用方面,首次就诊:对照组为92例(64.8%)、109例(76.8%)、87例(61.3%)、85例(59.9%),干预组为90例(65.2%)、107例(77.5%)、83例(60.1%)、80例(58.0%),两组差异无统计学意义(P>0.05),复诊或随诊时:对照组为118例(83.1%)、114例(80.3%)、98例(69.0%)、94例(66.2%),干预组为132例(95.7%)、128例(92.8%)、123例(89.1%)、120例(87.0%),干预组改善情况优于对照组(P<0.05);哮喘控制测试(ACT)评分,在良好控制、控制不佳方面,首次就诊:对照组为21例(14.8%)、121例(85.2%),干预组为19例(13.8%)、119例(86.2%),两组差异无统计学意义(P>0.05),复诊或随诊时:对照组为88例(62.0%)、46例(32.4%),干预组为105例(76.1%)、8例(5.8%),干预组改善情况优于对照组(P<0.05);吸入制剂药师指导前后测评,在操作一般、操作不佳方面,药师指导前:对照组为82例(60.3%)、32例(23.5%),干预组为81例(62.3%)、29例(22.3%),两组差异无统计学意义(P>0.05),药师指导后:对照组为76例(55.9%)、18例(13.2%),干预组为30例(23.1%)、2例(1.5%),干预组改善情况优于对照组(P<0.05)。结论 PCCM药学门诊与综合药学门诊相比,在哮喘病人的药物知识教育、吸入装置操作、哮喘控制效果等方面能够发挥出更好的药学服务作用,对其他医疗机构规划建设药学门诊具有一定的借鉴及参考意义。

信息化药物警戒系统用药风险防范研究20年

目的 为临床药师围绕用药安全风险防范开展药学服务提供参考。方法 介绍临床药师基于药学实践的特点和需求,依托信息化监测研究技术开展系列的药品不良反应(ADR)自发报告和药品不良事件(ADE)主动监测研究。结果 临床药师依托ADR自发报告平台,深入参与诊疗工作,提高了临床ADR监测水平。依托自发报告信息库海量数据,利用数据挖掘方法分析抗感染药物ADR发生特点,为临床提供抗感染药物安全信息。依托ADE主动监测平台,从初期的万古霉素、替加环素等单药ADE主动监测基于全部用药的条件下药源性血小板减少症、药源性低纤维蛋白原血症等风险预测模型建立,开展系列基于真实世界研究的ADE主动监测。结论 信息化药物警戒系统为专科临床药师开展临床药学实践和研究提供了良好的平台支撑,提升了临床药学服务效能。

考试焦虑障碍临床诊疗中国专家共识

考试焦虑障碍是一组与考试等评价性刺激相关的综合征,是考试带来的较为严重的心理问题之一。长期的考试焦虑容易引起紧张、恐惧、烦躁、抑郁等负性情绪,损害个体的工作记忆、注意等认知能力,严重的甚至会导致个体出现自杀意念。为进一步规范考试焦虑障碍的临床诊疗,在中华医学会心身医学分会考试焦虑协作组的组织下,由13名专家组成专家组,包括精神科医师和心理学专家,基于国内外文献和临床诊疗经验等制定本专家共识,以期从流行病学、病因、临床表现、评估、治疗等方面为临床医生提供科学、全面的指导。

全程管理模式对临床药师抗感染会诊效果影响的前后对照单臂观察性研究

目的 探讨全程管理模式对医院临床药师抗感染会诊的影响效果。方法 对长沙市第四医院临床药师抗感染会诊实施全程管理模式前(2021年2—7月)的592例会诊病例和实施全程管理模式后(2022年2—7月)的688例会诊病例的抗菌药物使用疗程、抗菌药物使用品种数、抗菌药物使用费用、抗菌药物使用累计DDD(限定日剂量)数、抗菌药物使用强度、病人住院天数、病人住院费用和病人住院药品费用等指标进行对比和分析。结果 实施全程管理模式后,临床药师参与管理的抗感染会诊病例的抗菌药物使用累计DDD数减少3.31(实施前21.16±19.65,实施后17.85±16.09)、抗菌药物使用强度减少6.79(实施前103.22±58.37,实施后96.43±48.80)、病人住院天数减少2.26 d[实施前(20.59±13.13)d,实施后(18.33±11.71)d],抗菌药物使用天数、抗菌药物使用品种数、抗菌药物使用费用、病人住院费用以及病人住院药品费用等指标差异无统计学意义。结论 全程管理模式对临床药师抗感染会诊效果影响显著,对降低临床药师参与抗感染会诊病例的抗菌药物使用强度及减轻病人疾病负担具有重要意义,值得推广应用。

以临床药学服务能力为导向的药物毒理学教学设计探讨

药物毒理学课程在医药学专业本科教育中日益重要。针对不同教学模块采用医学问题前移、刻意训练和切块拼接等教学设计提升学生对知识的掌握程度;通过药学服务实践、学科竞赛等第二课堂促进知识能力融合、技术素养共同进步,最终提升学生临床药学服务能力、为其奠定坚实的从业基础。

医药联合门诊在老年患者合理用药管理中的工作模式探讨及成效分析

目的介绍南京医科大学第二附属医院老年患者医药联合门诊的工作模式与成效,分析优点与不足,以期为其他药学门诊的建立提供参考。方法选取2019年7月至2022年7月年于该门诊就诊并建立完整随访档案的680例患者,统计分析其一般情况、疾病及用药情况、药物治疗相关问题、药学服务内容等。结果680例患者中53.82%患有高血压,51.91%患者同时患有3种及以上慢性疾病,43.82%患者同时使用4~6种药物。680例患者中有441例存在854个药物治疗问题,平均1.94个/人。其中类型最多的是用药依从性问题,占38.17%。药师干预后患者依从性评分显著提高(P<0.05)。结论药师通过建立医药联合门诊,参与老年患者慢性病药物治疗管理,显著改善患者依从性,提高药物治疗有效性和安全性,进一步促进合理用药。

基于智慧教室+SimMan 3G模型人中医临床技能教学方法

中医临床技能教学是新时代高层次中医药人才培养的重要环节。以中医临床医生岗位胜任力为导向,以培养应用型医学人才为目标,践行“以学生为本”的教育理念,通过创新教学方法、丰富教学内容、提升教学效率以实现临床技能教育教学改革。此文以综合急救虚拟仿真实训教学为例,探讨“智慧教室+SimMan 3G模型人”的中医临床技能教学方法的优势效果。

多学科联合多维度产后避孕服务模式的构建与应用

目的探讨多学科联合多维度产后避孕服务模式的建立及实践效果,为形成适宜医疗机构应用的产后避孕服务模式提供参考,保护女性生殖健康和生育力。方法采用非同期对照临床试验设计,便利选取该院2021年6-8月定期产检的育龄妇女1200例作为试验组,将2021年3-5月定期产检的育龄妇女1200例作为对照组。试验组采用多学科联合多维度产后避孕服务模式在妇女孕晚期及分娩期,产后42 d,产后6、12个月进行产后避孕知识宣教、避孕措施落实和随访,产后避孕服务档案信息多学科互通互享管理;对照组采用常规产后避孕服务方法。干预完成后对2组妇女产后避孕知识知晓情况及格率、性生活恢复时间、产后避孕启动时间、产后1年内持续规范避孕率、产后1年非意愿妊娠率、产后1年人工流产率、产后1年内采取避孕方法等进行统计分析。结果试验组妇女产后避孕知识知晓情况及格率、性生活恢复时间、产后避孕启动时间、产后1年内持续规范避孕率、产后1年非意愿妊娠率、产后1年人工流产率、产后1年内采取避孕方法等明显优于对照组,差异均有统计学意义(P<0.01)。结论采用多学科联合多维度产后避孕服务模式,利于提高育龄妇女产后避孕知识知晓率与避孕意识、落实长期高效避孕措施,降低产后1年内非意愿妊娠率、高危流产率等。

院前急救在高危胸痛患者救治中的应用效果分析

目的探索院前急救方案在高危胸痛急救过程中的应用效果。方法将2021年6月至2023年6月由漳州市急救中心收治的90例高危胸痛患者,采用随机数字表法分为观察组与对照组,每组各45例。观察组采取院前急救服务,对照组采取常规急救,对比两组患者的抢救时间、不良结局及临床疗效。结果观察组发病到急诊时间、发病到病情确诊时间、平均住院时间均显著短于对照组(P值均<0.001)。观察组并发症发生率为24.44%,死亡率为8.89%,对照组的并发症发生率为48.89%,死亡率为33.33%,观察组的并发症发生率及死亡率均显著低于对照组(P<0.005)。观察组的临床有效率为97.78%,显著高于对照组的82.22%,差异有统计学意义(P=0.014)。结论院前急救服务可有效缩短高危胸痛患者急救时间,降低不良结局的发生率,提高抢救的有效率。