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.

Adherence to Physical Measures during the SARS-COV2 Pandemic by Haemodialysis Patients in a Burkina Faso Tertiary Hospital: A Cross-Sectional Survey

Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures against SARS-Cov2 in haemodialysis patients. Methods and Material: From 13 to 19 July 2021, we administered the questionnaire to haemodialysis patients during or immediately after the dialysis session. The dependent variables were adherence to wearing masks, hand washing outside the dialysis centre, social distancing of at least 1.5 meters, and cough and sneeze hygiene. Statistical Analysis Used: Data were analyzed using Epi info software;descriptive statistics were presented as mean, headcount, and percentage;related factors were determined by multi-logistic regression. The significance level was 5%. The Health Research Ethics Committee approved the research protocol. Results: 142 patients were included (mean age: 42.5 ± 14 years). Wearing masks, hand-washing, social distancing, and coughing and sneezing hygiene were observed by 88%, 75%, 47%, and 60% of patients, respectively. Conclusion: Wearing masks was the most respected physical measure, while social distancing was the least respected.

Clinical Evaluation of Two Interferon-Gamma Release Assays for Diagnostic Tests of Tuberculosis Infection in a Tertiary Hospital: Clinical Evaluation of Two IGRAs for TB Infection

Background: The aim of this study was to evaluate the usefulness of two interferon-gamma release assays (IGRAs) (QuantiFERON-TB Plus (QFT-plus) and T-SPOT.TB assay) for patients suspected of having tuberculosis (TB) infection as supportive methods for diagnosing TB. Patients and Methods: The subjects consisted of 45 patients who required clinical differentiation of TB disease from June 2019 to August 2023. The final clinical diagnoses were: 14 patients with active TB disease, 4 with latent TB infection (LTBI), 17 with old (cured) TB disease, and 10 with pulmonary nontuberculous mycobacterial (NTM) disease. We used the two IGRAs for these patients and evaluated the data according to the manufacturer’s guidelines for interpretation or FDA-approved cutoffs. Results: Among the total of 14 patients with active TB disease (mean age: 64 years old, male: 9, and female: 5), a positive response was noted in 10 patients (71%) on QFT-plus and 9 (64%) on T-SPOT.TB. Four patients with a negative response on QFT-plus and T-SPOT.TB were elderly or cancer patients with lymphocytopenia or hypoalbuminemia. All four patients with LTBI showed a positive response (100%) on both QFT-plus and T-SPOT.TB. Among the seventeen patients with old (cured) TB disease, a positive response was noted in 8 patients (47%) on QFT-plus and 9 (53%) on T-SPOT.TB. All patients with pulmonary NTM disease showed a negative response on both QFT-plus and T-SPOT.TB. Conclusions: A false-negative response on QFT-plus as well as T-SPOT.TB was recognized in elderly patients and patients with an immunosuppressed condition, and half of patients with old (cured) TB showed no negative conversion after the completion of treatment through this study. Although it was recently reported that the positive response rate on QFT-plus of patients with active TB disease was high, we consider it necessary to be careful in diagnosing TB infection using IGRAs for patients with severe underlying diseases in a tertiary hospital based on the results.

System Assimilation of E-Skills in Tertiary Institutions to Empower Graduates in South Africa

The value of system assimilation is to improve working relationships between tutors and learners while increasing workflow efficiency among tertiary institutions with low operational costs. E-skills could be described as electronic education development, to assist ICT professionals to reach their future career goals and aim to help users boost their ICT skills. In a society that is expanding, it is also a crucial issue to take into account. Researchers have turned their attention to this topic because of its significance and contribution to the empowerment of graduates in digital education. Many scholars have proposed many methods for integrating e-skills into society with impressive results, but the rising rate of graduate unemployment in South Africa is gradually becoming a big worry in our society. A model based on Activity Theory (AT) and e-skills will be developed in our tertiary institution to equip graduates with skills that will increase their employability and provide more individualized work opportunities as part of this study’s effort to solve this issue. With the use of the Statistical Package for the Social Sciences (SPSS) and Cronbach’s Alpha for validity and reliability testing, the study will create an experimental performance to assess the approach taken to measure e-skills in tertiary institutions to empower graduates in South Africa. The study established that system development and e-skilled models for tertiary institutions are growing gradually, especially in South African institutions, that empower graduates with profitable employability with experiences to improve work operation in the industries. In conclusion, system development and e-skills are very demanding but important to empower graduate employability to determine competency in the professional workforce.

Evaluation of the Productivity of Intercropping Plantain Cultivar (PITA 3) Fertilized with Two Types of Manure, under Coconut Tree Based (Cocos nucifera L.), on the Tertiary Sands of Côte d’Ivoire

Pressure on land tenure is having a negative impact on the coconut sector, reducing farmers’ incomes. Intercropping cultivars plantain under coconut based has been considered as a solution to this problem. The aim of this work is to diversify the sources of income for coconut growers. The plantain variety PITA 3, popularised by the CNRA, was grown in coconut inter-rows (PB113+), with two types of manure (chemical, organic). Six (06) treatments D1, D2, D3, D4, D5 and D6 were studied. In the tenth month after planting, treatment D3, which included banana plants fertilised with 9 kg of manure/plant, got the best agromorphological performance: height (264.08 cm), neck circumference (57.68 cm) and 12 leaves. In terms of production parameters, D3 banana plants had a shorter production cycle (347 days) and the highest diet mass (9.3 kg). However, the plants that received no fertiliser (D6) showed stunted growth and were unable to produce brunch. The fertilization of plantain with 10 t/ha of laying hen droppings permitted good development and production of plantains on tertiary sands.

Some Haematological Parameters in Primary Hypertensive Subjects Attending a Tertiary Hospital in Nigeria

Background: Hypertension is a persistent elevation of blood pressure in the arteries which if not properly managed can lead to stroke, heart failure, atrial fibrillation, peripheral vascular disease and other life threatening outcomes. This study investigated some haematological parameters of Primary hypertensive subjects. Objectives: To compare some haematological parameters (haematocrit, haemoglobin concentration, Platelets count, White Blood Cells count, red blood cell count and Red Cells Indices between hypertensive and normotensive subjects. Materials and methods: Blood samples were collected from 76 known hypertensive subjects between 30 - 70 years attending the Cardiology clinic of the University of Abuja Teaching Hospital Gwagwalada. Another 37 normotensive subjects between 30 - 65 years served as the control. All subjects gave their consents. Platelets count, Haemoglobin estimation, Packed Cell Volume, Red Blood Cell Count, Mean Cell Volume, Mean Cell Haemoglobin, Mean Cell Haemoglobin Concentration and White Blood Cell count were determined using Mythic 22 five parts haematology analyzer. Results: Results for Hypertensive and Control subjects were, White Blood Cell, 5.76 ± 1.45 × 109/l and 4.76 ± 1.03 × 109/l, Platelet count, 248.7552.45 × 109/l and 284.95 ± 27.66 × 109/l, Mean Cell Volume, 91.81 ± 3.05 fl and 85.68 ± 6.48 fl, Mean Cell Haemoglobin, 30.59 ± 1.04 pg and 27.922 ± 2.74 pg, Mean Cell Haemoglobin Concentration, 33.34 ± 0.61 g/dl and 32.32 ± 0.93 g/dl, Red Blood Cell, 4.33 ± 0.39 × 109/l and 4.50 ± 0.52 × 109/l, Packed Cell Volume, 39% ± 3.15% and 40% ± 4.41% and Haemoglobin, 13.21 ± 1.10 g/dl and 13.50 ± 1.63 g/dl respectively. Mean Cell Volume, Mean Cell Haemoglobin, Mean Cell Haemoglobin Concentration (Red cells indices) were significantly higher in hypertensive compared to normotensive subjects (P 0.05), total White Blood Cell count was also higher in hypertensive than normotensive but not statistically significant (P > 0.05). However, Platelet counts, Red Blood Cell, Packed Cell Volume and Haemoglobin were significantly lower in hypertensive compared to normotensive (P 0.05). All the parameters were within established reference ranges for the age and sex of the subjects. Our findings show that hypertension may lead to haematological derangement, if not properly managed. Conclusively, haematological parameters can be used to monitor the prognosis of the disease and manage hypertensive related complications. It is important to assess haematological parameters for hypertensive individuals which may help to prevent complications associated with haematological disorders.

基于合成控制法的DRG改革对住院费用的影响——以北京市三级公立医院为例

目的:分析DRG改革对北京市三级公立医院例均住院总费用及其增速、内部结构的短期效应与长期影响。方法:基于2009—2018年北京市三级公立医院住院费用的年度报表数据,采用合成控制法分析2011年的DRG改革对例均住院总费用及各项费用占比的影响。结果:与未试点的医院相比,短期内试点医院的例均住院总费用有所降低,药占比下降显著,耗材费用占比增速下降明显,手术、治疗、护理费用占比有所下降,检查、化验费用占比略有上升。长期看,试点医院例均住院总费用与增速超过非试点医院,药占比、手术、治疗、护理费用占比低于非试点医院,耗材费用占比大幅提高,检查、化验费用占比呈现较强的个体差异性。结论:DRG改革短期内对控制费用增长具有积极作用,长期效果有待改善,费用结构有待优化;未来应从发挥“双中心”的多元作用、与三级公立医院绩效考核结合、提高体现医生技术劳动价值的收入等方面完善DRG改革。

青海省三级医院信息化护理质控平台建设及应用

目的/意义建立青海省三级医院信息化护理质控平台,分析其对护理质量的影响。方法/过程根据青海省护理质量管理现状,依托青海省护理质量数据平台,建立护理质量指标监测模块,选取1家三级医院作为试点,采用历史对照研究方法,将2021年1—6月该医院护理质量数据作为对照组,2022年1—6月采用信息化护理质控平台收集的数据作为观察组,对比平台应用前后护理质量的变化情况。结果/结论信息化护理质控平台应用后,住院患者身体约束率和气管插管非计划拔管率显著下降,患者对护理工作满意度评分显著提升,平台可操作性强,具有临床应用价值。

546名三甲综合医院护士核心能力调查及其影响因素分析

目的:调查宁夏银川市三甲综合医院护士的核心能力,分析影响护士核心能力的因素,为进一步完善临床护理培训计划提供参考。方法:采用“中国注册护士核心能力量表”对银川市4所三甲综合医院的546名护士进行调查,分析影响护士核心能力的相关因素。结果:银川市三甲综合医院护士核心能力平均总分为(142.05±51.01)分,处于中等水平。其中,伦理法律实践能力和领导能力得分较高,评判性思维、科学研究和职业发展得分较低。不同护理年龄、职称和工作编制护士的核心能力水平比较,差异有统计学意义(F=2.325、1.613、4.617,P<0.05)。结论:宁夏银川市三甲综合医院护士的整体核心能力处于中等水平,尤其是评判性思维能力、科研能力和专业发展能力偏低下。护理管理者需要科学设计临床护士的培训方案,提供多样化、个性化、人性化的培训模式,增强护士的职业竞争力,促进护理事业的发展。

我国三级公立医院绩效考核结果分析与思考

目的 对我国三级公立医院绩效考核结果进行分析,为推进三级公立医院高质量发展提供依据。方法 运用描述性分析法和对比分析法对2019年—2021年三级公立医院绩效考核结果及发展趋势进行分析。结果 出院患者手术占比、微创手术占比、四级手术比例和日间手术占择期手术比例均有所增长;Ⅰ类切口感染率下降,DRG组数中位数逐渐增加;抗菌药物使用强度逐步降低,且明显低于40 DDDs的国家上限要求;门诊预约诊疗率大幅度提升,门诊患者预约后平均等候时间稳中有降;人员支出占业务支出比例稳中有升;副高级以上职称的比例、接收对口支援医院和医联体内医院进修半年以上人员的比例逐步提升。存在的主要问题为三级公立医院发展不均衡,跨省异地就医现象仍然存在,医院管理水平有待进一步提高,患者就医感受和医务人员获得感仍需进一步改善。结论 为推进三级公立医院高质量发展,还需进一步提升医疗服务水平;加强医院科学管理,推进管理出效益;激活医务人员积极性,推动以人为本的全面发展。

共同富裕愿景下增进农村低收入人口福利的政策创新——基于三次分配分析框架

面向全体人民共同富裕的伟大愿景目标,迫切需要对标共同富裕、研判福利差距,并进行制度性的回应。三次分配制度是改善农村低收入人口福利差距、促进农村低收入人口持续增收、实现全体人民共同富裕的有效手段。中国农村和农民在不断分化转型,三次分配的契合性也不尽相同。脱贫攻坚期间,中国基于三次分配的不同着力点围绕农村低收入群体展开了一系列政策实践,但是存在初次分配效率不高、再分配水平低、第三次分配尚未找到切入点、不同层次分配间协同性不足等问题。未来政策调整应当以加大农业就业准入门槛、提高农村低收入群体的劳动报酬、扩大农村非农就业机会作为初次分配的着力点;以强化农村低收入人口的转移支付力度、提高基本公共服务和社会保障均等化的深度与广度、完善农业支持与资源保护政策等作为再分配的着力点;以丰富第三次分配的实现形式、强化第三次分配与初次分配、再分配间的协同配合作为第三次分配的创新着力点。

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。

基于三级妇幼保健院应用微信公众号开展健康科普传播状况的调查

目的了解我国三级妇幼保健院应用微信公众号开展健康科普传播的现状,为促进各级妇幼保健机构充分利用微信公众号平台开展健康科普宣传,提高新媒体健康传播效能提供参考依据。方法选取2021年参加全国三级妇幼保健机构绩效考核并有微信公众号的274所机构为调查对象。采用自制问卷,于2022年4—6月通过问卷星向被调查机构的微信公众号负责人进行调查。问卷内容涉及负责人基本情况,以及本机构纳入三级妇幼保健院微信公众号科普作品影响力监测的微信公众号建设和管理情况,科普作品的创作、发布和运营情况,针对用户调查情况等。结果274所有微信公众号的三级妇幼保健院中,67.9%的微信公众号为服务号;98.9%的微信公众号具有健康宣教功能;用户注册数超过20万人的微信公众号占29.2%。各机构微信公众号管理人员数量普遍较少,仅为1人的机构占29.2%,37.9%的机构无专人管理。微信公众号负责人所在科室主要为宣传科(38.7%)、健康教育科(27.4%)及院办(13.1%);负责人专业背景为医学相关专业的仅占36.9%;各机构确定科普作品主题的方法主要为配合科普宣传日(94.2%)、各科室提供(90.1%)、热点话题(81.8%)、根据节气/天气变化(59.5%)等,主题确定来源于用户需求调查的仅为37.2%;科普稿源以相关业务科室提供为主(95.3%);94.5%的机构在科普作品发布前有专人审核。发布的科普作品主要通过院内官方宣传媒体(84.3%)和院内自媒体(77.4%)进行推广,经由辖区妇幼体系推广的机构仅占13.1%。微信公众号运营管理人员主要是本机构专职(47.1%)和兼职人员(49.3%);79.6%的机构无运营经费支持;53.6%的机构设定了科普作品发布激励机制,仅有21.2%的机构开展过微信公众号用户调查。结论绝大多数三级妇幼保健院均能通过微信公众号开展妇幼健康科普传播工作,但普遍缺乏用户调查和对公众号运营的支持,应进一步加强对微信公众号的管理,并充分利用微信公众号开展与用户的沟通及需求评估,从而进一步促进微信公众号健康传播能力的提升。

国家三级公立医院绩效考核在我院的实践探讨

2019年国家卫生健康委启动了三级公立医院绩效考核工作,此后“国考”成为了全国公立医院的重点工作之一,也成为了医院推进管理工作、推动可持续发展的重要抓手。面对国家深化医改及公立医院高质量发展的要求,内蒙古某三级公立医院以“国考”为导向,找准发展定位,提高医疗水平,重视学科建设,构建医院质量管理体系,加强内部管理机制,提升了医院医疗服务能力、患者安全和服务质量,优化内部管理,推动了医院高质量发展。

基于DEMATEL模型的三级公立医院运营效率影响因素分析及对策研究

目的 分析影响医院运营效率的主要因素并提出意见建议,为医院管理部门提升医院运营效能提供参考依据。方法 利用决策试验和评价试验法(dematel)模型分析影响因素之间的相互作用关系。结果 员工工作负荷、人员结构比例、岗位责任、绩效考核方式等12个要素是影响三级公立医院运营效率的关键影响因素。结论 三级公立医院的高效运转是多种因素共同作用产生的结果,提高运营效率要从合理配置人力资源,完善绩效考核模式,优化医疗流程布局,创新发展运营模式等方面入手。

广东省二、三级医疗机构延续护理部门设立及运作现况调查

目的:了解广东省二、三级医疗机构延续护理部门的设立及运作情况,为医疗机构建设延续护理部门、开展延续护理提供参考和借鉴。方法:采用便利抽样法于2023年5月4日—19日选取广东省110所二、三级医疗机构的护理管理人员进行调查,调查其所在医疗机构延续护理部门的建立情况、运作情况、阻滞因素及相关建议。结果:110所医疗机构中有35所(31.82%)设立了延续护理部门,58所(52.73%)拟计划开展延续护理服务,17所(15.45%)暂无设立延续护理部门及开展延续护理的计划。已开展延续护理的35所医疗机构中,2010年前设立延续护理部门的有3所(8.57%),2010—2018年有9所(25.71%),2019年至今有23所(65.71%)。35所医疗机构延续护理运作情况良好,但在医疗收费、医院-社区联动及延续护理质量指标设置方面需进一步加强和完善。51所(46.36%)医疗机构认为设立延续护理部门开展延续护理服务无障碍,59所(53.64%)认为存在障碍,障碍因素主要包括人力资源短缺(79.66%)、经济效益受限(76.27%)、实施场地缺乏(54.24%)、不知如何开展(32.20%)、院领导不支持(23.73%)等。结论:因缺乏统一、规范的标准及指南,广东省二、三级医疗机构延续护理部门的设立及运作情况参差不齐且存在多方面争议、困惑及不足。建议从“相关政策制度、部门组织架构、信息共享与协调机制、服务收费与支付机制、延续护理质量评价指标、工作人员绩效”等方面完善延续护理部门的设立及运作,从而推进延续护理的发展,助力实施健康中国战略。

黑龙江省三级甲等医院护士长绩效考评指标体系构建

目的构建黑龙江省三级甲等医院护士长绩效考评指标体系,旨在为临床护理管理提供参考依据。方法通过文献分析、理论研究初步编制黑龙江省三级甲等医院护士长绩效考评指标体系框架与内容,采用德尔菲法进行2轮专家函询,最终构建黑龙江省三级甲等医院护士长绩效考评指标体系。结果构建的黑龙江省三级甲等医院护士长绩效考评指标体系包含5个一级指标、14个二级指标、49个三级指标,专家咨询可信度高。结论构建黑龙江省三级甲等医院护士长绩效考评指标体系不仅能为省内各级医疗机构的护理管理者和研究者提供参考依据,还能为护士长提高自身护理管理水平提供实践指导。

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。

基于国家公立医院绩效考核的医疗服务能力评价和提升策略研究

目的:以广州市为例,评价三级公立医院医疗服务能力,提出医疗服务能力的提升策略。方法:采用熵权-TOPSIS方法和Kernel密度估计,评估2019-2021年广州市省部属、市属和区属三级公立医院的医疗服务能力。同时,运用Dagum基尼系数分析医疗服务能力的不平等程度。结果:研究显示,广州市三级公立医院在医疗服务能力上存在显著差异。省部属医院整体表现较好,市属医院正在缩小与省部属医院的差距,而区属医院面临较大挑战。基尼系数分析揭示不同级别医院之间以及同一级别内部的医疗服务能力不平等问题。结论:为提升医院服务能力,建议实施差异化策略,明确不同类型医院的功能定位,并关注内涵式发展。加强跨医院合作和知识共享,提高科学管理水平,并加大政策和资金支持,尤其是对区属医院。

三级公立医院绩效考核背景下科技创新能力提升策略实践探索

科技创新是公立医院高质量发展的重要抓手。当前,医院青年人才科研起步难、交叉研究落地难、研究成果转化难等问题,制约了医院科技创新能力的提升。浙江大学医学院附属儿童医院积极响应医改政策,以问题为导向,探索并实践科技创新能力提升策略,从科研绩效评价制度改革、临床青年科技创新人才培养、科技创新平台建设、科技成果转化机制完善等方面,全方位推进医院科技创新体制机制建设,推动科技创新能力整体提升,取得了初步成效。有关实践经验可以为三级公立医院可持续高质量发展提供参考。