Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients:Case series and brief literature review

BACKGROUND Hospitalized and severely ill coronavirus disease 2019(COVID-19)patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites.Life-threatening bleeding complications include spontaneous iliopsoas hematoma,peritoneal bleeding,and extra-abdominal manifestations such as intracranial hemorrhage.CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding.In our case series of 9 patients,we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia.Contrast-enhanced computed tomography(CE-CT)is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach,whether interventional,surgical,or conservative management.CONCLUSION We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling.Finally,we provide a brief review of the literature.

Can public report cards affect consumer’s private learning of quality? An evaluation of the impact of Florida hospital report cards on acute myocardial infarction patient admission patterns

The empirical literature on hospital report cards typically assumes that report card cannot interact with consumer’s private learning. This study examines the impact of the implementation of FL hospital quality reporting system in late 2004 on hospital admission patterns using a pre-post difference-in-difference design. The estimation model allows for the possibility that report-card learning may interact with non-report-card learning. The study sample is comprised of all patients admitted to any FL hospital between 2000 and 2008 with a principal diagnosis of acute myocardial infarction (AMI). We find that hospital admission patterns for AMI patients did not respond to report card information. However, we find evidence consistent with the possibility that the implementation of a report card system may stimulate consumers (either patients or physicians) to seek higher quality hospitals through private information channels.

Self-Reporting of Adverse Drug Reactions in Iraqi Hospitals: Patient’s Perspectives

Background: Adverse drug reactions (ADRs) represent the important cause of morbidity and mortality that affect patients using drugs. Previous studies have clarified the knowledge and attitude toward ADRs reporting among healthcare providers, while studies toward awareness of patients are limited. Aim and Objective: To evaluate knowledge and attitude toward ADRs reporting among patients visiting general hospitals in Baghdad City. Methods: This observational study was conducted on randomly selected 300 patients at the out-patient setting of general hospitals in Baghdad. Demographic characteristics of participants were documented and questionnaire regarding knowledge and perceptions was given to fill up, and the data were analyzed using descriptive statistics. Results: Demographic analysis showed that 55% of patients were males, 62% of them were from rural areas, and only 34% were college graduates. Regarding knowledge about ADRs, 73.3% patients were aware about ADRs and 37% had experienced ADRs in past. None of the respondents were aware of ADR reporting center. Regarding perceptions toward ADR, 84.2% agreed to report ADR in future and 90% respondents believed that ADR reporting may strengthen the patient safety. According to 61% of patients, patient education program is the best way to educate them regarding ADR. Conclusion: Educational interventions are highly recommended to improve awareness among patients regarding the validity of ADRs reporting.

Behavioral Aspects in Obligatory Reports of Public Hospitals in Poland

The health care sector is the most difficult one to manage and control. Special units in this field are public hospitals which are required to prepare a lot of reports to various institutions, including the ownership body. The paper focuses on two issues. The first is the presence of behavioral factors in the reporting of public hospitals in Poland to the ownership bodies. This article aims to indicate the thematic areas of specific reports, most affected by behavioral factors and explain the causes and consequences of their occurrence. The second issue is the analysis of the legal status of obligatory reporting of public hospitals. Participants of the conducted research, due to their specific ownership and political and social position, were public hospitals in Poland. The paper uses the research methods of the meta-analysis of the literature, legal acts in Poland and empirical materials, and also the methods of synthesis, observation, and deduction. Data analysis focused on specific sample of reports issued by Polish public hospitals for their ownership body. The research shows that hospitals draw up a tremendous number of often thematically overlapping and redundant reports addressed to different institutions in different time periods. It is a consequence of legal regulations failing to streamline the reporting of the health care sector institutions, in particular public hospitals. The paper points to the large number of legal instruments that contain imprecise requirements resulting from the complex and obscure forms of control of public funds allocation in this sector. There are many behavioral factors that shape some fields of public hospitals＇ reports, for example, interpersonal relationships, egoism, private financial interests, strengthening of the employment status and professional position, and professional competences. There is considerable freedom in the reporting process fulfilled by public hospitals in Poland for their ownership body. It causes strong consequences, like poor-quality data, duplication of information, and its chaos, as well as high costs of obtaining information. Reporting system of financial and non-financial data of public hospitals in Poland is dysfunctional.

Perimortem caesarean section: A case report of an out-of-hospital arrest pregnant woman

Dear editor, In July 2015, a 39-year-old gravida 2, para 0 lady at 35 weeks＇ gestation was found collapsed at home and sent to the emergency department （ED） by ambulance. She had a background of chronic hypertension on anti- hypertensives and aspirin, but repeatedly refused in- patient treatment for her uncontrolled hypertension. She had received pre-hospital cardiopulmonary resuscitation （CPR） for 17 minutes en route to the ED.

Obstetrics Risk Management in 5 Iranian Hospitals (Tehran-2012)

Background: Risk management is improving quality of health care services and creating a safer system of care. We determined the main maternal and fetal risks in five Hospitals (Tehran-Iran) to offer some practical strategies to decline obstetric adverse events and provide better pregnancy outcome. Methods: A descriptive, cross-sectional study was carried out in 5 Iranian hospitals (2011-2012).?Twelve Obstetricians/perinatalogists and midwives from 5 hospitalswho were in charge of Maternity Units, were our assistants in these hospitals. We organized a secretariat including Obstetricians/perinatalogists and midwives. The principles of Obstetrics Risk Management were introduced to them in a 2 days’ workshop. Then the delegates from each hospital were asked to report the most common obstetrical complications of their hospitals. The main results were 24 complications. Then for sorting these risks we asked them to do scoring of the 24 complication with 1 - 10 grading in 4 aspects of probability of occurrence, possibility of prevention, priority of interventions and short term response to interventions. Post partum haemorrhage, labor management problems, and neonatal hypothermia got the highest scores in these regards, and then these 24 items were categorized in 2 groups of risk assessment and hospital management. Finally based on Risk Management Rules in Clinical Governance, the complications analysis was done with use of failure mode, effects analysis and practical strategies to decline obstetrical adverse events were suggested. Results: We understood all reported complications had common infrastructural problems: defects in Risk Assessment and Hospital Management Policies. We focused on basic infrastructural management in these 2 main subjects and in these two: our main problems were related to staff management and hospital management issues. Conclusion: Since managerial and staff dependent problems were our main problems, these two should be considered as our main priorities in risk management program.

某院药品不良反应上报工作改进实践

目的为建立医院药品不良反应(ADR)上报管理模式提供参考。方法收集四川省邛崃市医疗中心医院2016年ADR上报情况,利用质量管理工具进行第1轮上报工作改进(2017年1月至2019年12月);运用触发管理工具进行第2轮上报工作改进(2020年1月至2022年12月)。分析改进后的效果。结果2016年,该院ADR上报125例,2017年至2019年分别升至163例、236例、149例。2016年上报新的+严重ADR比例和严重ADR比例分别为31.20%和8.80%,2022年分别大幅升至74.65%和57.94%。结论运用质量管理工具及触发管理工具,能促进医院ADR上报数量增加及质量的提升。

基于岗位胜任力的主题式晨间报告在重症医学科住院医师规范化培训中的探索

目的探讨在重症医学科住院医师规范化培训带教中开展基于岗位胜任力的“主题式晨间报告”的作用。方法收录自2020年1月至2022年12月某院重症医学科参加住院医师规范化培训的住培医师共60名,随机分试验组和对照组,每组30人。试验组采用基于岗位胜任力的主题式晨间报告的互动教学方式,对照组采用传统带教方式。比较两组住培医师在不同带教方式下临床理论知识、操作实践技能考核成绩,采用360环评的方式收录患者或家属、护士、同事以及带教老师对住培医师岗位胜任力(自主学习能力、团队协作能力、有效沟通能力、学习兴趣)的多方位评价。结果试验组带教后的临床理论知识、操作实践技能考核得分均高于对照组,差异有统计学意义(理论考核:t=2.101,P<0.05;实践考核:t=9.647,P<0.05)。规培1月后无论护士、同事、带教老师对住培医师的各项岗位胜任力评分试验组均高于对照组,差异均有统计学意义(护士评价自主学习能力:t=3.182,P=0.002,团队协作能力:t=3.978,P<0.05,有效沟通能力:t=2.180,P=0.0335,学习兴趣:t=3.884,P<0.05;同事评价自主学习能力:t=2.888,P=0.005,团队协作能力:t=6.816,P<0.05,有效沟通能力:t=3.833,P<0.05,学习兴趣:t=4.086,P<0.05;带教老师评价自主学习能力:t=3.429,P=0.001,团队协作能力:t=3.086,P=0.003,有效沟通能力:t=3.493,P=0.001,学习兴趣:t=3.126,P=0.003)。患者或家属对两组规培医师的满意度评分对比差异有统计学意义(t=3.126,P=0.003)。结论对重症医学科住院医师规范化培训学员临床带教中采用基于岗位胜任力的主题式晨间报告的互动教学,不仅可以提高住培医师的理论实践以及病例分析的考核成绩,还能提升岗位胜任力,以及患者和家属的满意度。

基于微信小程序的医院设施设备报修系统设计

为改善医院设施设备维修数据手段落后问题,提出基于微信小程序的医院设施设备报修系统,结合粒子群算法与支持向量机改进设备故障预测。结果显示,该方法在测试集与验证集上运行时,当系统分别迭代至第11次与第8次时,实验所构建方法出现最大适应度值,数值分别为0.949与0.975。另外在测试集上,当数据量为400条时,实验构建的方法误差重合于目标误差线,仅为0.05。应用“一站式服务平台”后,综合维修满意率高达97.82%,说明该方法能对维修任务进度进行有效监督,调动维修人员的工作积极性。

医院感染预测模型研究方法学与报告质量评价

目的评价当前我国医院感染预测模型研究方法学质量和报告质量,以期为规范研究过程和报告方法提供参考。方法系统检索中英文数据库截至2022年底的国内医院感染相关预测模型研究,研究团队按纳入、排除标准独立筛选文献、交叉核对提取资料后,应用临床预测模型偏倚风险和适用性的评估工具(prediction model risk of bias assessment tool,PROBAST)评价方法学质量,使用个体预后与诊断预测模型研究报告规范(transparent reporting of a multivariable pre⁃diction model for individual prognosis or diagnosis,TRIPOD)声明评价研究报告质量。结果共纳入81篇医院感染预测模型研究,PROBAST偏倚风险评估的平均完成度为58.11%±13.88%,TRIPOD声明报告质量的平均完成度为56.11%±16.35%。方法学缺陷主要存在于数据来源、未考虑数据复杂性与采用单因素分析筛选预测因子等,报告质量中风险分层、样本量估算与补充信息等条目未报告或报告不全面。结论国内医院感染预测模型研究存在方法学缺陷与不完整的报告情况,限制了研究结果的可靠性与适用性,有较大的改进空间。

基于中国医院药物警戒系统建立地高辛不良事件主动监测电子触发器

目的 基于中国医院药物警戒系统(CHPS)探索建立地高辛药品不良事件(ADE)主动监测电子触发器。方法 通过查阅文献、药品说明书和不良反应数据库等,拟定地高辛ADE电子触发器初始条目;采用德尔菲(Delphi)专家调查法,对电子触发器条目进行修订;利用某三甲医院使用地高辛的住院患者病历进行回顾性审查,计算电子触发器的阳性预测值(PPV),并与医院不良事件自发上报数据进行比对。结果 初拟地高辛ADE电子触发器条目18项,经德尔菲法调查和讨论后,利用CHPS系统集成建模工具,将16项电子触发器条目设置成主动监测方案,其中实验室指标4项、解毒剂2项、临床症状7项、干预措施3项,电子触发器总体PPV为29.37%(79/269)。电子触发器检出并经人工审核确定的真阳性ADE病例41例,检出率为13.67%(41/300),而不良反应监测系统同期自发上报率为0。结论 基于CHPS建立的电子触发器可有效用于主动监测医疗机构ADE,增强监测敏感性,提高不良反应上报率。

Frequency and barriers of reporting workplace violence in nurses:An online survey in China

Objectives:This study aimed to explore the reporting of workplace violence against nurses and the reasons why they did not reported.Methods:A self-designed questionnaire regarding workplace violence and reporting was used to conduct a cross-sectional survey on nurses who submitted a manuscript to a Chinese nursing journal from 2016 to 2017.A total of 324 nurses agreed to participate in this study and 266 participants from 165 hospitals in 72 cities returned questionnaires.Results:A total of 172 nurses(64.7%)experienced violent incidents during the past year.Of these incidents,45.5%were reported;and the reporting rate of physical assaults(69.0%)was higher than those of verbal abuse(36.9%),threatening behavior(51.7%),and sexual harassment(60.0%).Formal reporting accounted for 25.4%(15.4%in written form and 10.0%through a computer-assisted reporting system).Almost half of the nurses(49.6%)stated that the hospital had no reporting system or they were uncertain about the reporting system.For reasons of not reporting,51.9%of the nurses were unware of how and what types of violence to report,and 50.6%of the nurses believed that the hospital paid greater attention to patients rather than staff.Conclusions:A clear definition of workplace violence and reporting procedures,establishment of a facile system for reporting,and supervisory support following a reporting are urgently required.

Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature

BACKGROUND Spinal metastases are common in patients with malignancies,but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis.Knowledge of surgical complications,particularly perioperative mortality,in patients with spinal metastases from unidentified sources is still insufficient.CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra(T7).Radiographic examinations,as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion,resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion.Therefore,spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis.Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma.As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery,the origin of this metastasis was undetermined.We discuss this case with respect to reported perioperative mortality in similar cases.CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.

中国医院药物警戒系统药品不良反应主动监测模块的应用探讨

目的:探讨中国医院药物警戒系统(CHPS)药品不良反应(ADR)主动监测模块在医院上报ADR时的作用。方法:从报告例数、报告类型、涉及药品、损害部位等方面,对比分析2020年下半年ADR主动监测上报情况与自发上报情况。结果:主动监测报告占总ADR报告例数的20%,严重的和新的、严重的ADR报告占总ADR报告例数的25%;主动监测ADR报告涉及的药品中有27种为自发上报未涉及品种,占所有ADR报告品种数的12.86%;严重的和新的、严重的ADR报告涉及的药品品种中,25%为主动监测获得;主动监测ADR报告涉及9个损害部位、40个科室,其中8个科室此前为自发上报零报告科室。结论:自发上报ADR仍为医院ADR报告收集的主要渠道;主动监测可扩大ADR报告的药品品种,提供重点监测药品品种选择依据,减少零报告科室,发现ADR上报工作中的薄弱环节。

基于司法判决角度的危急值报告制度管理策略

目的了解医院危急值报告相关医疗损害责任纠纷案件的情况,提出针对性的危急值报告制度管理策略。方法以“危急值报告”为关键词,在中国裁判文书网检索2010年1月1日-2021年12月31日与危急值报告相关的司法裁判文书,对案件中涉事医疗机构等级、损害结果情况、危急值涉及具体项目、法院判决医方有责任的原因等进行描述性统计分析。结果与危急值报告相关医疗损害责任纠纷案件主要发生在三级医院(72.5%)。案件损害结果中,死亡36例(90.0%)。心电图相关案件数最多,共计5例(12.5%)。法院判决医方有责任的原因中,危急值未处理或处理不及时占比最高(52.5%)。结论医院应重视危急值报告制度建设,合理选定危急值项目并设定界值,形成报告流程的闭环管理,有效提高危急值质量管理水平,确保患者安全。

COMPARISON OF A SAMPLE OF GREEN HOSPITALS WITH NON-GREEN HOSPITALS WITH RESPECT TO OPERATING EXPENSES AND PATIENT REVENUE

Concerns regarding the environmental impacts of hospitals have made the healthcare sector one of the most prominent settings for the green building movement.Despite these environmental concerns,the number of studies that document the benefits of sustainable healthcare facilities is limited.In this study,the authors used the Medicare and Medicaid cost report data to compare the financial performance of 14 Leadership in Energy and Environmental Design(LEED)certified hospitals against the average performance of non-green facilities.In line with studies conducted in other settings,the authors found that there are low and high performers among green hospitals.For this study,green hospitals had higher facility operating expenses than an average non-green hospital and spent more on plant operations.While green hospitals included in this study generated more revenue,the incomes were not high enough to validate the high operating expenses.

行风工作月度报告在北京积水潭医院一院多区行风管理中的应用与探索

为适应一院多区新形式下行风同质化管理的要求,同时呈现行风管理工作实施的客观情况,北京积水潭医院行风办从2021年9月开始制订行风工作月度报告,并向各院区全体科室发布。遵循SMART原则,该报告设有7个模块,包括“行风每月教育与警示教育”“行风提醒及行风要求”“案件通报”“专项治理”“耗材使用点评”“药品点评”“监督检查”,并以文字、数据和图表为主要呈现形式。该报告目前已发布12期,院内行风明显好转,全院人员的认知度明显提高,各科室的协作沟通加强,提升了一院多区同质化的行风管理水平。

六西格玛管理对提高肿瘤专科医院传染病信息报告质量的作用研究

目的探讨六西格玛管理对提高肿瘤专科医院传染病信息报告质量的作用。方法于2021年1月将提高传染病信息报告质量纳入项目管理,并以2020年6月—2021年12月传染病报告卡作为对照组(n=403082),2021年3月—2022年9月传染病报告卡作为改进组(n=515025)。比较两组传染病检查率及传染病报告的漏报率、迟报率和卡片填写不完整率。结果在所有就诊的肿瘤患者中,乙类传染病种报告发病数居前3位的依次为病毒性肝炎、梅毒、肺结核,占乙类传染病报告总数的95.48%;两组传染病检出率比较,差异有统计学意义(P<0.05)。改进组传染病信息漏报率0.12%、迟报率1.91%、卡片填写不完整率2.77%,均明显低于对照组的1.17%、7.72%、9.96%,差异有统计学意义(P<0.05)。结论通过六西格玛管理法有理可依,进行根因分析,不断优化信息报告流程,极大地提高了肿瘤专科医院的传染病信息报告质量。

新疆从/执业药师COVID-19知识和心理调查

目的了解新疆地区从业/执业药师对新型冠状病毒肺炎(COVID-19)知识掌握情况和心理健康状况,为后续培训和心理干预提供依据。方法通过微信、QQ等在线发放调查问卷,包括COVID-19知识、心理健康自评问卷(SRQ-20)、患者健康问卷抑郁症状群量表(PHQ-9),对新疆从/执业药师进行调查评估。结果有效回收问卷180份,有效回收率86.96%,COVID-19知识合格率为61.67%,女性、医院药师、执业西药师、中级技术职称与知识得分显著正相关(P<0.05);精神疾病史和医院隔离与其显著负相关(P<0.05);SRQ-20阳性率为23.89%、PHQ-9阳性率为43.89%,精神疾病史、医院隔离与SRQ-20和PHQ-9自评分均具有显著正相关性(P<0.05),而本科及大专学历、COVID-19掌握情况则与之显著负相关性(P<0.05);较未接触患者,可能接触确疑似患者与SRQ-20自评总分均具有显著正相关性(P<0.05)。结论部分执业药师COVID-19知识掌握相对薄弱,易出现心理应激和抑郁症状,需进一步加强学习;特定的药师人群易产生心理问题,宜给予更多关注和支持。