Use of Chinese Herbal Medicine Therapies in Comprehensive Hospitals in Central China: A Parallel Survey in Cancer Patients and Clinicians

Summary： Chinese herbal medicine （CHM）, as the largest application category of traditional Chinese medicine （TCM）, is widely accepted among cancer patients in China. Herbal slice （HS） and Chinese patent drug （CPD） are commonly used CHM in China. This study aimed to investigate the utilization of CHM among clinicians and cancer patients in central China. Five hundred and twenty-five patients and 165 clinicians in 35 comprehensive hospitals in central China were asked to complete an anonymous questionnaire that was designed to evaluate the use of CHM. The results showed that 90.74% clinicians and 72.24% cancer patients used CHM during cancer treatment. The educational backgrounds of the clinicians and the age, education level, annual income, and cancer stage of the cancer patients were re- lated to use of CHM. More than 90% clinicians and cancer patients had used CPD. Comparatively, the percentage of HS use was 10% lower than that of CPD use among clinicians and cancer patients. More clinicians preferred to use CHM after surgery than cancer patients did （20.41% vs. 5.37%）. Enhancing physical fitness and improving performance status were regarded as the most potential effect of CHM on cancer treatment （85.71% among clinicians and 94.07% among cancer patients）, in comparison with directly killing tumor cells （24.49% among clinicians and 31.36% among patients）. As for refusal rea- sons, imprecise efficacy was the unanimous （100%） reason for clinicians＇ rejection of CHM, and 95.58% patients objected to using CHM also for this reason. Furthermore, the side effects of CHM were more concerned by clinicians than by patients （33.33% vs. 15.81%）. In conclusion, our survey revealed that CHM was popularly accepted by clinicians and cancer patients in central China. The reasons of use and rejection of CHM were different between clinicians and cancer patients.

Survey on the Readiness for Hospital Discharge and Its Influencing Factors among Patients with Cardiac Valve Replacement

Background: There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the increase in hospital bed turnover rate, the average hospital stay of patients undergoing CVR surgery has been significantly shortened, and thus the patients are still in the recovery stage rather than fully recovered when they are discharged from the hospital. Good preparation for discharge can improve patients’ post-discharge self-care ability, reduce the risk of re-admission, and save medical resources. Objective: To describe the status of readiness for hospital discharge among postoperative patients that have undergone CVR, and to explore its influencing factors. Methods: The general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of discharge Teaching Scale were utilized to investigate 130 post-CVR patients admitted to the Cardiothoracic Surgery Department of a tertiary A-Class hospital in Guangzhou from July 2019 to October 2020. Results: The Readiness for Hospital Discharge Scale was at a moderate level with a total score of 163.88 ± 39.082, while the Quality of Discharge Teaching Scale was also at a moderate level with a total score of 194.09 ± 40.643. Multiple linear regression analysis revealed that the quality of discharge guidance, gender, and occupation were the influencing factors of CVR patient’s readiness for hospital discharge. These three variables jointly explained 45.8% of the total variation. Conclusion: The level of CVR patients’ readiness for hospital discharge is at a moderate level, and the quality of discharge guidance positively affects patients’ readiness for discharge. Therefore, in clinical work, attention should be paid to patient discharge guidance. Personalized health education should be implemented to improve the quality of patient guidance.

Newborn follow-up after discharge from a tertiary care hospital in the Western Cape region of South Africa:a prospective observational cohort study

Background:Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section.Mothers are instructed to bring their newborn to a clinic after discharge for a health assessment.We sought to determine the rate of newborn follow-up visits and the potential barriers to timely follow-up.Methods:Mother-newborn dyads at Tygerberg Hospital in Cape Town,South Africa were enrolled from November 2014 to April 2015.Demographic data were obtained via questionnaire and medical records.Mothers were contacted one week after discharge to determine if they had brought their newborns for a follow-up visit,and if not,the barriers to follow-up.Factors associated with follow-up were analyzed using logistic regression.Results:Of 972 newborns,794(82%)were seen at a clinic for a follow-up visit within one week of discharge.Mothers with a higher education level or whose newborns were less than 37 weeks were more likely to follow up.The follow-up rate did not differ based on hospital length of stay.Main reported barriers to follow-up included maternal illness,lack of money for transportation,and mother felt follow-up was unnecessary because newborn was healthy.Conclusions:Nearly 4 in 5 newborns were seen at a clinic within one week after hospital discharge,in keeping with local practice guidelines.Further research on the outcomes of this population and those who fail to follow up is needed to determine the impact of postnatal healthcare policy.

Potassium variability during hospitalization and outcomes after discharge in patients with acute myocardial infarction

BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.

PATIENT EXPERIENCE WITH HOSPITAL CARE-COMPARISON OF A SAMPLE OF GREEN HOS PITALS AND NON-GREEN HOSPITALS

Although the sustainability movement in the healthcare sector was initiated in response to ecological concerns,green hospitals are expected to outperform traditional hospitals on a variety of levels.The impacts of environmental quality on patients and caregivers are demonstrated in numerous studies.However,there is still a lack of evidence on the benefits of green hospitals with respect to different dimensions of patients’experiences.In this study,data from the public Hospital Consumer Assessment of Health Plans Survey is used to compare the performance of green hospitals with the average performance of traditional hospitals.This study included 19 green hospitals and found that patients hospitalized in green facilities reported overall higher ratings than those in traditional hospitals when compared to the average performance of traditional hospitals of similar sizes and locations.Additionally,patients in green hospitals were more likely to recommend the hospital to their friends and family.However,relationships between specific green building features and patient experiences were not identified in this study.

Patient safety culture regarding intravenous therapy in Guangzhou, China: a cross-sectional survey

Objective: To investigate the patient safety culture regarding intravenous therapy in parts of tertiary hospitals in Guangzhou, China.Methods: A cross-sectional survey was conducted. A total of 333 medical staffs members from eight hospitals in Guangzhou were included in our study using convenience sampling. An evaluation about the patient safety culture regarding intravenous therapy was conducted.Results: The summarized results show that the total and level one items' scores are greater than 4.3 points(the full mark is 5 points). The lowest scoring of the five level one items is for the hospital's security resources(4.53±0.526), and the highest is for the hospital's safety management commitment(4.65±0.445). Among the 25 secondary entries, the four lowest-scoring entries are "doctors who can master the knowledge of drug efficacy and adverse reactions"(4.44±0.622), "doctors who can master the knowledge of the choice of medicine"(4.45±0.621), "a guarantee of sufficient human resources"(4.46±0.647), and "doctors who can master the knowledge related to the observation and complications with the treatment of intravenous therapy operation"(4.435±0.634).Conclusions: The patient safety culture regarding intravenous treatment in parts of tertiary hospitals in Guangzhou is promising, but there are still shortcomings, including the need to increase relevant resources, such as equipment facilities, training resources, and especially human input.

Evaluation of patient safety culture as perceived by nurses during the COVID-19 pandemic

Objectives:A good patient safety culture(PSC)is linked to a reduced risk of patient problems and minimal undesirable occurrences.This study investigated the PSC levels from nurses'perspectives during the COVID-19 pandemic.Methods:A descriptive cross-sectional design was applied.The Hospital Survey on Patient Safety Culture(HSOPSC)questionnaire was administered to 315 nurses working at 2 major hospitals in Jeddah,Saudi Arabia.The data were analyzed using descriptive statistics,a t-test,and a one-way ANOVA test.The statistical significance of the correlation was determined at the 0.05 level.Results:PSC was rated as medium overall according to the nurses,with a weighted mean of 2.88–0.76 and a relative weight of 57.57%.In addition,all PSC composites were rated from medium to high,except organizational learning,which was rated low.The correlation between sociodemographic variables as well as PSC levels was investigated using the t-test and one-way ANOVA test.The association is statistically significant when P≤0.05.The findings revealed a statistically significant correlation between nurse nationality(t=-4.399,P=0.000),age(F=7.917,P=0.000),experience in years(F=3.760,P=0.024),and hospital(t=-0.401,P=0.689).Conclusions:The nurses in this study had a medium overall PSC level,and all PSC composites ranged from a medium to a high level,except organizational learning,which had a low level.In addition,the findings showed that there is a significant relationship between PSC levels,nurses'nationalities,experience in years,and the hospital itself.

三级医院老年患者出院延续护理转介单的设计及应用

目的设计三级医院老年患者出院延续护理转介单,评价其应用效果。方法参考文献资料,采用焦点小组讨论法,设计老年患者出院延续护理转介单,嵌入医院电子病历信息系统,病区护士使用转介单对有延续护理需求的患者进行转介,延续护理服务部专职护士接收转介,到病区为患者提供出院计划服务及出院后上门护理。结果2021-2022年全院21个老年患者所在科室均应用老年患者出院延续护理转介单实施转介,转介患者386例,其中80岁及以上老年患者219例(56.7%),内科系统9个科室共转介患者267例(69.2%)。为386例患者出院后1个月内提供上门护理服务597例次,患者出院30 d内非计划性再入院率为5.2%。结论设计及应用老年患者出院延续护理转介单,有利于促进转介及提高不同部门工作人员之间合作协调性,从而满足出院老年患者延续护理服务需求及降低出院后非计划性再入院率。

赋权用于下肢深静脉血栓形成导管溶栓治疗患者早期康复活动的效果

目的探讨赋权用于下肢深静脉血栓形成导管接触溶栓治疗患者早期康复的效果。方法选择下肢深静脉血栓形成拟行导管溶栓治疗患者110例,按随机数字表法分为对照组和干预组各55例。对照组常规实施康复活动,干预组用赋权指导早期康复活动。统计两组康复锻炼依从性、髌骨上/下缘腿围周径差、并发症发生率、置管溶栓时间及住院时间。采用慢性病自我效能感量表、中文版出院准备度量表、静脉功能不全生活质量问卷对两组患者进行评价。结果两组置管溶栓时间、并发症发生率、住院时间比较,差异无统计学意义(均P>0.05);干预组出院时髌骨上/下缘腿围周径差显著小于对照组,康复锻炼依从性、自我效能、出院准备度及出院后3个月生活质量显著优于对照组(均P<0.05)。结论赋权用于下肢深静脉血栓导管溶栓患者早期康复活动,能提高患者康复锻炼依从性和疾病自我效能感,改善患肢肿胀,提高出院准备度和出院后生活质量。

浅析医院平均住院日的计算方法

随着医院综合化程度的日益提高,为考核各临床专科的工作效率,在计算平均住院日时,需考虑转科因素。平均住院日为衡量医院医疗服务效率、工作开展质量水平的重要指标,直接反映了医院资源利用情况及医疗服务整体开展质量水平。当前随着医疗改革的不断深入及医疗需求不断增加,准确计算每位患者的住院日已成为提升医院竞争力、优化医疗资源配置的关键。基于此,本文综述了平均住院日的计算方法、影响因素以及在医院管理中的应用,旨在为医院管理提供参考。

老年人髋部脆性骨折术后出院过渡期护理依赖调查及影响因素分析

目的调查老年髋部脆性骨折术后出院过渡期护理依赖情况及其影响因素,为临床制定针对性干预提供参考。方法选取2022年8月至2023年6月于本院就诊的168例行手术治疗的老年髋部脆性骨折患者为研究对象,采用一般资料调查表、护理依赖量表、简易认知状态量表、简易微型营养评估状态量表对其进行调查,采用多元线性回归分析术后出院过渡期护理依赖的影响因素。结果老年髋部脆性骨折患者术后出院过渡期护理依赖总分为(47.82±6.33)分,为中度依赖水平,其中几乎独立10例(5.95%),大部分独立82例(48.81%),部分依赖54例(32.14%),绝大部分依赖22例(13.10%),完全依赖0例。多元线性回归结果显示:文化程度、家庭人均月收入、认知功能、营养状态、抑郁状态是老年髋部脆性骨折术后出院过渡期护理依赖的影响因素(P<0.05)。结论老年髋部脆性骨折患者术后出院过渡期处于中度护理依赖水平,术后出院过渡期护理依赖与文化程度、家庭人均月收入、认知功能、营养状态、抑郁状态有关,医护人员需重视患者的护理依赖情况,根据影响因素制定针对性的方案。

46所综合性医院出院患者延伸护理服务需求的调查分析

目的了解出院患者对延伸护理服务的需求,为探索满足患者需求的延伸护理服务模式及医疗机构制定相关政策提供参考。方法对全国46所综合性医院共2 209例当日出院的患者进行问卷调查,调查内容包括对延伸护理服务内容、方式、执行者的需求和对收费的态度。结果出院患者需求较高的延伸护理内容为用药指导(91.6%)、饮食指导(88.0%)和提醒复诊(85.3%);方式为出院宣教(79.2%)、电话/短信随访(78.0%)和举办健康知识讲座(72.7%);执行者为医院医生(67.8%)和护士(41.2%);76.2%的患者同意按照物价标准支付延伸护理费用。结论医院应建立多学科延伸护理服务团队,根据患者需求及疾病情况制定个体化的延伸护理服务方案,从而达到满足患者需求、节约医院资源的目的。

某三甲医院出院病人医疗服务满意度分析

目的分析出院病人满意度的调查结果.为医院改进医疗服务质量提供科学依据。方法收集某三级甲等医院2003年与2004年493份出院病人满意度调查回函.采用模糊综合评价法和SAS6.12软件,对调查项目的满意度进行分析和评价。结果两年之间的满意度差别有统计学意义(x2=14.16,P<0.0001)、2004年的总满意度高于2003年,说明针对调查结果进行的改进措施取得了成效。讨论模糊控制量作为出院病人满意度的评判值是切实可行的.并可依此查找出医疗服务质量的薄弱环节加以改进。

老年患者出院准备服务需求评估指标的构建

目的:构建老年患者出院准备服务需求评估指标,为早期识别具有较高延续性照护需求的老年群体提供依据。方法:通过文献研究、德尔菲法、层次分析法,确定老年患者出院准备服务需求评估指标及各指标权重。结果:2轮专家函询的专家积极性均为100%,专家权威系数为0.929,2轮专家函询后,一级指标的变异系数为0.06〜0.21,肯德尔和谐系数为0.208,二级指标的变异系数为0〜0.20,肯德尔和谐系数为0.140,最终构建的老年患者出院准备服务需求评估指标包括9个一级指标、34个二级指标。结论:本研究构建的老年患者出院准备服务需求评估指标科学可靠,可为临床护理人员评估老年患者出院准备服务需求、早期识别具有较高延续性照护需求的老年群体提供依据。

腹部外科患者及家属出院准备度自评比较

目的探讨腹部外科患者和家属的出院准备度现状,为提高患者出院准备度评估的准确性,开展个性化出院准备护理服务提供参考。方法纳入腹部外科住院患者及其家属各239例,采用一般资料调查表、中文版患者出院准备度量表和家属出院准备度量表进行问卷调查。结果腹部外科患者及其家属的出院准备度自评得分分别为159.94±37.61和166.49±36.17,两者比较,差异有统计学意义(P<0.01),4个维度中3个维度家属得分与患者存在统计学差异(均P<0.01)。结论腹部外科患者及其家属的出院准备度均处于中等偏上水平,但两者的出院准备度不同。医护人员应综合多方评价结果,客观、准确地评估患者的出院准备度,结合其特点给予个性化指导,积极开展以患者为中心的出院准备护理服务。

护患双方对糖尿病患者出院准备度的评估分析

目的分析护患双方对糖尿病患者出院准备度的评估现状。方法 2015年5-12月,便利抽样法选取成都市某三级甲等综合性医院住院治疗的糖尿病患者200例和其住院期间的责任护士为研究对象。采用患者基本资料问卷和患者出院准备度量表,对出院前4 h的糖尿病患者进行调查;同时采用护士出院准备度评估量表对责任护士进行调查。结果护患双方对糖尿病患者出院准备度的条目评分均分分别为(8.13±1.37)分、(8.29±1.12)分。护患双方对糖尿病患者出院准备度总分及疾病知识、自身状况、可获得的社会支持上的评分差异均无统计学意义(均P>0.05);但两者在关于出院后应对能力上的评分差异有统计学意义(P<0.05)。结论护患对糖尿病患者出院准备度的条目评分均处于中高水平,总体评估无差异,但在出院后应对能力的评估上存在差异,提示护士应更关注患者出院后的情况,加强院外随访。

脑卒中患者出院准备度的研究进展

本文聚焦于脑卒中患者的出院准备度,介绍脑卒中患者出院准备度的相关进展。对脑卒中患者出院准备度的内涵、测评工具、出院准备度现状、影响因素及干预措施进行归纳总结,以帮助提高患者出院准备度,改善患者结局。

出院病人随访工作常见的误区及对策

分析了目前出院病人随访工作中,在所有病人是否全面随访,随访在医院一对一营销中的地位等方面存在的误区,提出针对不同的随访目的设计不同的随访内容,构建立体的出院病人随访管理工作体系,提高沟通技巧,改进随访工作的有效对策。

加强医患沟通 实施出院患者全员电话访谈

目的:通过对出院患者全员电话访谈,获取患者对医院真实可靠的反馈信息,为持续改进医疗服务质量提供决策依据,从而培养医院忠实的客户群体。方法:聘请专职人员组成电话回访部;采用自行设计的电话问卷对出院患者进行全员访谈;电话访谈中解答患者疑问和误解,协调解决患者出院前遗留问题,化解纠纷隐患;归类汇总患者反馈意见,为医院职能部门管理提供当前主抓工作的"切入点"。结果:患者对医院综合满意度不断提高、医患关系得到了和谐的发展。结论:通过对出院患者全员电话访谈,拉近了患者与大医院的距离;弥补和缩小了住院期间医患间沟通不足和由此引发的负面影响;对医疗服务纠纷起到了"减压阀作用"。提升了患者对医院的信任度,促进了医院的形象建设。

疾病诊断相关组数据分析在医院绩效评估中的应用

背景疾病诊断相关组(diagnosis related groups,DRGs)作为一种新的医疗支付方式,不仅综合考虑了疾病复杂性及严重度,还考虑了医疗需要及资源使用强度。目的探讨DRGs数据分析在医院绩效评估中的应用效果。方法导入北京市某三甲综合医院(以下简称某院)2015年(模拟DRGs付费第1年)出院的医保病例,共计123591例。以住院医疗服务能力和专科能力建设为测算核心,选取DRGs组数、病例组合指数、费用消耗指数、时间消耗指数、低风险和中低风险死亡率为测算指标。选取北京市同等级同类别的三甲医院为标杆医院,标杆医院2015年同时期出院的医保病例10000例为标杆数据。通过对某院各专业与标杆医院相对应专业的比较,了解某院各专业医疗服务现状、资源使用和质量安全情况。结果2015年某院医保患者出院病例123591例,其中入组113402例,未入组10189例,入组率91.7%。某院涉及DRGs组数751组,标杆医院DRGs组数639组;某院病例组合指数(case mix index,CMI)为1.21,标杆医院1.34;某院费用消耗指数1.40,标杆医院1.20;某院时间消耗指数0.98,标杆医院0.84;某院低风险死亡率0.01%,标杆医院0;某院中低风险死亡率0.10%,标杆医院0.09%。与标杆医院比较,某院DRG组数较多,CMI较低,费用消耗和时间消耗指数较高,低风险和中低风险死亡率略高。结论与标杆医院DRGs数据比较,某院疾病诊疗广度较高,医疗技术难度较低,绝大多数病组费用偏高,但平均住院日控制较好,医院可以在基本绩效政策不动摇的前提下,较好地运用DRGs方法进行测算评估,为医院工作提供借鉴和思路。