The effects of cold region meteorology and specific environment on the number of hospital admissions for chronic kidney disease:An investigate with a distributed lag nonlinear model

Objective:To explore the effects of daily mean temperature(°C),average daily air pressure(hPa),humidity(%),wind speed(m/s),particulate matter(PM)2.5(μg/m3)and PM10(μg/m3)on the admission rate of chronic kidney disease(CKD)patients admitted to the Second Affiliated Hospital of Harbin Medical University in Harbin and to identify the indexes and lag days that impose the most critical influence.Methods:The R language Distributed Lag Nonlinear Model(DLNM),Excel,and SPSS were used to analyze the disease and meteorological data of Harbin from 01 January 2010 to 31 December 2019 according to the inclusion and exclusion criteria.Results:Meteorological factors and air pollution influence the number of hospitalizations of CKD to vary degrees in cold regions,and differ in persistence or delay.Non-optimal temperature increases the risk of admission of CKD,high temperature increases the risk of obstructive kidney disease,and low temperature increases the risk of other major types of chronic kidney disease.The greater the temperature difference is,the higher its contribution is to the risk.The non-optimal wind speed and non-optimal atmospheric pressure are associated with increased hospital admissions.PM2.5 concentrations above 40μg/m3 have a negative impact on the results.Conclusion:Cold region meteorology and specific environment do have an impact on the number of hospital admissions for chronic kidney disease,and we can apply DLMN to describe the analysis.

Heart Failure: Organization of Care after Hospitalization at the Abidjan Cardiology Institute

Introduction: The care pathway for heart failure (HF) patients is poorly documented in sub-Saharan Africa. A multidisciplinary management reduces hospitalizations and mortality. In our context of frequent rehospitalization of heart failure patients, the objective of this study was to analyse the post-hospital follow-up health care. Methods: We conducted a prospective study in the medical department of a Heart Institute from January 1st to December 31, 2015. Patients over 18 years of age, hospitalized for heart failure, consenting and followed up on an outpatient basis for 2 years were included. Results: We collected 396 patients hospitalized for HF. The mean age was 57.4 ± 16 years with a male predominance (59.3%). Retired and unemployed people represented 27% and 16.2% respectively. During the post-hospitalization follow-up, patients who were regularly followed up represented 10.8% of the cases. 74.1% of the cases were regular patients. Patients were not followed up by the usual practitioner (58.2%). Only 94 patients had undergone a cardiovascular rehabilitation programme, of which 21.3% for exercise rehabilitation and 78.7% for therapeutic education. Patients who had attended titration sessions (n = 59) had reached optimal doses of ACE inhibitors, ARB II and beta blockers in 67.8%, 7.3% and 38.5% respectively. The rates of decompensation (73.3%) and rehospitalization (49.5%) were higher. The paraclinic check-up (ECG, X-ray, Cardiac Doppler ultrasonography, Biology) was rarely requested. The probability of survival was higher in patients regularly monitored than in those irregularly monitored. Conclusion: The organisation of care and coordination between professionals should be structured or planned. Therapeutic strategies need to be intensified in order to optimise their long-term benefits.

An Online Outpatient Database System: A Case Study of General Hospital, Minna

Outpatients receive medical treatment without being admitted to a hospital. They are not hospitalized for 24 hours or more but visit hospital, clinic or associated facility for diagnosis or treatment [1]. But the problems of keeping their records for quick access by the management and provision of confidential, secure medical report that facilitates planning and decision making and hence improves medical service delivery are vital issues. This paper explores the challenges of manual outpatient records system for General Hospital, Minna and infers solutions to the current challenges by designing an online outpatient’s database system. The main method used for this research work is interview. Two (2) doctors, three (3) nurses on duty and two (2) staff at the record room were interviewed. Fifty (50) sampled outpatient records were collected. The combination of PHP, MYSQL and MACROMIDIA DREAMVEAVER was used to design the webpage and input data. The records were implemented on the designed outpatient management system and the outputs were produced. The finding shows these challenges facing the manual system of inventory management system. Distortion of patient’s folder and difficulty in searching a patient’s folder, difficulty in relating previous complaint with the new complains because of volume of the folder, slow access to patient diagnosis history during emergency, lack of back up when an information is lost, and preparation of accurate and prompt reports make it become a difficult task as information is difficult to collect from various register. Based on the findings, this paper highlights the possible solutions to the above problems. An online outpatient database system was designed to keep the outpatients records and improve medical service delivery.

SEIHCRD Model for COVID-19 Spread Scenarios,Disease Predictions and Estimates the Basic Reproduction Number,Case Fatality Rate,Hospital,and ICU Beds Requirement

We have proposed a new mathematical method,the SEIHCRD model,which has an excellent potential to predict the incidence of COVID-19 diseases.Our proposed SEIHCRD model is an extension of the SEIR model.Three-compartments have added death,hospitalized,and critical,which improves the basic understanding of disease spread and results.We have studiedCOVID-19 cases of six countries,where the impact of this disease in the highest are Brazil,India,Italy,Spain,the United Kingdom,and the United States.After estimating model parameters based on available clinical data,the modelwill propagate and forecast dynamic evolution.Themodel calculates the Basic reproduction number over time using logistic regression and the Case fatality rate based on the selected countries’age-category scenario.Themodel calculates two types of Case fatality rate one is CFR daily,and the other is total CFR.The proposed model estimates the approximate time when the disease is at its peak and the approximate time when death cases rarely occur and calculate how much hospital beds and ICU beds will be needed in the peak days of infection.The SEIHCRD model outperforms the classic ARXmodel and the ARIMA model.RMSE,MAPE,andRsquaredmatrices are used to evaluate results and are graphically represented using Taylor and Target diagrams.The result shows RMSE has improved by 56%–74%,and MAPE has a 53%–89%improvement in prediction accuracy.

Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers:A systematic review and meta-analysis

BACKGROUND The definition of diabetic foot syndrome(DFS)varies depending on the location and resources.Few classifications are available according to the indication.DF ulcers and vitamin D deficiency are common diseases among patients with diabetes.Previous literature has shown an association between DF ulcer(DFU)and vitamin D deficiency.However,the available meta-0analysis was limited by substantial bias.AIM To investigate the association between DFUs and vitamin D levels.METHODS We searched PubMed,MEDLINE,and Cochrane Library,EBSCO,and Google Scholar for studies comparing vitamin D levels and DF.The keywords DFU,DFS,diabetic septic foot,vitamin D level,25-hydroxy vitamin D,vitamin D status,and vitamin D deficiency were used.The search engine was set for articles published during the period from inception to October 2022.A predetermined table was used to collect the study information.RESULTS Vitamin D level was lower among patients with DFU compared to their counterparts[odds ratio(OR):-5.77;95%confidence interval(CI):-7.87 to-3.66;χ2 was 84.62,mean difference,9;I2 for heterogeneity,89%;P<0.001 and P for overall effect<0.001].The results remained robust for hospitalized patients(OR:-6.3295%CI:-11.66 to-0.97;χ2 was 19.39;mean difference,2;I2 for heterogeneity,90%;P=0.02).CONCLUSION Vitamin D was lower among outpatients and hospitalized patients with DFUs.Further larger randomized controlled trials are needed.

基于Spring Boot和WebSocket的医院门诊排队叫号系统的设计与应用

文章分析了苏州市广济医院(以下简称“我院”)原有的门诊排队叫号系统存在的痛点,实现了门诊排队叫号系统的总体设计。该设计优化了跨系统间的通信架构,开发并实现了门诊排队叫号系统功能和相关算法。应用结果显示,系统运行稳定,有效提高了门诊候诊就诊效率。

Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations

AIM： To examine the predictive factors of capsule en- doscopy （CE） completion rate （CECR） including the ef- fect of inpatient and outpatient status.METHODS： We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005. Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the pro- cedure. CE exams were reviewed by two physicians who were unaware of the study hypotheses. After retrospective analysis, 21 cases were excluded due to capsule malfunction, prior gastric surgery, endoscopic capsule placement or insufficient data. Of the remain- ing 334 exams [264 out-patient （OP）, 70 in-patient （IP）], CE indications, findings, location of the patients [IP vs OP and intensive care unit （ICU） vs general medical floor （GMF）] and gastrointestinal transit times were analyzed. Statistical analysis was completed us- ing SPSS version 17 （Chicago, IL）. Chi-square, t test or fisher exact-tests were used as appropriate. Multivari- ate logistic regression analysis was used to identify variables associated with incomplete CE exams. RESULTS： The mean age for the entire study popula- tion was 54.7 years. Sixty-one percent of the study population was female, and gender was not different between IPs vs OPs （P = 0.07）. The overall incomplete CECR was 14% in our study. Overt obscure gastroin- testinal bleeding （OGB） was significantly more com- mon for the IP CE （P = 0.0001）, while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams （P = 0.002 and P = 0.01, respec- tively）. Occult OGB was the most common indication and arteriovenous malformations were the most com- mon finding both in the IPs and OPs. The capsule did not enter the small bowel （SB） in 6/70 IPs and 8/264 OPs （P = 0.04）. The capsule never reached the cecum in 31.4% （22/70） of IP vs 9.5% （25/ 264） of OP ex- aminations （P 〈 0.001）. The mean gastric transit time （GTT） was delayed in IPs compared to OPs, 98.5 ± 139.5 min vs 60.4 ± 92.6 min （P = 0.008）. Minimal SB transit time was significantly prolonged in the IP com- pared to the OP setting [IP = 275.1±111.6 min vs OP = 244.0 ± 104.3 min （P = 0.037）]. CECR was also sig- nificantly higher in the subgroup of patients with OGB who had OP vs IP exams （95% vs 80% respectively, P = 0.001）. The proportion of patients with incomplete exams was higher in the ICU （n = 7/13, 54%） as com- pared to the GMF （n = 15/57, 26%） （P = 0.05）. There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture, and the remaining incomplete SB exams were due to slow transit. Medications which affect gastrointesti- nal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients （ICU and GMF） and were not predictive of incomplete capsule passage （P 〉 0.05）. Patient loca- tion （IP vs OP） and GTT were independent predictors of incomplete CE exams （P 〈 0.001 and P = 0.008, respectively）. CONCLUSION： Incomplete CE is a multifactorial prob- lem. Patient location and related factors such as sever- ity of illness and sedentary status may contribute to incomplete exams.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Hospital Admissions and Mortality in Patients with Rheumatic Heart Disease in Brazil: An Analysis from 2008 to 2018

Introduction: The Rheumatic Fever (RF) is a systemic inflammatory disease, caused by Group A beta-hemolytic Streptococcus, predominating in children and adolescents. The clinical manifestations are varied and included in Jones Criteria for diagnosis. The cardiac manifestations are the most relevant, causing severe sequelae such as valvulitis. The RF is still a major public health problem in developing countries despite its primary prophylaxis being simple and effective if well applied. The overall objective of this study was to evaluate the number of hospital admissions and deaths in Brazil from 2008 to 2018. Methodology: Cross-sectional, descriptive, quantitative, documentary study with database provided by the Health Informatics Department of the Brazilian Ministry of Health (DATASUS). Results: In the studied period, a higher prevalence was observed among females (48,232 hospitalizations) and in the adult age group (59,270 hospitalizations and 3972 deaths). The total number of hospitalizations was 83,209 and the total number of deaths was 6572. The total mortality rate was 7.84. The region with the highest number of hospitalizations was the Southeast (22,863 hospitalizations). The total amount spent in hospitalizations was R$879,676,458.63, with an average value per hospitalization of R$ 10,496.21. The average length of stay was 12.7 days. Conclusion: Rheumatic heart disease is an important cause of hospitalizations in Brazil. Measures of early diagnosis and adequate treatment should be strongly stimulated.

Relationship between Air Pollution Index (API) and Crowd Health in Nanchang City

Objective: To explore the effect of Air Pollution Index (API) on people’s health. Methods: The data on air pollution index (API), NO2, SO2 and PM10 were based on the everyday monitoring information from environmental monitoring station of Nanchang City. The everyday outpatient service diseases information of 2005 related to air pollution from some First Level Hospitals in Nanchang city was collected, and was summarized and analyzed by statistics software of Excel 2003 and SPSS11.5. Results: The average concentrations of NO2, SO2 and PM10 in the air of Nanchang city from 2006-2009 were 19.70 ± 8.56 μg/m3, 44.60 ± 10.45 μg/m3, 62.30 ± 19.76 μg/m3 respectively. Tight relationship was detected between NO2, SO2 and PM10. Air pollution index (API) can better reflect the air pollution status of Nanchang city. There were positive correlations between API and number of outpatient service diseases, including cardiovascular disease, respiratory disease, ophthalmology disease and ear-nose-throat (ENT) disease in Nanchang city. Conclusion API was related to the number of outpatient service relative diseases.

灰关联分析在医院财务管理中的应用研究

[目的]探讨灰关联分析在医院财务管理中的应用,为医院管理高质量发展提供借鉴。[方法]收集湖北省武汉市某三甲医院2017-2022年的门诊收入数据,计算门诊药费、门诊检查费、门诊挂号费和门诊其他收入与门诊总收入的灰关联度。[结果]计算得到灰关联度排序为门诊挂号费(0.839)>门诊检查费(0.643)>门诊药费(0.626)>门诊其他收入(0.543)。[结论]灰关联分析能帮助医院在财务管理上理解收入结构、提供决策支持、加强风险管理和预测未来趋势,在医院绩效管理上帮助医院辅助绩效评估,制定激励措施和优化资源配置。

基于门诊全流程服务管理的提升患者体验实践探索

提升患者门诊全流程就诊体验是改善患者就医感受的重要举措。首都医科大学附属北京同仁医院在持续改善医疗服务的基础上探索建立门诊全流程服务管理体系,通过理念向前服务前置,聚焦患者诊前体验;流程简化智慧引领,优化患者诊中体验;延续诊疗模式创新,提升患者诊后体验。打造现代门诊医疗服务模式,不断满足人民群众日益增长的医疗服务需要。

某三甲儿童医院门诊多学科协作诊疗特点与服务模式探索

目的:总结儿童专科医院门诊多学科协作诊疗(MDT)的特点,探索适合儿童医院的门诊MDT服务模式。方法:组建门诊多学科会诊专家团队,制定门诊多学科会诊制度与流程图,会诊流程标准化,门诊部设专人负责组织专家开展门诊MDT,建立门诊多学科会诊病例资料库,登记患者姓名、年龄、会诊原因、申请会诊途径、疾病转归等内容。结果:2021年6月至2023年3月共开展门诊MDT会诊220例。年龄段分布特点,大于5岁患儿107例(48.6%),占比最高;从申请门诊MDT原因统计,需要明确诊断150例(68.2%)是门诊MDT申请的首要原因;网络预约205例(93.2%)是最重要途径,现场分诊和首诊科室申请是次要途径;实施多学科会诊前,专科门诊就诊一次病例数123例(55.9%),就诊3次及以上60例(27.3%);患者转归结果显示,120例(54.5%)患儿痊愈,46例(20.90%)患儿治疗后好转;门诊满意度比较,2020-2022年门诊满意度逐年增高(P<0.01);患儿疾病涉及多系统133例(60.5%),疾病涉及一个系统的患儿87例(39.5%)。结论:儿童专科医院门诊MDT能充分发挥各科专业优势,实现跨学科专业互补及优势学科的强强联合,有利于疾病早期发现、精准诊断;“一站式”诊疗服务模式,优化了就诊流程,提高了就诊效率,改善了就医体验,提升了门诊患者满意度。

北京市某大型三甲医院综合治理号贩子实践研究

医疗资源分布不均、优质医疗资源稀缺一直是医疗体系的一大痛点。号贩子问题作为社会治理顽疾,其活动的主战场已悄然从线下转移至隐蔽性更强的线上。北京市某大型三甲医院对打击号贩子进行了积极探索,深入了解患者违规挂号途径后,配合执法部门对号贩子进行了强有力打击。本文通过查阅资料和结合实际工作经验,深入剖析了号贩子屡禁不绝的原因及其违规操作手段。结合实际情况提出综合治理的措施,以期加强院内外多部门合作,共同维护医疗秩序,维护患者权益。

北京市某三级口腔专科医院门急诊处方不合理情况分析

目的 点评分析北京大学口腔医学院口腔医院门急诊处方,了解处方质量和临床用药存在的问题,为促进合理用药提供参考。方法 随机抽取2021年7—12月该院门急诊处方6 000张,利用美康合理用药软件进行用药合理性初步筛查,再由药师进行人工复审,采用Excel软件对不合理处方进行分类统计及分析。结果 6 000张处方中,软件初筛不合理处方798张(含药品不合理条目828条),不合理率为13.30%。药师人工复审后确认不合理处方214张(含药品不合理条目219条),不合理率为3.57%,不合理条目类型为用法用量不适宜(112条,51.14%)、诊断描述不全(59条,26.94%)、遴选药品不适宜(15条,6.85%)、书写不规范(14条,6.39%)。不合理条目分布最多的科室为口腔黏膜科,占比50.68%。不合理条目数最多的药品为他克莫司软膏,占比30.59%,主要问题为用药频次不合理(超过规定次数)。结论 医院门急诊处方基本合理,但需关注用法用量、诊断描述等问题。合理用药软件有助于处方点评初筛但无效提醒较多、需定期改进,点评结果需要药师结合医药进展及临床实际情况进行人工审核后最终判定。可通过软件初筛结合人工复审并及时反馈问题、加强超说明书用药管理等手段,加强临床合理用药。

护理科研门诊的初步构建及实践

目的探索护理科研门诊的建立及实施效果。方法我院于2023年7月开设了护理科研门诊,选拔符合相应资质的成员组成护理科研门诊出诊团队,完善护理科研门诊组织管理、明确工作流程及服务范围,为临床护理人员提供课题申报、研究设计、论文撰写等针对性科研服务。最终通过护理科研门诊的接诊量、科研产出、护理人员的护理科研能力和对科研环境的满意度等对护理科研门诊的实践效果进行评价。结果护理科研门诊自运行以来,护理科研门诊量为294人次,相较于科研门诊咨询前,护理人员科研能力得到提升,对护理科研环境的满意度显著提高,差异有统计学意义(P<0.05)。结论护理科研门诊的建立致力于指导护理人员申报课题、开展研究、申请专利及论文写作与发表等,提升了护理人员的科研能力和对护理科研环境的满意度,为推动我国科研门诊的发展,提高医院临床科研水平提供借鉴与启示。

三级公立医院绩效考核背景下门诊医疗服务质量提升的实践效果研究

目的通过对内蒙古医科大学第二附属医院三级公立医院绩效考核实施前后门诊医疗服务质量进行对比,分析三级公立医院绩效考核对医院门诊医疗服务质量的影响,并提出改进措施。方法筛选三级公立医院绩效考核实施后2022年1月1日至12月31日及三级公立医院绩效考核实施前2018年1月1日至12月31日的门诊医疗服务质量的门诊运营、门诊预约管理、患者等候时间、门诊医疗安全和患者评价指标,分析三级公立医院绩效考核实施前后门诊医疗服务质量的差异。结果三级公立医院绩效考核实施后门诊总量同比增加11.8%,专家门诊量同比增加63.7%,普通门诊量同比下降45.7%,差异有统计学意义(P<0.05);线上预约挂号数同比增加46.4%,分时段就诊数同比增加41.0%,按时就诊数同比增加43.0%,退号数同比下降95.3%,差异有统计学意义(P<0.05);患者等候时间也都有所降低,差异有统计学意义(P<0.05);门诊医疗安全比较,差异无统计学意义(P>0.05),但是门诊医疗安全管理在逐步完善;门诊患者满意度也有显著提高。结论三级公立医院绩效考核是将各项服务质量进行量化管理,对提升医院门诊服务质量有显著效果。

“互联网+居家护理”在志愿护理服务中的应用效果

目的探讨"互联网+居家护理"在志愿护理服务中的应用效果。方法选取2020年12月至2021年12月"党群服务365平台"82例需要服务人群作为研究对象,采用随机数字表法将其分为对照组(41例)和观察组(41例)。对照组实施常规医疗服务,观察组实施"互联网+居家护理"服务,两组均持续护理12个月。比较两组的医院看病次数、医疗花费情况、日常生活能力、精神状态、照护者照护技能水平以及生活满意度。结果观察组医院看病次数、医疗花费情况均少于对照组,差异有统计学意义(P<0.05);观察组护理后日常生活活动能力量表(ADL)评分低于对照组,简易精神状态检查量表(MMSE)评分、照护技能水平评分均高于对照组,差异有统计学意义(P<0.05);观察组护理后生活满意度调查表(LSR)各项评分均高于对照组,差异有统计学意义(P<0.05)。结论通过互联网平台,护理志愿者对服务人群进行居家护理,能够改善服务人群的精神状态,促使其保持身心健康,提高生活自理能力,还能提高照护者的护理技能,一定程度上减少看病次数和医疗花费,从而提升服务人员满意度。

某大型三级医院门诊创新服务的实践探索

随着国民经济的快速发展和新时代医改政策的持续推进,医疗服务模式向“以患者为中心”转变,改善人民群众看病就医体验,是国家深化医药卫生体制改革之必需,也是落实健康中国战略、提升民众满意度的迫切需求。近年来国家出台一系列医改政策文件,对公立医院高质量发展提出新要求,将改善门诊服务水平的重要性提升到一个新的高度。济宁医学院附属医院以患者需求为导向,通过提升服务能力、简化就诊流程、加强智慧门诊建设等一系列门诊管理措施,构建门诊创新服务模式,由粗放式管理向精细化管理转变,提高医院内部的运营管理水平,提升医院核心竞争力,助力医院智能、高效、人性化发展,从而进一步提高服务效率和患者满意度,可为大型三级医院门诊管理提供参考。

基于季节ARIMA模型对某三级综合性医院门诊量的预测研究

目的 通过建立季节ARIMA模型,对浙江省某三级综合性医院门诊量进行预测,为医院合理配备门诊人力资源提供依据。方法 以2013年1—6月浙江省某医院门诊量数据为基线,利用SPSS软件构建季节ARIMA模型,对2023年7—12月的门诊量进行预测,通过对比门诊量实测值,评价季节ARIMA模型预测门诊人次的精度。结果 该综合性医院门诊量呈现逐年上升趋势,并呈现周期性波动的特征。拟合的最优季节ARIMA模型为ARIMA(0,1,1)(1,0,1)12,BIC(贝叶斯信息准则)为5.273,MAPE(平均绝对百分误差)为14.265,R2(模块决定系数)为0.408,总体相对误差为1.83%,预测结果良好。结论 季节ARIMA模型较好地模拟了该三级综合性医院门诊量在时间序列上的变化趋势,为该院门诊量的短期预测提供理论依据。