This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development o...This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.展开更多
Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teache...Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.展开更多
Objective:This article aims to deeply analyze the feedback on teacher training in an affiliated hospital,so as to clarify the current needs and situation of teacher training and provide a scientific basis for further ...Objective:This article aims to deeply analyze the feedback on teacher training in an affiliated hospital,so as to clarify the current needs and situation of teacher training and provide a scientific basis for further optimizing the teacher training system.Methods:The current situation and needs of teacher training in the affiliated hospital were collected by designing and distributing Tomato Form questionnaires on the DingTalk platform.The questionnaire adopted a percent-point system,all of which were indeterminate multiple-choice questions.Results:The average age of the clinical teachers participating in the survey was 40.44±7.85 years old,with an average teaching length of 4–10 years.The results showed that 60.20%of teachers think that the amount of teacher training in an affiliated hospital is sufficient;91.10%of teachers think that the factors affecting training conflict with working hours;97.96%of teachers believe that the training time has an impact on the training effect;81.63%of teachers prefer online training;51.53%of teachers tend to arrange training time on working days;33.16%of teachers tend to train once a month;17.78%of teachers prefer to receive training on clinical theoretical courses and practical teaching norms and skills content.Conclusion:Based on the above survey results,we propose to build a comprehensive management mechanism for teacher training,including improving the access,training,and assessment mechanism for clinical teachers,and adjusting and optimizing the training program according to actual needs.At the same time,an effective communication platform should be built to promote the deep integration of teaching and practice and enhance social recognition,so as to comprehensively improve the teaching quality and medical service of the hospital.展开更多
Many studies have been done about the treatment of KCOT, but the recurrence rate still remains high despite the combination of surgical techniques used, associated with or without the use chemical solutions such as Ca...Many studies have been done about the treatment of KCOT, but the recurrence rate still remains high despite the combination of surgical techniques used, associated with or without the use chemical solutions such as Carnoy’s solution or Cryosurgery. Currently, there is no consensus concerning the therapeutic choice for the KCOT. The purpose of this study was to evaluate the different treatment methods used for the management of KCOT in the Second Affiliated Hospital of Jiamusi University and the results obtained from those treatment methods. Settings and Design: Clinical study was done at the Second Affiliated Hospital of Jiamusi University. Materials and Methods: Analytical retrospective review of 63 cases treated surgically from 2009 to 2015 at the Maxillofacial and Oral Surgery Department of the Second Affiliated Hospital of Jiamusi University. All cases diagnosed as KCOT and registered in the archives were used. The level of statistical significance was set at P < 0.05. Results: Of the 63 cases, 55.56% were male and 44.44% female. The sex ratio was 1.25 in favor of male and the average age was 42 years. 81% of the lesions were located in the mandible. Of 40 cases treated by enucleation with peripheral ostectomy, curettage and electric cauterization with application of 2% iodine tincture, no recurrence was found. Of 20 cases treated by the same surgical method but without the application of 2% iodine tincture, recurrence was found in 3 cases (4.76%). 3 cases treated by resection had no recurrence. Significant relation between recurrence and type of treatment was found (P < 0.05). Conclusion: In our series, those cases that were treated by combination of surgical methods used with 2% iodine tincture showed an “improvement” in the reduction of recurrence, suggesting a future question to be examined in experimental study is to test the effectiveness of 2% iodine tincture.展开更多
Based on the blueprint of the training center for clinical skills of our hospital,this paper discusses the effect of‘the market for lemons’in its booking system from the perspective of economics of information,uses ...Based on the blueprint of the training center for clinical skills of our hospital,this paper discusses the effect of‘the market for lemons’in its booking system from the perspective of economics of information,uses the law of large numbers and the central limit theorem to model to carry out the case study of FAHSYSU Simulation T,and takes measures of offsetting adverse selections to increase booking efficiency.The paper also analyzes how to apply the ancient Chinese theory that man is an integral part of nature to wipe out‘the market for lemons’.展开更多
Objective:To build a set of teaching staff construction and teaching quality monitoring system suitable for clinical practice teaching in affiliated hospitals of medical colleges,achieve continuous improvement of clin...Objective:To build a set of teaching staff construction and teaching quality monitoring system suitable for clinical practice teaching in affiliated hospitals of medical colleges,achieve continuous improvement of clinical education and teaching level,and ensure the quality of medical education talent cultivation.Methods:A modern clinical practice teaching quality monitoring system is constructed based on organizational structure construction,teaching staff system construction,quality control system construction,and information platform construction,combined with external audit and evaluation.Results:The hospital has established a Faculty Development and Teaching Evaluation Office specifically responsible for the cultivation of clinical teachers and the evaluation and supervision of teaching quality.A relatively complete teacher construction and teaching quality monitoring system has also been established for clinical practice teaching,thus achieving integration with the school’s quality control system in terms of management mechanism.At the same time,a set of teaching quality control mode based on the“Internet+”platform has been created by means of informatization.At present,this mode has won three national computer software copyrights and two second prizes for school-level teaching achievements.Conclusion:Through five years of practice,an“Internet+”teaching quality evaluation and monitoring system with the characteristics of teaching hospitals affiliated to local medical colleges has been established.In order to further standardize the training system of clinical teachers in affiliated hospitals,achieve self-monitoring and self-improvement in terms of teaching quality,and ensure the continuous improvement of clinical teaching quality,we will continue to promote the development of clinical teachers with quality and excellence,enrich the main team of quality monitoring,guide the transformation of the education mode from being“centered on teachers”to being“centered on students,”and realize the integration of internal and external quality monitoring systems.展开更多
OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,tradit...OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,traditional Chinese medicine(TCM)herbs exhibit significant bioactivity and therapeutic effect.This study is aimed to evaluate the efficacy of four TCM preparations on 28-day mortality risk of patients and changes of the laboratory indicators.METHODS The retrospective cohort study included patients with COVID-19 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023,and those died within 48 hours of admission or cannot be tracked for outcomes were excluded.The primary outcome was survival status in 28 days(death or survival)starting from the day of admission.The second outcomes were laboratory indicators,including absolute lymphocyte count,lactate dehydrogenase,creatinine,and blood urea nitrogen.Binary logistic regressions were used to estimate the effect of TCM preparations on the primary and secondary outcomes in main analysis.Meanwhile,heterogeneity and robustness of results from main analysis were assessed by subgroup analyses and multiple sensitivity analyses.RESULTS 1816 eligible patients were included in analysis dataset,including 573 patients received standard care(control group)and 1243 patients received TCM preparations(hospital preparation group).The 28-day mortality rate of hospital preparation group was lower than that of control group(4.75%vs.14.83%),and the difference was statistically significant(χ^(2)=54.666,P<0.001).The risk of 28-day mortality was 0.535 times lower in the hospital preparation group as compared with the control group(OR=0.46,95%CI:0.305-0.708,P<0.001)showed by multivariable binary logistic regressions.Subgroup analyses showed that taking TCM preparations reduced the 28-day mortality risk.Sensitivity analyses demonstrated that the results of the main analysis for primary outcomes were robust.For secondary outcomes,the risk of abnormal absolute lymphocyte counts at discharge in the hospital preparation group decreased by 0.284 times(OR=0.703,95%CI:0.515-0.961,P=0.027).CONCLUSION Compared with standard of care,taking four hospital preparations including Kanggan Heji,Feining Heji,Qishen Gubiao Keli,and Qianghuo Qushi Qingwen Heji decreased risk of 28-day mortality among hospitalized COVID-19 patients.TCM therapy achieves adequate therapeutic effects in COVID-19.展开更多
[Objectives]This study was conducted to promote the rational use of special use level of antibiotics in clinic and delay the emergence of drug resistance.[Methods]The application of antibiotics for special use among i...[Objectives]This study was conducted to promote the rational use of special use level of antibiotics in clinic and delay the emergence of drug resistance.[Methods]The application of antibiotics for special use among inpatients of a hospital in 2019 was analyzed.The data in the drug information management system of the hospital were queried,and the collected expert consultation records of special-use antibiotics were sorted out.Indicators including the use rate of special-use antibiotics,antibiotic use density(AUD),defined daily dose system(DDDs)and defined daily dose system cost(DDDc)of each drug,the annual pathogen detection rate,disease distribution and pathogenic microorganism detection were summarized and analyzed for inpatients in the hospital retrospectively.[Results]In 2019,the average annual use rate of special-use antibiotics in the hospital was 1.53%,and the average annual use density was 1.59 DDDs.The antibiotics with the top three DDDs were imipenem and cilastatin,meropenem and cefepime.The antibiotics with the top three DDDc were voriconazole dispersible tablets,voriconazole for injection,and meropenem for injection.The average annual detection rate of microorganisms was 85.77%.The diseases were mainly diagnosed as respiratory infections such as pneumonia and secondary infections after radiotherapy and chemotherapy before medication,and the detected pathogens were mainly Candida and its subspecies,Escherichia coli,and Klebsiella and its subspecies.[Conclusions]The clinical use of special-use antibiotics in the hospital was basically reasonable,but there were still some problems.It is necessary to increase management efforts,strengthen training for relevant medical personnel,and provide management ideas for further standardizing the use of antibiotics in the hospital.展开更多
The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exace...The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exacerbated this issue by increasing selective pressure within bacterial populations.This study aimed to investigate the association between carbapenem consumption and resistance rates in four priority Gram-negative bacteria:Escherichia coli(EC),Klebsiella pneumoniae(KP),Acinetobacter baumannii(AB),and Pseudomonas aeruginosa(PA).Retrospective data were collected from the First Affiliated Hospital of Zhengzhou University,covering the period from January 2010 to December 2022.Trends in carbapenem consumption and resistance were analyzed using the Mann-Kendall test to assess statistical significance and the Sen’s slope(SS)estimator to determine the magnitude of change.Correlations between carbapenem use and bacterial resistance rates were evaluated via Spearman correlation analysis.Over the study period,the consumption of meropenem,imipenem,biapenem,and total carbapenems exhibited a significant upward trend(|Z|>1.96,SS>0).Correspondingly,the resistance rates of EC and KP to meropenem and imipenem also increased significantly(|Z|>1.96,SS>0).A strong positive correlation was observed between the resistance rate of EC to meropenem and the defined daily doses(DDDs)of meropenem(r=0.732,P<0.05)and between EC resistance to imipenem and its DDDs(r=0.49,P<0.05).Similar significant correlations were identified for KP.However,no significant associations were found between carbapenem resistance in AB or PA and carbapenem consumption.These findings underscored the strong correlation between carbapenem use and the resistance rates of EC and KP,highlighting the urgent need for stringent control and stewardship of carbapenem use in clinical settings to mitigate or delay the development of bacterial drug resistance.展开更多
Full cost accounting,as a comprehensive cost measurement method,integrates direct and indirect costs to reallocate costs across departments.Performance evaluation serves as a method to assess a hospital’s overall per...Full cost accounting,as a comprehensive cost measurement method,integrates direct and indirect costs to reallocate costs across departments.Performance evaluation serves as a method to assess a hospital’s overall performance and management capabilities.Both full cost accounting and performance evaluation are critical tools in the financial management of public hospitals,playing pivotal roles in accounting practices.The concepts of full cost accounting and performance evaluation were investigated in this study,and the existing challenges and the theoretical basis for their integration were analyzed.An integrated model was constructed,and its application cases and effectiveness in the financial management of public hospitals were discussed.Finally,measures to integrate full cost accounting and performance evaluation were proposed,including improving full cost accounting mechanisms,standardizing accounting practices,optimizing cost allocation methods,establishing a unified management platform,and fostering collaboration among stakeholders.This study provides new insights to enhance the quality and efficiency of financial management in public hospitals,laying a foundation for their sustainable development.展开更多
Objective:To explore the correlation between disease uncertainty and psychological distress in hospitalized patients with primary liver cancer,providing a basis for clinical nursing interventions.Methods:A convenient ...Objective:To explore the correlation between disease uncertainty and psychological distress in hospitalized patients with primary liver cancer,providing a basis for clinical nursing interventions.Methods:A convenient sampling method was used to select 82 patients with primary liver cancer from a tertiary first-class hospital in Guangzhou from September 2023 to March 2024 as the research subjects.General information questionnaires,the Mishel Uncertainty in Illness Scale-Adult Version(MUIS-A),and the Kessler Psychological Distress Scale(K10)were used for investigation.Pearson correlation analysis and linear regression analysis were performed to explore the relationship between the two.Results:The total score of disease uncertainty in hospitalized patients with primary liver cancer was(99.20±8.79),and the total score of psychological distress was(22.87±9.46),both at a medium level.There was a positive correlation between disease uncertainty and psychological distress(r=0.360,P<0.01),and the ambiguity dimension had the strongest correlation with psychological distress(r=0.399,P<0.01).Regression analysis showed that the ambiguity dimension had a significant predictive effect on psychological distress(β=0.399,P<0.01).Conclusion:There is a close correlation between disease uncertainty and psychological distress in patients with primary liver cancer.In clinical nursing,it is necessary to pay special attention to patients’ambiguity regarding disease symptoms and prognosis.Targeted health education should be carried out to reduce their uncertainty,thereby improving their psychological state.展开更多
Objective:In the Radiology Department of Mzuzu Central Hospital(MCH),daily training for radiographers now includes content on Computed Tomography(CT)image quality control and equipment maintenance to ensure the normal...Objective:In the Radiology Department of Mzuzu Central Hospital(MCH),daily training for radiographers now includes content on Computed Tomography(CT)image quality control and equipment maintenance to ensure the normal,continuous,and stable operation of the 16-slice spiral CT scanner.Methods:Through comprehensive analysis of relevant equipment,we have identified key parameters that significantly impact CT image quality.Innovative optimization strategies and solutions targeting these parameters have been developed and integrated into daily training programs.Furthermore,starting from an examination of prevalent failure modes observed in CT equipment,we delve into essential maintenance and preservation techniques that CT technologists must master to ensure optimal system performance.Results:(1)Crucial factors affecting CT image quality include artifacts,noise,partial volume effects,and surrounding gap phenomena,alongside spatial and density resolutions,CT dose,reconstruction algorithms,and human factors during the scanning process.In the daily training for radiographers,emphasis is placed on strictly implementing image quality control measures at every stage of the CT scanning process and skillfully applying advanced scanning and image processing techniques.By doing so,we can provide clinicians with accurate and reliable imaging references for diagnosis and treatment.(2)Strategies for CT equipment maintenance:①Environmental inspection of the CT room to ensure cleanliness and hygiene.②Rational and accurate operation,including calibration software proficiency.③Regular maintenance and servicing for minimizing machine downtime.④Maintenance of the CT X-ray tube.CT technicians can become proficient in equipment maintenance and upkeep techniques through training,which can significantly extend the service life of CT systems and reduce the occurrence of malfunctions.Conclusion:Through the regular implementation of rigorous CT image quality control training for radiology technicians,coupled with diligent and proactive CT equipment maintenance,we have observed profound and beneficial impacts on improving image quality.The accuracy and fidelity of radiological data ultimately leads to more accurate diagnoses and effective treatments.展开更多
Objective:To explore the trend of detection and antimicrobial resistance of Serratia marcescens with different infection types for 7 consecutive years,to provide a reference for future studies for the control of S.mar...Objective:To explore the trend of detection and antimicrobial resistance of Serratia marcescens with different infection types for 7 consecutive years,to provide a reference for future studies for the control of S.marcescens infections and a rational selection of antibiotics.Methods:S.marcescens isolates were collected from 2014 to 2020,and the trend of detection and antimicrobial resistance were analyzed according to different types of infection.Results:For 7 consecutive years,the data showed that patients with S.marcescens infections were mainly from the intensive care unit(ICU)(384 isolates,40.98%),and the isolates recovered were mainly from sputum samples(743 isolates,79.30%).The number of isolated strains increased every year,and the average rate of detection ranged from 0.60%to 0.80%.The detection rate of S.marcescens with hospital-acquired infections(HAI)showed a downward trend and that of S.marcescens with colonization showed an upward trend.The detection rate of multidrug-resistant S.marcescens fluctuated between 8.33%–16.89%.The resistance rate of S.marcescens to piperacillin was 17.0%–29.06%and the resistance rate to piperacillin tazobactam was 2.95%–13.13%.For cephalosporin antibiotics,the resistance rates of S.marcescens to cefuroxime and cefazolin were>99%and the resistance rates to ceftazidime and cefepime were<13%.The resistance rate of S.marcescens to aminoglycoside antibiotics,especially amikacin,was the lowest.The resistance rate of S.marcescens with community-acquired infections(CAI)to carbapenems was higher than that with HAI and colonization.Conclusion:The different infection types of S.marcescens have different detection and epidemic trends.In addition,resistance to carbapenems is different across the strains.展开更多
Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was condu...Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was conducted at a public tertiary hospital in Zhejiang, China, from September 2018 to March 2021. A total of 58 HH observers were trained to conduct a direct observation on the HH behaviors of personnel in the hospital amongst the health care workers. We have observed over 9000 hand hygiene opportunities. The collected data were classified according to time factors, department parameters, and profession conduct of the observed. Hand hygiene (HH) compliance rates were calculated for each category, and a chi-square test was used to analyze differences of the HH compliance rates. Furthermore, binary logistic regression was used for multivariate analysis in each of the hand hygiene moments. Results: The HH compliance rates of HCWs were statistically different before and after the Corona Virus Disease 2019 (COVID-19) pandemic, in the morning and the afternoon, this was observed per parameters stated into objectives on weekdays vs non weekdays. And we found that HH compliance rates drop off a cliff from weekdays to non-weekdays. Conclusions: COVID-19, departments, professions, and weekdays were all factors that influence HH compliance amongst HCWs. However, the influencing factors were not all present in every HH behavior, and had different intensities of influence on HH compliance amongst the HCWs. These findings provide some reference for us to propose improvement measures.展开更多
BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver fu...BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.展开更多
At the current stage,China’s medical and health industry is constantly developing,and it is essential to fully attach importance to the core role of Centers for Disease Control and Prevention(CDC).For tertiary hospit...At the current stage,China’s medical and health industry is constantly developing,and it is essential to fully attach importance to the core role of Centers for Disease Control and Prevention(CDC).For tertiary hospitals,one of their key work tasks is to carry out public health management.Based on this,this paper mainly expounds on some basic problems existing in the public health management of state-owned hospitals at the current stage,and puts forward corresponding countermeasures for the identified problems.These countermeasures include enhancing the emphasis on public health management,strengthening the intensity of medical management,effectively improving the allocation of medical management resources,and intensifying the training of relevant personnel.This paper aims to provide references for improving the level of hospital public health management.展开更多
BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset D...BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).展开更多
Purpose:This study aimed to determine the nurses’profile characteristics that are associated with moral distress among nurses in selected government hospitals in Shangdong,China.Methods:This is a descriptive-correlat...Purpose:This study aimed to determine the nurses’profile characteristics that are associated with moral distress among nurses in selected government hospitals in Shangdong,China.Methods:This is a descriptive-correlational study.A total of 185 clinical registered nurses who met the eligibility criteria from different departments in two tertiary governmental hospitals in Jinan city were purposively selected to participate in this study.The instruments included the general demographic characteristics and Chinese version of Moral Distress Scale-Revised(MDS-R).Correlation technique,specifically Spearman’s rho,was utilized to determine the significant correlation between the selected nurse’s characteristics and moral distress.Ethical considerations were given by the Far Eastern University ethics review committee(FEU-ERC Code:2020-2021-079).Results:The number of patients nurses handled per shift(rs=0.650,p=0.032)and the type of patients that nurses handled(rs=0.718,p=0.020)are the nurses’profile factors that are significantly correlated with nurses’moral distress(p-value<0.05).As there is an increase in the number of patients handled every shift and the patients are becoming unstable,requiring complex care,the frequency and intensity of moral distress increase as well.Conclusion:The nurses’moral distress was registered at a low level in this study.Characteristics related to patients,such as the number and type assigned to nurses,are correlated to moral distress.The main source of the high frequency and intensity of moral distress among nurses is“futile care”and“false hope”.Educational learning program is recommended to manage and alleviate the moral distress of nurses.展开更多
To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-ter...To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-term chronic damage caused by HCV leads to impaired liver function,portal hypertension,liver fibrosis,cirrhosis and even hepatocellular carcinoma(HCC)[1,2].Therefore,it is imperative to improve the diagnosis and treatment of hepatitis C.In 2016,World Health Organization(WHO)set the goal of“eliminating viral hep-atitis as a public health hazard by 2030”.Some associations intro-duced guidelines for hepatitis C screening and treatment.After a period of effort,in 2020,the number of people receiving treatment for chronic HCV infection had significantly increased compared to the number in 2015,and the HCV-related mortality rate had de-creased.Nevertheless,nearly 80%of infected individuals have not been timely diagnosed and treated[3,4].Like many other coun-tries,China still faces a significant gap in achieving the goal of hep-atitis C elimination,and some literature indicated limited public awareness and high medication costs might slow the progress of policy implementation[5-7].How to effectively improve the diag-nosis and treatment of hepatitis C has garnered widespread global attention.展开更多
BACKGROUND Fibrosis is a critical event in the progression of pediatric nonalcoholic fatty liver disease(NAFLD).AIM To develop less invasive models based on machine learning(ML)to predict significant fibrosis in Chine...BACKGROUND Fibrosis is a critical event in the progression of pediatric nonalcoholic fatty liver disease(NAFLD).AIM To develop less invasive models based on machine learning(ML)to predict significant fibrosis in Chinese NAFLD children.METHODS In this cross-sectional study,222 and 101 NAFLD children with available liver biopsy data were included in the development of screening models for tertiary hospitals and community health centers,respectively.Predictive factors were selected using least absolute shrinkage and selection operator regression and stepwise logistic regression analyses.Logistic regression(LR)and other ML models were applied to construct the prediction models.RESULTS Simplified indicators of the ATS and BIU indices were constructed for tertiary hospitals and community health centers,respectively.When models based on the ATS and BIU parameter combinations were constructed,the random forest(RF)model demonstrated higher screening accuracy compared to the LR model(0.80 and 0.79 for the RF model and 0.72 and 0.77 for the LR model,respectively).Using cutoff values of 90%for sensitivity and 90%for specificity,the RF models could effectively identify and exclude NAFLD children with significant fibrosis in the internal validation set(with positive predictive values and negative prediction values exceeding 0.80),which could prevent liver biopsy in 60%and 71.4%of NAFLD children,respectively.CONCLUSION This study developed new models for predicting significant fibrosis in NAFLD children in tertiary hospitals and community health centers,which can serve as preliminary screening tools to detect the risk population in a timely manner.展开更多
基金2023 Shaanxi Teacher Development Research Program“Research on the Construction and Improvement Path of a Teaching Engagement Model for Double-Qualified Teachers in Medical Colleges”(Project number:2023JSQ011)。
文摘This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.
基金2023 Shaanxi Teacher Development Research Program“Research on the Construction and Improvement Path of a Teaching Engagement Model for Double-Qualified Teachers in Medical Colleges”(Project number:2023JSQ011)。
文摘Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.
基金2023 Shaanxi Teacher Development Research Program“Research on the Construction and Improvement Path of a Teaching Engagement Model for Double Qualified Teachers in Medical Colleges”(2023JSQ011)2022 Education and Teaching Reform Research Project of Xi’an Medical University“Construction and Practice of the Teaching Quality Assurance System in the Three-Level Teaching Base of General Practice Medicine under the Internet+Model”(2022JG-05)。
文摘Objective:This article aims to deeply analyze the feedback on teacher training in an affiliated hospital,so as to clarify the current needs and situation of teacher training and provide a scientific basis for further optimizing the teacher training system.Methods:The current situation and needs of teacher training in the affiliated hospital were collected by designing and distributing Tomato Form questionnaires on the DingTalk platform.The questionnaire adopted a percent-point system,all of which were indeterminate multiple-choice questions.Results:The average age of the clinical teachers participating in the survey was 40.44±7.85 years old,with an average teaching length of 4–10 years.The results showed that 60.20%of teachers think that the amount of teacher training in an affiliated hospital is sufficient;91.10%of teachers think that the factors affecting training conflict with working hours;97.96%of teachers believe that the training time has an impact on the training effect;81.63%of teachers prefer online training;51.53%of teachers tend to arrange training time on working days;33.16%of teachers tend to train once a month;17.78%of teachers prefer to receive training on clinical theoretical courses and practical teaching norms and skills content.Conclusion:Based on the above survey results,we propose to build a comprehensive management mechanism for teacher training,including improving the access,training,and assessment mechanism for clinical teachers,and adjusting and optimizing the training program according to actual needs.At the same time,an effective communication platform should be built to promote the deep integration of teaching and practice and enhance social recognition,so as to comprehensively improve the teaching quality and medical service of the hospital.
文摘Many studies have been done about the treatment of KCOT, but the recurrence rate still remains high despite the combination of surgical techniques used, associated with or without the use chemical solutions such as Carnoy’s solution or Cryosurgery. Currently, there is no consensus concerning the therapeutic choice for the KCOT. The purpose of this study was to evaluate the different treatment methods used for the management of KCOT in the Second Affiliated Hospital of Jiamusi University and the results obtained from those treatment methods. Settings and Design: Clinical study was done at the Second Affiliated Hospital of Jiamusi University. Materials and Methods: Analytical retrospective review of 63 cases treated surgically from 2009 to 2015 at the Maxillofacial and Oral Surgery Department of the Second Affiliated Hospital of Jiamusi University. All cases diagnosed as KCOT and registered in the archives were used. The level of statistical significance was set at P < 0.05. Results: Of the 63 cases, 55.56% were male and 44.44% female. The sex ratio was 1.25 in favor of male and the average age was 42 years. 81% of the lesions were located in the mandible. Of 40 cases treated by enucleation with peripheral ostectomy, curettage and electric cauterization with application of 2% iodine tincture, no recurrence was found. Of 20 cases treated by the same surgical method but without the application of 2% iodine tincture, recurrence was found in 3 cases (4.76%). 3 cases treated by resection had no recurrence. Significant relation between recurrence and type of treatment was found (P < 0.05). Conclusion: In our series, those cases that were treated by combination of surgical methods used with 2% iodine tincture showed an “improvement” in the reduction of recurrence, suggesting a future question to be examined in experimental study is to test the effectiveness of 2% iodine tincture.
文摘Based on the blueprint of the training center for clinical skills of our hospital,this paper discusses the effect of‘the market for lemons’in its booking system from the perspective of economics of information,uses the law of large numbers and the central limit theorem to model to carry out the case study of FAHSYSU Simulation T,and takes measures of offsetting adverse selections to increase booking efficiency.The paper also analyzes how to apply the ancient Chinese theory that man is an integral part of nature to wipe out‘the market for lemons’.
基金supported by the 2020 Education and Teaching Reform Research Project of Xi’an Medical University,“Construction of‘Double-Qualified’Teachers in Affiliated Hospitals Based on‘Online Learning Platform for Clinical Teachers’and Construction and Practice of Quality Assurance System”(Project Number:2020JG-02)the 2021 Shaanxi Undergraduate and Higher Continuing Education Teaching Reform Research Project of Shaanxi Provincial Department of Education,“Construction of Teaching Staff Based on‘Online Learning Platform for Clinical Teachers of the First Affiliated Hospital of Xi’an Medical University’and Construction and Practice of Quality Assurance System”(Project Number:21BZ066).
文摘Objective:To build a set of teaching staff construction and teaching quality monitoring system suitable for clinical practice teaching in affiliated hospitals of medical colleges,achieve continuous improvement of clinical education and teaching level,and ensure the quality of medical education talent cultivation.Methods:A modern clinical practice teaching quality monitoring system is constructed based on organizational structure construction,teaching staff system construction,quality control system construction,and information platform construction,combined with external audit and evaluation.Results:The hospital has established a Faculty Development and Teaching Evaluation Office specifically responsible for the cultivation of clinical teachers and the evaluation and supervision of teaching quality.A relatively complete teacher construction and teaching quality monitoring system has also been established for clinical practice teaching,thus achieving integration with the school’s quality control system in terms of management mechanism.At the same time,a set of teaching quality control mode based on the“Internet+”platform has been created by means of informatization.At present,this mode has won three national computer software copyrights and two second prizes for school-level teaching achievements.Conclusion:Through five years of practice,an“Internet+”teaching quality evaluation and monitoring system with the characteristics of teaching hospitals affiliated to local medical colleges has been established.In order to further standardize the training system of clinical teachers in affiliated hospitals,achieve self-monitoring and self-improvement in terms of teaching quality,and ensure the continuous improvement of clinical teaching quality,we will continue to promote the development of clinical teachers with quality and excellence,enrich the main team of quality monitoring,guide the transformation of the education mode from being“centered on teachers”to being“centered on students,”and realize the integration of internal and external quality monitoring systems.
文摘OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,traditional Chinese medicine(TCM)herbs exhibit significant bioactivity and therapeutic effect.This study is aimed to evaluate the efficacy of four TCM preparations on 28-day mortality risk of patients and changes of the laboratory indicators.METHODS The retrospective cohort study included patients with COVID-19 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023,and those died within 48 hours of admission or cannot be tracked for outcomes were excluded.The primary outcome was survival status in 28 days(death or survival)starting from the day of admission.The second outcomes were laboratory indicators,including absolute lymphocyte count,lactate dehydrogenase,creatinine,and blood urea nitrogen.Binary logistic regressions were used to estimate the effect of TCM preparations on the primary and secondary outcomes in main analysis.Meanwhile,heterogeneity and robustness of results from main analysis were assessed by subgroup analyses and multiple sensitivity analyses.RESULTS 1816 eligible patients were included in analysis dataset,including 573 patients received standard care(control group)and 1243 patients received TCM preparations(hospital preparation group).The 28-day mortality rate of hospital preparation group was lower than that of control group(4.75%vs.14.83%),and the difference was statistically significant(χ^(2)=54.666,P<0.001).The risk of 28-day mortality was 0.535 times lower in the hospital preparation group as compared with the control group(OR=0.46,95%CI:0.305-0.708,P<0.001)showed by multivariable binary logistic regressions.Subgroup analyses showed that taking TCM preparations reduced the 28-day mortality risk.Sensitivity analyses demonstrated that the results of the main analysis for primary outcomes were robust.For secondary outcomes,the risk of abnormal absolute lymphocyte counts at discharge in the hospital preparation group decreased by 0.284 times(OR=0.703,95%CI:0.515-0.961,P=0.027).CONCLUSION Compared with standard of care,taking four hospital preparations including Kanggan Heji,Feining Heji,Qishen Gubiao Keli,and Qianghuo Qushi Qingwen Heji decreased risk of 28-day mortality among hospitalized COVID-19 patients.TCM therapy achieves adequate therapeutic effects in COVID-19.
基金Supported by National TCM Advantage Speciality Construction Project:Clinical Pharmacy(GZYYYZH[2024]90)Guizhou Provincial Key Discipline Construction Project of Traditional Chinese Medicine and Ethnic Medicine:Clinical Traditional Chinese pharmacy(QZYYZDXK(JS)-2023-04).
文摘[Objectives]This study was conducted to promote the rational use of special use level of antibiotics in clinic and delay the emergence of drug resistance.[Methods]The application of antibiotics for special use among inpatients of a hospital in 2019 was analyzed.The data in the drug information management system of the hospital were queried,and the collected expert consultation records of special-use antibiotics were sorted out.Indicators including the use rate of special-use antibiotics,antibiotic use density(AUD),defined daily dose system(DDDs)and defined daily dose system cost(DDDc)of each drug,the annual pathogen detection rate,disease distribution and pathogenic microorganism detection were summarized and analyzed for inpatients in the hospital retrospectively.[Results]In 2019,the average annual use rate of special-use antibiotics in the hospital was 1.53%,and the average annual use density was 1.59 DDDs.The antibiotics with the top three DDDs were imipenem and cilastatin,meropenem and cefepime.The antibiotics with the top three DDDc were voriconazole dispersible tablets,voriconazole for injection,and meropenem for injection.The average annual detection rate of microorganisms was 85.77%.The diseases were mainly diagnosed as respiratory infections such as pneumonia and secondary infections after radiotherapy and chemotherapy before medication,and the detected pathogens were mainly Candida and its subspecies,Escherichia coli,and Klebsiella and its subspecies.[Conclusions]The clinical use of special-use antibiotics in the hospital was basically reasonable,but there were still some problems.It is necessary to increase management efforts,strengthen training for relevant medical personnel,and provide management ideas for further standardizing the use of antibiotics in the hospital.
基金The Henan Key Research and Development and Promotion Project(Grant No.232102310245)the Joint Construction Project of Medical Science and Technology of Henan Province(Grant No.LHGJ20220426).
文摘The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exacerbated this issue by increasing selective pressure within bacterial populations.This study aimed to investigate the association between carbapenem consumption and resistance rates in four priority Gram-negative bacteria:Escherichia coli(EC),Klebsiella pneumoniae(KP),Acinetobacter baumannii(AB),and Pseudomonas aeruginosa(PA).Retrospective data were collected from the First Affiliated Hospital of Zhengzhou University,covering the period from January 2010 to December 2022.Trends in carbapenem consumption and resistance were analyzed using the Mann-Kendall test to assess statistical significance and the Sen’s slope(SS)estimator to determine the magnitude of change.Correlations between carbapenem use and bacterial resistance rates were evaluated via Spearman correlation analysis.Over the study period,the consumption of meropenem,imipenem,biapenem,and total carbapenems exhibited a significant upward trend(|Z|>1.96,SS>0).Correspondingly,the resistance rates of EC and KP to meropenem and imipenem also increased significantly(|Z|>1.96,SS>0).A strong positive correlation was observed between the resistance rate of EC to meropenem and the defined daily doses(DDDs)of meropenem(r=0.732,P<0.05)and between EC resistance to imipenem and its DDDs(r=0.49,P<0.05).Similar significant correlations were identified for KP.However,no significant associations were found between carbapenem resistance in AB or PA and carbapenem consumption.These findings underscored the strong correlation between carbapenem use and the resistance rates of EC and KP,highlighting the urgent need for stringent control and stewardship of carbapenem use in clinical settings to mitigate or delay the development of bacterial drug resistance.
文摘Full cost accounting,as a comprehensive cost measurement method,integrates direct and indirect costs to reallocate costs across departments.Performance evaluation serves as a method to assess a hospital’s overall performance and management capabilities.Both full cost accounting and performance evaluation are critical tools in the financial management of public hospitals,playing pivotal roles in accounting practices.The concepts of full cost accounting and performance evaluation were investigated in this study,and the existing challenges and the theoretical basis for their integration were analyzed.An integrated model was constructed,and its application cases and effectiveness in the financial management of public hospitals were discussed.Finally,measures to integrate full cost accounting and performance evaluation were proposed,including improving full cost accounting mechanisms,standardizing accounting practices,optimizing cost allocation methods,establishing a unified management platform,and fostering collaboration among stakeholders.This study provides new insights to enhance the quality and efficiency of financial management in public hospitals,laying a foundation for their sustainable development.
文摘Objective:To explore the correlation between disease uncertainty and psychological distress in hospitalized patients with primary liver cancer,providing a basis for clinical nursing interventions.Methods:A convenient sampling method was used to select 82 patients with primary liver cancer from a tertiary first-class hospital in Guangzhou from September 2023 to March 2024 as the research subjects.General information questionnaires,the Mishel Uncertainty in Illness Scale-Adult Version(MUIS-A),and the Kessler Psychological Distress Scale(K10)were used for investigation.Pearson correlation analysis and linear regression analysis were performed to explore the relationship between the two.Results:The total score of disease uncertainty in hospitalized patients with primary liver cancer was(99.20±8.79),and the total score of psychological distress was(22.87±9.46),both at a medium level.There was a positive correlation between disease uncertainty and psychological distress(r=0.360,P<0.01),and the ambiguity dimension had the strongest correlation with psychological distress(r=0.399,P<0.01).Regression analysis showed that the ambiguity dimension had a significant predictive effect on psychological distress(β=0.399,P<0.01).Conclusion:There is a close correlation between disease uncertainty and psychological distress in patients with primary liver cancer.In clinical nursing,it is necessary to pay special attention to patients’ambiguity regarding disease symptoms and prognosis.Targeted health education should be carried out to reduce their uncertainty,thereby improving their psychological state.
基金supported by the First Affiliated Hospital of Xi’an Jiaotong University Teaching Reform Project(Grant No.JG2023-0206 and JG2022-0324).
文摘Objective:In the Radiology Department of Mzuzu Central Hospital(MCH),daily training for radiographers now includes content on Computed Tomography(CT)image quality control and equipment maintenance to ensure the normal,continuous,and stable operation of the 16-slice spiral CT scanner.Methods:Through comprehensive analysis of relevant equipment,we have identified key parameters that significantly impact CT image quality.Innovative optimization strategies and solutions targeting these parameters have been developed and integrated into daily training programs.Furthermore,starting from an examination of prevalent failure modes observed in CT equipment,we delve into essential maintenance and preservation techniques that CT technologists must master to ensure optimal system performance.Results:(1)Crucial factors affecting CT image quality include artifacts,noise,partial volume effects,and surrounding gap phenomena,alongside spatial and density resolutions,CT dose,reconstruction algorithms,and human factors during the scanning process.In the daily training for radiographers,emphasis is placed on strictly implementing image quality control measures at every stage of the CT scanning process and skillfully applying advanced scanning and image processing techniques.By doing so,we can provide clinicians with accurate and reliable imaging references for diagnosis and treatment.(2)Strategies for CT equipment maintenance:①Environmental inspection of the CT room to ensure cleanliness and hygiene.②Rational and accurate operation,including calibration software proficiency.③Regular maintenance and servicing for minimizing machine downtime.④Maintenance of the CT X-ray tube.CT technicians can become proficient in equipment maintenance and upkeep techniques through training,which can significantly extend the service life of CT systems and reduce the occurrence of malfunctions.Conclusion:Through the regular implementation of rigorous CT image quality control training for radiology technicians,coupled with diligent and proactive CT equipment maintenance,we have observed profound and beneficial impacts on improving image quality.The accuracy and fidelity of radiological data ultimately leads to more accurate diagnoses and effective treatments.
基金Hospital Management Innovation Program of Jiangsu Hospital Association in 2021(Project No.:JSYGY-3-2021-511)。
文摘Objective:To explore the trend of detection and antimicrobial resistance of Serratia marcescens with different infection types for 7 consecutive years,to provide a reference for future studies for the control of S.marcescens infections and a rational selection of antibiotics.Methods:S.marcescens isolates were collected from 2014 to 2020,and the trend of detection and antimicrobial resistance were analyzed according to different types of infection.Results:For 7 consecutive years,the data showed that patients with S.marcescens infections were mainly from the intensive care unit(ICU)(384 isolates,40.98%),and the isolates recovered were mainly from sputum samples(743 isolates,79.30%).The number of isolated strains increased every year,and the average rate of detection ranged from 0.60%to 0.80%.The detection rate of S.marcescens with hospital-acquired infections(HAI)showed a downward trend and that of S.marcescens with colonization showed an upward trend.The detection rate of multidrug-resistant S.marcescens fluctuated between 8.33%–16.89%.The resistance rate of S.marcescens to piperacillin was 17.0%–29.06%and the resistance rate to piperacillin tazobactam was 2.95%–13.13%.For cephalosporin antibiotics,the resistance rates of S.marcescens to cefuroxime and cefazolin were>99%and the resistance rates to ceftazidime and cefepime were<13%.The resistance rate of S.marcescens to aminoglycoside antibiotics,especially amikacin,was the lowest.The resistance rate of S.marcescens with community-acquired infections(CAI)to carbapenems was higher than that with HAI and colonization.Conclusion:The different infection types of S.marcescens have different detection and epidemic trends.In addition,resistance to carbapenems is different across the strains.
文摘Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was conducted at a public tertiary hospital in Zhejiang, China, from September 2018 to March 2021. A total of 58 HH observers were trained to conduct a direct observation on the HH behaviors of personnel in the hospital amongst the health care workers. We have observed over 9000 hand hygiene opportunities. The collected data were classified according to time factors, department parameters, and profession conduct of the observed. Hand hygiene (HH) compliance rates were calculated for each category, and a chi-square test was used to analyze differences of the HH compliance rates. Furthermore, binary logistic regression was used for multivariate analysis in each of the hand hygiene moments. Results: The HH compliance rates of HCWs were statistically different before and after the Corona Virus Disease 2019 (COVID-19) pandemic, in the morning and the afternoon, this was observed per parameters stated into objectives on weekdays vs non weekdays. And we found that HH compliance rates drop off a cliff from weekdays to non-weekdays. Conclusions: COVID-19, departments, professions, and weekdays were all factors that influence HH compliance amongst HCWs. However, the influencing factors were not all present in every HH behavior, and had different intensities of influence on HH compliance amongst the HCWs. These findings provide some reference for us to propose improvement measures.
基金supported by the CAMS Innovation Fund for Medical Sciences(2024-12M-C&T-B-045).
文摘BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.
文摘At the current stage,China’s medical and health industry is constantly developing,and it is essential to fully attach importance to the core role of Centers for Disease Control and Prevention(CDC).For tertiary hospitals,one of their key work tasks is to carry out public health management.Based on this,this paper mainly expounds on some basic problems existing in the public health management of state-owned hospitals at the current stage,and puts forward corresponding countermeasures for the identified problems.These countermeasures include enhancing the emphasis on public health management,strengthening the intensity of medical management,effectively improving the allocation of medical management resources,and intensifying the training of relevant personnel.This paper aims to provide references for improving the level of hospital public health management.
基金Supported by National Natural Science Foundation of China,No.81972947Academic Promotion Programme of Shandong First Medical University,No.2019LJ005.
文摘BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).
文摘Purpose:This study aimed to determine the nurses’profile characteristics that are associated with moral distress among nurses in selected government hospitals in Shangdong,China.Methods:This is a descriptive-correlational study.A total of 185 clinical registered nurses who met the eligibility criteria from different departments in two tertiary governmental hospitals in Jinan city were purposively selected to participate in this study.The instruments included the general demographic characteristics and Chinese version of Moral Distress Scale-Revised(MDS-R).Correlation technique,specifically Spearman’s rho,was utilized to determine the significant correlation between the selected nurse’s characteristics and moral distress.Ethical considerations were given by the Far Eastern University ethics review committee(FEU-ERC Code:2020-2021-079).Results:The number of patients nurses handled per shift(rs=0.650,p=0.032)and the type of patients that nurses handled(rs=0.718,p=0.020)are the nurses’profile factors that are significantly correlated with nurses’moral distress(p-value<0.05).As there is an increase in the number of patients handled every shift and the patients are becoming unstable,requiring complex care,the frequency and intensity of moral distress increase as well.Conclusion:The nurses’moral distress was registered at a low level in this study.Characteristics related to patients,such as the number and type assigned to nurses,are correlated to moral distress.The main source of the high frequency and intensity of moral distress among nurses is“futile care”and“false hope”.Educational learning program is recommended to manage and alleviate the moral distress of nurses.
基金supported by a grant from the R&D Program of China(2022YFC2304500).
文摘To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-term chronic damage caused by HCV leads to impaired liver function,portal hypertension,liver fibrosis,cirrhosis and even hepatocellular carcinoma(HCC)[1,2].Therefore,it is imperative to improve the diagnosis and treatment of hepatitis C.In 2016,World Health Organization(WHO)set the goal of“eliminating viral hep-atitis as a public health hazard by 2030”.Some associations intro-duced guidelines for hepatitis C screening and treatment.After a period of effort,in 2020,the number of people receiving treatment for chronic HCV infection had significantly increased compared to the number in 2015,and the HCV-related mortality rate had de-creased.Nevertheless,nearly 80%of infected individuals have not been timely diagnosed and treated[3,4].Like many other coun-tries,China still faces a significant gap in achieving the goal of hep-atitis C elimination,and some literature indicated limited public awareness and high medication costs might slow the progress of policy implementation[5-7].How to effectively improve the diag-nosis and treatment of hepatitis C has garnered widespread global attention.
基金Supported by National Natural Science Foundation of China,No.82272433Fujian Provincial Key Laboratory of Hepatic Drug Research,No.2022-YF-0050+1 种基金the Major Science and Technology Projects for Health of Zhejiang Province,No.WKJ-ZJ-2216the Cyrus Tang Foundation for Young Scholar,No.2022(2022-B126).
文摘BACKGROUND Fibrosis is a critical event in the progression of pediatric nonalcoholic fatty liver disease(NAFLD).AIM To develop less invasive models based on machine learning(ML)to predict significant fibrosis in Chinese NAFLD children.METHODS In this cross-sectional study,222 and 101 NAFLD children with available liver biopsy data were included in the development of screening models for tertiary hospitals and community health centers,respectively.Predictive factors were selected using least absolute shrinkage and selection operator regression and stepwise logistic regression analyses.Logistic regression(LR)and other ML models were applied to construct the prediction models.RESULTS Simplified indicators of the ATS and BIU indices were constructed for tertiary hospitals and community health centers,respectively.When models based on the ATS and BIU parameter combinations were constructed,the random forest(RF)model demonstrated higher screening accuracy compared to the LR model(0.80 and 0.79 for the RF model and 0.72 and 0.77 for the LR model,respectively).Using cutoff values of 90%for sensitivity and 90%for specificity,the RF models could effectively identify and exclude NAFLD children with significant fibrosis in the internal validation set(with positive predictive values and negative prediction values exceeding 0.80),which could prevent liver biopsy in 60%and 71.4%of NAFLD children,respectively.CONCLUSION This study developed new models for predicting significant fibrosis in NAFLD children in tertiary hospitals and community health centers,which can serve as preliminary screening tools to detect the risk population in a timely manner.
