Seguridad de equipos de procuramiento de órganos y tejidos en Chile. ¿Qué esperamos?

Las tasa de trasplantes en Chile es baja en comparación con otros países. Si bien se han hecho importantes avances para aumentar este número, existe poca claridad en cuanto a protocolos de seguridad de los equipos de procuramiento de órganos. A nivel internacional existen diferentes tragedias que han marcado este trabajo, la más conocida es la ocurrida en Michigan, donde un equipo médico perdió la vida al caer sobre el lago en un transporte por un trasplante de pulmón. Años después de la tragedia se conocieron los reiterados reclamos por parte del personal médico en relación a la falta de seguridad durante los traslados. Si bien el procuramiento de órganos tiene un riesgo asociado inherente, este se debe mantener al mínimo. Para avanzar en esto se confeccionó una guía de seguridad donde participaron las organizaciones de trasplante más importantes de Estados Unidos. Se emitieron recomendaciones, donde se regula el transporte aéreo, terrestre, seguros y el futuro de esta actividad. En Chile la orientación técnica que regula el procuramiento, no especifica ninguno de estos puntos y no existe información pública disponible, dejando la seguridad a disposición de las instituciones locales. Si bien es importante reconocer el esfuerzo nacional por mejorar el número de trasplantes año a año, es necesario avanzar en mejorar la seguridad de los equipos de procuramiento, y no esperar que ocurra una tragedia, para generar cambios necesarios, particularmente en un país con una geografía desafiante como Chile.

The transplant rate in Chile is low compared to other countries. Although significant advances have been made to increase this number, there is little clarity regarding safety protocols for organ procurement teams. Internationally, various tragedies have marked this work, the most famous being the one that occurred in Michigan, where a medical team lost their lives when they crashed into a lake during transport for a lung transplant. Years after the tragedy, repeated complaints by medical personnel came to light concerning the lack of safety during transfers. Although organ procurement inherently carries associated risks, these should be kept to a minimum. In 2020, a safety guide was created to make progress with participation from the most crucial transplant organizations in the United States. Recommendations were issued regulating air and ground transportation, insurance, and the future of transplant activity. In Chile, technical guidelines that regulate procurement need to specify crucial safety metrics, and there is no publicly available information or recommendations, leaving safety to the discretion of local institutions. While it is essential to recognize the national effort to improve the number of transplants year after year, it is necessary to advance in improving the safety of procurement teams and not wait for a tragedy to occur to generate the required changes, particularly in a country with challenging geography like Chile.

A qualitative study on the work experience of nurses in community family medical team / 中华护理杂志

Objective To understand the feelings and experiences of nurses in family medical team in the process of implementing contracted services,in order to provide a reference for effectively exerting the function of nursing in contracted services,and promoting and optimizing the contracted services in China.Methods Using phenomenological research methods,14 team nurses from 3 community health service centers in Beijing were interviewed with semi-structured interviews.The content analysis method was used to analyze the data.Results 3 themes were extracted in the nurses'experiences and feelings during the implementation of the contracted services,personal growth and benefit,and the need to optimize the work.3 sub-themes were extracted in work experiences and feelings,namely sense of optimization of nursing philosophy,sense of changing focus of nursing,improvement of nurse and patient bond.4 sub-themes were extracted in personal growth and benefits,namely increasing job responsibility and accomplishment,forming a sense of teamwork,greater understanding and respecting for patients.5 sub-themes were extracted in the optimization of contracted service needs,namely clarifying the position of team nurses,improving the bidirectional referrals,improving the contracted team management and assessment mechanisms,strengthening the support of the policy on home care,and providing opportunities for continuing education and training.Conclusion In practicing contracted services,team nurses have gained recognition of their profession and continuous self-growth.The government should continue to improve the support of contracting-related policies to meet the needs of team nurses'career development,optimize contracted services,and attract more nurses into the practice of contracted services.

Analysis of disease spectrum and drug consumption of field medical team in field training in summer / 中华急诊医学杂志

Objective:To analyze the common disease spectrum and medication of field medical team in our hospital in summer, and to provide medical and medicinal material supply for field medical team.Methods:The data of all cases of field medical team members during the training period were collected. The types and composition ratio of diseases were analyzed, the drug consumption was counted, and the drug use indicators were calculated including daily drug dose (DDDs), daily drug dose cost (DDDC), drug utilization rate (DUR) and drug ranking ratio (R).Results:During the 12 days of the field training in summer, 77 field medical team members had 91 medical visits and 117 cases of diseases, including 44 males and 33 females, with an average age of 39.7 years. There were 52 cases of respiratory diseases, 21 cases of digestive diseases, 18 cases of mosquito bites and skin diseases, 15 cases of trauma and skeletal muscle system diseases, 5 cases of ophthalmic diseases, 2 cases of neurological diseases, 2 cases of gynecological diseases, 1 case of oral diseases and 1 case of heat stroke. The top five drugs of DDDs and DUR were respiratory drugs, sensory organ drugs, dermatological drugs, antibiotic drugs, digestive system drugs and musculoskeletal system drugs.Conclusions:The disease composition and drug demand of field training in summer have certain characteristics. It is of great guiding significance to know the characteristics of disease incidence and drug consumption of field training for the medical support ability and training tasks for field medical teams in field training in summer.

Establishment and implementation effect of rapid response medical team for extracorporeal cardiopulmonary resuscitation in emergency department / 中华急诊医学杂志

Objective:To retrospectively analyze the establishment and implementation effect of ECPR rapid response medical team in emergency department, and to explore a more efficient rescue mode.Methods:A total of 41 patients who started ECPR in the emergency room of a tertiary hospital in Beijing from November 2017 to September 2022 were selected as subjects. The 14 patients treated by the ECPR rapid response medical team in the emergency department were set as the experimental group, and the 27 patients treated by the ECPR team of the MDT mode led by the cardiac surgeon were set as the control group. The ECPR start-up time, pipeline pre-filling time, ECPR start-up to ECMO successful operation time, complication rate and treatment success rate were compared between the two groups.Results:There was no significant difference in the outcome between the two groups (all P>0.05), but the total time (min) of ECPR implementation by the rapid response medical team in the emergency department was shorter (20.86 ± 10.86 vs. 23.04 ± 11.40), the incidence of complications was lower, and the success rate of treatment was higher (28.57 % vs. 25.93 %). Conclusion:Establishing a mature ECPR rapid response team dominated by emergency medical care helps improve the rescue coordination and work efficiency, thereby providing the emergency protection and management of full -chain for the treatment of critical condition.

Application of intelligent consumables management belt in ward unit of emergency medical team / 医疗卫生装备

The current situation and problems of the consumables management in the ward unit of the emergency medical team were introduced.An intelligent consumables management belt was prepared based on two-dimensional code technology to solve the problems of the ward unit in consumables positioning,storage,inconvenient access,management process and support cost,which enhanced the efficacy of the emergency medical team greatly.

Time phased scheduling and Disease grading management to achieve efficient rescue of batches of COVID-19 infected patients in shelter hospital / 中华急诊医学杂志

Objective:To introduce how to quickly set up a doctor team to achieve efficient treatment of batchs COVID-19 patients in Changchun GongTi shelter hospital.Methods:A cross-sectional study was conducted to analyze the basic situation of the doctors who supported the Changchun Gongti shelter hospital. The workload is the total number of patients from April 3 to 28, 2022. At the beginning of the task, the first week and the third week of the task, the five point scoring method was used to reflect the doctor's physical and mental state, stress state and rescue achievement. The time phased scheduling and disease grading management were fully implemented after 10 days of operation in the shelter. The doctors' ward round efficiency and self scoring changes before and after the implementation of the plan were compared, and the rescue results were summarized.Results:Total of 56 doctors (the Sichuan medical assistance team to Changchun), who undertook the work of Changchun Gongti shelter Hospital, came from 12 professional departments of 14 hospitals. By internal and external linkage-time phased scheduling and information-based patient zoning and grading management, the admission time of batch patients was shortened from (14.64±10.09) min to (6.80±5.10) min per person( P<0.05), the number of patients that each doctor can view per hour ranges from (28.50±12.26) to (68.43±19.95) ( P<0.01). A total of 1 293 patients were treated. There were no deaths, no accidents and no mild illness to severe illness in shelter hospital. 35 doctors completed a continuous survey. Before and after the implementation of those measures, the average physical state scores and the psychological state scores of doctors improved ( P=0.03), the self-score of stress feeling decreased ( P<0.01), and the self-score of professional achievement increased ( P<0.01). Conclusions:To adapt to the characteristics of emergency treatment for batch COVID-19 patients, the internal and external linkage-time phased scheduling and information-based patient zoning and grading management could help the temporarily convened doctors deal with a large number of patients efficiently, reduce work stress and exposure risk in shelter hospital.

Information support practice for anti-COVID-19 consortium composed of multi-medical institutions’ staff / 西安交通大学学报(医学版)

In the emergency of the outbreak of COVID-19 in December 2019, Shaanxi Provincial Health Committee mobilized several medical teams from major hospitals in the province, and, by relying on Xi’an Chest Hospital, jointly established an anti COVID-19 consortium to control and eradicate the epidemic in a short time. Information support is an important guarantee for winning this battle. In order to realize the efficient cooperation among multiple medical teams, we have carried out some exploratory and innovative information support services on the basis of the original information system of the chest hospital. In this process, we have gone through some detours. Some compromises were made on some problems that could not be solved in the short term. Finally, in an environment full of uncertainty, a set of information support management system with basically smooth operation was built through rapid trial and error adjustment. The system mainly includes the following aspects: support of the organizational structure and operation process of the anti-epidemic consortium, support for medical collaboration related businesses of multiple medical teams, and support for statistical reports and online meetings. Information support has played a very important role in this action, and this practice has also accumulated experience for us to deal with similar situations in the future.

Mental health status and influencing factors of China medical team members in Africa during COVID-19 / 西安交通大学学报(医学版)

【Objective】 To analyze the mental health status and influencing factors of China medical team （CMT） members in Africa during COVID-19 pandemic. 【Methods】 From July 2021 to August 2021， 72 members of the 8th CMT in Malawi， the 36th CMT in Sudan and the 22nd CMT in Zambia were tested by 12-item General Health Questionnaire （GHQ-12）， Generalized Anxiety Disorder-7 （GAD-7）， and Patient Health Questionnaire-9（PHQ-9）， general information form and influencing factors form. 【Results】 The results of GHQ-12 were positive for 33.3% （24/72） of the CMT members. 51.4% （37/72） of the CMT members showed different levels of anxiety： 40.3% （29/72） of them had mild anxiety， 8.3% （6/72） of them had moderate anxiety， and 2.8% （2/72） of them had severe anxiety. 52.8% （38/72） of the CMT members had different degrees of depression： 34.7% （25/72） of them had mild depression， 11.1% （8/72） of them had moderate depression， 4.2% （3/72） of them had moderate-severe depression， and 2.8% （2/72） of them had severe depression. The CMT members who contacted with COVID-19 patients got significantly high scores of GHQ-12， GAD-7 and PHQ-9 （P<0.05） compared to those who did not have contact with COVID-19 patients. And CMT members who did not adapt to the local social life got significantly higher scores than those who adapted to the local social life （P<0.05）. These factors were the main factors affecting the mental health of the CMT members. 【Conclusion】 During COVID-19， the psychological pressure of CMT members was increased significantly， and both the incidence and severity of anxiety and depression were increased. Paying attention to and improving CMT members’ mental health status can ensure the smooth development of medical aid to Africa.

Experience of healthcare-acquired infection control against coronavirus disease 2019 by integrated medical team in Wuhan / 上海交通大学学报（医学版）

Objective: To sum up the experience of healthcare-acquired infection control against coronavirus disease 2019 (COVID-19) in Wuhan by a medical team from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for the contain strategy of sudden infectious diseases in China. Methods: The whole process of prevention and control of HAI was implemented through methods such as management organization construction, institutional establishment and implementation, personnel training, occupational exposure planning, and introduction of hightech methods. Results: There were a total of 136 members in the medical team, including 30 doctors, 100 nurses, and 6 administrative staffs. None of them were infected with COVID-19, achieving zero infection among medical staff. Conclusion: Although the task of assisting Wuhan was tight in time, and materials and heavy, under the leadership of the team leader and the cooperation of all the staff, all measures were implemented, the training covered all the staff, and high-tech means were introduced to optimize the control strategy, achieving the goals of zero infections among medical staffs and zero cross infections among patients.

Practice and experience of the anti-epidemic medical team participating in the medical treatment mission of the COVID-19 specialist hospital / 医学研究生学报

In response to the outbreak of COVID-19 in Wuhan, Hubei province, more than one thousand medical staff members from the army undertook the medical task of working in Wuhan Huoshenshan Hospital.200 medical staff members were from Wuxi Joint Logistic Support Center. It was proved that the medical team responded quickly and rushed from multiple links such as receiving tasks, task analysis and judgment, team construction, epidemic analysis, ward planning, patient treatment, testing and rapid turnover of beds. These actions were finished orderly and carefully, which reflected the supportive capabilities of our military health service forces. By analyzing the characteristics and experience of the medical tasks of the COVID-19 special hospital, we expected to improve the ability of performing multiple tasks of mobile health service unit.

Practice and experience of the anti-epidemic medical team participating in the medical treatment mission of the COVID-19 specialist hospital / 医学研究生学报

In response to the outbreak of COVID-19 in Wuhan, Hubei province, more than one thousand medical staff members from the army undertook the medical task of working in Wuhan Huoshenshan Hospital.200 medical staff members were from Wuxi Joint Logistic Support Center. It was proved that the medical team responded quickly and rushed from multiple links such as receiving tasks, task analysis and judgment, team construction, epidemic analysis, ward planning, patient treatment, testing and rapid turnover of beds. These actions were finished orderly and carefully, which reflected the supportive capabilities of our military health service forces. By analyzing the characteristics and experience of the medical tasks of the COVID-19 special hospital, we expected to improve the ability of performing multiple tasks of mobile health service unit.

The decision-making process in families of terminal ICU patients / O processo de tomada de decisão da família na terminalidade em UTI / Proceso de toma de decisiones de la familia al término de la vida en la UCI

The objective of this research is to investigate family members' perceptions as to the end-of-life decision-making process in an ICU. The authors conducted a qualitative descriptive study in which they interviewed six family members of critically ill patients admitted to the ICU of a private hospital. Five categories of analysis emerged from the examination of the material. This study will discuss two of those categories: the decision-making process and the relationship with the medical staff. The results indicate that family members were satisfied with communication with the medical staff, an important aspect for the decision-making process. Within this context, the shared model, prioritization of palliative care and identification of futile treatments prevailed, aimed at ensuring the patient's comfort and dignity at the end of life. The results also reveal the need for integration of palliative care in ICUs, particularly in end-of-life situations. (AU)

O presente estudo tem como objetivo investigar a percepção dos familiares acerca do processo de tomada de decisão na terminalidade em UTI. Realizou-se uma pesquisa descritiva de cunho qualitativo, na qual foram entrevistados seis familiares de pacientes gravemente enfermos, internados na UTI de um hospital privado. Do estudo do material emergiram cinco categorias de análise. Neste trabalho serão discutidas duas categorias: processo de tomada de decisão e relação com a equipe médica. Os resultados indicam que os familiares se mostraram satisfeitos com a comunicação com os membros da equipe de saúde, aspecto importante para o processo de tomada de decisão. Neste contexto prevaleceram o modelo compartilhado, a priorização de medidas paliativas e a identificação de medidas fúteis, a fim de garantir o conforto e a dignidade no processo de morrer do paciente. Evidenciou-se a busca de integração dos cuidados paliativos em UTI, principalmente em situações finais de vida. (AU)

El presente estudio tiene como objetivo investigar la percepción de los familiares sobre el proceso de toma de decisiones en el estado terminal de vida en la UCI. Se realizó una investigación descriptiva de carácter cualitativo, en la cual fueron entrevistados seis familiares de pacientes gravemente enfermos, internados en la UCI de un hospital privado. Del estudio del material surgieron cinco categorías de análisis. En este trabajo serán discutidas dos categorías: proceso de toma de decisiones y relación con el equipo médico. Los resultados indican que los familiares se mostraron satisfechos con la comunicación con los miembros del equipo de salud, aspecto importante para el proceso de toma de decisiones. En este contexto prevalecieron el modelo compartido, la priorización de medidas paliativas y la identificación de medidas inútiles, con el fin de garantizar comodidad y dignidad en el proceso de muerte del paciente. Se evidenció la búsqueda de integración de los cuidados paliativos en la UCI, principalmente en situaciones finales de vida. (AU)

Study on the general mental health status and influencing factors of Chinese Medical Team members / 中华流行病学杂志

Objective@#To analyze the mental health status of the Chinese Medical Team (CMT) members and its influencing factors.@*Methods@#A total of 1 015 members of the CMT were recruited and surveyed by using a self-administered questionnaire and 12-item General Health Questionnaire (GHQ-12) from May 10 to June 10, 2018. Multivariable logistic regression models were used to identify risk factors for mental health problems.@*Results@#A total of 808 subjects completed the questionnaire and an estimated 25.9% of them were suspected to have mental health problems (GHQ-12≥3). Logistic model analysis indicated that family life (OR=1.928, 95%CI: 1.162-3.197), domestic work status (OR=2.069, 95%CI: 1.210-3.538), father’s health status (OR=1.703, 95%CI: 1.060-2.736), disease symptoms (OR=2.087, 95%CI: 1.363-3.194), captain (OR=1.996, 95%CI: 1.128-3.532), cultural differences (OR=2.439, 95%CI: 1.621-3.671) were the risk factors for mental health. Age (OR=0.736, 95%CI: 0.571-0.949), leisure activities (OR=0.654, 95%CI: 0.490-0.872) were the protective factors. Drinking habits (OR=7.439, 95%CI: 1.290- 42.900), loneliness (OR=4.094, 95%CI: 2.438-6.875), and respect from the hospital (OR=0.783, 95%CI: 0.610-1.004) were relative to mental health problems.@*Conclusion@#CMT members have certain mental health problems, especially young members and captains. Therefore, interventions should be implemented to improve the mental health of CMT members and to promote the development of foreign aid work.

Practice and effect evaluation of establishment of first aid green channel for acute ischemic stroke based on medical team resource management model / 中国实用护理杂志

Objective To explore the application effectiveness of medical team resource management model in the first aid green channel of acute ischemic stroke (AIS). Methods A total of 215 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2015 to October 2017 as an observation group.The observation group adopted AIS first aid green channel based on medical team resource management mode.A total of 61 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2013 to October 2015 as a control group.The control group adopted three districts and four treatment procedures.The time course of intravenous thrombolysis was compared between the two groups and to compare the satisfaction of the two groups with different AIS procedures. Results Application of medical team resource management model to establish a dedicated first aid green channel, the key links were significantly shortened,Door-to-Needle Time (DNT) decreased from (114.84 ± 8.05) minutes prior to establishment to (57.63 ± 6.30) minutes, the difference was statistically significant (t=51.263, P<0.05), the satisfaction degree of the medical staff was improved,the overall satisfaction increased from (2.86 ± 0.20) before establishment to (4.27 ± 0.20) points, the difference was statistically significant (t=-34.368,P<0.05).Conclusions The medical team resource management model applied to the treatment of AIS patients, the establishment of multidisciplinary integration of first aid green channel, to strengthen the team to effectively improve the timeliness of the key aspects of intravenous thrombolysis, shorten DNT, improve the quality of treatment of patients.

China Medical Team: Medical rescue for "4.25" Nepal earthquake / 中华创伤杂志(英文版)

In recent years, global natural disasters have been frequent and resulted in great casualties and property loss. Since Wenchuan earthquake, the disaster emergency rescue system of China has obtained considerable development in various aspects including team construction, task scheduling, personnel training, facilities and equipments, logistics, etc. On April 25, 2015, an earthquake that measured 8.1 on the Richter scale attacked Nepal. Chinese government firstly organized a medical team, named China Medical Team, and sent it to the attacked region in Nepal to implement medical rescue. The medical team completed the rescue mission successfully and creatively based on their experiences.

Improving ultrasonic unit configuration in field medical team / 医疗卫生装备

Objective To improve ultrasonic unit configuration of the field medical team.Methods The problems of the ultrasonic unit were analyzed in operating platform setup,personnel and facility allocation,application of interventional ultrasound,cross infection prevention and etc,and some countermeasures were put forward accordingly.Results There were interdependence and interaction among the elements of the ultrasonic unit,and the rational configuration made the requirements satisfied for interventional therapy,massive casualty diagnosis,bed side application and etc.Conclusion Improved configuration enhances the efficacy of the ultrasonic unit of the field medical team.

Design of simulated maritime rescue training platform / 医疗卫生装备

Objecive To design and develop a simulated maritime rescue training platform to emulate different sea conditions and carry out maritime rescue training.Methods Corresponding computer program was used to control a 3 degreeof-freedom electric platform,and the rolling,pitching and heaving of the ambulance boat were simulated by setting vibration frequency and displacement.An operating training room was set up and equipped with necessary emergency devices.Results By changing the frequency and displacement of the training platform,the operating environment in the ambulance boat was simulated under the second to fifth grades of sea conditions to execute the training for antivertigo,fine operation and nursing.Conclusion The platform facilitates the medical staff to be familiar with maritime environment,master treatment techniques at different sea conditions and enhance support efficiency.

Design and Development of Drug Management System of Peacekeeping Medical Team / 中国药房

OBJECTIVE:To improve the drug comprehensive management level of peacekeeping medical team,achieve dynam-ic management of drug information and network. METHODS:The design and development of drug management system of peace-keeping medical team were introduced in terms of overall system architecture,technical routes,system function design,etc.,and the application effect was evaluated. RESULTS:The system was designed by referencing military hospital No.1 drug management system,adopting C/S two-tier architecture,which included system settings,drug dictionary management,inventory management and other 8 modules and numbers of sub-modules. It achieved drug getting out and entering warehouse,supplying maintenance man-agement,prescription dispensing,drug withdrawal and inquiries,expendable drug monitoring,rotation transfer export data,the whole English electronic medical instruments generation,data query statistics,timely query of drugs and disease diagnosis knowl-edge base and other functions. The application of system standardized drug management and significantly improved working efficien-cy of physicians and pharmacists. CONCLUSIONS:The application of the system promotes the transform of drug management from extensive management model to elaborating management model,and the data is safe and easy to operate.

Improving ultrasonic unit configuration in field medical team / 医疗卫生装备

Objective To improve ultrasonic unit configuration of the field medical team.Methods The problems of the ultrasonic unit were analyzed in operating platform setup,personnel and facility allocation,application of interventional ultrasound,cross infection prevention and etc,and some countermeasures were put forward accordingly.Results There were interdependence and interaction among the elements of the ultrasonic unit,and the rational configuration made the requirements satisfied for interventional therapy,massive casualty diagnosis,bed side application and etc.Conclusion Improved configuration enhances the efficacy of the ultrasonic unit of the field medical team.

Design and implementation of materials management system for hospital warehouse of combat readiness based on RFID / 中国医学装备

Objective:To develop a materials management information system for military hospital warehouse of combat readiness based on RFID so as to enhance the management of military medical corps for materials of war preparation.Methods:RFID(Radio Frequency Identification) tags were attached on war materials and the information could been read by bar-code reader. SQL Server 2005 was used as the backend database, and VC# was combined with RFID to develop the software system.Results: This research has developed a materials management information system for military hospital warehouse of combat readiness based on RFID and this system could achieve informatization for information management, management of out and in warehouse, emergency plans management and forewarning management. Through manoeuvre, the average time of war materiel out warehouse has saved 12min.Conclusion: The research and development of information management system for materiel information of hospital warehouse for combat readiness has reference value for the application of researching RBID technique in material management.