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ABSTRACT Purpose: To analyze teleconsultation at a public ophthalmic teaching hospital during the COVID-19 pandemic in Brazil. Methods: Medical records of patients who requested ophthalmological teleconsultation between June 2020 and March 2021 were reviewed. The main outcomes included demographic data, eye disease symptoms, hypothesized diagnosis, and management. Moreover, the results of a satisfaction survey administered after the consultation were analyzed. Results: Medical records of a total of 161 patients were reviewed. The mean age was 45.98 ± 17.57 (8-90) years, and most were women (113, 70.20%). Only 57 (35.60%) of the patients had made previous follow-up visits to the hospital. The most frequent reason for consultation was the need for a new eyeglass prescription (73, 45.34%), followed by dry eye symptoms (16, 9.93%) and pterygium (13, 8.07%). Other reasons were the monitoring of previously diagnosed eye diseases, such as glaucoma, retinopathies, strabismus, and keratoconus. Regarding the satisfaction survey, 151 (93.78%) patients answered the online questionnaire. Most reported that they were satisfied with the teleconsultation (94.03%) and would participate in a future teleconsultation (90.06%). Conclusion: Teleconsultation could be widely used to assist patients in public ophthalmology healthcare and teaching hospitals. Even though new eyeglass prescriptions are a frequent reason for ophthalmological appointments, patients tend to be satisfied with teleconsultation, as it also provides guidance.
RESUMO Objetivo: Analisar a teleconsulta em um hospital público de ensino oftalmológico, durante o período da pandemia do COVID-19. Métodos: Foram revisados os registros médicos dos pacientes que solicitaram teleconsulta oftalmológica, no período de Junho de 2020 a Março de 2021. Os resultados incluem dados demográficos, sintomas de queixas oculares e hipóteses diagnósticas. Além disso, foram analisados dados da pesquisa de satisfação aplicada após cada teleconsulta. Resultados: Um total de 161 prontuários foram revisados. A idade média dos pacientes foi de 45.98 ± 17.57 (8 a 90) anos, a maioria mulheres, 113 (70,20%). Apenas 57 (35,60%) eram pacientes acompanhados no hospital previamente. A principal razão pela busca pela teleconsulta foi o erro refracional, 73 (45.43%), seguido de olho seco, 16 (9.93%), pterígio, 13 (8.07%). Outros motivos foram o acompanhamento de doenças prévias como glaucoma, retinopatias, miopia, estrabismo e ceratocone. Quanto a pesquisa de satisfação, 151(93,87%) pacientes responderam a pesquisa on-line. A maioria deles mostrou-se satisfeito com a teleconsulta (94.03%) e fariam uma nova teleconsulta (90.06%). Conclusão: A teleconsulta pode auxiliar a saúde pública em oftalmologia podendo ser utilizada em hospitais universitários. Embora o erro refracional tenha sido o motivo mais frequente nas consultas, os pacientes mostraram-se satisfeitos com essa modalidade de atendimento que serve como um serviço de orientação.
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Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.
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Internal auditing for infrastructure projects carried at multi-campuses of a hospital to support hospital strategic growth, is a crucial means in raising the business performance and capacity. A public hospital made a research-based audit to examine infrastructure projects across multi-campuses since 2021. At the pre-trial stage, the audit plan was created in a " two-coordination" manner to define the scope of authority and responsibility of audit objectives; at the in-trial stage, audit priorities were focused on in advance through intelligent early warning, and full-course audit guidance and quality control was made through online real-time audit operation system; at the post-trial stage, efforts were focused on resolving problems, summarizing audit findings. The authors introduced the practice of the hospital and further explained the specific application methods and achievements through case analysis, providing reference for internal audit of infrastructure projects in multi-campus hospitals, for reference in likewise internal auditing.
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With business activities expanding and number of business contracts growing, the management of multi-campus hospitals is faced with constantly escalating requirements for risk prevention and control within the hospital. Being an important part of hospital internal management, the internal audit plays an irreplaceable role in the high-quality development of hospitals. The authors elaborated on the value of business contract audit in the management of multi-campus hospitals from three dimensions of internal control, risk management and hospital added value, introduced the practices by the Second Affiliated Hospital Zhejiang University School of Medicine in the management of its multi-campus management since 2018, by adopting the strategy of architecture integration, rule homogenization, process standardization, and vertical supervision, and put forward suggestions from three aspects, including the practical difficulties in the participation process, the dynamic adjustment of role positioning, and the development of better integrating business contract auditing into multi-campus hospital management.
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Objective:To analyse the settings of sub-campus of public hospitals directly under the National Health Commission, so as to provide research reference and suggestions for further promoting the scientific and standardized construction of sub-campuses of public hospitals.Methods:Data before August 30, 2022 were collected from the official websites of the hospitals in question including their introduction, overview, navigation, news and other categories of information.Relevant literatures on multi-campus published by hospitals under the direct management of the National Health Commission were obtained from the China National Knowledge Network, which was identified by searching the keywords " sub or multi-campus hospital" with " author affiliation", using such search conditions as " MeSH major topic" or " title/keywords/abstract" of the studied hospitals in advanced search builder. Descriptive analysis and frequency analysis were conducted on the numbers, the construction reasons, geographical location, operation scale, characteristics and positioning of the sub-campuses in the studied hospitals.Results:Of the 44 such hospitals, 30 had a total of 50 sub-campuses in operation. Generally there were two modes of construction. 35 were newly constructed and 15 formed by mergers; 37 sub-campuses were built and put into operation since 2010. Sub-campuses were usually located in the same area of the main campus, with 11 in the same area of the same city and areas, 35 in different areas of the same city, and 4 in different cities; the average geographical distance between the sub-campus and the main hospital campus was 31.18 kilometers; 27 sub-campuses had beds ≤ 500, 12 sub-campuses had beds between 501-1 000, 11 had beds>1 000; 14 specialized sub-campuses and 31 out of the 35 comprehensive sub-campuses clearly indicating their characteristics of specialized departments, and 1 other (research institute areas with research beds).Conclusions:Future proofing is characteristic of these public hospitals in terms of their sub-campus construction, regional setting, planning and positioning, and functional layout. However, both government regulatory departments and public hospitals should comprehensively consider and make prudent decisions on the planning, investment, demonstration, layout, and other aspects of the construction of sub-campuses of hospitals.
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Objective:To analyze the hospitalization costs of delivery for postpartum women with different delivery methods, ages and comorbidities or complications, for references for medical institutions and medical insurance management departments to develop payment and compensation standards for inpatient delivery.Methods:The first page of medical records of hospitalized delivery women admitted to 8 large tertiary hospitals in Beijing from January 2018 to December 2021 were selected. Descriptive analysis was made on the mode of delivery, age, hospitalization expenses and cost structure of puerpera, as well as the hospitalization expenses of puerpera with different complications or complications. Wilcoxon rank sum test, Kruskal-Wallis H test, and Chi-squared test were used to statistically compare the level and structure differences between groups. Results:A total of 23 320 pregnant women were included, with an average age of 32.3 years. There were 13 605 cases of natural delivery and 9 715 cases of caesarean section. The median cesarean section rate in the right age group (<35 years old) and the elderly group (35-50 years old) were 36.73% and 56.58%, respectively, and the median hospital expenses were 5 865 yuan and 7 042 yuan, respectively. The median hospital expenses for natural delivery and caesarean section were 4 452 yuan and 10 033 yuan, respectively. The highest proportion of hospitalization expenses for natural delivery and cesarean section were treatment expenses (23.45%) and medicine expenses (29.19%), respectively. The median of hospitalization cost for women with≥2 comorbidities or complications (6 736 yuan) was higher than that for women with 1 comorbidities or complications (5 794 yuan).Conclusions:The hospitalization cost of cesarean section was significantly higher than that of natural delivery and the rate of cesarean section and the cost of delivery in women aged 35 and above were higher than those under 35 years old. The structure of hospitalization cost was different in different delivery modes, and the complications or complications had a greater impact on the average hospitalization expenses.
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The assessment of the Party branch is conducive to improving the quality of Party building, giving full play of the role of Party branch, and better realizing the two-way integration of Party building and health care, to promote the high-quality development of public hospitals. Oriented by problems, West China Hospital, Sichuan University comprehensively adopted a series of methods, such as literature research, Delphi method and in-depth interview and so on, to construct the index system of the Party branch assessment and explored an effective operation mechanism. As a result, the basic management was consolidated, the normalization and standardization of Party branch work was advanced, and the roles of Party branch became more prominent, which is expected to provide decision-making and work references for health authorities and national counterparts.
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Objective:To explore the influencing factors and pathways of social responsibility of public hospitals, and to provide a reference for public hospitals in China to further improve the social responsibility level.Methods:From 2019 to 2020, 22 tertiary public hospitals in a region were selected as study cases. The social responsibility score was used as the outcome variable, social benefit, appropriateness, quality, and efficiency were used as the conditional variables, and the qualitative comparative analysis was applied to investigate the combination of conditions affecting social responsibility evaluation of public hospitals.Results:The consistency of the social benefit, appropriateness, and quality was less than 0.9 and greater than 0.8, indicating that they were sufficient and non-necessary conditions for high social responsibility of public hospitals. The consistency of efficiency was 0.747, indicating that it was neither sufficient nor necessary condition. The configuration analysis showed that there were three paths for public hospitals to achieve high social responsibility: co-driven social benefit and appropriateness with high quality assistance, co-driven social benefit and efficiency with high quality assistance, and co-driven appropriateness and efficiency, with a coverage rate of 92.6%.Conclusions:Social benefit, appropriateness, quality, and efficiency can be combined in different ways to achieve high social responsibility in public hospitals. Public hospitals could develop targeted social responsibility improvement strategies according to the actual situation, and strengthen the synergy between the elements to improve the level of social responsibility in hospitals.
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Objective:To analyze the efficiency of medical resource utilization in public traditional Chinese medicine (TCM) hospitals in Gansu province from 2016 to 2020, so as to provide decision-making reference.Methods:The number of in-service staff, actual number of open beds, number of diagnosis and treatment, and number of discharge from TCM hospitals in Gansu province from 2016 to 2020 were extracted, and their technical efficiency, pure technical efficiency, scale efficiency, and returns to scale were analyzed by data envelopment analysis.Results:From 2016 to 2020, the average technical efficiency, pure technical efficiency, and scale efficiency of the sample hospitals were 0.647, 0.680, and 0.952, respectively. Among them, 213 hospitals (48.2%) were in a decreasing state of returns to scale, 54 hospitals (12.2%) were in a constant state of returns to scale, and 175 hospitals (39.6%) were in an increasing state of returns to scale; Out of the 45 tertiary hospitals, 42 (93.3%) were in the stage of diminishing returns to scale, while 226 (56.9%) of 397 secondary and lower hospitals were in a state of constant or increasing returns to scale.Conclusions:The utilization efficiency of medical resources in public TCM hospitals in Gansu province is relatively low, and there is a significant gap between different levels of TCM hospitals.
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Objective:To investigate the status and willingness of information disclosure based on social supervision in tertiary and secondary public hospitals, so as to provide reference for expanding information disclosure content.Methods:By using stratified cluster random sampling method, 66 tertiary public hospitals and 126 secondary public hospitals in 6 provinces were selected for questionnaire survey in April 2021. Thirty-one indicators in 3 categories and 5 groups were selected to obtain the information disclosure status and willingness. Chi-square test, variance analysis and paired t-test were used to conduct difference analysis. Results:The indicators with higher disclosure rates in public hospitals were drug prices and medical service price adjustments (93.9% in tertiary hospitals and 92.1% in secondary hospitals) and medical insurance reimbursement policies and compensation processes (90.9% in tertiary hospitals and 86.5% in secondary hospitals), while the indicators with lower disclosure rates were case fatality rates in low-risk groups (24.2% in tertiary hospitals and 26.2% in secondary hospitals), proportion of special needs medical services (27.3% in tertiary hospitals), and average daily outpatient visits per practitioner (27.3% in tertiary hospitals and 26.2% in secondary hospitals). The indicators that public hospitals thought could be disclosed at a higher rate were drug and medical service price adjustments, medical insurance reimbursement policies and compensation processes, and prices and medical insurance reimbursement of commonly used drugs and major medical consumables, while the indicators that were thought to be disclosed at a lower rate were some medical service safety indicators and hospital financial indicators.For all indicators, the percentage that the hospitals thought could be disclosed was higher than the percentage that had been disclosed.Conclusions:At present, China′s secondary and tertiary public hospitals have a low rate of disclosure about medical service efficiency, medical service safety, statistical summary cost and financial indicators. However, except for some medical service indicators and financial related indicators, the hospitals′ information disclosure willingness is relatively high, and the scope of information disclosure can be expanded in an orderly manner in steps.
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Medical homogenization in multi-campus hospital plays an essential role in leveraging the advantages of public hospitals, promoting the expansion of high-quality medical resources and balancing regional layout. The Second Affiliated Hospital Zhejiang University School of Medicine deeply used digital intelligence technology to build a new integrated mobile health service system consisting of internet hospital and 5G intelligent applications, which empowered medical efficiency in multi-campus hospital. This system broke the limitations of inconsistent medical resources, unbalanced discipline layout, and insufficient information connectivity in the construction of multi-campus hospitals, and achieved remarkable results in practice. It could provide reference for the multi-campus construction of other large public hospitals.
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The multi-campus mode is an important way to give full play to the advantages of public hospitals and promote the expansion of high-quality medical resources and balanced regional layout. The authors summarized the practical experience of the Second Affiliated Hospital Zhejiang University School of Medicine in promoting multi-campus cultural integration, including vertical dimensional initiatives including raising cultural construction to a strategic level, improving the working mechanism of cultural construction, and building a distinctive cultural identity system; horizontal dimensional initiatives including creating equal status and intergroup cooperation conducive to cultural integration, building a variety of forms of the main cultural communication platform, and building a unified and diverse cross-campus communication bridge. Through cultural integration, the internal cohesion of the hospital was enhanced and the influence of the hospital brand was improved. The authors suggested that cultural integration should always be based on the principle of " seeking common ground while preserving minor differences" , focusing on the construction of systems and standards, and focusing on the construction of communication platforms.
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The development of multi-campus is an effective way to expand and enlarge high-quality medical resources for public hospitals. In view of the problems in the relationship between power, responsibility and benefit, functional positioning, discipline layout, homogenization of medical quality and service, and management of human and financial resources in multi-campus, the authors introduced the integrated management system built by the Second Affiliated Hospital Zhejiang University School of Medicine in the process of multi-campus construction. The system included a standard-oriented quality system, a demand-oriented service system, a position-oriented personnel system, an efficiency-oriented financial system, a sharing-oriented information system and a mutual integration-oriented culture system, and formed an integrated management mode of " hospital-area synergy, differential positioning, and homogeneous development" , which significantly improved the management efficiency, service capacity and operational efficiency of the hospital, and could provide an effective reference for public hospital managers.
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The performance appraisal of tertiary public hospitals is key to their high-quality development. Since 2019, Children′s Hospital of Zhejiang University School of Medicine has taken the following measures to leverage performance appraisal. Namely promoting medical technology innovation to enhance the diagnosis and treatment capabilities of difficult and critical diseases; Reasonably setting a target system, improving the performance appraisal mechanism of the hospital; Improving operational efficiency, enhancing the sense of gain by children patients; Building a high-quality talent pool, promoting sustainable development, and effectively promoting high-quality development of hospitals. These measures can provide reference for promoting the high-quality development of hospitals.
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Objective:To analyze the experiences and practice in the reform of public hospital salary system in Sichuan province, summarize the typical modes of such reform in the province, and provide references for further reform.Methods:As of October 29, 2021, the research group received 77 sets of typical experience materials submitted by the health commissions and public hospitals in Sichuan province on enforcing the reform of the public hospital salary system. The analysis framework was based on the five main elements proposed in the Guidance to Deepening the Reform of the Salary System of Public Hospitals for the purpose of furthering the reform. These five elements refer to " reasonably determining the level of salary in public hospitals" " fully implementing the autonomy of internal distribution in public hospitals " " establishing and improving the incentive and restraint mechanism for the remuneration of public hospital leaders" " improving the assessment and evaluation mechanism oriented to public welfare" and " funding sources ". A quantitative analysis was made on the typical experience materials using the social network analysis method, while a qualitative analysis was made on the typical experience materials using the content analysis method. Results:The results of social network analysis showed that the network density was 0.272; the highest point centrality was " fully implement the autonomy of internal distribution in public hospitals" (0.935), and the highest intermediary centrality was " improving the assessment and evaluation mechanism oriented to public welfare" (0.870), while the closeness to centrality of " establishing and improving the incentive and constraint mechanism for the salary of public hospital leaders" (0.434) and " funding sources" (0.421) were relatively low. The results of content analysis showed that the ones with higher frequency among all the typical experience materials were " fully implementing the autonomy of internal distribution of hospitals" (72 times) and " improving the assessment and evaluation mechanism oriented to public welfare" (67 times), while the ones with lower frequency were " establishing and improving the salary incentive and constraint mechanism for public hospital leaders" (17 times) and " funding sources" (14 times). In terms of unity and synergy, the typical models of public hospital salary system reform in the province could be categorized as the fine standard mode, the fair value mode, the autonomous synergy mode and the circular symbiosis mode.Conclusions:Deepening the reform of the salary system of public hospitals should unify the standards and improve the fair and refined assessment and evaluation mechanism; explore various forms of distribution and build an internal autonomous and synergistic incentive mechanism; pay attention to the weak remuneration incentive mechanism for hospital leaders and the problem of a relatively single source of funding.
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The human resource management of organ donation coordinators in China is still in its infancy stage, plagued by such problems as unclear career orientation, poor management and unclear career planning. In March 2010, a tertiary public hospital was approved as a medical institution in a national pilot province for organ donation. In recent years, the hospital had kept exploring human resource management of coordinators and established a relatively complete management mode for organ donation coordinators. This mode featured the establishment of full-time recruitment positions, development of human resource management plans, refinement of job descriptions, establishment of performance evaluation plans, optimization of assessment and incentive mechanisms, and innovation of talent cultivation modes. The management practice had achieved certain results, ensuring the sustainable development of hospital organ donation operation, and providing a reference for the scientific and standardized development of organ donation and transplantation in China.
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In recent years, public hospitals have been facing pressure from the reform of medical insurance payment methods. It is urgent to strengthen the operation and management of public hospitals. In June 2022, a tertiary public hospital utilized hospital intelligent agents to carry out refined cost management practices for medical service charging projects, sorted out medical service charging projects, designed management paths, and calculated project costs. The hospital conducted refined management on the cost of medical service charging items from three control dimensions of project unit cost with manpower, equipment and consumables, and two comparative directions with horizontal and vertical. The refined cost management practice not only pointted out the direction for global refinement cost control within the hospital, but also reduced the proportion of hospital consumption, which provided reference for improving the level of refined operation and management of public hospital hospitals.
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ABSTRACT Objective To determine the rate of complications associated with the use of temporary pacemakers in patients in the waiting list for the definitive pacemaker implantation in a public hospital located in São Paulo, SP, Brazil. Methods Retrospective observational study based on data extracted from medical records of patients admitted to Hospital Municipal Dr. Moyses Deutsch, Hospital Israelita Albert Einstein from January 2014 to December 2018. Patients aged 18 years or older, diagnosed with high degree atrioventricular block upon admission and with indications for definitive pacemaker implantation were included. All-cause mortality, clinical and surgical complications and length of hospital stay while waiting for the procedure were defined as primary outcomes. Results The sample comprised 66 patient allocated to one of two groups: with and without the need of temporary pacemaker while in hospital (n=45 and n=21, respectively). The rate of complications was higher in patients who used a temporary pacemaker (p<0.001). These included primarily pneumonia (p=0.048) and length of hospital stay (p=0.029). Conclusion Patients who required a temporary pacemaker stayed longer in hospital. Longer hospital stay is associated with higher rates of general complications and all-cause mortality.
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ABSTRACT Objective: analyze the relationship between sleep quality, excessive daytime sleepiness, and health symptoms among the nursing team working in a hospital. Method: cross-sectional research, carried out with the nursing team of a public hospital in Brazil, between September 2017 and April 2018. A sociodemographic questionnaire, health symptoms, Sleepiness Scale, and the Pittsburgh Sleep Quality Index were used. Data are presented as absolute and relative frequencies, means, standard deviations, bivariate analysis, and binary logistic regression. Results: a total of 308 workers participated in the study, and poor sleep quality and absence of daytime sleepiness predominated among them. There was an association between sleepiness, children (p=0.006), and work accidents (p=0.044). Factors associated with poor sleep quality and drowsiness, appetite disorders, feeling of poor digestion, flatulence, weight gain, irritability, headache, feeling of low self-esteem, and mood lability. Conclusion: appetite disorder was the main factor for poor sleep quality for the nursing team working in a hospital in Brazil. This suggests that it is important to consider sleep quality when examining a worker´s health.
RESUMEN Objetivo: analizar la relación entre la calidad del sueño, la somnolencia diurna excesiva y los síntomas de salud entre el personal de enfermería que trabajaba en un hospital. Método: investigación transversal, realizada con el equipo de enfermería de un hospital público en Brasil, entre septiembre de 2017 y abril de 2018. Se utilizó un cuestionario sociodemográfico, síntomas de salud, Escala de Somnolencia e Índice de Calidad del Sueño de Pittsburgh (PSQI-BR). Los datos fueron presentados como frecuencias absolutas y relativas, medias, desviaciones estándar, análisis bivariado y regression logística binaria. Resultados: Participaron del estudio 308 trabajadores, con predominio de pobre calidad del sueño y ausencia de somnolencia diurna entre ellos. Hubo asociación entre somnolencia, hijos (p=0,006) y accidentes de trabajo (p=0,044). Los factores asociados con la mala calidad del sueño y la somnolencia fueron trastornos del apetito, sensación de mala digestión, flatulencia, aumento de peso, irritabilidad, dolor de cabeza, sensación de baja autoestima y labilidad del estado de ánimo. Conclusión: el trastorno del apetito fue el principal factor de mala calidad del sueño para el equipo de enfermería de un hospital en Brasil. Esto sugiere la importancia de tener en cuenta la calidad del sueño al examinar la salud del trabajador.
RESUMO Objetivo: analisar a relação entre qualidade do sono, sonolência diurna excessiva e sintomas de saúde entre a equipe de enfermagem que atuava em um hospital. Método: pesquisa transversal, realizada com a equipe de enfermagem de um hospital público do Brasil, entre setembro de 2017 e abril de 2018. Foram utilizados questionário sociodemográfico, sintomas de saúde, Escala de Sonolência e Índice de Qualidade do Sono de Pittsburgh (PSQI-BR). Os dados são apresentados como frequências absolutas e relativas, médias, desvios padrão, análise bivariada e regressão logística binária. Resultados: participaram do estudo 308 trabalhadores, predominando entre eles a má qualidade do sono e a ausência de sonolência diurna. Houve associação entre sonolência, crianças (p=0,006) e acidentes de trabalho (p=0,044). Os fatores associados à má qualidade do sono e sonolência foram distúrbios do apetite, sensação de má digestão, flatulência, ganho de peso, irritabilidade, dor de cabeça, sensação de baixa autoestima e labilidade do humor. Conclusão: o transtorno do apetite foi o principal fator de má qualidade do sono para a equipe de enfermagem que atuava em um hospital no Brasil. Isso sugere que é importante considerar a qualidade do sono ao examinar a saúde do trabalhador.
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Objective:To analyze the impact of the comprehensive reform of public hospitals on the economic operation of county-level hospitals, by taking a county-level hospital as an example.Methods:The hospital launched the public hospital general reform in 2014. The hospital information system, hospital resource planning system and cost accounting information system collected the data of hospital business operation, expenditure/revenue, reimbursement for revenue loss due to " drug zero price gap" policy, charges and costs from 2014 to 2019, which were used to calculate the cost of medical service items and disease costs. The hospital′s service volume, changes in medical expenses, income structure, balance of revenue and expenditure and the compensation level for the zero difference rate of drugs were analyzed by descriptive analysis, and the actual charge and cost difference of medical service items and diseases were analyzed by comparative analysis.Results:Compared with 2014, the number of outpatient/emergency, surgery and discharge in 2019 increased by 31.51%, 40.21% and 12.21% respectively, and the average hospitalization cost increased by 4.39%. The proportion of drug cost and material cost decreased by 4.27 and 1.78 percentage points respectively, the proportion of laboratory tests and examinations cost increased by 3.15 and 3.98 percentage points respectively. Changes in the proportion of expenses reflecting the value of technical labor services, such as surgery, treatment, diagnosis and nursing, were all less than 0.60 percentage points. Since 2017, the business expenditure of the hospital had exceeded the income. The proportion of drug income reduced due to " drug zero price gap" policy compensated by medical service income had decreased from 82.00% in 2015 to 58.63% in 2019, and 66.82% of medical service items were defective items. In addition to type 2 diabetes, the actual charges of the 9 main " list" diseases were lower than the standard cost accounting values.Conclusions:After the comprehensive reform of medical price, there may be a large revenue/expenditure gap in a short term, and the cost may be higher than the charges. When formulating the comprehensive reform policy of regional pharmaceutical prices, we should consider the superposition effect of the policies implemented in the same period, and strengthen the short-term financial responsiveness, to provide space for public hospitals to gradually adapt to the reform.